Browsing by Author "Biccard, Bruce M"
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- ItemOpen AccessBarriers to clinical research in Africa, a quantitative and qualitative survey of 27 African countries(2019) Conradie, Aletta; Duys, Rowan; Biccard, Bruce MBackground There is a need for high quality research to improve perioperative patient care in Africa. The aim of this study was to understand the particular barriers to clinical research in this environment. Methods Electronic survey of African Surgical Outcomes Study (ASOS) investigators, including 29 quantitative Likert scale questions and eight qualitative questions with subsequent thematic analysis. Protocol compliant and non-compliant countries were compared according to the WHO statistics for research and development, health workforce data and world internet statistics. Results Responses were received from 134/418 invited researchers in 24/25 (96%) participating countries, and three non-participating countries. Barriers included the lack of a dedicated research team (47.7%), reliable internet access (32.6%), staff skilled in research (31.8%) and team commitment (23.8%). Protocol compliant countries had significantly more physicians per 1000 population (4 vs 0.9 p<0.01), internet penetration (38% vs 28% p=0.01) and published clinical trials (1461 vs 208 p<0.01) compared to non-compliant countries. Facilitators of research included establishing a research culture (86.9%), simple data collection tools (80%) and ASOS team interaction (77.9%). Most participants are interested in future research (93.8%). Qualitative data reiterated human resource, financial resource, and regulatory barriers. However, the desire to contribute to an African collaboration producing relevant data to improve patient outcomes, was expressed strongly by the ASOS investigators. Conclusions: Barriers to successful participation in ASOS related to resource limitations and not the motivation of clinician investigators. Practical solutions to individual barriers may increase the success of multi-centre perioperative research in Africa.
- ItemOpen AccessClinical utility of B-type natriuretic peptide (NP) in paediatric cardiac surgery: a systematic review(2014) Afshani, Nura; Thomas, Jenny; Biccard, Bruce MB-type natruiretic peptide (NP) is a biomarker that has gained widespread use in several patient populations and clinical situations. It is a hormone secreted primarily by ventricular myocytes in response in myocyte stretch or ischaemia.
- ItemOpen AccessNatriuretic peptide-directed medical therapy: a systematic review(2020-02-18) Alphonsus, Christella S; Govender, Pooveshnie; Rodseth, Reitze N; Biccard, Bruce MAbstract Natriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcome was to determine whether NP-directed medical therapy is effective in reducing NP levels within 6 months, compared to standard of care. The secondary outcome was to determine whether reducing NP levels is associated with decreased mortality. Full texts of 18 trials were reviewed. NP-directed medical therapy showed no significant difference compared to standard care in decreasing NP levels (standardized mean difference − 0.04 (− 0.16, 0.07)), but was associated with a 6-month (relative risk (RR) 0.82 (95% confidence interval (CI) 0.68–0.99)) reduction in mortality.
- ItemOpen AccessPostoperative outcomes associated with procedural sedation conducted by physician and non-physician anaesthesia providers: findings from the prospective, Observational African Surgical Outcomes Study (ASOS)(2021) van der Merwe, Freliza; Biccard, Bruce MBackground There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Non-physician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation in order to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by non-physicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death. Methods A secondary analysis of a prospective cohort of in-hospital adult surgical patients, representing 25 African countries was performed. An inverse probability of treatment weighting model was developed to assess the association between receiving procedural sedation conducted by a non-physician (vs physician) and in-hospital outcomes. All patients who only received procedural sedation for surgery were included. The primary outcome was the incidence of the composite of severe complications and death. Results 336 patients met the inclusion criteria, of which 98 (29.2%) received sedation from a non-physician provider. The incidence of severe postoperative complications and death was 10/98 (10.2%) in the non-physician group, and 5/238 (2.1%) in the physician group. The association between procedural sedation conducted by a nonphysician provider and in-hospital outcomes showed an eight-fold increase in the odds of severe complications and death (odds ratio 7.7; 95% CI 2.5 to 23.7). Conclusions The modest number of observations in this secondary data analysis, suggests that shifting the task of procedural sedation from physicians to non-physicians in order to increase access to care may be associated with severe postoperative complications and death in Africa. Research focusing on identifying factors contributing to adverse outcomes associated with procedural sedation is necessary to make this practice safer.
- ItemOpen AccessThe role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review(2019-11-18) Alphonsus, Christella S; Govender, Pooveshni; Rodseth, Reitze N; Biccard, Bruce MAbstract Exercise is recommended in patients with cardiac failure. In the perioperative patient, exercise is also gaining popularity as a form of prehabilitation. In this meta-analysis, we examine if exercise is able to reduce natriuretic peptide levels. Natriuretic peptide (NP) has strong prognostic ability in identifying patients who will develop adverse postoperative cardiovascular outcomes. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcomes were to determine whether exercise therapy was effective in reducing NP levels as compared to control group, the shortest time period required to reduce NP levels after exercise therapy, and whether reducing NP levels decreased morbidity and mortality. Full texts of 16 trials were retrieved for this review. Exercise therapy showed a significant reduction in natriuretic peptide levels between the intervention and control groups (SMD − 0.45, 95% CI − 0.88 to − 0.03) with significant heterogeneity between the included trials. This was also shown in the within a 12-week period.