Browsing by Author "Khan, Waseela"

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Open Access
    Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital
    (2023) Mbanga, Kedibone; Khan, Waseela
    Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen.
  • Thumbnail Image
    Item
    Open Access
    Initiating the development of a South African curriculum for education in Neonatal Critical Care Transfers
    (2022) Williams, West; Stassen, Willem; Theron, Elzarie; Khan, Waseela
    Background Owing to limited neonatal care resources, the transfer of neonates to district and tertiary facilities is inevitable in a Low- and Middle-Income Country (LMIC) such as South Africa. The lack of neonatal transport is one of the top ten avoidable causes of under-5 mortality. In South Africa, these transfers are mostly conducted by Advanced Life Support (ALS) Providers with limited neonatal specific education. The transfer of neonates by teams with limited neonatal knowledge can lead to high adverse event rates. Dedicated Critical Care Retrieval Services (CCRS) teams have providers with additional education in neonatal critical care transfers and have shown a lower risk of adverse events in developed settings. Given the limited neonatal education of ALS providers that conduct transfers and the lack of dedicated CCRS teams in South Africa, it is the aim of this study to initiate the development of a neonatal critical care transfer curriculum. Methods A general and targeted needs assessment was conducted through semi-structured interviews with experts in the field and a focus group discussion with a learner group. The voice recordings were transcribed verbatim and data were analysed inductively, using content analysis to the manifest level. Results Six experts in neonatal critical care transfers participated in semi-structured interviews with a mean duration of 59 minutes (51-68min). Following transcription and analysis, 372 codes were extracted. Seven learners that involved in neonatal transfers in South Africa participated in a semi-structured focus group discussion with a duration of 91 minutes. The audio recording was transcribed and analysed with 97 codes extracted. The main categories were: Current status of neonatal CCR in South Africa; Learning and education in neonatal CCR; and proposed curriculum structure. The proposed curriculum structure described 13 broad course outcomes to be delivered as a blended postgraduate programme. Participants noted that funding, employer buy-in and internet resources would be required. The targeted student group should be all ALS providers with a change in their scope of practice on completion. Conclusion This study described the specific needs of prehospital learners as it pertains to the teaching, learning and assessment (TLA) of a curriculum in neonatal critical care transfers. It also described some of the limitations in the current and past education systems in neonatal critical care transfers. This study provides broad course outcomes and the results can be used to inform the next steps in curriculum development for education in neonatal critical care transfers.