Browsing by Author "Welzel, Tyson"

Now showing 1 - 9 of 9
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    Case mix and workload of patients seen at three private emergency centres in Cape Town, South Africa
    (2017) Moolla, Zuraida; Welzel, Tyson
    Objectives: To determine the case mix and workload of patients presenting to three private emergency centres in Cape Town Design: A Prospective cross sectional observational study was undertaken Setting and subjects: A convenience sample of all prospective patients that presented to three private emergency centres namely Melomed Gatesville, Melomed Bellville and Melomed Mitchell's plain during the month of September 2013 The outcome measures included the following:- ● Determining basic metrics across all three units over study time ● Determining the triage parameters for patients sampled across three units ● Direct time study of patients through unit ● Determining Doctor to patient workloads ● Determining Nurse to patient workloads ● Determining average number of patients receiving special investigations Results: Third party funding was responsible for 91 % of patients seen. The patient profiles consisted primarily of lower acuity presentations. There were clear peaks of attendance with lower acuity presentations decreasing after 10 pm. The majority of patients were discharged and very few required specialist follow up. Conclusions: This study provides valuable information with regards to private emergency centres in the predominantly low income and low socio economic sectors of the Western Cape, Cape town thus allowing a greater focus on the operational aspects of Emergency Centres In these areas and to assist with future planning of the management and running of similar Emergency Centres.
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    Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population
    (2018) Bulajic, Bojana; Welzel, Tyson; Vallabh, Kamil
    Introduction: The diagnosis of Pulmonary Embolism (PE) is challenging to make and is often missed in the Emergency Centre. The true incidence of PE in South Africa is unknown. The diagnostic work-up of PE has been improved by the use of Clinical decision rules (CDRs) and CT Pulmonary Angiography (CTPA) in high-income countries. Currently used CDRs have not been validated in the South African environment, where HIV and TB are highly prevalent. Both conditions are known to induce a hyper-coagulable state. Methods: This study was a retrospective chart review of patients with suspected PE that had CTPAs performed from October 2013 to October 2015 at Mitchell’s Plain Hospital in South Africa. Data was collected on demographics, presenting symptoms and signs, vitals, bedside investigations, HIV and TB status, use of CDRs and CTPA result. A Revised Geneva Score was calculated retrospectively and compared to the CTPA result. Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%), followed by cough and chest pain. 29% of patients also had clinical features of DVT. No sign or symptom was seen to be markedly different in those with confirmed PE compared to those without. Among patients with confirmed PE, 37% were HIV positive and 52% had current TB. The retrospective revised Geneva Scores compared poorly with the CTPA results. Discussion: PE remains a diagnostic challenge. Worldwide, the use of CDRs has shown to improve the utilization of CTPA. In our study, the retrospectively calculated CDR was not predictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious when making a clinical probability assessment of PE in this setting. However, further studies are needed to determine whether HIV and TB could be independent risk factors for PE.
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    A cross-sectional analysis of the short-term outcomes of patients receiving prehospital treatment for symptomatic hypoglycaemia in Cape Town
    (2013) Booley, Mohammed Ridhaa; Welzel, Tyson
    Includes abstract. Includes bibliographical references.
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    Current practice in the air medical services for the inter-facility transfer of paediatric patients in the Western Cape, South Africa
    (2013) Howard, Ian; Welzel, Tyson
    Includes abstract. Includes bibliographical references.
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    Non-invasive ventilation during paediatric retrieval: a systematised review
    (2018) Cheema, Baljit Kaur; Welzel, Tyson; Rossouw, Beyra
    Background: In hospital critical-care and emergency settings, non-Invasive ventilation (NIV) is increasingly used in neonatal and paediatric patients as an alternative to invasive positive pressure ventilation (IPPV). Critically ill children and babies may need transfer to higher levels of care, but the emergency transport setting is lagging behind the hospital sector in terms of availability of NIV. Aim and objectives: The goal of this study was to assess the evidence on the safety and effectiveness of NIV in children during transportation. Safety outcome measures were intubation or escalation of ventilation mode (during and soon after transport) and adverse event (AE) occurrence during transport. Effectiveness outcome measures related to improvement in clinical parameters during transfer. Methods: A systematised review of the literature was conducted, based on searches of MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials (CENTRAL), African Index Medicus, Web of Science Citation Index and the World Health Organisation Trials Registry (ICTRP). Two reviewers independently reviewed all identified studies for eligibility, with an initial screening round followed by a full-text review of potentially relevant articles. The quality of studies meeting inclusion criteria was evaluated using an adapted quality assessment tool developed for this study. Results: A total of 1287 records were identified; of these, 12 studies met inclusion criteria. Following quality assessment, eight studies were included and four studies were excluded. There were no randomised controlled trials, quasi-randomised controlled trials or non-randomised studies of intervention, to answer the research question. The included studies were all observational in design: seven studies (n= 708) evaluated in-transport use of continuous positive airway pressure (CPAP) and one study (n=150) reported on use of high-flow nasal cannula (HFNC) in children during transport. During transport on NIV, 3/858 (0.4%) patients required either intubation (1/708; 0.1%; CPAP studies) or escalation of mode of ventilation (2/150; 1%; HFNC study). In the 24 hours following transfer, 63/650 (13%) of children transferred on NIV, were intubated. The odds of intubation within 24 hours were significantly higher for CPAP transfer 60/500 (12%) compared with HFNC 3/150(2%): OR (95% CI) 6.68 (2.40 - 18.63), p=0.00003. Adverse events, where reported, were found to occur in 2-4% of NIV transports, with use of BVM in 8/334 (2%), desaturation episodes in 9/290 (3%), apnoea in 11/290(4%) and administration of CPR in 0/290 (0%) cases being described. There was insufficient reporting of change in vital signs or clinical condition during transport for meaningful analysis. Conclusion: This study is the first systematised review indicating that NIV use in children during transport is likely to be safe. From the low-reliability evidence available, it was calculated that NIV use in children during transport would result in a 0.4% rate of intubation or escalation during transport and an in-transport adverse event rate of 2-4%. There was insufficient evidence to comment on clinical effectiveness of NIV during transfer. Following NIV transfer, 13% of patients were intubated within 24 hours, with significantly higher odds of intubation in children transported on CPAP compared with HFNC. Recommendations: Further research is needed in order to make firm recommendations regarding the safety and effectiveness of NIV during transport of children. A recommended minimum data set, for the standardised reporting of observational studies of paediatric NIV use during transport, is suggested. It is recommended that transport databases and registries are expanded to include NIV details as well as information regarding the presence or absence of pre-specified adverse events during transport.
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    The prevalence of hypotension and hypoxaemia in the prehospital setting of traumatic brain injury in Johannesburg, Gauteng
    (2013) Stassen, Willem; Welzel, Tyson
    Includes abstract. Includes bibliographical references.
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    Risk adjusted mortality rates : Do they differ if bases on administrative data (hospital standardised mortality ratio) versus a physiological predictive model (APACHE IV ®)?
    (2015) Du Toit, Rene; Welzel, Tyson
    Background: The measurement of, and reporting on clinical outcomes, is an integral part of clinical governance but no consensus has been reached about which measures to use and the validity thereof. Objective: To compare an administrative predictive model (Hospital Standardised Mortality Ratio [HSMR]) with a physiological predictive model (APACHE ®IV) to determine the correlation in the predicted risk adjusted mortality rates. To determine whether stratifying the patients into low (<10%), medium (<50%) or high (>80%) risk bands will lead to more accurate comparisons. Design: Prospective cohort study Setting: 63 critical care units in 34 private acute care facilities across South Africa Methods: Both HSMR and APACHE ®IV are calculated routinely in all participating facilities and the research study will use the data generated. An additional audit process will be implemented to determine and ensure the integrity of the data. Ethics: The healthcare facilities have standard processes in place to ensure confidentiality and the statistician analysing the data is employed by the healthcare group and bound to a confidentiality agreement. Ethics approval has also been obtained by the University of Cape Town ethic committee before the approval of the research proposal.
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    Text Reminders in Pyrexial Paediatric Patients (TRIPPP): a randomized controlled pilot study
    (2020) Mohamed, Zunaid; Welzel, Tyson
    Transitions in care – including at the point of discharge from a hospital - may potentially place patients in a position of increased risk and vulnerability.(1) This is recognised to be of particular concern for paediatric patients, compounded by the fact that no widely accepted or used standards of care for paediatric discharge exist. Current research and quality improvement efforts to optimize care transitions in children are considered an essential contributor to reducing post hospitalization morbidity and improving family centred care. (2)(3) Care transitions are also considered especially challenging during the discharge process from the Emergency Centre. Effective patient education and follow-up arrangements may be compromised in the frequently fast paced, high patient volume environment often characterised by interruptions and distractions thus increasing the risk of medical error. This is further complicated by shift working healthcare providers who are required to treat unfamiliar patients of varying clinical acuity who present for care.(1)(4)(5)
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    Waveform capnography in the South African prehospital setting: knowledge assessment of qualified advanced life support (ALS) paramedics
    (2016) Wylie, Craig Alexander; Welzel, Tyson; Hodkinson, Peter
    Although there is extensive literature regarding out-of-hospital use of capnography, the willingness and knowledge of South African paramedics where capnography is available for routine use is poorly understood. From informal reviews, it would appear that even when capnography is available the practitioners decided to not use the tool. Aim: To determine the knowledge of prehospital providers with respect to the use of capnography to guide decision making in the treatment of patients. Methods: A cross-sectional research-generated survey of 80 out-of-hospital advanced life support paramedic providers in South Africa working in the private industry where capnography is available. Participants will be recruited with the assistance of the company's research committee using an email platform, and consent process. The questionnaire will establish the knowledge, ability and willingness of advanced life support paramedics to identify and use capnography as part of their clinical decision making process. Descriptive statistics will be used to interpret and report the data. The study should be concluded within 6 months of receiving ethical approval from Human Research Ethics Committee of the University of Cape Town. Discussion: The findings of the study will describe a cohort of out-of-hospital practitioners' knowledge and willingness to use capnography in an environment where it is routinely available. Recommendations will be made regarding the need for further policy development and change management for the implementation of best practice.