Browsing by Subject "Anaesthesia and Perioperative Medicine"
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- ItemOpen AccessA Prospective, Descriptive Study Evaluating The Evolution Of Covid-19 Associated Coagulopathy In Mechanically Ventilated, Critically-Ill Patients Using Standard Laboratory Coagulation Studies And Thromboelastography(2023) Neethling, Colette; Miller, Malcolm; Opie JessicaObjectives: Few studies detail the evolution of Coronavirus disease 2019 (COVID-19) associated coagulopathy in critically-ill patients. We aimed to perform serial thromboelastography (TEG) and laboratory coagulation studies on critically-ill patients with COVID-19 over a 14-day period, comparing variables in 30-day survivors with those in non-survivors. Design: Prospective. Setting: Intensive care unit (ICU) in Cape Town, South Africa. Subjects: Forty patients with severe COVID-19 pneumonia admitted to ICU for mechanical ventilation. Interventions: None. Measurements & Main Results: On admission, TEG maximum amplitude (MA) with heparinase correction was above the upper limit of the reference range in 80% of patients while 82.5% presented with absent clot lysis. The functional fibrinogen MA was also elevated above the upper limit of the reference range in 92.5% of patients. All patients had elevated D-dimer and fibrinogen levels, prolonged prothrombin times (PT), normal platelet counts and activated partial thromboplastin times (aPTT). No significant differences in laboratory coagulation studies and TEG analysis were noted between survivors and non-survivors on admission. The heparinase MA decreased significantly with time and normalised in non-survivors on day 14 (p=0.01). The functional fibrinogen MA continued to increase in non-survivors compared to survivors on day 14 however this difference was not statistically significantly (p=0.07). No patients developed disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) after 14 days, however thrombosis and bleeding were each reported in 7.5% of patients. Conclusion: Critically-ill patients with COVID-19 admitted to ICU for mechanical ventilation were in a hypercoagulable state as demonstrated by TEG analysis. This state evolved over the 14-day observation period, emphasizing the importance of regular monitoring of coagulation parameters in these patients. A small group developed thrombotic complications despite therapeutic anticoagulation, however a similar proportion suffered a bleeding event, indicating that routine therapeutic anticoagulation should be practiced with caution.
- ItemOpen AccessDeveloping an in-depth understanding of the prevalence, risk factors and treatment recommendations for phantom limb pain, and patient-generated care priorities for people who have undergone lower limb amputations(2022) Limakatso, Maxwell Katleho; Parker, RomyIntroduction: Phantom limb pain is a common complication in people who have undergone limb amputation, with prevalence estimates ranging between 29% and 85.6%. Current systematic-review evidence suggests that recommended treatments are no more effective than placebo for reducing Phantom Limb Pain (PLP). Moreover, there is evidence suggesting that people with amputations may not be getting the treatment they want at different time-points after amputation. In consideration of these points, a research project comprised of a series of interconnected studies aimed to develop an in-depth understanding of the global burden of PLP and patient care priorities after limb amputations, and generate expert recommendations on the best management of PLP in people with amputations. Methods: The research project is comprised of a series of four interconnected studies addressing the four primary aims of the project. A systematic review and meta-analysis were conducted to determine the pooled prevalence estimate and risk factors for PLP in people with amputations. A cross sectional study was conducted to determine the prevalence and risk factors for PLP in people who had undergone lower limb amputations at Groote Schuur Hospital. An expert Delphi study was conducted to reach expert consensus and make recommendations on the effective treatments for PLP in people with limb amputations. Lastly, a patient Delphi study was conducted to generate patient consensus on care priorities for people who have had lower limb amputation for a year or less and for those who have had lower limb amputations for more than a year. Results: The systematic review and meta-analysis of 39 studies revealed a pooled PLP prevalence estimate of 64% [95%CI: 60.01 – 68.05], with a significantly higher prevalence estimate in studies conducted in developed countries 66.55% [95% CI: 62.02 –71.64] than those conducted in developing countries 53.98% [95% CI: 44.79–63.05] (U = 57, p = 0.03). Risk factors that were consistently positively associated with PLP included having an amputation of a lower limb, stump pain, non-painful phantom sensations, persistent pre-amputation pain, proximal site of amputation, and diabetic cause of amputation. The cross-sectional study using a sample of African people with amputations showed a PLP prevalence of 50.78% [95% CI: 41.80 – 59.72] during the week preceding data collection. In this group of patients, persistent pre-operative pain was the only risk factor associated with PLP in the multivariate logistic regression analysis [OR 2.25 (1.03 – 5.05); P=0.04]. In the expert Delphi study, consensus was reached on one pharmacological (amitriptyline) and six nonpharmacological (Graded Motor Imagery, mirror therapy, Cognitive Behavioural Therapy, virtual reality training, sensory discrimination training, use of a functional prosthesis) treatments that were considered effective for managing PLP, and on two treatments [citalopram (60%) and Pulsed Radiofrequency Stimulation of the dorsal root ganglion (70%)] that were considered ineffective. In the patient Delphi study, consensus was reached on 24 short-term care priorities and 12 long-term care priorities. The general consensus among the participants was that pre-amputation, they wanted education support to help them manage their expectations and prepare for life after amputation. In the early stage after amputation, they wanted help with dealing with the psychological trauma of having lost a limb. In the long-term, however, the participants prioritised the need for living a functional and normal life, with respect and dignity like everyone else. Conclusion: The prevalence of PLP in people with limb amputations is high, and awareness of this condition needs to be raised among healthcare professionals to implement evidence-based strategies for alleviating PLP by targeting the relevant underlying mechanisms and modifiable risk factors. Evidence-based medicine indicates that PLP is best managed using non-pharmacological and noninterventional treatments addressing biopsychosocial contributors for PLP. Finally, preparing people for life after amputation and helping them deal with the psychological trauma of having lost a limb may contribute to improved clinical outcomes that may enable them to live a functional and normal life, with respect and dignity.
- ItemOpen AccessEffects of the Lubo cervical collar on airway patency in awake adults – A magnetic resonance imaging study(2022) Jaga, Rudhir; Hofmeyr, RossIntroduction: Intended for use by prehospital first responders, the Lubo TM cervical collar is an adjustable, radiolucent, single-use device that incorporates a mechanical jaw thrust mechanism. The combination enables non-invasive airway management in cases of trauma where cervical motion restriction is necessary. The potential benefits include use as an airway adjuvant maintaining upper airway patency, reducing provider task loading. The limited research on the device efficacy and safety requires further investigation. Methods: A randomized , crossover, interventional study was performed to compare mean differences in airway patency at the level of the uvula, epiglottis, tongue and soft palate with and without the Lubo collar in awake volunteers using magnetic resonance imaging (MRI). Fourteen participants each underwent two MRI scans of the upper airway: A control scan with no Lubo collar, and an intervention scan with the Lubo collar applied and jaw thrust mechanism activated. Two independent radiologists measured anterior-posterior diameter of the airway at four anatomical levels on the resulting MRI images. Results: There was no significant difference in mean airway diameter between the control and intervention measurements at any level. Mean (SD; 95% CI: p-value) differences were 0.9 mm (-2.38; 2.3 to 0.5; p= 0.17) at the epiglottis, 0.5 mm (1.6; -0.5 to 1.4; p= 0.29) at the soft palate, 0.2 mm (2.86; -1.4 to 1.9; p = 0.78) at the tongue, 0.4 mm (4.04; -1.9 to 2.7; p = 0.72) at the uvula. Conclusion: The Lubo TM airway collar did not show a significant change in upper airway patency at four anatomical levels measured in awake adult participants. Further research is required to investigate its clinical use in patients that are unable to maintain upper airway tone. Groups of interest would include trauma, obstructive sleep apnoea, obesity and patients under general anaesthesia.
- ItemOpen AccessGeneral anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry(2023) Seymour, Lisa; Fernandes, Nicole; Hofmeyr MichaelBackground Regional anesthesia (RA) is preferred for cesarean section (CS). In women at risk of spinalepidural hematoma, thrombocytopenia should be excluded. In South Africa, this investigation is often unavailable due to the absence of urgent laboratory services. Methods The obstetric airway management registry (ObAMR) is currently active across all training institutions affiliated with the University of Cape Town, including secondary and tertiary level obstetric services. This retrospective multicenter observational study aimed to determine the incidence of general anesthesia (GA) performed either because thrombocytopenia (platelet count < 75 x 109 /L. In group Tbcp NE, 46/52 (88.5%) platelet counts could be traced. The median (interquartile range) platelet count was 178 x 109 /L (93-233 x 109 /L), and > 75 x 109 /L in 41/46 (89.1%) patients. In the 5/46 patients with thrombocytopenia, 2 had hemolysis elevated liver enzymes and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. Conclusions In 17% of patients the indication for GA was thrombocytopenia. Many patients received GA because a platelet count was unavailable at the time of obstetric surgery. The importance of early laboratory assessment, when available, should be emphasized. Most patients in whom thrombocytopenia had not been excluded, and whose hypertension was uncomplicated, had a platelet count >75 x 109 /L. After careful decision consideration of risk and benefit, there may be circumstances in which the clinician justifiably opts for RA when a platelet count is indicated but unavailable.
- ItemOpen AccessHow WEIRD are the South African acute pain guidelines? An analysis of the 2015 South African acute pain guidelines(2022) Deedat, Raees; Parker, RomyBackground: There is increasing recognition that health care research is biased owing to skewed reliance on data from WEIRD (Western, Educated, Industrialized, Rich, Democracies) populations. This research explores health care discrepancy, primarily experienced by non-westernised, non-industrialised, non-rich and non-white people in the context of formulating the South African Acute Pain Guidelines, 2015 as published by the South African Society of Anaesthesiologists (the extant protocol at the time of writing). Methods: An established, peer-reviewed and published WEIRD (Western, Educated, Industrialized, Rich, Democracies) / non-WEIRD protocol for categorizing clinical population datasets was applied to the published datasets used in formulating the 2015 South African Acute Pain Guidelines. Results: A total of 5,246,847 patient data points were included in the numerous studies that formed part of the final analysis. Only 1% (n=73,539) of the patient data points originated from countries classified as nonWEIRD. Conclusions: The results confirmed the hypothesis that the 2015 South African Acute Pain Guidelines are based primarily on data from WEIRD population datasets. This study reveals an important type of bias in the scientific pain literature and also demonstrates a form of analysis that will encourage future published guidelines and research to be more inclusive of the depth and diversity of South African clinical practice.
- ItemOpen AccessIntubation during spinal motion restriction using the Lubo TM cervical collar a minikin simulation study(2022) Behari, Dinell; Hofmeyr, RossIntroduction: The Lubo TM collar is a cervical motion restriction device featuring a unique external jaw-thrust mechanism designed to provide non-invasive airway patency. In addition, tracheal intubation is facilitated by releasing an anterior chin strap; this allows better mouth opening than the previous generation of semi-rigid cervical collars. This study aimed to compare tracheal intubation using the Lubo TM collar combined with manual in-line stabilization (MILS) to intubation with MILS alone. The primary outcome was the time to successful intubation. Secondary outcomes compared intubation success rate, Cormack-Lehane grade, ease of intubation and dental trauma. Methods: A randomized, cross-over, equivalence study was performed. Eighty full-time physician anaesthesia providers were recruited. Participants performed tracheal intubation using direct laryngoscopy on a manikin under two different scenarios: with the Lubo TM collar and MILS applied, and with MILS and no cervical collar. The time to successful intubation was measured and compared using two-one-sided and paired t-tests. Results: Intubation times fell well within the a priori equivalence limits of 10 seconds, with a mean difference (95% CI) of 0.52 seconds (-1.30 to 2.56). There was no significant difference in intubation time with the Lubo TM collar (mean [SD] 19.2 [4.5] seconds) compared to the MILS alone group (19.7 [5.2] seconds). The overall success rate was 98.7% in the Lubo group and 100% in the MILS group. Adequate laryngoscopy views (Cormack-Lehane grades I to IIb) were equivalent between groups (Lubo 92.5% versus MILS alone 93.7%). Conclusion: In this manikin-based study, the time to intubation with the Lubo TM collar and MILS applied was equivalent to time to intubation with MILS alone, with similar intubating conditions. Thus, the Lubo TM collar and MILS may simplify airway management by reducing the number of steps required to perform intubation in patients requiring cervical motion restriction.
- ItemOpen AccessMyocardial injury after non-cardiac surgery: A prevalence study(2018) Coetzee, Ettienne; Biccard, Bruce; Dyer, RobertBackground Worldwide, the number of patients suffering from surgical complications account for a significant burden on healthcare systems. Myocardial injury after non-cardiac surgery (MINS) is a new entity that has recently been identified as an independent risk factor associated with 30-day all-cause mortality. The risk of death increases approximately 10 fold following MINS in the perioperative period. Diagnosing myocardial injury in nonsurgical patients often relies on specific symptomatology and clinical findings combined with special investigations. However, in surgical patients, more than 80% of patients with postoperative myocardial injury will be asymptomatic, and hence the majority of diagnoses will be missed. Studies identifying the prevalence and risk factors for MINS have been conducted in countries with a different surgical population to South Africa. The primary outcome of this study was to investigate the prevalence of MINS after non-cardiac, elective, elevated risk surgery in South Africa. Methods Patients undergoing elevated risk, elective, non-cardiac surgery ≥ 45 years of age were enrolled via convenience sampling. The new 5th generation, high sensitivity cardiac troponin T (hscTnT) blood test was used to identify MINS. Blood samples were taken between 24 to 72 hours after surgery. Exclusion criteria included patients with known renal disease, a recent cardiac event, pulmonary embolism or sepsis. Results A total of 244 patients were included in the study. The prevalence of MINS was 4.9% (95% CI 2.2-7.6) which was not significantly different (p=0.078) to reports from international prospective observational studies. Conclusion Elective, elevated risk surgical patients in South Africa have a similar incidence of MINS when compared to patients from international studies. As the risk profile of South African patients is significantly lower than other similar international observational studies, it is possible that the prevalence of MINS is more common in South Africa, when patients are adjusted for cardiovascular risk profile. The burden of MINS on public health morbidity is therefore likely to be proportionally more in South Africa when compared to international reports. This may suggest that the calibration of international cardiovascular risk prediction models is incorrect for South African patients, or there are confounding comorbidities which should be included in South African cardiovascular risk prediction models. Larger studies are required to confirm this hypothesis however, and should also aim to address the need for appropriate cardiovascular risk predicting models in South Africa, to ensure timeous identification of patients at risk of MINS.
- ItemOpen AccessOne-year retrospective analysis of red cell concentrate requisition and utilization practices at Regional and District hospitals with no blood bank on-site, Metro West Cape Town, South Africa: A multicentre descriptive study(2023) Chiu, Chian-Jia; ,Introduction: The usage of red cell concentrate (RCC) is an essential part of patient blood management (PBM). While a substantial amount of literature describes RCC usage at tertiary institutions, very few exists in the setting of regional or district hospitals with no blood bank on-site (H-NBBOS). Addressing this shortfall in countries with a strained health economy, such as South Africa, is imperative. This scarcity of resources also renders the intervention studies needed to improve blood utilisation and PBM particularly difficult. Material and Methods: A 12-month retrospective and comparative study investigating RCC usage across a hospital with a blood bank on-site (H-BBOS) or H-NBBOS and the various specialities, in Metro West Cape Town, South Africa. We proposed a set of new blood utilisation indices: individualised crossmatch-to-transfusion ratio (iCTR) and individualised transfusion-to-crossmatch ratio (iTCR), over and above conventional indices, to comprehensively ascertain the efficiency of both RCC crossmatching and transfusion practices through individualised cases. Regression analyses were performed to provide recommendations for a cost-effective intervention study to improve future PBM. Results: Apart from wastage ratio (3.74%) of H-NBBOS, all other overall blood utilisation indices for both H-BBOS and H-NBBOS were in accordance with international benchmarks. The overall crossmatch-to-transfusion ratio (CTR) of 1.19 in H-NBBOS indicated greater crossmatching efficiency than the H-BBOS (1.31). The superior efficiency of H-NBBOS was substantiated via statistical inference of our proposed individualised patient indices of iCTR and iTCR (p<0.05). Regression analyses of the various specialities revealed that Surgery and Obstetrics/Gynaecology of both H-NBBOS and the H-BBOS had the least efficient blood utilisation practices and higher chances of wastage. Conclusions: The conventional overall CTR showed that H-NBBOS were considerably more efficient than the H-BBOS. However, only a marginal difference was detected through the analysis of our proposed iCTR (p<0.05). There was a more distinctive difference in transfusion practices, with H-NBBOS transfusing proportionately more than the BBOS hospital. This advocates the importance of also investigating the utilisation efficiency from a transfusion perspective. A cost-effective intervention study focused on Surgery and Obstetrics/Gynaecology departments, particularly in H-NBBOS, is recommended to improve future blood utilisation practices in South Africa. In addition, our proposed indices enabled comprehensible and insightful interrogation of both crossmatching and transfusing practices. The individualisation of efficiency indices also permitted further objective statistical inferences. Therefore, we propose the incorporation of these indices in future blood utilisation analyses.
- ItemOpen AccessPenetrating cardio-thoracic injuries at a district level hospital in Cape Town South Africa : A retrospective case audit(2018) Hameed-Ikram, Sarwat; Nkanyiso, Hadebe; Swanevelder, JustiaanThe Khayelitsha District Hospital (KDH) faces the difficult challenge of managing patients with high acuity penetrating cardiothoracic injuries, but without the full complement of resources to provide optimal care. At the time of this dissertation, we were unaware of the outcome of patients cared for at KDH, and of any potential modifiable risk factors that could improve their outcome. We therefore undertook a retrospective case audit to determine the outcome of patients presenting alive at our emergency unit with penetrating chest injuries (PCI). Objective: The objective of this study is to audit the KDH experience with penetrating chest injuries and to identify potential risk factors that predict outcomes in patients who sustain these injuries and require surgery at this district level hospital. The total study duration was 34 months. Methods: A retrospective review of all medical records of patients with PCI who were alive on presentation and had undergone surgery at KDH between 1st February 2012 and 31st December 2014 was undertaken .An audit was conducted on these files. During the audit, affected patient's clinical and physiological variables on admission, intra- and post-operative were collected and evaluated as potential predictors of outcome. This study also assessed a possible relationship between physiological parameters together with arterial blood gases (ABG) on presentation with immediate 48-hour mortality. The selected variables were: SBP (systolic blood pressure) <90 mmHg or >90 mmHg, palpable pulse, presence of a precordial stab wound, vascular injury, base deficit (BD) and lactate. A logistic regression analysis was performed to investigate the relationship between the selected variables and the 48-hour mortality. The relationship between fluid, BD and lactate was compared using Pearson correlation. Continuous data is presented as means ± standard deviations. Estimates for predictor variables are presented with odd's ratios (OR) and 95% confidence intervals (95% CI). Permission of this study was gained from human research ethics committee of University of Cape town. Results: Over the 34-month study period, a total of 646 patients were admitted to KDH with penetrating cardiothoracic trauma. Fifty-six patients required surgery at KDH. These results show that KDH had a PCI incidence of 5.1%, and that this was predominantly amongst males in the 15 - 24 year age group. Fifty-five patients were male and only one female. Of the 56 operated patients, 37 (66%) presented in hemorrhagic shock with SBP < 90mmHg. The mean amount of resuscitation fluid, which included both crystalloid and colloid, administered in the Emergency Room (ER) was 2481 ml per patient. Ten (17.8%) patients had a front room thoracotomy (FRT), with a mortality rate of 6 (60%). The overall mortality rate amongst operated patients was 16 (31.3%). Thirty-three patients (58.9%) had an isolated cardiac chamber injury and 23 (41.1%) had a vascular injury. Mortality amongst patients with isolated cardiac chamber injury was 5 (31.2%) and mortality among patients with isolated vascular injury was 7 (43.7%). Two patients sustained a combined cardiac and vascular injury with a mortality of 12.5%. The results of the logistic regression analysis revealed no statistically significant correlation between the selected predictors and 48-hour mortality (p-values: BP<90mmH p=0.27, palpable pulse p=0.181, precordial stab p=1.17, vascular injury p=0.38, BE p=0.98, Lactate p=0.06). Additionally, there was no statistically significant relationship between administered EC fluids and the acid base severity (Pearson correlation coefficient: BD r =0.091, Lactate r = -0.13). Conclusion: Physiological (blood pressure, pulse) and ABG parameters (lactate and base deficit) were not identified as significant risk factors for survival in the sample studied. The risk factor of isolated cardiac injury carried a better prognosis. Logistic regression analysis did not support the initial observation of higher mortality in patients with vascular injury. Additionally, there was no correlation between the severity of the acid base disturbance and the volume of fluid administered during resuscitation in ER. The outcomes of patients with PCIs presenting at KDH was within those published in the literature (range of published mortality: 17%-80%, survival 3-84%). The ideal predictor for PCI outcome in our cohort was indeterminate. Limitations of this study that include a small sample size and incomplete medical records, may have led to a type 2 error. A more comprehensive prospective study with meticulous record keeping is required to identify the factors that can influence the outcome of patients with PCI.
- ItemOpen AccessPeople with chronic non-cancer pain receiving chronic morphine treatment at the Chronic Pain Management Clinic of Groote Schuur Hospital: a cross-sectional survey of characteristics and satisfaction with treatment(2023) Moodley, Prenisha; Parker, Romy; Van Nugteren JaniekeIntroduction Chronic pain is an ever-growing burden whose complex nature and interpatient variability make management challenging. Evidence for the use of chronic opioids for the treatment of chronic non-cancer pain is controversial with limited data to support its long-term efficacy. The use of opioids both acutely and chronically is associated with several risks. In this study, we assessed the characteristics of chronic non-cancer pain patients attending the Chronic Pain Management Clinic (CPMC) of Groote Schuur Hospital (GSH) and evaluated their satisfaction with treatment. Methods A cross-sectional observational study of chronic non-cancer pain patients attending the CPMC who are on chronic morphine (> 3 months). We collected data on patient characteristics, pain intensity, mental health status, health-related quality of life, central sensitization, and satisfaction with their treatment. Results The majority of our patients were older, overweight, currently unemployed, and from low socioeconomic status. Patients reported an overall severe pain severity score of 7 (IQR: 4.5- 8.5) with a moderate pain interference score of 4.85 (IQR: 2.4-7.5), where the maximum score is 10 for both categories. All patients had scores suggestive of moderate to severe childhood trauma on the Childhood Trauma Questionnaire and all, but one patient was at risk of anxiety/depression based on their scores on the Hospital Anxiety and Depression Scale. Health-related quality of life, as measured by the EQ-5D overall index, was high (median 1, IQR: 0.87-1) but VAS scores for the state of health today were notably low (median 50, IQR: 40-50). Most patients reported an improvement in their pain, mood, work- v related activities, physical activities, and overall well-being since starting treatment with morphine. However, one patient reported no change, with another patient reporting much worse pain and physical activity since initiating morphine therapy. Overall, most patients did not receive alternative non-pharmacological therapies, and none of the patients participated in the Pain Education Empowerment Programme. Conclusion The use of chronic morphine did not significantly lower pain severity or pain interference with function in our patients. Furthermore, we found these patients to be at a higher risk of developing anxiety or depression. Although patients reported high overall HRQoL as suggested by high EQ-5D utility scores, their individual VAS scores were concerningly low. Their older age, lower socioeconomic status, and disability may be determinant factors in this discrepancy.
- ItemOpen AccessThe costing of operating theatre time in a secondary level, state sector hospital: A quantitative observational study(2020) Samuel, John Philip; Reed, AnthonyBackground: There is no established costing model for operating theatres in South Africa, yet both sectors have existing charges for operating theatre (OT) time: in the state sector, Uniform Patient Fee Schedule (UPFS) rates, and in the private sector, Rands/minute (R/min) rates for OT time. Understanding the cost of providing the separate components of a health service is important for planning and funding purposes. Objective: The primary objective of this study was to develop a costing model that would allow the calculation of the R/min cost of OT time. The secondary objective was to determine the actual costs, in order to establish the comparable costs that would be included in the R/min charges for OTs in the private health sector. Method: The OTs in a secondary level, state sector hospital in Cape Town were used in this quantitative observational study to develop a top-down costing model for OTs in South Africa. The inclusive costing model was developed in a consultative process with professionals, managers and experts from the state and private sector. The model was then populated with utility measurements (water and electricity) for the month of August 2018, staff salaries, excluding surgeons and anaesthetists, and other costs for the 2018/19 financial year. Results: Costs were considered in the categories of full costs, shared costs and capital or annualised costs. Due to uncertainty in costing of OTs, two models - with different annualisation times assigned to the capital costs - were developed to demonstrate the difference. For shared costs, correction factors were determined using either an activity based (work-load) factor, or a more generic estimation of workload using theatre nursing staff as a percentage of total hospital nursing staff. To determine a R/min cost of creating a minute of available theatre time, all the annual costs were divided by minutes that the OTs are explicitly available, each year, to provide patient care. The model was then populated with costs using the appropriate correction factors. The longer annualisation model costed OT time at R31,46 per minute, and the shorter annualisation model at R33,77 per minute. In both the longer and shorter capital annualisation models, nursing was the largest contributor to costs at 36% and 33% respectively, followed by construction costs at 9% and 11%, and then OT equipment at 8% and 11%. Conclusion: An inclusive, top-down costing model for OTs in South Africa was developed. This costing model will support work to develop costing for individual procedures, the appropriate charge for planned and emergency OT time, and to better determine budgeting for OT services. Meaningful critique of the model will improve its fidelity, and likely increase its utility, especially as SA moves towards universal health coverage.
- ItemOpen AccessThe profile of patients attending the Groote Schuur Hospital Chronic Pain Management Clinic(2022) Keenoo, Faadhila; Parker, RomyIntroduction Chronic pain affects 10- 25% of the population worldwide. However, studies of people with chronic pain have primarily been conducted in WEIRD (Western, Educated, Industrialised, Rich and Democratic) countries. There is a paucity of data from developing countries with the existing biased data being used to guide treatment of patients in developing countries. To address this knowledge gap, we have analysed the data of 623 patients attending the Chronic Pain Management Clinic (CPMC), at a tertiary facility in Cape Town, South Africa. The profile of the patients was compared to the global data. Methods A cross-sectional study of patients who attended the CPMC was conducted to describe their profile according to age, sociodemographic characteristics, health, gender and use of illicit drugs. Results The typical patient attending the CPMC was of middle age, female gender, of low educational level and less advantageous socio-economic status. They were also more likely to be on a disability grant and suffer from anxiety and depression. Conclusion The profile of the patients attending the CPMC was found to be similar to those from WEIRD countries. These results suggest that we can apply global data of people with chronic pain to patients attending this clinic.
- ItemOpen AccessUltrasonographic circumferential strain pattern analysis of the cardiac septal wall in rodents with experimental pulmonary hypertension.(2023) Van Heyningen, Charl; Swanevelder, JustiaanPulmonary arterial hypertension (PAH) remains a devastating disease. Early diagnosis remains challenging, but is associated with improved outcomes. Rodent models have been extensively used to investigate PAH. Ultrasonographic strain pattern analysis provides a novel method of assessing cardiac function, but difficulties in transthoracic imaging of the right heart are a barrier to its use in diagnosis of PAH. Segmental strain pattern analysis of the intraventricular septum circumvents this problem while still providing insight into right ventricular (RV) function. In this paper, the authors compare the septal strain pattern of rodents with chemically-induced PAH, to a known indicator of right heart pressures, pulmonary arterial acceleration time (PAAT). Method This was a secondary analysis of ultrasonographic data of rodents from a previous study with chemically-induced PAH. Strain pattern analysis was used to identify peak circumferential strain (CS) of the septal segment on short axis views via transthoracic echocardiography. PAAT was also measured. Regression analysis was performed to assess the relationship between the parameters. Results The relationship between CS and PAAT was linear (y = 7.1343 + -0.6118 x, p=0.001, R2 0.69). Rodents' predicted CS was equal to 0.59 + (-1.1 x PAATms). CS increased by 1.1% for every 1 ms decrease in PAAT. Conclusion In rodents with PAH, peak CS of the septal segment on short axis view can be used to predict PAAT, and thus be used as a measure of PAH. Peak CS can reliably and easily be measured using transthoracic echocardiography, and may be valuable in the investigation and management of PAH in humans. Further studies should be conducted.
- ItemOpen AccessUltrasonographic circumferential strain pattern analysis of the cardiac septal wall in rodents with experimental pulmonary hypertension.(2023) Van Heyningen, Charl; Swanevelder, JustiaanPulmonary arterial hypertension (PAH) remains a devastating disease. Early diagnosis remains challenging, but is associated with improved outcomes. Rodent models have been extensively used to investigate PAH. Ultrasonographic strain pattern analysis provides a novel method of assessing cardiac function, but difficulties in transthoracic imaging of the right heart are a barrier to its use in diagnosis of PAH. Segmental strain pattern analysis of the intraventricular septum circumvents this problem while still providing insight into right ventricular (RV) function. In this paper, the authors compare the septal strain pattern of rodents with chemically-induced PAH, to a known indicator of right heart pressures, pulmonary arterial acceleration time (PAAT). Method This was a secondary analysis of ultrasonographic data of rodents from a previous study with chemically-induced PAH. Strain pattern analysis was used to identify peak circumferential strain (CS) of the septal segment on short axis views via transthoracic echocardiography. PAAT was also measured. Regression analysis was performed to assess the relationship between the parameters. Results The relationship between CS and PAAT was linear (y = 7.1343 + -0.6118 x, p=0.001, R2 0.69). Rodents' predicted CS was equal to 0.59 + (-1.1 x PAATms). CS increased by 1.1% for every 1 ms decrease in PAAT. Conclusion In rodents with PAH, peak CS of the septal segment on short axis view can be used to predict PAAT, and thus be used as a measure of PAH. Peak CS can reliably and easily be measured using transthoracic echocardiography, and may be valuable in the investigation and management of PAH in humans. Further studies should be conducted.