Browsing by Subject "acute care"

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    Clinical Outcomes Associated with Speech, Language and Swallowing Difficulties Post-Stroke – A Prospective Cohort Study
    (2022) Kaylor, Stephanie Anne; Singh, Shajila
    Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.
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    Curriculum renewal in acute care: a South African based study for returning Cuban-trained students
    (2025) Khan, Waseela; Jansen, Marvin; Cilliers, Francois
    Background: Emergency Care plays an integral role in Universal Health Coverage (UHC), yet several limitations have been identified in Low- and Middle-Income Countries (LMIC), one of which is the lack of dedicated, integrated curricula. In 1996 the Nelson Mandela Fidel Castro (NMFC) student program was developed in response to societal health needs for equitable health care in rural and under-served areas, affirmative action, and the low doctor-to-population ratios nationally. Cuban medical education is Primary Health Care focussed and not aligned with Acute Care competencies. This study explores the NMFC students' needs, the barriers to learning, and the role of transition in this process, as a first integral step in curriculum renewal in Acute Care. Methods: A qualitative approach of focus group interviews with 18 UCT NMFC students and semi-structured interviews with preceptors was conducted. Data was then analysed thematically and with the lens of the chosen theoretical framework framed by Transition theory and Situated Learning theory. Results: The findings indicate that skills and simulation-based teaching methodologies are favoured. A structured orientation within an Acute Care transition program and supervised and integrated workplace supervision is needed. Barriers to student learning include time, a perceived sense of ‘othering,' and educational ‘differences' to Cuban training. NMFC students were identified for their willingness to learn. Preceptors further identified a lack of dedicated time for Acute Care and a lack of resources as barriers to facilitation. Conclusions: As socially responsible educators we must be considerate of student needs and respond with a robust curriculum. The challenge is designing a curriculum in Acute Care that addresses the specific learning needs of a group of designated adult learners from previously disadvantaged backgrounds, transitioning between institutions with different educational outcomes, in the care of undifferentiated critically ill patients, within the short timeframes in resource-constrained educational and health institutions. Recommendations include the addition of a robust transition program to integrate, orientate and scaffold Acute Care knowledge and skills deficits. The curriculum must include skills and simulation-based methodologies for ‘hands-on' practice, opportunities for self-directed learning, and situated learning within supportive communities of practice.