Research Articles (General Medicine)
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- ItemEvaluation of factors and patterns influencing the 30-day readmission rate at a tertiary-level hospital in a resource-constrained setting in Cape Town, South Africa(Health & Medical Publishing Group, 2019) Dreyer, R.; Viljoen, A. J.Background. Factors contributing to and causes of hospital readmissions have been investigated worldwide, but very few studies have been performed in South Africa (SA) and none in the Western Cape Province. Objectives. To investigate possible preventable and non-preventable factors contributing to readmissions to the Department of Internal Medicine at Tygerberg Hospital (TBH), Cape Town, within 30 days of hospital discharge. The researchers tested a risk-stratification tool (the LACE index) to evaluate the tool’s performance in the TBH system. Methods. A retrospective analysis was conducted of all 30-day readmissions (initial hospitalisation and rehospitalisation within 30 days) to the Department of Internal Medicine at TBH for the period 1 January 2014 - 31 March 2015. Potential risk factors leading to readmission were recorded. Results. A total of 11 826 admissions were recorded. Of these patients, 1 242 were readmitted within 30 days, representing a readmission rate of 10.5%. The majority of patients (66%) were readmitted within 14 days after discharge. The most important risk factor for readmission was the number of comorbidities, assessed using the Charlston score. The study also identified a large burden of potentially avoidable causes (35% of readmissions) due to system-related issues, premature discharge being the most common. Other reasons for 30-day readmission were nosocomial infection, adverse drug reactions, especially warfarin toxicity, inadequate discharge planning and physician error. Conclusions. Despite TBH being a low-resource, high-turnover system, the 30-day readmission rate was calculated at 10.5%. Global readmission rates vary from 10% to 25%, depending on the reference article/source used. We found that 35% of 30-day readmissions were potentially avoidable. Venous thromboembolism was a minor contributor to readmission but was associated with a very high mortality rate. A secondary outcome evaluated was the utility of the LACE and modified LACE (mLACE) index in the TBH environment. The risk tool performed well in the TBH population, and a high LACE and mLACE score correlated with an increased risk of 30-day readmission (p<0.001).
- ItemThe prevalence and risk factors for diabetes mellitus in healthcare workers at Tygerberg hospital, Cape Town, South Africa : a retrospective study(MedPharm Publications, 2019) Coetzeea, Ankia; Beukes, Amanda; Dreyer, Reinhardt; Solomon, Salaamah; Du Toit, Lourentia; Mistry, Roshni; Conradie, Magda; Van De Vyver, MariObjectives: To assess the contribution of traditional and modifiable risk factors to the overall risk and prevalence of type 2 diabetes mellitus (T2DM) amongst health workers (HWs) in the public sector. Design: A retrospective analysis was performed on data obtained from 260 participants. Setting and subjects: HWs at Tygerberg Hospital, Western Cape attending the World Diabetes Day (WDD) metabolic screening and educational event. Outcome measures: The 10-year risk stratification for T2DM was calculated in all HWs attending the WDD event. This was based on the Finnish ‘Test2prevent’ diabetes risk calculator endorsed by the International Diabetes Federation assessing a set of wellestablished metabolic risk factors. Self-reported consumption of sugar-sweetened beverages (SSBs) was added to the questionnaire but did not add to the risk calculation. Results: The prevalence of known hyperglycaemia in this cohort is concerning (11%, n = 62). An additional 29 health workers were identified as at high risk to develop T2DM within 10 years. Consumption of SSBs and minimal physical activity were identified as modifiable targets for intervention. Conclusions: Education and lifestyle interventions are of paramount importance to ensure the metabolic health of HWs and their communities. Policies and guidelines focused on limiting unhealthy/obesogenic work environments are urgently needed.
- ItemThe rise and fall of hydroxychloroquine for the treatment and prevention of COVID-19(American Society of Tropical Medicine and Hygiene, 2021) Lee, Zelyn; Rayner, Craig R.; Forrest, Jamie I.; Nachega, Jean B.; Senchaudhuri, Esha; Mills, Edward J.ENGLISH ABSTRACT: The efficacy and safety of hydroxychloroquine (HCQ) for the prevention and treatment of COVID-19 has received great attention, and most notably, the enthusiasm for HCQ has been one of politicization rather than science. Laboratory studies and case series published early in the pandemic supported its efficacy. The scientific community raced to conduct observational and randomized evaluations of the drug in all stages of the disease, including prophylaxis, early treatment, and advanced disease. Yet a divisive media response affected recruitment, funding, and subsequent enthusiasm for continuing scientific investigations. Of the more than 300 HCQ trials registered, fewer than 50% report having recruited any patients, and most trials might fail to achieve any useful portions of their intended sample size. Multiple observational studies and two large randomized trials have demonstrated HCQ does not offer efficacy against COVID-19 in hospitalized patients. Prophylaxis studies and early treatment studies provided heterogeneous results and are plagued by low event rates and poor study outcome monitoring. Emerging high-quality evaluations of prophylaxis and early treatment do not support a role for HCQ in these populations. The story of HCQ for COVID-19 has followed a pattern of initial enthusiasm supported by poor quality evidence, followed by disappointment based on more rigorous evaluations. The experience of HCQ in the COVID-19 era calls for the depoliticization of science away from media glare.
- ItemExploring the factors that affect new graduates’ transition from students to health professionals : a systematic integrative review protocol(BMJ Publishing Group, 2020-05-15) Opoku, Eric Nkansah; Van Niekerk, Lana; Jacobs-Nzuzi Khuabi, Lee-AnnIntroduction: To become a competent health professional, the nature of new graduates’ transition plays a fundamental role. The systematic integrative review will aim to identify the existing literature pertaining to the barriers during transition, the facilitators and the evidence-based coping strategies that assist new graduate health professionals to successfully transition from students to health professionals. Methods and analysis: The integrative review will be conducted using Whittemore and Knafl’s integrative review methodology. Boolean search terms have been developed in consultation with an experienced librarian, using Medical Subject Heading terms on Medline. The following electronic databases have been chosen to ensure that all relevant literature are captured for this review: PubMed, EBSCOhost (including Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), Scopus and Web of Science. A follow-up on the reference list of selected articles will be done to ensure that all relevant literature is included. The Covidence platform will be used to facilitate the process. Ethics and dissemination: Ethical approval is not required for this integrative review since the existing literature will be synthesised. The integrative review will be published in a peer-reviewed journal once all the steps have been completed. The findings will also be presented at international and national conferences to ensure maximum dissemination.
- ItemStaff testing for COVID-19 via an online pre-registration form(medRxiv, 2020) Moolla, Muhammad Saadiq; Parker, Arifa; Parker, Mohammed Aslam; Sithole, Sthembiso; Amien, Leila; Chiecktey, Rubeena; Bawa, Tasneem; Mowlana, AbdurasietBackground: Healthcare workers are at increased risk of contracting SARS-CoV-2 and potentially causing institutional outbreaks. Staff testing is critical in identifying and isolating infected individuals while also reducing unnecessary workforce depletion. Tygerberg Hospital implemented an online pre-registration system to expedite staff and cluster testing. Objectives: We aimed to identify (1) specific presentations associated with a positive or negative result for SARS-CoV-2 and (2) staff sectors where enhanced strategies for testing might be required. Methods: Retrospective descriptive study involving all clients making use of the hospital's pre-registration system during May 2020. Results: Of 799 clients, most were young and female with few comorbidities. The most common occupation was nurses followed by administrative staff, doctors and general assistants. Doctors tested earlier compared to other staff (median: 1.5 vs 4 days). The most frequent presenting symptoms were headache, sore throat, cough and myalgia. Amongst those testing positive (n=105), fever, altered smell, altered taste sensation, chills and history of fever were the most common symptoms. Three or more symptoms was more predictive of a positive test, but 12/145 asymptomatic clients also tested positive. Conclusion: Staff coronavirus testing using an online pre-registration form is a viable and acceptable strategy. While some presentations are less likely to be associated with SARS-CoV-2 infection, no symptom can completely exclude it. Staff testing should form part of a bundle of strategies to protect staff including wearing masks, regular hand washing, buddy screening, physical distancing, availability of PPE and special dispensation for COVID-19-related leave.