Browsing by Author "Smith, M."

Now showing 1 - 7 of 7
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    Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown
    (Health & Medical Publishing Group, 2020) Chu, K. M.; Smith, M.; Steyn, E.; Goldberg, P.; Bougard, H.; Buccimazza, I.
    Background. In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. Objectives. To report changes in SA hospital surgical practices in response to COVID-19 preparedness. Methods. In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. Results. A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. Conclusions. Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.
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    Establishing a South African national framework for COVID-19 surgical prioritisation
    (Health & Medical Publishing Group, 2021-03-23) Chu, K. M.; Owolabi, E. O.; Smith, M.; Hardcastle, T. C.; Maswime, S.; Geduld, H.; Gopalan, P. D.; Marco, J.; Mendelson, M.; Biccard, B. M.; Cairncross, L.
    Background. Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelines on surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need for context-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the South African National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a national framework for COVID-19 surgical prioritisation. Objectives. To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculator for operative care. Methods. The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and local recommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the available literature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated. Results. A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to draw up six recommendations for preoperative COVID-19 screening and testing as well as the use of appropriate personal protective equipment. Ninety-nine perioperative practitioners from eight SA provinces evaluated the COVID-19 surgical risk calculator, which had high acceptability and a high level of concordance (81%) with current clinical practice. Conclusions. This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable and personalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.
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    Liver and renal and platelet counts after delivery in patients with severe pre-eclampsia
    (Health & Medical Publishing Group, 1998) Moser, E. C.; Van den Blerk, G. E. L.; Smith, M.; Odendaal, H. J.
    Pregnancy complicated by sever pre-eclampsia remote from term is associated with increased maternal and perinatal morbidity and mortality. Pre-eclampsia usually improves soon after deliver, but may persist and may cause complications in the puerperium. In deciding how long after delivery the investigations should be continued it is necessary to know how soon after delivery results of the special investigations return to normal.
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    Preterm labour : is bacterial vaginosis involved?
    (Health & Medical Publishing Group, 2002) Odendaal, H. J.; Popov, I.; Schoeman, J.; Smith, M.; Grove, D.
    Objective. To assess the efficacy of treatment of bacterial vaginosis (BV) using metronidazole to reduce preterm labour in primigravidae and multigravidae with previous midtrimester abortion or preterm labour. Design. Randomised controlled trial. Setting. Tertiary academic hospital. Method. Two different groups of patients were screened for BV at the first antenatal visit, namely primigravidae and high-risk multigravidae who had had a previous midtrimester abortion or preterm delivery. Patients where BV was diagnosed clinically or on Gram's stain of a smear taken from the posterior vaginal fornix, received either 400 mg metronidazole, or 100 mg vitamin C orally twice daily for 2 days. The Gram's stain was repeated after 4 weeks. If BV was found again, treatment with the same drug was repeated. Outcome measures. Preterm delivery, birth weight and perinatal deaths. Results. One thousand and five patients entered the study, but 40 were excluded for various reasons and 10 were lost to follow-up. There were 464 primigravidae, of whom 150 (32%) had BV. Except for the 5-minute Apgar score, no significant differences were found between primigravidae negative for BV and those who received either metronidazole or vitamin C. There were 491 high-risk multigravidae, of whom 127 (26%) had BV. The mean gestational age in the BV negative group was 37 weeks, in contrast to 37.4 weeks in the vitamin C group and 35.6 weeks in the metronidazole group. Birth weights in these three groups were 2 752 g, 2 759 g and 2 475 g respectively, significantly less (P = 0.0109) in the metronidazole group in comparison with the BV-negative group. Delivery before 37 weeks occurred in 29% of high-risk multigravidae with no BV but in 24% of those who took vitamin C and in 43% who took metronidazole. Differences were significant between the BV-negative and metronidazole groups (P = 0.0231) and also between the metronidazole and vitamin C groups (P = 0.0274). Delivery before 28 weeks occurred in 4% of the high-risk multigravidae with no BV but in 10% of those with BV who took metronidazole. The difference was significant (P = 0.0430). Analysis for maximum likelihood estimates for preterm labour identified only previous preterm labour or midtrimester abortion as risk factors. Conclusion. Metronidazole does not seem to reduce the prevalence of preterm labour when given for BV before 26 weeks' gestation.
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    The role of prenatal alcohol exposure in abruptio placentae
    (Health and Medical Publishing Group (HMPG), 2010-12) Du Toit, M. M.; Smith, M.; Odendaal, H. J.
    Objective. To investigate the association between preconception and prenatal alcohol use and abruptio placentae. Methods. A case-control study of women with the clinical diagnosis of abruptio placentae, 65 cases and 66 controls, at Tygerberg Academic Hospital, Western Cape, South Africa. Women in whom a retroplacental blood clot, covering at least 15% of the placental surface, was found at delivery at 24 weeks’ gestation or later were asked to complete a timeline follow-back questionnaire to determine their alcohol intake 12 and 3 months before and during pregnancy. The same questionnaire was administered to a control group of high-risk women who had no antepartum haemorrhage. Outcome. Women who drank alcohol 12 months before conception were more than 4 times more likely to develop abruptio placentae than the control group (odds ratio (OR) 4.49, p=0.00009). Women who drank alcohol 3 months prior to conception were 3 times more likely to develop abruptio placentae than the control group (OR 3.06, p=0.003). Drinking alcoholic beverages during pregnancy carried a more than 3 times greater risk of developing abruptio placentae (OR 3.52, p=0.0006). In the study group, women consumed a mean of 13.6, 12.0 and 11.2 standard drinks in a typical week at 12 and 3 months before and during pregnancy, respectively. The study group demonstrated a binge-drinking pattern, with two to four sessions per month. Conclusion. An association was found between preconception and prenatal consumption of alcohol and abruptio placentae.
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    The spectrum of self inflicted injuries managed at a major trauma centre in South Africa
    (Health and Medical Publishing Group, 2019) Moffatt, S. E.; Kong, V. Y.; Weale, R. D.; Buitendag, J. P.; Ras, A. B.; Ras, M.; Smith, M.; Bruce, J. L.; Laing, G. L.; Clarke, D. L.
    ENGLISH ABSTRACT: Self-harm behaviour is a major public health problem that is commonly underreported. This study reviews the spectrum of these self inflicted injuries managed by a major trauma centre in South Africa. METHODS: A retrospective review of the regional trauma registry was undertaken over a five-year period from December 2012 to December 2017 at the Pietermaritzburg Metropolitan Trauma Service (PMTS) in South Africa. All patients who were admitted after they had sustained an injury as a result of self-harm were included. RESULTS: During the five-year study period, a total of 179 patients were included. The mean age was 29 years (SD12) and there were 139 (77%) males and 40 (23%) females. Of these, 16 had a previously established psychiatric diagnosis and two had a prior history of having sustained self-harm. The previously diagnosed psychiatric illnesses included mood dysphoria disorders (5), schizophrenia (3), substance abuse and dependency (1), anti-social personality disorder (1) and unspecified (6). The mechanism was penetrating trauma in 47 (26%). The penetrating mechanisms included stab wounds (SW) in 33, gunshot wounds (GSW) in 10, broken glass in 2 and a single impalement. Blunt mechanisms accounted for the remaining 131 (73%) injuries. The most common mechanism of blunt self-harm was hanging in 101 patients. This was followed by vehicular related trauma (8), jumping in front of a train (1) and jumping from a height (1). In 17 patients the exact mechanism of the blunt trauma was unclear. There was no statistical difference in the mechanism of injury between male and female patients. There were 38 (28%) men and 9 (23%) women who sustained a penetrating injury and there were 100 (72%) male and 31 (78%) female patients who had a blunt mechanism of injury. A total of 53 CT scans were obtained, 40 chest X-rays, 9 abdominal X-rays and 2 ultrasounds. There were 113 neck injuries, 68 head injuries, 24 abdominal injuries, 15 upper limb and 15 lower limb injuries and four facial injuries. A total of 32 operations were performed. These included laparotomy (14), neck exploration (5), tracheostomy (4). A total of 22 patients developed a complication CONCLUSION: Self-inflicted injury is not uncommon and frequently requires investigation and or surgical treatment. Patients who sustain such an injury constitute a distinct vulnerable group who are under researched. Future research on this vulnerable patient group is needed.
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    Surgery as a component of universal healthcare : where is South Africa?
    (Health & Medical Publishing Group, 2019) Reddy, C. L.; Makasa, E. M.; Biccard, B.; Smith, M.; Steyn, E.; Fieggen, G.; Maswime, S.; Meara, J. G.; Chu, K. M.
    ENGLISH ABSTRACT: No abstract available