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- ItemRehabilitation and primary care treatment guidelines, South Africa(World Health Organization, 2022-08-22) Conradie, Thandi; Charumbira, Maria; Bezuidenhout, Maryke; Leong, Trudy; Louw, QuinetteThe World Health Organization recognizes rehabilitation as an essential component of universal health coverage (UHC). In many countries, UHC builds on a standard benefits package of services that is informed by the country’s essential medicines list, standard treatment guidelines and primary health care essential laboratory list. In South Africa, primary health care is largely provided and managed by primary health-care nurses and medical officers in accordance with primary health care standard treatment guidelines. However, rehabilitation is mostly excluded from these guidelines. This paper describes the 10-year process that led to rehabilitation referral recommendations being considered for inclusion in South Africa’s primary health care standard treatment guidelines. There were five key events: (i) a breakthrough moment; (ii) producing a scientific evidence synthesis and formulating recommendations; (iii) presenting recommendations to the national essential medicines list committee; (iv) mapping rehabilitation recommendations onto relevant treatment guideline sections; and (v) submitting revised recommendations to the committee for final consideration. The main lesson learnt is that, by working together, rehabilitation professionals can be of sufficient number to make a difference, improve service delivery and increase referrals to rehabilitation from primary health care. A remaining challenge is the lack of a rehabilitation representative on the national essential medicines list committee, which could hamper understanding of rehabilitation and of the complexities of the supporting evidence.
- ItemThe effect of a post‑anaesthesia high‑care unit (PAHCU) admission on mobilization, length of stay and in‑hospital mortality post‑surgery in low energy neck of femur fracture patients(Springer Link, 2024-01-09) Essa, S.; Venter, S.; Jordaan, J. D.Purpose/aim: With an ageing population and an increase in fragility fractures of the hip (FFH), the role of an anaesthetist is evolving to include more peri-operative care. A post-anaesthesia high-care unit (PAHCU) should enhance care in postoperative patients. To our knowledge, there are no studies that have investigated the effect of a PAHCU admission on postoperative outcomes after FFH. This study aimed to compare post-operative outcomes of FFH patients admitted to PAHCU versus a standard post-operative orthopaedic ward (POOW). Methodology: A retrospective cohort study was conducted on adult patients with FFH who underwent surgery between January 2019 and December 2020 at our institution. Data were sourced from electronic medical records. SPSS version 28 was used to analyse data. Results: A total of 231 patients were included. The PAHCU group (n = 35) displayed a higher burden of chronic illness and higher peri-operative risk scores as compared to the POOW group (n = 196). Median time to mobilize (TTM) in PAHCU was 84 h vs. 45 h in POOW group (p = 0.013). Median length of stay (LOS) in PAHCU was 133 h vs. 94 h in POOW (p = 0.001). The in-hospital mortality was 2.9% (n = 1) for PAHCU and 3.6% (n = 7) for POOW (p = 1). The 30-day mortality was 11.8% (n = 4) for PAHCU and 10.1% (n = 19) in POOW. Conclusion: PAHCU admission resulted in delayed time to surgery and TTM, together with prolonged LOS, compared to those managed in POOW. However, these mortality rates remained comparable in both groups. This study contributes valuable insights into post-operative care of FFH patients in a resource-poor setting.
- ItemBovine tuberculosis in African buffalo (Syncerus caffer): Progression of pathology during infection(PLOS, 2022-11-11) Lakin, Hilary Ann; Tavalire, Hannah; Sakamoto, Kaori; Buss, Peter; Miller, Michele; Budischak, Sarah A.; Raum, Kristina; Ezenwa, Vanessa O.; Beechler, Brianna; Jolles, AnnaBackground Bovine tuberculosis (BTB) is a zoonotic disease of global importance endemic in African buffalo (Syncerus caffer) in sub-Saharan Africa. Zoonotic tuberculosis is a disease of global importance, accounting for over 12,000 deaths annually. Cattle affected with BTB have been proposed as a model for the study of human tuberculosis, more closely resembling the localization and progression of lesions in controlled studies than murine models. If disease in African buffalo progresses similarly to experimentally infected cattle, they may serve as a model, both for human tuberculosis and cattle BTB, in a natural environment. Methodology/Principal findings We utilized a herd of African buffalo that were captured, fitted with radio collars, and tested for BTB twice annually during a 4-year-cohort study. At the end of the project, BTB positive buffalo were culled, and necropsies performed. Here we describe the pathologic progression of BTB over time in African buffalo, utilizing gross and histological methods. We found that BTB in buffalo follows a pattern of infection like that seen in experimental studies of cattle. BTB localizes to the lymph nodes of the respiratory tract first, beginning with the retropharyngeal and tracheobronchial lymph nodes, gradually increasing in lymph nodes affected over time. At 36 months, rate of spread to additional lymph nodes sharply increases. The lung lesions follow a similar pattern, progressing slowly, then accelerating their progression at 36 months post infection. Lastly, a genetic marker that correlated to risk of M. bovis infection in previous studies was marginally associated with BTB progression. Buffalo with at least one risk allele at this locus tended to progress faster, with more lung necrosis. Conclusions/Significance The progression of disease in the African buffalo mirrors the progression found in experimental cattle models, offering insight into BTB and the interaction with its host in the context of naturally varying environments, host, and pathogen populations.
- ItemDevelopment of an improved approach to transcatheter heart valve heart valve replacement in younger patients(2024-03-26) Weich, Hellmuth Stephan von Heyderhoff; Doubell, Anton F; Smit, Francis E
- ItemFlood frequency analysis – Part 2: Development of a modified plotting position(South African Water Research Commission., 2022-04-27) Van der Spuy D; Du Plessis JAThe original plotting position concept was suggested more than a century ago. Since then, many alternative plotting position approaches have been developed. Despite a general lack of agreement around which plotting position is theoretically ‘correct’ and the ‘best’ to use, all plotting positions fail to adequately address outliers and data of similar magnitude. Hydrologists generally fail to acknowledge that the plotting position primarily offers an informative display of data, against which distributions can be compared, rather than an absolute measure of probability. This paper does not intend to challenge any of the many lengthy theoretical mathematical arguments, utilised to ‘prove’ why one plotting position is superior to the others. These theoretical arguments may very well be valid for a ‘population’ of flood peaks – the reality, however, is that hydrologists are confronted with the challenge of analysing very limited ‘samples’ of the population. Consequently, the plotting position issue demands a more pragmatic approach, rather than a purely theoretical approach. This paper illustrates various problems with existing plotting position techniques in use and offers an alternative approach and a more sensible plotting position technique, using Z-scores and referred to as the Z-set PP, against which distributions can be checked. The study further illustrates how effectively the Z‑set PP deals with outliers and its robustness with various record lengths. Although derived from a study of flood peak data obtained from South African flow-gauging sites, it is deemed that it will be universally applicable.