Pub Date : 2024-03-01DOI: 10.7196/samj.2024.v114i4.1927
N. Chandiwana, W.D. Francois Venter, Jennifer Manne-Goehler, Alisha Wade, Carel Le Roux, Nzama Mbalati, Angelika Grimbeek, Petronell Kruger, Eunice Montsho, Zukiswa Zimela, Anele Yawa, S. Tshabalala, Ndivhuwo Rambau, Ngqabutho Mpofu, Sasha Stevenson, Bridget McNulty, N. Ntusi, Yogan Pillay, Joel Dave, Angela Murphy, Sue Goldstein, Karen Hfman, Sameera Mahomedy, Elizabeth Thomas, Busi Mrara, Jeff Wing, Jeanne Lubbe, Zack Koto, M. Conradie-Smit, Sean Wharton, Wayne May, Ian Marr, Hilton Kaplan, Mariam Forgan, Graham Alexander, John Turner, V. R. Fourie, J. Hellig, Mandy Banks, Kim Ragsdale, Marisa Noeth, Farzahna Mohamed, L. Myer, L. Lebina, Salome Maswime, Yunus Moosa, Sumy Thomas, Mzamo Mbelle, P. Sinxadi, Linda-Gail Bekker, S. Bhana, June Fabian, Eric Decloedt, Z. Bayat, R. Daya, B. Bobat, Fiona Storie, Julia Goedecke, Kathleen Kahn, S. Tollman, Brett Mansfield, Mark Siedner, Vincent C Marconi, Aaloke Mody, N. Mtshali, Elvin H. Geng, Suman Srinivasa, Mohammed Ali, Samanta Lalla-Edwards, Alison Bentley, G
-
-
{"title":"Obesity is South Africa’s new HIV epidemic","authors":"N. Chandiwana, W.D. Francois Venter, Jennifer Manne-Goehler, Alisha Wade, Carel Le Roux, Nzama Mbalati, Angelika Grimbeek, Petronell Kruger, Eunice Montsho, Zukiswa Zimela, Anele Yawa, S. Tshabalala, Ndivhuwo Rambau, Ngqabutho Mpofu, Sasha Stevenson, Bridget McNulty, N. Ntusi, Yogan Pillay, Joel Dave, Angela Murphy, Sue Goldstein, Karen Hfman, Sameera Mahomedy, Elizabeth Thomas, Busi Mrara, Jeff Wing, Jeanne Lubbe, Zack Koto, M. Conradie-Smit, Sean Wharton, Wayne May, Ian Marr, Hilton Kaplan, Mariam Forgan, Graham Alexander, John Turner, V. R. Fourie, J. Hellig, Mandy Banks, Kim Ragsdale, Marisa Noeth, Farzahna Mohamed, L. Myer, L. Lebina, Salome Maswime, Yunus Moosa, Sumy Thomas, Mzamo Mbelle, P. Sinxadi, Linda-Gail Bekker, S. Bhana, June Fabian, Eric Decloedt, Z. Bayat, R. Daya, B. Bobat, Fiona Storie, Julia Goedecke, Kathleen Kahn, S. Tollman, Brett Mansfield, Mark Siedner, Vincent C Marconi, Aaloke Mody, N. Mtshali, Elvin H. Geng, Suman Srinivasa, Mohammed Ali, Samanta Lalla-Edwards, Alison Bentley, G","doi":"10.7196/samj.2024.v114i4.1927","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i4.1927","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"124 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140090677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.7196/samj.2024.v114i1b.711
W. M. Simmonds, Y. Awuku, C. Barrett, M. Brand, K. Davidson, D. Epstein, E. Fredericks, S. Gabriel, S. Grobler, C. Gounden, L. Katsidzira, V. J. Louw, V. Naidoo, C. Noel, E. Ogutu, N. Ramonate, N. Seabi, M. Setshedi, J. Van Zyl, G. Watermeyer, C. Kassianides
Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
背景。全世界 30% 以上的人口患有贫血症，其中很大一部分人缺铁。由于男性和绝经后妇女的缺铁性贫血（ID）主要是由胃肠道失血或吸收不良引起的，因此对 ID 贫血患者的初步评估需要转诊至胃肠病学家。目前，撒哈拉以南非洲地区（SSA）正在推动患者血液管理，这要求我们不仅要规范输血的使用，还要规范对铁流失或铁吸收不足患者的管理。制定建议的目的是(i)帮助临床医生评估疑似胃肠道铁流失和铁吸收不良的情况，以及经常出现的这两种情况的结合；(ii)改善胃肠道原因引起的 ID 患者的临床治疗效果；(iii)提供最新的、以证据为基础的、针对具体情况的建议，用于 ID 的治疗；以及(iv)通过确保血液和血液制品的合理利用来节约资源。撒哈拉以南非洲肠胃病学基金会（Gastroenterology Foundation of Sub-Saharan Africa）和南非肠胃病学协会（South African Gastroenterology Society）协助制定了该指导文件。21 位撒哈拉以南非洲地区的胃肠病学和血液学专家参与了这一严格的过程，并在此基础上提出了共识建议。在专家们讨论了指导文件的范围和目的之后，对文献和现有指南进行了初步审查。随后，编写了建议声明草案，以实现指导文件概述的目的。2022 年期间，委员会全体成员利用在线平台 "研究电子数据采集 "进行了两轮电子德尔菲活动，对这些建议声明进行了圆桌讨论审查，并进行了两轮匿名共识投票。考虑到上一轮的反馈意见，对建议进行了修改，达成 80% 以上共识的建议被纳入最终文件。最后，工作组全体成员阅读并批准了文件中的 44 项陈述。建议包括六个方面，即：一般建议和实践、幽门螺杆菌、乳糜泻、疑似小肠出血、炎症性肠病和术前护理。建议的实施针对不同层面，从个体从业者到医疗机构、部门以及地区、县、省和国家平台。这些建议旨在推动制定针对特定中心的指南，并将其与相关的患者血液管理规程相结合。整合这些建议旨在促进对 ID 患者的最佳评估和管理，无论患者是否存在贫血。
{"title":"Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa","authors":"W. M. Simmonds, Y. Awuku, C. Barrett, M. Brand, K. Davidson, D. Epstein, E. Fredericks, S. Gabriel, S. Grobler, C. Gounden, L. Katsidzira, V. J. Louw, V. Naidoo, C. Noel, E. Ogutu, N. Ramonate, N. Seabi, M. Setshedi, J. Van Zyl, G. Watermeyer, C. Kassianides","doi":"10.7196/samj.2024.v114i1b.711","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i1b.711","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products.\u0000Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group.\u0000Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"36 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139869141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.7196/samj.2024.v114i1b.711
W. M. Simmonds, Y. Awuku, C. Barrett, M. Brand, K. Davidson, D. Epstein, E. Fredericks, S. Gabriel, S. Grobler, C. Gounden, L. Katsidzira, V. J. Louw, V. Naidoo, C. Noel, E. Ogutu, N. Ramonate, N. Seabi, M. Setshedi, J. Van Zyl, G. Watermeyer, C. Kassianides
Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
背景。全世界 30% 以上的人口患有贫血症，其中很大一部分人缺铁。由于男性和绝经后妇女的缺铁性贫血（ID）主要是由胃肠道失血或吸收不良引起的，因此对 ID 贫血患者的初步评估需要转诊至胃肠病学家。目前，撒哈拉以南非洲地区（SSA）正在推动患者血液管理，这要求我们不仅要规范输血的使用，还要规范对铁流失或铁吸收不足患者的管理。制定建议的目的是(i)帮助临床医生评估疑似胃肠道铁流失和铁吸收不良的情况，以及经常出现的这两种情况的结合；(ii)改善胃肠道原因引起的 ID 患者的临床治疗效果；(iii)提供最新的、以证据为基础的、针对具体情况的建议，用于 ID 的治疗；以及(iv)通过确保血液和血液制品的合理利用来节约资源。撒哈拉以南非洲肠胃病学基金会（Gastroenterology Foundation of Sub-Saharan Africa）和南非肠胃病学协会（South African Gastroenterology Society）协助制定了该指导文件。21 位撒哈拉以南非洲地区的胃肠病学和血液学专家参与了这一严格的过程，并在此基础上提出了共识建议。在专家们讨论了指导文件的范围和目的之后，对文献和现有指南进行了初步审查。随后，编写了建议声明草案，以实现指导文件概述的目的。2022 年期间，委员会全体成员利用在线平台 "研究电子数据采集 "进行了两轮电子德尔菲活动，对这些建议声明进行了圆桌讨论审查，并进行了两轮匿名共识投票。考虑到上一轮的反馈意见，对建议进行了修改，达成 80% 以上共识的建议被纳入最终文件。最后，工作组全体成员阅读并批准了文件中的 44 项陈述。建议包括六个方面，即：一般建议和实践、幽门螺杆菌、乳糜泻、疑似小肠出血、炎症性肠病和术前护理。建议的实施针对不同层面，从个体从业者到医疗机构、部门以及地区、县、省和国家平台。这些建议旨在推动制定针对特定中心的指南，并将其与相关的患者血液管理规程相结合。整合这些建议旨在促进对 ID 患者的最佳评估和管理，无论患者是否存在贫血。
{"title":"Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa","authors":"W. M. Simmonds, Y. Awuku, C. Barrett, M. Brand, K. Davidson, D. Epstein, E. Fredericks, S. Gabriel, S. Grobler, C. Gounden, L. Katsidzira, V. J. Louw, V. Naidoo, C. Noel, E. Ogutu, N. Ramonate, N. Seabi, M. Setshedi, J. Van Zyl, G. Watermeyer, C. Kassianides","doi":"10.7196/samj.2024.v114i1b.711","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i1b.711","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products.\u0000Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group.\u0000Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139809301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.1136
C Gage, B Spies, K Crombie, L Gwyther, W Stassen
Background. An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection. Objective. To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes.Methods. An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. Results. In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). Conclusion. EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.
{"title":"The use of emergency medical services for palliative situations in Western Cape Province, South Africa: A retrospective, descriptive analysis of patient records","authors":"C Gage, B Spies, K Crombie, L Gwyther, W Stassen","doi":"10.7196/samj.2023.v113i11.1136","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.1136","url":null,"abstract":"Background. An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection. Objective. To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes.Methods. An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. Results. In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). Conclusion. EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.497
J-D K Lotz, J Porter, H Conradie, T Boyles, B Gaunt, S Dimanda, D Cort
Background. Progressive interventions have recently improved programmatic outcomes in drug-resistant tuberculosis (DR-TB) care in South Africa (SA). Amidst these, a shorter regimen was introduced in 2017 with weak evidence, and has shown mixed results. Outcomes still fall short of national targets, and the coronavirus disease 2019 pandemic has undermined progress to date. Objectives. To describe the outcomes of participants treated for DR-TB using a shorter, compared with a longer, regimen in a deeply rural SA setting, and to explore other factors affecting these outcomes. Methods. This retrospective cohort study describes outcomes in short and long DR-TB treatment regimens, over 5 years, at two rural treatment sites in SA. Characteristics were analysed for outcome correlates using multivariable logistic regression models. Results. Of 282 treatment episodes, 62% were successful, with higher success in shorter (69%) compared with longer regimens (58%). Mortality was approximately 21% in both groups. Characteristics included high proportions of HIV co-infection (61%). Injectables (adjusted odds ratio (aOR) 3.00, 95% confidence interval (CI) 1.48 - 6.09), bedaquiline (aOR 3.16, 95% CI 1.36 - 7.35), increasing age (aOR 0.97, 95% CI 0.95 - 0.99) and HIV viraemia defined as final HIV-RNA viral load >1 000 copies/mL (aOR 0.16, 95% CI 0.07 - 0.37) were all significantly and independently associated with treatment success. Injectables (aOR 0.22, 95% CI 0.08 - 0.57), bedaquiline (aOR 0.05, 95% CI 0.01 - 0.19), increasing age (aOR 1.09, 95% CI 1.05 - 1.13), extra-pulmonary TB (aOR 8.15, 95% CI 1.62 - 41.03) and HIV viraemia (aOR 9.20, 95% CI 3.22 - 26.24) were all significantly and independently associated with mortality. Conclusion. In a rural context, treating DR-TB amid limited resources and a high burden of HIV co-infection, we found that after considering controls, a short regimen was no different to a longer regimen in terms of success or mortality. Therefore, by alleviating burdens on multiple stakeholders, a short regimen is likely to be favourable for rural patients, clinicians, and healthcare systems. Besides other previously described correlates of outcomes, HIV viraemia emerged as a novel marker for reliably predicting poor outcomes in DR-TB with HIV co-infection, and a pragmatic target for intervention.
背景。渐进式干预措施最近改善了南非耐药结核病(DR-TB)治疗的规划结果。其中，2017年引入了一种较短的治疗方案，证据不足，结果好坏参半。成果仍未达到国家目标，2019年冠状病毒病大流行破坏了迄今取得的进展。目标。描述在SA农村地区使用较短方案与较长方案治疗耐药结核病的参与者的结果，并探讨影响这些结果的其他因素。方法。这项回顾性队列研究描述了南非两个农村医疗点5年以上短期和长期耐药结核病治疗方案的结果。使用多变量逻辑回归模型分析结果相关因素的特征。结果。282次治疗中，62%的治疗成功，较短疗程(69%)的成功率高于较长疗程(58%)。两组的死亡率均约为21%。特点包括HIV合并感染比例高(61%)。注射剂(调整优势比(aOR) 3.00, 95%可信区间(CI) 1.48 - 6.09)、贝达喹啉(aOR 3.16, 95% CI 1.36 - 7.35)、年龄增长(aOR 0.97, 95% CI 0.95 - 0.99)和HIV病毒血症(定义为最终HIV- rna病毒载量为1 000拷贝/mL)均与治疗成功显著且独立相关。注射(aOR 0.22, 95% CI 0.08 ~ 0.57)、贝达喹啉(aOR 0.05, 95% CI 0.01 ~ 0.19)、年龄增长(aOR 1.09, 95% CI 1.05 ~ 1.13)、肺外结核(aOR 8.15, 95% CI 1.62 ~ 41.03)和HIV病毒血症(aOR 9.20, 95% CI 3.22 ~ 26.24)均与死亡率有显著且独立的相关性。结论。在农村地区，在资源有限和艾滋病毒合并感染负担高的情况下治疗耐药结核病，我们发现在考虑控制后，短期方案与长期方案在成功率或死亡率方面没有什么不同。因此，通过减轻多个利益相关者的负担，短期方案可能有利于农村患者、临床医生和卫生保健系统。除了其他先前描述的结果相关因素外，HIV病毒血症成为可靠预测耐药结核病合并HIV感染不良结果的新标记物，也是一个实用的干预目标。
{"title":"Treating drug-resistant tuberculosis in an era of shorter regimens: Insights from rural South Africa","authors":"J-D K Lotz, J Porter, H Conradie, T Boyles, B Gaunt, S Dimanda, D Cort","doi":"10.7196/samj.2023.v113i11.497","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.497","url":null,"abstract":"Background. Progressive interventions have recently improved programmatic outcomes in drug-resistant tuberculosis (DR-TB) care in South Africa (SA). Amidst these, a shorter regimen was introduced in 2017 with weak evidence, and has shown mixed results. Outcomes still fall short of national targets, and the coronavirus disease 2019 pandemic has undermined progress to date. Objectives. To describe the outcomes of participants treated for DR-TB using a shorter, compared with a longer, regimen in a deeply rural SA setting, and to explore other factors affecting these outcomes. Methods. This retrospective cohort study describes outcomes in short and long DR-TB treatment regimens, over 5 years, at two rural treatment sites in SA. Characteristics were analysed for outcome correlates using multivariable logistic regression models. Results. Of 282 treatment episodes, 62% were successful, with higher success in shorter (69%) compared with longer regimens (58%). Mortality was approximately 21% in both groups. Characteristics included high proportions of HIV co-infection (61%). Injectables (adjusted odds ratio (aOR) 3.00, 95% confidence interval (CI) 1.48 - 6.09), bedaquiline (aOR 3.16, 95% CI 1.36 - 7.35), increasing age (aOR 0.97, 95% CI 0.95 - 0.99) and HIV viraemia defined as final HIV-RNA viral load >1 000 copies/mL (aOR 0.16, 95% CI 0.07 - 0.37) were all significantly and independently associated with treatment success. Injectables (aOR 0.22, 95% CI 0.08 - 0.57), bedaquiline (aOR 0.05, 95% CI 0.01 - 0.19), increasing age (aOR 1.09, 95% CI 1.05 - 1.13), extra-pulmonary TB (aOR 8.15, 95% CI 1.62 - 41.03) and HIV viraemia (aOR 9.20, 95% CI 3.22 - 26.24) were all significantly and independently associated with mortality. Conclusion. In a rural context, treating DR-TB amid limited resources and a high burden of HIV co-infection, we found that after considering controls, a short regimen was no different to a longer regimen in terms of success or mortality. Therefore, by alleviating burdens on multiple stakeholders, a short regimen is likely to be favourable for rural patients, clinicians, and healthcare systems. Besides other previously described correlates of outcomes, HIV viraemia emerged as a novel marker for reliably predicting poor outcomes in DR-TB with HIV co-infection, and a pragmatic target for intervention.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"26 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.814
J Van Der Walt, R Parker
Healthcare providers face the challenging task of managing patients who suffer from chronic nociplastic pain conditions. Pain is a multidimensional experience, and the current approach to managing people in chronic pain often fails to meet the needs of these patients. Novel ways of treating people who suffer from chronic nociplastic pain with classic psychedelic agents may offer a new lens through which to approach their pain. Lysergic acid diethylamide (LSD) and psilocybin are both serotonergic agents with a long history of use in treating people with chronic pain and mental health disorders. The new wave of research into psychedelics for major depressive disorder provides an opportunity to investigate and understand the potential for incorporating these drugs into chronic pain management pathways. This narrative review presents healthcare workers with a framework to understand the method of action of these drugs in chronic nociplastic pain pathways and a brief history into their use. We conducted an online search using Pubmed with keywords ‘chronic pain’ AND/OR ‘psilocybin’ AND/OR ‘lysergic acid diethylamide’ AND/OR ‘psychedelics’ with no date limit applied. We identified further articles that contained information on the neuroscience of psychedelics and the serotonergic system using Google Scholar. During the final stages of writing the article, the latest publications on psychedelics and chronic pain in leading pain journals were again included to update the information.
{"title":"LSD and psilocybin for chronic nociplastic pain: A narrative review of the literature supporting the use of classic psychedelic agents in chronic pain","authors":"J Van Der Walt, R Parker","doi":"10.7196/samj.2023.v113i11.814","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.814","url":null,"abstract":"Healthcare providers face the challenging task of managing patients who suffer from chronic nociplastic pain conditions. Pain is a multidimensional experience, and the current approach to managing people in chronic pain often fails to meet the needs of these patients. Novel ways of treating people who suffer from chronic nociplastic pain with classic psychedelic agents may offer a new lens through which to approach their pain. Lysergic acid diethylamide (LSD) and psilocybin are both serotonergic agents with a long history of use in treating people with chronic pain and mental health disorders. The new wave of research into psychedelics for major depressive disorder provides an opportunity to investigate and understand the potential for incorporating these drugs into chronic pain management pathways. This narrative review presents healthcare workers with a framework to understand the method of action of these drugs in chronic nociplastic pain pathways and a brief history into their use. We conducted an online search using Pubmed with keywords ‘chronic pain’ AND/OR ‘psilocybin’ AND/OR ‘lysergic acid diethylamide’ AND/OR ‘psychedelics’ with no date limit applied. We identified further articles that contained information on the neuroscience of psychedelics and the serotonergic system using Google Scholar. During the final stages of writing the article, the latest publications on psychedelics and chronic pain in leading pain journals were again included to update the information.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"27 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.1345
D W Thaldar
Bronstein and Nyachowe recently argued that the conditions for the lawful processing of personal information, as provided in the Protection of Personal Information Act 4 of 2013 (POPIA), do not apply to health research in South Africa. This article critically analyses the authors’ interpretation of section 3(2)(b) of POPIA and challenges two of its aspects.
{"title":"POPIA does indeed apply to health research: A response to Bronstein and Nyachowe","authors":"D W Thaldar","doi":"10.7196/samj.2023.v113i11.1345","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.1345","url":null,"abstract":"Bronstein and Nyachowe recently argued that the conditions for the lawful processing of personal information, as provided in the Protection of Personal Information Act 4 of 2013 (POPIA), do not apply to health research in South Africa. This article critically analyses the authors’ interpretation of section 3(2)(b) of POPIA and challenges two of its aspects.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"29 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.1653
H Schneider, T Masilela, J Mndebele, K Vallabhjee, I Petersen, L Gilson, B Engelbrecht
-
-
{"title":"Special series on the District Health System","authors":"H Schneider, T Masilela, J Mndebele, K Vallabhjee, I Petersen, L Gilson, B Engelbrecht","doi":"10.7196/samj.2023.v113i11.1653","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.1653","url":null,"abstract":"-","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"27 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.1558
H Schneider, F Mukinda, J Cupido, J Wessels, P Kupa, P Leboho, N Nkoana, N Bosch, Y Pillay
Background. There is a gap in understanding of potential roles and actions at the subdistrict level to improve quality of care and health outcomes in South Africa (SA). Objectives. To report on the evaluation of a subdistrict health system-strengthening initiative that aimed to reduce maternal, newborn and child mortality, referred to as the ‘3 feet model’ in Waterberg District, Limpopo Province, SA. The model is centred on systems of real-time morbidity/mortality surveillance and co-ordinated responses. It was implemented in three of five Waterberg subdistricts over an 18-month period in 2021 and 2022. Methods. A prospective, process-tracing evaluation was conducted jointly between researchers, intervention partners and subdistrict decision-makers. Data sources combined ~100 hours of researcher participant observation, interviews with 14 health system actors, structured reflections by three subdistrict managers and information from the routine District Health Information System. Sources were triangulated and analysed based on a priori hypotheses on mechanisms of action. Results. Following uptake of the model, the perinatal mortality rate (PMR) improved by 28.8%, 11.5% and 28% in the three subdistricts, respectively, while the PMR worsened in two of four neighbouring subdistricts. Plausible factors in implementation successes were the presence of stable and committed hybrid (clinical-managerial) subdistrict leaders and their ability to overcome entrenched silos between a variety of system actors; new collaborative relationships between primary healthcare facilities, hospitals and emergency medical services; the generation and packaging of information in ways that directed responses (‘actionable intelligence’); and support from senior district managers. Conclusion. While not advocating for a cut-and-paste approach to improving quality and outcomes, positive experiences in Waterberg District suggest that the principles and mechanisms of action of the 3 feet model have wider relevance for policy and practice, especially as emphasis shifts towards the subdistrict as a core unit of population health and wellbeing in SA.
{"title":"Improving health outcomes and quality at the subdistrict level: Evaluation of the ‘3 feet model’ in Waterberg District, Limpopo Province, South Africa","authors":"H Schneider, F Mukinda, J Cupido, J Wessels, P Kupa, P Leboho, N Nkoana, N Bosch, Y Pillay","doi":"10.7196/samj.2023.v113i11.1558","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.1558","url":null,"abstract":"Background. There is a gap in understanding of potential roles and actions at the subdistrict level to improve quality of care and health outcomes in South Africa (SA). Objectives. To report on the evaluation of a subdistrict health system-strengthening initiative that aimed to reduce maternal, newborn and child mortality, referred to as the ‘3 feet model’ in Waterberg District, Limpopo Province, SA. The model is centred on systems of real-time morbidity/mortality surveillance and co-ordinated responses. It was implemented in three of five Waterberg subdistricts over an 18-month period in 2021 and 2022. Methods. A prospective, process-tracing evaluation was conducted jointly between researchers, intervention partners and subdistrict decision-makers. Data sources combined ~100 hours of researcher participant observation, interviews with 14 health system actors, structured reflections by three subdistrict managers and information from the routine District Health Information System. Sources were triangulated and analysed based on a priori hypotheses on mechanisms of action. Results. Following uptake of the model, the perinatal mortality rate (PMR) improved by 28.8%, 11.5% and 28% in the three subdistricts, respectively, while the PMR worsened in two of four neighbouring subdistricts. Plausible factors in implementation successes were the presence of stable and committed hybrid (clinical-managerial) subdistrict leaders and their ability to overcome entrenched silos between a variety of system actors; new collaborative relationships between primary healthcare facilities, hospitals and emergency medical services; the generation and packaging of information in ways that directed responses (‘actionable intelligence’); and support from senior district managers. Conclusion. While not advocating for a cut-and-paste approach to improving quality and outcomes, positive experiences in Waterberg District suggest that the principles and mechanisms of action of the 3 feet model have wider relevance for policy and practice, especially as emphasis shifts towards the subdistrict as a core unit of population health and wellbeing in SA.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"27 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.7196/samj.2023.v113i11.885
L Pistorius, C A Cluver, I Bhorat, L Geerts
Background. Screening for trisomy 21 provides pregnant women with accurate risk information. Different algorithms are used to screen for trisomy 21 in South Africa (SA). The Fetal Medicine Foundation (FMF) provides software to screen for trisomy 21 in the first trimester by ultrasound or a combination of ultrasound and biochemistry (combined screening), and requires regular and stringent quality control. With αlpha software, first trimester combined screening and screening with biochemistry alone in the first or second trimester are possible. The αlpha screening requires quality control of biochemical tests, but not of ultrasound measurements. Ideally, a screening test should have a high detection and a low screen positive rate. Despite the availability of these screening programmes, only a minority of infants with trisomy 21 are detected prenatally, raising questions about the effectiveness of screening. Objectives. To determine the screen positive and detection rates of prenatal screening for trisomy 21 in the SA private healthcare system. Methods. Data from the three largest laboratories collected between 2010 and 2015 were linked with genetic tests to assess screen positive and detection rates. Biochemical screening alone with αlpha software (first or second trimester) and combined screening using either FMF or αlpha software were compared. Results. One-third of an estimated 675 000 pregnancies in private practice in the 6-year study period underwent screening. There were 687 cases of trisomy 21 in 225 021 pregnancies, with only 239 (35%) diagnosed prenatally. The screen positive rates were 11.8% for first trimester biochemistry, 7.6% for second trimester biochemistry, 7.3% for first trimester FMF software ultrasound alone, 3.7% for combined first trimester screening with FMF software, and 3.5% for combined first trimester screening with αlpha software. The detection rates for a 5% false positive rate were 63% for first trimester biochemistry, 69% for second trimester biochemistry, 95% for combined first trimester screening with FMF software and 80% for combined first trimester screening with αlpha software. Detection and confirmation rates were highest with FMF software. Conclusion. Screening with FMF software has a similar screen positive rate and better detection rate than screening with αlpha software. The low prenatal detection rate of trisomy 21 is mainly due to a low prevalence of screening. More research is needed in the SA setting to explore why screening and confirmatory testing after high-risk results are not performed in many pregnancies.
{"title":"Trisomy 21 screening with αlpha software and the Fetal Medicine Foundation algorithm","authors":"L Pistorius, C A Cluver, I Bhorat, L Geerts","doi":"10.7196/samj.2023.v113i11.885","DOIUrl":"https://doi.org/10.7196/samj.2023.v113i11.885","url":null,"abstract":"Background. Screening for trisomy 21 provides pregnant women with accurate risk information. Different algorithms are used to screen for trisomy 21 in South Africa (SA). The Fetal Medicine Foundation (FMF) provides software to screen for trisomy 21 in the first trimester by ultrasound or a combination of ultrasound and biochemistry (combined screening), and requires regular and stringent quality control. With αlpha software, first trimester combined screening and screening with biochemistry alone in the first or second trimester are possible. The αlpha screening requires quality control of biochemical tests, but not of ultrasound measurements. Ideally, a screening test should have a high detection and a low screen positive rate. Despite the availability of these screening programmes, only a minority of infants with trisomy 21 are detected prenatally, raising questions about the effectiveness of screening. Objectives. To determine the screen positive and detection rates of prenatal screening for trisomy 21 in the SA private healthcare system. Methods. Data from the three largest laboratories collected between 2010 and 2015 were linked with genetic tests to assess screen positive and detection rates. Biochemical screening alone with αlpha software (first or second trimester) and combined screening using either FMF or αlpha software were compared. Results. One-third of an estimated 675 000 pregnancies in private practice in the 6-year study period underwent screening. There were 687 cases of trisomy 21 in 225 021 pregnancies, with only 239 (35%) diagnosed prenatally. The screen positive rates were 11.8% for first trimester biochemistry, 7.6% for second trimester biochemistry, 7.3% for first trimester FMF software ultrasound alone, 3.7% for combined first trimester screening with FMF software, and 3.5% for combined first trimester screening with αlpha software. The detection rates for a 5% false positive rate were 63% for first trimester biochemistry, 69% for second trimester biochemistry, 95% for combined first trimester screening with FMF software and 80% for combined first trimester screening with αlpha software. Detection and confirmation rates were highest with FMF software. Conclusion. Screening with FMF software has a similar screen positive rate and better detection rate than screening with αlpha software. The low prenatal detection rate of trisomy 21 is mainly due to a low prevalence of screening. More research is needed in the SA setting to explore why screening and confirmatory testing after high-risk results are not performed in many pregnancies.","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"31 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：