A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent

Psychosocial and Behavioural Correlates of Attitudes Towards Antiretroviral Therapy (ART) in a Sample of South African Mineworkers

Despite being one of the worst affected sectors in South Africa; the mining sector has proven to be one of the most active in intervention efforts in the fight against HIV and AIDS (Ellis; 2007). Owing to low uptake rates of antiretroviral therapy (ART) in mining companies in recent years (Connelly et Rosen; 2006) and the positive relationship between attitudes towards ART and ART uptake (Cooper et al.; 2002; Horne; Cooper; Gellaitry; Leake; et Fisher; 2007); this study sought to describe and investigate the psychosocial and behavioural correlates of attitudes towards ART in a sample of South African mineworkers. A total of 806 mineworkers from a large South African mine participated in this quantitative study. Despite a high rate of HIV testing behaviour (83.0) as well as favourable attitudes towards ART; analysis indicated that temporary employees and contractors were more vulnerable in terms of HIV risk; HIV testing behaviours and ART knowledge and attitudes. Employees who had more positive attitudes towards ART were more knowledgeable of ART and; importantly; had a more favourable attitude towards the mine's HIV/AIDS treatment programme. These findings are discussed in relation to the low ART uptake rates in this context and recommendations for the improvement of ART uptake amongst employees at this mining site

Retention of Knowledge of and Skills in Cardiopulmonary Resuscitation among Healthcare Providers after Training

This study assesses the retention of core knowledge and skills among healthcare providers (HCPs) who attended a Basic Life Support (BLS) course. The format for teaching this course changed in 2006 and a review of the effectiveness and acceptability of the new course was considered vital. Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however; the knowledge and skills of HCPs in basic life support vary. International recommendations on the BLS course were that HCPs repeat the course every two years. However; no studies have been conducted in South Africa to determine the ideal time when HCPs should be re-evaluated to ensure that they retain adequate knowledge and skills. This study was conducted at a training centre in a hospital in KwaZulu-Natal; where a new format for training was introduced in 2006. Participants were HCPs who had completed a BLS course. The sample was taken sequentially from half of the annual intake of a BLS course three months after completion of the course. Data were collected using the accredited American Heart Association written test and the Critical Skills Checklist; and a further questionnaire was developed to collect variables such as demography and profession. Results indicate that skills retention was good and; although there was some fall-off in skills and knowledge; there was no significant difference between the scores at the end of the course and retest scores. Staff working in accident and emergency departments had more practical experience and their knowledge and skills retention was better than that of staff working in other areas of the hospital. Nurses performed nearly as well as doctors and are an important skills resource in the management of patients who need to be resuscitated. All participants were satisfied with the new format and had no suggestions on how to improve it

Bullying Boys:The Traumatic Effects of Bullying in Male Adolescent Learners

Objective:This study investigated the nature and extent of the relationship between bullying and trauma among male adolescent learners. Trauma was operationalised through the multiple constructs of post-traumatic stress; anxiety; depression; dissociation and anger. Method: In this quantitative study; two objective measures were administered (viz. the Olweus Bullying/Victimisation Scale and the Trauma Symptom Checklist for children) to a sample of male adolescent learners between the ages of 12 and 17; from a South African male-only high school (n = 486). Results and Discussion: Statistical analysis (correlational analysis and MANOVA) produced evidence to suggest that there was a statistically significant relationship between bullying and trauma; and this was strongest for the victim role. The relationship between bullying and trauma was dependent on the frequency of bullying; as the frequency of being bullied increased so too did the mean scores of all the five trauma subscales. In general; the findings indicated that learners presented with elevated levels of internalising trauma outcomes. Depression demonstrated the highest correlation with the victim role; followed by Posttraumatic stress. In addition; 22.4of learners could be clinically and sub-clinically diagnosed with post-traumatic stress and 21.0with dissociation. Overall; the findings corroborate the argument that repetitive stressful events (such as bullying) are related to symptomclusters of ongoing trauma