A tropical tertiary neurosurgical center response to COVID-19 pandemic and its effect on neurosurgical practices

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic, but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics

Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals

Background: Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings. Methods: A cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence. Results: Completion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers' performance because of workload pressures. Conclusion: Low GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality

Exercise, illness and drug use: guiding principles for approaching a complex triad

Regular, low to moderate intensity exercise is considered beneficial to the human body, not only having ergogenic advantages, but also being anti-inflammatory, cardio- and neuroprotective.1 On the other hand, although high intensity training (HIT) is able to exaggerate cardiac conditions, e.g., hypertension2 as well as exacerbate inflammatory and oxidative stress responses,1,3 such exercise programs are becoming more popular as they too have shown demonstrable health benefits if performed appropriately. Indeed, various studies have reported on the superior beneficial cardiac and vascular effects of high intensity exercise programs over that of moderate intensity continuous training (MICT),4-7 contributing to the growing popularity of such time-efficient programs. As such, exercise can accurately be described as a double-edged sword ­ able to induce positive, beneficial physiological effects when performed chronically at lower intensities, but generating harmful effects when performed at high intensities without sufficient recovery periods. From a toxicological point of view, exercise mediates hormesis, i.e., the biphasic dose response to an environmental agent characterised by a low dose stimulation or beneficial effect and a high dose inhibitory or toxic effect.8

Compliance with local diabetic guidelines at a district hospital in KwaZulu-Natal, South Africa

Background: Diabetes mellitus (DM) represents a major health-related problem in South Africa and throughout the world. The management goals of diabetes are first to maintain normal blood glucose levels and second to prevent the development of complications. Local guidelines developed by the Society for Endocrine Metabolism and Diabetes South Africa (SEMDSA) have shown that tight glycaemic control and appropriate monitoring can prevent or delay the development of diabetic complications. The demographic profile of patients with type 2 DM and the compliance of doctors to the guidelines were determined.Methods: Five hundred records of patients with type 2 DM were selected from the medical outpatients' department (MOPD) by systematic sampling. Demographic information on age, sex and ethnicity was obtained. The performance and timing of recommended investigations were recorded and compared with the 2012 SEMDSA guidelines.Results: The mean age of patients was 61 years. Black and Indian patients formed the majority, comprising 44.4% and 43.0% respectively. Glycated haemoglobin was measured in 29.2% of patients once and 13.2% of patients twice in the past year.Lipid studies were done on 40.4% of patients. A serum creatinine (sCr), estimated glomerular filtration rate (eGFR) and serum potassium were done on 38.2% of patients. Eyeexaminations were done on 13.60% patients and examination of the foot was done on 7.8% of patients. Some 15% had a urine dipstick test done at least once in the past year and 10.4% had a urine albumin/creatinine ratio (ACR) requested. Only 21 patients (4.2%) were compliant with the SEMDSA guidelines. Measurements of blood pressure and blood glucose were 100% compliant. Anthropometric measurements (height, weight and body mass index), dietitian referral and foot examinations were the least compliant, being performed 4.2%, 5.0% and 7.8% of the time respectively. Conclusion: Black and Indian patients formed the majority of the study population. The screening for chronic complications of type 2 DM was poor in the majority of patients. Evaluation of selected records demonstrated compliance with the SEMDSA guidelines in only 4.2% of patients. There is an urgent need to review barriers to the implementation of guidelines in South Africa

Guidelines for the use of transient elastography in South Africa

Liver fibrosis assessment is key to rapid decision making with respect to treatment and prognosis in liverdisease Liver biopsy remains the gold standard for assessing fibrosis and pattern of injury but is invasive, costly, relatively unavailable and is unsuited to the rapid and efficient upscaling of treatment to those in need of care e.g. viral hepatitis Non invasive technologies are supplanting liver biopsy as the primary means of assessing liver fibrosis Transient elastography (FibroScan® ) ­ first introduced in 2003 ­ has evolved as a reliable and validated noninvasive technology for assessing liver fibrosis The technique is simple and requires easily transferrable operator skills A minimum of 10 readings are required to be valid Substantial data supports its validity in a variety of chronic liver diseases with AUROC scores that range between 0.85 and 0.95 FibroScan® has the added benefit of assessing fatty change in the liver via the CAP (Controlled Attenuation Parameter) assessment score Potential users of this technology should acquire the requisite upskilling to operate Transient Elastography (FibroScan® ) To achieve the objectives of the National Viral Hepatitis Elimination Strategy in South Africa, such technology will be needed in the public sector The cost effectiveness of this technology with appropriate allocation of funding codes is required for the private sector

The development of ethical guidelines for telemedicine in South Africa

Telemedicine has the potential to assist in the provision of healthcare in South Africa (SA). This means of healthcare service provision involves patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. Although the practice is largely beneficial, certain legal and ethical challenges arise from the use of electronic healthcare services. Certain ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care;quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication.While various legal, regulatory and governance measures offer potential solutions and remedies for protection, ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. Recently, the Health Professions Council of SA (HPCSA) made an attempt to address the ethical issues by publishing a set of telemedicine guidelines.Despite this, issues around the practice of telemedicine remain unresolved. This article seeks to inform the development of a new ethical framework by addressing three distinct and relevant ethical issues: the fiduciary nature of healthcare and the changing nature of the doctor-patient relationship; privacy, confidentiality and the sensitivity of health data; and informed consent. It does so by proposing a broader and more nuanced solution to these ethical obstacles by identifying conceptual and operational difficulties within the existing HPCSA telemedicine guidelines, and advancing suggestions for reform. This speaks to a more highly integrated perspective that is culturally and contextually aware, and which affirms the need to strike a balance between individual rights protection and transformative, ethical, healthcare innovation

Guidelines for the use of transient elastography in South Africa

The World Health Organization (WHO) published a report in 2016 towards combating hepatitis B and C to reach elimination by 2030. Viral hepatitis is a leading cause of death worldwide and in 2013, 1.46 million deaths were attributed to this disease ­ more than 90% due to complications of hepatitis B and C. Shockingly, less than 0.3 % of patients with HBV infection gets diagnosed in the WHO African region. This combined with the fact that fewer than 1% receives treatment, greatly contributes to the spread of the disease

Physicians' compliance with malaria treatment guidelines of under-five children in a secondary maternal and child care centre in Lagos State

Background: The global malaria agenda has the ultimate goal of eliminating malaria in all countries of the world by 2030 through universal access to malaria prevention, diagnosis and treatment. Presumptive treatment of malaria with Artemisinin Combination Therapy (ACT) has been associated with the development of resistance, therefore parasitological confirmation of all fevers is crucial in the context of eliminating malaria. This study assessed physicians' compliance with the national guidelines in the treatment of malaria among under-five (U-5) children and their prescription pattern in a Maternal and Child Care (MCC) centre in Lagos State. Methods: This was a descriptive cross-sectional study conducted as an exit interview among 427 mothers/caregivers of febrile U-5 children who were consecutively sampled.The data was collected using a pre-tested interviewer-administered questionnaire and a proforma. Epi-info version 7.2.1 was used to analyze the data and the level of significance was set as p<0.05. Results: Malaria Rapid Diagnostic Test (mRDT) was done for 75 17.6%) of the children and 37 (49.3%) was positive. Anti-malarial drugs were prescribed at consultation to 400 (93.7%) of the febrile children. Artemisinin Combination Therapy (ACT) was prescribed for 364 (91.0%) of the children. The most prescribed ACT was Artemether-Lumefantrine (AL) in 222 (60. 9%).Conclusion: The physician's compliance with malaria treatment guidelines for febrile illnesses in U-5 children was poor with regards to parasitological confirmation before treatment. However, the use of ACTs was adhered to in almost all cases. Regular training workshops are recommended for health workers to improve adherence to parasitological confirmation before treatment

Awareness of hypertension guidelines and the diagnosis and evaluation of hypertension by primary care physicians in Nigeria

Background: The availability of numerous hypertension guidelines seems not to have impacted significantly on the burden of hypertension. We evaluated awareness of hypertension guidelines among primary-care physicians (PCPs) in Nigeria and its relationship to hypertension diagnosis and work up.Methods: Anonymous self-administered questionnaires were filled in by PCPs categorised into two groups: hypertension guideline aware (GA) and unaware (GU). Results: The 403 participating PCPs had a mean age and experience of 40 ± 11.34 and 14 ± 11.10 years, respectively, with 46.7% (n = 188) of them being GA. Out of the 19 questions assessed, GA and GU PCPs performed better in seven and two questions, respectively, while the two subgroups had a similar performance in 10 questions. The performance of the PCPs in government and private practice was similar.Conclusions: There is a gap between guideline recommendations and hypertension care in Nigeria that is further widened by PCPs' unawareness of the guidelines.Popularising hypertension guidelines among PCPs may significantly improve hypertension care and reduce the burden of disease

Proposed Guidelines for a Workplace Health Promotion Policy and Implementation Framework

Since workplace health promotion programmes are often not guided by a specific policy or health promotion framework; a study was conducted to develop guidelines for the implementation of health promotion in South African workplaces. A Delphi technique involving twelve health promotion experts was used to reach consensus about the proposed policy framework and guidelines. These guidelines are directed towards implementing a comprehensive workplace health promotion programme that aims to accommodate all employee health and safety needs. They can be used to develop relevant health promotion or wellness policies that are easy to implement; monitor and evaluate

Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa

The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions; or to avoid all breastfeeding; based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission; adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However; one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children

Prescribing and dispensing practices of the new treatment protocol for malaria at the dispensary level in White Nile State, Sudan 2005

Background: The National Malaria Control Programme has adopted recently a new treatment guideline. The guideline recommends the use of artemisinin based combination therapy (ACT) as first and second line for uncomplicated malaria at all levels of health system.The aim of this study is to assess the prescribing and dispensing practices at the level of dispensaries in relation to treatment of malaria.Methods:This is a descriptive, cross sectional, health facility based study conducted in White Nile State, central Sudan in September to October 2005, where all the four localities were included and represented by random selection of six administrative units. Out of all, 20 dispensaries and their health workers, as well as 734 patients were selected randomly and investigated using a modified WHO manual. Results: The study found that 90% of the health workers have not been trained on the new protocol and Only 0% of dispensaries have a copy of the new protocol in poster form. Malaria diagnosis in only 25% of dispensaries depends upon symptoms, signs and microscopy. There is a high rate of prescribing combination of antibiotics with antimalarial as well as high rate of injectable preparations; 52.4% and 45% respectively. The most frequent antimalarial drug available in the dispensaries and prescribed for patients was chloroquine (32.1%). Out of all, 56.1% of prescription was a single drug and 57% of the prescription contained analgesic. Conclusion: The implementation of the new treatment guideline at this level of health system is far from the required. Efforts are urgently needed to increase the coverage with ACTs