Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa

Background: The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients. Methods: In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa. Results: A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (p<0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), p<0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (p<0.001). Conclusion: The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.

Burnout and associated factors in undergraduate medical students at a South African university

Background. Medical students are at risk of burnout owing to various challenges.Objectives. To investigate burnout and associated factors among undergraduate students at a South African medical school.Methods. In this cross-sectional study, findings of the Copenhagen Burnout Inventory (CBI), demographic data and information related to resilience were collected by means of an anonymous self-administered questionnaire. Associations between burnout subscales and various factors were determined.Results. Five-hundred students (preclinical, n=270; clinical, n=230) completed the questionnaire. CBI mean scores for preclinical and clinical students were 17.9 and 17.4 (personal), 22.3 and 21.9 (work related) and 24.8 (patient related; clinical students only), respectively. High scores on the subscale reflect low levels of burnout in related areas. Male students and students with high self-reported resilience and low stress had significantly lower burnout levels. White preclinical students had lower levels of personal and work-related burnout, and black clinical students had less patient-related burnout.High mean scores in all three burnout subscales indicated low burnout levels among students. Academic and personal stress, as well as perceived poor support from institutional structures, were associated with significantly higher personal and work-related burnout, but not patient-related burnout in clinical students

Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital's dynamic adaptation response

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic

Research of the yeasts Candida non-albicans on various medical devices in the service of resuscitation of the Teaching hospital of Tlemcen, Algeria

Background and aim: The fungic infections, more particularly the Candidiasis are frequent in the intensive care units. This had a relation with the heaviness of the pathologies, presented by the patients and the quasi-systematic recourse to various medical devices. In addition, we observe more and more and more the emergence of numerous species of Candida non- albicans in these hospital structures. That's why we undertook this study which concerns the evaluation of the incidence of the sepathogenic on medical devices implanted during 48hours and more on patients hospitalized in the resuscitation service of CHU of Tlemcen. Methods:After isolation of yeast son selective mediums, the strains obtained were identified by using chromogenic mediums (CHROMagar®Candida) and the Api identification Candida galleries (BioMérieux®).Results:The results showed that among100 samples are taken, 15% been altered by yeasts of Candida non-albicans.Conclusion: It appears from this study that the fungal infections on medical devices are widely present in hospitals especially in the intensive care unit. The presence of Candida non- albicans yeasts is not negligible; they are 15% on the level of the various medical devices implanted

Effectiveness of the credit-line approach for support of CD4 equipment functionality in northern Uganda

Background: Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment.Objectives: We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator. Method: A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs); 18 level-four health centres (HC IVs); and 10 hospitals in 15 districts of mid-northern Uganda; including the Lango (17 facilities) and Acholi sub-regions (18 facilities); between July 2013 and August 2013. Functionality; was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by subregion; facility type; and equipment type.Results: A total of 38 CD4 test analysers were assessed. Of these; 26 (68%) were functional. In hospitals; 85% of CD4 analysers were functional; in HC IVs; 67% were functional and in HCIIIs; 43% were functional. The differences did not reach statistical significance. In the Langosub-region; 72% of analysers were functional; in the Acholi sub-region; 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges; as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment.Conclusion: The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However; there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care; especiallyat HC IIIs

The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape

Introduction :The failed or difficult airway is a rare; but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province; South Africa. Methods :A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results :Twenty-six different types of alternative airway devices were documented. Three centres (20) had no alternative airway device. Five centres (33.3) stocked only one device; three centres (20) had two devices and four centres (26.7) had more than two devices. Most centres (n = 12; 80) stocked supraglottic airways (only one centre (6.7) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3). Four centres (26.7) had video-laryngoscopes; but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3). Although surgical cricothyroidotomy equipment was available; the equipment was widely dispersed and only three centres (20) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion: The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed

The Use of Hearing Protection Devices in South Africa: Exploring the Current Status in a Gold and a Non-Ferrous Mine

This study investigated mine workers' current use of hearing protection devices (HPDs) in South African gold and non-ferrous mining subsectors. A descriptive study design was employed using structured interviews.Ninety participants were interviewed. Descriptive statistics and the chi-square test were used to analyse data.All participants reported wearing HPDs; with custom-made earplugs being preferred by those with more years of work experience and used by those most at risk to noise exposure. Comfort; design and work-related communication were factors infl uencing use of HPDs. Relationships between participants' demographic factors and use of HPDs were not statistically signifi cant. Participants seemed reasonably aware of HPD importance which highlights progress. Findings further highlight the importance of occupational audiologists in improving hearing conservation programmes (HCPs) in this sector

An analysis of inter-healthcare facility transfer of neonates within the ethekwini health district of KwaZulu-natal

Objectives: To assess the time frames for the inter-healthcare facility transfer of neonates and investigate the factors that may have led to delays in the transfer; and investigate any adverse events encountered during the transfer of the neonate. Methods: A prospective study was conducted from December 2011 to January 2012. A quantitative, non-experimental design was used to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two questionnaires.Results: All the transfers were undertaken by road ambulances of which 83 (62.2%) by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Twenty nine (24.2%) were specialised transfers. The mean time ± standard deviation (SD) to complete an inter-healthcare facility transfer was 3 h 49 min±1 h 57 min with the minimum time of 5 min and the maximum time of 10 h 34 min. Equipment required for neonatal transport was a major problem due to poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The study identified 10 (8.3%) physiological related adverse events which included 1 (0.8%) death and 18 (15.0%) equipment related adverse events. Conclusions: The EMRS eThekwini Health District is involved in the transportation of a significant number of intensive care and non-intensive

Essentials for emergency care: lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

Introduction:The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra; Ghana; to determine quality improvement needs.Methods A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results :Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control; advanced airway management; and ophthalmologic or gynaecological examinations. Several additional items; such as glucometers and pulse oximeters; were available and often used for patient care. Conclusion:Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre; our inventory assessment indicated a need to develop better implementation strategies for infection control policies; to collaborate with other departments on coordination of patient care; and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and 'ready-to-hand'. Consequently; key factors in determining readiness to provide quality emergency care include supply-chain; healthcare financing; functionality of systems; and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development

Audits of Emergency Trolleys' Contents in Selected Hospitals in Botswana

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment; as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana's hospitals' wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley; some units failed to check their emergency trolleys' contents daily. All 20 hospital wards or units that participated in this study; needed to improve the contents and maintenance of their emergency trolleys; otherwise in-hospital CPR efforts in Botswana might be doomed to failure; losing lives that could have been saved if emergency trolleys' equipment and supplies had been up to standard

La pratique de l'echographie dans le district sanitaire de San-Pedro

Notre travail est une etude comportant une enquete prospective sur une periode de six mois (de septembre 2003 a fevrier 2004) portant sur l'analyse de 902 Comptes rendus d'examens echographiques de l'unite d'echographie du CHR de San-Pedro et une enquete prospective portant sur l'entretien avec 74 prescripteurs du district sanitaire dudit departement. Son but essentiel est de montrer l'interet de l'echographie dans un district sanitaire provincial. Il ressort de cette etude que l'echographie affirme de plus en plus son efficacite dans l'exploration obstetricale; abdominale; pelvienne; testiculaire; mammaire; thyroidienne; parotidienne et des tissus mous. Malheureusement; l'echographie n'a pas ete exploitee dans un but therapeutique ou interventionnel durant la periode de notre etude. Le district sanitaire de San-Pedro dispose d'un echographe pour 60.574 habitants et d'un radiologue pour 242.188 habitants. Les patients provenaient pour la plupart de la ville de San-Pedro (71.73pour cent). C'etait le plus souvent des adolescents et des adultes jeunes (84;92pour cent) de sexe feminin (82;71pour cent) avec une forte prevalence de l'echographie pelvienne chez les femmes et de l'echographie abdominale chez les hommes. Les explorations obstetricales etaient les plus frequentes avec 44.35pour cent des cas; suivies des explorations pelviennes feminines et des explorations abdominales respectivement avec 29.27pour cent et 21;40pour cent des cas. Les atteintes annexielle uterines dominaient la pathologie pelvienne (60;81pour cent) avec une prevalence des dystrophies ovariennes (71;09pour cent) des cas. Au niveau abdominal; les affections hepatiques etaient les plus frequentes (30;81pour cent) avec une predominance des hepatomegalies homogenes (52.16pour cent des cas). 63;51pour cent des prescripteurs etaient satisfaits des prestations echographiques. Pour 45pour cent d'entre eux le cout constitue un obstacle a la prescription de l'examen echographiques. L'echographie constitue une source de rentabilite financiere de l'ordre 1.6. Outre sa rentabilite financiere et diagnostique; l'echographie est interessante innocuite et ses depenses de fonctionnement faibles. Son installation dans un hospitalier regional rapproche les populations de l'un des moyens d'exploration en imagerie medicale les plus adaptes aux diagnostics de pathologies frequemment rencontrees

Standardization of anaesthetic equipment and maintenance of medical equipment in Malawi

The Danida sponsored mission recommended exchanging existing anesthetic equipment for to modern; simple and standardized types and strengthening existing maintenance organizations and establishing stocks of spares

Standardization of anaesthetic equipment in Malawi: report for the period April 1st 1987 - April 1st 1988

Reviews implementation of the Danish International Development Agency [DANIDA] plan to modernized anesthetic equipment in Malawi for the 1987 financial year which show a reduction in expenditure on oxygen and transportation for cylinders and patients to central hospitals

Karonga lakeshore integrated rural groundwater supply project: village level operation and maintenance; first sociological and technical monitotring report

In 1986 the Government of Malawi; with assistance from the Danish International Development Agency [DANIDA] commenced an integrated rural groundwater supply project in the southern lakeshore part of Karonga District. The project handed over 295 boreholes to communities on 31 March 1991. From that date operation and maintenance will be achieved at village level. This report presents and discusses the findings from sociological and technical monitoring during the first four months of the system's existence

Drugs and medical supplies: manufacture; procurement; control and distribution

This document deals with the development of improved systems and procedures for procurement; inventory control and storage of medical supplies at CMS

A study on factors leading to non-functioning of medical equipment at Parirenyatwa Group of Hospitals

(Summary of findings and recommendations) - The Parirenyatwa Group of Hospitals has been experiencing the problem of non-functioning medical equipment. A lot of medical equipment breakdown in every department to such an extent that the Hospital staff has realised that most of the Departments complain of having equipment which are non-functioning. This problem is so severe that it affects their role in providing health care delivery services to patients. The main objective of this study was to identify factors which led to non-functioning of medical equipment at Parirenyatwa Group of Hospitals in order to make recommendations for improvements to the management; users; and the Ministry of Health. The study was carried out in fifty (50) departments of the Parirenyatwa Group of Hosptials which were identified according to their different functions and services they provide to the patients. The study was mainly descriptive with quantitative and qualitative elements. Information on functioning and non-functioning medical equipment was obtained from the users. An inventory on both functioning and non-functioning medical equipment for each department was first carried out. From; this inventory; a random sample of two (2) functioning medical equipment and three (3) non-functioning medical equipment was done for each department. A total of one hundred (100) and one hundred and fifty (150) functioning and non-functioning medical equipment respectively; was obtained. Furthermore information was obtained from five (5) Hospital Equipment Technicians and four (4) purchasers who were interviewed using structured questionnnaires