Osmolality of Modified Enteral Tube Feeds for Adults in Hospitals Across the Western Cape Province

Objectives: The first aim of this study was to determine the incidence of use; reasons for use; and procedures/recipes followed in modifying enteral tube feeds (ETFs) for adults in state and private hospitals across the Western Cape Province (WCP); South Africa (baseline data). The second aim was to determine the osmolality of the modified ETFs used by these hospitals (osmolality data). Design: A descriptive cross-sectional study. Setting and subjects: The study was conducted in January/February 2007. The baseline data was collected by means of a coded questionnaire sent to all state and private hospitals in the WCP (n = 111); excluding all children's hospitals. The osmolality data was obtained by means of freeze-point depression of the modified ETF recipes obtained from the participating hospitals. Results: A total response rate of 94was obtained. Of the participating hospitals (n = 104); 48were state (n = 50) and 52were private hospitals (n = 54). Sixty-two per cent of hospitals (n = 64) made use of ETFs; with 25modifying their feeds (n = 16). Twelve recipes were obtained for the osmolality testing. Eight recipes (66) were significantly lower (p 0.001); two (16) were significantly higher (p 0.001) and two of the recipes did not differ from the standard enteral product. Eight recipes (66) had a significantly higher average osmolality (p 0.001) than that of body fluid. The concentrated ETF recipe (1.43 kcal/ml) had the highest osmolality (707 mOsm/kg/H20). Conclusions: Modular ETFs had lower average osmolality than those of the semi-modular and the standard enteral products; and of body fluid (300 mOsm/kg/H20)

The profile analysis of attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment from 1 May 2005 to 30 April 2006

Background. Suicide is an increasing phenomenon worldwide. A suicide occurs every 40 seconds; and there is 1 attempt every 1 to 3 seconds. By 2020; these figures may have doubled. No accurate statistics regarding the occurrence of attempted suicide (or non-fatal suicidal behaviour) in South Africa exist; because there has been no systematic data collection. Aim. The aim of the study was to determine the profile of patients who had attempted suicide and were referred to Pelonomi Hospital; Bloemfontein; for psychologicalevaluation and treatment during the period 1 May 2005 to 30 April 2006. Method. A descriptive; retrospective study was conducted. The study population comprised 258 attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment. A data form was compiled to transfer the relevant information from patients' clinical files. Results. The majority of patients were female (68.9). The median age was 22 years. The most common method used in suicide attempts was drug overdose (66) - mostly antidepressants (19.7)) and analgesics (8.2). More females than males overdosed on drugs (p=0.0103). The main precipitating factors included problematic relationships (55.4); financial problems (22.9); psychiatric problems (22.1); arguments (19.8); abuse (emotional; sexual; physical - 18.2); low self-esteem/ worthlessness/hopelessness/humiliation (16.7); and recent life changes (13.2). Conclusion. The aim of the study was to determine the profile of patients who had attempted suicide. Possible factors associated with suicide attempts in our sample were identified and summarised in the form of a screening checklist. The value of the checklist is that it can be used as a screening method to identify possible suicide risk in patients

The Role of Educational Strategies to Reverse the Inverse Performance Spiral in Academically Isolated Rural Hospitals

The importance of continuous professional development for health care workers is widely acknowledged; but the identification of optimal implementation strategies remains a challenge; particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province; South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence; increased the levels of job satisfaction they experienced; increased their willingness to stay in a rural environment; and impacted positively on the quality of services provided. However; the success of educational strategies is heavily dependant on the local environment (context); as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals; however; this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care