Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study.

BACKGROUND: The erector spinae block is an efficacious analgesic option for the management of rib fracture--related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anesthesia techniques in patients at risk of complications. The primary aim of this study was to characterize the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aim of this study was to characterize the incidence of late adverse events, as well as the erector spinae plane block catheter failure rate. METHODS: We analyzed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 and September 2020. To assess early adverse events, data collection included hypotension, hypoxemia, local anesthetic systemic toxicity, and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site hematoma. RESULTS: A total of 224 patients received 244 continuous erector spinae catheters during the study period. After insertion of the erector spinae, there were no immediate complications such as hypotension, hypoxia, local anesthetic toxicity, or pneumothorax. Of all blocks inserted, 7.7% were removed due to catheter failure (8.4 per 100 catheters; 95% confidence interval [CI], 5.1-13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95% CI, 1.1-6.7 catheter days). Late complications included 2 erythematous catheter sites and 2 small hematomas not requiring intervention. The incidence of a minor late complication was 16.7 per 1000 catheters (95% CI, 6.1-45.5 per 1000 catheters). CONCLUSIONS: This study supports the statements made by regional anesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low-risk analgesic technique that may be performed in the presence of abnormal coagulation status or systemic infection.

Emergomyces africanus in Soil, South Africa.

We detected Emergomyces africanus, a thermally dimorphic fungus that causes an HIV-associated systemic mycosis, by PCR in 18 (30%) of 60 soil samples from a wide range of habitats in South Africa. Direct and indirect culture techniques were unsuccessful. Experimental intraperitoneal inoculation of conidia induced murine disease.

Emotional Reactions of Medical Doctors and Students Following the Loss of Their Patients at the Dr George Mukhari Hospital Emergency Unit; South Africa

Background: Studies on death and dying predominantly emphasise the needs of the dying patient and the process of bereavement. Few studies have focused on the reactions of medical doctors and students when the patients they have cared for die. Methods: The aim of the study was to explore the thoughts and feelings of doctors and medical students who have lost patients while under their care at the Dr George Mukhari Hospital emergency unit in Ga-Rankuwa; South Africa. The participants included 10 medical doctors and final-year medical students. A qualitative study methodology using a phenomenological approach was used. Results: Meanings were formulated from transcriptions and themes were identified. The following themes emerged: emotional reactions; which included anger; helplessness; guilt and pain; recurrent thoughts about the incident; blame; perceived incompetence; detachment from emotions; religion; death of a paediatric patient; medical training; psychological services; work environment; coping with the family of the deceased; and facing mortality. Conclusion: From the study it was concluded that doctors needed enhanced training in communication skills and communicating death to the patients' families. Bereavement counselling and debriefing should be available to provide them with an opportunity to share emotional responses and reflect on patients' fatality

Personality Profile and Coping Resources of Family Medicine Vocational Trainees at the University of Limpopo; South Africa

Background: Doctors are exposed to various stress factors in their personal and family lives; as well as in the workplace. Stress inherent to the responsibilities and challenges of the medical field may become a health hazard and threaten the well-being of the medical practitioner. Methods: The aim of this study was to investigate the personality traits and coping resources that contribute to the wellbeing of medical practitioners. A cross-sectional study of 44 out of 45 (98response rate) family medicine vocational trainees at the Medical University of Southern Africa (now known as the University of Limpopo) was conducted. A biographic questionnaire was utilised to obtain specific information regarding the participants. The principal researcher used the Coping Resources Inventory (CRI) questionnaire to assess coping resources; and the 16PF personality analysis (16PF) to establish a personality profile of the participants. Results: The majority of participants (81.8) indicated that they mainly experienced work-related stress. Thirty-two participants (72.72) self-medicated. Fourteen participants (31.81) claimed to experience burn-out and twenty (45.45) reported fatigue. In terms of their coping resources; 24 male participants (54.54) did not cope socially (p . 0.008) and eight (18.18) also did not cope physically (p . 0.024). Conclusions: The medical practitioners had a universal personality profile. They lacked insight regarding the symptoms they were experiencing that warranted management; e.g. depression and anxiety. The medical practitioners in this study did not utilise their social and physical coping resources optimally and reported poor help-seeking behaviour

Oral health education provided by oral hygienists in private practice.

The purpose of this study was to identify the health education services provided by oral hygienists working in private dental practices. A questionnaire was designed, pilot tested and posted to all hygienists registered with the SAMDC. Thirty eight per cent returned the questionnaire. Results indicated that an average of only 6 to 10 minutes was spent on oral hygiene instruction per patient. The reasons given for this were identified as lack of time and resistance of patients to change their habits. Education procedures most often performed were the demonstration of brushing and flossing techniques. The least performed procedures included the use of disclosing agents and periodontal measurements. A statistical significant correlation was found between the number of patients consulted per day and salary paid by the dentist. Hygienists who earn more treat more patients per day, but do not spend less time on providing oral hygiene information. Patient resistance is an obstacle to oral hygiene instruction and more emphasis should be placed on the psychological approach to behavioural change than on techniques of oral hygiene. More time should be spent on oral health education and follow-up appointments should be scheduled to support patients in maintaining good oral health care.

Continuing education for dental practitioners.

Attendance of continuing education courses by dentists is important for the practitioner, the profession and the patient. This survey was undertaken to determine the attendance pattern and discipline preferences for such courses during the period 1985 to 1989. A total of 2674 questionnaires were sent to dentists and 706 (26.4 per cent) were returned. Courses were attended by 88.5 per cent of the respondents. The most popular disciplines were Operative Dentistry, Aesthetic Dentistry and Fixed Prosthodontics.

Human trypanosomiasis in Southern Africa.

Five cases of human trypanosomiasis are presented. The clinical picture and course of the disease, and the results of haematological, immunological and other special examinations, are presented. The persistence of decreased total haemolytic complement, increased serum igM levels, decreased plasma fibrinogen levels, raised plasma and urinary fibrinogen split products, cryofibrinogenaemia and significant proteinuria in the presence of apparent clinical cure, tends to indicate the continuation of an immune complex process in spite of eradication of the parasite.

[Comparison of the digestive utilization of methionine, of its hydroxylated analog, and of sodium sulfate in goats using 35s compounds]. / Etude comparée de l'utilisation digestive de la méthionine, de son analogue hydroxylé et du sulfate de sodium chez la Chèvre à l'aide de composés 35S

35S and 35S free and protein bound amino acids were estimated in goats' abomasal contents and blood after ruminal injections of sulfer labelled compounds: methionine, methionine hydroxy analog (M.H.A.) and sodium sulfate. 35S incorporation into microbial and plasma proteins was higher with methionine than with M.H.A. or sulfate. 35S.M.H.A. utilisation seems to be less different from Na2 35SO4 utilisation than from 35S methionine utilisation.