South African Medical Journal - Volume 103, Issue 5, 2013
Volumes & issues
Volume 103, Issue 5, 2013
Author Bridget FarhamSource: South African Medical Journal 103, pp 270 –271 (2013)More Less
Screening asymptomatic patients is now an established part of medical practice. We routinely measure blood pressure, test urine, and carry out a chest X-ray pre-operatively. Screening is also offered to those who haven't asked for medical intervention. Many medical aids advise women over 50 to have an annual mammogram and to have their bone mineral density (BMD) measured at various intervals. Some even reward these women in the form of 'points' in various schemes linked to medical cover. People are advised to have an annual health check that includes cholesterol measurement. Screening has become routine - but few stop and ask whether it is beneficial, and even fewer stop to look at potential harms.
Source: South African Medical Journal 103, pp 271 –272 (2013)More Less
Bottom-lining the 'zero-sum' game
Don't blame the products for poisoning - blame the end-users!
Vaccination against HPV for girls ... and boys?
Screening for HPV
Hepatitis B guideline 2013
Autism in Izindaba
TB diagnosis in children
Validation of the revised South African Triage Scale (SATS) for children
An adapted triage tool (ETAT) at Red Cross War Memorial Children's Hospital Medical Emergency Unit, Cape Town, South Africa : an evaluation : correspondenceSource: South African Medical Journal 103 (2013)More Less
Source: South African Medical Journal 103 (2013)More Less
In her editorial, Molyneux joins with the authors of 'An adapted triage tool (ETAT) at Red Cross War Memorial Children's Hospital Medical Emergency Unit, Cape Town: An evaluation'. Their evaluation of ETAT implied that the inclusion of physiological parameters was superfluous and, in the triage of a paediatric patient, was 'time-consuming to perform and, if manually and hastily undertaken, could be incorrect'. Summarily doing away with an entire aspect of medical evaluation has a sense of throwing the baby out with the bathwater. There can be no question regarding the value of physiological measures in the assessment of acuity.
Author J.V. LarsenSource: South African Medical Journal 103, pp 274 –275 (2013)More Less
Source: South African Medical Journal 103 (2013)More Less
Source: South African Medical Journal 103 (2013)More Less
Severe malaria is a serious and deadly complication of Plasmodium falciparum malaria. We searched the literature to identify the current most efficacious pharmacotherapy for severe malaria. A recent Cochrane meta-analysis compared the efficacy of quinine with artesunate for severe malaria. The primary outcome was all-cause death. The meta-analysis included 8 trials. Artesunate reduced the risk of death both in adults (relative risk (RR) 0.61, 95% confidence interval (CI) 0.50 - 0.75; 1 664 participants, 5 trials) and in children (RR 0.76, 95% CI 0.65 - 0.90; 5 765 participants, 4 trials). In addition, artesunate was less likely to cause hypoglycaemia.
Source: South African Medical Journal 103, pp 276 –277 (2013)More Less
As autism burgeons worldwide, with the latest estimates of 1 in 50 children in the USA between 6 and 17 years old now affected, parents are imploring physicians to go 'all out' for early diagnoses to enable highly effective and timely nutritional and behavioural intervention.
Source: South African Medical Journal 103, pp 278 –279 (2013)More Less
The newly strengthened Competition Commission says it will probably begin its long-awaited, robust probe into South Africa's increasingly unaffordable private healthcare market towards the end of this year, with final recommendations and findings due out in late 2015.
Source: South African Medical Journal 103, pp 279 –280 (2013)More Less
Santam, one of South Africa's largest insurance companies, has repudiated a R3 million payout claim from a former Stellenbosch schoolboy rugby hooker, whose deliberate 'jack-knife' scrumming tactics temporarily paralysed his opponent and left him with life-long disabilities.
Source: South African Medical Journal 103, pp 281 –282 (2013)More Less
Is the mass circumcision drive in KwaZulu-Natal involving neonates and children less than 16 years of age legal? What should doctors do? : forum - medicine and the lawAuthor D.J. McQuoid-MasonSource: South African Medical Journal 103, pp 283 –284 (2013)More Less
As a result of the revival of male circumcision among Zulu males as a cultural practice and an attempt to reduce the incidence of HIV infection, the KwaZulu-Natal government has implemented a programme of mass circumcision of Zulu males. The question arises whether the implementation of such a programme on neonates and children under 16 years of age is legal in terms of the Constitution and the Children's Act. The answer hinges on whether the circumcision is done as a cultural practice or for medical reasons. Doctors are provided with guidance as to what they should do when faced with neonates or males under 16 years of age being presented for circumcision.
Author D. HartmannSource: South African Medical Journal 103, pp 285 –287 (2013)More Less
Introduction. A large private operating theatre complex was investigated to address the lack of published South African benchmarks for utilisation. All major theatres were staffed during normal working hours (07h00 - 19h00), emergency cases being provided for on an ad hoc basis through spare capacity.
Methods. An extensive billing database, amounting to 28 991 records of procedures performed during normal working hours and spanning the period October 2007 - February 2010, was data-mined using Visual Basic for Applications (VBA) scripts. Theatre utilisation was analysed per day, per theatre.
Results. The results showed an average utilisation of 43% with significant variation in day-to-day operations. If the very underutilised minor theatre was excluded from the analysis, overall utilisation rose to 48%. Individual theatre utilisation ranged from 14% to 61%. An analysis of change in utilisation with time during a day showed that peak utilisation of 71% was achieved at 09h30 (90 minutes after lists start). Utilisation dropped to 25% at the end of the working day and was sustained for some time after hours.
Conclusion. The 48% utilisation observed was significantly lower than the global benchmark of between 70% and 80%.
Author G.H. VerdoornSource: South African Medical Journal 103, pp 288 –289 (2013)More Less
Poison information centres are confronted daily by reports of, and requests for, support after alleged exposures to various types of toxins. These emanate from healthcare professionals, veterinarians, members of the public, farmers, scientists and activists, most of whom believe their own diagnosis to be correct. Based on their diagnoses, often erroneous, such individuals often prescribe or administer a range of treatments, many of which are incorrect. Furthermore, people who may not have been exposed to a clinically significant dose of toxins, or in fact any toxins at all, often unjustifiably fear for their health or lives as a result of alarmist statements by activists.
Author R. FryattSource: South African Medical Journal 103 (2013)More Less
Screening for disease is one of the cornerstones of medicine and public health, used to help make a diagnosis in individuals presenting with suggestive clinical signs and symptoms, and to find early signs of disease in high-risk groups such as tuberculosis in miners and pre-eclampsia in pregnant women. In addition, community-based screening for chronic diseases is becoming a regular part of healthcare systems in middle- and high-income countries. This has been defined as 'the systematic application of a test or enquiry to identify individuals at sufficient risk of a specific disorder to benefit from further investigation or direct preventive action, among people who have not sought medical attention because of symptoms of that disorder'.
Source: South African Medical Journal 103, pp 290 –292 (2013)More Less
Thirty years ago the now Nobel Prize winner Harald Zur Hausen first described high-risk human papillomavirus (hrHPV) type 16 in cervical cancer specimens (Fig. 1). Since then, hrHPV infection has been established as a prerequisite for the development of cervical cancer. Cervical cancer prevention programmes in many developed countries already include primary prevention through immunisation against hrHPV types 16 and 18 before hrHPV exposure, combined with secondary prevention via cytology-based screening, often augmented by testing for hrHPV infection. The benefit of acquired knowledge and new technologies must now be extended to developing countries, where 85% of deaths attributable to cervical cancer occur.
Toxicovigilance I : a survey of acute poisonings in South Africa based on Tygerberg Poison Information Centre data : researchSource: South African Medical Journal 103, pp 293 –297 (2013)More Less
Background. The incidence and spectrum of acute poisonings in South Africa are unknown. Poisoning data can be derived from sources such as hospital admission records and poison information centre (PIC) records.
Objectives. This study was conducted to examine the extent of the problem and to identify trends and toxicovigilance issues using PIC data.
Methods. A survey was conducted based on Tygerberg Poison Information Centre (TPIC) consultations over 1 year. TPIC consultation forms were analysed for patient demographics and causes of poisoning.
Results. The TPIC dealt with 4 771 consultations related to human exposures to poisonous substances. The study showed that accidental exposure was more common than intentional poisoning (65.2% v. 34.8%); that 55.8% of cases were adults, of which 57.6% were females; and that 61.4% of adult cases were intentional exposures, and of these 64.3% were females. There was a predominance of accidental exposures (98.8%) and a male predominance (59.7%) in children. Categories of poisoning exposures across all age groups were non-drug chemicals (52.7%), medicines (35.2%) and biological toxins (12.6%). Pesticides (34.8%), irritant/corrosive substances (27.7%) and volatile hydrocarbons (8.3%) were the most common classes of non-drug chemical exposures. Cholinesterase inhibitors (8.8%), anticoagulant rodenticides (7.1%) and pyrethroids (5.0%) were the most commonly ingested non-drug chemicals. Aldicarb and amitraz poisoning were identified as toxicovigilance targets. Analgesics (26.1%) were the most common class of medicine-related exposure, and paracetamol (15.8%), benzodiazepines (9.2%) and antihistamines (5.2%) were the most common medicine-related exposures.
Conclusion. The study provided information on evolving trends and identified toxicovigilance targets and the need for continuing toxicology education programmes.
Toxicovigilance II : a survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals : researchSource: South African Medical Journal 103, pp 298 –303 (2013)More Less
Background. Initial management of acute poisoning in South African (SA) hospitals such as gastric decontamination and use of antidotes has not been evaluated relevant to current international guidelines.
Objectives. The objective of this study was to conduct a toxicovigilance survey of SA hospital admissions to assess the spectrum of acute poisonings, current practices in gastric decontamination, and use of antidotes in the management of acute poisoning.
Methods. A survey was undertaken based on acute poisoning admissions to Tygerberg Academic Hospital (TAH) as well as hospital-based poisoning consultations with the Tygerberg Poison Information Centre (TPIC) over 1 year to investigate trends in admissions and the initial management of hospital admissions for acute poisoning. TAH admission details and TPIC consultation forms for hospital-based cases were analysed for patient demographics, causes of poisoning, gastric decontamination measures and use of antidotes.
Results. There were 662 admissions to TAH and 2 459 hospital-based TPIC consultations. Paracetamol and cholinesterase inhibitors were the most common exposures in both studies. Gastric decontamination measures were employed at TAH in 47.7% of cases and in 5.3% of hospital cases reported to the TPIC. Of these, 67.4% in the TAH study and 26.1% in the TPIC study did not comply with international guidelines. N-acetylcysteine was administered inappropriately in 22.1% of the paracetamol poisoning cases at TAH and in 1.6% in the TPIC study. Atropine was administered unnecessarily in 12 of 30 TPIC cases.
Conclusion. This study has identified the need for directed training on gastric decontamination measures and use of antidotes and, combined with the previous study, has identified national trends in poisoning.
Vital signs for children at triage : a multicentre validation of the revised South African Triage Scale (SATS) for children : researchSource: South African Medical Journal 103, pp 304 –309 (2013)More Less
Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both.
Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS.
Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%).
Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.
Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population : researchSource: South African Medical Journal 103, pp 309 –312 (2013)More Less
Background. Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups. There is widespread geographical variation in the quality of care. Few data are available on national screening rates in South Africa and how these vary across the provinces.
Objective. To examine screening rates for chronic diseases of lifestyle (CDL), HIV and cancer in a privately insured population for a single insurer across all nine provinces in South Africa, and to determine whether or not there are any differences between the provinces.
Method. Screening rates were calculated as the proportion of eligible members who had received screening tests during 2011 in each province. Mean screening rates were compared between Gauteng and the other eight provinces.
Results. Nationwide screening rates were 20.5% for CDL, 8.2% for HIV and 31.9% for cancer. Despite similar insurance coverage, screening rates ranged from 0.3% to 0.95% lower in other provinces compared with Gauteng. Of all the provinces, Gauteng had the highest annual screening rates for CDL, breast cancer, prostate cancer and HIV (p<0.001), while the Western Cape had the highest rate for cervical cancer (p<0.001).
Conclusion. There is much variation in preventive care utilisation across the provinces within this health-insured population. Provinces with more abundant healthcare resources have higher screening rates. Further research is required to understand the reasons for the variation, given equal payment access.