scholarly journals Clinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa: a research protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039455
Author(s):  
Brian W Allwood ◽  
Coenraad FN Koegelenberg ◽  
Elvis Irusen ◽  
Usha Lalla ◽  
Razeen Davids ◽  
...  
Keyword(s):  
South Africa ◽  
Research Team ◽  
Proportional Hazards Model ◽  
Clinical Care ◽  
Cox Proportional Hazards Model ◽  
High Rate ◽  
Clinical Approach ◽  
Western Cape ◽  
Care Providers ◽  
Hospital Data

IntroductionThe outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital.Methods and analysisThe study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB.Ethics and disseminationThe research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.

scholarly journals Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

2020 ◽  
Author(s):  
Andrit Lourens ◽  
Peter Hodkinson ◽  
Romy Parker
Keyword(s):  
South Africa ◽  
Emergency Care ◽  
Pain Assessment ◽  
Prehospital Setting ◽  
Western Cape ◽  
Care Providers ◽  
Attitudes And Practices ◽  
The Mean ◽  
Pain Care ◽  
Knowledge Attitudes And Practices

Abstract Background: Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between health care providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: Responses of 100 participants was included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD8.13) years and the mean years’ experience 10.02 (SD6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last two years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Further, gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.

scholarly journals Risk factors for failure in small businesses in the footwear and textile industry of Gauteng Province, South Africa

2015 ◽  
Vol 5 (3) ◽  
pp. 114-125
Author(s):  
Zeleke Worku
Keyword(s):  
South Africa ◽  
Financial Services ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Gauteng Province ◽  
Entrepreneurial Skills ◽  
Hazards Model

The study was based on the 5-yearlong study (2007 to 2012) of Small, Micro and Medium-sized Enterprises (SMMEs) that conduct business in Gauteng Province, South Africa conducted by Marivate (2014) from 2007 to 2012. The sample consisted of 187 businesses (36.52%) that utilized financial services routinely provided by the South African Small Enterprises Development Agency (SEDA), and 325 businesses (63.48%) that utilized non-financial services provided by SEDA. Out of the 187 businesses that utilized financial services, 85.42% of them were viable, whereas 14.58% of them were not viable. Out of the 325 businesses that utilized non-financial services, 43.25% of them were viable, whereas 56.75% of them were not viable. The degree of entrepreneurial skills in each of the 512 businesses that were selected for the study was measured by using a composite index defined by Le Brasseur, Zannibbi & Zinger (2013). The multilevel logistic regression model (Hosmer and Lemeshow) was used for identifying and quantifying predictors of utilization of financial and non-financial services provided by SEDA to SMMEs. Predictors of long-term survival were estimated by using the Cox Proportional Hazards Model (Cleves, Gould & Gutierrez, 2004). The results showed that the 187 businesses that utilized financial services (36.52%) were relatively more viable in comparison with businesses that utilized non-financial services (63.48%). Results obtained from the Cox Proportional Hazards Model showed that long-term viability in the 512 businesses that were selected for the study was significantly influenced by utilization of financial services, degree of entrepreneurial skills, and the ability to order large volumes of stock in bulk, in a decreasing order of strength. The top 3 predictors of utilization of financial services in the 187 businesses that utilized financial services were degree of entrepreneurial skills, the ability to order large volumes of stock in bulk, and access to training opportunities on entrepreneurial or vocational skills, in a decreasing order of strength. The top 3 predictors of utilization of non-financial services in the 325 businesses that utilized non-financial services were the age of business, past history of bankruptcy, and the practice of selling on credit, in a decreasing order of strength.

FDA analysis of depth of response (DpR) and survival across 10 randomized controlled trials in patients with previously untreated unresectable or metastatic melanoma (UMM) by therapy type.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9508-9508 ◽  
Author(s):  
Christy Osgood ◽  
Flora Mulkey ◽  
Pallavi Shruti Mishra-Kalyani ◽  
Steven Lemery ◽  
Ashley Ward ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
High Rate ◽  
Controlled Trials ◽  
Tumor Shrinkage ◽  
Full Spectrum ◽  
Randomized Controlled

9508 Background: Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 may not capture the full spectrum of benefit that patients with melanoma derive from targeted kinase inhibitors (TKI) or immunotherapies. We explored the relationship between DpR and overall survival (OS) in patients treated with TKI (BRAF, MEK inhibitors), immunotherapy (antibodies targeting PD-1 or CTLA-4), or chemotherapy (dacarbazine or paclitaxel). Methods: Ten randomized controlled trials of patients with previously untreated UMM were pooled and evaluated by type of therapy. DpR was grouped by maximal tumor shrinkage (G0 = no shrinkage or increase, G1 = ≤25%, G2 = 26-50%, G3 = 51-75%, G4 = 76- < 100%, and G5 = 100%). We performed an exploratory analysis evaluating the association between DpR and OS using hazard ratios (HR) generated from a Cox proportional hazards model where maximal tumor shrinkage category was included as a time varying covariate. Results: There were 3778 patients evaluable for tumor response. The table displays the HR for OS by DpR group and therapy type. Estimated OS at 24m in patients with deep response ( > 75%; G4+G5) treated with TKI and immunotherapy was 69% and 92%, respectively, although many patients were censored. Conclusions: For patients with previously untreated UMM a larger DpR correlates with a longer OS, regardless of therapy type. Deep response ( > 75%) is associated with a high rate of estimated OS at 24 months in patients treated with immunotherapy. Analysis of DpR provides additional granularity of response data and may provide a more nuanced prediction of clinical outcome. [Table: see text]

Missed opportunity: An intersectional approach to disparities in long-term survival in bladder cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 476-476
Author(s):  
Samuel L. Washington ◽  
Stephen Gregorich ◽  
Sikai Song ◽  
Maxwell V. Meng ◽  
Anne Suskind ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Care Providers ◽  
Term Survival ◽  
Race Ethnicity ◽  
Muscle Invasive ◽  
Better Than

476 Background: For individuals with muscle-invasive bladder cancer (MIBC), studies focused on racial disparities have shown black race is associated with 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed black-white differences in survival. To characterize how the interaction between race/ethnicity and receipt of GBT drive within- and between-race differences in survival for black, white, and Latino individuals with MIBC. Methods: We identified a cohort of individuals with cT2-4 MIBC from 2004-2013 in the National Cancer Database. GBT was defined by American Urological Association guidelines. A Cox proportional hazards model of patient mortality estimated effects of patient GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. Results: Of 54,910 MIBC individuals with 125,821 person-years of post-treatment observation (max=11 years), 90.1% were white, 6.9% black, and 3.0% Latino. Half (50.2%) received GBT. Averaging across GBT status, Latino individuals had lower hazard of death compared to black (HR 0.81, 95% CI 0.75-0.87) and white individuals (HR 0.92, 0.86-0.98). With GBT, Latino and white individuals had similar outcomes (HR=1.00, 0.91-1.10) and both groups fared significantly better than black individuals (HR=0.88, 0.79-0.99 and HR=0.88, 0.83-0.94, respectively). Without GBT, Latino individuals fared better than white (HR=0.85, 0.77-0.93) and black individuals (HR=0.74, 0.67-0.82) while white individuals fared better than black individuals (HR=0.87, 0.83-0.92). Latino without GBT fared better than black individuals with GBT (H=0.98, 0.88-1.09), although not statistically significant. Conclusions: Our study finds that not only are GBT levels generally low, which is concerning, but there is also an apparent 'under-allocation' of GBT to a patient group who arguably needs it the most-- black individuals. Future efforts to improve the delivery of GBT, a factor directly impacted by urologic care providers, may mitigate the race-based survival differences observed in individuals with MIBC.

Dispatcher Triage Accuracy in the Western Cape Government Emergency Medical Services System, Cape Town, South Africa

2020 ◽  
Vol 35 (6) ◽  
pp. 638-644
Author(s):  
Mohammed F. Alshehri ◽  
Jennifer L. Pigoga ◽  
Lee A. Wallis
Keyword(s):  
South Africa ◽  
Emergency Medical Services ◽  
Training Programs ◽  
Clinical Care ◽  
Medical Services ◽  
Western Cape ◽  
Predictive Values ◽  
Emergency Medical ◽  
One Year ◽  
Dispatch Protocols

AbstractIntroduction:Triage - the sorting of patients according to urgency of need for clinical care - is an essential part of delivering effective and efficient emergency care. But when frequent over- or under-triaging occurs, finite time and resources are diverted away from those in greatest need of care and the entire Emergency Medical Services (EMS) system is strained. In resource-constrained settings, such as South Africa, poor triage in EMS only serves to compound other contextual challenges. This study examined the accuracy of dispatcher triage over a one-year period in the Western Cape Government (WCG) EMS system in South Africa.Methods:A retrospective analysis of existing dispatch and EMS data to assess the accuracy of dispatch-assigned priorities was conducted. The mismatch between dispatcher-assigned call priority and triage levels determined by EMS personnel was analyzed via over- and under-triage rates, sensitivity and specificity, and positive and negative predictive values (PPVs and NPVs, respectively).Results:A total of 185,166 records from December 2016 through November 2017 were analyzed. Across all dispatch complaints, the over-triage rate was 67.6% (95% CI, 66.34-68.76) and the under-triage rate was 16.2% (95% CI, 15.44-16.90). Dispatch triage sensitivity for all included records was 49.2% (95% CI, 48.10-50.38), specificity 71.9% (95% CI, 71.00-72.92), PPV 32.5% (95% CI, 30.02-34.88), and NPV 83.8% (95% CI, 81.93-85.73).Conclusion:This study provides the first evaluation of dispatch triage accuracy in the WCG EMS system, identifying that the system is suffering from both under- and over-triage. Despite variance across dispatch complaints, both under- and over-triage remained higher than widely accepted norms, and all rates were significantly above acceptable target metrics described in similar studies. Results of this study will be used to motivate the development of more rigorous training programs and resources for WCG EMS dispatchers, including improved dispatch protocols for conditions suffering from high over- and under-triage.

Abstract 17403: Prognositic Significance of T peak - T end Interval in Transthyretin Cardiac Amyloidosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alan Sugrue ◽  
Ammar M Killu ◽  
JoJo Hai ◽  
Stehpanie Joppa ◽  
Grace Lin ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
High Rate ◽  
Inclusion Criteria ◽  
Cardiac Amyloid ◽  
Increased Risk ◽  
Surface Ecg

Introduction: The T peak - T end interval (Tpe) is a measure of transmural dispersion of repolarisation with prolongation of this interval linked to an increased risk of ventricular arrhythmias and sudden death. Patients with cardiac amyloid experience a high rate of sudden cardiac death. Objective: To determine the prognostic utility of the Tpeak-Tend interval in patients with transthyretin (TTR) cardiac amyloidosis. Methods: Of the 240 patients who underwent evaluation for TTR amyloidosis at our tertiary referral center from 1966 to 2010, 39 met inclusion criteria (65 excluded for AF, 66 BBB/Paced Rhythm, 25 CAD, 21 other). Inclusion criteria were presence of histological diagnosis of TTR amyloid and confirmed cardiac involvement by echocardiogram or biopsy and absence of atrial fibrillation (AF) or bundle branch block/paced rhythm on the index surface ECG, or history of coronary heart disease (CAD). Tpe was measured in leads V3 and V5. Cox proportional hazards model were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Kaplan-Meier curves were used to estimate overall survival and differences between curves were estimated using log rank. Primary endpoints were death or heart transplantation. Results: Of the 39 patients, 85% were male, and 69% were mTTR. Mean age 66.4 ± 13.9 years. Mean follow up period of 4.2 ± 3.2 years, 25 died and 5 received heart transplants. Median survival was 3.8 years, with 5 year survival 34%. On univariate analysis, Tpe in lead V3 was predictive of adverse outcome, HR per 10msec, 1.195 (1.051-1.370). Further multivariate analysis, in a model accounting for age, gender, Lead V3 Tpe was independently associated with survival, HR per 10msec, 1.207, (1.094-1.411, p=0.009). Conclusions: The Tpe interval in Lead V3 at diagnosis is a novel, noninvasive independent predictor of survival in transthyretin cardiac amyloidosis patients in sinus rhythm.

scholarly journals Data mining to analyse recurrent crime in South Africa

2021 ◽  
Author(s):  
◽  
Phirime Monyeki
Keyword(s):  
South Africa ◽  
Data Mining ◽  
High Rate ◽  
Western Cape ◽  
Residential Burglary ◽  
Crime Trends ◽  
Changepoint Analysis ◽  
The Government ◽  
High Crime ◽  
Insight Into

When South Africa is compared to other countries, it has a notably high rate of crime. The country has seen a concomitantly high occurrence of murder, residential burglary, drug-related crime and carjacking (hijacking) crime. The government is desperately seeking solutions that can be implemented to reduce recurrent crime. Several reasons to explicate high crime trends in different areas include alcohol or drug abuse, low standards of education, poor parenting skills and a lack of social and vocational skills. This study aimed to gain better insight into crime trends in South Africa using data mining techniques. Decision-making linked to the data could help the government implement a coherent crime strategy to mitigate crime. The crime dataset chosen for this study was publicly available at kaggle.com. The dataset was prepared using Python programming code. The research design was utilised as an overall strategy to compile all different components of this study with an intention of answering the research questions and attaining the research objectives. To identify the significant changes, ChangePoint Analysis (CPA) was performed to pinpoint the abrupt change in the South African crime dataset. Two methods called Cumulative Sum (CUSUM) and Bootstrap were implemented in this study of CPA. To analyse the trend of data, CUSUM and Bootstrap were performed to measure the occurrence of change points based on the confidence levels. The CPA outcome depicted multiple significant changes and abrupt shifts in several provinces of South Africa. Linear regression (LR) was utilised to predict the future trends of crime in South Africa from 2016 – 2022 based on the erstwhile 2005 – 2015 crime statistics. The results showed that crime has been on the increase in South Africa with certain provinces such as Western Cape, Gauteng and KwaZulu-Natal being identified as crime hotspots. Future studies on crime should focus only on one province to gain insight into the dominating crimes and hotspots within that particular province, with a view to developing highly specific crime-reduction interventions.

scholarly journals Paving the Path: Preparing for Microbicide Introduction—Report of a Qualitative Study in South Africa

2004 ◽  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Health Care Providers ◽  
Hiv Transmission ◽  
National Level ◽  
Urban Site ◽  
Western Cape ◽  
Care Providers ◽  
Aids Epidemic ◽  
Critical Issues

With recently accelerated support for the development of microbicides to prevent HIV transmission and the urgency of the global AIDS epidemic, it is important to begin to identify strategies for introducing a microbicide once it is proven safe and effective and is approved for use. This report presents results from a qualitative study that explored a range of issues likely to influence microbicide introduction—positively or negatively—at three levels: community, health service, and policy. The study, which identified critical issues to be addressed in building support for microbicides and facilitating a smooth introduction, was conducted between September 2002 and September 2003 in Langa, a peri-urban site in the Western Cape Province of South Africa, and at national and provincial levels. Through in-depth interviews and focus group discussions, this study explored and identified issues that could facilitate or undermine access to and use of microbicides. Respondents included community members, health care providers and managers, provincial- and national-level government officials, and representatives from national and provincial nongovernmental organizations and health professional bodies that influence policy.

scholarly journals Paving the Path: Preparing for Microbicide Introduction—Report of a Qualitative Study in South Africa [Executive Summary]

2004 ◽  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Health Care Providers ◽  
Hiv Transmission ◽  
National Level ◽  
Urban Site ◽  
Western Cape ◽  
Care Providers ◽  
Executive Summary ◽  
Critical Issues

With recently accelerated support for the development of microbicides to prevent HIV transmission and the urgency of the global AIDS epidemic, it is important to begin to identify strategies for introducing a microbicide once it is proven safe and effective and is approved for use. This executive summary presents results from a qualitative study that explored a range of issues likely to influence microbicide introduction at the community, health service, and policy levels. The study, which identified critical issues to be addressed in building support for microbicides and facilitating a smooth introduction, was conducted between September 2002 and September 2003 in Langa, a peri-urban site in the Western Cape Province of South Africa, and at national and provincial levels. Through in-depth interviews and focus group discussions, this study explored and identified issues that could facilitate or undermine access to and use of microbicides. Respondents included community members, health care providers and managers, provincial- and national-level government officials, and representatives from national and provincial nongovernmental organizations and health professional bodies that influence policy.

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