scholarly journals Multi-method appraisal of clinical quality indicators for the Emergency Medical Services in the Low- and Middle-Income Setting: The South African Perspective

2020 ◽  
Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Maaret Castrén ◽  
Lee Wallis ◽  
Veronica Lindström
Keyword(s):  
South African ◽  
Rank Correlation ◽  
Healthcare Setting ◽  
Prehospital Emergency Care ◽  
Group Consensus ◽  
The South ◽  
Rater Reliability ◽  
Measurement Framework ◽  
The Individual ◽  
Method Approach

Abstract Background: Quality Indicator (QI) appraisal protocols are a novel methodology that combine multiple appraisal methods in order to comprehensively assess the “appropriateness” of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. The aim of this paper was to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods: An appraisal protocol was developed consisting of two categorical-based appraisal methods, the Qualify tool and Rand/Appropriateness method, combined with the qualitative analysis of the discussion generated during the consensus application of each method, by a QI Appraisal Working Group. Inter-rater reliability of each individual method was assessed prior to group consensus rating. Variation in the number of non-valid QIs identified between each method and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results: There was mixed inter-rater reliability of the individual methods prior to the group consensus. There was similarly poor to moderate correlation of the results obtained between the individual methods (Spearman’s rank correlation = 0.42, p<0.001). From a series of 104 QIs, 11 were identified that were shared between the appraisal methods. A further 19 QIs were identified and not shared by each method, highlighting the benefits of a multimethod approach. There was little evidence to support a difference in the proportion of non-valid QIs identified between individual methods (difference=-0.03); between the Quality tool and the protocol (difference=-0.05); or between the Rand method and the protocol (difference=-0.02). The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input towards understanding and appraising the appropriateness of the QIs that would not have otherwise been captured or understood by the individual methods alone. Conclusion: The utilisation of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the measurement framework can be QI successfully implemented and employed.

Multi-Method Vs Single Method Appraisal of Clinical Quality Indicators for the Emergency Medical Services

2020 ◽  
Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Maaret Castrén ◽  
Lee Wallis ◽  
Veronica Lindström
Keyword(s):  
Group Discussion ◽  
Rank Correlation ◽  
Healthcare Setting ◽  
Prehospital Emergency Care ◽  
Spearman’S Rank Correlation ◽  
Prehospital Emergency ◽  
Single Method ◽  
Multi Method Approach ◽  
The Individual ◽  
Method Approach

ABSTRACT Background Quality Indicator (QI) appraisal protocols are a novel methodology that combines multiple appraisal methods to comprehensively assess the "appropriateness" of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. This paper aimed to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results There was mixed IRR of the individual methods. There was similarly low to moderate correlation of the results obtained between the particular methods (Spearman’s rank correlation=0.42,p&lt;0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. Conclusion The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.

scholarly journals Depression in the South African workplace

2016 ◽  
Vol 22 (1) ◽  
pp. 2
Author(s):  
Marthinus P. Stander ◽  
Margreet Bergh ◽  
Helen Elizabeth Miller-Janson ◽  
Janetta C. De Beer ◽  
Frans A. Korb
Keyword(s):  
South Africa ◽  
Work Environment ◽  
South African ◽  
Depression And Anxiety ◽  
The South ◽  
Anxiety Group ◽  
Prevalence Of Depression ◽  
The Individual ◽  
The Impact ◽  
Insight Into

Depression is a common psychiatric disorder and can be costly, having a significant impact on the individual and employers. The South African Depression and Anxiety Group (SADAG) in partnership with HEXOR, with the support of Lundbeck, undertook research into depression in the workplace, because South African information is not available on this topic. It provides insight into the prevalence of depression within the workplace in South Africa, as well as the impact of depression on the employees and employers in terms of sick leave and levels of productivity, especially when the symptoms include cognitive impairment. It is apparent that stigma plays a pivotal role in the reasons for non-disclosure to employers. It further highlights the magnitude of awareness, early detection and the provision of a holistic support system within the work environment, free from bias, to ensure that optimum benefit can be achieved for both employer and employee.

The South African Cash-In-Transit Heist Enterprise: Managing its Wellspring and Concatenation

2019 ◽  
Vol 57 (1-2) ◽  
pp. 198-224
Author(s):  
Mahlogonolo Stephina Thobane
Keyword(s):  
South African ◽  
The South ◽  
The Public ◽  
Reduction Strategies ◽  
Career Criminals ◽  
Risk Reduction Strategies ◽  
Master Of Arts ◽  
In Transit ◽  
Method Approach

AbstractSouth African cash-in-transit (CIT) robberies appear to be in a state of flux. According to the Minister of Police, Mr Bheki Cele, the incidence of these crimes has steadily decreased due to rapid response by the police in arresting more than 200 suspects between June and November 2018. Given the rhizomatic, eclectic nature of this crime type – and possible mechanical linkages and/or linear causality within the genesis of the crime – it is debatable whether arrests and incarceration offer a long-term solution. CIT robbers interviewed for this study reported that they were career criminals, less likely to be rehabilitated and that incarceration was only an interruption to their career. These findings were backed by life-course theories. This article contends that if the South African Criminal Justice System wants to curb CIT robberies, an investigation into proactive methods for combating the crime should be developed and risk reduction strategies crafted. After investigating possible causes of CIT robberies, this research made recommendations based on holistic measures involving the public, family, and various government and non-governmental departments. The research was conducted for a Master of Arts degree in Criminology. A mixed-method approach was followed and 40 incarcerated offenders who committed robbery with aggravating circumstances participated in the study.

scholarly journals Clinical practice guideline adaptation methods in resource-constrained settings: four case studies from South Africa

2019 ◽  
Vol 25 (6) ◽  
pp. 193-198 ◽  
Author(s):  
Michael McCaul ◽  
Dawn Ernstzen ◽  
Henk Temmingh ◽  
Beverly Draper ◽  
Michelle Galloway ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Practice ◽  
Case Studies ◽  
South African ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Local Context ◽  
Prehospital Emergency Care ◽  
The South ◽  
High Quality

Developing a clinical practice guideline (CPG) is expensive and time-consuming and therefore often unrealistic in settings with limited funding or resources. Although CPGs form the cornerstone of providing synthesised, systematic, evidence-based guidance to patients, healthcare practitioners and managers, there is no added benefit in developing new CPGs when there are accessible, good-quality, up-to-date CPGs available that can be adapted to fit local needs. Different approaches to CPG development have been proposed, including adopting, adapting or contextualising existing high-quality CPGs to make recommendations relevant to local contexts. These approaches are attractive where technical and financial resources are limited and high-quality guidance already exists. However, few examples exist to showcase such alternative approaches to CPG development. The South African Guidelines Excellence project held a workshop in 2017 to provide an opportunity for dialogue regarding different approaches to guideline development with key examples and case studies from the South African setting. Four CPGs represented the topics: mental health, health promotion, chronic musculoskeletal pain and prehospital emergency care. Each CPG used a different approach, however, using transparent, reportable methods. They included advisory groups with representation from content experts, CPG users and methodologists. They assessed CPGs and systematic reviews for adopting or adapting. Each team considered local context issues through qualitative research or stakeholder engagement. Lessons learnt include that South Africa needs fit-for-purpose guidelines and that existing appropriate, high-quality guidelines must be taken into account. Approaches for adapting guidelines are not clear globally and there are lessons to be learnt from existing descriptions of approaches from South Africa.

Who is responsible for protecting my health during the COVID- 19 pandemic?

2021 ◽  
Author(s):  
Karlien Kallmeyer ◽  
Melvin A Ambele ◽  
Chrisna Durandt ◽  
Graeme Ford ◽  
Simone Grobbelaar ◽  
...  
Keyword(s):  
South Africa ◽  
South African ◽  
Fundamental Question ◽  
South African Government ◽  
Infected Person ◽  
The South ◽  
African Government ◽  
Global Pandemic ◽  
The Government ◽  
The Individual

Since the report of the first COVID-19 infected person in South Africa, COVID-19 moved from being a distant threat to a new reality overnight. Metaphorically, COVID-19 could be described as rain, and in order to be protected one would need to stand under an umbrella. The fundamental question that stems from this is who is holding this protective umbrella? Is the government holding the umbrella or are we holding the umbrella? In this article/commentary/perspective, we briefly discuss the responsibility of the South African government and the individual during this global pandemic, the reasoning behind the implementation of lockdown and the consequences thereof. We conclude that both government and citizens need to cooperatively take responsibility and work together to fight COVID-19. The protective umbrella needs to be held by both government and by ourselves.

scholarly journals Validity and reliability of the South African Triage Scale in prehospital providers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nee-Kofi Mould-Millman ◽  
Julia M. Dixon ◽  
Taylor Burkholder ◽  
Jennifer L. Pigoga ◽  
Michael Lee ◽  
...  
Keyword(s):  
South Africa ◽  
South African ◽  
Gold Standard ◽  
Hospital Setting ◽  
Early Warning Score ◽  
Western Cape ◽  
Validity And Reliability ◽  
The South ◽  
Rater Reliability ◽  
Prehospital Triage

Abstract Background The South African Triage Scale (SATS) is a validated in-hospital triage tool that has been innovatively adopted for use in the prehospital setting by Western Cape Government (WCG) Emergency Medical Services (EMS) in South Africa. The performance of SATS by EMS providers has not been formally assessed. The study sought to assess the validity and reliability of SATS when used by WCG EMS prehospital providers for single-patient triage. Methods This is a prospective, assessment-based validation study among WCG EMS providers from March to September 2017 in Cape Town, South Africa. Participants completed an assessment containing 50 clinical vignettes by calculating the three components — triage early warning score (TEWS), discriminators (pre-defined clinical conditions), and a final SATS triage color. Responses were scored against gold standard answers. Validity was assessed by calculating over- and under-triage rates compared to gold standard. Inter-rater reliability was assessed by calculating agreement among EMS providers’ responses. Results A total of 102 EMS providers completed the assessment. The final SATS triage color was accurately determined in 56.5%, under-triaged in 29.5%, and over-triaged in 13.1% of vignette responses. TEWS was calculated correctly in 42.6% of vignettes, under-calculated in 45.0% and over-calculated in 10.9%. Discriminators were correctly identified in only 58.8% of vignettes. There was substantial inter-rater and gold standard agreement for both the TEWS component and final SATS color, but there was lower inter-rater agreement for clinical discriminators. Conclusion This is the first assessment of SATS as used by EMS providers for prehospital triage. We found that SATS generally under-performed as a triage tool, mainly due to the clinical discriminators. We found good inter-rater reliability, but poor validity. The under-triage rate of 30% was higher than previous reports from the in-hospital setting. The over-triage rate of 13% was acceptable. Further clinically-based and qualitative studies are needed. Trial registration Not applicable.

A Survey of African Material in the Libraries and Archives of Protestant Missionary Societies in England

1981 ◽  
Vol 8 ◽  
pp. 277-307 ◽  
Author(s):  
Maidel Cason
Keyword(s):  
South African ◽  
The South ◽  
Christian Missions ◽  
Recent Developments ◽  
History Of ◽  
African Writer ◽  
Unique Source ◽  
Missionary Societies ◽  
The Individual ◽  
African Missions

The libraries and archives of mission societies provide rare, often unique, source material concerning the last two centuries of African history. The following survey of Protestant mission societies in England is based on a survey done in 1970. In 1978 letters were written to all societies listed in order to update the material. Replies were received from twenty-one. When no information was received in 1978 this has been indicated in the text. Bibliographical and reference material has also been updated. Included for each of the societies covered is a list of the areas where the society worked in Africa, the types of material held, the mission periodicals produced and notes about access.There are two guides available which cover some of the groups considered. Rosemary Keen's A Survey of the Archives of Selected Missionary Societies (1968) describes the archives of nineteen societies. It is very uneven in coverage and includes a number of inaccuracies. A Guide to Manuscripts and Documents in the British Isles Related to Africa compiled by Noel Matthews and M. Doreen Wainwright was published in 1971 based on a survey done in 1965. It covers eleven of the societies listed here and the extent of coverage is indicated in the individual sections.Early in this century a South African writer attempted to cover all of African missions south of the Sahara. Du Plessis' A History of Christian Missions in South Africa (1911) and his Evangelization of Pagan Africa (1929) are carefully done, detailed accounts from the South African viewpoint. In 1958 Gerdener continued the coverage of South African work with his Recent Developments in the South African Mission Field.

Constitutional Developments in Foreign Countries During 1908 and 1909

1910 ◽  
Vol 4 (3) ◽  
pp. 325-349 ◽  
Author(s):  
W. F. Dood
Keyword(s):  
United States ◽  
South African ◽  
The United States ◽  
Political Life ◽  
State Governments ◽  
African Union ◽  
The South ◽  
Federal States ◽  
Federal Organization ◽  
The Individual

Perhaps the two most important constitutional events during recent years are the establishment of the South African Union and the struggle in Great Britain over the budget and with reference to the powers of the House of Lords. Both of these events are excluded from treatment here—the South African Union is discussed somewhat fully in another part of this Review; the British constitutional struggle is still in progress, and cannot be satisfactorily treated at the present time.However, with reference to the South African Union it may be well to call attention to the movement away from loosely-constructed federal states. In the United States the state governments have steadily tended to become of less importance as compared with the national government, but this change has necessarily been produced not so much by textual changes in the constitution as by judicial interpretation. By the German imperial constitution of 1871 a fairly centralized federal organization was established, and since 1873 when the federal legislative power was extended over the whole field of civil law there have been no important extensions of federal power by textual changes in the constitution; but here as in the United States the federal power has increased at the expense of the states in a manner not shown by changes in the written instrument of government. “The most important and most weighty interests of the nation are common to all and must be cared for in a uniform manner, and all branches of public law and political life stand in a close and indissoluble relation the one to the other, so that by the logic of facts particularism must give place to unity, the common will must to an ever increasing extent displace the separate wills of the individual states.”

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