scholarly journals An audit of unnecessary preoperative urea and electrolyte panel tests in patients undergoing major orthopaedic surgery at a quaternary South African hospital

2021 ◽  
pp. 36-39
Author(s):  
Y Moodley ◽  
SS Mashele
Keyword(s):  
Risk Factors ◽  
South African ◽  
Orthopaedic Surgery ◽  
Kidney Injury ◽  
Healthcare Sector ◽  
Major Surgery ◽  
Public Healthcare ◽  
Hospital Data ◽  
Retrospective Audit ◽  
Major Orthopaedic Surgery

Background: Preoperative urea and electrolyte (U&E) panels are frequently requested for major surgery patients at risk for postoperative acute kidney injury (AKI). There is only one published study that has audited unnecessary preoperative U&E test panel utilisation in major surgery patients at a South African (SA) public sector hospital. This has significant implications for laboratory workloads, healthcare expenditure, and patient-friendly practice in the resource-limited SA public healthcare sector. Objective: To audit preoperative U&E panel requests in a sample of SA patients undergoing major orthopaedic surgery. Methods: We conducted a retrospective audit of adult primary hip arthroplasty patients who attended a quaternary SA hospital. Data on demographics, medical history, preoperative anaesthetic evaluations, operation details, and U&E panel requests were collected from each patient’s medical chart. The National Institute for Health and Care Excellence (NICE) guidelines, based on American Society of Anesthesiologists (ASA) grading and the presence of AKI risk factors, was used to distinguish between necessary and unnecessary preoperative U&E requests. We used descriptive statistics to analyse our study data. Results: Of the 175 patients comprising our study sample, 23 (13.1%) had preoperative U&E panels requested unnecessarily. All 23 patients were otherwise healthy and did not have any AKI risk factors. Conclusion: A small proportion of preoperative U&E test panels in our study sample of major orthopaedic surgery patients were deemed unnecessary. With that being said, there is still room for improvement in practices around preoperative U&E panel requests, which could be achieved through educational, computerised, and audit feedback interventions.

scholarly journals Survival of South African patients on renal replacement therapy

2020 ◽  
Vol 13 (5) ◽  
pp. 782-790 ◽  
Author(s):  
Thabiet Jardine ◽  
Esther Wong ◽  
Retha Steenkamp ◽  
Fergus J Caskey ◽  
Mogamat Razeen Davids
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
South African ◽  
Healthcare Sector ◽  
Hiv Positive ◽  
Public Healthcare ◽  
South Africans ◽  
Public Healthcare Sector ◽  
Potential Risk Factors ◽  
African Patients

Abstract Background The majority of South Africans rely on a resource-constrained public healthcare sector, where access to renal replacement therapy (RRT) is strictly rationed. The incidence of RRT in this sector is only 4.4 per million population (pmp), whereas it is 139 pmp in the private sector, which serves mainly the 16% of South Africans who have medical insurance. Data on the outcomes of RRT may influence policies and resource allocation. This study evaluated, for the first time, the survival of South African patients starting RRT based on data from the South African Renal Registry. Methods The cohort included patients with end-stage kidney disease who initiated RRT between January 2013 and September 2016. Data were collected on potential risk factors for mortality. Failure events included stopping treatment without recovery of renal function and death. Patients were censored at 1 year or upon recovery of renal function or loss to follow-up. The 1-year patient survival was estimated using the Kaplan–Meier method and the association of potential risk factors with survival was assessed using multivariable Cox proportional hazards regression. Results The cohort comprised 6187 patients. The median age was 52.5 years, 47.2% had diabetes, 10.2% were human immunodeficiency virus (HIV) positive and 82.2% had haemodialysis as their first RRT modality. A total of 542 patients died within 1 year of initiating RRT, and overall 1-year survival was 90.4% [95% confidence interval (CI) 89.6–91.2]. Survival was similar in patients treated in the private sector as compared with the public healthcare sector [hazard ratio 0.93 (95% CI 0.72–1.21)]. Higher mortality was associated with older age and a primary renal diagnosis of ‘Other’ or ‘Aetiology unknown’. When compared with those residing in the Western Cape, patients residing in the Northern Cape, Eastern Cape, Mpumalanga and Free State provinces had higher mortality. There was no difference in mortality based on ethnicity, diabetes or treatment modality. The 1-year survival was 95.9 and 94.2% in HIV-positive and -negative patients, respectively. One-fifth of the cohort had no data on HIV status and the survival in this group was considerably lower at 77.1% (P < 0.001). Conclusions The survival rates of South African patients accessing RRT are comparable to those in better-resourced countries. It is still unclear what effect, if any, HIV infection has on survival.

Significant risk factors associated with facilities management (FM) outsourcing

2015 ◽  
Vol 22 (6) ◽  
pp. 771-796 ◽  
Author(s):  
Dubem I. Ikediashi ◽  
Stephen O. Ogunlana
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
The Body ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Facilities Management ◽  
Content Type ◽  
Healthcare Facilities ◽  
Factors Associated ◽  
Body Of Knowledge

Purpose – The purpose of this paper is to extend the body of knowledge on healthcare facilities management (FM) by investigating the risks associated with outsourcing of FM services in hospitals. Design/methodology/approach – The paper relied on two strands of methodology common with pragmatic research. Questionnaire survey (QS) used data from 208 respondents representing ten hospitals while three out of the ten hospitals involved in the QS were selected based on their willingness to enter the case study (CS) interview. Data collected were analysed using descriptive and inferential statistics for QS and using narrative techniques by discussing themes, sub-themes for the CS. Findings – Findings established 24 out of the 35 risk factors as critical, four factors as somehow critical, and five factors as not critical. Besides, nine risk factors were found to be significantly loaded on the five risk categories. The rank analysis also revealed that the top five critical risk factors are: inexperience and lack of requisite skills; possibility of fraud by vendor; financial failure of chosen vendor; vendor opportunism; and fall in morale of employees. Originality/value – The study provides an unambiguous contribution to exiting body of knowledge on outsourcing risks as it relates to healthcare FM. It reinforces the theory that risks exist in any form of relationship but developed a distinct body of factors associated with outsourcing of FM services particularly from the context of Nigeria’s public healthcare sector.

scholarly journals Incidence and Risk Factors of Postoperative Acute Kidney Injury in Non- Cardiac Major Surgery.

2017 ◽  
Vol 11 (2) ◽  
pp. 47-49
Author(s):  
Swapan Kumar Mondal ◽  
Bablu Kumar Paul ◽  
Shubharthi Kar ◽  
Swapan Kumar Biswas ◽  
Zebunnesa Parvin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Volume ◽  
Major Surgery ◽  
Published Data ◽  
Cross Sectional ◽  
Impair Renal Function ◽  
Nephrotoxic Drugs ◽  
Volume Blood

Acute kidney injury (AKI) occurs in approximately 1-7% of all hospitalized patients. Those patients undergo major surgical procedures are at high risk for AKI due to high volume blood loss, electrolytes disturbance, development of preoperative infection or sepsis and presence of several co-morbidities that may impair renal function. However, published data on postoperative kidney injury are scarce outside the cardiovascular surgery setting. Therefore the study was designed to find out the incidence and risk factors of postoperative acute kidney injury in non-cardiac major surgery. A cross-sectional observational study was conducted in the department of nephrology, BSMMU, Dhaka from January 2014 to December 2014. In this study we found the overall incidence of postoperative AKI 6%. Among the risk factors-male sex, increased age, lengthy operation, exposure to general anesthesia, perioperative hypotension, blood transfusion and use of nephrotoxic drugs (NSAIDs, Aminoglycosides) are important.Faridpur Med. Coll. J. Jul 2016;11(2): 47-49

scholarly journals Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tayeba Roper ◽  
Muhammad Amaran ◽  
Prakash Saha ◽  
Cormac Breen ◽  
David Game
Keyword(s):  
Risk Factors ◽  
Early Recognition ◽  
Femoral Vein ◽  
Kidney Injury ◽  
Major Surgery ◽  
Percutaneous Mechanical Thrombectomy ◽  
Intravascular Haemolysis ◽  
Post Procedure ◽  
Potential Risk Factors ◽  
Laboratory Investigations

Abstract Background AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet® has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. We aim to explore the mechanism and potential risk factors associated with developing AKI in these patients and suggest steps to optimise patient management. Case presentation A 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet® thrombectomy for an occluded femoral vein stent. Urine and laboratory investigations showed evidence of intravascular haemolysis, which was the likely cause of AKI. Following a brief period of RRT he completely recovered renal function. Conclusions AKI is an increasingly recognised complication following AngioJet® thrombectomy, but remains underappreciated in clinical practice. AKI results from intravascular haemolysis caused by the device. Up to 13% of patients require RRT, but overall short-term prognosis is good. Pre-procedural risk factors for the development of AKI include recent major surgery. Sodium bicarbonate should be administered to those who develop renal impairment. Renal biopsy is high risk and does not add to management. Increased clinician awareness and vigilance for AKI post-procedure can allow for early recognition and referral to nephrology services for ongoing management.

scholarly journals Self-reported outcomes of aural rehabilitation for adult hearing aid users in a developing South African context

2010 ◽  
Vol 57 (1) ◽  
Author(s):  
Elaine Pienaar ◽  
Natalie Stearn ◽  
De Wet Swanepoel
Keyword(s):  
Quality Of Life ◽  
South African ◽  
Hearing Aids ◽  
Hearing Impaired ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
South African Context ◽  
Aural Rehabilitation ◽  
African Context

Hearing impairment has far reaching consequences for affected individuals, in terms of quality of life indicators. In a developing South African context the hearing impaired population is faced with limited aural rehabilitation services. This study evaluated self-reported outcomes of aural rehabilitation in a group of adults in the public healthcare sector with a standardized outcomes measurement tool (IOI-HA). Sixty-one respondents participated (44% males; 56% females), with a mean age of 69.7 years. Results revealed that the majority of respondents experienced favourable outcomes in all domains of the inventory comprising of: daily use of hearing aids, benefits provided by hearing aids, residual activity limitation, satisfaction with hearing aids, residual participation restriction, impact of hearing difficulties on others, and changes in quality of life. Statistically significant relationships were obtained between the daily use of hearing aids, the degree of hearing loss, and the type of hearing aids fitted, as well as the benefits received from hearing aids in difficult listening environments (p < 0.05). Despite challenges of developing contexts, the mean scores distribution compared positively to similar reports from developed countries. Outcomes of improved quality of life emphasize the importance of providing affordable hearing aids and services to all hearing impaired individuals in South Africa.

Acute kidney injury post-major orthopaedic surgery: A single-Centre case-control study

Nephrology ◽  
2018 ◽  
Vol 23 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Tracey Ying ◽  
Samantha Chan ◽  
Stephen Lane ◽  
Christine Somerville
Keyword(s):  
Acute Kidney Injury ◽  
Orthopaedic Surgery ◽  
Case Control Study ◽  
Kidney Injury ◽  
Case Control ◽  
Single Centre ◽  
Major Orthopaedic Surgery ◽  
Control Study

scholarly journals Perceptions of chiropractors in the eThekwini Municipality on the integration of chiropractic into the public healthcare sector of South Africa

2018 ◽  
Author(s):  
◽  
Natalie Davies
Keyword(s):  
South Africa ◽  
South African ◽  
Healthcare System ◽  
Chiropractic Profession ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Medical Doctors ◽  
The Public ◽  
Public Healthcare Sector

Background Currently, chiropractic is not incorporated into the South African public healthcare sector despite its emphasis on the values of wellness and health. This is due to a poor relationship with mainstream medical practitioners, the construct of chiropractic education and its long standing isolation within the healthcare system within South Africa. The public healthcare sector in South Africa is strained. Low back pain is one of the main reasons patients seek medical attention from primary medical doctors. A growing body of evidence is now emerging which supports the role of chiropractic in post-­surgical rehabilitation and the treatment of extraspinal non-­pathological musculoskeletal conditions. Based on the findings of these studies, an argument could be made for the transition of chiropractic from a mainly private practice base to one that would enable it to reach to the wider population in the public healthcare sector. Aim The aim of the research study was to explore and describe the perceptions that chiropractors have about the integration of the chiropractic profession into the South African public healthcare sector. Method A descriptive exploratory qualitative approach was used to guide the study. In-­ depth interviews were conducted with ten chiropractors within the eThekwini municipality. The main research question for this study was “What are the perceptions of chiropractors in the eThekwini Municipality on the integration of chiropractic into the public healthcare sector of South Africa?” The data was analysed through thematic analysis. Results The main themes that emerged were the role of chiropractic in the healthcare system, the integration of chiropractic into the healthcare sector and the challenges facing chiropractors in the healthcare system. The themes and sub-­ themes were as follows;; • Theme 1 Role of chiropractic in the healthcare system Sub-­theme 1.1 Primary contact for neuromuscular medicine. • Theme 2 Integration of chiropractors into the public healthcare sector Sub-­theme 2.1 Relief of overworked healthcare workers. Sub-­theme 2.2 Decrease costs in surgical and medication use. Sub-­theme 2.3 Increased learning opportunities. Sub-­theme 2.4 Use of chiropractic in post-­surgical care. Sub-­theme 2.5 Need for pre-­surgical assessment. Sub-­theme 2.6 Integration facilitated by the Chiropractic Association of South Africa (CASA). • Theme 3 Challenges facing chiropractors in the public healthcare sector Sub-­theme 3.1 Opposition from medical doctors. Sub-­theme 3.2 Opposition from within the chiropractic profession. Sub-­theme 3.3 Inability to function as the primary practitioners. Sub-­theme 3.4 Unfamiliar structure of the public health care sector. Conclusion A lack of clarity on the identity and role of chiropractic in the public healthcare sector emerged from the findings of this study. Individual chiropractors, the professional body (CASA) and the Allied Health Professions Council of South Africa (AHPCSA) need to engage in active roles in the integration of chiropractic into the public healthcare sector of South Africa.

Analysis of the operational risk factors in public hospitals in an Indian state

2019 ◽  
Vol 33 (1) ◽  
pp. 67-88 ◽  
Author(s):  
C.R. Vishnu ◽  
R. Sridharan ◽  
P.N. Ram Kumar ◽  
V. Regi Kumar
Keyword(s):  
Risk Factors ◽  
Healthcare System ◽  
Significant Risk ◽  
Public Hospitals ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Content Type ◽  
Indian State ◽  
The Government ◽  
The Impact

Purpose Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality. Design/methodology/approach The current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL–ISM–PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors. Findings The analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels. Practical implications Multiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources. Originality/value Only limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL–ISM–PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.

Sign in / Sign up

Export Citation Format

Share Document