Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420140002&lang=es vol. 104 num. 2 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Medicine and the humanities - doctors as artists</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Editor’s Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200002&lng=es&nrm=iso&tlng=es <![CDATA[<b>A multidisciplinary approach to cardiac rehabilitation in SA</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200003&lng=es&nrm=iso&tlng=es <![CDATA[<b>The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200004&lng=es&nrm=iso&tlng=es <![CDATA[<b>LCHF</b>: <b>Response to Drs Boyles and Wasserman</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200005&lng=es&nrm=iso&tlng=es <![CDATA[<b>LCHF: Response to Dr Evenepoel</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200006&lng=es&nrm=iso&tlng=es <![CDATA[<b>LCHF: Response to Dr Kapp</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200007&lng=es&nrm=iso&tlng=es <![CDATA[<b>Activists warn</b>: <b>Don't fall victim to our HIV successes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200008&lng=es&nrm=iso&tlng=es <![CDATA[<b>Louis Heyns</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200009&lng=es&nrm=iso&tlng=es <![CDATA[<b>Peter Jacobs</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200010&lng=es&nrm=iso&tlng=es <![CDATA[<b>Walter Hift</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200011&lng=es&nrm=iso&tlng=es <![CDATA[<b>Eleanor Nash</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200012&lng=es&nrm=iso&tlng=es <![CDATA[<b>Withholding or withdrawing treatment and palliative treatment hastening death</b>: <b>The real reason why doctors are not held legally liable for murder</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200013&lng=es&nrm=iso&tlng=es Doctors who hasten the termination of the lives of their patients by withholding or withdrawing treatment or prescribing a potentially fatal palliative dose of medication satisfy the elements of intention and causation of a charge of murder against them. However, the courts have held that, for policy reasons based on 'society's legal convictions', such conduct is not unlawful if the patient consented to it or medical treatment would be futile or palliative treatment may hasten death. Doctors are not held liable for murder because society regards their omissions or acts as lawful - not because they did not have the intention in law to kill or did not cause the death of their patients. <![CDATA[<b>Strengthening pharmacovigilance in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200014&lng=es&nrm=iso&tlng=es This report outlines findings and recommendations of a national pharmacovigilance workshop held in August 2012 in South Africa (SA). A survey of current pharmacovigilance activities, conducted in preparation for the meeting, identified multiple programmes collecting drug safety data in SA, with limited co-ordination at national level. The meeting resolved that existing pharmacovigilance programmes need to be strengthened and consolidated to ensure that important local safety issues are addressed, data can be pooled and compared and outputs shared more widely. Pharmacovigilance activities should inform treatment guidelines with the goal of improving patient care. A variety of pharmaco-epidemiological approaches should be employed, including nesting drug safety studies within existing sentinel cohorts and the creation of a pregnancy exposure registry. The attendees agreed on key principles that will inform a national pharmacovigilance plan and compiled a list of priority pharmacovigilance issues facing public health programmes in SA. <![CDATA[<b>Surgery and anaesthesia in art: The contribution of Dorothy Kay</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200015&lng=es&nrm=iso&tlng=es Dorothy Kay, the acclaimed Irish-born Port Elizabeth artist, married Dr Hobart Kay, FRCSI, in Cape Town, South Africa, in 1910. She was an exceptional portrait painter, whose astute observation of detail and ability to empathise with her subject and convey character brought her much important work. Her traditional British realist-school style of painting, and ability to depict mechanical equipment accurately, led to several industrial commissions. In 1937 these skills combined to produce her largest painting, 'Surgery', which depicts a patient undergoing an abdominal operation in a Port Elizabeth hospital. The painting graphically captures the skill and care exhibited by the anaesthetist, together with the anaesthetic equipment used at that time. During the war Dorothy became an accredited war artist. Eight of her wartime paintings were purchased by the Union Government and are now housed in the Ditsong National Museum of Military History in Saxonwold, Johannesburg. Two of these paintings of medical interest are discussed. The first, entitled 'Operation in a Base Hospital', depicts surgery being performed in a base hospital and is very similar in composition to 'Surgery'. The second, entitled 'Blood to Save Lives', portrays a volunteer donating blood. <![CDATA[<b>The 'medical humanities' in health sciences education in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200016&lng=es&nrm=iso&tlng=es A new masters-level course, 'Medicine and the Arts', will be offered in 2014 at the University of Cape Town, setting a precedent for interdisciplinary education in the field of medical humanities in South Africa. The humanities and social sciences have always been an implicit part of undergraduate and postgraduate education in the health sciences, but increasingly they are becoming an explicit and essential component of the curriculum, as the importance of graduate attributes and outcomes in the workplace is acknowledged. Traditionally, the medical humanities have included medical ethics, history, literature and anthropology. Less prominent in the literature has been the engagement with medicine of the disciplines of sociology, politics, philosophy, linguistics, education, and law, as well as the creative and expressive arts. The development of the medical humanities in education and research in South Africa is set to expand over the next few years, and it looks as if it will be an exciting inter-disciplinary journey. <![CDATA[<b>The intercalated BSc (Med) Honours/MB ChB and integrated MB ChB/PhD tracks at the University of Cape Town: Models for a national medical student research training programme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200017&lng=es&nrm=iso&tlng=es The Faculty of Health Sciences at the University of Cape Town is addressing the shortage of clinician-scientists in South Africa by introducing two research training tracks in parallel with the professional MB ChB programme, namely the intercalated BSc (Med) Hons/MB ChB track and the integrated MB ChB/PhD track. The BSc (Med) Hons/MB ChB track is available to MB ChB students who have completed the first two years of study. The track comprises a course in Molecular Medicine given concurrently with the MB ChB third-year curriculum, followed by a BSc (Med) Hons as a 'year out' of MB ChB. Subsequently students may enrol into the integrated MB ChB/PhD track that enables them to undertake a PhD concurrently with MB ChB studies, which will be spread over additional years, or alternatively to undertake a PhD after completion of the MB ChB. These tracks, which were launched in 2011, represent an opportunity to train a new cadre of young African clinician-scientists at the undergraduate level. <![CDATA[<b>Palliative care in chronic disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200018&lng=es&nrm=iso&tlng=es The Faculty of Health Sciences at the University of Cape Town is addressing the shortage of clinician-scientists in South Africa by introducing two research training tracks in parallel with the professional MB ChB programme, namely the intercalated BSc (Med) Hons/MB ChB track and the integrated MB ChB/PhD track. The BSc (Med) Hons/MB ChB track is available to MB ChB students who have completed the first two years of study. The track comprises a course in Molecular Medicine given concurrently with the MB ChB third-year curriculum, followed by a BSc (Med) Hons as a 'year out' of MB ChB. Subsequently students may enrol into the integrated MB ChB/PhD track that enables them to undertake a PhD concurrently with MB ChB studies, which will be spread over additional years, or alternatively to undertake a PhD after completion of the MB ChB. These tracks, which were launched in 2011, represent an opportunity to train a new cadre of young African clinician-scientists at the undergraduate level. <![CDATA[<b>A new mental health policy for South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200019&lng=es&nrm=iso&tlng=es The Faculty of Health Sciences at the University of Cape Town is addressing the shortage of clinician-scientists in South Africa by introducing two research training tracks in parallel with the professional MB ChB programme, namely the intercalated BSc (Med) Hons/MB ChB track and the integrated MB ChB/PhD track. The BSc (Med) Hons/MB ChB track is available to MB ChB students who have completed the first two years of study. The track comprises a course in Molecular Medicine given concurrently with the MB ChB third-year curriculum, followed by a BSc (Med) Hons as a 'year out' of MB ChB. Subsequently students may enrol into the integrated MB ChB/PhD track that enables them to undertake a PhD concurrently with MB ChB studies, which will be spread over additional years, or alternatively to undertake a PhD after completion of the MB ChB. These tracks, which were launched in 2011, represent an opportunity to train a new cadre of young African clinician-scientists at the undergraduate level. <![CDATA[<b>Failing to numb the pain</b>: <b>The untreated epidemic</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200020&lng=es&nrm=iso&tlng=es The Faculty of Health Sciences at the University of Cape Town is addressing the shortage of clinician-scientists in South Africa by introducing two research training tracks in parallel with the professional MB ChB programme, namely the intercalated BSc (Med) Hons/MB ChB track and the integrated MB ChB/PhD track. The BSc (Med) Hons/MB ChB track is available to MB ChB students who have completed the first two years of study. The track comprises a course in Molecular Medicine given concurrently with the MB ChB third-year curriculum, followed by a BSc (Med) Hons as a 'year out' of MB ChB. Subsequently students may enrol into the integrated MB ChB/PhD track that enables them to undertake a PhD concurrently with MB ChB studies, which will be spread over additional years, or alternatively to undertake a PhD after completion of the MB ChB. These tracks, which were launched in 2011, represent an opportunity to train a new cadre of young African clinician-scientists at the undergraduate level. <![CDATA[<b>Maintaining wellbeing for South Africans receiving ART</b>: <b>The burden of pain and symptoms is greater with longer ART exposure</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200021&lng=es&nrm=iso&tlng=es BACKGROUND: Physical and psychological symptom burden among people with HIV infection is associated with poor quality of life, poorer treatment adherence, viral rebound and risk behaviour. Symptomatology has not been investigated among outpatients in sub-Saharan Africa. OBJECTIVE: To measure the seven-day period prevalence, burden and correlates of pain and other physical and psychological symptoms among HIV patients receiving antiretroviral therapy (ART). METHODS: This was a cross-sectional self-report study. A total of 378 patients were interviewed using validated tools in three South African public sector clinics. RESULTS: The most prevalent symptoms were feeling sad (64%), feeling irritable (61.6%), worry (60.8%), numbness and tingling in hands/ feet (59.8%), and sexual problems (51%). In multivariate analysis, later disease stage was associated with worse psychological symptom burden (ß=0.359; 95% confidence interval (CI) 0.202 - 0.516; p<0.001), global symptom burden (ß=0.365; 95% CI 0.204 - 0.526; p<0.001) and number of symptoms (3=0.308; 95% CI 0.150 - 0.465; p<0.001). Those receiving treatment for a greater number of years also reported higher burden for physical (3=0.083; 95% CI 0.037 - 0.129; p<0.001), psychological (3=0.068; 95% CI 0.019 - 0.117; p=0.007) and global symptoms (ß=0.065; 95% CI 0.016 - 0.115; p=0.010), and a greater number of symptoms (ß=0.081; 95% CI 0.032 - 0.130; p=0.001). CONCLUSIONS: The data reveal a high symptom burden despite treatment. Detailed symptom assessment and control continues to be required in the era of treatment. <![CDATA[<b>A 5-year analysis of the helicopter air mercy service in Richards Bay, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200022&lng=es&nrm=iso&tlng=es BACKGROUND: A helicopter emergency medical service (HEMS) was established in 2005 in Richards Bay, KwaZulu-Natal, South Africa, to provide primary response and inter-facility transfers to a largely rural area with a population of 3.4 million people. OBJECTIVE: To describe the first 5 years of operation of the HEMS. METHODS: A chart review of all flights from 1 January 2006 to 31 December 2010 was conducted. RESULTS: A total of 1 429 flights were undertaken; 3 were excluded from analysis (missing folders). Most flights (88.4%) were inter-facility transfers (IFTs). Almost 10% were cancelled after takeoff. The breakdown by age was 61.9% adult, 15.1% paediatric and 21.6% neonate. The main indications for IFTs were obstetrics (34.5%), paediatrics (27.9%) and trauma (15.9%). For primary response most cases were trauma (72.9%) and obstetrics (11.3%). The median on-scene time for neonates was significantly longer (48 min, interquartile range (IQR) 35 - 64 min) than that for adults (36 min, IQR 26 - 48; p<0.001) and paediatrics (36 min, IQR 25 - 51; p<0.02). On-scene times for doctor-paramedic crews (45 min, IQR 27 - 50) were significantly longer than for paramedic-only crews (38 min, IQR 27 - 57; p<0.001). CONCLUSION: The low flight-to-population ratio and primary response rate may indicate under-utilisation of the air medical service in an area with a shortage of advanced life support crews and long transport distances. Further studies on HEMSs in rural Africa are needed, particularly with regard to cost-benefit analyses, optimal activation criteria and triage systems. <![CDATA[<b>The cost of harmful alcohol use in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200023&lng=es&nrm=iso&tlng=es BACKGROUND: The economic, social and health costs associated with alcohol-related harms are important measures with which to inform alcohol management policies and laws. This analysis builds on previous cost estimates for South Africa. METHODS: We reviewed existing international best-practice costing frameworks to provide the costing definitions and dimensions. We sourced data from South African costing literature or, if unavailable, estimated costs using socio-economic and health data from secondary sources. Care was taken to avoid possible causes of cost overestimation, in particular double counting and, as far as possible, second-round effects of alcohol abuse. RESULTS: The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 - 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP. DISCUSSION: The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy. CONCLUSIONS: Existing frameworks that guide the regulation and distribution of alcohol frequently focus on maximising the contribution of the alcohol sector to the economy, but should also take into account the associated economic, social and health costs. Current interventions do not systematically address the most important causes of harm from alcohol, and need to be informed by reliable evidence of the ongoing costs of alcohol-related harms. <![CDATA[<b>Attitudes to organ donation among some urban South African populations remain unchanged: A cross-sectional study (1993 - 2013)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200024&lng=es&nrm=iso&tlng=es BACKGROUND: A 1993 paper in the SAMJ suggested that public attitudes to organ donation in South Africa were positive. However, statistics reveal a decline in the annual number of transplants in this country. OBJECTIVE: To repeat the 1993 survey as far as possible and determine whether public attitudes to organ donation in some South African populations have changed over the past 20 years. METHODS: The 1993 study was replicated in 2012 to generate a current data set. This was compared with the raw data from the 1993 study, and an analysis of percentages was used to determine variations. RESULTS: Generally attitudes to organ donation have not changed since 1993, remaining positive among the study population. However, individuals are significantly more hesitant to consider donating the organs of a relative without being aware of that person's donation preference. Individuals in the black African study population are currently more willing to donate kidneys than in 1993 (66% v. 81%; p<0.0001), but less willing to donate a heart (64% v. 38%; p<0.0001), a liver (40% v. 34%; p<0.036) and corneas (22% v. 15%, p<0.0059). CONCLUSIONS: Publicity campaigns aimed at raising awareness of organ donation should emphasise the importance of sharing donation preferences with one's family in order to mitigate discomfort about making a decision on behalf of another. These campaigns should be culturally and linguistically sensitive. The study should be repeated in all populations over time to continually gauge attitudes. <![CDATA[<b>A point-prevalence survey of public hospital inpatients with palliative care needs in Cape Town, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200025&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Vascular disease - everyone's problem</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200026&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Anticoagulation: Where have we come from and where are we going? The evidence for and against novel anticoagulants</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200027&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Chronic venous disorders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200028&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Screening for peripheral arterial disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200029&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Abstracts</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200030&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes. <![CDATA[<b>Case Report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000200031&lng=es&nrm=iso&tlng=es OBJECTIVES: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. METHODS: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. RESULTS: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. CONCLUSIONS: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes.