Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 101 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>The extraordinary story of the life after death of Henrietta Lacks</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>Failing emergency medical services</b>]]> <![CDATA[<b>Restraint use for child passengers in South Africa</b>]]> <![CDATA[<b>Maternal and perinatal health</b>]]> <![CDATA[<b>'Off-key' note speakers</b>]]> <![CDATA[<b>Unbowed respect for tradition saves countless initiates' lives</b>]]> <![CDATA[<b>'Fix the damn system!'</b>: <b>Johannesburg's tertiary hospital doctors</b>]]> <![CDATA[<b>'We didn't "strip" medical aid reserves'</b>: <b>Sanlam CEO</b>]]> <![CDATA[<b> </b><b>The 11 P's of an Afrocentric trauma system for South Africa </b>: <b>time for action!</b>]]> <![CDATA[<b>Pre-hospital rapid sequence intubation</b>]]> <![CDATA[<b>Disclosure of child murder: a case study of ethical dilemmas in research</b>]]> <![CDATA[<b>George Trevor Nurse</b>]]> <![CDATA[<b>Trauma care in South Africa: a call to arms</b>]]> <![CDATA[<b>Assessment of safe endotracheal tube cuff pressures in emergency care: time for change?</b>]]> <![CDATA[<b>The rat lung-worm <i>Angiostrongylus cantonensis</i></b>: <b>a first report in South Africa</b>]]> <![CDATA[<b>Direct admission versus inter-hospital transfer to a level I trauma unit improves survival</b>: <b>an audit of the new Inkosi Albert Luthuli Central Hospital trauma unit</b>]]> OBJECTIVE: To audit the performance of a new level I trauma unit and trauma intensive care unit. METHODS: Data on patients admitted to the level I trauma unit and trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, from March 2007 to December 2008 were retrieved from the hospital informatics system and an independent database in the trauma unit. RESULTS: Four hundred and seven patients were admitted; 71% of admissions were inter-hospital transfers (IHT) and 29% direct from scene (DIR). The median age was 27 years (range 1 - 83), and 71% were male. Blunt injury accounted for 66.3% of admissions and penetrating trauma for 33.7%. Of the former, motor vehicle-related injury accounted for 87.4%, with 81% of paediatric admissions due to pedestrian-related injuries. The median injury severity score (ISS) for the entire cohort was 22 (survivors 18, deaths 29; p<0.001). Patients in the DIR group had a significantly higher mean ISS compared with the IHT group (DIR 25, IHT 20; p<0.02). The overall mortality rate was 26.3%. There were 37 deaths (31.1%) in the DIR group and 70 (24.3%) in the IHT group (p=0.19). In patients surviving more than 12 hours the overall mortality rate was 21.1% (DIR 13.7%, IHT 23.5%; p=0.042). CONCLUSIONS: Trauma is a major cause of premature death in the young. Despite a significantly higher median ISS in direct admissions, there was no difference in mortality. Of those surviving more than 12 hours, patients admitted directly had a significant decrease in mortality. Dedicated trauma units improve outcome in the critically injured. <![CDATA[<b>Is universal coverage via social health insurance financially feasible in Swaziland?</b>]]> OBJECTIVE: The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population. METHODS: The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team. RESULTS AND CONCLUSION: SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018 <![CDATA[<b>Phaeochromocytoma in black South Africans: a 30-year audit</b>]]> OBJECTIVE: Phaeochromocytomas are catecholamine-secreting tumours, the majority of which arise from the adrenal medulla. Untreated, they are potentially lethal; early diagnosis and treatment offer a good chance of cure. They are rarely reported in blacks. The clinical presentation and outcome of phaeochromocytoma in a large cohort of black South Africans is reviewed. METHODS: Patients' records in a tertiary care university hospital were reviewed. Fifty-four black patients presenting with phaeochromocytoma between 1980 and 2009 were included. The clinical presenting features, tumour localisation and outcome were assessed. RESULTS: Fifty-four (41 female, 13 male; age range 8 - 57 years) patients were identified. Five (9%) had familial syndromes; 49 (91%) were deemed sporadic. All tumours were intra-abdominal: 34 (61%) were adrenal and 22 (39%) extra-adrenal in origin. The most common symptoms were headache (77%), palpitations (77%), and sweating (74%). All were hypertensive, almost equally divided between paroxysmal and sustained hypertension. Six (11%) presented in congestive cardiac failure including 2 with catecholamine-induced myocarditis. Two patients had features which simulated hypertrophic obstructive cardiomyopathy. Nine women presented in pregnancy: there was no maternal mortality; fetal mortality included 1 early neonatal death and 1 intrauterine death. There were 4 deaths: 1 from postoperative haemorrhage, 1 from multisystem crisis, 1 from metastatic medullary thyroid carcinoma, and 1 from catecholamine-induced myocarditis. CONCLUSION: Phaeochromocytoma is an important although rare tumour in blacks, with similar clinical presentations and complications to those in white patients. Timely diagnosis and appropriate treatment resulted in a favourable outcome in over 90% of patients in this study. <![CDATA[<b>Guideline for the assessment of trauma centres for South Africa</b>]]> INTRODUCTION: Trauma is a well-known leading cause of unnatural death and disability in South Africa. Internationally the trend is moving toward systematised care. AIM: To revise the Trauma Centre Criteria of the Trauma Society of South Africa and align these with the terminology and modern scope of emergency care practice, using best-care principles as a prelude to the development of trauma systems in South Africa. METHODOLOGY: Revision of existing documents of the Trauma Society of South Africa, the Emergency Medicine Society of South Africa and the Critical Care Society of Southern Africa, where these are relevant to the care of trauma. The committee attempted to harmonise these criteria with the goals of the World Health Organization essential trauma care guidelines for trauma centres and trauma systems. Wide expert consultation was undertaken to refine the criteria before final compilation. RESULTS AND RECOMMENDATIONS: Four levels of trauma care facility are outlined, with the criteria focusing on the trauma-specific requirements of the facilities and their place in the greater trauma system. Accreditation of hospitals according to the criteria will allow for appropriate transfer and designation of patient destination for trauma patients and will improve the quality of care provided. The criteria address structural, process and human resource requirements and medical aspects for the accreditation of various level of trauma centre. CONCLUSION: There is a great opportunity to apply best practice criteria to improve the care of trauma in South Africa and improve patient outcome <![CDATA[<b>Guideline</b>: <b>procedural sedation in the emergency centre</b>]]> BACKGROUND: The performance of safe and effective procedural sedation in the emergency centre has become a core competency in emergency medicine internationally. However, in South Africa clear guidelines are lacking and this guideline attempts to set out the standard for the routine safe use of procedural sedation by clinical staff in emergency centres. METHOD: The Emergency Medicine Society of South Africa (EMSSA) appointed a task group to analyse the international literature and guidelines, and a draft document was produced which was revised by consensus input from an expert panel. RESULTS AND CONCLUSION: A simple and clear practice guideline has been developed for health professionals working in emergency centres in South Africa. This guideline will help to improve the provision of emergency procedural sedation, which is an important component of the care provided in emergency centres