Category: Hospitals

Categories : HospitalsTags :

Mixed Responses to Gauteng Health’s Latest Security Plans

On By ModernMedia
Photo by Maxim Hopman on Unsplash

By Thabo Molelekwa for Spotlight

Following reports of healthcare workers who have been bitten, punched, hit in the face, robbed, assaulted, or even killed in healthcare facilities in Gauteng, the province’s health department announced that healthcare workers will now be trained in handling patients who become violent.

The initiative was recently announced by Motalatale Modiba, spokesperson for the Gauteng Department of Health, on social media.

A lack of security at public healthcare facilities is not a new problem. A previous series of Spotlight articles highlighted security challenges in public health facilities in several provinces – including Gauteng – and reports of robberies and assaults at some facilities. Last year, there was a fatal shooting of a nurse at Tembisa Hospital which sparked an outcry among health worker unions over the safety of their members.

The departments’ announcement prompted questions by organised labour and an opposition politician about whether the authorities have lost trust in the multi-million rand security measures already in place in health facilities to protect both workers and patients, with some arguing that security guards, rather than healthcare workers, should be responsible for safety.

However, according to Modiba, the training of staff has nothing to do with the security contracts of security companies.

“Security personnel are non-medical personnel, therefore, their presence in facilities does not substitute the need to ensure that our staff is empowered with techniques to know how to handle difficult patients,” he told Spotlight.

‘Just a tick-box exercise’

The training plans, however, have inspired little confidence among healthcare workers.

According to the nurses’ union Denosa’s Gauteng Provincial Secretary, Bongani Mazibuko, the training does not address the safety concerns that exist in the facilities. “It’s just a tick-box exercise to say the employer is trying to do something. The root cause of these attacks is the influx of mental health patients and the mixing of mental health patients with medical patients,” he told Spotlight.

The department in a statement in April said many of the incidents were reported at Weskoppies Psychiatric Hospital with 21 cases since January last year. At Carletonville Hospital there were nine safety incidents, nine incidents at the Far East Rand Hospital, seven at Chris Hani Baragwanath Academic Hospital, four at Thelle Mogoerane Hospital, and three at Kopanong Hospital. There were also reports of some isolated incidents at other facilities.

Mazibuko said that from the reports they received from their members working in Gauteng public health facilities, the training has also not yet taken place. “We would like the department to tell us which institutions they have provided the training to so that we can confirm with our members if they received the training or not.”

Modiba, however, did not respond to Spotlight’s questions about where training had taken place so far, how many healthcare workers have been trained, or the impact this is having.

Explaining aspects of the plan, however, Modiba said that the department training staff to know how to protect themselves is a practical step that shows that they are conscious of the environment they operate in. According to him, training on how to manage a violent mental healthcare user is generic to the training of doctors and psychiatric nurses as regulated by the Health Professions Council of South Africa, which is a statutory body established in terms of the Health Professions Act. “A special course on management of violent mental healthcare users is planned to be rolled out from the second quarter of the 2023-2024 financial year. It is based on a similar course attended by one of the healthcare workers in the UK. He will be working in one of our Specialist Psychiatric hospitals, Sterkfontein Hospital. He will be the main facilitator and will be working with other employees from the Regional Training Centres, the Office of Health Standards Compliance (OHSC), and Wellness Practitioners,” said Modiba. He said the department is also working with the police.

But Mazibuko said Denosa has had many talks with the department on healthcare workers’ safety concerns and the need to create a safe working environment. “This was part of our demands when we marched last year. Even on International Nurses Day, we were vocal about our concerns about the safety of our members at the workplace.”

He said the union had previously presented its safety campaign to the department.

SAMA ‘deeply concerned’

Meanwhile, following a scoping review study, the South African Medical Association (SAMA) recently published a report outlining the nature and extent of violence against healthcare workers between 2012 and 2022. The study found an increase in violent acts targeting healthcare workers, with the most affected being doctors, nurses, and paramedics. The study found that female healthcare workers were disproportionately affected compared to their male counterparts and most of the incidents were reported in Gauteng.

In an interview with Spotlight, SAMA Chairperson Dr Mvuyisi Mzukwa said they are “deeply concerned” about the safety of healthcare professionals. He said they appreciate efforts that can realistically improve the safety of healthcare workers in the workplace.

“SAMA has shared an interim report [based on the study findings] on violence targeting healthcare workers with DENOSA and the media. This report was designed to sensitise all stakeholders about crime targeting healthcare workers and to prime the stakeholders, including the National Department of Health, to initiate intersectoral solutions to limit and prevent safety threats in the workplace against all healthcare workers in the country,” Mzukwa said.

SAMA’s report found eight murders of healthcare workers reported in the media, “with six of the deaths (or 75%) occurring among doctors”. One nurse and one paramedic were also murdered in the set period the report found. “Of all the 45 media reports examined, only 17 arrests (38%) were reported, with only two resulting in successful prosecution.”

According to Mzukwa, SAMA had recommended that a multi-sectorial strategy for the security of healthcare workers to protect them from targeted crime be developed and implemented.

“Without this intervention, healthcare in itself continues being further jeopardised and more doctors will feel threatened and seek safer refuge in foreign countries, taking with them critical skills and expertise that are in dire need locally. Law enforcement agencies should also act swiftly in dealing with crime and to ensure the safety of both patients and healthcare providers,” Mzukwa said.

61 safety incidents

Speaking in the Gauteng Legislature in April, MEC for Health and Wellness, Nomantu Nkomo-Ralehoko said there were 61 incidents reported in health facilities between January 2022 and April 2023. She told MPLs that most of these incidents were attributed to mental healthcare users, while others relate to patients’ anger towards staff for various reasons, such as refusal to buy them items or patients trying to escape, as well as angry relatives and patients linked to criminal activities.

Nkomo-Ralehoko said that staff training in responding to aggression and violence in the affected institutions is one element of their intervention. She said the department will be installing CCTV cameras at strategic locations for monitoring purposes.

“Our goal is to minimise – if not eradicate – such incidents in our facilities. We have to work with healthcare workers and other stakeholders such as hospital boards, clinic committees, and the patients themselves to curb incidents of attacks inside our facilities,” she said.

But security concerns in Gauteng’s public health facilities are also fuelled by systemic and contract management issues – something the MEC vowed to address. In March, responding to concerns over these multi-million rand security contracts that are rolled over year on year without a proper tender, Nkomo-Ralehoko acknowledged that the situation is unacceptable. The department is spending over R59 million on month-to-month security contracts at its facilities.

“The security contracts are rolled over irregularly as there is currently no contract in place; only service level agreements are used to manage the contracts,” she said.

Responding to a question from Spotlight on the progress with the new security tender, Modiba said that the tender was advertised and has since closed. “The evaluation committee has been appointed and will now go through the evaluation process to assess the various bids that have been received. We are still on course to complete the process within this financial year,” Modiba said.

But according to Denosa’s Mazibuko, in-sourcing security services, separating mental health patients from other patients, and ensuring that mental health patients are only admitted to where the institutions can commit them, will help the department and the healthcare workers work in a safe space.

He said that the fact that there have been years of year-on-year security contracts, shows that the department is not in touch with the challenges on the ground. “In-sourcing of security will help as well since it will address the issue of security withholding their services as they have not been paid and security being given proper gear for work,” he said.

According to Jack Bloom, the Democratic Alliance’s health spokesperson in Gauteng, the department is failing in its basic responsibility to provide a safe working environment for staff and patients in public hospitals.

“A huge amount of money is spent on security companies that don’t do their job, and it is high time that new security contracts are awarded to competent providers,” he said.

Bloom said that healthcare providers should not have to defend themselves against attacks because that is what security guards are supposed to do. “There needs to be a complete overhaul of security arrangements at our hospitals, with a professional assessment of what should be provided at a reasonable cost,” he said.

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight

Categories : Hospitals Medical IndustryTags :

Review Links Private Equity Takeovers of Healthcare Services to Patient Harm

On By ModernMedia
Photo by Hush Naidoo Jade Photography on Unsplash

Private equity ownership of healthcare services such as nursing homes and hospitals is associated with harmful impacts on costs and quality of care, suggests a review of the latest evidence published by The BMJ. No consistently beneficial impacts of private equity ownership were identified, and the researchers say these results confirm the need for more research on private equity ownership in healthcare and possibly increased regulation.

Private equity firms use capital from wealthy individuals and large institutional investors to buy companies, and, after a relatively brief period of ownership, sell them for substantial returns. Over the past decade, private equity firms have increasingly invested in, acquired, and consolidated healthcare facilities, with global healthcare buyouts exceeding $200bn since 2021 alone. But despite much speculation, it’s still not clear what impact private equity ownership of healthcare operators has on costs, quality of care, and health outcomes.

To address this uncertainty, researchers analysed the results of 55 studies (47 focused exclusively on the US) published in peer reviewed journals in the past two decades.

Nursing homes were the most commonly studied settings, followed by hospitals and dermatology facilities. The studies were designed differently, and were of varying quality, but the researchers were able to allow for that in their analysis.

Nine of 12 studies showed higher costs to patients or payers at health facilities owned by private equity firms (harmful impact), three found no differences, and none showed lower costs (beneficial impact).

Private equity ownership was also associated with mixed to harmful impacts on quality. Of 27 studies that assessed healthcare quality, 12 found harmful impacts, three found beneficial impacts, nine found mixed impacts (some quality measures declined, some improved), and in three the results were neutral.

Health outcomes showed both beneficial and harmful results, as did costs to operators, but the volume of studies for these outcomes was too low for any definitive conclusions to be drawn.

When nursing homes were analysed separately, private equity ownership often had mixed impacts on quality, but the researchers point out that more evidence suggests a degradation rather than an improvement in quality, such as a decrease in nurse staffing or a shift to lower nursing skill mix.

The researchers acknowledge that they did not differentiate between different types of private equity investment and ownership, and were unable to assess larger possible impacts of private equity on access to care. And because most of the included studies occurred in the US, the impacts identified may not apply to all global settings.

Nevertheless, they say this study fills a gap in the current literature on private equity ownership in healthcare, and presents emergent patterns related to private equity ownership that other studies have been unable to synthesise.

As such, they say: “The results of this study confirm the need for increased rigorous research on private equity ownership in healthcare, particularly its impacts on health outcomes and system costs and in other non-US settings, such as Europe.”

“This said, the current body of evidence is robust enough to confirm that private equity ownership is a consequential and increasingly prominent element in healthcare, warranting surveillance, reporting, and possibly increased regulation.”

Source: EurekAlert!

Categories : Hospitals Surgeries & ProceduresTags :

Cancellation of Operations at the Charlotte Maxeke Johannesburg Academic Hospital

On By ModernMedia

The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) would like to dismiss the misleading information shared by Mr Jack Bloom regarding cancelled operations.

CMJAH would like to put it on record that there were no “more than 50 elective cases cancelled due to the cold weather conditions”. The statement by Mr Bloom creates the impression that all elective cases were cancelled, which is not true.

There were 53 operations scheduled for Monday, 10 July 2023, and 26 cases were done, while only 15 were cancelled due to low temperatures at theatres and 12 were cancelled for reasons not related to low temperatures.

Out of the 15 cancelled cases, 3 were for Thoracic, 6 were for Trauma Orthopaedic, 2 were for Paeds Orthopaedic, 1 was for Paeds plastics, and 3 were for Ear, Nose, & Throat.

The problem of temperature control has been a challenge for the facility for years, but it became worse in the last two years due to the copper theft which took place during the period when the facility was evacuated for months after the fire incident. This affected the central heating system of the facility, which regulates the level of acceptable temperatures in the entire hospital, but mostly in the theatres.

To remedy the situation, the process of installing Schedule 40 pipes, which are less susceptible to theft as they do not have an attractive market value as copper does, has started. During the installation process, the theatres and intensive care units (ICU) were prioritised. From the date of appointment, 28 June 2023, to date, the contractor has completed the installation of schedule 40 pipes for Blocks 2, 3 and 4. The installation process at Block 5 has already started and the work is progressing well, ahead of schedule.

The water system is currently running, with close monitoring, at all three blocks where the schedule 40 pipes were installed to check for any possible leaks as the system has not been running for the past two years.

The facility would like to apologise to the public for any inconvenience this might have caused. The installation of the schedule 40 pipes is a necessary project that would address the issue of copper theft and the central heating system.

The facility would further like to assure the public that this matter is getting the urgency it deserves, and cancelled cases are being attended to.

News release issued by the Charlotte Maxeke Johannesburg Academic Hospital

Categories : HospitalsTags :

Staff at Chatsworth Hospital Picket over Poor Working Conditions

On By ModernMedia
Staff, including nurses, at RK Khan Hospital in Chatsworth, Durban, picketed on Wednesday over poor working conditions at the facility. Photo: Tsoanelo Sefoloko

By Tsoanelo Sefoloko

Nurses, administration staff and general workers brought parts of RK Khan Hospital in Chatsworth, Durban, to a standstill for about an hour on Wednesday. They protested outside the hospital to highlight what they say are poor working conditions. 

Protesting nurses say they are forced to perform cleaning duties in addition to patient care because the hospital has not employed enough cleaners. Other workers complained of staff shortages in the administration and general units.

Workers say they met with the management in February. Union leaders had asked the facility to commit to resolving their complaints.

Nurse Zizakele Ndlovu said they were told by the union leaders that working conditions would improve. But nothing changed, she said.

“The conditions we work under at the hospital are not good. We end up having to work more hours, and we don’t get paid for overtime. Sometimes I even work as a clerk,” she said.

“The department treats us as if we don’t know our job, and we don’t deserve what we are asking for. We lost many workers to Covid; some retired and others resigned. Those vacancies have not been filled. Even at top management there are lots of vacancies and this leads to poor service.”

Chairperson at the hospital of the National Education, Health and Allied and Workers’ Union (NEHAWU) David Mpongose said they had engaged management and had been promised that the situation would improve.

“Our bosses are arrogant. They really don’t take us seriously. Each time they make empty promises, so we decided to protest for the provincial government to assist us,” said Mpongose.

Xolani Mnguni, a cleaner, said he earned R7800 per month under the hospital’s previous contractor, but now only earns R3000 under the current contractor. He also said he has to do jobs other than cleaning.

Hospital CEO Linda Sobekwa accepted the workers’ memorandum and signed it on behalf of the provincial health department. She promised to ensure that the department responded within ten days as requested.

Agiza Hlongwane, spokesperson for the KwaZulu-Natal Department of Health, said officials would consider the workers’ demands and respond to them.

Republished under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Hospitals Medical Research & TechnologyTags :

Would it be Ethical to Entrust Human Patients to Robotic Nurses?

On By ModernMedia
Photo by Alex Knight on Unsplash

Advancements in AI have resulted in typically human characteristics like creativity, communication, critical thinking, and learning being replicated by machines for complex tasks like driving vehicles and creating art. With further development, these human-like attributes may develop enough to one day make it possible for robots and AI to be entrusted with nursing, a very ‘human’ practice. But… would it be ethical to entrust the care of humans to machines?

In a step toward answering this question, Japanese researchers recently explored the ethics of such a situation in the journal Nursing Ethics.

The study was conducted by Associate Professor Tomohide Ibuki from Tokyo University of Science, in collaboration with medical ethics researcher Dr Eisuke Nakazawa from The University of Tokyo and nursing researcher Dr Ai Ibuki from Kyoritsu Women’s University.

“This study in applied ethics examines whether robotics, human engineering, and human intelligence technologies can and should replace humans in nursing tasks,” says Dr Ibuki.

Nurses show empathy and establish meaningful connections with their patients, a human touch which is essential in fostering a sense of understanding, trust, and emotional support. The researchers examined whether the current advancements in robotics and AI can implement these human qualities by replicating the ethical concepts attributed to human nurses, including advocacy, accountability, cooperation, and caring.

Advocacy in nursing involves speaking on behalf of patients to ensure that they receive the best possible medical care. This encompasses safeguarding patients from medical errors, providing treatment information, acknowledging the preferences of a patient, and acting as mediators between the hospital and the patient. In this regard, the researchers noted that while AI can inform patients about medical errors and present treatment options, they questioned its ability to truly understand and empathise with patients’ values and to effectively navigate human relationships as mediators.

The researchers also expressed concerns about holding robots accountable for their actions. They suggested the development of explainable AI, which would provide insights into the decision-making process of AI systems, improving accountability.

The study further highlights that nurses are required to collaborate effectively with their colleagues and other healthcare professionals to ensure the best possible care for patients. As humans rely on visual cues to build trust and establish relationships, unfamiliarity with robots might lead to suboptimal interactions. Recognising this issue, the researchers emphasised the importance of conducting further investigations to determine the appropriate appearance of robots for facilitating efficient cooperation with human medical staff.

Lastly, while robots and AI have the potential to understand a patient’s emotions and provide appropriate care, the patient must also be willing to accept robots as care providers.

Having considered the above four ethical concepts in nursing, the researchers acknowledge that while robots may not fully replace human nurses anytime soon, they do not dismiss the possibility. While robots and AI can potentially reduce the shortage of nurses and improve treatment outcomes for patients, their deployment requires careful weighing of the ethical implications and impact on nursing practice.

“While the present analysis does not preclude the possibility of implementing the ethical concepts of nursing in robots and AI in the future, it points out that there are several ethical questions. Further research could not only help solve them but also lead to new discoveries in ethics,” concludes Dr Ibuki.

Source: Tokyo University of Science

Categories : HospitalsTags :

Don’t Teach us Resilience – Fix the Problem, Doctors and Nurses Say

On By ModernMedia
Source: Pixabay CC0

A unique collaborative study on hospital clinician wellbeing by teams at 60 of the best US hospitals, was published in JAMA Health Forum. The study found that physicians and nurses, even at hospitals known to be good places to work, experienced adverse outcomes during the pandemic and want hospital management to make significant improvements in their work environments and in patient safety.

The solutions to high hospital clinician burnout and turnover, they say, are not resilience training for clinicians to better cope with adverse working conditions but organisational improvements that provide safe workloads and better work-life balance.

Researchers sought information in 2021 from 21 050 physicians and registered nurses practicing in 60 Magnet recognised hospitals in 22 states. Forty-seven percent of nurses and 32% of physicians experienced high burnout. Twenty-three percent of physicians and 40% of nurses said they would leave their jobs if possible. Less than 10% of physicians and nurses reported experiencing joy in their work.

Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.

Linda H Aiken, PhD, study lead author

Not having enough nurses to care for patients, having little control over workloads, lack of confidence in management to resolve problems in patient care, and concerns about patient safety were all associated with higher burnout, job dissatisfaction, and intent to leave among both nurses and physicians.

Lead author Linda H Aiken, PhD, at the University of Pennsylvania said, “Physicians and nurses largely agree about what hospital management could do to address their burnout, job dissatisfaction, and plans to leave their current jobs; they want improved staffing, modern working conditions in which they can spend more time in direct patient care, greater control over their workloads and work schedules, and a higher priority on patient safety.”

Eighty-seven percent of nurses and 45% of physicians said improving nurse staffing was very important to their own mental health and wellbeing. Other high priorities for clinicians were health breaks without interruption and reduced time spent on documentation. Aiken added, “Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.”

Clinicians are concerned about quality and safety of care. Half of physicians and nurses lack confidence that their patients can safely manage their care after discharge highlighting the need for improvement in discharge planning. Patient safety remains a concern with 26% of nurses and 12% of physicians giving their own hospitals an unfavorable patient safety grade. Thirty-nine percent of nurses and 33% of physicians feel mistakes are held against them contrary to recommendations of the National Academy of Medicine to search for and correct system deficiencies that cause most medical errors.

The study was carried out by Penn Nursing’s Center for Health Outcomes and Policy Research in collaboration with the US Clinician Wellbeing Study Consortium composed of 60 Magnet Hospitals. The study took place in 2021 during the COVID pandemic, a time when all US hospitals were severely challenged. Previous research shows that clinicians in hospitals with better work environments prior to the pandemic had better outcomes during the pandemic. The Consortium committed to this study to learn from their experiences during the pandemic how to sustain and further improve their favourable work environments to better withstand external threats and to rebound rapidly.

Source: University of Pennsylvania School of Nursing

Categories : Antibiotics HospitalsTags :

‘Nothing Compares’ to Antibiotic Resistance Discovered in War-torn Ukraine

On By ModernMedia
Photo by Vony Razom 🇺🇦 on Unsplash

Researchers assisting microbiologists in Ukraine have found an extremely high level of bacterial resistance among the war-wounded patients treated in hospitals. The study, recently published in The Lancet Infectious Diseases, found resistance in many hospital-acquired infections stemming from damaged and overwhelmed healthcare infrastructure, with many samples resistant to the last-resort antibiotic colistin.

“I am quite thick-skinned and have witnessed numerous situations involving patients and bacteria. However, I must admit that I have never encountered bacteria as resistant as this before,” says Kristian Riesbeck, professor of Clinical Bacteriology at Lund University in Sweden.

There was never any doubt about helping out when Dr Oleksandr Nazarchuk, a microbiologist at a university in Vinnytsia, Ukraine, got in touch, says Kristian Riesbeck. Help was needed in Ukraine to assess the extent of antibiotic resistance in bacteria among severely injured patients in hospital.

In addition to all the human suffering caused by the war in Ukraine, another battle is being fought — an invisible war against resistant bacteria. This became evident when Kristian Riesbeck and his research colleagues analysed patient samples from seriously wounded patients, many of whom had burn injuries, in Ukraine. The patients had acquired infections while in hospital, primarily due to the overwhelmed wards and destroyed infrastructure.

Samples were collected from a total of 141 war victims, 133 adults who sustained injures during the war and eight infants diagnosed with pneumonia. These patients were admitted to three different hospitals in Ukraine, where they received emergency surgeries and intensive care to address their conditions.

“We observed that several the Gram-negative bacteria exhibited resistance to broad-spectrum antimicrobial agents, including newly developed enzyme-inhibiting antibiotics that are not yet available in the market. Moreover, nearly ten per cent of the samples contained bacteria that demonstrated resistance even to our ‘last-resort’ antibiotic, colistin. While we have encountered similar cases in India and China before, nothing compares to the extent of resistance observed in this study. As much as six per cent of all the samples contained bacteria resistant to every antibiotic we tested,” says Kristian Riesbeck.

He emphasizes that this clearly highlights the challenges posed by resistant bacteria in times of war. In particular, Kristian Riesbeck expresses concern regarding the resistance displayed by Klebsiella pneumoniae bacteria, as they have the potential to cause illness in individuals with a healthy and well-functioning immune system.

“This makes me very worried. It’s rare to encounter Klebsiella with such high levels of resistance, and it was not what we anticipated. While isolated cases have been documented in China, the magnitude of this situation surpasses anything we have seen before. While many countries are providing military aid and resources to Ukraine, it is equally crucial to assist them in addressing this ongoing situation. There is an evident risk of further spread of resistant bacteria, and this threatens the entire European region,” remarks Kristian Riesbeck.

Source: Lund University

Categories : General Interest HospitalsTags :

Gauteng Hospitals’ Food Woes Continue and Health Dept Outsources Cancer Care

On By ModernMedia
Photo by Thought Catalog on Unsplash

A number of service providers have voluntarily ended their contracts with the Gauteng Department of Health to provide food to hospitals. In response, Gauteng Health is looking at a multi-vendor approach to tackle the problem which it blames on vendors being unable to fulfil their orders.

Meanwhile, Gauteng continues to battle with surgical and cancer treatment backlogs. R784 million has been allocated to this end, with a portion allocated to cancer treatment services, some of which will be outsourced to the private sector and some of which is going to new radiotherapy equipment.

This year has seen a number of Gauteng hospitals battling to secure their food supplies. Responding to SA parliamentary questions, Gauteng Health MEC Nomantu Nkomo-Ralehoko wrote that 26 out of 34 Gauteng public hospitals have been affected by food shortages.

“The shortages were mostly due to suppliers not being paid, contracts expiring, or companies not delivering. It was so bad for two hospitals, Bronkhorstspruit and Lenasia South, they had to borrow food from other hospitals!” said DA Shadow MEC for Health, Jack Bloom, who posed the questions.

Hospitals have being going through long stretches of not being able to provide full meals: at George Mukhari Hospital, chicken, fish and frozen vegetables were unavailable for four months, and there was no milk from February to May. The petty cash budgets are woefully insufficient to cover the gap: Kalafong hospital can only spend R2000 a day, not nearly enough to feed its 700 patients, reports SA People.

According to News24, Gauteeng Health spokesperson, Motalatale Modiba, said that the main problem was down to vendors struggling to fulfil their orders on time.

Currently, Gauteng health is running a tender to outsource oncology services for the Charlotte Maxeke and Steve Biko hospitals. The outsourcing programme should be able to ensure that patients who are currently awaiting treatment in the public sector will be able to access private sector treatment instead.

In their announcement, Gauteng Health stated: “We recognise the urgency of the situation and want to assure the public that we are committed to handling the outsourcing of radiation oncology sources diligently and are nearing implementation.”

The open tendering process will last 14 days, and is divided into categories for oncology specialists, treatment services and radiation planning services.

The department has already procured 4 Llinac machines, and has recently closed a tender for a Brachytherapy, and have advertised a tender for another Linac machine for Charlotte Maxeke. Ongoing investigations by Spotlight have also revealed that the oncology procurement process is lagging behind. The GDoH aims to have the first treatments under the outsourcing programme to start in August 2023.

Categories : HospitalsTags :

Which IV Fluids to Use in Sepsis… and When Not to Use Them

On By ModernMedia
Photo by Marcelo Leal on Unsplash

In the leading Journal of the American Medical Association, two researchers outline how to use intravenous fluids to treat sepsis, a deadly condition that affects nearly a third of all ICU patients. Despite the fact that IV fluid therapy is a cornerstone of sepsis treatment, it’s not always a sure bet – in fact, as the authors outline in their paper, giving IV fluids can sometimes worsen sepsis.

Which fluids to give, how much to give and when have been fiercely debated for years.  

“This is an intervention that is cheap and easy to use and it can be life-saving, but it can also be harmful for patients if too much fluid is given,” explains first author Fernando Zampieri, a newly recruited assistant professor at University of Alberta.    

The new JAMA article sums up the latest science on the phases of sepsis and how much IV fluid to give at each stage of treatment. 

“It’s aimed at the clinician who works on the wards, who works in community hospitals, who works in emergency departments, explaining the mechanisms to assess whether patients are responding or not and decide whether more fluid needs to be given,” says Sean Bagshaw, professor and chair of critical care medicine, who co-wrote the paper with Zampieri and Matthew Semler of Vanderbilt University.

“These are really fundamental issues that have been challenging for clinicians to reconcile and have long been controversial, so this concise review bundles all recent evidence together,” Bagshaw says.

A complex and life-threatening condition

One in four patients who develop sepsis die from it, and it’s responsible for 11 million deaths per year, Zampieri estimates. Sepsis is an extreme response by the body to an infection, leading to a drop in blood pressure and thus a lack of oxygen circulation. Death occurs when oxygen-deprived organs such as the brain, kidneys or liver fail. 

Treatment almost always includes administering intravenous fluids, along with other interventions such as antibiotics and medications to boost blood pressure and oxygen delivery to tissues. The goal is to restore circulation without causing edema, or swelling, which can also be harmful to organs. 

Sepsis can occur at any time in life from infancy to old age, says Bagshaw. Zampieri points out that sepsis is not really one disease, but a complex condition with multiple causes. 

“When we talk about sepsis, you can be talking about things as different as a young woman with an infection after delivery all the way through to an elderly patient with a urinary tract infection. Those are two completely separate sources of infection, and the patient’s other conditions make treatment more complicated,” he says.

Zampieri says there are numerous clinical trials underway to refine sepsis treatment, but much is still unknown. Zampieri himself has been involved with trials in Brazil to determine whether slower fluids make a difference to clinical outcomes, to compare the efficacy of using saline versus a balanced solution (Plasma-Lyte 148), and to find out whether measuring lactic acid, which is produced when the body is starved of oxygen, is a good indicator of whether enough fluids have been given.

Digging for evidence to improve practice

Zampieri plans to continue his program of clinical trials and also wants to help physicians and health systems adopt best treatment practices as they are verified. Eventually he hopes to develop an accurate bedside test, such as using ultrasound, to better determine what level of fluids a patient requires.  

“Clinical trials are the best way to provide evidence that will change practice,” he says.

Bagshaw expects sepsis treatment to improve rapidly over the next decade thanks to such work.

“It took us 30 or 40 years to get to this point, and I think there’s still lots of questions to be answered about how best to individualise the resuscitation strategies amongst patients with life-threatening infection and sepsis,” Bagshaw says. “My hope is that Fernando will help catalyse some of those advances here at the U of A.”

Source: University of Alberta

Categories : HospitalsTags :

How Well do Patients Understand Probabilities in Medical Results?

On By ModernMedia
Photo by Cottonbro on Pexels

To communicate medical results to patients, who may find them hard to understand, is a challenging task – especially when it comes to making sense of statistical information. An interdisciplinary team of scientists has published a study in PLOS ONE investigating how communication between doctors and patients about actual risks can be made more effective.

“Even doctors sometimes have difficulties in determining the right predictive value. And if the data is difficult for the doctor to interpret, it’s even harder to communicate the information accurately to patients in a way they will understand,” says study author and mathematics educationalist Karin Binder.

The following case will serve as an example: A patient has just received a conspicuous sonographic finding of his thyroid. Does this mean he has thyroid cancer? Not necessarily, because there is a certain probability that the result of the examination will be positive even though the patient does not have thyroid cancer.

To explain to patients what the statistical picture looks like after such a positive test result, there are two approaches. One of them requires some lateral thinking, while the other is much easier to interpret from the patient’s perspective, as the researchers were able to demonstrate.

Bayesian vs diagnostic information

The commonly used Bayesian approach proceeds from the number of patients who actually have the disease. First of all, the doctor explains how frequently the disease occurs overall – for example: “out of 1000 patients, 50 have thyroid cancer.” Then the doctor lays out: a) for how many of these patients with thyroid cancer, the test result is positive (20 out of 50) and b) how many people who do not have thyroid cancer nonetheless have a positive test result (110 out of the remaining 950).

This is generally the information the doctor either knows or can easily research. Positive tests as a proportion of people with the disease is also known as sensitivity – a term that may be familiar from the COVID pandemic, when it was used, for example, as a quality criterion for rapid tests. Unfortunately, however, positive tests as a proportion of people with the disease is often confused with people with the disease as a proportion of positive tests! And these two percentages can greatly differ depending on the situation.

So what do the numbers quoted above mean in relation to a person with a positive test result? How many people who test positive actually have the disease? If for you the answer is not immediately apparent, you are not alone: Without further information, only 10% of participants were able to calculate how many people with positive results actually had the disease.

“Diagnostic” communication of information proceeds very differently: First of all, the doctor explains how many patients have positive test results, irrespective of whether they actually have the disease or not. In our example, this would be 130 people with a conspicuous thyroid ultrasound (out of 1000 people examined). Next, the doctor explains how many of these people with positive tests actually have the disease (20 out of 130) and how many of the people with negative test results have the disease (30 out of 870).

The relevant information is contained here directly and without the need for mental arithmetic: If my result is positive, then the probability is a 20 out of 130 that I actually have thyroid cancer. When communicated in this form, 72% of study participants were capable of arriving at this conclusion, compared to 10% with the Bayesian approach.

How to best communicate statistical information?

“With Bayesian communication, moreover, participants were considerably slower in reaching the correct result, if they got there at all,” says Karin Binder. “And in busy doctor’s offices and hospitals, this time is often not available.” The team of authors therefore calls on doctors to use diagnostic information communication more readily in future. This would go some way to avoiding confusion, misinterpretation, and wrong decisions.

It would be even better, however, to take the time to give patients a full picture of the situation, containing both diagnostic and Bayesian information. Only this can explain the surprising phenomenon whereby even a medical test with outstanding quality criteria can have very limited predictive power under certain circumstances (eg, routine screenings).

Source: Ludwig Maximilian University of Munich