Category: Hospitals

Categories : General Interest HospitalsTags :

Maternity Wards at Dora Nginza Hospital ‘Chaotic’ as Nurses Down Tools

On By ModernMedia

By Joseph Chirume at GroundUp

Services at the Dora Nginza Hospital in Gqeberha, Eastern Cape are under strain as the nurse’s strike entered its second day on Friday. The striking nurses are demanding that management provide more beds and staff to the maternity wards, among other demands. They claim that their previous engagements with the health department have been fruitless.

On Thursday, some patients were moved to another hospital. Dora Nginza Hospital is the centre for maternal and paediatric care for the western part of the Eastern Cape.

A pregnant woman at the hospital described the maternity ward as “chaotic”.

“Heavily pregnant women were crying for help that was not coming. Many people are sleeping on the cold floor and there is a smell of blood in the ward. The few nurses there are overwhelmed,” she said.

Vuyo Nodlawu, regional chairperson of the Democratic Nursing Organisation of South Africa (DENOSA), told GroundUp that the maternity wards do not have enough beds and resources to cope with the influx of patients since Monday. “Patients, be it prenatal or postnatal, did not have beds to sleep on. The situation has been getting worse, to the extent that patients who had given birth were removed from beds to accommodate those in labour,” he said.

Nodlawu said the hospital’s management had told medical practitioners to stop admitting patients if there were no more beds available or until the matter was resolved. “However, the doctors continued to admit patients. Nurses then decided to allocate all available beds within the maternal department to everyone who didn’t have a bed,” said Nodlawu.

A meeting was called between the maternal directorate from the head office and the hospital but it was unsuccessful.

Mzikazi Nkatha, provincial deputy secretary of the National Union of Public Service and Allied Workers (NUPSAW)’s, said, “Nurses are saying enough is enough. They can’t continue as normal when patients have to lie on the floor and not on hospital beds. This is also an overwhelming number of patients and not enough health providers to care for them.”

Health department spokesperson Yonela Dekeda said union leaders have not been willing to negotiate with officials sent by management. Dekeda said plans to “decongest” Dora Nginza Hospital are underway, with emergency cases being referred to Port Elizabeth Provincial Hospital.

She said a team from other hospitals across the district were deployed to assist. The team included Anaesthetics, Obstetrics , Gynaecology, Paediatrics, Neonatology, Nursing and non-clinical support services.

“The designated ward and theatre at the Provincial Hospital has been staffed and equipped with the relevant equipment and medication. The Emergency Medical Services is also part of the response team and will coordinate patient transfers between facilities,” she said.

Dekeda said the department considers the nurses’ action as an unprotected strike. “These essential workers are refusing to engage with senior management nor do they want to return to work. The department takes this very seriously and the administrative and legal remedies at our disposal are being deployed,” she said.

DENOSA’s deputy regional chairperson Vuyo Dlanga has vowed that nurses would continue their action until provincial government officials meet them to resolve the issues.

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

Source: GroundUp

Categories : HospitalsTags :

Haloperidol Could be Better for Some ED Patients with Nausea and Vomiting

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Source: Mat Napo on Unsplash

For certain patients with vomiting and nausea in the emergency department (ED), haloperidol may be a better alternative to the usual ondansetron, according to a small study presented at the American College of Emergency Physicians annual meeting.

“[Haloperidol] is definitely a drug that’s going to help young patients with benign abdomens who come in with vomiting and generalised abdominal pain,” study presenter Jessica McCoy, MD, told MedPage Today.

Dr McCoy presented data showing that, at 90 minutes, median abdominal pain Visual Analogue Scale (VAS) score fell from 5 to 0 in the patients who received haloperidol compared with a VAS score drop from 6 to 3.5 in the ondansetron group.

Also at 90 minutes, median nausea VAS score fell from 7 to 0.5 in the haloperidol group versus 6 to 3.5 in the ondansetron group.

Of 48 patients (ages 18-55) who were included and completed the study, 22 were randomised to receive 2.5mg of intravenous haloperidol (half the usual dose) and 26 to receive 4mg of IV ondansetron.

Dr McCoy said despite concern over haloperidol prolonging the QT interval, no sign of a difference between the drugs was found. Among the 29 cannabis users in the study, haloperidol was not found to be superior at 90 minutes post-treatment, she said.

Halving the dose of haloperidol seemed to prevent common side effects of anxiety, sedation, and restlessness, Dr McCoy noted.

Adverse effects, which resolved by the time of discharge from the ED, included three cases of anxiety/restlessness and one case of tongue swelling in the haloperidol group and single cases of restlessness, sleepiness, and irritated throat in the ondansetron group.

Nausea and vomiting is commonly reported by ED patients, one of the top five complaints in the ED, and a diagnosis may be elusive if urgent treatment is not needed, she explained. “There’s this whole list of things it could be that make you feel lousy for a little bit but get better on their own.”

Increased chronic cannabis use, meanwhile, has caused more cases of nausea and vomiting, she said.

ED physicians often use ondansetron, developed for nausea in chemotherapy patients, Dr McCoy said. However, ondansetron “doesn’t work great. And it really wasn’t developed for people who were actively vomiting.”

The new study follows on from Dr McCoy’s previous research demonstrating the benefit of haloperidol for severe benign headache. She noted that the new study is small and was halted at the interim analysis due to COVID. At that time, ED waits were six or seven hours long, she said, and some patients with nausea and vomiting gave up and went home.

Dr McCoy noted that the ED physicians at her institution continue to turn to alternatives to ondansetron such as haloperidol in appropriate cases, especially in patients with anxiety. Haloperidol, however, is not appropriate, she cautioned, for more complex cases such as patients with rigid abdomens, possible dissections, or who have a need for surgery.

Like ondansetron, haloperidol is inexpensive, she added. “I hope [the new research] spurs more interest in studying this drug and its pain-relieving properties.”

Source: MedPage Today

Categories : HospitalsTags :

Patient Safety Incidents Doubled for Docs Suffering from Burnout

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Photo by Mulyadi on Unsplash

Doctors experiencing burnout are twice as likely to be involved in patient safety incidents and four times more likely to be dissatisfied with their job, suggests research published today in The BMJ.

The scale of burnout amongst clinicians and the serious impact it can have on patient safety and staff turnover has been revealed in the largest and most comprehensive systematic review and analysis of studies on the subject to date.

Evidence is showing that burnout is is reaching global epidemic levels among physicians. Representatives have warned that spare capacity in the field of medicine is nearing what they call crisis point.

Burnout is defined as emotional exhaustion, cynicism and detachment from the job, and a feeling of reduced personal accomplishment. In the UK, a third of trainee doctors report that they experience burnout to a high or very high degree, while in the US, four in 10 physicians report at least one symptom of burnout. And in a recent review of low and middle income countries the overall single-point prevalence of burnout ranged from 2.5% to 87.9% among 43 studies.

Yet there is a lack of evidence about the association of burnout with a physician’s career engagement and how that potentially impacts on the quality of patient care.

To address this, a team of researchers based in the UK and Greece set out to examine the association of burnout with the career engagement of physicians and the quality of patient care globally.

To do this, they selected and analysed the results of 170 observational studies on the subject involving nearly 240 000 physicians.

Their analysis showed that physicians with burnout were up to four times more likely to be dissatisfied with their job and more than three times as likely to have thoughts or intentions to leave their job (turnover) or to regret their career choice.

Equally worrying was the finding that physicians with burnout were twice as likely to be involved in patient safety incidents and show low professionalism, and over twice as likely to receive low satisfaction ratings from patients.

The analysis also found that burnout and poorer job satisfaction was greatest in hospital settings, physicians aged 31–50 years, and those working in emergency medicine and intensive care, while burnout was lowest in general practitioners.

The association with burnout and patient safety incidents was strongest among physicians aged 20–30 years and emergency medicine workers.

The study authors acknowledge some limitations in their research including the fact that precise definitions of terms, such as patient safety, professionalism, and job satisfaction, varied between the studies analysed so may have led to some overestimation of their association with burnout.

The assessment methods varied widely between the 170 studies, and the design of the original studies imposed limits on their ability to establish causal links between physician burnout and patient care or career engagement.

Nevertheless, the authors concluded: “Burnout is a strong predictor for career disengagement in physicians as well as for patient care. Moving forward, investment strategies to monitor and improve physician burnout are needed as a means of retaining the healthcare workforce and improving the quality of patient care.”

“Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency,” they added.

This research adds to growing evidence that the poor mental health of healthcare providers jeopardises the quality and the safety of patient care, says Matthias Weigl, Professor of Patient Safety at Bonn University, in a linked editorial.

“The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector,” Prof Weigl warned. 

“Urgent action is imperative for the safety of physicians, patients, and health systems, including interventions that are evidence based and system oriented, to design working environments that promote staff engagement and prevent burnout,” he concluded.

Source: The British Medical Journal

Categories : Ethics and Law HospitalsTags :

Health MEC Liable for Patient Who Fell to His Death, Court Rules

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Photo by Tingey Injury Law Firm on Unsplash

By Tania Broughton for GroundUp

The High Court in Gqeberha has found that the Eastern Cape MEC for Health and Livingstone Hospital are liable to pay damages to the widow of a man who died after falling from the fifth floor of the hospital.

In the ruling last week, Acting Judge Ivana Bands found that the patient, George Williams, had not been properly medicated or monitored. She said that had this been done, Williams would not have been “pacing up and down the ward, in confused, restless and disoriented state”, and would not have fallen to his death from the window.

Judge Bands said the conduct of the medical and nursing personnel who treated Williams after he was admitted to the hospital on 3 October 2013, “fell far short of what is regarded as sound practice” in dealing with patients suffering from alcohol withdrawal – delirium tremens which involves sudden and severe mental or nervous system changes – and secondary schizophrenia.

“Had he been properly medicated, it cannot be gainsaid [denied] that he would have been reduced to a calm and lightly dozing state. This would have enabled the medical and nursing staff to monitor his vital signs and his condition appropriately until such time that delirium tremens had abated,” Judge Bands said.

Read the judgment

Judge Bands’s finding of negligence means that Williams’s widow Jeanine can now pursue a monetary damages claim against the MEC and hospital. This could be determined at another trial or through negotiation.

Jeanine Williams, in her papers, contended that the hospital staff were under a legal duty to provide her husband with adequate and timeous medical treatment; that they had not properly sedated him, restricted his movements and monitored his condition.

The defendants, however, argued that Williams had been treated with sedatives, including diazepam (Valium) and that he had been put in an “enclosed locked ward” close to the nurses’ station.

Bands said Wiliams was a known alcoholic who was admitted to the hospital late on 3 October 2013. In the early hours of the morning, he had been given diazepam, with little effect. During the evening of 4 October, he was given more sedatives and an antipsychotic agent, also with no effect.

Soon after, at about 10:30pm, Williams broke the outside entrance glass door of the nurses’ tearoom and fell from the fifth floor. He died about an hour later.

Two key witnesses during the trial were Dr Candice Harris, a professional nurse and general practitioner, who testified for Williams, and Dr Michelle Walsh, a general surgeon, who testified for the MEC and the hospital.

In her evidence, Harris had said delirium tremens was a “medical emergency” and, according to guidelines, immediate management of the condition was necessary. She had stressed the importance of re-orientating the patient and said it was the nurse’s duty to inform the doctor if the patient was not responding to medication.

The judge said Walsh’s evidence was that it was not that the hospital was doing nothing – “they were doing something”.

“She said the sedation prescribed is usually based on what the assessing doctor thinks will have the desired effect to calm the patient to the extent that they would sit calmly in a chair. It is common cause that this desired state was never reached,” the judge said.

“Not only was he under-sedated, there is no evidence that the initial dose, which had no effect, was ever increased as per the published guidelines, in spite of multiple entries in the hospital records that he remained confused, disorientated, restless and walking up and down – and that he had become so agitated that the nursing staff feared he would assault them,” the judge said.

Bands said Williams had not been treated according to the guidelines, thus the MEC and the hospital are liable for any proven damages.

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

Source: GroundUp

Categories : HospitalsTags :

Operation Dudula Harasses Immigrants outside Kalafong Hospital

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Police were present at Kalafong Hospital in Tshwane on Wednesday after the Gauteng Health Department obtained an interdict to prevent members of Operation Dudula from threatening immigrants. Photo: Mosima Rafapa

Members of Operation Dudula were outside Kalafong provincial hospital in Tshwane on Wednesday, shouting at immigrant patients and employees. Police were present, enforcing the court interdict obtained last week by the Gauteng Health Department against the threats.

A security guard who did not want to give his name said for most of August Operation Dudula members had been operating outside the hospital, until the Gauteng Department of Health obtained a court interdict last Friday.

“They greeted patients who were of a dark skin colour one by one, to check which language they spoke and to listen to their accent. The local language here is Tswana or Pedi. If they found that you don’t know those languages, they turned you away,” said the security officer, whose station is not far from the pedestrian entrance.

Since 4 August, Operation Dudula has been trying to deny access to patients and employees from other countries.

“I’m here at 5:30 in the morning. Just before 8am this morning, a member of Operation Dudula was speaking through a loudspeaker saying they don’t want makwerekwere. On Monday, they checked their ID documents before people could enter the hospital. Today, they were about five or six of them outside. I think they wanted to scare people away because they just stood there until the police arrived,” he added.

Last Friday, the Gauteng MEC for Health obtained a court interdict against the members from threatening or denying access to patients and employees. The interdict was pinned to the notice board outside the hospital.

When GroundUp arrived just after 10am, a handful of Operation Dudula members were still gathered outside. Some were shouting that foreigners should leave.

Chairperson of Operation Dudula in Atteridgeville and regional coordinator in Greater Tshwane Elias Makgwadi said they were picketing outside the hospital entrance to get management to enforce the hospital’s admission rules and not admit “illegal foreign nationals”.

“We are saying, enforce your own rules. If illegal foreign nationals have been admitted to hospitals they must be discharged to law enforcement officers and immigration officers. That’s why we’re here, ” said Makgwadi.

Members of the Economic Freedom Fighters (EFF) put up a tent outside the hospital entrance and started chanting songs. Provincial spokesperson Phillip Makwala told the crowd: “Operation Dudula is acting as doctors, they are interfering with the process of the South African Police Service and the immigration office.”

Police officers were stationed outside the hospital.

Verrah Frace, from Zomba in Malawi, condemned the xenophobia. She works as a domestic worker in Laudium, west of Pretoria. Frace, who had come to visit her sick sister, said it was painful to see what Operation Dudula was doing.

“I came to South Africa in 2019 to look for a job because we are very poor back in Malawi. We are in South Africa to earn a living,” said Frace.

GroundUp heard a hospital employee wearing a pharmacy tag praising the Operation Dudula members. “These people get our medicine for free. They get everything for free. You guys are helping us. You are doing a great job,” said the employee before going back inside the hospital.

James Chasiya, from Magochi in Malawi, was at the hospital to see his wife who had given birth to a premature baby. He arrived in South Africa in 2014 and works as a plumber, living in one room in Laudium with his wife.

“Sometimes the piece jobs are hard to come by so I sell some of the furniture I have in order to pay rent. It’s not as easy living here as people think. We struggle. My wife works at a creche but it’s still hard. I’m undocumented so I can’t find a real job. There’s no way I can pay for a private hospital,” said Chasiya.

Head of Communication for the Gauteng Department of Health Motalatale Modiba had not responded to GroundUp’s questions by the time of publication.

The health department’s Motalatale Modiba said that the facility reported that operations are continuing as normal with no change in the number of patients.

“There is now increased police monitoring the situation. Patients are no longer obstructed from coming into the facility. The Department would like to assure patients that the hospital continues to render services to all who need such care,” he said.

Modiba said the department will not hesitate “to call law enforcement agencies to act against those that put the lives of patients and staff at risk”. He said the Department obtained a court interdict on 26 August from the High Court in Pretoria “to prevent a group of people from threatening, preventing and denying patients (deemed to be non-South African) and employees at Kalafong Hospital from accessing the facility to receive medical attention and to administer care respectively”.

Written by Mosima Rafapa

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

Source: GroundUp

Categories : Diseases, Syndromes and Conditions HospitalsTags :

Toss Out Hospital Sinks Colonised by MDRO, Evidence Suggests

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Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Credit: CDC

An outbreak of a pandrug-resistant nosocomial pathogen was interrupted by not using hospital sinks during COVID, according to Basma Mnif, Professor of Microbiology at Habib Bourguiba University Hospital of Sfax, Tunisia. In her presentation at the 14th SAFHE Southern African Healthcare Conference, she said that infection control methods to eradicate the pathogen failed and that other research indicated it was necessary to replace the sinks entirely.

Multidrug-resistant organisms (MDRO) are a growing threat in hospitals, especially to critically ill patients.

Over 2017 to 2021, 90 critically ICU patients in a Tunisian hospital were infected with pandrug-resistant Proteus mirabilis strains. This is the first known long-term outbreak by pandrug-resistant P. mirabilis strains.

P. mirabilis is an uncommon nosocomial pathogen causing opportunistic infections. P. mirabilis survives well in the natural environment and is increasingly implicated in nosocomial outbreaks worldwide.

The all-cause mortality rate in the infected was 47%, with patients ranging in age from 16 to 78 years. The average length of stay before infection was 23.56 days.

An outbreak was recognised in April 2017, and IDC measures were taken to contain it. The outbreak was suppressed but reoccurred in July and December. Analysis revealed overlapping ICU stays of infected patients, suggesting horizontal, intra-ICU transmission. Lab analysis of phenotypes revealed two clones, A and B, both with drug resistance genes, to which a third clone was added in 2018. This Clone C proved to have resistance to all known antibiotics.

During the COVID pandemic in 2020, hospital sinks were not used and enhanced infection prevention interventions were deployed. This period coincided with a complete absence of P. mirabilis infections. The outbreak resumed in 2021, with the same three clones causing infections in patients.

“The outbreak intermission during COVID could be related to the enhanced protection measures implemented during this period,” Prof Mnif noted, “but we think that the sinks are in fact the reservoirs of these MDRO, and must in fact be removed and replaced, and the chemical disinfection that we had performed was not sufficient to control the outbreak.”

The outbreak highlighted the need for proper infection control protocols. Hospital wastewater is a major source of outbreaks, Prof Mnif pointed out. A study found that “over the past 20 years, there have been 32 reports of carbapenem-resistant organisms in the hospital water environment.”

She said when it came to replacing the sinks, hospitals should “respect FGI guidelines, especially in having sufficient depths of the sink, deep enough to prevent splashing.” Having sufficient pressure and splash reduction measures such as splash guards are also important, Prof Mnif added.

Although there are CDC guidelines to help prevent colonisation, there is no clear strategy for eradication for when a sink is colonised. There is likely genetic interchange between organisms in biofilms, something which needs to be investigated further, as well as means of eradication.

Categories : Expert Opinion HospitalsTags :

Proper Handwash Basin Design and Use is Critical to Controlling AMR

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Photo by Piron Guillaume on Unsplash

Some 10 million people annually are projected to die annually from antimicrobial resistance AMR in 2050, says Briëtte Du Toit, Programme Manager and Training Coordinator at Infection Control Africa Network (ICAN). While efforts to develop new antibiotics and conserve current ones are under way, it is vitally important to limit hospital-acquired infections as this is where many resistant strains spread. One of the key ways of controlling this is through the proper use of handwash basins, which necessitates a collaboration between the medical and engineering disciplines.

Presenting at the 14th SAFHE Southern African Healthcare, Du Toit stressed the importance of proper handwashing protocol and the critical importance of handwash basin design and placement to control the spread of hospital-acquired infections amid rising antimicrobial resistance.

The simple protocol of hand washing is perhaps one of the most important in modern medicine. In the past, clinicians might perform and autopsy and then deliver a child, all without washing their hands. It was only until the mid 1800s when Hungarian doctor Ignaz Semmelweis discovered the importance of hand washing, causing infection rates to plummet after the introduction of this most simple of protocols.

In modern hospitals, handwash basin design and placement, along with inadequate water supply and inadequate knowledge on the part of staff, contributes to inadequate hand washing and therefore high infection rates, Du Toit pointed out.

The design of handwash basins may seem straightforward, but there are many factors to consider. Water may drop onto other surfaces, or splash onto HCWs’ clothes. If medical supplies are stored nearby, then stray water droplets may also land on them.

A study of handwash basins showed that only 23% of basins were used for handwashing, while the remainder were used for a variety of activities including waste disposal. Of the basins used for waste disposal, 55% were contaminated. Another study showed that, in the ICU setting, washbasins were used for handwashing a mere 4% of the time. A sluice is also needed in close proximity to patients, otherwise staff will use handwash basins for incorrect disposal of body fluids.

Having the outlet directly beneath the tap as in a traditional domestic basin increases contamination. A bowl depth less than 19cm also contributed to contamination. Without a bowl cover, 9% of gowns and 6% of hands were found to be contaminated with gram-negative bacili (GNB), versus 2% of gowns and 0% of hands when a cover was present.

Significant improvements were also seen in ‘water-free’ protocols at the point of care, which involved the extensive use of disposable wipes, bottled water and practices such as using electric shaving. The implementation of water-free protocols at one hospital saw a drop in GNB colonisations from 26.3 to 21.6 / 1 000 ICU admission days. An even greater effect was seen for long-term ICU stays, with a 3.6 fold-reduction for stay exceeding 14 days.

Du Toit concluded by stressing the importance of collaboration between the medical and engineering fields, sharing data. Engineers should also be on IPC committees. Likewise, medical personnel should be part of the project team during building and renovations.

Categories : Healthcare Politics and Regulations HospitalsTags :

Battling to Increase Nurse Numbers, SA Looks Abroad

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Image by Hush Naidoo from Unsplash
Image by Hush Naidoo from Unsplash

The addition of specialist nurses by the Department of Home Affairs to the critical skills list has drawn renewed attention to and criticism of the chronic shortage of nurses in South Africa.

According to a statement by Life Healthcare last year, the country would need as many 26 000 additional nurses in 2022 to meet growing demand.

“Nurses have been on the frontline of the efforts to combat COVID for over two years. They are understandably exhausted and require our support as they continue to deliver quality care to our patients,” the group said, adding that it was embarking on programme to train an additional 3000 nurses per year.

In an open letter on the situation, the Hospital Association of South Africa (HASA) said that there was considerable training capacity and willingness from private sector hospitals, while also noting that the transition to new nursing qualifications has interrupted nurse training.

Last week, following engagement with the Minister of Health, South African Nursing Council, Health Professions Council of South Africa, public hospital CEOs and other experts, the DHA published an updated critical skills list, which was expanded to include specialist nurses and medical specialists.

The registered nurse specialties are intensive/critical care, psychiatric, peri-operative, trauma and paediatric nursing, as well as midwife specialists.

What many seen as the government’s inaction over the situation has not gone without criticism.

Speaking to the the Sunday Tribune, Sibongiseni Delihlazo of the Democratic Nursing Organisation of SA said that they were “extremely angry that we have to import specialist nurses because of the government’s actions.”

He points to falling numbers of nurses being produced each year and the shutting of nursing colleges as a sign of government neglect. World Health Organization studies showed a worldwide nursing shortage of 10 million positions by 2030, which needed an 8% annual increase in new nurses.

“Our country has not adhered to the warning, but has done the opposite,” he said.

Delihlazo said that most nursing students received government funding which was drying up, yet the population growth continued as did public healthcare system demand.

Public healthcare was not releasing nurses for specialist training, as doing so would cause the system to crumbled, Delihlazo said. In addition, local nurses are being effectively poached by first world nations.

“We could have produced our own nurses in a country with serious unemployment issues. The government doesn’t have a strategy to keep our nurses,” he said.

Categories : Hospitals Medical IndustryTags :

Mediclinic Agrees to £3.7bn Buyout by Remgro Consortium

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After turning down a previous bid, Mediclinic has agreed to a £3.7 billion buyout by a consortium consisting of investment group Remgro Limited and Mediterranean Shipping Company (MSC).

The buyout will give Remgro and MSC, through a jointly owned subsidiary, a 50/50 stake in the healthcare company.

The offer still has to be cleared by 75% of Mediclinic’s shareholders (Remgro is already a shareholder), but according to the The Daily Maverick, Mediclinic’s CFO, Gert Hattingh, the company’s directors consider the terms of the sale to be fair and reasonable. In addition, regulatory approval must be granted in South Africa, Namibia, Switzerland and Cyprus for the acquisition to proceed.

The current bid is offering 504 pence per share, a 35% increase on the first rejected offer, according to MoneyWeb. With the £3.7 billion buyout, Mediclinic has an implied enterprise value of roughly £6.1 billion.

Mediclinic operates 74 hospitals as of March this year, with 50 hospitals in Southern Africa (three of which are in Namibia), 17 hospitals in Switzerland, seven in the UAE and a 200-bed hospital due to open in Saudi Arabia.

The 72-year-old Johann Rupert who leads Remgro and has a 7% ownership, is South Africa’s richest person, with a personal fortune of $8.8bn, according to the most recent estimate by Forbes.

Commenting on the acquisition, Dame Inga Beale, Chair of Mediclinic, said: “The recommended offer represents a near-term value realisation for Mediclinic shareholders at an attractive premium.

“Over 39 years, Mediclinic has developed into the leading international healthcare services group it is today. During this time, Remgro has remained a supportive long-term shareholder. Together with SAS, the Consortium’s resources will put Mediclinic in a strong position to continue to serve patients through our broad range of high-quality healthcare services.”

Categories : HospitalsTags :

Study Shows that Not Everyone can Adjust to Shift Work

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Photo by SJ Objio on Unsplash

A new study of French hospital workers have challenged the widely held belief that shift workers adjust to the night shift over time, using data drawn from wearable sensors.

By monitoring groups of the hospital workers working day or night shifts during their working and free time, the researchers have shown that not only does night work significantly disrupt both sleep quality and circadian rhythms, also that workers can experience such disruption even after years of night shift work.

Their findings, reported in eBioMedicine, are the most detailed analysis of the sleep and circadian rhythm profiles of shift workers yet attempted, and the first to also monitor body temperature. This key circadian rhythm is driven by the brain pacemaker clock, and coordinates the peripheral clocks in all organs.

In addition, the research demonstrates the value of telemonitoring technology for identifying early warning signs of disease risks associated with night-shift work opening up intervention opportunities to improve the health of workers.

The study compared 63 night-shift workers, working three or more nights of 10 hours each per week, and 77 day-shifters alternating morning and afternoon shifts at a single university hospital near Paris. Both groups wore accelerometers with chest surface temperature sensors throughout the day and night for a full week.

The accelerometer measured movement intensity and served as an estimate for participants’ sleep duration, how regular were their circadian rhythms, and whether that sleep was disrupted by movement. Patterns in the chest surface temperature gave a further indication of the participants’ circadian rhythm, which coordinates rest-activity phases, varying core body temperature, and an array of other bodily rhythms.

Analysis of interruptions to sleep and rhythmic variations in core body temperature showed that night-shift workers had less than half the median regularity and quality of sleep of their day-shift colleagues. 48% of the night-shift workers had a disrupted circadian temperature rhythm.

Using information from questionnaires on the participants’ chronotypes, they also found that the centre of sleep for those working the night shift didn’t correlate with their respective chronotype, ie their morningness or eveningness orientation. This meant they were not sleeping in synch with their internal clocks.

Even workers with years of being on night shifts still showed these negative effects on circadian and sleep health. The more years of night work they had, the more severe the circadian disruption – contradicting widely held assumptions about night work adaptation.

This helps explain why previous studies have shown an association between disrupted circadian rhythms with long term health risks, such as cancer and cardiovascular disease.

Professor Bärbel Finkenstädt from the University of Warwick Department of Statistics said: “There’s still an assumption that if you do night work, you adjust at some stage. But you don’t. We saw that most workers compensate in terms of quantity of sleep, but not in terms of quality during the work time.”

Dr Julia Brettschneider of the University of Warwick Department of Statistics said: “I think there’s a misunderstanding that night shift work is just an inconvenience, whereas it can be linked to serious health risks. We can’t avoid shift work for many professions, like healthcare workers, so we should be thinking about what can be done in terms of real-world adjustments to improve working conditions and schedules of shift workers. A better understanding of the biological mechanisms helps to find answers to this question.

“Together with our PhD student Yiyuan Zhang, we have developed a statistical analysis framework that enables the discovery of patterns and predictive factors in the complex data sets created by wearable tech.”

Professor Francis Lévi from Université Paris-Saclay further added: “Nearly 20% of the night workers could not even adjust their circadian rhythms during their free time, with the severity of impairment tending to increase with the number of years of night work. The telemonitoring technology, and analysis methods we have set up make it now possible to objectively evaluate circadian and sleep health in night workers in near real time, and design prevention measures for individual workers whenever necessary.”

In future research, the team may look at more long-term outcomes, such as diseases such as cancer that have been linked to circadian disruption.

Source: University of Warwick