The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein

BACKGROUND

Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries.

METHOD

This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire.

RESULTS

A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh.

CONCLUSION

The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns.

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation

BACKGROUND

We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma.

METHODS

This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000-December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant).

RESULTS

Among 65 patients (mean age 50.9 years, range 37-69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26-69) years in the HIV-positive and 57.2 years (range 26-89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma.

CONCLUSION

Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age.

Allergic rhinitis in medical students at the University of the Free State

Background: Allergic rhinitis, the most common form of chronic rhinitis, can adversely affect quality of life. The prevalence of allergic rhinitis in adolescents in South Africa has been estimated to be 38.5%, but there is a paucity of data from African countries on allergic rhinitis.Aim: The aim of this study was to determine the prevalence of allergic rhinitis in medical students in the Faculty of Health Science at the University of the Free State (UFS). Information was acquired on the effects that the condition had on participants with regard to symptoms, quality of life, disease management and treatment.Methods: A cross-sectional study design was used. A self-administered anonymous questionnaire was distributed to all medical students registered with the Faculty of Health Sciences at UFS in 2016. The estimated population was 706 students.Results: The response rate was 62.6%. The prevalence of allergic rhinitis was 39.1%. The most common symptoms were rhinorrhoea (64.8%), repeated sneezing (64.3%) and nasal obstruction (58.5%). Symptoms were at their worst during August to October. Antihistamines had been used by 82.4% of participants to treat their symptoms in the previous 12 months, while 28.8% had used an intranasal steroid spray.Conclusion: The prevalence of allergic rhinitis in medical students at UFS was 39.1%. Rhinorrhoea, sneezing and nasal obstruction were the most frequent and bothersome symptoms.

Treating and reducing anxiety and pain in the paediatric emergency department-TIME FOR ACTION-the TRAPPED quality improvement collaborative

BACKGROUND/OBJECTIVES

In 2013, the TRAPPED-1 survey reported inconsistent availability of pain and distress management strategies across all 15 Canadian paediatric emergency department (PEDs). The objective of the TRAPPED-2 study was to utilize a procedural pain quality improvement collaborative (QIC) and evaluate the number of newly introduced pain and distress-reducing strategies in Canadian PEDs over a 2-year period.

METHODS

A QIC was created to increase implementation of new strategies, through collaborative information sharing among PEDs. In 2015, 11 of the 15 Canadian PEDs participated in the TRAPPED QIC. At the end of the year, the TRAPPED-2 survey was electronically sent to a representative member at each of the 15 PEDs. The successful introduction of the chosen strategies by the QIC was assessed as well as the addition of new strategies per site. The number of new strategies introduced in the participating and nonparticipating QIC sites were described.

RESULTS

All 15 PEDs (100%) completed the TRAPPED-2 survey. Overall, 10/11 of QIC-participating sites implemented the strategy they had initially identified. All 15 Canadian PEDs implemented some new strategies during the study period; participants in the QIC reported a mean of 5.2 (1-11) new strategies compared to 2.5 (1-4) in the nonactively participating sites.

CONCLUSION

While all PEDs introduced new strategies during the study, QIC-participating sites successfully introduced the majority of their previously identified new strategies in a short time period. Sharing deadlines and information between centres may have contributed to this success.

Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure

Background: One of the main reasons for the spread of infection in the healthcare environment is inadequate hand hygiene. Poor knowledge of hand hygiene techniques leads to poor compliance. This study aimed to determine Free State University finalyear medical students’ knowledge of hand hygiene as a basic infection control measure. Methods: This was a cross-sectional study using self-administered anonymous questionnaires. The questions and memorandum were based on an extensive literature review with WHO documentation on the guidelines for hand hygiene in health care. Each participant received an envelope with an optical computer card, questionnaire and information document during a pre-arranged class. Participants recorded their answers on the card by shading in the squares corresponding to their responses.Results: The average score of the 107 participants was 46.8% (range 10.1–73.6%). Participants who felt that they had basic knowledge of hand hygiene (n = 32, 30.5%) had an average score of 47.9%. Participants with a self-reported knowledge level of more than basic but less than advanced (n = 56, 53.3%) had an average score of 44.9% while those who reported advanced knowledge (n = 17, 16.2%) had an average score of 50.8%. Three-quarters (n = 81, 77.1%) felt that their training was sufficient. Only 53.3% knew that the most important way to prevent the spread of infection is good hand hygiene. Only 10.5% of the students knew that hands should not be rinsed with water after using alcohol-based sanitisers.Conclusion: Medical students have a poor level of knowledge regarding hand hygiene as a basic measure of infection control.

Anthropometric profile and complications in patients with diabetes mellitus seen at Maluti Adventist Hospital, Lesotho

Background: Patients attending outpatient departments for follow-up of diabetes mellitus (DM) may seem content about the control of their disease. However, complications resulting from DM may present before diagnosis and treatment initiation or continue to develop while on treatment.Aim: This study aimed to report on the prevalence of DM complications in patients with DM at Maluti Adventist Hospital, Lesotho.Methods: A cross-sectional study was conducted in 150 DM patients recruited from Maluti Adventist Hospital’s newly formed clinic between May and June 2009. Demographic information was obtained through a structured interview. Patients underwent physical and eye examinations to obtain an anthropometric profile and identify DM complications. Laboratory and ECG investigations were done to establish level of glycaemic control and identify other complications.Results: Patients were female (80.7%) with a mean age of 58.2 years (standard deviation 13.2). Almost all patients had type 2 DM (94.7%) and 60.1% had been diagnosed during the preceding five years. The most common co-morbidity was hypertension (85.3%) and 49.7% of patients were obese (mean body mass index 30.4 kg/m2). Patients had poor short-term (46.2%) and longterm (57.5%) glycaemic control. Nearly half (43.3%) of the patients had evidence of peripheral neuropathy. Almost 60% of the patients had a blood pressure of 130/80 mmHg. Of the 128 patients seen by the ophthalmologist, 29.9% had evidence of cataracts in both eyes. Funduscopic abnormalities were found in 32.8% of the patients. Patients with complications or poor glycaemic control had been diagnosed for a significantly longer time.Conclusion: Patients showed evidence of DM complications at the time of study. Coupled with significant co-morbidities and high body mass index, the risk of morbidity and mortality is high. A comprehensive approach is needed in managing these patients, if meaningful reductions in morbidity and mortality are to be achieved.

Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey

BACKGROUND

Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits.

METHODS

We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors.

RESULTS

A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment.

INTERPRETATION

Parents' reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help.

Injury and illness profiles during the 2014 South African Ironman triathlon

   Background: There is a need for ongoing scrutiny of injury and illness profiles of ultra-distance athletes. This study aimed to record the medical history, illness and injuries of athletes receiving medical attention during the 2014 Ironman South Africa (IMSA) triathlon, and to investigate the temporal presentation of medical encounters.  Methods: This was a retrospective, cross-sectional study. All athletes who required medical attention at the main medical tent and all of the medical posts or mobile units along the route were included in this study A total of 2 331 athletes started the race. Data included age, gender, time and stage of the race when medical attention was required, pre-race medical history and medication use, illness and injuries treated, special investigations performed, and weather conditions.  Results: Overall, 179 athletes (7.7%) required medical attention. The incidence of medical encounters was 7.8%. A significantly higher percentage of younger participants encountered medical problems (P = 0.04). Most patient encounters (80.1%) occurred after the race. The median duration of treatment was 26 minutes. Medication was used by 35.1% of patients during the race. The most common medical encounters were exertion-related (71.2%), gastro-intestinal (16.4%), dermatological (11.9%), musculoskeletal (9.6%) and cardiorespiratory conditions (2.4%).  Conclusion: Medical encounters occurred more frequently in later stages of the race. Most medical conditions were exertion-related. Potential higher risk may be associated with medication use, recent illness, and in younger participants. Temporal stacking of medical personnel, planning of resources according to expected conditions, preventative measures for high-risk behaviour, and on-going data collection with comparable methodology are recommended. 

Methylphenidate use among students living in junior on-campus residences of the University of the Free State

Background: The use of methylphenidate as cognitive enhancer is a growing trend among students at tertiary institutions globally. This study aimed to determine the prevalence of methylphenidate use and co-use with alcohol among on-campus residence students of the University of the Free State (UFS). Methods: For this cross-sectional study, 10 junior residences were randomly selected and 1 761 anonymous questionnaires handed out for all students living in these residences during 2015. Data were collected on demographics, use of methylphenidate and co-use of methylphenidate with alcohol. Results: In total, 585 questionnaires (response rate 33.2%) were received and analysed. Sixty-six (11.3%) participants reported past-year use of methylphenidate. While only 18 (27.3%) of past-year users were diagnosed with ADHD, 44 (66.7%) obtained their supply through doctors’ prescriptions, 21 (31.8%) from friends without payment, and 4 (6.1%) bought it from illegal sources. Of the past-year users, 24.2% had used methylphenidate before consuming alcohol. Conclusion: Off-label prescribing, diversion of prescriptions and illegal trade in methylphenidate occur among students at the UFS. The frequent co-use of methylphenidate and alcohol may indicate a lack of information on the effects of the medication, rather than deliberate misuse. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1292695

Undergraduate medical students’ interest in specialising in Family Medicine at the University of the Free State, 2014

Background: There is a large demand for Family Medicine specialists, yet not enough medical students specialise in this field. This study investigated the interest of undergraduate medical students at the University of the Free State in pursuing a career in Family Medicine, factors associated with this interest, and their opinion of Family Medicine as a specialty. Methods: In this prospective cross-sectional study, anonymous, self-reporting questionnaires, available in English and Afrikaans, were distributed to first- to fifth-year undergraduates. Data were collected on demographic variables and interest in Family Medicine and other disciplines. The students had to rate the likelihood of them selecting 15 different specialties as a future career according to a five-point Likert scale. Opinions concerning Family Medicine were tested with a yes/no response as to the agreement to five statements. Results: Fifth-year students were excluded due to poor response rate (13.6%). The response rate for the first- to fourth-year groups was 86.4%. Interest in Family Medicine decreased from first to third year (22.4, 21.2 and 14.0%, respectively), but increased again in the fourth year (23.3%). Females and speakers of African languages showed the most interest in this field. Medical students, especially first years, generally had poor knowledge regarding Family Medicine. Conclusion: Family Medicine is not a preferred specialty in any of the four year groups, and students had insufficient knowledge of the field. Family Medicine should be introduced earlier into the medical curriculum. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1317977

Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein

Background: It is generally accepted that doctors have illegible handwriting. The writer usually knows what is written, but other parties often have problems with reading and interpreting. Aim: The aim of the study was to determine whether illegible doctors’ handwriting and other factors that can lead to dispensing errors occur on prescriptions at National District Hospital. Method: In part one the prescriptions of 20 doctors were read by five doctors, nurses and pharmacists to detect who could read it most accurately. In part two, these doctors were asked to write a prescription with an IntelliPen®. Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used. Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1254932

The eventual outcome of patients who had lower limb amputations due to peripheral vascular disease at Pelonomi Hospital, Bloemfontein

Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: Prospective data collection of a retrospective cohort study group was performed. Included were patients with PVDinduced LLAs. Demographic and contact information was collected from Meditech. Living status (alive or dead) was determined using the Department of Home Affairs database and interviews with relatives. Results: Of the study population (n = 224), 119 had contact information. Data of 158 people were available to determine living status: 71.5% had died by follow-up in 2014. Forty-nine interviews were possible, 31 patients had died, with cause of death reported to be primarily vascular related. The cumulative mortality showed that 16.1% died within a month and 48.4% within one year post-amputation. Among the 18 living amputees, 50.0% became unemployed, 77.8% used wheelchairs, 11.1% used crutches and 11.1% a prosthesis. Conclusion: Lower limb amputation due to PVD is indicative of a poor prognosis. In our study only 28.5% of patients survived 3–6 years post-amputation. Restoration to ideal mobility was achieved in a minority of cases. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.12481450

Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes

OBJECTIVES

Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration.

METHODS

We conducted a cross-sectional study involving children aged 4-17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x-ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x-ray, the reference standard. Secondary outcomes included self-reported pain using the Faces Pain Scale-Revised, caregiver satisfaction using a five-item Likert scale, and procedure duration.

RESULTS

POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7-99.8) and specificity was 93.5% (95% CI = 88.6-98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x-ray: 1 (0-2) versus 2 (1-3), respectively (median difference = 0.5; 95% CI = 0.5-1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4-5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x-ray: 1.5 (0.8-2.2) minutes versus 27 (15-58) minutes, respectively (median difference = 34.1, 95% CI = 26.8-41.5, p < 0.001).

CONCLUSIONS

Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.

Intranasal ketamine for procedural sedation and analgesia in children: A systematic review

BACKGROUND

Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children.

METHODS

We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946-2016), EMBASE (1947-2016), Google Scholar (2016), CINAHL (1981-2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000-2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively.

RESULTS

The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants.

CONCLUSIONS

IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children.