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Poonai N, Paskar D, Konrad S, Rieder M, Joubert G, Lim R, Golozar A, Uledi S, Worster A, Ali S. Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis. Acad Emerg Med 2014; 21:1183-92. [PMID: 25377394 DOI: 10.1111/acem.12509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications. METHODS Trials were identified through electronic searches of MEDLINE (1946-2013), EMBASE (1980-2013), Cochrane Central Register of Controlled Trials (2013), CINAHL (1981-2013), and Google Scholar (2013). All randomized controlled trials (RCTs) of children aged 0-18 years with acute abdominal pain that compared any opioid analgesic to placebo were included. The methodologic 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 system, respectively. RESULTS Six RCTs met inclusion criteria, and each compared a single-dose parenteral opioid to a placebo, providing data on 342 children aged 5 to 18 years. The pooled mean pre/post difference in self-reported pain scores was 19.61 mm (95% confidence interval [CI] = -1.16 to 40.37 mm) lower in those receiving opioid analgesia. There was no significant increase in the risk of perforation or abscess associated with opioids in cases of appendicitis (relative risk [RR] = 1.03, 95% CI = 0.55 to 1.93). The risk of side effects was significantly greater in patients who received opioids (RR = 6.06, 95% CI = 1.10 to 33.49). Subtherapeutic dosing of opioids was detected in all six trials. CONCLUSIONS The use of opioids in undifferentiated acute abdominal pain in children is associated with no difference in pain scores and an increased risk of mild side effects. However, there is no increased risk of perforation or abscess. The overall quality of evidence is low, suggesting the need for larger, high-quality trials that are powered to detect both serious complications of appendicitis and determine the most efficacious opioid dosing for children.
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Sonnekus PH, Louw VJ, Ackermann AM, Barrett CL, Joubert G, Webb MJ. An audit of the use of platelet transfusions at Universitas Academic Hospital, Bloemfontein, South Africa. Transfus Apher Sci 2014; 51:44-52. [PMID: 25457007 DOI: 10.1016/j.transci.2014.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An audit was performed at a tertiary hospital in Bloemfontein, South Africa, to establish whether clinicians adhered to local platelet transfusion guidelines. The audit showed poor compliance with local guidelines, with 34% of platelet transfusions not aligned with guidelines and 29.9% of transfusions administered to patients with platelet counts of ≥ 150 × 10(9)/L. When compared to medical disciplines, surgical disciplines tended significantly more to transfuse platelets inappropriately (17.1% and 53.7%, respectively; p < 0.0001). Documentation was poor and in 48.4% of orders for platelets, the indication for the platelet transfusion was not clearly stated. Considerable cost could be avoided with improved adherence to guidelines. This study emphasises the need for improving education in transfusion medicine amongst medical doctors. It is hoped that the information gleaned from this study would assist in the design of educational programmes in transfusion medicine as we attempt to close the existing gaps in knowledge and skills in the field, while ensuring that blood is transfused in a cost-effective and appropriate manner.
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78
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Du Toit M, Claassen D, Le Roux A, Nel E, Van Biljon W, Joubert G, Louw VJ. Percutaneous injuries in doctors in the School of Medicine, University of the Free State: incidence, reporting and adherence to precautionary and management procedures. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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79
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Dippenaar H, Joubert G, Brussow ME. Guidelines for kangaroo care in district hospitals and primary healthcare maternity sections in the Free State. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2006.10873458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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80
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De Jager GF, Prinsloo EAM, Joubert G. Use of traditional medicine versus use of the community-based primary health care clinic by the San community at Platfontein. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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81
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Bezuidenhout MM, Joubert G, Hiemstra LA, Struwig MC. Reasons for doctor migration from South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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82
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Pienaar PE, De Swardt M, De Vries M, Roos H, Joubert G. Physical activity knowledge, attitudes and practices of the elderly in Bloemfontein old age homes. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2004.10873121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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83
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Prinsloo EAM, Joubert G, Mohale M, Nyindi N, Matu N, Ntechane L, Struwig MC. The prevalence and perception of obesity and its association with the lifestyle of women at the Mangaung University Community Partnership Project healthcare centre, Bloemfontein. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2011.10874116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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84
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Dippenaar H, Joubert G, Nel R, Bantobetse ML, Opawole AA, Roshen KS. Homemade sugar-salt solution for oral rehydration: Knowledge of mothers and caregivers. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2005.10873188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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85
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Carey R, Simmons S, Malherbe M, Jansen van Rensburg BJ, Joubert G. Clinical features of patients with systemic lupus erythematosus (SLE) attending the SLE outpatient clinic at Universitas Hospital in Bloemfontein, South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2008.10873674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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86
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Nel CPG, Schoeman LC, Van Wyngaardt M, Horn H, Goedhals L, Joubert G. The prevalence of HIV amongst women with cervix cancer. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2006.10873334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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87
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Brits H, Joubert G. An investigation into the dramatic increase in deaths from gastroenteritis during the summer of 2007/08 at National District Hospital, Bloemfontein, Free State. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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88
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Foulkes S, Joubert G, Faber BL, Hiemstra LA. Obstetrical ultrasound training of and practise by general practitioners in the private sector, Free State. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2004.10873095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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89
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Stark K, Joubert G, Struwig M, Pretorius M, Van der MN, Botha H, Kotzé J, Krynauw D. Suicide cases investigated at the state mortuary in Bloemfontein, 2003–2007. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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90
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Lee KH, Human GP, Fourie JJ, Louw WAN, Larson CO, Joubert G. Medical students' use of caffeine for ‘academic purposes’ and their knowledge of its benefits, side-effects and withdrawal symptoms. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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91
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Oni TE, Prinsloo EAM, Nortje JD, Joubert G. High school students' attitudes, practices and knowledge of contraception in Jozini, KwaZulu-Natal. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2005.10873247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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92
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Dommisse J, Joubert G. Profile of research methodology and statistics training of undergraduate medical students at South African universities. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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93
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Stemmett GD, Joubert G, Van Vuuren MVJ. Kennis en hantering van slangbyte deur algemene praktisyns op die platteland van die Vrystaat en Noord-Kaap. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2004.10873140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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94
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Venter A, Schirm N, Joubert G, Fock JM. Profile of children diagnosed with cerebral palsy at Universitas Hospital, Bloemfontein, 1991–2001. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2006.10873350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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95
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Joubert G. Authorship: practices and experiences in the Faculty of Health Sciences of the University of the Free State. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2005.10873220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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96
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Lamacraft G, Kenny PJ, Diedericks BJ, Joubert G. Training and experience of doctors administering obstetric anaesthesia in the Free State Level 1 and 2 Hospitals. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2008.10872540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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97
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Lamacraft G, Schmidt MJ, Diedericks BJS, Joubert G. An Audit of the Use of Regional Anaesthesia for Caesarean Section in the Free State: from 2002 to 2004. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2007.10872494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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98
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Poonai N, Gregory J, Thompson G, Lim R, Van Osch S, Andrusiak T, Mekhaiel S, Sangha G, Seabrook J, Joubert G. Is Pelvic Ultrasound Associated with an Increased Time to Appendectomy in Pediatric Appendicitis? J Emerg Med 2014; 47:51-8. [PMID: 24680102 DOI: 10.1016/j.jemermed.2013.11.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/09/2013] [Accepted: 11/17/2013] [Indexed: 01/05/2023]
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99
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Calitz FJW, De Jongh NJ, Horn A, Nel ML, Joubert G. Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex. S Afr J Psychiatr 2014. [DOI: 10.4102/sajpsychiatry.v20i1.441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<p><strong>Background.</strong> Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents.</p><p><strong>Methods.</strong> The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study.</p><p><strong>Results.</strong> Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy.</p><p><strong>Conclusions.</strong> Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.</p>
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100
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Bodenstein X, Van Vuuren E, Joubert G. Breat care in breast-feeding mothers: the benefit of therapeutic laser applied by physiotherpasts. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.4102/sajp.v70i3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Breast-feeding is promoted worldwide as it has many health and nutritional benefits.
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