Category: Statistics

J Elder Abuse Negl. 2025 Jan 31:1-25. doi: 10.1080/08946566.2025.2460835. Online ahead of print.

ABSTRACT

Elder mistreatment occurs in as many as one-half of the 11 million family care partnerships with persons living with Alzheimer’s disease or related dementias (AD/ADRD) in the United States. Knowledge and Interpersonal Skills to Develop Enhanced Relationships is an 8-week psychoeducational intervention to prevent psychological mistreatment among family caregivers to persons living with dementia by building healthy caregiving relationships. The investigators conducted a single-arm pre- and posttest study to assess KINDER‘s feasibility. A total of 45 caregivers enrolled, among whom 37 completed the follow-up survey (82.2% retention). Caregivers attended an average of 2.1 of 3 discussion sessions (SD = 0.76). Paired t-test analyses comparing outcomes at baseline and post-intervention demonstrated a statistically significant decrease in psychological mistreatment and relationship strain, and an increase in resourcefulness skills. These findings suggest KINDER is a feasible low- to moderate-intensity intervention to prevent psychological mistreatment with AD/ADRD caregiving. Future research will test KINDER‘s efficacy.

PMID:39886850 | DOI:10.1080/08946566.2025.2460835

S Afr J Surg. 2024 Dec;62(4):44-48.

ABSTRACT

BACKGROUND: Bowel trauma, encompassing injuries to the small and large intestine, represents a significant medical challenge due to its potential for morbidity and mortality. Management of bowel injuries remains surgical, but multiple factors influence the outcome in these patients. This study provides an in-depth analysis of the high-risk features of hollow visceral trauma in the ICU setting and the corresponding mortality rates, shedding light on the critical factors that influence outcomes in these cases.

METHODS: Retrospective review of patients admitted to the trauma intensive care unit (ICU) at Inkosi Albert Luthuli Hospital from January 2017 until September 2022 were reviewed to identify risk features associated with morbidity and mortality. Statistical analysis was performed using Python 3.10.

RESULTS: Ninety-four patients were reviewed, the majority (88.3%) were male and median age was 31.5 years. Mortality was 31.9%. The median length of stay in the ICU was 9.0 days (IQR 4-19 days, range 2-94 days). Small bowel injuries were more common than colonic injuries (75.3% vs 63.8%). Multiple colon injuries, renal injuries, extra hepatic biliary injuries and older age were associated with significant increase in mortality.

CONCLUSION: This study’s findings underscore the multifaceted nature of bowel injury management in an ICU population. A comprehensive, multidisciplinary approach that considers injury severity, anatomical site, and patient-specific factors is crucial for achieving favourable outcomes in bowel trauma cases.

PMID:39886827

S Afr J Surg. 2024 Dec;62(4):39-43.

ABSTRACT

BACKGROUND: Data on trauma burden and outcome varies amongst the nine South African Provinces. In Limpopo Province there is a paucity of data which this study aimed to quantify and characterise the severe trauma burden in the province.

METHODS: A retrospective chart review for all patients with injury severity score (ISS) > 16 over a 6-year period (Jan 2015-Dec 2020) at two central hospitals in Limpopo province. Descriptive analysis was undertaken of the following variables: patient demographics, injury patterns and outcomes.

RESULTS: The review identified 355 patients whose mean age was 31 years (Range 0.25-74 years). Eighty four per cent were males. Forty nine per cent were unemployed. The most common mechanisms of injury were interpersonal violence 49 % and motor vehicle crashes (MVCs) 34.9%. Head (41%), torso (25%) and limbs (15.2%) were the body-regions most frequently involved. The median ISS was 16 with IQR (16-16) (0). The median length of stay was 7 days with IQR (5-15) (10). Of the ICU admissions 50% were MVCs and 56% due to head injury. Of the 50 deaths 50% were due to MVC and pedestrian vehicle crashes (PVCs), and head injuries were present in 54% of those who died.

CONCLUSION: Young males were the most predominantly affected. Assault and MVC were the most common mechanisms of injury. The unemployment rate also seems to be a key factor in trauma epidemiology in the province. Further study of the wider trauma burden is required.

PMID:39886826

S Afr J Surg. 2024 Dec;62(4):35-38.

ABSTRACT

BACKGROUND: KwaZulu-Natal bears a significant trauma burden, with polytrauma patients often experiencing traumatic limb amputations. This study investigates traumatic limb amputations in the subgroup of severely injured polytrauma patients admitted to the trauma ICU in KwaZulu-Natal. This study aims to describe the management and outcomes of traumatic limb amputations in polytrauma patients at the trauma ICU.

METHODS: This retrospective observational study utilised data from the trauma ICU registry (BCA207/09). Descriptive methods were employed to analyse demographics, injury mechanisms, timing of amputations, anatomical sites affected, injury complexes, injury severity scores, and patient outcomes.

RESULTS: Twenty-three patients were included, with a mean age of 32 years. The most common injury mechanism was motor vehicle collision pedestrian (43%), 82% of included cases underwent early amputation. The left lower leg was the most frequently affected site (62%), with a median injury severity score (ISS) score of 25 (13-42) and median new injury severity score (NISS) of 34 (20-43). Most were ultimately above-knee amputations but started as below-knee amputations. Most patients were discharged to base (60.8%), while 22% died.

CONCLUSION: This study provides valuable insights into traumatic limb amputations in polytrauma patients, emphasising the need for comprehensive management strategies. The outcomes of traumatic limb amputations require optimised patient care and better rehabilitation services.

PMID:39886825

S Afr J Surg. 2024 Dec;62(4):15-19.

ABSTRACT

BACKGROUND: District hospitals in South Africa have limited surgical capacity and regional hospitals treat most essential surgical conditions. This study aimed to describe the pathway and time to regional hospital surgical care for persons with general surgery conditions (PSC) in South Africa.

METHODS: This was a retrospective audit of all persons referred on the Vula Mobile App to the general surgery service at Worcester Regional Hospital (WRH) from 1 January 2019 to 31 December 2019. Outcomes were time to care and the proportion lost to follow-up. Reasons for the proportion lost to follow-up were not reported.

RESULTS: There were 617 index PSC referrals to WRH from 23 health facilities. Of these, 472 (76.5%) were referred from district hospitals and 88 (14.3%) from health clinics. Overall, 171 (27.7%) PSC referrals were handled via online-consultation only, 249 (40.4%) were referred to the WRH outpatient clinic, and 197 (31.9%) for inpatient admission. 133 (53.4%) outpatient referrals were lost to follow-up. One hundred and seventy-nine (29.0%) PSC had an operation at WRH. The median number of days from referral to operation was 28 days (IQR:10-86) for those evaluated in the outpatient clinic and 10 days (IQR: 1-125) for those directly admitted as inpatients.

CONCLUSION: Most surgical referrals to this South African regional hospital came from district hospitals and were for outpatient conditions. The use of telemedicine allowed triage of one quarter of referrals without the need for face-to-face consultation. Median time to operation was less than a month for outpatients; however, there was a high loss to follow-up. Further studies are needed to understand why many PSC did not access outpatient care.

PMID:39886821

S Afr J Surg. 2024 Dec;62(4):9-14.

ABSTRACT

BACKGROUND: COVID-19 was first identified in Wuhan, China, in December 2019, where it spread over a wide geographic area until it reached the status of a pandemic in 2020. We postulated that patients who were diagnosed with incidental COVID-19, and underwent surgery, did not have a worse outcome due to the COVID-19 virus compared to their counterparts who did not have the virus.

METHODS: This retrospective study included surgical patients (COVID-19 incidentals and COVID-19 negatives) who were admitted to the surgical intensive care unit (SICU) at Tygerberg Academic Hospital between 1 May 2020 and 31 December 2021.

RESULTS: The sample consisted of 578 patients. Forty-one (41) patients had incidental COVID-19 infection, and 537 patients were COVID-19 naïve. The mean age was 43.9 years (SD = 16.7 years; range = 13.0-82.0 years) and 181 (31.3%) were female. The rates of complications in patients with COVID-19 infection (7.3%) and those without (5.0%) were similar (p = 0.64). Grades of complications, as measured using the Clavien-Dindo classification were also similar between patients with and without COVID-19 infection (p = 0.19). The mortality rates of patients with COVID-19 infection (17.1%) and those without (13.6%) were similar (p = 0.53).

CONCLUSION: This study demonstrates that surgery among asymptomatic PCR-positive patients was not associated with increased mortality or morbidity in the SICU. This also adds a valuable contribution to the growing body of literature regarding COVID-19 infections. Further prospective and multicentred studies are required to provide more robust results.

PMID:39886820

S Afr J Surg. 2024 Dec;62(4):4-8.

ABSTRACT

BACKGROUND: This study aimed to assess the contribution of human error to adverse events over 10 years in a single surgical department in South Africa.

METHODS: A retrospective database analysis was undertaken to identify all adverse events, which were further assessed to identify which were error-associated.

RESULTS: A total of 14 237 adverse events occurred between December 2012 and January 2023, of which 7 504 (52.7%) were judged to be error-associated. An error rate of 14% per admission, or 2% per inpatient day was shown. Errors during delivery of care accounted for 76% of all errors and 40% of all adverse events. Of those, medication errors contributed 29%, those due to indwelling devices contributed 28%, and iatrogenic injuries 18%. Errors in assessment accounted for 14% of the total errors and 7% of all adverse events, with clinical assessment failure contributing 55.8% and missed injuries 19%. Mixed type errors contributed 10% of the total. Assessment by year demonstrated an upward trend from 2013 to 2016, followed by a downward trend from 2016 to 2022. Error-associated adverse events increased length of stay and mortality significantly.

CONCLUSION: Error contributes to more than half of adverse events and increased length of stay and mortality and is potentially avoidable. Errors may occur at any stage during an admission and highlights the need for multilevel interventions. The decrease in error noted is due to the cumulative effect of multiple endeavours, and not a single intervention.

PMID:39886819

Int Clin Psychopharmacol. 2025 Mar 1;40(2):119-122. doi: 10.1097/YIC.0000000000000561. Epub 2025 Jan 29.

ABSTRACT

This study evaluates the impact of neuroscience-based nomenclature (NbN) training on psychiatric residents in Flanders, Belgium. Addressing Zemach et al.’s findings on NbN’s potential, we investigated its application in clinical practice. We assessed changes in knowledge, prescribing habits, and communication skills through focus groups and a longitudinal survey. Our results indicated no statistically significant shifts post-training, highlighting the complexity of integrating NbN into clinical practice. These findings underscore the critical need for psychopharmacological nomenclature and psychopathology to evolve in tandem, ensuring that advancements in understanding mental disorders align with pharmacological education.

PMID:39886812 | DOI:10.1097/YIC.0000000000000561

J Glob Health. 2024 Dec 30;14:04235. doi: 10.7189/jogh.14.04235.

ABSTRACT

BACKGROUND: Risk prediction tools for acutely ill children have been developed in high- and low-income settings, but few are validated or incorporated into clinical guidelines. We aimed to assess the performance of existing paediatric early warning scores for use in low- and middle-income countries using clinical data from a recent large multi-country study in Africa and South-Asia.

METHODS: We used data (children across three nutritional strata) from the Childhood Acute Illness and Nutrition (CHAIN) Network cohort study (n = 3101). We assessed 10 scores where similar predictor variables were available in the CHAIN cohort. We evaluated performance using the area under the receiver operating curve (AUC) (primary outcome), sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio (secondary outcomes).

RESULTS: Most scores showed poor discrimination, and all scores had low sensitivity. The paediatric early death index for Africa (AUC = 0.80; 95% confidence interval (CI) = 0.77-0.83), respiratory index of severity in children (AUC = 0.77; 95% CI = 0.74-0.81), and respiratory index of severity in children in Malawi (AUC = 0.78; 95% CI = 0.75-0.82) showed acceptable/good overall discrimination. Among children without wasting, most scores had acceptable/good performance, some even excellent. Poor discrimination was found for most scores among children with moderate and severe wasting or kwashiorkor.

CONCLUSIONS: All scores demonstrated lower validation performance than originally reported. Among children without wasting, most risk prediction scores performed acceptably whilst in malnourished children they performed poorly. There is a need for a malnutrition specific score. Further research is needed on specific actions in responding to scores. Integration into future guidelines will require acknowledging staffing, resources and workflows.

PMID:39886744 | DOI:10.7189/jogh.14.04235

Disaster Med Public Health Prep. 2025 Jan 31;19:e19. doi: 10.1017/dmp.2024.334.

ABSTRACT

OBJECTIVES: Plastics in the environment have moved from an “eye-sore” to a public health threat. Hospitals are one of the biggest users of single-use plastics, and there is growing literature looking at not only plastics in the environment but health care’s overall contribution to its growth.

METHODS: This study was a retrospective review at a 411-bed level II trauma hospital over 47 months pre and post the last wave of COVID-19 affecting this hospital. Deidentified data were gathered: daily census in the emergency department, hospital census, and corresponding number of admitted COVID-19 patients. Additionally, for the same time frame, personal protective equipment (PPE) supply purchases and gross tonnage of nonhazardous refuse were obtained.

RESULTS: There was a large increase in PPE purchased without a significant change in gross tonnage of weight of trash.

CONCLUSIONS: PPE is incredibly important to protect health care workers. However, single-use plastic is not sustainable for the environment or public health. Understanding the full effect of the pandemic on hospital waste production is critically important as health care institutions focus on strategies to decrease their carbon footprint and increase positive impacts on public health and the environment.

PMID:39886740 | DOI:10.1017/dmp.2024.334