South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Observational Study
A severity-of-illness score in patients with tuberculosis requiring intensive care.
We previously retrospectively validated a 6-point severity-of-illness score aimed at identifying patients at risk of dying of tuberculosis (TB) in the intensive care unit (ICU). Parameters included septic shock, HIV infection with a CD4 count <200 cells/µL, renal dysfunction, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F) <200 mmHg, a chest radiograph demonstrating diffuse parenchymal infiltrates, and no TB treatment on admission. ⋯ The 6-point severity-of-illness score identified patients at increased risk of death. We were able to derive and retrospectively validate a simplified 4-point score with superior predictive power.
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Evidence on mask use in the general population is needed to inform SARS-CoV-2 responses. ⋯ Direct evidence for cloth and medical mask efficacy and effectiveness in the community is limited. Decision-making for mask use may consider other factors such as feasibility and SARS-CoV-2 transmission dynamics; however, well-designed comparative effectiveness studies are required.
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In recent years there have been significant advances in the management of stroke. In particular, reperfusion therapies have been shown to confer significant benefit, with the possibility of reversing ischaemic stroke or reducing disability when administered to suitable patients. However, these therapies also carry significant risk, including death. The South African (SA) and other international guidelines for stroke care provide recommendations to optimise benefit and reduce risk of these novel treatments. Failure to adhere to recommended guidelines can lead to increased preventable morbidity and mortality in such patients. ⋯ The two stroke units at the level 3 hospitals adhered most closely to the recommended SA stroke guideline. Elsewhere, ischaemic stroke care varied widely across general medical wards at all hospital levels. Adherence to the guideline was influenced by factors such as limited access to diagnostic investigations, patient delays in receiving medical attention, and shortages of staff. Monitoring systems for continuous evaluation of the quality of acute and post-acute stroke services are needed. The shortfall in compliance with recommended stroke treatment guidelines could lead to worse outcomes and exposure to litigation.
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Most South Africans depend on the public sector for health services. There is an increasing demand for arthroplasty in the public sector, but a paucity of academic data regarding its cost. ⋯ The study showed that clinicians need to be aware of procedural costing in the current financial climate. There are still opportunities to optimise cost containment in the state sector.