South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. ⋯ ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.
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We aimed to investigate the stage of breast cancer at first diagnosis and assess possible determinants of late-stage presentation. A consecutive series of women with newly diagnosed breast cancer at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa were analysed. We retrospectively reviewed electronic patient records. ⋯ However, in younger patients, age showed no clear association with stage at presentation. Travel distance was an important predictor of later-stage disease at diagnosis, which was more noticeable in elderly patients. Patients with more aggressive triple-negative and HER2+ tumours presented with later-stage disease.
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We used modern error theory to develop a tick-box admission form for emergency surgical patients. The tick boxes were designed to actively direct care down appropriate clinical algorithms by encouraging staff to make decisions based on recorded clinical data. ⋯ Although the use of tick-box admission forms improves the quality of documentation, the impact on clinical behaviour is less certain. Quality improvement is a multifactorial endeavour, and without a pervasive culture of patient safety, tick-boxes alone may well be ineffective.
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Tuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88% of HIV-uninfected young adults (31 - 35 years) are latently infected with TB. ⋯ A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control.