South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Globally there is increasing awareness of the need for end-of-life care and palliative care in hospitalised patients who are in their final year of life. Limited data are available on palliative care requirements in low- and middle-income countries, hindering the design and implementation of effective policies and health services for these patients. ⋯ Despite a median age <60 years at admission, a substantial percentage of patients admitted to public sector hospitals in SA are in the final year of their lives. This finding should be seen in the context of SA's high communicable and non-communicable disease burden and resource-limited public health system, and highlights the need for policy development, planning and implementation of end-of-life and palliative care strategies for hospitals and patients.
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There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA). ⋯ The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.
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Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. ⋯ An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.
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The discovery of human leucocyte antigen (HLA), serological matching and HLA-typing techniques, combined with the development of immunosuppressive medicines and improvements in infection control, have opened the way to cell, tissue and vascularised organ transplantation. Since the early 1960s, more than a million haematopoietic progenitor cell (HPC) transplantations have been performed worldwide to restore haematopoiesis and support immune system recovery after bone marrow ablation. ⋯ Research in biological sciences supported by new technologies is increasingly translated into therapeutic products intended to augment, repair, replace or regenerate genes, cells, tissues, organs and metabolic processes in the body. These products are referred to as regenerative medicine therapies or advanced therapy medicinal products, and include gene therapies, cell-based therapies and engineered tissue products.