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  1. Article ; Online: A descriptive study of trauma patients transported by helicopter emergency medical services to a level one trauma centre

    Marwala Simon Pule / Peter Hodkinson / Timothy Hardcastle

    African Journal of Emergency Medicine, Vol 12, Iss 3, Pp 183-

    2022  Volume 190

    Abstract: Background: KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable ... ...

    Abstract Background: KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable prehospital asset for the transport of time sensitive trauma. This study reviews the impact of HEMS in the management of trauma at Inkosi Albert Luthuli hospital (IALCH) which is the only public accredited level one trauma centre in the province. Methods: A retrospective descriptive study of polytrauma patients transported by HEMS in KZN to IALCH over a three-year period from 01 January 2014 to 31 December 2016. Data was collected around patient demographics, transfer details and patient outcomes. Results: Over the three-year period, 117 HEMS transfers were reviewed, with the majority being male (90.6%). Just 26% of HEMS transfers were direct from the scene, with the balance being interhospital transfers largely from distant regional hospitals around the province. Some 60% of injuries were caused by vehicle crashes, and 31% by intentional injury. Mortality was 30% which is reflective of the high severity of injury of the cohort. The injury severity scores (ISS) (median 26 overall) of those who died was higher (median 38) (P-= .0002), and there were more interventions before and during transfer such as thoracostomy, ventilation and immobilization. Overall, 88% required admission to ICU at IACLH. Conclusions: HEMS in the KwaZulu Natal province was mainly used for long-distance transfer of major trauma patients which is an appropriate use of this essential service, given the single major trauma centre in the province. The majority of patients that were transported by HEMS had severe injury, which was also associated with increased mortality outcomes. Rational use of this essential but expensive resource will require clear policy around the role of HEMS and call out criteria in each setting.
    Keywords HEMS ; Trauma ; Outcome ; Pre-hospital care ; South Africa ; Medicine ; R ; Medicine (General) ; R5-920
    Language English
    Publishing date 2022-09-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Development of a checklist for auditing completion of patient report forms

    Robert Bruce Mckenzie / Robin Pap / Timothy Hardcastle

    African Journal of Emergency Medicine, Vol 12, Iss 3, Pp 191-

    A Delphi study

    2022  Volume 198

    Abstract: Introduction: Medical records are an integral part of patient care. Information loss during the handover from Emergency Care Providers to hospital staff is common and has a significant impact on patient care. Information loss can be prevented with ... ...

    Abstract Introduction: Medical records are an integral part of patient care. Information loss during the handover from Emergency Care Providers to hospital staff is common and has a significant impact on patient care. Information loss can be prevented with medical documentation that is accurate, complete and contains the relevant information regarding patient management. Patient report Forms (PRF's) are used by Emergency Care Providers to record the details of their patient care and they form part of the patients’ medical records. Quality assuring of PRF's is required to determine if the required information has been recorded on the PRF. Checklists are one the means of quality assuring PRF, by comparing the points on the checklist to the content of the PRF. Methods: An three-round Delphi survey was conducted with experts to determine the relevant information (data elements) required for the completion of a PRF including any additional South African – specific elements. Results: Thirty-two experts participated in the Delphi survey, which identified 166 data elements for the check list and this was refined to a final 133 elements after collation by the researchers. A proposed checklist was developed. Discussion: The Delphi process is a useful technique to develop a checklist. A checklist consisting of 133 total possible data elements to quality assure PRFs was designed. Further research regarding the use and reliability of the checklist is required.
    Keywords Emergency medical services ; Delphi ; Patient report form ; Quality assurance ; Audit ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 650
    Language English
    Publishing date 2022-09-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Defining current facial fracture patterns in a quaternary institution following high-velocity blunt trauma

    Senzwesihle C. Magagula / Timothy Hardcastle

    South African Journal of Radiology, Vol 20, Iss 1, Pp e1-e

    2016  Volume 6

    Abstract: Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in ...

    Abstract Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions. Objectives: A retrospective study to define facial bone fractures occurring subsequent to highvelocity trauma. Method: A retrospective study comprising the review of CT scans of 52 patients with highvelocity facial fractures was performed between April 2007 and March 2013. Injuries were classified using the Le Fort classification system. Deviations from the true Le Fort types, which are often depicted in the literature as occurring bilaterally and symmetrically, were documented; these included unilaterality, occurrence of several Le Fort fractures on one side of the face, occurrence of several Le Fort fractures on different levels and on different sides of the face, and occurrence of other fractures in addition to Le Fort fractures. Results: Of the 52 cases, 12 (23%) had Le Fort injuries, with true Le Fort fractures occurring in only 1, and 11 deviating from the classic description. Nine patients had Le Fort fractures and additional fractures. Mandibular and zygomatic bone fractures were found to be common associations with Le Fort injuries, occurring in 58% and 33% of the cases respectively. Conclusion: Fractures occurring in modern practice often deviate from the traditional Le Fort classification. Precise recognition of these deviations and recognition of additional associated fractures is pivotal in their management, assisting the surgeon in determining the treatment plan, such as the surgical approach and the order in which to fix the various fractured components.
    Keywords Maxillofacial facture patterns ; High velocity trauma ; Le Fort fractures ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Subject code 616
    Language English
    Publishing date 2016-09-01T00:00:00Z
    Publisher AOSIS
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: HIV trauma and the emergency departments

    Timothy Hardcastle / Bhakti Hansoti

    South African Journal of Bioethics and Law, Vol 9, Iss 2, Pp 57-

    The CDC optout approach should be adopted in South Africa

    2016  Volume 57

    Abstract: Background. Trauma is the fourth burden of disease in South Africa (SA). The risk group is the same as that for HIV/AIDS. The Centers for Disease Control and the World Health Organization promulgated the opt-out testing system 10 years ago and several ... ...

    Abstract Background. Trauma is the fourth burden of disease in South Africa (SA). The risk group is the same as that for HIV/AIDS. The Centers for Disease Control and the World Health Organization promulgated the opt-out testing system 10 years ago and several high- and lower-middleincome countries have adopted this approach.Objective. To review the feasibility of implementing the opt-out system in SA emergency departments.Methods. We examined the clinical, economic, practical and patient/provider perceptions concerning the scientific and ethical aspects of the opt-out concept.Results. Patients were generally positive about the opt-out system and the overall test rate and disease identification rates were better than with other systems. Although initial costs may increase, the long-term cost benefit and prevention of transmission, due to linking to care,make this option attractive.Conclusion. The opt-out option for patients presenting to emergency departments with an acute life-threatening illness or trauma, and for those in critically ill states in an intensive care unit, is justifiable based on international and regional practices. This also has the potential to advance early highly active antiretroviral therapy and reduce treatment costs and the disease-adjusted life years for HIV management and trauma critical care. SA should adopt an opt-out testing system instead of the current tedious opt-in system.
    Keywords Medical legislation ; K3601-3611 ; Medicine ; R ; Medical philosophy. Medical ethics ; R723-726
    Subject code 170
    Language English
    Publishing date 2016-12-01T00:00:00Z
    Publisher South African Medical Association
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Dysmagnesaemia and outcome in a trauma ICU

    Timothy Hardcastle / Jonathan Ilicki / Hans Barle / David Muckart

    Southern African Journal of Critical Care, Vol 30, Iss 2, Pp 45-

    2014  Volume 50

    Abstract: Objective. To determine the prevalence of dysmagnesaemia among patients admitted to a trauma intensive care unit (ICU) and to investigate whether dysmagnesaemia at admission correlated with a worse outcome. Methods. In this retrospective case study of ... ...

    Abstract Objective. To determine the prevalence of dysmagnesaemia among patients admitted to a trauma intensive care unit (ICU) and to investigate whether dysmagnesaemia at admission correlated with a worse outcome. Methods. In this retrospective case study of patients admitted to a regional level 1 trauma unit, from April 2007 to November 2010, de-identified patient data were obtained from the local patient database. Patients were divided into three groups (hypomagnesaemic, normomagnesaemic and hypermagnesaemic), which in turn were divided into two subgroups (blunt and penetrating trauma). The mortality between normo- and hypomagnesaemic patients, as well as between the subgroups, was analysed using χ2 tests. The University of KwaZulu-Natal Biomedical Research Ethics Committee approved the study (BE207/09). Results. Of the 759 trauma patients studied, 10.7% were hypomagnesaemic and 1.3% were hypermagnesaemic at admission. No statistically significant difference in mortality was observed between the hypo- and normo-/hypermagnesaemic patients. Conclusion. Dysmagnesaemia is common among trauma patients admitted to the ICU, but is not necessarily correlated with a poorer outcome.
    Keywords Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 616
    Language English
    Publishing date 2014-11-01T00:00:00Z
    Publisher South African Medical Association
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Genomic Analysis of Carbapenemase-Producing Extensively Drug-Resistant Klebsiella pneumoniae Isolates Reveals the Horizontal Spread of p18-43_01 Plasmid Encoding bla NDM-1 in South Africa

    Yogandree Ramsamy / Koleka P. Mlisana / Mushal Allam / Daniel G. Amoako / Akebe L. K. Abia / Arshad Ismail / Ravesh Singh / Theroshnie Kisten / Khine Swe Swe Han / David J. Jackson Muckart / Timothy Hardcastle / Moosa Suleman / Sabiha Y. Essack

    Microorganisms, Vol 8, Iss 1, p

    2020  Volume 137

    Abstract: Whole-genome sequence (WGS) analyses were employed to investigate the genomic epidemiology of extensively drug-resistant Klebsiella pneumoniae strains, focusing on the carbapenem resistance-encoding determinants, mobile genetic support, clonal and ... ...

    Abstract Whole-genome sequence (WGS) analyses were employed to investigate the genomic epidemiology of extensively drug-resistant Klebsiella pneumoniae strains, focusing on the carbapenem resistance-encoding determinants, mobile genetic support, clonal and epidemiological relationships. A total of ten isolates were obtained from patients admitted to the intensive care unit (ICU) in a public hospital in South Africa. Five isolates were from rectal swabs of colonized patients and five from blood cultures of patients with invasive carbapenem-resistant infections. Following microbial identification and antibiotic susceptibility tests, the isolates were subjected to WGS on the Illumina MiSeq platform. All the isolates showed genotypic resistance to tested β-lactams (NDM-1, OXA-1, CTX-M-15, TEM-1B, SHV-1) and other antibiotics. All but one isolate belonged to the ST152 with a novel sequence type, ST3136, differing by a single-locus variant. The isolates had the same plasmid multilocus sequence type (IncF[K12:A-:B36]) and capsular serotype ( KL149 ), supporting the epidemiological linkage between the clones. Resistance to carbapenems in the 10 isolates was conferred by the bla NDM-1 mediated by the acquisition of multi-replicon [ColRNAI, IncFIB(pB171), Col440I, IncFII, IncFIB(K) and IncFII(Yp)] p18-43_01 plasmid. These findings suggest that the acquisition of bla NDM-1 -bearing plasmid structure (p18-43_01), horizontal transfer and clonal dissemination facilitate the spread of carbapenemases in South Africa. This emphasizes the importance of targeted infection control measures to prevent dissemination.
    Keywords genomics ; carbapenemase ; klebsiella pneumoniae ; extensively drug-resistant ; mobile genetic elements ; epidemiology ; phylogenomic ; south africa ; Biology (General) ; QH301-705.5
    Subject code 580
    Language English
    Publishing date 2020-01-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: A pandemic recap

    Federico Coccolini / Enrico Cicuttin / Camilla Cremonini / Dario Tartaglia / Bruno Viaggi / Akira Kuriyama / Edoardo Picetti / Chad Ball / Fikri Abu-Zidan / Marco Ceresoli / Bruno Turri / Sumita Jain / Carlo Palombo / Xavier Guirao / Gabriel Rodrigues / Mahir Gachabayov / Fernando Machado / Lostoridis Eftychios / Souha S. Kanj /
    Isidoro Di Carlo / Salomone Di Saverio / Vladimir Khokha / Andrew Kirkpatrick / Damien Massalou / Francesco Forfori / Francesco Corradi / Samir Delibegovic / Gustavo M. Machain Vega / Massimo Fantoni / Demetrios Demetriades / Garima Kapoor / Yoram Kluger / Shamshul Ansari / Ron Maier / Ari Leppaniemi / Timothy Hardcastle / Andras Vereczkei / Evika Karamagioli / Emmanouil Pikoulis / Mauro Pistello / Boris E. Sakakushev / Pradeep H. Navsaria / Rita Galeiras / Ali I. Yahya / Aleksei V. Osipov / Evgeni Dimitrov / Krstina Doklestić / Michele Pisano / Paolo Malacarne / Paolo Carcoforo / Maria Grazia Sibilla / Igor A. Kryvoruchko / Luigi Bonavina / Jae Il Kim / Vishal G. Shelat / Jacek Czepiel / Emilio Maseda / Sanjay Marwah / Mircea Chirica / Giandomenico Biancofiore / Mauro Podda / Lorenzo Cobianchi / Luca Ansaloni / Paola Fugazzola / Charalampos Seretis / Carlos Augusto Gomez / Fabio Tumietto / Manu Malbrain / Martin Reichert / Goran Augustin / Bruno Amato / Alessandro Puzziello / Andreas Hecker / Angelo Gemignani / Arda Isik / Alessandro Cucchetti / Mirco Nacoti / Doron Kopelman / Cristian Mesina / Wagih Ghannam / Offir Ben-Ishay / Sameer Dhingra / Raul Coimbra / Ernest E. Moore / Yunfeng Cui / Martha A. Quiodettis / Miklosh Bala / Mario Testini / Jose Diaz / Massimo Girardis / Walter L. Biffl / Matthias Hecker / Ibrahima Sall / Ugo Boggi / Gabriele Materazzi / Lorenzo Ghiadoni / Junichi Matsumoto / Wietse P. Zuidema / Rao Ivatury / Mushira A. Enani / Andrey Litvin / Majdi N. Al-Hasan / Zaza Demetrashvili / Oussama Baraket / Carlos A. Ordoñez / Ionut Negoi / Ronald Kiguba / Ziad A. Memish / Mutasim M. Elmangory / Matti Tolonen / Korey Das / Julival Ribeiro / Donal B. O’Connor / Boun Kim Tan / Harry Van Goor / Suman Baral / Belinda De Simone / Davide Corbella / Pietro Brambillasca / Michelangelo Scaglione / Fulvio Basolo / Nicola De’Angelis / Cino Bendinelli / Dieter Weber / Leonardo Pagani / Cinzia Monti / Gianluca Baiocchi / Massimo Chiarugi / Fausto Catena / Massimo Sartelli

    World Journal of Emergency Surgery, Vol 16, Iss 1, Pp 1-

    lessons we have learned

    2021  Volume 8

    Abstract: Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white ...

    Abstract Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
    Keywords Pandemia ; International ; Thoughts ; Reflection ; Ethics ; Biology ; Surgery ; RD1-811 ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 360
    Language English
    Publishing date 2021-09-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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