Day: September 15, 2023

Categories : Ethics and LawTags :

Elevating Patients’ Voices for Greater Healthcare Safety

On By ModernMedia

With four in ten patients injured in primary and outpatient healthcare and 134 million adverse events occurring on the back of unsafe care in hospitals globally every year,1 World Patient Safety Day aims to address the avoidable challenges that will bolster patient safety across the healthcare spectrum.

Even in an era marked by incredible innovation and advancements in medical science, the reality is that within the four walls of the hospital environment, patients continue to face preventable challenges that could potentially threaten their health and well-being.

Recognising the seriousness of this, the World Health Organization (WHO) launched its World Patient Safety Day initiative in 2005 to increase awareness of unsafe healthcare, and to drive high-level support and commitment to address patient safety issues across all parts of the world.2

Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa, adds that under the theme of “engaging patients for patient safety”, World Patient Safety Day 2023 is positioned to recognise the crucial role that patients, families and caregivers play in safety in the healthcare sector.3

“Patients are the core of all healthcare systems, and evidence shows that when patients are treated as partners in their care, significant gains are made in safety, patient satisfaction and overall health outcomes,” explains Pharasi.

Patient safety is fundamental to delivering quality and essential health services and prevents and reduces risks, errors and harm to patients. A cornerstone of this lies in continuous improvement based on learning from errors and previous adverse events that have impacted patient well-being.  

More than 10% of patients have experienced harm due to negligence during treatment, and alarmingly, this has resulted in over three million deaths globally every year.5 Even more concerning is that up to 80% of these instances are avoidable, with the most significant factors accounting for these errors being related to misdiagnosis and the prescribing and use of incorrect medications.1

“An integral part of addressing this plight is to elevate patients’ voices,” adds Pharasi. “This can be accomplished by ensuring that patients are involved in policy formulation, represented in governance structures, engaged in co-designing safety strategies, and are active partners in their own care.”3

Here, patients should enquire why the medication has been prescribed, how long the medication will take to resolve symptoms if the medication can be taken with others, and what are the potential side effects of the medication.6

Furthermore, patients should be cognisant of not taking medication prescribed to someone else, discarding medicines that have passed their expiry date, never exceeding dosage recommendations, carefully reading the patient information leaflets included with medications, and being aware that some medications may contain addictive substances.

For patient safety strategies to be successful, patients need to report instances where they have been prescribed the incorrect medication and the adverse effects it may have caused. To report these, patients can record their complaints on the Med Safety app, the SAHPRA e-reporting portal on its website, or via email or telephone.7

“As IPASA, we are committed to a healthier South Africa and a patient-centred healthcare system. We support the WHO mandate to ensure safer patient treatments and outcomes, and strive to continue informing healthcare professionals and patients about the benefits and risks of pharmaceutical products. In doing so, we believe we can make a notable difference in ensuring patient safety across all facets of the South African healthcare sector,” concludes Pharasi.  

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Categories : Diseases, Syndromes and ConditionsTags :

An Antibacterial for Livestock may be a Magic Bullet for Acne

On By ModernMedia
Photo by cottonbro studio

In a study published in the journal Nanoscale, researchers encased Narasin, a new antibacterial compound, in tiny, soft nanoparticles 1000 times smaller than a single strand of human hair and applied in a gel form to targeted acne sites. The University of South Australia (UniSA)-led research team found that the drug proved successful against drug-resistant acne bacteria and delivered via nanocarriers achieved a 100-fold increase in absorption than simply taken with water.

Lead author UniSA PhD student Fatima Abid says this is the first time that nano-micelle formulations of Narasin have been developed and trialled.

“Acne severely impacts approximately 9.4% of the world’s population, mainly adolescents, and causes distress, embarrassment, anxiety, low self-confidence and social isolation among sufferers,” Abid says.

“Although there are many oral medications prescribed for acne, they have a range of detrimental side effects, and many are poorly water soluble, which is why most patients and clinicians prefer topical treatments.”

Abid’s supervisor, pharmaceutical scientist Professor Sanjay Garg, says a combination of increasing antibiotic resistance and the ineffectiveness of many topical drugs to penetrate hair follicles in acne sites means there is a pressing need to develop new antibacterial therapies that are effective and safe.

Narasin is commonly used for bacterial infections in livestock but has never been previously investigated as a viable treatment for acne.

Abid, Prof Garg and researchers from UniSA, the University of Adelaide, and Aix-Marseille Université in France also investigated how well Narasin encased in nanoparticles penetrated various layers of skin, using pig’s ear skin as a model.

“The micelle formulation was effective in delivering Narasin to acne targets sites, as opposed to the compound solution which failed to permeate through skin layers,” Prof Garg says.

Source: University of South Australia

Categories : Hospitals NeurologyTags :

New Evidence of Patients Recalling Death Experiences after Cardiac Arrest

On By ModernMedia

Up to an hour after cardiac arrest, some patients revived by cardiopulmonary resuscitation (CPR) had clear memories afterward of experiencing death and had brain patterns while unconscious linked to thought and memory, report investigators in the journal Resuscitation.

In a study led by researchers at NYU Grossman School of Medicine, some survivors of cardiac arrest described lucid death experiences that occurred while they were seemingly unconscious. Despite immediate treatment, fewer than 10% of the 567 patients studied, who received CPR in the hospital, recovered sufficiently to be discharged. Of the survivors, four in 10 recalled some degree of consciousness during CPR not captured by standard measures.

The study also found that in a subset of these patients, who received brain monitoring, nearly 40% had brain activity that returned to normal, or nearly normal, from a “flatline” state, at points even an hour into CPR. As captured by EEG, the patients saw spikes in the gamma, delta, theta, alpha, and beta waves associated with higher mental function.

Survivors have long reported having heightened awareness and powerful, lucid experiences, say the study authors. These have included a perception of separation from the body, observing events without pain or distress, and a meaningful evaluation of their actions and relationships. This new work found these experiences of death to be different from hallucinations, delusions, illusions, dreams, or CPR-induced consciousness.

The study authors hypothesise that the “flatlined”, dying brain removes natural inhibitory (braking) systems. These processes, known collectively as disinhibition, may open access to “new dimensions of reality,” they say, including lucid recall of all stored memories from early childhood to death, evaluated from the perspective of morality. While no one knows the evolutionary purpose of this phenomenon, it “opens the door to a systematic exploration of what happens when a person dies.”

Senior study author Sam Parnia, MD, PhD, associate professor in the Department of Medicine at NYU Langone Health and director of critical care and resuscitation research at NYU Langone, says, “Although doctors have long thought that the brain suffers permanent damage about 10 minutes after the heart stops supplying it with oxygen, our work found that the brain can show signs of electrical recovery long into ongoing CPR. This is the first large study to show that these recollections and brain wave changes may be signs of universal, shared elements of so-called near-death experiences.”

Dr Parnia adds, “These experiences provide a glimpse into a real, yet little understood dimension of human consciousness that becomes uncovered with death. The findings may also guide the design of new ways to restart the heart or prevent brain injuries and hold implications for transplantation.”

The AWAreness during REsuscitation (AWARE)-II study followed 567 adults who suffered in-hospital cardiac arrest between May 2017 and March 2020 in the US and UK. Only hospitalised patients were enrolled to standardise the CPR and resuscitation methods used, as well as recording methods for brain activity. A subset of 85 patients received brain monitoring during CPR. Additional testimony from 126 community survivors of cardiac arrest with self-reported memories was also examined to provide greater understanding of the themes related to the recalled experience of death.

The study authors conclude that research to date has neither proved nor disproved the reality or meaning of patients’ experiences and claims of awareness in relation to death. They say the recalled experience surrounding death merits further empirical investigation and plan to conduct studies that more precisely define biomarkers of clinical consciousness and that monitor the long-term psychological effects of resuscitation after cardiac arrest.

Source: Elsevier

Categories : Medical Industry Mental HealthTags :

Stress, Overwork, Understaffing Driving Healthcare Workers from NHS

On By ModernMedia
Photo by Usman Yousaf on Unsplash

Work stress, high workload, and understaffing are the primary factors driving health professionals out of the NHS, suggest the results of a survey published in the open access journal BMJ Open.

The findings prompt the researchers to suggest that pay increases alone may not be sufficient to fix NHS staff retention. The NHS is short of well over 100 000 staff and fallout from COVID-19 has seen worsening retention.

The researchers investigated the ‘push’ factors behind decisions to leave the NHS, and whether these were ranked differently by profession and NHS setting, a year after exposure to the effects of the pandemic.

In 2021, NHS health professionals completed an online survey to determine the relative importance they gave to 8 factors as the key reasons for leaving NHS employment.

The respondents included 227 doctors; 687 nurses/midwives; 384 healthcare assistants and other nursing support staff; 417 allied health professionals, such as physiotherapists and occupational therapists; and 243 paramedics from acute, mental health, community, and ambulance services.

Using the paired comparison technique, whereby two push factors at a time were presented at a time, respondents were asked: ‘Which of these two factors is the bigger influence on why staff in your profession/job role leave the NHS’?’

Photo by Pavel Danilyuk

Compared to other professions, paramedics gave a much higher relative weighting to work stress, work-life balance, work intensity and pay higher relative weighting.

The factors compared were: staffing levels; working hours; mental health/stress; pay; time pressure; recognition of contribution; workload intensity; and work–life balance.

Compared to other professions, paramedics gave a much higher relative weighting to work stress, work-life balance, work intensity and pay higher relative weighting. Paramedics also ranked work-life balance as a stronger driver to leave the NHS. They ranked this second compared to a fourth or fifth ranking across the other professions.

Pay was considered more important by healthcare assistants and other nursing support staff and paramedics, but was generally ranked fourth or fifth by other professional groups. 

This contrasts with “some contemporary media and industrial relations accounts, and some academic research findings,” say the researchers, who nevertheless add: “While other variables appear to exert a stronger push than pay, this is not grounds to diminish it as a potential source of dissatisfaction in absolute terms.” 

Overall, health professionals ranked work-related stress, workload intensity, and staffing levels as the primary ‘push factors’ underpinning decisions to leave the NHS. Recognition of effort and working hours were ranked lowest. But there were differences in the order of importance and relative weighting given to the push factors among the different health professions.

Work intensity in acute care hospitals and community services; time pressure in community services; and recognition of effort in mental health services were given higher relative weightings.

“In common with the NHS annual staff survey and all other voluntary participation employee surveys, the potential for self-selection response bias cannot be discounted,” emphasise the researchers. 

But they conclude: “Excepting paramedics, rankings of leave variables across the different health professional families exhibit a high degree of alignment, at the ordinal level, and highlight the primacy of psychological stress, staff shortages, and work intensity.”

They add: “While increases in pay are transparently important to NHS staff, findings from this research suggest that enhancements in that domain alone may produce a modest impact on retention.

“An equivalent conclusion might be drawn with respect to the current high-profile emphasis on increased access to flexible working hours as a solution within contemporary NHS staff retention guidance to employers. 

“Both have potential to do good, but there are grounds for inferring there is a risk that neither may deliver sufficient good to redress the high and rising exodus in the absence of attention to what present as more fundamental factors driving exit.” 

Source: BMJ Open

Categories : Injury & TraumaTags :

SA’s Injury Statistics are not Accurate, Experts Warn

On By ModernMedia
Photo by Maxim Hopman on Unsplash

By Sonia A. Rao for GroundUp

Reporting of gun crime in South Africa is wildly inaccurate, work by the South African Medical Research Council (SAMRC) suggests. This is because the official death notification form does not distinguish between gun deaths from accidents and gun deaths from homicide.

The SAMRC has called on the government to update the country’s official death notification form. In a September 2023 South African Medical Journal (SAMJ) editorial, researchers and scientists Pam Groenewald, Richard Matzopoulos, Estevão Afonso and Debbie Bradshaw, say the form does not comply with international standards. While the World Health Organisation recommends reporting manner of death on the medical certificate for cause of death, South Africa’s form does not allow this, they say.

As a result, South Africa does not have accurate information on injury statistics, says Groenewald, a specialist scientist at SAMRC.

“Given that South Africa has got a really high injury burden, this is really not acceptable,” she said.

The SAMRC has pointed out that accurate, timely mortality data for natural and non-natural deaths is especially important after the Covid pandemic.

In a press release, the SAMRC said natural deaths had spiked during Covid waves, while injuries had fallen during government-imposed lockdowns and alcohol sales bans. “Of particular concern is the significant impact of alcohol bans on injury-related deaths,” the council said.

The release also said the statistics are necessary to develop and monitor programs to reduce injuries and violence, and track Sustainable Development Goals of road traffic injury reduction, gender equality and reducing violence-related death rates.

South Africa’s official mortality statistics overestimate accidental injuries and underestimate homicides, transport and suicide deaths, according to a research report also published in the September 2023 SAMJ.

In official death notification form data from Stats SA for 2017, nearly 99% of firearm deaths were classified as accidental and only 1% as homicide. But the SAMRC’s National Cause-of-Death Validation Project (NCoDV) found more than 88% of firearm deaths were homicide, and its Injury Mortality Survey (IMS) found more than 93%.

Similar differences occurred for suicides. Only 0.3% of firearm deaths were recorded as suicide in the 2017 Stats SA data, but they were recorded as 7% in NCoDV and IMS data.

The research report says NCoDV and IMS provide more detailed and consistent data on causes of injury than the death notification form, but they are costly and time-consuming, and not feasible for routine surveillance.

“It costs a lot of money, when we could be getting this data in with every death certificate that gets completed,” Groenewald says.

She says the SAMRC has been asking for an updated death certificate form since 2012.

No annual mortality report since 2018

Also, Stats SA has not published an updated mortality report since the pandemic. The last official report was released in 2021 for the year 2018.

“We’ve got no cause-of-death data at all, not just injuries, nothing. We haven’t seen a death certificate from during the Covid period; we don’t know what doctors have reported,” she said. “It’s mind boggling.”

Felicia Sithole, deputy director of media relations for Stats SA, said in a statement that the Mortality and Causes of Death report had been delayed by a backlog of processing death notification forms as a result of the Covid lockdown, and because of Census 2022 work.

Sithole said Stats SA is committed to publishing the 2019 and 2020 Mortality and Causes of Death reports by the end of March 2024.

“Stats SA fully comprehends the importance of the Mortality and Causes of Death release, especially during the Covid-19 pandemic, and acknowledges that our data must conform to international standards,” she said.

The SAMRC report also calls for the dormant National Forensic Pathology Services Committee to be reactivated. This would help improve data quality, the report says. The committee, established in 2014, has been inactive since 2018/9.

Foster Mohale, a media officer for the Department of Health, said the Minister of Health is in the process of appointing a new National Forensic Pathology Services Committee.

The Department of Home Affairs had not responded to requests for comment at the time of publication.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp