Browsing by Subject "South Africa"
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Item The Burden of Gunshot Injuries on Orthopaedic Healthcare Resources in South Africa(2016-04-07) Martin, Case Wilemon; Nwariaku, Fiemu; Niwagaba, Lillian; Salazar, AdrianBACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense burden on the South African healthcare system. In 2005, Allard et al. estimated South African state hospitals treat approximately 127,000 firearm victims annually and concluded the cost of treating an abdominal GSW is approximately USD 1,467 per patient. No study has been conducted to estimate the burden of GSWs from an orthopaedic perspective. OBJECTIVE: This study sought to estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in a South African tertiary level hospital. METHODS: This retrospective study surveyed over 1,500 orthopaedic admissions over a 12-month period in 2012 in Cape Town, South Africa at Groote Schuur Hospital (GSH) - an 893-bed university-affiliated state hospital. Chart review subsequently yielded data on, which allowed for cost analysis of, theatre time, number and type of implants, duration of admission, diagnostic-imaging studies performed, blood products used, laboratory studies ordered, and medications administered. RESULTS: A total of 111 patients with an average age of 28 years (range 13-74) were identified. Each patient was hit by an average of 1.69 bullets (range 1-7). These patients sustained a total of 147 fractures, the majority of which occurred in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical theatre time of greater than 306 hours. Theatre costs, excluding implants, were in excess of USD 94,490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD 53,381 cumulatively, or USD 667 per patient. Patients remained in the hospital for an average of 9.75 days, and total costs were USD 130,427 (R1.106 million) for ward admissions, USD 21,583 for imaging, USD 22,563 for blood products, USD 1,914 for laboratory investigations, and USD 1,964 for discharge medication. Individual patient costs range from USD 20,046 to USD 305 for an average of about USD 2,940 (R24,944.68) per patient. CONCLUSION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs USD 2,940, utilizes just over three hours of theatre time per operation, and necessitates a hospital bed for an average period of 9.75 days. With a greater understanding of not only the high incidence of orthopaedic GSWs treated in a South African tertiary care trauma center but also the costs incurred, the state healthcare system can better prioritize orthopaedic trauma funding and training opportunities while also supporting cost saving measures, including the redirection of financial resources to primary prevention initiatives.Item The Burden of Orthopaedic Gunshot Injuries on Healthcare Resources in South Africa(2015-01-26) Martin, Case; Maqungo, Sithombo; Thiart, Gerhard; McCollum, Graham; Roche, SteveBACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense financial burden on the South African healthcare system. In 2005, Allard et al. estimated South African state hospitals treat approximately 127,000 firearm victims annually and concluded the cost of treating an abdominal GSW is approximately $1,467 per patient. No study has been conducted to estimate the burden from an orthopaedic perspective. OBJECTIVE: This study sought to estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in a South African tertiary level hospital. METHODS: This retrospective study surveyed over 1,500 orthopaedic admissions over a 12-month period in 2012 in Cape Town, South Africa at Groote Schuur Hospital (GSH) - a 893-bed university-affiliated state hospital. Chart review subsequently yielded data on, which allowed for cost analysis of, theatre time, number and type of implants, duration of admission, diagnostic-imaging studies performed, blood products used, laboratory studies ordered, and medications administered. RESULTS: A total of 111 patients with an average age of 28 years (range 13-74) were identified. Each patient was hit by an average of 1.69 bullets (range 1-7). These patients sustained a total of 147 fractures. The majority of injuries occurred in the lower extremities with 38.8% of all fractures in femurs, 15.6% in tibias, and 11.6% in fibulas. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical time of 220 hours 3 minutes. Cumulative anesthesia time was 306 hours 25 minutes. Theatre costs, excluding implants, were in excess of R800,000 (estimated $94,284). Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional R452,935 ($53,381) cumulatively, or R5,661.70 ($667.26) per patient. Total costs were in excess of R1 million for ward admissions, R180,000 for imaging, R190,000 for blood products, R16,000 for laboratory investigations, and R16,000 for discharge medication. Individual patient costs range from $18,603 to $305 for an average of about R24,834.43 ($2,927) per patient. INTERPRETATION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs $2,927, utilizes about 3 hours of theatre time per operation, and necessitates a hospital bed for an average period of 10 days. With a greater understanding of not only the high incidence of orthopaedic GSWs treated in a South African tertiary care trauma center but also the costs incurred, the state healthcare system can better prioritize orthopaedic trauma funding and training opportunities while also supporting cost saving measures, including the redirection of financial resources to primary prevention initiatives.Item Optimizing Medical Resources for the Treatment of Infectious Diseases in South Africa(2016-04-04) Davis, Kelly A.; Nwariaku, Fiemu; Raja, Hari; Niwagaba, LillianBACKGROUND: Over the past two decades, healthcare expenditures worldwide have increased dramatically. In an era of rising antibiotic resistance, the need for more effective and efficient utilization of healthcare resources could not be more applicable than in the field of infectious diseases. Based on a review of available literature, several interventions targeted at improving antibiotic stewardship have been successful in decreasing healthcare costs in high income countries. Unfortunately, little research has been done in low income countries, including those on the African continent. South Africa in particular lends itself to further study. Despite spending more of its gross domestic product (GDP) per capita on healthcare than most of its neighbors, South Africa is still faced with many of the healthcare issues present in the rest of the continent, including the rise of multidrug-resistant pathogens and an increased Human Immunodeficiency Virus (HIV) seroprevalence. OBJECTIVE: The objective of this research was to analyze current healthcare practices in the treatment of infectious diseases in South Africa in order to identify areas needing more efficient utilization of resources. METHODS: The objective was accomplished by conducting two prospective observational cohort studies. In the first study, data related to patients presenting to two emergency departments in Cape Town, South Africa, were collected to evaluate the efficacy of clinical decision rules currently used when drawing blood cultures. The decision to collect a set of blood cultures was made by the physician, who then recorded a set of clinical parameters known at the time of collection. In the second study, a quality improvement analysis was done to evaluate effectiveness of current intravenous (IV)-to-oral antibiotic switch therapy practices at a tertiary referral center in Cape Town. During the study, all patients receiving IV antibiotic therapy in the internal medicine wards were followed throughout the course of their IV therapy and were evaluated on their eligibility to switch to oral antibiotic therapy based on a list of criteria. RESULTS: In the first study, 500 blood culture sets were collected from 489 patients. Thirty-nine (7.8%) of these were positive for disease causing pathogens, and 13 (2.6%) contained contaminants. Clinical features that were independently associated with a positive culture result included the presence of diabetes, systolic blood pressure <90 mmHg, diastolic blood pressure <60 mmHg, and a suspected biliary source of infection. Thirty-six (95%) of these positive cultures were found to influence patient management in a significant way. In the second study, 71 (55%) of the 129 patients receiving IV antibiotic therapy met all the criteria for switching to oral antibiotics and only 4 (5.6%) of those were switched once the patient became eligible. Patients eligible for switching were continued on IV therapy for a mean of 3.1 (+/-1.6) days (median=3, Interquartile range (IQR)= 2-4 days) after meeting the criteria, and the most common indications for therapy within this group were community-acquired pneumonia (58.2%), sepsis of unknown cause (13.4%), and urinary tract infection (11.9%). The most common IV antibiotics used in this group were ceftriaxone 1 g (77.6%) and amoxicillin/clavulanate 1.2 g (13.4%). Fifteen (21.1%) of the patients meeting the criteria for switching did not have a blood culture sample taken prior to initiation of therapy. CONCLUSIONS: In the end, the stated objective of the project was met: analyzing current healthcare practices in the treatment of infectious diseases in South Africa helped to identify areas needing more efficient utilization of resources. The first study determined that, while blood cultures are an essential aspect of the treatment of infectious diseases, no consistent set of rules exists that allows physicians to predict when to order these studies. Further, when relying on clinical judgment, the vast majority of blood cultures ordered are negative. The second study identified several key mechanisms that led to inappropriately continued IV antibiotic treatment. The results of both studies highlight the need for more research to facilitate targeted interventions.Item [UT Southwestern Medical Center News](2006-05-16) Rian, Russell