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Nel D, McNamee L, Wright M, Alseidi AA, Cairncross L, Jonas E, Burch V. Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context. J Surg Educ 2023; 80:1462-1471. [PMID: 37453897 DOI: 10.1016/j.jsurg.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa. DESIGN Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach. SETTING AND PARTICIPANTS Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022. RESULTS Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees. CONCLUSIONS Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.
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Affiliation(s)
- D Nel
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - L McNamee
- Center for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - M Wright
- Department of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - A A Alseidi
- Department of Surgery, University of California, San Francisco, California
| | - L Cairncross
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - E Jonas
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - V Burch
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, and the Colleges of Medicine of South Africa, South Africa
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Hannington M, Nel D, Miller M, Nicol A, Navsaria P. The impact of thromboelastography on patients with penetrating abdominal trauma requiring intensive care. S AFR J SURG 2023; 61:133-138. [PMID: 37381810 DOI: 10.36303/sajs.3950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Trauma-induced coagulopathy (TIC) is a complex multifaceted process which contributes to higher mortality rates in severely injured trauma patients. Thromboelastography (TEG) is effective in detecting TIC which assists in instituting goal-directed therapy as part of damage control resuscitation. METHODS This retrospective study included all adult patients over a 36-month period with penetrating abdominal trauma who required a laparotomy, blood products and admission for critical care. Analysis included demographics, admission data, 24-hour interventions, TEG parameters and 30-day outcomes. RESULTS Eighty-four patients with a median age of 28 years were included. The majority (93%; 78/84) suffered from a gunshot injury, with 75% (63/84) receiving a damage control laparotomy. Forty-eight patients (57%) had a TEG. Injury severity score and total fluid and blood product administered in the first 24 hours were all significantly higher in patients who had a TEG (p < 0.05). TEG profiles were: 42% (20/48) normal, 42% (20/48) hypocoagulable, 12% (6/48) hypercoagulable and 4% (2/48) mixed parameters. Fibrinolysis profiles were: 48% (23/48) normal, 44% (21/48) fibrinolysis shutdown and 8% (4/48) hyperfibrinolysis. Mortality rate was 5% (4/84) at 24 hours and 26% (22/84) at 30 days, with no difference between the two groups. High-grade complication rates, days on a ventilator and intensive care unit length of stay were all significantly higher in patients who did not have a TEG. CONCLUSION TIC is common in severely injured penetrating trauma patients. The usage of a thromboelastogram did not impact on 24-hour or 30-day mortality but did result in a decreased intensive care stay and a decreased high-grade complication rate.
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Affiliation(s)
- M Hannington
- Department of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - D Nel
- Department of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - M Miller
- Department of Critical Care, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A Nicol
- Department of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Trauma Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - P Navsaria
- Department of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Trauma Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Yousef M, Roodt L, Masu A, Nel D, Malherbe F. Sentinel lymph node biopsy in a resourcelimited setting: a retrospective comparison of sentinel lymph node biopsy before and after the introduction of Sentimag at an academic breast unit. S AFR J SURG 2023; 61:91-95. [PMID: 37381806 DOI: 10.36303/sajs.3962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is performed for staging and prognostication of breast cancer (BC) in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold standard for SLNB. This study aims to evaluate the SLNB outcomes before and after the introduction of Sentimag at an academic breast unit. Sentimag uses an injection of superparamagnetic iron oxide which is then detected in the sentinal lymph node using a magnetometer. METHODS A retrospective cohort study was performed comparing SLNBs done from 1 January 2017 to 31 December 2018. During 2017, a nuclear medicine technique was used for all SLNBs, while the Sentimag system was used in 2018. RESULTS There was no difference between the two groups comparing age, T-stage, size of tumour, and molecular status. The only statistically significant difference found was more higher-grade tumours in the group where a nuclear medicine technique was used in 2017 (p = 0.04). There was no difference in the type of surgery performed comparing mastectomy and breast-conserving surgery rates between the two groups. There was an 11% increase in the number of patients who had an SLNB done with the Sentimag technique (2018). In 2017, 42% (58/139) had an SLNB and in 2018, 53% (59/112) had an SLNB. CONCLUSION This result demonstrates the feasibility of the magnetic technique for SLNB in a resource-limited setting. This new method shows promise as a safe and effective technique for SLNB - it is a valuable alternative in the absence of nuclear medicine (N.Med) facilities.
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Affiliation(s)
- M Yousef
- Department of Surgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, South Africa
| | - L Roodt
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A Masu
- Department of Statistics, University of Cape Town, South Africa
| | - D Nel
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - F Malherbe
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Nel D, Cairncross L, Burch V, Burch E, Green-Thompson L, Koto Z, Montwedi O, Fagan J, Jonas E. Workplace-based assessment - a new era of surgical training competency assessment in South Africa. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nel D. Strategies for recovery of a surgical service in the COVID-19 era. S AFR J SURG 2022; 60:154-159. [PMID: 36155368 DOI: 10.17159/2078-5151/sajs3783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of "elective" surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall survival. Delays in elective surgery also have significant consequences for the health system: added emotional strain on healthcare workers, a reduction in training opportunities, increased costs, and increased inequality in health-service provision. As the virus is likely to become endemic, the recovery of surgical services from the initial shock of the first three waves needs to be carefully planned, in order to mitigate the further loss of elective surgical services. This article presents a narrative review of the latest international guidelines and recommendations pertaining to surgical recovery strategies in the COVID-19 pandemic. To begin with, any recovery plan should be led by a local governance committee, who need to design and implement a number of strategies across the three phases of recovery. The preparation phase includes deciding on a system of case prioritisation, assessing and organising resources, and planning innovative ways to reorganise the service itself. The perioperative phase involves putting measures in place to reduce the risk of COVID-19 transmission. The post discharge phase includes the implementation of telemedicine for follow-up, as well as methods of service audit to enable continuous adjustment and improvement. Surgical service recovery presents many challenges; however, these also present a unique opportunity to reassess and improve the efficiency of surgical care delivery.
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Affiliation(s)
- D Nel
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Gouws J, Nel D, Bougard HC, Koto Z, Oodit R, Kloppers JC. Compliance to the South African ventral hernia guidelines: inaugural results from the HIG(SA) registry. S AFR J SURG 2021; 59:145-148. [PMID: 34889536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry. METHODS A retrospective analysis of the prospectively maintained HIG(SA) hernia registry from 1 February 2019 to 29 February 2020. Compliance to six recommendations made in the HIG(SA) ventral hernia guidelines were assessed in both the public and private healthcare systems. RESULTS Three hundred and fifty-three ventral hernia repair cases were included in the study. Fifty-four per cent were private and 46% were public sector cases. Laparoscopic repair for patients with a BMI > 35 kg/m2 occurred in 38% of eligible cases and a minimum 5 cm of mesh overlap was achieved in 50% of cases. Overall, 80% of elective cases occurred in non-smokers; 97% of the intraperitoneal on-lay mesh (IPOM) repairs used composite mesh; 96% of ventral hernias with defects of larger than 2 cm and 95% of incisional hernias were repaired with mesh. Non-smokers undergoing repair numbered 72% in public and 85% in private practice, p = 0.01. CONCLUSION Ventral hernia repair practices in SA facilities overall had good compliance to four out of the six HIG(SA) ventral hernia guidelines highlighted for the purposes of this study. The two guidelines that had poor compliance overall were 'laparoscopic repair for patients with a BMI of > 35 kg/m2' and 'ensuring a mesh overlap of 5 cm'. The public sector had higher rates of current smokers undergoing elective ventral hernia repair.
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Affiliation(s)
- J Gouws
- Division of General Surgery, University of Cape Town, South Africa and Groote Schuur Hospital, South Africa
| | - D Nel
- Division of General Surgery, University of Cape Town, South Africa and Groote Schuur Hospital, South Africa
| | - H C Bougard
- Division of General Surgery, University of Cape Town, South Africa, New Somerset Hospital, South Africa and Hernia Interest Group of South Africa Executive Committee
| | - Z Koto
- Hernia Interest Group of South Africa Executive Committee and 5 Sefako Makgatho Health Sciences University, South Africa
| | - R Oodit
- Division of General Surgery, University of Cape Town, South Africa and Hernia Interest Group of South Africa Executive Committee
| | - J C Kloppers
- Division of General Surgery, University of Cape Town, South Africa, Groote Schuur Hospital, South Africa and Hernia Interest Group of South Africa Executive Committee
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Queiroz C, Norström AV, Downing A, Harmáčková ZV, De Coning C, Adams V, Bakarr M, Baedeker T, Chitate A, Gaffney O, Gordon L, Hainzelin É, Howlett D, Krampe F, Loboguerrero AM, Nel D, Okollet C, Rebermark M, Rockström J, Smith M, Wabbes-Candotti S, Matthews N. Investment in resilient food systems in the most vulnerable and fragile regions is critical. Nat Food 2021; 2:546-551. [PMID: 37118178 DOI: 10.1038/s43016-021-00345-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Cibele Queiroz
- Global Resilience Partnership, Stockholm, Sweden.
- Stockholm Resilience Centre, Stockholm, Sweden.
| | - Albert V Norström
- Global Resilience Partnership, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm, Sweden
| | - Andrea Downing
- Stockholm Resilience Centre, Stockholm, Sweden
- Swedish Royal Academy of Sciences, Stockholm, Sweden
| | - Zuzana V Harmáčková
- Stockholm Resilience Centre, Stockholm, Sweden
- Global Change Research Institute of the Czech Academy of Sciences, Brno, Czechia
| | | | - Vanessa Adams
- Alliance for a Green Revolution in Africa (AGRA), Nairobi, Kenya
| | | | | | - Ange Chitate
- African Risk Capacity Ltd, Johannesburg, South Africa
| | - Owen Gaffney
- Potsdam Institute for Climate Impact Research (PIK), Potsdam, Germany
| | - Line Gordon
- Global Resilience Partnership, Stockholm, Sweden
| | | | | | - Florian Krampe
- Stockholm International Peace Research Institute (SIPRI), Solna, Sweden
| | - Ana Maria Loboguerrero
- CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) and International Center for Tropical Agriculture, Cali, Colombia
| | - Deon Nel
- WWF Netherlands, Zeist, the Netherlands
| | | | - Maya Rebermark
- Misum-Mistra Centre for Sustainable Markets, Stockholm School of Economics, Stockholm, Sweden
| | - Johan Rockström
- Stockholm Resilience Centre, Stockholm, Sweden
- Potsdam Institute for Climate Impact Research (PIK), Potsdam, Germany
| | - Mark Smith
- International Water Management Institute, Colombo, Sri Lanka
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Nel D, Kloppers C, Panieri E. Laparoscopic splenopexy for wandering spleen with absorbable mesh fixation. S AFR J SURG 2021; 59:30a-30b. [PMID: 33779107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Wandering spleen is a rare condition characterised by lack of fixation of the spleen to its usual position in the left upper quadrant. Laparoscopic splenopexy has become the standard of care. Although a number of methods have been described, the use of an absorbable mesh to secure the spleen to the left upper quadrant has been shown to be safe, effective and quick to perform. We present a case of a 32-year-old female with this condition and describe our surgical technique for fixation of the spleen using an absorbable mesh.
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Affiliation(s)
- D Nel
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - C Kloppers
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - E Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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9
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Beal M, Dias MP, Phillips RA, Oppel S, Hazin C, Pearmain EJ, Adams J, Anderson DJ, Antolos M, Arata JA, Arcos JM, Arnould JPY, Awkerman J, Bell E, Bell M, Carey M, Carle R, Clay TA, Cleeland J, Colodro V, Conners M, Cruz-Flores M, Cuthbert R, Delord K, Deppe L, Dilley BJ, Dinis H, Elliott G, De Felipe F, Felis J, Forero MG, Freeman A, Fukuda A, González-Solís J, Granadeiro JP, Hedd A, Hodum P, Igual JM, Jaeger A, Landers TJ, Le Corre M, Makhado A, Metzger B, Militão T, Montevecchi WA, Morera-Pujol V, Navarro-Herrero L, Nel D, Nicholls D, Oro D, Ouni R, Ozaki K, Quintana F, Ramos R, Reid T, Reyes-González JM, Robertson C, Robertson G, Romdhane MS, Ryan PG, Sagar P, Sato F, Schoombie S, Scofield RP, Shaffer SA, Shah NJ, Stevens KL, Surman C, Suryan RM, Takahashi A, Tatayah V, Taylor G, Thompson DR, Torres L, Walker K, Wanless R, Waugh SM, Weimerskirch H, Yamamoto T, Zajkova Z, Zango L, Catry P. Global political responsibility for the conservation of albatrosses and large petrels. Sci Adv 2021; 7:7/10/eabd7225. [PMID: 33658194 PMCID: PMC7929510 DOI: 10.1126/sciadv.abd7225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Migratory marine species cross political borders and enter the high seas, where the lack of an effective global management framework for biodiversity leaves them vulnerable to threats. Here, we combine 10,108 tracks from 5775 individual birds at 87 sites with data on breeding population sizes to estimate the relative year-round importance of national jurisdictions and high seas areas for 39 species of albatrosses and large petrels. Populations from every country made extensive use of the high seas, indicating the stake each country has in the management of biodiversity in international waters. We quantified the links among national populations of these threatened seabirds and the regional fisheries management organizations (RFMOs) which regulate fishing in the high seas. This work makes explicit the relative responsibilities that each country and RFMO has for the management of shared biodiversity, providing invaluable information for the conservation and management of migratory species in the marine realm.
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Affiliation(s)
- Martin Beal
- MARE-Marine and Environmental Sciences Centre, ISPA-Instituto Universitário, Lisboa, Portugal.
- BirdLife International, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK
| | - Maria P Dias
- MARE-Marine and Environmental Sciences Centre, ISPA-Instituto Universitário, Lisboa, Portugal
- BirdLife International, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK
| | - Richard A Phillips
- British Antarctic Survey, Natural Environment Research Council, High Cross, Madingley Road, Cambridge CB3 0ET, UK
| | - Steffen Oppel
- RSPB Centre for Conservation Science, Royal Society for the Protection of Birds, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK
| | - Carolina Hazin
- BirdLife International, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK
| | - Elizabeth J Pearmain
- BirdLife International, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK
| | - Josh Adams
- U.S. Geological Survey, Western Ecological Research Center, Santa Cruz Field Station, 2885 Mission St, Santa Cruz, CA 95060, USA
| | - David J Anderson
- Department of Biology, Wake Forest University, Winston Salem, NC 27109 USA
| | - Michelle Antolos
- Department of Fisheries and Wildlife, Oregon State University, 104 Nash Hall, Corvallis, OR 97331, USA
| | - Javier A Arata
- Independent researcher, 204-100 Coe Hill Dr, Toronto, ON M6S 3E1, Canada
| | - José Manuel Arcos
- SEO/BirdLife, Marine Programme, C/Murcia 2-8, local 13, 08026 Barcelona, Spain
| | - John P Y Arnould
- School of Life and Environmental Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Jill Awkerman
- Gulf Ecology Division, U.S. Environmental Protection Agency, Gulf Breeze, FL 32561, USA
| | - Elizabeth Bell
- Wildlife Management International Limited, P.O. Box 607, Blenheim 7240, New Zealand
| | - Mike Bell
- Wildlife Management International Limited, P.O. Box 607, Blenheim 7240, New Zealand
| | - Mark Carey
- Department of Environmental Management and Ecology, La Trobe University Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Ryan Carle
- Oikonos Ecosystem Knowledge, Yerbas Buenas 498, Valparaíso, Chile
| | - Thomas A Clay
- School of Environmental Sciences, University of Liverpool, Liverpool, UK
| | - Jaimie Cleeland
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | | | - Melinda Conners
- Department of Ocean Sciences, University of California Santa Cruz, Santa Cruz, CA 95064, USA
| | - Marta Cruz-Flores
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Richard Cuthbert
- World Land Trust, Blyth House, Bridge Street, Halesworth, Suffolk IP19 8AB, UK
| | - Karine Delord
- Centre d'Etudes Biologiques de Chizé, CNRS La Rochelle Université, 79360 Villiers en Bois, France
| | - Lorna Deppe
- The Hutton's Shearwater Charitable Trust, 100 Watsons Road, Blenheim 7273, New Zealand
| | - Ben J Dilley
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | | | - Graeme Elliott
- Department of Conservation, Private Bag 5, Nelson, New Zealand
| | - Fernanda De Felipe
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Jonathan Felis
- U.S. Geological Survey, Western Ecological Research Center, Santa Cruz Field Station, 2885 Mission St, Santa Cruz, CA 95060, USA
| | - Manuela G Forero
- Department of Conservation Biology, Estación Biológica de Doñana, Consejo Superior de Investigaciones Científicas (EBD-CSIC), Avenida de Américo Vespucio, 26 Isla de la Cartuja 41092, Sevilla, Spain
| | - Amanda Freeman
- Nature North, P.O. Box 1536, Atherton, QLD 4883, Australia
| | - Akira Fukuda
- Shizuoka University, Johoku 3-5-1, Hamamatsu, Japan
| | - Jacob González-Solís
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - José Pedro Granadeiro
- CESAM, Departamento de Biologia Animal, Faculdade de Ciências Universidade de Lisboa, Rua Ernesto Vasconcelos, 1749-016 Lisboa, Portugal
| | - April Hedd
- Environment and Climate Change Canada, Wildlife Research Division, 6 Bruce Street, Mount Pearl, NL A1N 4T3, Canada
| | - Peter Hodum
- Oikonos Ecosystem Knowledge, Yerbas Buenas 498, Valparaíso, Chile
- Biology Department, University of Puget Sound, 1500 N. Warner St., Tacoma, WA 98416, USA
| | - José Manuel Igual
- Animal Demography and Ecology Unit, Institut Mediterrani d'Estudis Avançats (IMEDEA, CSIC-UIB), Miquel Marques 21, 07190 Esporles, Balears, Spain
| | - Audrey Jaeger
- UMR ENTROPIE (Université de La Réunion, IRD, CNRS, IFREMER, Université de Nouvelle-Calédonie) Université de La Réunion, Université de La Réunion, 15 Avenue René Cassin, CS92003, 97744 Saint Denis messag cedex 9, La Réunion, France
| | - Todd J Landers
- School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Auckland Museum, The Domain, Parnell, Auckland 1052, New Zealand
- Auckland Council, Private Bag 92300, Victoria Street West, Auckland 1142, New Zealand
| | - Matthieu Le Corre
- UMR ENTROPIE (Université de La Réunion, IRD, CNRS, IFREMER, Université de Nouvelle-Calédonie) Université de La Réunion, Université de La Réunion, 15 Avenue René Cassin, CS92003, 97744 Saint Denis messag cedex 9, La Réunion, France
| | - Azwianewi Makhado
- Oceans and Coasts, Department of Environment, Agriculture and Fisheries, Cape Town, South Africa
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | - Benjamin Metzger
- BirdLife Malta, 57/28 Marina Court, Abate Rigord Street, Ta' Xbiex, XBX 1120, Malta
| | - Teresa Militão
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | | | - Virginia Morera-Pujol
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Leia Navarro-Herrero
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Deon Nel
- WWF-Netherlands, Driebergseweg 10, 3708 JB Zeist, The Netherlands
| | - David Nicholls
- Chisholm Institute, Bonbeach Campus, Breeze Street, Carmm, VIC 3197, Australia
| | - Daniel Oro
- Centre d'Estudis Avançats de Blanes CEAB (CSIC), Acces Cala Sant Francesc 14, 17300 Blanes, Spain
| | - Ridha Ouni
- Tunisian Wildlife Conservation Society. Faculté des Sciences Mathématique, physique et biologiques de Tunis (FST), Campus Universitaire, El Manar, CP 2092 Tunis, Tunisia
| | - Kiyoaki Ozaki
- Division of Avian Conservation, Yamashina Institute for Ornithology, 115 Konoyama, Abiko, Chiba 270-11, Japan
| | - Flavio Quintana
- Instituto de Biología de Organismos Marinos (IBIOMAR), National Research Council of Argentina (CONICET), Bv. Almte Brown 2915, Puerto Madryn, Chubut, Argentina
| | - Raül Ramos
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Tim Reid
- Institute of Marine and Antarctic Studies, University of Tasmania, Commonwealth Science and Industrial Research Organization, CSIRO, Castray Esplanade, Hobart, Tasmania 7000, Australia
| | - José Manuel Reyes-González
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | | | - Graham Robertson
- Independent researcher, 9 Roba Court, Kingston, Tasmania 7050, Australia
| | - Mohamed Salah Romdhane
- Université de Carthage Institut National Agronomique de Tunisie, 43 Avenue Charles Nicole, 1082 Tunis, Tunisie
| | - Peter G Ryan
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | - Paul Sagar
- National Institute of Water and Atmospheric Research Ltd., 10 Kyle Street, Riccarton, Christchurch 8011, New Zealand
| | - Fumio Sato
- Division of Avian Conservation, Yamashina Institute for Ornithology, 115 Konoyama, Abiko, Chiba 270-11, Japan
| | - Stefan Schoombie
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | - R Paul Scofield
- Canterbury Museum, Rolleston Avenue, Christchurch 8053, New Zealand
| | - Scott A Shaffer
- Department of Biological Sciences, San Jose State University, One Washington Square, San Jose, CA 95192-0100, USA
| | - Nirmal Jivan Shah
- Nature Seychelles Centre for Environment and Education, Sanctuary at Roche Caiman, Mahe, Seychelles
| | - Kim L Stevens
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
| | | | - Robert M Suryan
- Department of Fisheries and Wildlife, Oregon State University, Hatfield Marine Science Center, Newport, OR 97365, USA
| | - Akinori Takahashi
- National Institute of Polar Research, Tachikawa, Tokyo 190-8518, Japan
| | - Vikash Tatayah
- Mauritian Wildlife Foundation, Grannum Road, Vacoas, Mauritius
| | - Graeme Taylor
- Department of Conservation, P.O. Box 10420, Wellington 6143, New Zealand
| | - David R Thompson
- National Institute of Water and Atmospheric Research Ltd., 301 Evans Bay Parade, Hataitai, Wellington 6021, New Zealand
| | - Leigh Torres
- Department of Fisheries and Wildlife, Marine Mammal Institute, Oregon State University, Newport, OR 97365, USA
| | - Kath Walker
- Department of Conservation, Private Bag 5, Nelson, New Zealand
| | - Ross Wanless
- FitzPatrick Institute of African Ornithology, DST-NRF Centre of Excellence, University of Cape Town, Rondebosch 7701, South Africa
- Institute of Marine Affairs and Resources Management, National Taiwan Ocean University, Keelung, Taiwan
| | - Susan M Waugh
- Office of the Parliamentary Commissioner for the Environment, 2 The Terrace, Wellington 6011, New Zealand
| | - Henri Weimerskirch
- Centre d'Etudes Biologiques de Chizé, CNRS La Rochelle Université, 79360 Villiers en Bois, France
| | - Takashi Yamamoto
- Meiji Institute for Advanced Study of Mathematical Sciences, Nakano, Tokyo 164-8525, Japan
| | - Zuzana Zajkova
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Laura Zango
- Institut de Recerca de la Biodiversitat (IRBio) and Department de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona, Av Diagonal 643, Barcelona 08028, Spain
| | - Paulo Catry
- MARE-Marine and Environmental Sciences Centre, ISPA-Instituto Universitário, Lisboa, Portugal
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Nel D, Panieri E, Malherbe F, Steyn R, Cairncross L. Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa. World J Surg 2021; 44:1918-1924. [PMID: 32055970 DOI: 10.1007/s00268-020-05420-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa. METHODS This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheochromocytoma and abdominal paragangliomas, from January 2002 to June 2019. RESULTS Sixty patients were included in the study, of which 33% were male and 67% female. The mean age was 47 years (range 14-81). The median tumor size was 6 cm, with 45% larger than 6 cm. 92% were located in the adrenal gland (87% unilateral, 5% bilateral), and 8% were extra-adrenal. The conversion rate for laparoscopic cases was 20%, with 55% of cases overall completed laparoscopically. Eleven patients with tumors > 6 cm were initially attempted laparoscopically, of which 3 were converted to open, without any associated increased morbidity. A major adverse event was recorded for 5 cases (8%), including 1 mortality. Overall morbidity, blood loss, operating time and hospital stay were all significantly reduced in the laparoscopic group. There were 5 patients with malignant disease (8%). CONCLUSION This large series, from an established academic endocrine surgery unit in Africa, can serve as a benchmark for units with similar settings and resource limitations, to compare their surgical management and perioperative outcomes.
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Affiliation(s)
- D Nel
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - E Panieri
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - F Malherbe
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - R Steyn
- Division of Nuclear Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - L Cairncross
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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11
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Gouws J, Nel D, Bougard HC, Koto Z, Oodit R, Kloppers JC. Compliance to the South African ventral hernia guidelines: inaugural results from the HIG(SA) registry. S AFR J SURG 2021. [DOI: 10.17159/2078-5151/2021/v59n4a3526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT BACKGROUND: The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry METHODS: A retrospective analysis of the prospectively maintained HIG(SA) hernia registry from 1 February 2019 to 29 February 2020. Compliance to six recommendations made in the HIG(SA) ventral hernia guidelines were assessed in both the public and private healthcare systems RESULTS: Three hundred and fifty-three ventral hernia repair cases were included in the study. Fifty-four per cent were private and 46% were public sector cases. Laparoscopic repair for patients with a BMI > 35 kg/m2 occurred in 38% of eligible cases and a minimum 5 cm of mesh overlap was achieved in 50% of cases. Overall, 80% of elective cases occurred in non-smokers; 97% of the intraperitoneal on-lay mesh (IPOM) repairs used composite mesh; 96% of ventral hernias with defects of larger than 2 cm and 95% of incisional hernias were repaired with mesh. Non-smokers undergoing repair numbered 72% in public and 85% in private practice, p = 0.01 CONCLUSION: Ventral hernia repair practices in SA facilities overall had good compliance to four out of the six HIG(SA) ventral hernia guidelines highlighted for the purposes of this study. The two guidelines that had poor compliance overall were 'laparoscopic repair for patients with a BMI of > 35 kg/m2' and 'ensuring a mesh overlap of 5 cm'. The public sector had higher rates of current smokers undergoing elective ventral hernia repair Keywords: registry, low-middle income countries, ventral hernia, hernia guidelines
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Nel D, Oodit R, Bougard H, Panieri E. Consensus statement regarding minimally invasive surgery during the COVID-19 pandemic. S AFR J SURG 2021. [DOI: 10.17159/2078-5151/2020/v58n2a3330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yang X, Li Y, Chen L, Xu M, Wu J, Zhang P, Nel D, Sun B. Protective effect of hydroxysafflor yellow A on dopaminergic neurons against 6-hydroxydopamine, activating anti-apoptotic and anti-neuroinflammatory pathways. Pharm Biol 2020; 58:686-694. [PMID: 32658590 PMCID: PMC7470140 DOI: 10.1080/13880209.2020.1784237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/28/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Hydroxysafflor yellow A (HSYA) has been shown to have neuroprotective effects in cerebral infarction. However, its underlying roles in apoptosis and inflammation in Parkinson's disease (PD) are unknown. OBJECTIVE The present study investigates the effects and underlying mechanisms of HSYA on dopaminergic (DA) neurodegeneration, inflammation, and apoptosis. MATERIALS AND METHODS The PD model was established by 2 μL of 6-hyroxydopamine (6-OHDA) (3 μg/μL) striatal injection in C57BL/6J mice with different doses of HSYA (2, 4, or 8 mg/kg). In vitro, after being treated with HSYA for 1 h, SH-SY5Y cells were exposed to 6-OHDA for 24 h before analysis. Expression of tyrosine hydroxylase (TH) in substantia nigra (SN) and corpus striatum (STR) was evaluated by immunohistochemistry (IHC) and western blot. In addition, apoptosis-related and inflammatory proteins were examined by western blot. RESULTS Administration of HSYA significantly reduced the Apomorphine (APO)-induced rotation, decreased from 122.5 ± 15.1 (6-OHDA group) to 47.2 ± 14.3 (8 mg/kg HSYA group). HSYA partially restored a deficit in the SN and STR of PD mice brains in TH. Furthermore, western blot analysis revealed that HSYA reduced inflammatory proteins, including iNOS, COX-2 and NF-κB and attenuated the elevation of DA neuronal apoptosis observed in PD. In vitro assays showed that HSYA reduced the levels of p-p38 and p-JNK and increased that of p-ERK in 6-OHDA-leisoned SH-SY5Y cells. CONCLUSIONS These findings indicate that HSYA protects against 6-OHDA induced DA neurodegeneration partly by regulating the MAPK inflammatory signalling pathway and apoptosis which highlight its therapeutic potential in the treatment of PD.
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Affiliation(s)
- Xiaomei Yang
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Jinan, P.R. China
| | - Yun Li
- Department of Traditional Chinese Medicine, Dezhou People’s Hospital, Dezhou, P.R. China
| | - Lin Chen
- Department of Pharmacology, School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, P.R. China
| | - Mingguo Xu
- Department of Pediatric Cardiology, Shenzhen Children’s Hospital, Shenzhen, P.R. China
| | - Jianbo Wu
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Jinan, P.R. China
| | - Peng Zhang
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Jinan, P.R. China
| | - Deon Nel
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Jinan, P.R. China
| | - Baozhu Sun
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Jinan, P.R. China
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Carneiro APB, Pearmain EJ, Oppel S, Clay TA, Phillips RA, Bonnet‐Lebrun A, Wanless RM, Abraham E, Richard Y, Rice J, Handley J, Davies TE, Dilley BJ, Ryan PG, Small C, Arata J, Arnould JPY, Bell E, Bugoni L, Campioni L, Catry P, Cleeland J, Deppe L, Elliott G, Freeman A, González‐Solís J, Granadeiro JP, Grémillet D, Landers TJ, Makhado A, Nel D, Nicholls DG, Rexer‐Huber K, Robertson CJR, Sagar PM, Scofield P, Stahl J, Stanworth A, Stevens KL, Trathan PN, Thompson DR, Torres L, Walker K, Waugh SM, Weimerskirch H, Dias MP. A framework for mapping the distribution of seabirds by integrating tracking, demography and phenology. J Appl Ecol 2020. [DOI: 10.1111/1365-2664.13568] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Thomas A. Clay
- School of Environmental Sciences University of Liverpool Liverpool UK
| | | | | | - Ross M. Wanless
- Institute of Marine Affairs and Resources Management National Taiwan Ocean University Keelung Taiwan
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
| | | | | | - Joel Rice
- Rice Marine Analytics Saint Paul MN USA
| | | | | | - Ben J. Dilley
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
| | - Peter G. Ryan
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
| | - Cleo Small
- Royal Society for the Protection of Birds Sandy UK
| | - Javier Arata
- Centro FONDAP de Investigacion en Dinamica de Ecosistemas Marinos de Altas Latitudes Valdivia Chile
| | - John P. Y. Arnould
- School of Life and Environmental Sciences Deakin University Burwood Vic. Australia
| | - Elizabeth Bell
- Wildlife Management International Ltd. Blenheim New Zealand
| | - Leandro Bugoni
- Universidade Federal do Rio Grande‐FURG Rio Grande Brazil
| | - Letizia Campioni
- MARE‐Marine and Environmental Sciences Centre ISPA‐Instituto Universitario Lisbon Portugal
| | - Paulo Catry
- MARE‐Marine and Environmental Sciences Centre ISPA‐Instituto Universitario Lisbon Portugal
| | | | - Lorna Deppe
- The Hutton's Shearwater Charitable Trust Kaikoura New Zealand
| | | | | | - Jacob González‐Solís
- Departament de Biologia Evolutiva Ecologia i Ciències Ambientals Universitat de Barcelona Barcelona Spain
| | | | - David Grémillet
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
- CEFE CNRS Université de MontpellierUniversité Paul‐Valéry MontpellierEPHE Montpellier France
| | - Todd J. Landers
- Auckland Council, Research and Evaluation Unit (RIMU) Auckland New Zealand
- School of Biological Sciences University of Auckland Auckland New Zealand
| | - Azwianewi Makhado
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
- Department of Environmental Affairs Oceans & Coasts Branch South Africa
| | - Deon Nel
- Global Resilience Partnership Stockholm Resilience Centre Stockholm University Stockholm Sweden
| | | | | | | | - Paul M. Sagar
- National Institute of Water and Atmospheric Research Christchurch New Zealand
| | | | | | | | - Kim L. Stevens
- FitzPatrick Institute of African Ornithology DST/NRF Centre of Excellence University of Cape Town Cape Town South Africa
| | - Philip N. Trathan
- British Antarctic Survey Natural Environment Research Council Cambridge UK
| | - David R. Thompson
- National Institute of Water and Atmospheric Research Christchurch New Zealand
| | - Leigh Torres
- Department of Fisheries and Wildlife Oregon State University Newport OR USA
| | | | - Susan M. Waugh
- Museum of New Zealand Te Papa Tongarewa Wellington New Zealand
| | | | - Maria P. Dias
- BirdLife International Cambridge UK
- MARE‐Marine and Environmental Sciences Centre ISPA‐Instituto Universitario Lisbon Portugal
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Cluver CA, Charles W, Merwe C, Bezuidenhout H, Nel D, Groenewald C, Brink L, Hesselman S, Bergman L, Odendaal H. The association of prenatal alcohol exposure on the cognitive abilities and behaviour profiles of 4‐year‐old children: a prospective cohort study. BJOG 2019; 126:1588-1597. [DOI: 10.1111/1471-0528.15947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- CA Cluver
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
- Mercy Perinatal Mercy Hospital for Women Melbourne Victoria Australia
- Translational Obstetrics Group University of Melbourne Melbourne Victoria Australia
| | - W Charles
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - C Merwe
- Department of Psychiatry Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - H Bezuidenhout
- Division of Molecular Biology and Human Genetics Department of Biomedical Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - D Nel
- Centre for Statistical Consultation Stellenbosch University Stellenbosch South Africa
| | - C Groenewald
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - L Brink
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - S Hesselman
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Dalarna Falun Hospital Falun Sweden
| | - L Bergman
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Dalarna Falun Hospital Falun Sweden
- Department of Obstetrics and Gynaecology Institute of Clinical Science Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - H Odendaal
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
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Nel D, Omar M, Chinnery G, Jonas E. Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia. S AFR J SURG 2019; 57:10-15. [PMID: 31342678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND For most patients with oesophageal cancer worldwide, palliation of dysphagia is the goal which is most commonly achieved with self-expanding metal stents (SEMS). The aim of this study was to assess the profile and management of oesophageal cancer patients at Frere Hospital in the Eastern Cape, and compare this to a similar cohort from Groote Schuur Hospital (GSH) in the Western Cape Province. METHOD This study is a retrospective comparative cohort which reviewed all patients diagnosed with oesophageal cancer by the Frere Hospital and GSH endoscopy units from January to December 2015. Independent prospective electronic databases for the two hospitals were merged for comparative analysis. RESULTS During the study period, 346 and 108 patients were diagnosed with oesophageal cancer at Frere Hospital and GSH respectively. The rate of curative intended intervention was similarly low, with 3% of cases at Frere Hospital undergoing oesophagectomy or definitive radiotherapy as compared to 5% at GSH (p=0.48). In terms of palliation, significantly more patients received palliative oncological therapy at GSH as compared to Frere Hospital (21% vs 8%, p < 0.001). At Frere Hospital, 281 patients (81%) were treated primarily with serial dilatations. At GSH, 9 patients received a single dilatation, all as a bridge to radiotherapy or stenting. At Frere Hospital, 28 patients (8%) were stented, as compared to GHS where 69 patients (64%) were managed with a stent (p < 0.001). CONCLUSION This study shows significant differences in the oncological and endoscopic palliation of patients between the two institutions, highlighting a gross disparity in healthcare provision between them. The reasons for these disparities should be investigated and equipoise addressed by national health policy makers.
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Affiliation(s)
- D Nel
- Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - M Omar
- University of Cape Town, South Africa
| | - G Chinnery
- Upper GI surgery, Surgical Gastroenterology Unit, Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - E Jonas
- Surgical Gastroenterology Unit, Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Nel D, Omar M, Chinnery G, Jonas E. Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia. S AFR J SURG 2019. [DOI: 10.17159/2078-5151/2019/v57n2a2842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Blaauw R, Achar E, Dolman R, Harbron J, Moens M, Munyi F, Nel D, Nyatefe D, Visser J. MON-P198: Hospital Malnutrition on the African Continent: We have a Problem. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30889-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Deon Nel
- Department of Marketing, Aston Business School, Aston University and Leyland Pitt, Professor of Management Studies, Henley Management College
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Van der Merwe S, Du Plessis L, Jooste H, Nel D. Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province. South African Journal of Clinical Nutrition 2016. [DOI: 10.1080/16070658.2015.11734546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nel D. Revisiting the Difficult Airway with special reference to the new Difficult Airway Society Guidelines. S Afr Fam Pract (2004) 2016. [DOI: 10.4102/safp.v58i7.4482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
No abstract available.
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Blaauw R, Daniels L, Du Plessis L, Koen N, Koornhof L, Marais M, Nel D, Van Niekerk E, Visser J. MON-PP256: Missed and Used Opportunities in Health Status Assessment of Children. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petersen S, Shearing C, Nel D. Sustainability Transitions: An Investigation of the Conditions under Which Corporations Are Likely To Reshape Their Practices to Reverse Environmental Degradation. ACTA ACUST UNITED AC 2015. [DOI: 10.5296/emsd.v4i1.6673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nel D, Vogel J, Muller E, Barday Z, Kahn D. Slow early graft function: a neglected entity after renal transplantation. Nephron Clin Pract 2012; 120:c200-4. [PMID: 22922445 DOI: 10.1159/000340032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 05/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND After renal transplantation, early graft function (EGF) can be divided into delayed graft function (DGF), slow graft function (SGF) and immediate graft function (IGF). DGF is well documented. However, when evaluating the long-term significance of early function, the literature shows conflicting definitions and inconsistent results. In addition, SGF, a new entity separate to DGF and IGF, is a recent and poorly understood development. AIM To investigate the risk factors for and the impact of poor EGF (PEGF) on long-term outcome. METHODS This retrospective study reviewed the records of local adult patients who underwent renal transplantation at the Groote Schuur Hospital (Cape Town, South Africa) between 2004 and 2008. EGF was divided according to day 5 serum creatinine into IGF (serum creatinine <150 µmol/l), SGF (serum creatinine >150 but <450 µmol/l) and DGF (serum creatinine >450 µmol/l or dialysis in the first week). DGF and SGF together comprised PEGF, with IGF alone representing good EGF (GEGF). RESULTS A total of 121 patients (77 men, 44 women; mean age 39 years, range 14-67) were included in the study. Eighteen were excluded due to nephrectomy (n = 8), death (n = 6) or loss to follow-up (n = 4) within the first year. Analysis of cadaveric donors showed no significant risk factors for PEGF with the exception of cold ischaemic time, which differed significantly between the GEGF and PEGF groups, with means of 12 and 16 h, respectively (p = 0.013). Considering both living and cadaveric grafts, the 1-year estimated glomerular filtration rate (eGFR) was significantly different between IGF and DGF (p = 0.038) as well as between IGF and SGF (p = 0.028), with no significant difference between SGF and DGF (p > 0.05). A comparison of the PEGF and GEGF groups yielded significantly different 1-year eGFR values (60 and 50 ml/min, respectively; p = 0.07), with PEGF also associated with a longer hospital stay (20 vs. 14 days; p = 0.00005). Acute rejection was independently associated with a lower 1-year eGFR (p = 0.028), but in the absence of rejection, GEGF and PEGF remained significantly different with regards to 1-year eGFR (p = 0.024). CONCLUSIONS SGF is not related to IGF but rather to DGF and should thus be regarded as a form of PEGF as opposed to GEGF. PEGF has a worse long-term outcome, and this indicates the need for increased efforts in its prevention and greater attention to its management.
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Affiliation(s)
- D Nel
- Renal Transplant Unit, Department of Surgery, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa
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Abstract
Brand personality has often been considered from the perspective of products, corporate brands or countries, but rarely among service offerings. Moreover, there remains the consideration of how these entities are communicated online. This article explores the brand personality dimensions that business schools communicate and whether they differ in putting across clear and distinctive brand personalities in cyberspace. Three clusters from the Financial Times’ top 100 full-time global MBA programs in 2005 are used to undertake a combination of computerised content and correspondence analyses. The content analysis was structured using Aaker's Rve-dimensional framework whilst the positioning maps were produced by examining the data using correspondence analysis. Results indicate that some schools have clear brand personalities while others fail to communicate their brand personalities in a distinct way. This study also illustrates a powerful, but simple and relatively inexpensive way for organisations and brand researchers to study the brand personalities actually being communicated.
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Affiliation(s)
- Robert Ankomah Opoku
- Department of Marketing, King Fahd University of Petroleum and Minerals, Saudi Arabia
| | - Albert Caruana
- Centre for Communication Technology, University of Malta, Malta
| | - Leyland Pitt
- Segal Graduate School of Business, Simon Fraser University, Vancouver, BC, Canada
| | - Pierre Berthon
- Department of Marketing, Bentley College, Waltham, Massachusetts, USA
| | - Asa Wahlstrom
- Division of Industrial Marketing, e-Commerce and Supply Chain Management, Lulea University of Technology, Lulea, Sweden
| | - Deon Nel
- School of Management and Marketing, Deakin University, Melbourne, Australia
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Abstract
Friendship is very often a component of business relationships. Organisations frequently have relationships with their suppliers, customers and collaborators that could be described as ‘friendly’. However, there is little comparative evidence concerning the extent to which business friendships resemble true social friendships. This article illustrates some differences that may exist between social and business friendships, with particular reference to the extent that interpersonal relationships are trusting, and are based on the nature of personal acquaintance. This means that managers need to understand the differences between business and personal friendships and adjust the type of interactions they, and those who report to them, have with customers, suppliers, collaborators, and the like.
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Affiliation(s)
- Lars Bäckström
- Division of Industrial Marketing and eCommerce, Lulea University of Technology, Lulea, Sweden
| | - Deon Nel
- School of Management and Marketing, Deakin University, Melbourne, Australia
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Abstract
Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.
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Affiliation(s)
- F N Youssef
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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29
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Abstract
Discusses the utilization of an instrument--SERVQUAL--as a means of assessing patient satisfaction with service quality. Patients treated (174) for a variety of health problems in a number of departments completed the SERVQUAL questionnaire. There is a dearth of knowledge in this important field and the authors note that the results indicate the need for improvement in service quality as identified by the study population.
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Affiliation(s)
- F Youssef
- Aston Business School, Aston University, Birmingham
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30
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Pitt LF, Caroline Tynan A, Nel D. Discourse and Deed. Journal of Managerial Psych 1994. [DOI: 10.1108/02683949410066345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Watson RT, Pitt LF, Cunningham CJ, Nel D. User Satisfaction and Service Quality of the IS Department: Closing the Gaps. Journal of Information Technology 1993. [DOI: 10.1177/026839629300800406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurement and management of user satisfaction with information systems (IS) have been issues of concern for practitioners and academics in the field for some time. This paper introduces the ‘Gaps’ approach to service quality, a topic widely discussed in the marketing literature, and proposes that a similar approach is applicable in the IS domain. The user gap is explained and its measurement suggested, and the other gaps within the IS arena are described and their causes and cures addressed.
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Affiliation(s)
| | | | | | - Deon Nel
- Aston University, Birmingham, UK
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32
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McLean AJ, Barned J, Ioannides-Demos L, Nel D, Tong N, Mereer W, Wood T. Computer-based prescription audit as a research, educational and management tool. AUST HEALTH REV 1983; 7:260-8. [PMID: 10269944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
An existing dedicated pharmacy computer system (MIDAS system, Alfred Hospital and Health Computing Services, Victoria) used primarily for pharmacy labelling and dispensing, has been rewritten for an in-house minicomputer, with enhancements that allow it to be used in budgetary predictions, drug use monitoring, therapeutic audit and as a research tool. An automatically updated hard copy record of individual patient prescription profiles is generated and represents a valuable addition to the patient medical record. Allied to automatic "sorting" and retrieval techniques, all patients on nominated drugs can be identified and their records examined for particular combination use. Current application to assessment of nifedipine- beta blocker use will be presented, as will an application to cimetidine audit. Prescriptions can be scanned and segregated in terms of numbers of prescriptions in addition to segregation in terms of a particular therapeutic agent. Initial application to audit has detected an unacceptable level of polypharmacy (more than 26% of all prescriptions involve greater than or equal to 5 items and more than 3% involved greater than or equal to 10 items). Statistical information on the volume and unit cost of outpatient prescribing allows a precise estimate of ongoing budgetary commitments, while trends in discharge medication profiles allow a basis for prediction of budgetary trends, particularly with respect to the use of recent additions to the formulary. The system allows for expansion at minimal cost with potentially revolutionary applications, for example, interactive prescriber education if and when "on-line" capabilities are developed. Cross-linking with relevant data-bases will allow a major expansion of applied research into therapeutic drug use and its consequences.
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Nel D, Smit PJ, Stoker DJ. [The influence of sports injuries on sport participation and work]. S Afr Med J 1979; 55:426-8. [PMID: 432748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The incidence and complications of sport injuries in athletics, basketball, gymnastics, hockey, netball, cricket, tennis and soccer were analysed from questionnaire responses of 239 sport participants in Pretoria. Lower limb injuries were most common (73%). Torn tendomuscular organs represented 29,3% of the total number of injuries; sprains, strains and dislocations 35,9%; and fractures 20,5%. Medical treatment was sought by 62,8% of the patients. A total of 60,7% of the subjects was advised to suspend further participation in sport, but 30,6% failed to do so and more than half of these again sustained injuries. Those who were booked off from work totalled 18,0%, but a further 4,5% stayed away from work voluntarily.
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