Danie Venter

Endotracheal tube cuff pressure management in adult critical care units

Background. The monitoring of endotracheal tube (ETT) cuff pressure in intubated patients is important in preventing complications related to cuff over- and under-inflation. Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional nurses from adult CCUs in the public and private healthcare sectors in the Nelson Mandela Metropole, Eastern Cape, South Africa, using a structured self-administered questionnaire based on a literature review. Results. The survey response was 75% (100/134). Practice variances included the frequency of cuff pressure monitoring: only 52% of respondents performed cuff pressure measurements every 6 - 12 hours; 32% reported performing measurements at 2 - 4 hourly intervals; 15% only assessed cuff pressure when a leak occurred; and 1% never monitored cuff pressure. Of the 100 respondents, 37% used the cuff pressure measurement (CPM) method, 24% used the palpation method or listened to air leaks, and 22% used minimal occlusive volume (MOV). None of the respondents used the minimal leak technique (MLT). Only 20% of the respondents maintained cuff pressures at 18 - 22 mmHg. Thirty-one per cent indicated that they still performed the practice of cuff deflation and re-inflation before and after suctioning. There were incongruities related to the management of air leaks and the amount of air instilled. Conclusion. Practice variances were noted among the professional nurses, especially in the private healthcare sector. The lack of evidence-based clinical decision-making related to cuff pressure management in mechanically ventilated patients was evident. Best practice recommendations need to be used effectively when performing ETT cuff pressure management, to reduce practice variance, standardise safe patient care, and minimise complications.

Socio-economic and demographic factors related to HIV status in urban informal settlements in the Eastern Cape, South Africa

The prevalence of HIV&AIDS is embedded in social and economic inequity and the relationship between social determinants and HIV incidence is well established. The aim of this study was to determine which socio-economic and demographic factors are related to HIV status in the age group 18 to 49 years in informal settlements in the Eastern Cape, South Africa. This cross-sectional study was conducted in 3 informal settlements (n = 752) during March 2013 within the Nelson Mandela Bay and Buffalo City districts. A proportional cluster sample was selected and stratified by area and formal plot/squatter households in open areas. Respondents who volunteered to participate had to provide informed written consent before trained, bilingual peer educators interviewed them and completed the structured questionnaire. HIV status was determined and information on demographic and socio-economic variables was included in the bivariate analysis. The prevalence of HIV was higher, at 17.3%, than the 2011 estimated national prevalence among the general population in South Africa. The level of education (χ2 = 5.50, df = 1, p < 0.05), geographical site (χ2 = 7.41, df = 2, p < 0.05), gender (χ2 = 33.10, df = 1, p < 0.0005), household food insecurity (χ2 = 4.77, df = 1, p < 0.05), cooking with cast iron pots (χ2 = 15.0, df = 3, p < 0.05) and availability of perceived ‘wealth’ indicators like mobile telephones and refrigerators (χ2 = 9.67, df = 2, p < 0.05) were significantly associated with HIV-status. No significant associations could be demonstrated between household income, the number of people living in the household and the availability of electricity/water and HIV status. As the observed levels of HIV prevalence underlined gender bias and failure to graduate from high school, future interventions should focus on HIV prevention in female schoolchildren. However, HIV infection is also prevalent among wealthier individuals in informal settlements, which indicates that renewed efforts should be made to improve sexual risk behaviour within this group.

The relative importance of ethics, environmental, social and governance criteria

Responsible investing (RI) is a growing phenomenon in the international investment arena. This article investigates the level of knowledge of members of South African pension/provident funds with regard to RI and the importance with which they view various ethical, environmental, social and governance (ESG) criteria. Respondents (n = 281) indicated a relatively low level of understanding of the concept of RI. Significant differences were noted in the perceptions of respondents about the relative importance of ethical and ESG criteria based on their gender and level of education. The findings could assist asset owners in reformulating their investment mandates, which in turn, will enable fund managers to invest in a more responsible manner.

The quality of life of HIV-infected South African university students: Experiences with the WHOQOL-HIV-Bref

ABSTRACT HIV and AIDS has serious repercussions on psychological, social and physical well-being, and the assessment of Quality of Life (QoL) of people living with HIV and AIDS is essential to gauge how these challenges are met. The WHOQoL-HIV Bref forms part of a suite of instruments developed by the World Health Organisation. The purpose of this paper is to describe the quality of life of a sample of HIV-infected students at a South African university, as well as explain the internal consistency between questions within each of the QoL domains. A descriptive, cross-sectional study design using a quantitative approach was applied. A non-probability, purposive sampling approach was utilized and students enrolled in the antiretroviral therapy or wellness programme were invited to voluntarily participate in this study. The WHOQOL-HIV Bref was self-administered after explanation of the questions by a registered, trained health care professional. A total of 63 students returned completed questionnaires that were included in the analysis. Acceptable to good reliability scores were established for the following domains: Level of Independence; Social Relations; Environment and Spiritual or Personal Beliefs. Assessing QoL in the sample, the lowest score was for “Spirituality” and the highest “Social Relations”. The “Physical” and “Psychological” domain scores for females were significantly lower than the score for males. There was no significant difference between any of the domain scores among participants with CD4 cell counts above or below 350 cells/mm3. In general the performance of this sample is encouraging and it is recommended that the measure be utilized for QoL screening, and further research. The WHOQOL-HIV Bref for students does not contain an academic wellness component which should be added considering the significant effects of HIV on neuropsychological functioning. Also further investigation into the reasons for poor scores obtained in physical and psychological well-being in females should be encouraged.

Systemic isotretinoin in the management of acne - a patient questionnaire survey

Abstract Background: The primary aim was to investigate the appropriateness (as outlined in the South African Acne Treatment Guideline1) for the prescription of systemic isotretinoin in the management and counselling of acne in the Nelson Mandela Bay Metropole. Methods: A questionnaire was distributed to patients receiving systemic isotretinoin by 30 community pharmacies. The response rate was 29.2% (57 respondents). Results: The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions. Conclusions: Many prescribers did not follow the recommendations for isotretinoin prescription. The counselling of patients regarding isotretinoin therapy was substandard, especially with respect to pregnancy prevention.

Social determinants of subjective well-being among young adults living in the Eastern Cape, South Africa

We investigated the relationships between certain social determinants (age, gender, marital status, education, income, and employment) and subjective well-being (SWB) in a young adult population in the Eastern Cape Province in South Africa. The participants consisted of 977 persons aged 18 to 40 years living in the historically deprived Eastern Cape, South Africa (females = 48%; age range = 18 to 40; rural dwellers = 15%). We measured their SWB utilising the World Health Organization (Ten) Well-Being Scale. Results following analysis of variance showed that age, education, and income were predictors of SWB. Higher SWB was associated with being older, having a higher level of formal education, and having a higher level of income. However, employment status did not have a significant relationship with SWB, suggesting the relative importance of other social indicators of social functioning in this population.

Use of Mid Upper-Arm Circumference (MUAC) as screening tool in an urban township in the Eastern Cape: Rationale for testing changed cut-off values to identify malnutrition

Introduction Children with a weight-for-height z-score (WHZ) -3 SD of this standard. The WHO therefore recommends the use of a WHZ of below -3 SD to identify children with SAM. The mid-upper arm circumference (MUAC) cut-off values of 11.5 cm and 12.5 cm are used globally as screening tools to identify SAM and MAM, respectively, in children between six and 60 months of age. According to the WHO and UNICEF the WHZ and MUAC may be used interchangeably as a screening tool to identify malnourished infants and children, as they reveal a very similar prevalence of SAM in the field. However, more recent data indicate that there may be little overlap between the children identified with SAM and MAM by WHZ and those identified using the MUAC cut-offs. Therefore, more recently the recommendation is to use WHZ and MUAC measurements as independent but complementary admission criteria for SAM. Methods In this descriptive study with a cross-sectional design, data from a convenience sample of 400 infants and young children younger than 24 months were gathered from five clinics and 15 early childhood development (ECD) centres in Motherwell, Nelson Mandela Bay Health District (NMBHD) from October 2015 to February 2016. The Pearson correlation co-efficient (r) was used to measure the strength or degree of the relationship between variables. Sensitivity and specificity tests were used on the data with the existing recommended MUAC cut-off values as well as new calculated MUAC cut-off values to determine whether the new MUAC cut-off values were more sensitive in the identification of children affected by wasting, without including false negatives (children without SAM or MAM). Results The current WHO MUAC cut-off values to identify MAM have a high specificity, but performed poorly when tested for sensitivity. The r-value (0.78) for the relationship between WHZ and MUAC suggests a dependent relationship between these two indicators. The least squares regression formula (Y = 15.409 + 0.803x (males); Y = 15.13 + 0.83x (females)) was then used to predict where WHZ = -2 is most likely to correspond with a MUAC value in cm. The new predicted MUAC values of 13.8 cm (males) and 13.5 cm (females) were subsequently tested for sensitivity and specificity. The sample was too small to calculate sensitivity for both genders, but 96.4% specificity was achieved for females. A sensitivity of 100% and specificity of 94.5% was achieved with the male MUAC cut-off. Thus, the proposed cut-offs identified all of the wasted children (WHZ < -2), while identifying an acceptably low number of false positives Conclusion The current WHO MUAC cut-off values lacked the sensitivity to identify cases of MAM in a South African urban township population. A revised, single MUAC cut-off value for males and females younger than two years may increase the correct diagnosis of MAM, thus providing health workers the opportunity to prevent SAM. This new cut-off value should be tested in the field with larger samples

Nutritional status and metabolic risk in HIV-infected university students: challenges in their monitoring and management

Objective: This study aims to describe challenges in the management of HIV-infected university students focusing on their nutritional status and metabolic risk. Methods: A cross-sectional, descriptive study design was used to assess the anthropometry, food intake and clinical status of a cohort of known HIV-infected registered students at a South African university. Results: Participants (n = 63) had a mean CD4 cell count of 411 (SD = 219.9) cells/mm3, a mean body mass index (BMI) of 28.05 (SD = 7.9) kg/m2 and only half of the participants (n = 31) were on antiretroviral therapy (ART). A higher BMI (> 25 kg/m2) was significantly (p < 0.05; V = 0.32) associated with higher CD4 cell counts of > 350 cells/mm3. Some 40% (n = 25) of students were at risk for metabolic complications based on their waist circumference and 11% (n = 7) had clinical signs of lipodystrophy. The ‘obese’ group consumed a mean energy intake of 24 kcal/kg bodyweight which was lower than the ‘overweight’ and normal weight groups. Conclusions: In total 51% of HIV-positive students in the sample presented with signs of metabolic complications. Side effects of ART can be prevented and/or treated by regular physical activity, adequate nutritional intake, monitoring of side effects and BMI, combined with optimal care and support.

A Group of Sexually Abused Adolescents' Perceptions of their Future Life-Roles: An Exploratory Study

Sexual abuse of adolescents can have detrimental effects on their perceptions of their different future life-roles. We investigated such perceptions of students with a history of sexual abuse (n=163) as well as typically developing others (n=237). Participants completed the Life-role Inventory of the then called Human Sciences Research Council (Langley, 1990). Between-group comparisons were carried out. Adolescents with a history of sexual abuse reported negative perceptions of themselves fulfilling some of their roles in the future, being committed to these roles and attaching value to them, compared to typically developing others.

The Women's Health Initiative Study: individualisation of hormone replacement therapy in a defined South African population

Objective The aim of this study was to investigate the impact of the Womens Health Initiative (WHI) study on the prescribing of hormone replacement therapy (HRT) in a defined South African population and to establish whether patient therapy was appropriately individualised as a result of the WHI study.