Browsing by Author "Steyn, E."

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    Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown
    (Health & Medical Publishing Group, 2020) Chu, K. M.; Smith, M.; Steyn, E.; Goldberg, P.; Bougard, H.; Buccimazza, I.
    Background. In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. Objectives. To report changes in SA hospital surgical practices in response to COVID-19 preparedness. Methods. In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. Results. A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. Conclusions. Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.
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    Efficacy and patterns of use of antimicrobial prophylaxis for gunshot wounds in a South African hospital setting : an observational study using propensity score-based analyses
    (Medpharm, 2020-03) Visbeek, M. C.; Taljaard, J. J.; De Boer, M. G. J.; Cronje, U. J.; Steyn, E.
    BACKGROUND: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in prevention of gunshot wound-related (GSW-related) infection in resource restricted areas. At Tygerberg Hospital, South Africa, it is standard care for GSW patients to receive one dose of broad-spectrum AP. For various reasons, this protocol is not consistently followed. This study aimed to assess the efficacy of AP in the reduction of in-hospital GSW-related infection and to identify opportunities for practice improvement METHODS: All patients admitted with GSW over a three-month period were eligible for inclusion. Patients who did and did not receive AP were identified retrospectively the morning of admission; thereafter, data was collected prospectively. Data regarding circumstances of the incident, injury characteristics, type of AP and surgery was obtained. The occurrence of in-hospital GSW-related infection was recorded over 30 days or until discharge. Propensity score matching (PSM) and inverse probability weighting (IPW) methods were utilised to assess the effect of AP on the prevention of GSW-related infection RESULTS: 165 consecutive patients were assessed, of which 103 received AP according to protocol within 12 hours of admission. PSM showed a reduced in-hospital GSW infection risk of 12% (95% CI, 0.2-24%, p = 0.046) with AP. IPW showed that AP reduced the risk for infection by 14% (95% CI, 3-27%, p = 0.015 CONCLUSIONS: Providing AP to GSW patients in a civilian setting appeared to result in a modest but clinically relevant lower risk of in-hospital GSW-related infection. In this study setting, optimisation of AP for all patients with GSWs should significantly lower the burden of wound infection.
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    Impact of COVID-19 pandemic on transplantation
    (Medpharm, 2020-09) Steyn, E.; Al-Benna, S.
    The evolving epidemic has led to reduced activities in organ donation and transplantation across South Africa. Similarly, transplantation programmes have been suspended in other countries because of scarce resources (especially ICU beds) and concerns regarding immunosuppressive induction regimens.
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    Surgery as a component of universal healthcare : where is South Africa?
    (Health & Medical Publishing Group, 2019) Reddy, C. L.; Makasa, E. M.; Biccard, B.; Smith, M.; Steyn, E.; Fieggen, G.; Maswime, S.; Meara, J. G.; Chu, K. M.
    ENGLISH ABSTRACT: No abstract available
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    Towards a future policy for transplantation in South Africa
    (Health & Medical Publishing Group, 1993) Steyn, E.
    Tansplantations now universally accepted as the treatment of choice for end-stage organ failure. For patients suffering from corneal blindness or end-stage renal failure, transplantation is the only hope for a cure. In patients with hepatic, cardiac, pulmonary and pancreatic island failure, transplantation could provide a new lease on life