Transforming communication across surgical generations – bridging the gap
Effective communication is the cornerstone of successful surgical practice, directly influencing patient safety, team efficiency, and clinical outcomes. However, the modern surgical workforce faces challenges due to generational diversity, with surgeons possessing distinct communication styles shaped by their era’s technology and education. These differences, coupled with traditional hierarchical structures in surgery, create barriers to open dialogue, which can negatively impact teamwork and patient care. Bridging these divides are crucial to maintaining high standards in surgical practice.
Defining the contribution of human error to adverse events in a surgical service
The realisation that human error is pervasive in complex systems such as the healthcare industry has generated a great deal of interest over the last two decades. Research has highlighted the fact that medical error is more common than previously recognised. To err is human, published in 2000, is the foundational text in the field of error in healthcare. It described a significant number of deaths secondary to error in American hospitals, and garnered much attention. To err is human built on earlier work by Leape and colleagues in the 1990s. In light of this there is a significant interest in strategies to reduce error and enhance safety. The industrial psychologist Reason’s work on human error provides insight on the genesis of human error, and he describes error as being either skills based, a slip or lapse, rule-based mistakes, or knowledge-based mistakes. Reason’s writings focus on the individual’s contribution to an error, which has been adapted more recently into a human performance deficiency identification tool. Whilst an individual certainly plays a role in error genesis, other authors advocate for a wider "systems approach", for example the System Engineering Initiative for Patient Safety (SEIPS). Chang developed a taxonomy of patient safety events, which describes five nodes by which each error event should be considered, namely impact, type, domain, cause, and prevention or mitigation. Chang’s approach covers both individual factors and system factors, and asks users to assess how each contributed to a particular adverse event. Other industries have used error theory to drive highly effective safety strategies. The most well-known example of this is the aviation industry, which has an enviable safety record dating back over four decades. In attempting to emulate the successes of aviation, healthcare has adopted similar strategies to improve safety. These include ongoing workplace-based education, simulation-based training, checklists, procedural standardisation, and reporting of all adverse events. Despite this, healthcare has lagged behind aviation in optimising safety. Supporting all these safety efforts is the need to collect data on error. To that end, our department has developed and maintained an electronic medical record for over a decade, which specifically allows for recording of adverse events. We set out with the primary objective of quantifying the contribution of human error to these adverse events. Our secondary objective was to appraise the trend of such error over time, with the view to understanding where the gaps lie.
Outcomes of surgical patients in a tertiary ICU with incidental COVID-19 in comparison with COVID-19 naïve patients
The COVID-19 virus is an enveloped, non-segmented, positive sense single-stranded RNA virus and is believed to have zoonotic origin. It was first identified in Wuhan, China, in December 2019 where it spread over a wide geographic area until it reached the status of a pandemic in 2020. The mortality rate for COVID-19 infection is approximately 5% but greatly increases with age (up to 15% in patients > 80 years of age) and the presence of comorbidities. The virus itself has cytopathic effects, commonly damaging the alveolar tissue in the lungs but can directly affect other organs. Additionally, clinical deterioration has been attributed to the cytokine storm, causing an acute inflammatory response due to immune dysregulation which consequently leads to organ failure and death.
Time to regional surgical care in rural South Africa
Surgical conditions account for one-third of the global burden of disease.1 Access to timely surgical care has been limited and inequitable, especially in low-to middle-income countries (LMICs) resulting in large populations without access to essential and emergency surgical care (EESC), key components of universal health coverage. Decentralisation of other chronic medical conditions such as diabetes mellitus, hypertension, and HIV/AIDS has been shown to decrease cost, improve patient satisfaction, and improve outcomes.
Experience of a tertiary/quaternary unit with surgery for endocrine hypertension
Hypertension is one of the most common chronic medical conditions. In the majority of cases, the aetiology is unknown and is labelled “essential hypertension”. Although an endocrine aetiology is rare, we believe that the incidence may be underestimated worldwide especially in low-to middle-income countries. The literature is scarce in sub-Saharan Africa with some publications reported from Cape Town and Johannesburg in South Africa. Selective screening of young patients, those with newly diagnosed hypertension and patients on three or more anti-hypertensive drugs are beneficial to enable early diagnosis of endocrine hypertension. Regardless of aetiology, hypertension has systemic repercussion on the target organs that affects the quality of life if undiagnosed.
The adapted Caprini score as a proxy for postoperative venous thromboembolism prophylaxis: a tertiary hospital experience
Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). DVT is a blood clot that occurs mostly in the deep veins of the lower limb, but can also occur in the vena cava, deep veins of the upper limbs and visceral veins. PE occurs when such a clot travels to the lungs. The occurrence of VTE is equal between the sexes but increases as people age.1 There is an increase in mortality shortly after development of VTE as well as in the long-term.
Epidemiology and anatomic distribution of colorectal cancer in South Africa
Colorectal cancer (CRC) is the 5th most common cancer in sub-Saharan Africa (SSA) and the 3rd most common cancer in South Africa (SA).1 Adenocarcinoma (AC) accounts for the vast majority of cases. SA is an upper-middle-income country with high human development index (HDI). The incidence of CRC in SA is lower than in high-income countries (HICs). This may be due to variations in genetic and environmental factors such as nutrition, obesity and activity. Additionally, differences in life expectancy and access to screening, diagnostics and treatment between SA and HIC countries may influence the variation between regions. For example, SA and the United States of America (US) have a 16-year difference in life expectancy. Given that CRC often develops over the age of 50 years, SA’s lower life expectancy and limited access to screening programmes may impact incidence rates. While the incidence of CRC is lower in SA than HICs, more than two-thirds of people with CRC in low- to middle-income countries die from the disease, compared with approximately half in HIC countries.
Traumatic limb amputations in polytrauma ICU admissions
KwaZulu-Natal (KZN) bears a significant trauma burden, with polytrauma patients often experiencing traumatic limb amputations either directly from the injury or requiring early amputation due to non-viable limbs. This study aims to describe the management and outcomes of severely traumatised limbs requiring amputations in a subgroup of severely injured polytrauma patients admitted to an accredited level 1 trauma intensive care unit (TICU). Polytrauma is defined as multiple-injured patients with physiological derangement,2 which arise from these common injury mechanisms – motor vehicle collisions (MVC), industrial incidents, sports injuries, or even in conflict situations. In this context, the trauma severity impacts the likelihood of amputation. Importantly for survivors, there are both psychological and emotional effects affecting the rest of their life.