Second victim experiences of healthcare providers after adverse events: A cross-sectional study.

Background: Adverse events in healthcare are inevitable as most treatments and investigations have the potential to cause harm. Healthcare providers often witness or are involved in adverse events, putting them at risk of becoming second victims, which may further impact patient safety. Aim: The researchers report on the physical and psychological symptoms experienced by healthcare providers following adverse events during patient care as well as their perceptions of the quality of support received and the desired forms of support following adverse events. Setting: A single secondary public hospital in the Limpopo province, South Africa. Methods: Using total population sampling, healthcare providers were invited to anonymously participate in a cross-sectional survey using the Second Victim Experience and Support questionnaire to assess experiences after adverse events and desired forms of support. Results: Healthcare providers (N = 181) experienced more psychological distress (mean = 2.97, standard deviation [SD] = 1.33) than they experienced physical distress. Most healthcare providers relied on non-work-related support (mean = 4.08, SD = 1.19). Healthcare providers reported that adverse events influenced their perceptions of professional self-efficacy (mean = 2.71, SD = 0.94) and mostly desired support in the form of discussing the event with supervisors or managers (mean = 3.72, SD = 1.37). Conclusion: Healthcare providers in different clinical settings are at risk of suffering second victim effects. Health institutions should offer support to all victims of adverse events. Contribution: The information offered could enable healthcare management to modify existing practices to a non-punitive style, improve communication and provide better support following adverse events.

A Comparison Between Manual Count, Flow Cytometry and Quantitative Real-Time Polymerase Chain Reaction as a Means of Determining Babesia rossi Parasitaemia in Naturally Infected Dogs.

PURPOSE: Light microscopic manual count is the current gold standard for parasite quantification. The ability to determine parasite density in whole blood is crucial to understanding disease pathogenesis and finding a suitable automated method of Babesia rossi parasite quantification would facilitate higher throughput and provide results that are more objective. This study investigated both peripheral capillary and central venous whole blood to estimate the correlations between light microscopy, flow cytometry and quantitative real-time polymerase chain reaction (qPCR). METHODS: Peripheral capillary and central venous blood were sampled from 40 naturally B. rossi-infected dogs and 10 healthy control dogs. Samples were analysed by reverse line blot hybridization assay to confirm a mono-B. rossi infection. Capillary blood parasite density was detected using light microscopic manual counting and venous blood parasitaemia detected by manual counts, flow cytometry and qPCR. RESULTS: A significant correlation was found between the venous manual counts and flow cytometry (rs = 0.465; P < 0.001), as well as qPCR (rs = - 0.500; P < 0.001). A significant correlation was also observed between the capillary manual counts compared to venous manual counts (rs = 0.793; P < 0.001), flow cytometry (rs = 0.399; P = 0.004), and qPCR (rs = - 0.526; P < 0.001). CONCLUSIONS: The study results suggest that qPCR is of value as an alternative to the gold standard manual count for detecting B. rossi parasitaemia in canine whole blood and that flow cytometry may be useful with further refinement of issues such as background fluorescence and the influence of reticulocytes.

Tongue position and its relation to the cause of death and sequential stages of body decomposition observed during 608 forensic post-mortems.

The purpose of this study was to document tongue position and its relation to the cause of death and sequential stages of body decomposition, as observed during the routine forensic pathological examination of bodies. The sample of 608 included all bodies examined by the first and third authors during the period April 2016 to September 2016. Tongue position was recorded in all cases where position of the tongue could be visually determined. The condition of the body was recorded as follows: fresh flaccid, fresh with rigor mortis, early decomposition, and advanced decomposition. The cause of death was recorded where known. The results showed that 86% of all bodies examined did not show a protruded tongue and that 92.8% of the bodies were in a state of fresh rigor mortis. The study also showed that tongue protrusion was more prevalent in certain causes of death, namely, hanging, burning, and drowning, but was never absolute. The authors believe that due to the low numbers of bodies presenting with protruded tongues, this phenomenon has previously been overlooked, the significance thereof underestimated, and the pathophysiology and pathomorphology never fully investigated.

An analysis of dental intercanine distance for use in court cases involving bite marks.

High levels of crime in South Africa and the resulting court cases requiring bite mark evidence have necessitated continuous research into the prevalence and interrelationship of recognisable dental features present in bite marks. This study represents the largest data set of descriptive statistics related to intercanine distance, in which the means, standard deviations, medians and interquartile ranges across four racial groups were determined. Intercanine distances were also statistically weighted by determining the common, uncommon and very uncommon values for each of the racial groups. The results of this research show that we can consider any maxillary intercanine distance more than 24.1 mm and less than 43.0 mm to represent a human bite mark. Black males had the largest mean (average) intercanine distance of 36.33 mm (standard deviation 2.49 mm) and white females the smallest mean intercanine distance of 33.4 mm (standard deviation 2.13 mm). The analyses showed statistically significant differences between the mean intercanine distances of different race and gender groupings. The authors do not advocate trying to determine the race or gender from intercanine distances determined, but rather the relevance of the intercanine distances in the specific race and gender groupings. This study makes a meaningful scientific contribution to the presentation of bite mark evidence at a time when subjective opinions need to be replaced with scientific data.

Toward a standardized investigation protocol in sudden unexpected deaths in infancy in South Africa: a multicenter study of medico-legal investigation procedures and outcomes.

INTRODUCTION: South Africa manifests a socio-economic dichotomy that shows features of both a developed and developing country. As a result of this, areas exist where a lack of resources and expertise prevents the implementation of a highly standardized protocol for the investigation of sudden and unexpected deaths in infants (SUDI). Although the medico-legal mortuaries attached to academic centers have the capacity to implement standardized protocols, a previous study conducted at two large medico-legal mortuaries indicated otherwise. This study also revealed that the exact number and incidence of sudden infant death syndrome (SIDS) cases was unknown. These findings prompted a multicenter study of the medico-legal investigation procedures and outcomes in five academic centers in South Africa. METHODS: A retrospective case audit was conducted for a 5-year period (2005-2009) at medico-legal laboratories attached to universities in Bloemfontein, Cape Town-Tygerberg, Durban, Johannesburg, and Pretoria. The total case load as well as the total number of infants younger than 1 year of age admitted to these mortuaries was documented. The case files on all infants younger than 1 year of age who were admitted as sudden and unexpected or unexplained deaths were included in the study population. Data collected on the target population included demographic details, the nature and scope of the post-mortem examinations, as well as the final outcome (cause of death). RESULTS: A total case load of 80,399 cases were admitted to the mortuaries over the 5 year period with a total of 3,295 (6.5 %) infants. In the infant group, 591 (0.7 %) died from non-natural causes and 2,704 (3.3 %) cases of sudden, unexpected and/or unexplained deaths in infants were admitted and included in the detailed case analysis study. One hundred and ninety-nine babies were between 0 and 7 days of age and 210 babies between 8 and 30 days. The remaining 2,295 infants were between 1 month and 12 months of age. Death scene investigation was done in a total of 14 (0.5 %) cases. Discrepancies were present in the extent of the macroscopic post-mortem examinations, as well as the type and extent of the ancillary investigations performed. The investigations were completed in 2,583 of the cases. The majority of these infants died from natural disease processes [1,976 infants (76.5 %)]. Bronchopneumonia was the leading cause of natural deaths at all the mortuaries [674 cases (26.1 %)]. SIDS was diagnosed in only 224 cases (8.7 %) and in 383 (14.8 %) cases, where a full post-mortem examination with ancillary investigations was conducted; the cause of death was recorded as "unascertained." CONCLUSIONS: This study indicated that the admission criteria (to medico-legal mortuaries) and the investigative process/protocols in cases of SUDI differ greatly among 5 of the largest academic medical institutions in South Africa. Establishing and implementing standardized admission criteria (to medico-legal mortuaries) and implementing uniform investigative and autopsy protocols would appear to be an essential prerequisite to gain better understanding of the mystery of SIDS in South Africa.