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1.
S Afr Med J ; 111(10): 934-937, 2021 08 17.
Article de Anglais | MEDLINE | ID: mdl-34949284

RÉSUMÉ

Some clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals of efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit by including studies at high risk of bias and with active rather than placebo controls. If these studies are discounted, the pooled mortality effect is no longer statistically significant, and evidence of benefit is very weak. Relying on this evidence could cause clinical harm if used to justify vaccine hesitancy. Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, evidence-based medicine (EBM) principles have largely been ignored under the guise thatin a pandemic the 'rules are different', probably to the detriment of vulnerable patients and certainly to the detriment of the profession's image. Medical schools and professional interest groups are responsible for transforming EBM from a taught but seldom-used tool into a process of lifelong learning, promoting a consistent call for evidence-based and unconflicted debate integral to clinical practice.


Sujet(s)
Traitements médicamenteux de la COVID-19 , Ivermectine/administration et posologie , Types de pratiques des médecins/normes , Réticence à l'égard de la vaccination/psychologie , Vaccins contre la COVID-19/administration et posologie , Médecine factuelle/normes , Humains , Ivermectine/effets indésirables , Plan de recherche , République d'Afrique du Sud
2.
S Afr Med J ; 110(8): 753-755, 2020 Jul 29.
Article de Anglais | MEDLINE | ID: mdl-32880301

RÉSUMÉ

The research requirement for South African specialist registration offers opportunities and challenges. For some clinicians it may spark a lifelong interest in clinical investigation, while for many others it may provide a potential publication opportunity. Integrating the specific requirements of an MMed mini-dissertation with those of standard medical publications can be difficult for first-time authors and their supervisors; published guidance caters to full-length laboratory Master's or doctoral research. We suggest that research is more likely to be publishable if it is locally relevant, has a clear clinical message and is coherently presented.


Sujet(s)
Dissertations universitaires comme sujet , Enseignement spécialisé en médecine , Édition , Recherche biomédicale , Humains , République d'Afrique du Sud , Spécialisation
3.
S Afr Med J ; 110(11): 1077-1080, 2020 09 29.
Article de Anglais | MEDLINE | ID: mdl-33403981

RÉSUMÉ

The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.


Sujet(s)
AMP/analogues et dérivés , Alanine/analogues et dérivés , Antiviraux/usage thérapeutique , Traitements médicamenteux de la COVID-19 , Dexaméthasone/usage thérapeutique , Médicaments essentiels , Glucocorticoïdes/usage thérapeutique , Processus politique , Guides de bonnes pratiques cliniques comme sujet , AMP/usage thérapeutique , Alanine/usage thérapeutique , Prise de décision , Médecine factuelle , Humains , SARS-CoV-2 , Indice de gravité de la maladie , République d'Afrique du Sud , Facteurs temps
9.
S Afr Med J ; 87(10): 1365-70, 1997 Oct.
Article de Anglais | MEDLINE | ID: mdl-9472250

RÉSUMÉ

OBJECTIVE: To determine the probable effect of increasing clinical frugality on health system expenditure by measuring cost distribution and waste at an individual patient level. DESIGN: Retrospective cost analysis evaluating the distribution of variable costs (i.e. costs excluding salaries and other fixed expenses) and wastage (i.e. expenditure without adequate clinical gain). SETTING: A peri-urban regional referral (level 2) hospital and two district hospitals. SUBJECTS: 500 folders (350 inpatient and 150 outpatient). RESULTS: Accommodation costs accounted for the largest proportion of overall admission costs (42.3%), followed by drugs (19.5%), intravenous fluids (15.4%), laboratory investigations (12.9%) and radiology (10%). Waste accounted for 4.4% (R15.15, SD 41.92) of mean inpatient variable costs of R344.33 (median R208.89, minimum R19.06, maximum R5, 627.25) and this mean admission cost concealed a group of high-cost admissions, with the most expensive 5% accounting for 27.1% of total variable costs and 24.9% of waste. CONCLUSION: Four concepts important for economical bedside decision-making emerged: 1. Cumulative costs mount rapidly, even if individual items appear cheap. 2. The savings achieved by foregoing the use of an individual item (the variable cost) may be considerably less than the listed total cost to the State of that item (fixed costs are unaffected by reduced short-term utilisation.) 3. More care when ordering investigations and therapy may reduce waste. 4. Global views of hospital costs conceal a group of patients whose care is more expensive than average but who may be difficult to identify prospectively. Although the wastage rate in this group is about the same as the global rate, it may represent a useful target for future study.


Sujet(s)
Ressources en santé/économie , Hôpitaux urbains/économie , Audit médical , Types de pratiques des médecins , Adolescent , Adulte , Sujet âgé , Maîtrise des coûts/méthodes , Coûts et analyse des coûts , Économie hospitalière , Déontologie médicale , Coûts des soins de santé , Dépenses de santé , Ressources en santé/statistiques et données numériques , Ressources en santé/ressources et distribution , Mésusage des services de santé/économie , Hôpitaux de district (USA)/économie , Humains , Adulte d'âge moyen , Études rétrospectives
10.
S Afr Med J ; 77(4): 199-202, 1990 Feb 17.
Article de Anglais | MEDLINE | ID: mdl-2300855

RÉSUMÉ

In a survey of patients admitted to the medical and surgical wards of Groote Schuur Hospital during the 5-year period 1983-1987 38 patients with severe drug-induced hepatitis were identified. Fifty-three per cent of these reactions were caused by anti-tuberculosis drugs, 21% to phenytoin and 11% to methyldopa. Whereas 82% of the patients were jaundiced, only one-third had gastro-intestinal symptoms and/or fever and only 24% had a rash. Twenty-six per cent of patients were encephalopathic on admission. The overall mortality rate was 24%. Forty per cent of patients with hepatitis caused by anti-tuberculosis therapy died. Many patients had continued to receive therapy despite signs of liver disease. These findings underline the need for a high index of suspicion in the diagnosis of drug-induced liver disease and for early withdrawal of the offending agent(s).


Sujet(s)
Lésions hépatiques dues aux substances/épidémiologie , Adolescent , Adulte , Facteurs âges , Sujet âgé , Sujet âgé de 80 ans ou plus , Antituberculeux/effets indésirables , Femelle , Humains , Mâle , Adulte d'âge moyen , Études rétrospectives , Facteurs sexuels , République d'Afrique du Sud/épidémiologie
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