Search results for: Rhodine Hickman

Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

Abstract:

Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

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Authors: Beatriz Mella Lira, Karla Yohannessen, Robin Hickman

Abstract:

The aim of the paper is recognising inequalities through the self-assessment of health-related factors, in the context of daily mobilities in Santiago de Chile. Human capabilities will be used as the theoretical basis for the recognition and assessment of these factors regarding the functioning (what people are currently able to do) and capabilities (what people want to achieve and what is valuable for them), reflecting differences across social groups and among types of transport users. The self-assessment of health-related factors considers perceptions of stress, physical effort, proximity to other transport users, pollution, safety, and comfort. The types of transport users are classified as: private (cars, taxis, colectivos, motos), public (buses and metro) and active (bicycles and walking). The methodology follows a capability-based questionnaire, which was applied in different areas of Santiago de Chile, considering concepts extracted from the human capabilities list. The self-assessment of these health-related factors examines the context of peoples’ mobilities for performing their daily activities, considering socioeconomic differences as income, age, gender, disabilities, residence location and primary mode choice. The paper uses Relative Importance Index (RII) for weighting the relative influence or valuation of the factors. The respondents were asked to rate the importance of each factor on a scale from 1 to 5, in an ascending order of importance. The results suggest that these health-related factors impact not just the perceptions of users, but their well-being and their propensity for achieving their capabilities and the things they value in life. The paper is focused on the development of an applicable approach, measuring factors that should be included in transport project appraisal, as a more comprehensive and complementary method.

Keywords: active transport, health, human capabilities, Santiago de Chile, transport inequalities, transportation planning, urban planning

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Authors: Louis Hickman

Abstract:

Stakeholder theory is a powerful conception of the firm based on the notion that a primary focus on shareholders is inadequate and, in fact, detrimental to the long-term health of the firm. As such it represents a departure from prevalent business school teachings with their focus on accounting and cost controls. Herein, it is argued that stakeholder theory can be better conceptualized as a critical theory, or one which represents a fundamental change in business behavior and can transform the behavior of businesses if accepted. By arguing that financial interests underdetermine the success of the firm, stakeholder theory further democratizes business by endorsing an increased awareness of the importance of non-shareholder stakeholders. Stakeholder theory requires new, non-financial, measures of success that provide a new consciousness for management and businesses when conceiving their actions and place in society. Thereby, stakeholder theory can show individuals through self-reflection that the capitalist impulses to generate wealth cannot act as primary drivers of business behavior, but rather, that we would choose to support interests outside ourselves if we made the decision in free discussion. This is due to the false consciousness embedded in our capitalism that the firm’s finances are the foremost concern of modern organizations at the expense of other goals. A focus on non-shareholder stakeholders in addition to shareholders generates greater benefits for society by improving the state of customers, employees, suppliers, the community, and shareholders alike. These positive effects generate further positive gains in well-being for stakeholders and translate into increased health for the future firm. Additionally, shareholders are the only stakeholder group that does not provide long-term firm value since there are not always communities with qualified employees, suppliers capable of providing the quality of product needed, or persons with purchasing power for all conceivable products. Therefore, the firm’s long-term health is benefited most greatly by improving the greatest possible parts of the society in which it inhabits, rather than solely the shareholder.

Keywords: capitalism, critical theory, self-reflection, stakeholder theory

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Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Bookun

Abstract:

Introduction: Dialysis access is a key component of the care of patients with end stage renal failure. In our institution, a combined service of vascular surgeons and nephrologists are responsible for the creation and maintenance of arteriovenous fisultas (AVF), tenckhoff cathethers and Hickman/permcath lines. This poster investigates the last 10 years of dialysis access surgery conducted at St. Vincent’s Hospital Melbourne. Method: A cross-sectional retrospective analysis was conducted of patients of St. Vincent’s Hospital Melbourne (Victoria, Australia) utilising data collection from the Australasian Vascular Audit (Australian and New Zealand Society for Vascular Surgery). Descriptive demographic analysis was carried out as well as operation type, length of hospital stays, postoperative deaths and need for reoperation. Results: 2085 patients with renal failure were operated on between the years of 2011 and 2020. 1315 were male (63.1%) and 770 were female (36.9%). The mean age was 58 (SD 13.8). 92% of patients scored three or greater on the American Society of Anesthiologiests classification system. Almost half had a history of ischaemic heart disease (48.4%), more than half had a history of diabetes (64%), and a majority had hypertension (88.4%). 1784 patients had a creatinine over 150mmol/L (85.6%), the rest were on dialysis (14.4%). The most common access procedure was AVF creation, with 474 autologous AVFs and 64 prosthetic AVFs. There were 263 Tenckhoff insertions. We performed 160 cadeveric renal transplants. The most common location for AVF formation was brachiocephalic (43.88%) followed by radiocephalic (36.7%) and brachiobasilic (16.67%). Fistulas that required re-intervention were most commonly angioplastied (n=163), followed by thrombectomy (n=136). There were 107 local fistula repairs. Average length of stay was 7.6 days, (SD 12). There were 106 unplanned returns to theatre, most commonly for fistula creation, insertion of tenckhoff or permacath removal (71.7%). There were 8 deaths in the immediately postoperative period. Discussion: Access to dialysis is vital for patients with end stage kidney disease, and requires a multidisciplinary approach from both nephrologists, vascular surgeons, and allied health practitioners. Our service provides a variety of dialysis access methods, predominately fistula creation and tenckhoff insertion. Patients with renal failure are heavily comorbid, and prolonged hospital admission following surgery is a source of significant healthcare expenditure. AVFs require careful monitoring and maintenance for ongoing utility, and our data reflects a multitude of operations required to maintain usable access. The requirement for dialysis is growing worldwide and our data demonstrates a local experience in access, with preferred methods, common complications and the associated surgical interventions.

Keywords: dialysis, fistula, nephrology, vascular surgery

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