BACKGROUND: Mayo type Ila olecranon fractures are typically managed with plate osteosynthesis (PO) or tension band wire (TBW) fixation. Reoperation rates for the removal of prominent metalware are high following TBW. All-suture anchors (ASA) in a tension band configuration can potentially capitalise on tension band principles and reduce hardware irritation. This investigation aimed to review the outcomes of patients with Mayo Ila olecranon fractures managed with this technique METHODS: This retrospective chart review describes the ASA surgical technique and assesses the outcomes of adult patients with Mayo Ila olecranon fractures managed with the technique between 1 August 2017 and 31 October 2021. Patient charts were used to capture basic demographic details, injury characteristics, timing of surgery and surgical outcomes. The outcomes of interest included the union rate, functional outcomes, complications and reoperation rates RESULTS: Thirty patients met inclusion criteria; 60% were male, the majority of which (63%) were injured from a direct blow. Two injuries were compound. All but one fracture united, representing a union rate of 97%. The median postoperative total range of motion was 130°. The median Mayo Elbow Performance Score (MEPS) was 100 (excellent). Three cases complicated: two with superficial sepsis and exposed suture material, and one developed a fibrous non-union. No patients required reoperation CONCLUSION: The adult patients with transverse olecranon (Mayo type Ila) fractures managed with the described all-suture anchor technique in this investigation had a union rate of 97%, with excellent functional results as measured by the MEPS. No reoperations were required LEVEL OF EVIDENCE: 4
This chapter presents an explorative approach examining the inter-relationships between System Dynamics (SD), Participatory Action Research (PAR), and Theory U viewed from an inter- penetrative perspective. This chapter seeks to uncover the various multi-factorial aetiological reasons underpinning service delivery in a public healthcare facility. This approach demonstrated that a conglomeration of PAR with a qualitative approach such as SD yielded the potential to address public healthcare imbalances, promote action research participation, and bolster initiatives aimed at individual empowerment. In the health literature, this combination is supported and seen as a liberating, transformative undertaking whereby researchers and participants generate knowledge. This co-occurs whilst engendering a sense of social cohesion, expanding knowledge databases and raising awareness of challenges that have the most enduring impact on the public healthcare system. There has thus been a bridging of the hiatus between theory and praxis by instilling collaborative problem-solving.
Background. Hyperglycaemia is common in hospitalised patients. Acute illness or injury may result in glucose intolerance and insulin resistance leading to hyperglycaemia. There is a lack of data on the incidence and impact of early hyperglycaemia in critically ill patients in South Africa (SA). Objectives. To determine the incidence of hyperglycaemia within 48 hours of admission to a multidisciplinary SA ICU and to determine if there was any association between blood glucose level and ICU outcomes. Methods. This was a retrospective observational study of patients admitted to ICU at King Edward VIII Hospital from November 2021 to August 2022. All blood glucose values were recorded within the first 48 hours of admission. The primary outcome was ICU mortality, with secondary outcomes including ICU length of stay (LOS), ventilator days (LOV), renal replacement therapy (RRT) and wound infection. Results. A total of 177 patients were included in the study. Hyperglycaemia with a blood glucose of more than 10 mmol/L within 48 hours of ICU admission occurred more frequently in those who died in ICU (79.5%) v. ICU survivors (60.1%) (p=0.026). Hyperglycaemia was associated with an increase in ICU LOS, LOV and wound infection. No statistically significant relationship was found between hyperglycaemia and RRT. Hypoglycaemia within 48 hours of ICU admission was also associated with an increased ICU mortality. Conclusion. Extremes of blood glucose were associated with increased ICU mortality. We recommend a moderate glycaemic control target of 6 - 10 mmol/L in resource-limited settings.
Aims/hypothesis We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. Methods Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. Results At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA 1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p <0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p <0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p <0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p <0.001) or required insulin treatment (72.3% vs 98.1%, p <0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. Conclusions/interpretation Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes. Graphical Abstract
