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Background: In South Africa, the doctrine of informed consent (introduced by the South African courts, Cape Provincial Division) dictates that all reasonable patients be told of material risks and alternative options before consenting to medical treatment or procedural interventions. The reasonable patient standard requires that a patient be told of all material risks that would influence a reasonable person in determining whether or not to consent to the treatment. Regional anaesthesia, including peripheral nerve blocks (PNBs), provides a plethora of benefits to patients undergoing surgery but, due to potential risks involved, also requires informed consent. Studies have shown that South African anaesthetists do not regularly obtain adequate informed consent for these procedures. We implemented a quality improvement project to facilitate and enhance documented informed consent in our setting. Methods: A prospective quality improvement project was established at Groote Schuur Hospital, Cape Town, including all PNBs performed in two-week blocks before and after the introduction of a standardised regional anaesthesia informed consent form. The primary outcome, comparing the incidence of documented informed consent between the two groups, was assessed with the McNemar's test for differences in proportions. Regression analysis was used to explore the effect of prespecified confounders (such as documented consent taken, benefits discussed, alternatives discussed, complications discussed and whether autonomy was documented). Results: In total, 39 and 43 patients were included in the pre- and post-intervention groups, respectively. In our setting, anaesthetists were 4.16 times (95% confidence interval (CI) -6.67 to -2.98, p < 0.001) more likely to take documented informed consent when provided with a standardised form. The incidence of documented informed consent improved from 7.7% to 60.5%. Regression analysis showed that these confounders influenced the recall of the PNB consent and discussed benefits and complications. Overall, recall was mostly influenced when benefits were discussed with patients (95%CI -20.023 to -14.64, p < 0.001). Conclusion: Documentation of informed consent for PNBs in our setting is poor. A standardised consent form can facilitate the documentation of consent significantly. Patient recollection of the consent process also improved, specifically when benefits were discussed. [ABSTRACT FROM AUTHOR]

Background: Clinical registries are pivotal for advancing patient care and clinical research. The prospective Point of Care Ultrasound Registry (PURE) is a unique, pioneering initiative that aims to accumulate essential ultrasound data through a dedicated collection tool. This study investigates user satisfaction with the implementation of PURE, a first-of-its-kind registry, focusing on a spectrum of implementation outcomes. Methods: Using a cross-sectional survey approach, this study evaluated diverse implementation metrics such as acceptability, appropriateness, adoption, accessibility, feasibility, efficacy and efficiency. Statistical analyses were conducted to determine the overall user satisfaction with the implementation of this novel registry. Results: The study yielded a mean implementation score (IS) of 3.83 (95% CI 3.59-4.07). Effectiveness (E) had a mean score of 1.93 (95% CI 1.80-2.05) and Cumulative Implementation Factor (A) averaged 1.90 (95% CI 1.78-2.03). Notably, 11 of the 30 participants achieved an IS above 4, with a predominant 21 of 30 surpassing an IS of 3.8. Nevertheless, the scores for efficiency and feasibility, registered at 0.392/0.625 and 0.165/0.250, respectively, indicate areas for improvement. Conclusion: While PURE represents an innovative step forward in point-of-care ultrasound (POCUS) data collection, its initial implementation did not fully resonate with user satisfaction expectations. Significant possibilities for enhancement lie particularly within the efficiency and feasibility sectors. To improve its utility, measures such as optimising the data collection tool, bolstering training programmes, merging with existing systems, and implementing thorough evaluation and feedback processes are recommended. A nuanced understanding of the time pressure faced by anaesthetists during data input can provide valuable insights into further areas of potential refinement. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is becoming part of the standard skill set of the modern-day anaesthetist. There is limited knowledge regarding the availability of ultrasound (US) and POCUS skills in South Africa. There may be barriers to adopting US in many institutions. Methods: An observational cohort questionnaire was distributed via an online REDCap survey. All doctors practising anaesthesia in South Africa were eligible. Recruitment was done via an email link that was sent to South African Society of Anaesthesiologists (SASA) members. Non-SASA members were recruited via departmental mailing lists or social media. Results: Of the 580 respondents, 478 were SASA members (response rate 22.9%, confidence interval 3.94) and 102 were non- SASA members. In total, 571 surveys were suitable for analysis, 397 (69.5%) respondents had more than five years anaesthesia experience, 558 (97.7%) of respondents worked in hospitals that have US machines available, and 76.7% had US readily available after hours. Respondents used US mostly for central venous catheter (CVC) insertions (77.9%), regional anaesthesia (82.3%), and cardiac and lung assessments (26.4% and 17.7%, respectively). It is used much less frequently for neuraxial anaesthesia (1.4%). Of the respondents, 382 (66.9%) had received US training, only 198 (34.7%) felt confident in their US skills, and 482 (84.4%) wish to have further US training. The two most significant barriers to US were lack of equipment and lack of training at postgraduate level. Conclusion: South African anaesthetists work at institutions where US equipment is generally available, and most practitioners want to incorporate US in their practice. However, anaesthetists feel insecure with respect to their skills and indicated that they wish to receive further training. Efforts should be made to formalise POCUS training in the Fellowship of the College of Anaesthetists (FCA) curriculum and make US training more accessible. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) is a widely accepted and used modality across many fields of medicine, particularly in anaesthesia. Ultrasound devices with improved image quality and mobility as well as reduced cost and size have made POCUS widely available, even in resource-poor settings. Many adult protocols have been adapted for neonatal use, as ultrasound is easily able to visualise neonatal organs and vessels. Functional or focused echocardiography is routinely performed in many institutions, with many bedside applications including central line placement, peripheral and arterial line placement, lung ultrasound and endotracheal tube localisation. [ABSTRACT FROM AUTHOR]

Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics., (Copyright © 2019 Elsevier Ltd. All rights reserved.)