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BACKGROUND. In the intensive care unit (ICU) environment, inter-professional team collaborations have direct impact on patient care outcomes. Current evidence shows that providing physiotherapy to ICU patients shortens their length of stay and reduces their incidence of ventilator associated pneumonia and severity of critical illness neuropathy. Physiotherapists' perceptions of their interactions with nurses and doctors as inter-professional team members in the ICU is important. OBJECTIVES. To identify barriers and enablers of physiotherapists' interactions with inter-professional team members in adult ICU settings, identify solutions to the barriers and determine if perceptions of interactions with ICU team members differ between junior and senior physiotherapists. METHODS. A qualitative study was done using semi-structured group discussions. Participants were recruited using convenience sampling. Participants were junior and senior physiotherapists from four private and four public sector hospitals in urban Johannesburg, South Africa. Interviews were audio recorded. Recordings were transcribed and direct content analysis of data was done to create categories, subcategories and themes. RESULTS. Twenty-two junior and 17 senior ICU physiotherapists participated in the study. Barriers raised by physiotherapists regarding communication with inter-professional team members in the ICU were non-ICU trained staff working in ICU, personality types, lack of professional etiquette, and frequent rotation of ICU staff. Enablers of communication with inter-professional team members were presence of team members in ICU during the day, good time management, teamwork approach to care and sharing of knowledge. Differing paradigms of teamwork among health professionals was highlighted as a cause of tension in the ICU inter-professional collaborations. CONCLUSION. Physiotherapists are important members of the inter-professional ICU team. Exploring their interactions with other team members identified solutions that may improve collaboration between inter-professional team members to facilitate improved patient outcomes. Inter-professional education should inform ICU policies to create an environment that fosters teamwork. Finding creative ways to adequately staff the ICU without losing quality or driving up costs of care are matters that should take priority among policy makers.

Background: Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives: To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans. Method: A single-centred pre–post quasi-experimental study was conducted. The population was a consecutive sample of surgical and trauma ICU patients. Participants’ functional ability was assessed with the CPAx tool on alternative days during their ICU stay, and rehabilitation goals were modified according to their CPAx score. Intensive care unit and hospital LOS data were collected and compared to data of a matched historical control group. Descriptive and inferential statistics were used. Results: A total of 26 ICU patients were included in the intervention group (n = 26). They received CPAx-guided therapy, and outcomes were matched with ICU patients in the historical control group (n = 26). The median sequential organ failure assessment (SOFA) score was significantly higher in the control group (p = 0.005) (3.5 [IQR 2–6.3]) versus (2 [IQR 1.8–2.5]) for the intervention group. The median admission CPAx score for the intervention group was 33.5 (IQR 16.1–44), and the median ICU discharge score was 38 (IQR 28.5–43.8). No significant differences were found in ICU days (control 2.7 [IQR 1.1–5.2]; intervention 3.7 [IQR 2.3–5.4]; p = 0.27) or hospital LOS (control 13.5 [IQR 9.3–18.3]; intervention 11.4 [IQR 8.4–20.3], p = 0.42). Chelsea critical care physical assessment scores on ICU admission had a moderate negative correlation with hospital LOS (r = −0.58, p = 0.00, n = 23). Chelsea critical care physical assessment scores at ICU discharge had strong positive correlation with discharge SOFA scores (r = 0.7; p = 0.025; n = 10). Conclusion: Problem-oriented patient rehabilitation informed by the CPAx tool resulted in improvement of physical function but did not reduce ICU or hospital LOS. Clinical implications: A higher level of physical function at ICU admission, measured with CPAx, was associated with shorter hospital LOS.

BACKGROUND. Recent evidence shows that early mobilisation of patients in an intensive care unit (ICU) is feasible, safe and associated with improvement in patients’ clinical outcomes. However, its successful implementation is dependent on several factors, which include ICU structure and organisational practices. OBJECTIVES. To evaluate the structure and organisational practices of Zimbabwean government hospital ICUs and to describe early mobilisation practices of adult patients in these units. METHODS. A cross-sectional survey was conducted in all government hospitals in Zimbabwe. Data collected included hospital and ICU structure, adult patient demographic data and mobilisation activities performed in the ICU during the 24 hours prior to the day of the survey. RESULTS. A total of five quaternary level hospitals were surveyed, with each hospital having one adult ICU. Four of the units were open-type ICUs. The majority of the units (n=3; 60%) reported that they had a permanent physiotherapist who covered their unit, but none of the physiotherapists worked solely in the ICU. The nurse-to-patient ratio across all units was 1:1. None of the units utilised a standardised sedation scoring system or a standardised outcome measure to assess patient mobility status. Only one ICU (20%) had a patient eligibility guideline for early mobilisation in place. Across the ICUs, 40 patients were surveyed. The median (interquartile range) age was 33 (23.3 – 38) years and 24 (60%) were mechanically ventilated. Indications for admission into the ICU included acute respiratory failure (n=12; 30%) and postoperative care (n=10; 25%). Mobilisation activities performed in the previous 24 hours included turning the patient in bed (n=39; 97.5%), sitting over the edge of the bed (n=10; 25%) and walking away from the bedside (n=2; 5%). The main reason listed for treatment performed in bed was patients being sedated and unresponsive (n=13; 32.5%). CONCLUSION. Out-of-bed mobilisation activities were low and influenced by patient unresponsiveness and sedation, staffing levels and lack of rehabilitation equipment in ICU.

• Opsomming: Die Kora het 'n belangrike rol in die Transgariep (OVS) gedurende die eerste helfte van die negentiende eeu gespeel. Teen 1858 egter, na die nederlaag van Goliat Yzerbek, het die veeboer-swerwers van die toneel verdwyn. In die artikel word gekyk na die lotgevalle van die mense. Georganiseer in klein kapteinskappe en as besitters van vuurwapens en perde kon die Kora dekades lank d.m.v. strooptogte en militêre alliansies hulle gesag tussen die Riet- en Vaalrivier laat geld. Met die intrek van die Griekwas o.l.v. Adam Kok en later die blanke veeboere en trekkers is daar nie alleen perke gestel aan die Kora se vrye beweging nie, maar al hoe groter druk is op hulle gronde geplaas wat in Griekwa en blanke besit gekom het. Uiteindelik is hulle deur die twee sterker groepe verdring en verdryf. • Summary: The Kora played an important role in the Transgariep (OFS) during the first half of the 19th century. By 1858, however, after the defeat of Goliat Yzerbek, these migrant cattle farmers disappeared from the scene. This article focuses on the fortunes of these people living between the Riet and Vaal Rivers. Organized in small chieftainships and in possession of fire-arms and horses, the Kora dominated the area with their constant raids, sometimes in military alliance with other groups. The Griqua settlements under Adam Kok and the infiltration of whites into this region however, restricted their movements and put pressure on Kora land. Eventually, they were displaced and dispersed by these more powerful communities.

• Opsomming: Myntering was een van die vernaamste en mees gevreesde bedryfsiektes op die goudmyne van die Witwatersrand tussen 1886 en 1920. Daar was 'n duidelike verband tussen die toename van die siekte en die gebruik van moderne tegnologie, veral meganiese rotsbore. Die bore het baie stof veroorsaak en ondergrondse mynwerk gevaarliker gemaak. Deur die ingebruikneming van nuwe stofwerende apparate is tegnologie ook ingespan om die voorkoms van myntering te bekamp. Tot en met 1920 was die pogings slegs deels suksesvol omdat nog die staat nog die mynbedryf 'n duidelike gesondheids- en tegnologiebeleid neergelê en toegepas het. • Summary: Miners' phthisis was the most prevalent and most dreaded industrial disease on the gold mines of the Witwatersrand during the period from 1886 until 1920. There is a clear connection between the rising incidence in miners' phthisis and the use of modem technology such as mechanical rock drills. The drills caused a large amount of dust and thus made underground mining operations more dangerous. New technology was, however, also used to prevent dust and consequently contain the incidence of miners' phthisis. Up to 1920 these efforts were only partially successful because neither the state nor the mining industry had a clear health and technology policy.