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Robot-aided surgery now available in Eastern Cape Province

The first robot-assisted surgeries to treat prostate cancer in the Eastern Cape were performed by Netcare Greenacres urologists Dr Hannes Brummer and Dr Johan Coetzee this week following the installation of the Da Vinci Si robotic surgical system at the hospital.

Similar robotic systems have been installed at Netcare hospitals in Cape Town, Johannesburg and Durban.

Coetzee and Brummer have been training in South Africa and Europe to perform robot-assisted surgery.

Netcare hospital division managing director Jacques du Plessis said that after robotic surgery systems had been introduced in other provinces there had been an increased number of referrals from other provinces.

“We have now brought the technology and capacity for robotic-assisted procedures to the Eastern Cape.

“We identified a need for the intricate and highly complex interventions the Da Vinci Si system enables trained surgeons to achieve,” he said.

Netcare Greenacres Hospital general manager Andre Bothma hailed the development and the benefits it would bring for patients with localised prostate cancer. It is also used for kidney and bladder cancer surgery.

“The new technology will make it possible for trained specialists to offer our patients world-class prostate cancer treatment,” he said.

Urologist and robotic surgeon Dr Gregory Boustead, consultant adviser to Netcare hospitals, said these surgeries were the gold standard in the treatment of localised prostate cancer in Europe and the US.

The technology enabled surgeons to achieve greater surgical precision due to better visibility of the surgical site.

He said the first 500 robotic-assisted prostate surgeries at Netcare facilities had shown excellent results.

He further explained that patients are only required to stay in hospital for two to three days and complication rates were very low.


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Medical software crippled by recent cyber attack

Many doctors still can’t use a transcription service made by Nuance Communications Inc. three weeks after the company was hit by a powerful, debilitating computer attack.

Hospital systems including Beth Israel Deaconess in Boston and the University of Pittsburgh Medical Center said eScription, a Nuance staple product that allows physicians to dictate notes from a telephone, still isn’t functioning. The outage obliterated doctors’ instructions to patients, forcing some to revert to pen and paper.

The computer virus, called Petya, has sent ripples through health care, among the last industries to make the switch to digital record keeping and one of the most frequently targeted by hackers, said Michael Ebert, a partner with KPMG who advises health and life-science companies on cybersecurity.

“Health care has been late to respond to the need for protected information, and the information is worth more,” Ebert said. “It’s amazing how far behind we are, and we know we have to do something.”

Hackers increasingly use viruses to encrypt companies’ information systems, unlocking the data only when a ransom is paid. After the Petya attack began in late June, companies from Oreo-maker Mondelez International Inc. to Reckitt Benckiser Group Plc warned of a blow to their sales. Information systems used by FedEx Corp.’s TNT unit may never fully recover, the shipping company said Monday.

Nuance shares were down 2.3 percent to $17.14 at 10:57 a.m. in New York. They’ve dropped about 6 percent since June 27, when the attack began.

The University of Pittsburgh Medical Center, a system of 25 hospitals and 3,600 doctors, said that its dictation and transcription services are still affected “with no estimated time of resolution.” The nonprofit is using features of medical records systems made by Cerner Corp. and closely held Epic Systems in the interim, said Ed McCallister, the Pittsburgh system’s chief information officer.

When the hack hit in June, the virus spread quickly. Ebert said one of his clients stood in a parking lot with a bullhorn, pleading with employees not to turn on computers, lest the virus spread into them. Another saw 100 workstations infected in an hour. Others shut down their entire systems, painstakingly starting computers one by one offline to see whether they had been tainted.

After acknowledging June 28 that portions of its network were affected, Nuance, based in Burlington, Massachusetts, is still picking up the pieces. In addition to transcription, Nuance named about 10 other affected products, including those used for radiology, billing and software that tracks quality of care.

About half of the company’s $1.95 billion in revenue came from its health-care and dictation business last year. The malware attack represents a big risk for Nuance, as many of its customers use products that appear to have been affected, according to Bloomberg Intelligence analyst Mandeep Singh.

“Any time there is a cyberattack and a company is exposed to that threat, that presents both reputational risk as well as the risk from disruption,” he said. “Since a lot of the deals get signed toward the end of the quarter, the timing of it could have impacted certain deal closures.”

Enhancing Security

Nuance said it has been fixing affected systems, enhancing security and bringing customers back online. The company declined to say how many clients were affected by the attack.

“We are doing everything within our power to support our health-care customers and provide them with the information and resources they need to provide quality patient care, including offering an alternative system and solutions,” company spokesman Richard Mack said Wednesday in an email. “We have no indication that any customer information has been lost or removed from the network.”

Other Products

The loss of service is an invitation to customers to seek other products and vendors, such MModal, a Nuance rival. Even though Intermountain Health Care, a Salt Lake City-based company that operates 22 hospitals, wasn’t affected, it turned off all its Nuance products and is using other transcription tools, said Daron Cowley, a spokesman.

At Beth Israel Deaconess, a Harvard-affiliated hospital, doctors who have been accustomed to using Nuance’s telephone-based product are switching to its Dragon system, where physicians dictate into a computer, making edits as they go.

That still means lost revenue for Nuance. While the computer-based product is a single software purchase, Nuance bills for eScription by line of text. So far, it’s been three weeks of revenue they can’t get back, and more users may drop away, said John Halamka, Beth Israel’s chief information officer.

“The hardest thing for a clinician is a change in workflow,” he said. “If you’ve changed for a couple of weeks, you might not go back.”

Nuance has done well to try to maintain customers in the aftermath of the attack, KPMG’s Ebert said, but the damage has already been done.


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No Bone Scanner for Cancer patients at Livingstone Hospital due to tax glitch

A tender given to a company which had a tax glitch has resulted in hundreds of state cancer patients waiting months for bone scans, with some so desperately in need they were put on buses to the Western Cape.

The standoff due to the tax issue has brought the construction of a special bunker for a bone scanner at Port Elizabeth’s Livingstone Hospital to a halt.

Now Health MEC Pumza Dyantyi has been asked to step in and explain the situation to the provincial legislature.

The hospital’s old scanner broke down around January this year and technicians said it could no longer be fixed as it was too old.

A new multimillion-rand machine was purchased, but is standing idle at provincial hospital as it needs a special concrete bunker for health and safety reasons.

The old casualty unit at Livingstone Hospital was identified as a suitable place for the installation of the new machine.

But Eastern Cape health spokesman Sizwe Kupelo said the delays were caused by a standoff over the tax situation of the contractor.

“The contractor we appointed had tax problems and we have insisted that he needs to get his tax situation in order before he can continue with the building,” Kupelo said.

“We are now looking for an alternative contractor and we have approached the supply chain unit to find a compliant service provider.”

He said the construction of the bunker was a specialised job.

“We anticipate that construction will resume soon to ensure this machine can be used,” he said.

Two patients with severe back problems, who asked not to be named as they feared being victimised, told The Herald they had been sent to Cape Town by bus to get bone scans.

The DA’s Celeste Barker said the appointment of a contractor that was not tax-compliant was reckless and careless.

“It will increase patient suffering, delay service provision and add to the already overstretched bed utilisation rates,” she said.

“Those in need will have their healthcare compromised by the inefficient and careless appointment process. This will undoubtedly cost lives and cause unspeakable agony.”

Barker said she would submit questions to the legislature, asking Dyantyi to explain how this had happened.

Fikile Boyce, of the Eastern Cape Health Crisis Coalition Action Group, said it did not help for the department to boast about “substantial investment” in radiotherapy in Nelson Mandela Bay and the Sarah Baartman District.

“A new machine that cannot be installed is as bad as no machine . Taxpayers’ money is being wasted while people die,” he said.


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Kind in Wes-Kaap dood aan witseerkeel

’n 10-jarige meisie van die Nomzamo-township naby die Strand is dood en drie familielede is besmet met die hoogs aansteeklike bakteriële siekte witseerkeel, het die Wes-Kaapse gesondheidsdepartement Maandag bevestig.

Die meisie het op 3 Augustus positief getoets vir die siekte en is die volgende dag dood “weens die erns van die siekte”, sê Mark van der Heever, woordvoerder van die departement.

Die siekte is ook by die meisie se ma en twee sibbe gediagnoseer nadat die departement al haar gesinslede getoets het in ’n poging om die verdere verspreiding te keer.

Hulle het medikasie en entstowwe gekry,” sê Van der Heever.

“Meer as 600 individue is in hierdie spesifieke gemeenskap ingeënt,” sê hy.

Volgens die Wêreldgesondheidsorganisasie is 30 000 gevalle van witseerkeel en 3 000 sterftes wêreldwyd in 2000 aangemeld, in vergelyking met byna 100 000 infeksies in 1980.

Hulle het medikasie en entstowwe gekry,” sê Van der Heever.

MEER AS 600 INDIVIDUE IS IN HIERDIE SPESIFIEKE GEMEENSKAP INGEËNT
Gesondheidsdepartement
“Meer as 600 individue is in hierdie spesifieke gemeenskap ingeënt,” sê hy.

Witseerkeel is ’n aansteeklike en potensieel lewensgevaarlike bakteriese siekte. Dit word veroorsaak wanneer die bakterieë ’n gif in ’n persoon se liggaam vrystel wat liggaamsweefsel en organe kan beskadig of vernietig.

Die gif word ook geabsorbeer en kan ’n verskeidenheid sistemiese effekte veroorsaak wat die niere, hart en senuweestelsel aantas.

Dit kom by mense van alle ouderdomme voor maar meestal by kinders wat nie ingeënt is nie. Dit versprei deur hoes of nies.

Volgens die Wêreldgesondheidsorganisasie is 30 000 gevalle van witseerkeel en 3 000 sterftes wêreldwyd in 2000 aangemeld, in vergelyking met byna 100 000 infeksies in 1980.

Deur: Netwerk 24


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Could you have hepatitis and not know it?

According to the World Health Organisation, Africa has one of the highest hepatitis infection rates in the world. Sadly, many people are unaware they have it.

Hepatitis affects 60 million people in Africa. Worldwide, an estimated 325 million people are living with chronic hepatitis-B virus (HBV) or hepatitis-C virus (HCV) infections.

What makes this particularly concerning is that many are unaware that they have hepatitis and are at risk of a slow progression to chronic liver disease, cancer and even death.

What is hepatitis?

Hepatitis is an inflammatory disease of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or cancer.

The most common cause of hepatitis is due to infection by one of the hepatitis viruses but it can be caused by other infections, medication, alcohol, toxic substances and certain autoimmune diseases.

What are the different hepatitis viruses?

There are five main hepatitis viruses, referred to as types A, B, C, D and E. Types B and C lead to chronic disease and are the most common cause of liver cirrhosis and cancer.

  • Hepatitis A virus (HAV) is present in the faeces of infected people and is most often transmitted through the consumption of water or food contaminated with faecal matter. Certain sexual practices can also spread HAV. In many cases these infections are mild and most people make a full recovery and are then immune from further HAV infection. However, HAV infections can also be severe and life threatening. The good news is that safe and effective vaccines are available to prevent HAV.
  • Hepatitis B virus (HBV) is transmitted through exposure to infected blood, semen and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from an infected family member to an infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through the sharing of needles by intravenous drug abusers. HBV also poses a risk to healthcare workers who sustain accidental needle injuries while caring for HBV-infected patients.

As with hepatitis A, safe and effective vaccines are available to prevent HBV.

  • Hepatitis C virus (HCV) is mostly transmitted through exposure to infected blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through drug use that involves needles. Sexual transmission is also possible, but is much less common.
  • Hepatitis D virus (HDV) infections occur only in those who are infected with hepatitis B. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
  • Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognised as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed.
    How is it caused and spread?

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur through contact with infected body fluids.

What are the symptoms of hepatitis?

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Treatment and protection from hepatitis

Treatment options vary depending on which type of hepatitis you have. You can prevent some forms of hepatitis through immunisation and lifestyle precautions.

Jackie Maimin, CEO of Independent Community Pharmacy Association (ICPA), says that people can protect themselves from hepatitis by doing the following:

  • Avoid contact with blood and body fluids by wearing gloves when touching or cleaning up other people’s blood, vomit or other body fluids
  • Don’t share razors, toothbrushes, pierced earrings, or other personal items with anyone
  • Use condoms if you have multiple sexual partners, or when having sex with an infected person
  • Don’t share chewing gum with anyone
  • Make certain any needles or other sharp implements – for drugs, ear piercing, manicuring or tattooing – are properly sterilised
  • Be careful about the water you drink when travelling abroad
  • Have your family vaccinated

“Vaccination against Hepatitis B forms part of the Expanded Programme of Immunisation for infants and has very effectively lowered the rate of new infection in children. All children should receive the three recommended doses of hepatitis B vaccine,” says Maimin.

“If you are planning to travel to a country with poor sanitation we recommend that you protect yourself against hepatitis A by getting vaccinated as soon as you start planning the trip. Hepatitis A vaccination consists of two injections spaced six months apart.”

Safe and effective vaccines against most of the different types of hepatitis are available. The ICPA advises you to visit your local pharmacy and ask for advice and guidance if you think you may be at risk.

Source: Independent Community Pharmacy Association


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New gene editing technique could treat ALS and Huntington’s.

A team of researchers from the University of California San Diego School of Medicine have developed a new RNA-oriented gene editing technique which could treat hereditary diseases such as ALS and Huntington’s.

The team used a method called RNA-targeting CAS9 (RCas9) to track RNA in live cells and correct “molecular mistakes” which lead to diseases.

The new technique eliminated over 95% of the RNA markers linked to a type of ALS and Huntington’s disease.

Professor of cellular and molecular medicine Gen Yeo said that while this study provides evidence the technique works in a laboratory, there is still a long way to go before it can be tested on patients.

“Before this could be tested in humans, we would need to test it in animal models, determine potential toxicities, and evaluate long-term exposure,” he said.


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Attack on doctors at public hospitals in South Africa sparks security concerns

The South African Medical Association (Sama), and its Eastern Cape branch, has condemned the lack of proper security at public hospitals in the province after a doctor was assaulted by a patient.

Dr Archie Solombela sustained a fracture to his right arm and a general worker was also hurt during the attack by a psyciatric patient at the Cecilia Makiwane Hospital in East London. According to a report in the Daily Dispatch, suspected mentally ill patients are being admitted to general wards for observation, and because resources are so thinly stretched at government hospitals in the province this takes much longer than the standard 72 hours.

This is an unacceptable situation which requires urgent attention,” Sama said in a statement. “Of concern now is why no precautionary measures were put in place, considering the patient has a known violent history. This indicates either a lack of proper planning and coordination, or a lack of will to ensure the safety of healthcare professionals in the province.”

Drug abuse to blame

This is not the first incident involving psychiatric patients at the hospital. In June, a fight broke out among 24 mentally ill patients, which left six of them injured. In addition, a ward was damaged, prompting doctors to close it down. Police and security guards had to be called to calm the fighting patients.

In another incident, guard died of head injuries when he was attacked by a psychiatric patient at Nompumelelo Hospital in Peddie last year.

The Eastern Cape Department of Health blames a sharp rise in drug abuse in the province for the influx of mentally ill patient, particularly teenagers and young men, with which it is battling to cope.

As a first step in dealing with this problem, Sama met the management of the hospital with a view to resolving issues going forward. “During this meeting we stressed that a violent patient is a danger, not only to healthcare workers, but also other patients, and that patient safety is one of the six priorities of healthcare in South Africa. As an association, we are convinced the incident could have been avoided, and we urge authorities to do everything they can to protect our members and our patients in hospitals.”


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Do Artificial Sweeteners Raise Odds for Obesity?

Artificial sweeteners may be less helpful than many believe in helping people lose weight and avoid health problems associated with extra pounds, a new evidence review suggests.

Aspartame, saccharin, sucralose and other artificial sweeteners did not lead to any significant weight loss in more than 1,000 participants in seven clinical trials, said lead researcher Meghan Azad. Clinical trials are considered the “gold standard” of medical research, added Azad, an assistant professor of pediatrics with the University of Manitoba in Winnipeg, Canada.

At the same time, the combined data from 30 observational studies involving more than 400,000 participants showed that artificial sweeteners are associated with obesity, high blood pressure, type 2 diabetes and heart health problems. Observational studies cannot prove a cause-and-effect relationship, however.

These results are “kind of the opposite of what these products are intended for,” Azad said. “It should make people think and question whether they really need to be eating these artificial sweeteners.”

However, it’s possible this evidence review is blaming artificial sweeteners for health problems attributable to an otherwise poor diet or other unhealthy lifestyle choices, countered the Calorie Control Council. The group represents the low- and reduced-calorie food and beverage industry.

“Low-calorie sweeteners are a tool to help provide sweet taste without calories, to address one aspect of calorie intake,” council president Robert Rankin said in a statement. “Taste preferences are an important component of dietary habits, but successful weight management requires a well-rounded strategy.”

Such strategies should address not only dietary preferences, but also physical activity and medical considerations, Rankin added.

For their review, Azad and her colleagues weeded through more than 11,000 published studies, narrowing their review down to seven clinical trials and 30 long-term studies.

The combined seven clinical trials showed that artificial sweeteners had no impact on a person’s body mass index (BMI), the researchers reported. BMI is a measurement of body fat, based on height and weight.

At the same time, the 30 observational studies showed that over an average follow-up of 10 years, people regularly using artificial sweeteners tended to develop health problems associated with excess weight.


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Doctors Sound Alarm That SA Mental Healthcare Is Collapsing

While almost all the previous Life Esidimeni psychiatric patients have been transferred from the NGOs in Gauteng back into hospitals, a group of doctors have warned that the psychiatric structure in South Africa is collapsing.

Reports reveal that in some mental health hospitals there are no psychiatrists, and none of the provinces have organised community-based psychiatric services at present. The South African Society of Psychiatrists (SASOP) said even 150 days after the Health Ombudsman released a report, many hospitals were still facing a shortage of staff with minimal resources.

The president of the SASOP, Professor Bernard Janse van Rensburg, told Health24 that South Africa’s healthcare system is totally fragmented and broken. “Esidimeni was just the tip of the iceberg,” he said. At the beginning of this year, Health Ombudsman Professor Malegapuru Makgoba said the death toll of mentally ill patients who were transferred from Life Esidimeni to 27 NGOs would continue to rise, and at that time it was above 100.

Prof. Janse van Rensburg said the Health Ombudman’s report recommended some action to be implemented within 45 days, however, 150 days later, it was apparent that the general poor access to both physical and mental healthcare at community level remained unaddressed. He added that no comprehensive remedial strategy had been submitted in Gauteng or any other province. Janse van Rensburg added that SASOP’s own report now served as a second call for action to be taken.

Significant discoveries

Some of the most concerning discoveries from the organisation’s report include:

No more than six public sector psychiatrists are serving the whole of Limpopo.
Limpopo’s Hayani hospital, a 390-bed mental health specialist hospital, where there was a report that a psychiatric nurse was killed by an inpatient in 2016, currently has no psychiatrist.
In every province, psychiatrists have to admit children and adolescents unlawfully into adult psychiatry wards.
KwaZulu-Natal is experiencing a massive specialist staffing crisis, where only 20 of the 45 specialist posts are filled.
At present, none of the provinces have organised community-based psychiatric services.

Situation not difficult to resolve

Prof. Janse van Rensburg further highlighted that SASOP engages with government continually, but there was no interest shown in taking the matter seriously. “Their priorities are wrong and the sector is seriously underfunded. We will never have enough psychiatrists and psychologists, but we need better care at community level,” he added.

He concluded that they were not asking for high-tech equipment, but all they needed were well-trained multidisciplinary teams. “The solution is quite simple,” he said. These developments can be devastating for psychiatric patients without Medical Aid, who might need to be admitted to private mental health hospitals if the situation gets worse.


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Experts decry plan to consolidate small medical schemes !!

The plan by the Council for Medical Schemes (CMS) to consolidate or dissolve small medical schemes posed risks to the people who belong to these schemes and might force some to drop their cover, industry sources warned this week.

More than 228,000 people belonged to 31 medical schemes that had fewer than 6,000 members at the end of 2015, according to the CMS 2015-16 annual report. All but three of these schemes are restricted employer groups. Restricted employer group schemes generally subsidise members on low incomes, enabling them to buy cover they could not afford on the open market.

CMS acting registrar Sipho Kabane said consolidating the industry was in line with the white paper on National Health Insurance (NHI).

Medical schemes with fewer than 6,000 principal members were targeted as they fail to meet the requirements of the Medical Schemes Act. The act says schemes must have 6,000 members to register.

Consolidation was necessary because fragmented risk pools were expensive and limited the scope for cross-subsidisation, said Kabane. “It isn’t just about noncompliance [with the act]. This is just the beginning. In NHI, we will have one risk pool: from 83 [medical schemes in SA] we will consolidate into one.

“We are going through a consultative process, to come up with a clear mandate on how this will be [achieved],” he said.

Insight Actuaries joint CEO Christoff Raath said: “These people won’t be able to get similar benefits on the open market and may get dumped on the state.”

Alex van den Heever, University of the Witwatersrand chairman of Social Security Systems Administration and Management Studies, said consolidation would harm consumers as it would limit choice. Closing small schemes due to their size was indefensible.

Discovery Health CEO Jonathan Broomberg said “the legality of forcing small schemes to close” was an issue, while there were “concerns about the impact on the members of many small schemes”.

Medscheme CEO Kevin Aron said an attempt by the CMS to deregister medical schemes was likely to be met with legal and constitutional challenges.


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