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Objectives:Nutritional support is a fundamental component of holistic patient care in the intensive care unit (ICU). There is a paucity of local data pertaining to nutritional support practices at ICUs in South Africa. The aim of this study was to determine nutritional support practices at an academic hospital ICU in Johannesburg, South Africa.Methods:In this cross-sectional, descriptive and retrospective study, a simple random sampling method was utilised to select 50 data collection days from a three-month period (1 August–31 October 2018). Data relevant to the study were extracted from the ICU charts of patients who received formulae-based enteral and/or parenteral nutrition on the selected days. Charts were categorised into acute phase days (≤ 72 hours from ICU admission) and recovery phase days (> 72 hours from ICU admission).Results:A total of 387 ICU charts were included in the final sample, comprising 114 acute phase and 273 recovery phase days. Overall, enteral nutrition was prescribed on 296 (76.5%) chart days while parenteral nutrition was prescribed on 111 (28.7%) chart days. The median daily fluid balance was approximately 600 ml positive. Target protein and calorie intake was achieved on 67 (17.3%) and 110 (28.4%) chart days respectively.Conclusion:Although protein and calorie intake was suboptimal in comparison with the recommended targets, it is in keeping with general international trends. Regular audits, training of staff, attention to minimising feeding interruptions and encouraging the timely initiation of enteral nutrition are recommended interventions that may be useful in achieving nutritional targets.

Supplemental Digital Content is available in the text.Presentation to the emergency department with renal colic has been reported as between 6.7 and 27.9 per 1000 emergency department visits. Clinicians rely on various radiological investigations for the prompt and accurate diagnosis of urolithiasis. This review assesses the validity of the colour Doppler ultrasonographic twinkling artefact (TA) sign as a diagnostic tool for the presence of urolithiasis. A systematic search of the Cochrane Database of Systematic Reviews, Embase, PubMed, Scopus and Web of Science databases was performed (October 2018) using specific search terms. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool were applied to rank and evaluate selected studies. Twenty-two articles that included 4389 participants were assessed. The median sample size was 102.5 (interquartile range: 47–292.5) and the age range of participants was 4–91 years. Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity for the ultrasonographic TA sign of 88.16 [95% confidence interval (CI): 87.07–89.19%] and 79.22% (95% CI: 73.41–84.26%) respectively, with an estimated summary effect of 3.84 (95% CI: 1.08–6.60, P0.006) in log odds ratio terms. There was significant interstudy heterogeneity as suggested by an I2-statistic of 94.51% (95% CI: 94.51–99.58) and an estimated τ2parameter of 7.21 (SE: 7.44). Despite the suboptimal pooled sensitivity and specificity of the TA sign and the large heterogeneity between published studies, the current body of evidence suggests that the colour Doppler ultrasonographic TA sign may be useful as a complementary tool in the diagnostic workup of patients with suspected urolithiasis.