An important characteristic of being a professional is keeping up to date with one's professional practice requirements - its knowledge, skills and application. This was usually done voluntarily, and regulatory authorities have only recently imposed mandatory continuing professional development (CPD) requirements.
Blanket laboratory screening of patients presenting with a mental disorder is wasteful and unnecessary
An audit tool to identify gaps and promote improvement in TB/HIV/STI care in rural districts
Medical officers without formal anaesthetic training can safely administer procedural sedation and analgesia
Malaria risk - be warned!
Aan die Redakteur: Tygerbergers vir die Behoud van Afrikaans in die Klaskamer (TBAK) is 'n studentevereniging op die Tygerbergkampus van die Universiteit van Stellenbosch (US). TBAK is 'n nie-politiese, nie-rassige organisasie wat die saak van Afrikaans namens studente op Tygerberg aanvoer. TBAK woeker binne 'n veranderende kampusomgewing wat betref taalsake en is trots om deel te kan wees van 'n kampus wat seer sekerlik die mees geïntegreerde universiteitskampus in Suid-Afrika is!
To the Editor: Commendably, our Minister of Health is on a road show to give first-hand insight on the NHI, while the green paper is out for comments. His presentation to the North-West medical constituency at Klerksdorp in October 2011 dispelled many myths. He was eloquent, spoke with passion on wide-ranging health issues, and indicated that the NHI is only a component in the grand scheme of transforming the delivery of healthcare to all South Africans. After a 4-hour talk, there was insufficient time for questions. No sane person would gainsay the urgent need for a revolutionary culture for healthcare delivery. However, I wish to make some comments.
South Africa's healthcare system is enduring the most comprehensive audit ever conducted as local and international experts gear up to mine the unprecedented mountain of data for criteria to identify 10 of the country's 52 health districts to pilot national health insurance (NHI) delivery from April next year.
A happy disposition, an accepting attitude, and an innovative community-orientated work ethic that enrolled thousands into being tested for HIV and hundreds benefitting from early treatment have garnered Nigerian Dr Kolawole Adigun South Africa's Rural Doctor of the Year award.
Imagine the Western Cape's R64 million health budget under-spend (2010/2011) being redirected into one tightly knit, strategic unit of social entrepreneurs, NGOs and public sector specialists tasked with growing primary healthcare capacity in burgeoning underserved urban areas.
Over the past decade, the National Department of Health (DoH) has focused intense efforts on preventing the local transmission of malaria, and on ensuring the prompt and effective management of cases, especially in the endemic provinces. The DoH has recorded significant success in reducing the burden of malaria through the implementation of its key interventions: Vector Control, Case Management, Surveillance, Health Promotion, and Epidemic Preparedness and Response.
Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yet been established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting.
South African-born anthropologist, Ida Susser, re-visits her native land to examine the multifaceted cultural environment pertaining to the HIV pandemic. Gender subordination is at the heart of the book: the forces of globalised economies make women particularly vulnerable. Susser focuses her skills on this disadvantaged HIV-afflicted group. She seeks to explicate the nexus between the personal and the political, the powerful and the dispossessed, the macroeconomic and the domestic, and exposes how HIV acts as a powerful palimpsest of the troubling divisions of global human interactions.
More than a century ago, the American poet Emily Dickinson said, 'Beauty is not caused. It is', yet it seems that history does not concur. Much effort has gone into 'causing' beauty, resulting in a worldwide, multibillion-dollar industry. Fashion has evolved from the Afro's, tight curls and perms of the 1970s and 1980s, to current trendy ultra-straight hair.
The New Delhi Metallo-β-lactamase (NDM) resistance mechanism in Enterobacteriaceae threatens to render serious Gram-negative infections untreatable. The NDM-1 enzyme hydrolyses all available penicillin, cephalosporin and carbapenem antibiotics, and is commonly accompanied by additional resistance mechanisms to multiple antibiotic classes. Initially identified as a significant healthcare risk on the Indian sub-continent, it has rapidly become a global problem, posing significant diagnostic and management challenges. Here we report the first laboratory-confirmed case of NDM-1 in South Africa.
Objectives. To evaluate common factors associated with the development of acute renal failure (ARF) in Comrades Marathon runners.
Methods. This was a retrospective case series of 4 runners hospitalised post-race with ARF in the 89 km 2010 Comrades Marathon. The outcome measures were incidence of analgesic use, levels of creatine phosphokinase (CPK) and degree of electrolyte supplementation (sodium, potassium, calcium and magnesium).
Results. The prevalence of ARF was 1/4 125 runners. They presented with rhabdomyolysis (mean admission CPK of 36 294 IU) and hyponatraemia (mean admission blood sodium level of 133 mEq/l). All had ingested an analgesic during the run (3 ingested a non-steroidal anti-inflammatory drug) and the same readily available anti-cramp electrolyte supplement. The average amount of supplemental sodium (452 mg), potassium (393 mg), calcium (330 mg) and magnesium (154 mg) ingested via this particular electrolyte supplement before and during the run did not exceed the recommended upper limits of daily intake. Three of the runners were Comrades Marathon novices.
Conclusions. There is a continuing need to clarify the specific cluster variants that cause ARF in Comrades Marathon runners, as the risk factors appear to have evolved since the first case was described over 40 years ago.
Objective. To assess the immunogenicity and safety of a pentavalent diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Hib polysaccharide-conjugate vaccine booster.
Design, setting and participants. A DTaP-IPV//PRP∼ T vaccine (Pentaxim, a Sanofi Pasteur AcXim family vaccine) was given to 182 healthy children in South Africa at 18 - 19 months of age following priming with the same vaccine plus a monovalent hepatitis B vaccine at 6, 10 and 14 weeks of age.
Outcome measures. Seroprotection (SP) and seroconversion (SC) rates, geometric mean titres (GMTs) and concentrations (GMCs) were assessed before, and 1 month after, the booster dose. Safety was assessed using parental reports.
Results. One month after primary vaccination, at least 94.3% of participants were seroprotected against tetanus (≥0.01 IU/ml), diphtheria (≥0.01 IU/ml), poliovirus (≥8 1/dil) and Haemophilus influenzae type b (Hib) infection (≥0.15 μg/ml). Before the booster dose, the SP rates ranged from 65.7% to 100%. One month after the booster dose, SP rates were 97.7% for Hib (anti-PRP titre ≥1.0 μg/ml), 100.0% for diphtheria (≥0.1 IU/ml) and 100% for tetanus (≥0.1 IU/ml) and poliovirus types 1, 2, 3 (≥8 1/dil). At least 95.7% of participants had fourfold post-booster increases in anti-pertussis antibody titres. GMTs increased from 11.21 to 465.51 EU/ml and from 12.89 to 520.35 EU/ml for anti-PT and anti-FHA respectively. Anti-PRP GMT increased from 0.35 to 47.01 μg/ml. The DTaPIPV/ / PRP∼ T vaccine booster was well tolerated, with fever ≥39.0°C in only 1.7% of participants.
Conclusions. Antibody persistence following priming was satisfactory. The pentavalent DTaP-IPV/ / PRP∼ T vaccine booster was highly immunogenic and well tolerated.
Little is known about how adolescents experience clinical trials. We assessed the experiences of South African adolescent participants in a clinical trial, employing semi-structured interviews to gather qualitative data on the experiences and effects of trial participation. Despite misunderstanding certain concepts regarding assent and trial processes subsequent to enrolment, participants reported positive experiences overall. Subjects' motivations for participation included: an ability to help others; receipt of healthcare; and free blood screening. Participants expressed fears associated with trial procedures, such as phlebotomy; however, these apprehensions diminished as the trial progressed. We found that conducting qualitative research within a trial site is feasible, and can provide insight into the uptake and acceptability of interventions.
Setting. Despite the prioritisation of TB, HIV and STI programmes in South Africa, service targets are not achieved, have had little effect, and the magnitude of the epidemics continues to escalate.
Objective. To report on a participatory quality improvement intervention designed to evaluate these priority programmes in primary health care (PHC) clinics in a rural district in KwaZulu-Natal.
Methods. A participatory quality improvement intervention with district health managers, PHC supervisors and researchers was used to modify a TB/HIV/STI audit tool for use in a rural area, conduct a district-wide clinic audit, assess performance, set targets and develop plans to address the problems identified.
Results. We highlight weaknesses in training and support of staff at PHC clinics, pharmaceutical and laboratory failures, and inadequate monitoring of patients as contributing to poor TB, HIV and STI service implementation. In the 25 facilities audited, 71% of the clinical staff had received no training in TB diagnosis and management, and 46% of the facilities were visited monthly by a PHC supervisor. Eighty per cent of the facilities experienced non-availability of essential drugs and supplies; polymerase chain reaction (PCR) results were not documented for 54% of specimens assessed, and the mean length of time between eligibility for ART and starting treatment was 47 days.
Conclusion. Through a participatory approach, a TB/HIV/STI audit tool was successfully adapted and implemented in a rural district. It yielded information enabling managers to identify obstacles to TB, HIV and STI service implementation and develop plans to address these. The audit can be used by the district to monitor priority services at a primary level.
Our study suggests that routine laboratory screening provides no additional information to that obtained from a thorough history and clinical examination in patients at high risk of having an underlying medical cause of presenting psychotic symptoms.
Objectives. To study the efficacy and safety of procedural sedation and analgesia (PSA) administered by medical officers (MOs) without formal anaesthetic training.
Methods. A retrospective descriptive study in the Emergency Department (ED) of False Bay Hospital (FBH), situated in the southern suburbs of the Cape Town Metro Health District. The study included all patients who received PSA at FBH between 1 March 2007 and 31 August 2009. Variables recorded included age, gender, physical status as determined by the American Society of Anesthesiologists (ASA status), procedure, fasting and intoxication status, PSA medications, adverse effects, rescue manoeuvres performed, if any, and time to discharge. Analysis was largely descriptive and clinical and demographic data are presented as means (standard deviations), medians, ranges and proportions as appropriate. Success of sedation and incidence of adverse effects are presented as proportions.
Results. Of 166 patients, 140 (84.3%) showed a good level of sedation, 14 (8.4%) were inadequately sedated, 5 (3%) were too deeply sedated but showed no signs of respiratory compromise, and 7 (4.2%) developed respiratory side-effects. Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference in the risk of adverse effects between the fasted and non-fasted groups. Mildly intoxicated patients who received PSA were at a higher risk of adverse effects.
Conclusion. PSA can be administered safely by medical officers. Future research should expand on PSA research in this setting and focus on safety and patient satisfaction.