South African Family Practice - Volume 46, Issue 5, 2004
Volume 46, Issue 5, 2004
Author Jan De MaeseneerSource: South African Family Practice 46 (2004)More Less
Extracted from text ... Editorial During the last months I had the privilege to be able to follow most interesting discussions about content and position of family medicine in South-Africa. A first reflection is that the discussion is also most important and relevant for other countries e.g. in Western Europe. The discussion reflects the tension between the intrinsic characteristics of family medicine: first contact with health care system, longitudinal relationship with patients, comprehensive and holistic approach, generalism, integration of curative, preventive, palliative, rehabilitative interventions on the one hand and the question how to implement this in a concrete context of a society on the ..
Author Funeka MadikizaSource: South African Family Practice 46 (2004)More Less
Extracted from text ... Letter to the Editor SA Fam Pract 2004;46(5) 4 Family Medicine as a New Speciality in South Africa. To the editor: The proposed development of family medicine as a speciality is a welcomed decision by the HPCSA to finally upgrade the status of a trained generalist. Congratulations to the people who worked on this matter! This announcement is followed in March 2004 by the proposed midlevel medical worker to assist the doctors mostly in the under serviced areas. A sign of strengthening the backbone first level of entry of patients seeking medical attention and to minimise secondary and tertiary level ..
Author I.D. CouperSource: South African Family Practice 46, pp 5 –7 (2004)More Less
General practitioners from Iran will shortly be arriving to work in South Africa. Iran is a large country with a well developed health care system, both public and private. It has sufficient doctors to meet its needs. It has a welldeveloped primary health care network which offers care right down to the village level for all people in the country, and a well-functioning referral system. <br>Iranian doctors train for seven years. Competition for places at medical school is great with only 1% of applicants being accepted. About 4000 doctors graduate every year. All graduates are required to do two years community service, largely in rural health centres. <br>The health care system is specialist orientated. As a result, Iranian general practitioners are somewhat limited in their range of skills, but their basic training is sound and they have good experience from rural public health care.
Author J.A. KerSource: South African Family Practice 46 (2004)More Less
This feature in <i>SA Family Practice</i> emphasises the importance of ophthalmoscopy in general practice. Identifying target organ damage in a hypertensive patient is of cardinal importance. It immediately warrants anti-hypertensive therapy in those with even Stage I (mild) hypertension. A clinical workshop and clinical atlas will further enable the general practitioner to master the technique and diagnosis.
Author P. RouxSource: South African Family Practice 46, pp 10 –14 (2004)More Less
Extracted from text ... SA Fam Pract 2004;46(5) 10 Roux P, MBChB, DPH, MpraxMed, FCS (SA)(Ophth), FRCOphth Professor of Ophthalmology, University of Pretoria Faculty of Health Sciences Department of Ophthalmology Correspondence: Prof P Roux Prof of Ophthalmology, University of Pretoria, Faculty of Health Sciences, Department of Ophthalmology, PO Box 667, Pretoria, South Africa, 0001. Tel: +27 12 354 1782, Fax: 27 12 319 2643, Email: firstname.lastname@example.org (SA Fam Pract 2004;46(5): 10-11) Ophthalmoscopy for the general practitioner DIRECT OPHTHALMOSCOPY Description: Direct ophthalmoscopy allows for the visual examination of the retina and ocular media. The hand-held direct ophthalmoscope uses the patient's eye as a simple magnifier ..
Author D. MeyerSource: South African Family Practice 46, pp 16 –18 (2004)More Less
Extracted from text ... Introduction The drugs discussed in this section are essential in executing a basic eye examination and assessing certain ocular complaints commonly encountered by the primary care physician. Three very commonly used diagnostic drugs in basic eye examinations are fluorescein dye, local anaesthetics and mydriatic drugs. Practical aspects of these agents are discussed. Before administering any topical medication, always attempt to get a drug allergy history. Management Fluorescein dye Sodium fluorescein is a watersoluble, orange-yellow dye that becomes a brilliant green when viewed under cobalt-blue or fluorescent light. This light source is available on any modern ophthalmoscope set. The dye, which ..
Source: South African Family Practice 46, pp 19 –20 (2004)More Less
Extracted from text ... Background The SACENDU Project is an alcohol and other drug (AOD) sentinel surveillance system operational in Cape Town, Durban, Port Elizabeth (PE), Mpumalanga, and Gauteng (Johannesburg/ Pretoria). The system, operational since July 1996, monitors trends in AOD use and associated con-sequences on a six-monthly basis from multiple sources. Data are collected from over 50 specialist treatment centres, psychiatric hospitals, mortuaries, and the police Forensic Science Laboratories (FSL). Other data sources (e.g. community studies) are included when available. In this period treatment data were also collected from the central part of the Eastern Cape. Forensic data from the police for the ..
The prevalence of post-abortion syndrome in patients presenting at Kalafong hospital's family medicine clinic after having a termination of pregnancy : original researchSource: South African Family Practice 46, pp 21 –24 (2004)More Less
<i>Background:</i> Post-abortion syndrome (PAS) is said to be the emotional, psychological, physical and spiritual trauma caused by an abortion, which is an event outside the normal range of human experience. Post-abortion syndrome is a type of post-traumatic disorder and is characterised by a stressor (the abortion), the event being re-experienced, avoidance and/or numbing of general responsiveness, and physical symptoms such as insomnia and depression. The question was asked whether the patients at Kalafong Hospital experienced any of the after-effects of a termination of pregnancy and whether these effects would fulfill the criteria of post-abortion syndrome. <br><i>Method:</i> A prospective descriptive study was done over a six-month period. All female patients presenting at the Family Medicine Clinic of Kalafong Hospital who were known to have had a previous abortion on request were asked to participate in the study. After obtaining informed consent, a structured questionnaire on their psychological symptoms was completed by the participants with the help of the researcher. The questionnaire contained demographic data, as well as questions on the above-mentioned symptoms of PAS. To fulfill the criteria of PAS, the symptoms should have been present for more than a month and must have affected the subject's daily functioning. <br><i>Results:</i> Of the 48 woman recruited, 16 (33%) fulfilled the criteria of PAS, and more than 50% of the women had had some or other emotional or psychological after-effect. <br><i>Conclusion:</i> This study showed that one out of every three women presenting at Kalafong Hospital after abortion fulfilled the criteria of PAS. Since family physicians are committed to their patients and regard it as their duty to address problems prevalent in the community they serve, it is necessary to investigate further the possible link between termination of pregnancy and the emotional problems identified. It is imperative that women requesting termination of pregnancy receive comprehensive counseling prior to the procedure, as well as support thereafter, to ensure that they are not unnecessarily traumatised.
Source: South African Family Practice 46, pp 25 –30 (2004)More Less
<i>Background:</i> The Master's in Family Medicine (M Fam Med) is a postgraduate training programme in family medicine at Medunsa. M Fam Med students have to write patient studies as part of requirements to complete their degree. This research was undertaken to develop a deeper understanding of their perceptions about patient studies. <br><i>Methods:</i> A descriptive qualitative method was used. A purposeful sample of eight students was selected, with a maximum variation in dimensions of interest. Data were gathered by free attitude interviews, recorded on audiotape. These were transcribed verbatim; themes were identified from the text and were coded into categories. A model was developed to demonstrate the process, and the interrelatedness of and relationships between the themes. <br><i>Results:</i> The students generally perceive patient studies as a good learning tool. However, they face certain problems while doing patient studies. These problems arise from difficult student-facilitator relations and from the logistics of doing patient studies, such as a lack of orientation and difficulty in obtaining literature. <br><i>Conclusion:</i> Patient studies are appropriate assignments for the M Fam Med programme at Medunsa. The problems, such as strained facilitator-student relationship and logistic problems, encountered during the writing of patient studies, should be addressed.
Author G.J.O. MarincowitzSource: South African Family Practice 46, pp 31 –36 (2004)More Less
<i>Background:</i> The aim of the article is to share the findings of participatory action research performed to develop a mutual participatory doctor-patient relationship model, and to apply this model in a rural cross-cultural primary care setting. <br><i>Method:</i> Participatory action research was performed with four patient groups. Four patients with incurable illnesses formed groups with their family members and significant others. Seven monthly meetings with each group were audio recorded. The question asked at each meeting was "How can the group work together to achieve the best possible health outcome for the patient?". The recorded interviews were transcribed and translated from the local vernacular (Tsonga) into English. Themes were identified from the transcripts, field notes and a reflective diary. A list of combined themes was compiled and a model was constructed to depict the themes and their interrelatedness. The model was interpreted and conclusions were drawn. <br><i>Results:</i> To apply a mutual participatory model in a rural cross-cultural practice, the physician is required to operate from certain basic tenets. The patients have to participate actively to benefit optimally, and basic interviewing techniques are helpful to facilitate mutual participation. <br><i>Conclusions:</i> It is not easy to implement a mutual participatory model in a disadvantaged, rural practice, but it is possible. We need a paradigm shift in health care, from "helping" patients (which may nurture dependence), towards facilitating the personal growth and development of patients (to nurture self-reliance).
Author Ian CouperSource: South African Family Practice 46, pp 37 –39 (2004)More Less
Extracted from text ... SA Fam Pract 2004;46(5) 37 RHI RURAL HEALTH Initaitive The South African Academy of Family Practice's Rural Health Initiative (RHI) is proud to be able to bring you the following section of the journal, that will concentrate on issues pertaining to rural health in South Africa. We hope to provoke discussion on these issues and would encourage anyone interested in rural health to offer contributions to future issues. Rural Health Issues Introduction This article describes the rural primary health care network in Iran, and my experience of visiting some of the structures which form part of this health service as ..
Source: South African Family Practice 46, pp 40 –44 (2004)More Less
Extracted from text ... SA Fam Pract 2004;46(5) 40 CPD Ethics Ethical Issues in Family Practice: Are we prudent when using antimicrobials? Introduction The term 'emerging infectious diseases' generally is used to classify a variety of diseases: 1 (1) Completely new diseases, (2) Old diseases occurring in new places and in new populations; (3) Old diseases with new presentations; (4) Diseases newly resistant to available drug therapies. In this article, we focus on the latter, diseases newly resistant to available drug therapy in other words, diseases, the treatment of which is compromised because of drug resistance and argue for the prudential use of antimicrobials. ..
Source: South African Family Practice 46 (2004)More Less
Extracted from text ... SA Fam Pract 2004;46(5) 46 CDL - guidelines at a glance Asthma in adults Diagnosis Made on symptoms and signs Objective measurement: ? FEV1 improvement possible > 15% ? [& 200ml increase after short acting ?2 agonist (400?g MDI and spacer)] Aims of Management: Control symptoms and prevent exacerbations Achieve best possible peak flow Minimise adverse effects Stepwise Approach 1. Start treatment at step most appropriate to initial severity 2. Achieve early control 3. Maintain stepping up or stepping down therapy CLASSIFICATION OF SEVERITY Management of Chronic Asthma in Adults Classify Severity at Presentation START TREATMENT AT MOST APPROPRIATE STEP ..