South African Family Practice - Volume 47, Issue 3, 2005
Volume 47, Issue 3, 2005
Author Claire Van DeventerSource: South African Family Practice 47 (2005)More Less
Source: South African Family Practice 47, pp 5 –6 (2005)More Less
It would be unlikely that many of today's practicing family doctors have not been involved in Continuing Medical Education (CME) activities. It would be equally unlikely, however, that these activities were part of any contextually structured educational plan towards professional development. Often driven by external need towards a reaccredidation procedure, CME can be seen as a burden upon the average practitioners working day, or more usually evening. <br>The concept of Continuing Professional Development takes the practitioner away from these short-term goals and moves them into a planned educational environment. Using the principles of adult education, this article supports the concept of Continuing Professional Development and demonstrates the value to the practitioner of an educational activity that is both relevant and purposeful towards daily practice, hopefully equally beneficial to the practitioner and patient alike. This article considers some of the theory that underlies the change from Continuing Medical Education ( CME ) to Continuing Professional Development (CPD), the evidence for its effectiveness, and the ways in which CPD interacts with the processes of appraisal and assessment of medical practitioners.
Author F. GuidozziSource: South African Family Practice 47, pp 42 –44 (2005)More Less
The menopause will bring with it a number of health challenges that may significantly affect the quality of life of women. Not uncommonly, women feel overwhelmed and daunted by what they perceive, or are led to believe, will occur with the menopause. Yet, provided that women understand and their physicians individualise care, the menopause can be a time of positive change.
Source: South African Family Practice 47, pp 49 –50 (2005)More Less
Previous reports have shown that zolpidem could reverse semi-coma and improve cerebral perfusion after brain injury. Studies in animals have implicated omega 1 GABAergic action as reason for this improvement. Evidence for the efficacy of zolpidem in a wide range of brain pathology is reviewed here and the mechanism of zolpidem in brain injury is considered from the perspective of diaschisis and neurological dormancy after brain injury.
Hypertension guideline adherence of private practitioners and primary health care physicians in Pretoria : original researchAuthor S. ErnstSource: South African Family Practice 47, pp 51 –54 (2005)More Less
<i>Background:</i> Hypertension remains a healthcare problem in South Africa. When prescribing evidence-based, cost-effective anti-hypertensive treatment, guideline adherence is essential. The Joint National Committee's Sixth Report (JNC VI) built its evidence-based review on the outcome of clinical trials. The objective of this study was to assess the hypertension guideline adherence of general practitioners in private practice and of primary health care physicians in an academic government hospital setup in Pretoria, using the JNC VI guidelines. <br><i>Methods:</i> A survey was conducted on a random sample of 240 general practitioners in Pretoria and on 35 primary health care physicians working in the outpatient departments of the Pretoria Academic, Kalafong and Mamelodi hospitals. <br><I>Results:</I> The survey showed that private practitioners and primary health care physicians do not follow the JNC VI guidelines when treating hypertensive patients. Physicians in both study populations do not adhere to the guidelines when treating hypertensive patients with isolated systolic hypertension (ISH), previous myocardial infarction (MI) and renal disease. Even so, most doctors correctly prescribe angiotensin-converting enzyme (ACE) inhibitors when treating congestive cardiac failure (CCF) and diabetic nephropathy. <br><i>Conclusions:</i> This study indicates the need to educate physicians in both private and public setup regarding the value of prescribing cost-effective anti-hypertensive medication, based on evidence from clinical trials.
Relevance of Schneider's first-rank symptoms in Zulu patients with paranoid schizophrenia : original researchSource: South African Family Practice 47, pp 55 –60 (2005)More Less
<I>Background:</I> The aim of this study was to examine the prevalence of Schneider's first-rank symptoms (FRS) in Zulu patients diagnosed with paranoid schizophrenia and to ascertain the diagnostic and prognostic significance of Schneider's FRS in this group. <br><i>Methods:</i> This descriptive study was done on 75 psychiatric Zulu in- and outpatients diagnosed with paranoid schizophrenia. A questionnaire was completed and included sociodemographic data, Schneider's FRS and a functional assessment. <br><i>Results:</i> Fifty-three percent of the patients heard voices at some or other time. Most patients (90.7%) confirmed having experienced at least one of the five related symptoms of thought disturbances and 80% of the patients confirmed the presence of passivity phenomena. Most patients (87%) indicated that they had presented at least one type of primary delusion, at the time of the interview. Regarding functional assessment, some (12%) patients were still entirely productive ("no problems"), 28% rated "mild problems", 45% "moderate problems" and 15% "severe problems". With regard to social functioning, 8% of the patients scored "no problems", 25% "mild problems", 50% "moderate problems" and 17% "severe problems". <br><i>Conclusions:</i> The prevalence of Schneider's FRS in these patients is 100%, with a 95% confidence interval [95.2%; 100%]. Even though extremely sensitive for paranoid schizophrenia, the specificity of Schneider's FRS merits further study.
Die sesweke-ondersoek ná koronêre vatchirurgie : bevindinge by Bloemfontein Medi-Clinic Hospitaal : original researchSource: South African Family Practice 47, pp 61 –64 (2005)More Less
<b>The six-week examination after coronary bypass surgery. Findings at a Medi-Clinic Hospital in Bloemfontein.</b> <br><i>Background:</i> Surgery provides symtomatic relief and improves the prognosis in patients with coronary artery disease. The general practitioner manages the postoperative patient. The aim of the study was to establish which symptoms and signs are present at the time of the six-week follow-up after coronary artery bypass graft surgery. <br><i>Methods:</i> A descriptive database search with a retrospective direction of enquiry was undertaken to establish the symptoms and signs experienced by patients six weeks after coronary artery bypass surgery (CABG). The patients were operated on by one surgeon in one hospital. The prevalence of readmissions, chest pain, angina, blood pressure, NYHA class, lung auscultation, wounds and medications were noted. <br><i>Results:</i> Records were available for 181 patients. However, only 158 patients were seen in the surgeon's rooms six weeks after surgery. Patients were also consulted before and after the six weeks, but usually in hospital. One patient died before her appointment and two patients did not return for follow-up. Fifteen (8.5%; 95% CI 4.9% to 13.7%) patients were readmitted to a hospital for a variety of reasons, Severe chest pain was present in 3.4% (95% CI 1.3% to 7.2%) patients. One patient had a myocardial infarction with patent grafts at cardiac catheterisation. Another two patients were investigated for possible angina, but it could not be proved. A total of 82.2% (95% CI 76.5% to 87.9%) of the patients were in NYHA I, whereas 3.5% (95% CI 1.3% to 7.4%) were class III, of whom two thirds were in class III before the operation. Hypertension was noticed in 70.1% of the patients (95% CI 62.9% to 77.2%). During auscultation of the lungs, abnormalities were picked up in 4.9% of the patients, while the sternum was not properly healed in 3.4% (95% VI 1.3% tot 7.2%). All the patients were on aspirin, but only 57% took an ACE inhibitor, 37% took a statin and 29% a beta-blocker. <br><i>Conclusions:</i>This study provides a picture of what to expect six weeks after a CABG.