South African Family Practice - Volume 49, Issue 3, 2007
Volume 49, Issue 3, 2007
Emergency care provision for, and psychological distress in, survivors of domestic violence : original researchSource: South African Family Practice 49 (2007)More Less
Background: This study aimed (i) to ascertain the number of treatment referrals and information about protection orders given to survivors of domestic violence presenting for emergency trauma care, as reported at the one-month visit, (ii) to obtain a profile of violent incidents and injuries, and (iii) to assess self-esteem and posttraumatic and depressive symptomatology in the aftermath of injury.
Methods: A survey of 62 participants presenting in the acute aftermath of domestic violence (as defined by the Domestic Violence Act of 1998) was conducted over 12 weeks at the Trauma and Resuscitation Unit of a Level One trauma centre in an urban public hospital in South Africa. Following informed consent, face-to-face structured interviews were conducted during admission and a month later. The following instruments were administered at baseline: a Demographic and Injury Questionnaire, the Beck Depression and Rosenberg Self-Esteem Inventories, and the Davidson Trauma Scale. A psychosocial questionnaire was administered at the one-month follow-up.
Results: Fifty-eight per cent of the participants were female and 42% were male. Seventy-four per cent of the perpetrators were male. Ninety-five per cent of the participants said that no health professional had informed them about where or how they could find help. Although all were seriously injured, 76% of the participants said only the researcher had asked about their experience. Sixty-six per cent of the cases of domestic violence were related to intimate partner violence. Overall, subjects displayed high levels of depressive and post-traumatic stress symptomatology that had neither been treated nor adequately referred.
Conclusion: Even though domestic violence poses significant health threats and costs to the health system, it appears to be a neglected area of South African health care. Health professionals should at least be able to identify and intervene within the "open window" period when psychosocial opportunities are pivotal.
Occupational exposure to bloodborne viruses amongst medical practitioners in Bloemfontein, South Africa : original researchSource: South African Family Practice 49 (2007)More Less
Background: The possibility of occupational exposure to bloodborne viruses such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality for healthcare workers. This study reports on the extent and outcome of doctors? exposure to bloodborne viruses in Bloemfontein.
Methods: A descriptive study was done. Doctors (n=441) actively involved in public and / or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV, HBV and HCV).
Results: A response rate of 51.7% was obtained. More than half (54.2%, 95% CI [47.7%; 60.5%]) of the respondents were exposed to bloodborne viruses. Of these cases, 48.3% occurred with HIV-positive patients and 4.3% with known HBV-positive patients. No cases involved positive HCV patients. After the exposure had occurred, 68.9% of the patients were tested for HIV, 10.9% for HBV and only 4.2% for HCV infection. The frequency of serological testing for doctors immediately after exposure was 65.3% for HIV, 21.7% for HBV and 8.2% for HCV. No seroconversion to HIV or HCV was reported, while two seroconversions to HBV were reported. Most of the exposures occurred as a result of needlestick injury (85%), often in the operating theatre during procedures (59.3%). The majority (59.8%) of exposed doctors did not take any prophylactic treatment and those who did, did not always complete the treatment.
Conclusion: The risk of seroconversion to HIV after occupational exposure was as expected, while seroconversion to HBV was less than expected. The lack of adequate follow-up serological testing after occupational exposure is alarming. It is the responsibility of the occupationally exposed doctor to adequately comply with prophylactic measures and undergo serological testing to ensure the least possible risk of contracting infection from a bloodborne virus.
Assessing clinical skills - standard setting in the objective structured clinical exam (OSCE) : open forumAuthor B. MashSource: South African Family Practice 49, pp 5 –7 (2007)More Less
Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. The traditional "long case" has been largely abandoned as it lacks reliability and validity. Summative assessment of family physician's clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Although a well designed and organized OSCE can have reasonable reliability and validity, a pass mark of 50% may in fact be an arbitrary figure, which does not credibly represent the required competency of a family physician. Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. A number of standardisation processes have been described that either judge the test items prior to the exam or judge the individual during the exam. In this paper we report on an example of the latter called the borderline regression method.
The time delay between when patients present with symptoms of tuberculosis at TC Newman Hospital, Paarl and the start of their treatment : scientific letterSource: South African Family Practice 49 (2007)More Less
Source: South African Family Practice 49, pp 20 –22 (2007)More Less
Author R.J. GreenSource: South African Family Practice 49, pp 36 –38 (2007)More Less
Asthma may be intermittent or persistent and persistent asthma may be mild, moderate, or severe. Many factors influence asthma severity, both from day-to-day and from month-to-month. In individual patients, asthma severity may fluctuate because of many extrinsic (allergens, viral infections) and intrinsic (behavioural) factors. This article discusses the pathogenesis of episodic asthma and wheezing outlines a treatment approach for episodic asthma.