South African Family Practice - Volume 49, Issue 4, 2007
Volume 49, Issue 4, 2007
Pretoria medical students' perspectives on the assessable attributes of professionalism : original researchSource: South African Family Practice 49 (2007)More Less
Background: Professionalism forms an important aspect of medicine's contract with society, and it is therefore important that it should be assessed and developed in medical schools. For the effective assessment of medical students' professionalism,clear objectives, or outcomes based on a clear definition of professionalism, have to be accepted by society, the faculty and the students. A Physician's Charter, 'Medical Professionalism in the New Millennium", was published by the Annals of Internal Medicine in February 2002. Fifth-year medical students of the University of Pretoria were challenged to comment on the applicability of this Charter's principles and responsibilities in the South African context. The majority of the students did not fully agree with the principles and responsibilities. A following cohort of fifth-year students was requested to define professionalism and describe attributes that could be included in an assessment tool.
Methods: A qualitative design was employed to explore the students' perceptions. An analysis of the scripts was performed using qualitative content analysis. All the scripts were read twice and the emergent themes (attributes of professionalism)were identified by two researchers. The scripts were reviewed and coded independently to enhance reliability. Investigator triangulation, involving researchers with diverse research backgrounds, was done to validate the identified attributes. The themes were organised into categories (domains of professionalism). The authors discussed differing concepts with the other members of the Professional Attitude Development and Assessment Committee (PADAC) to arrive at a consensus. In the second stage of analysis, the identified themes were compared to the Charter. This was supported by quotations taken from the students' perceptions, as well as from the relevant literature. Tabulations were used to determine the frequencies of the different themes.
Results: The attributes used to describe professionalism were grouped under four main domains: attitude and personal conduct, teamwork, patient care and professional competence. These correspond, to some extent, with the Charter. Most of the students, however, stressed the humanistic attributes of professional behaviour, which are not mentioned in the Charter. These attributes include empathy, interpersonal relationships, integrity, respect, maturity and teamwork.
Conclusion: The students' perceptions of professionalism differed from that described in the Charter. The fact that the students value the humanistic part of professionalism could possibly be ascribed to the following factors:
- Teaching of professionalism at the University of Pretoria focuses on the humanistic attributes, which form an important part of patient consultations and teamwork.
- Medical students are not actively involved in the social contract that is prominent in the Charter. They have very little influence regarding social justice, access to care, distribution of resources and conflict of interest.
- The Charter is considered vague and open to interpretation
It is recommended that a universally acceptable charter be developed for the Medical School of Pretoria by involving faculty members to validate and accept the students' perspectives. It is also recommended that these mutually acceptedattributes then be used as the assessment criteria of a professionalism assessment tool. This should also encourage faculty members to act as good role models.
Knowledge of and attitude towards pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa : original researchSource: South African Family Practice 49 (2007)More Less
Background: This study determined women's knowledge of and attitudes to pain relief during labour.
Methods: This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief.
Results: The median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3%) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5%) or from friends and relatives (55.3%). Of the women who had knowledge of pain relief (n=85), 65.9% indicated injections. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. Of those who had been told (n=41), 75.6% found the information useful. The women who had previously delivered in a health facility rated the service received in relieving labour pain as fair (47.3%) and good (31.2%). Most of the women (99.3%) believed that the staff had an important role to play in helping to relieve labour pain. Most of the women (78%) expressed no concern about problems associated with pain relief methods, while a large number (83.4%) expressed little or no confidence in labour pain relief.
Conclusion: Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief.
Family practitioners' perceptions of, knowledge about and use of peak flow meters in the Lenasia, Lenasia South and Soweto Community Health Clinics : original researchSource: South African Family Practice 49 (2007)More Less
Background: The purpose of this paper was to determine the availability of peak flow meters, perceptions about their usefulness and the perceptions of clinical indications for their use.
Methods: A questionnaire was administered to private and public sector practitioners (n=72) working in three urban areas of greater Johannesburg. Data were collected concerning practice profiles, the characteristics of the practitioners, the extent of and indications for use, and the reasons for failure to use these meters.
Results: The results showed that only 21 (29%) of the practitioners advised their asthma patients to use peak flow meters for home monitoring. A scoring system (summary score), which was developed to summarise knowledge of both the indications for the use of the meters and the method of peak flow measurement, showed that only 33.3% of the practitioners attained maximum or close to maximum scores (6 to 8 of an 8-point scale).
Conclusion: Peak flow meters were underutilised by family practitioners. The cost of the peak flow meter was an important reported cause of underutilisation. It is recommended that the importance of the peak flow meter in the management of asthma be emphasised at the undergraduate and continuing medical education level. The findings of this study could also be used to guide the national campaign coordinators in South Africa in their strategy to improve asthma care among family practitioners. Since asthma may be under-diagnosed in the community, further research is needed to assess the effects of education in assisting people to recognise asthma. Early recognition and diagnosis of asthma, together with appropriate asthma education, may significantly reduce morbidity. The role of illiteracy and cost in limiting the use of peak flow meters warrants investigation, as does the possibility of developing suitable meters for populations with limited formal education. Doctors need to make more conscientious, concerted and informed efforts to monitor their asthma patients and to collaborate, where appropriate, with health educators to optimise the management of asthma. This could include workshops within the community and with fellow healthcare workers (doctors, primary healthcare sisters) on various aspects of asthma care, which will incorporate inhaler techniques and peak flow meter use.
Source: South African Family Practice 49 (2007)More Less
Aim: The appropriateness of patients' visits to an emergency unit was investigated in the study on which this article is based.
Method: This descriptive study included 2 968 patient cards from the National District Hospital, Bloemfontein emergency unit during 2003. Patient information was evaluated according to predetermined criteria to determine whether a visit was appropriate or not.
Results: The patients' ages varied between 0 and 97 years (median 29 years) of which 50.8% was female. Informal settlements represented 26.4% of patients' neighbourhoods. The most common chronic condition was hypertension (7.9%). Only 8.4% of patients were already using medication for their presenting condition. Most patients (72.4%) presented after hours and 36.6% presented over weekends. The total number of injuries was 22.9%, while 75.6% of the patients were examined for medical or surgical problems. The criterion with the most visits was the trauma category (21.8%). The criterion with the least patients (0.3%) was the criterion for significant bleeding. According to the results, more than a third (35.4%; 95% CI 33.7%; 37.2%) of the patients' visits can be seen as inappropriate.
Conclusion: The emergency unit is used inappropriately.
Doel: In die studie waarop hierdie artikel gebaseer is, is die toepaslikheid van pasiëntbesoeke aan 'n noodgevalle-eenheid ondersoek.
Metode: Die beskrywende studie het 2 968 pasiëntkaarte van die Nasionale Distrikshospitaal in Bloemfontein se noodgevalle-eenheid gedurende 2003 ingesluit. Pasiëntinligting is volgens voorafbepaalde kriteria geëvalueer om sodoende die besoek as toepaslik te beskou of nie.
Resultate: Die ouderdomme van pasiënte het gewissel van 0 tot 97 jaar (mediaan 29 jaar) en 50.8% was vroulik. Informele nedersettings het 26.4% van die pasiënte se woonbuurte uitgemaak. Die algemeenste chroniese toestand was hipertensie (7.9%). Slegs 8.4% van die pasiënte het reeds medikasie vir hulle presenterende toestand gebruik. Die meeste pasiënte het na-uurs aangemeld (72.4%) met 36.6% wat oor 'n naweek gepresenteer het. Die totale aantal beserings het 22.9% uitgemaak en 75.6% is vir 'n mediese of chirurgiese probleem ondersoek. Die kriterium met die meeste besoeke was die kategorie vir trauma (21.8%). Die kriterium met die minste pasiënte (0.3%) was die kriterium vir betekenisvolle bloeding. Volgens die resultate kan meer as 'n derde (35.4%; 95% VI 33.7%; 37.2%) van die pasiënte se besoeke as ontoepaslik beskou word.
Gevolgtrekking: Die noodgevalle-eenheid word ontoepaslik gebruik.
Author I.D. CouperSource: South African Family Practice 49, pp 4 –10 (2007)More Less
There are seven key principles in the care of patients with chronic illnesses which are fundamental in offering an appropriate service and adequate care for these patients. These are the principles that should underlie the setting up and management of any primary health care service endeavouring to treat patients with chronic illness. They determine how one understands the care of such patients and how to organise a service or practice. These principles are discussed in this article and will provide both the right mindset and the right organisational approach for effective chronic illness care.
Source: South African Family Practice 49, pp 19 –23 (2007)More Less
This article is the last in a series of 6 articles that discussed the management of HIV-infected children in a clinically orientated, practical and concise fashion. The topics covered previously include; 1) Preventing and diagnosing HIV-infection in infants and children, 2) Initiating anti-retroviral therapy in HIV-infected infants and children, 3) Maintaining HIV-infected infants and children on anti-retroviral therapy, 4) Common opportunistic infection in HIV-infected children: Part 1-respiratory infections and 5) Part 2 non-respiratory infections.
Author L.C. SnymanSource: South African Family Practice 49, pp 25 –26 (2007)More Less
Contraception in the perimenopausal transition years is a very important aspect of women's health, and it is the responsibility of all health care workers to discuss and render adequate counselling in this regard. Failure to do so can have serious health and mental consequences caused by unplanned pregnancies. There are a number of safe and effective options that one can offer these women. Most of these methods also have beneficial non-contraceptive properties.
Author P.M. JeenaSource: South African Family Practice 49, pp 28 –32 (2007)More Less
Moderate severity asthma occurs in approximately 10 to 15% of patients with chronic reversible airway obstruction and is defined by more than four daytime symptoms per week, more than four night time symptoms per month and peak expiratory flow rates of between 60 and 80% of predicted values. Currently recommended first line chronic maintenance treatment for children and adults for moderate severity asthma is the use of combination therapy of inhaled corticosteroids and long acting beta-2 agonists. Other agents such as leukotriene receptor antagonist, theophyllines and soluble TNF alpha-receptor blockers could be considered in special circumstances when adequate control is not obtained.