South African Family Practice - Volume 49, Issue 7, 2007
Volume 49, Issue 7, 2007
A comparison of clinical communication skills between two groups of final-year medical students with different levels of communication skills training : original researchSource: South African Family Practice 49 (2007)More Less
Background: Training in communication skills is prominent in many undergraduate medical programmes. In South Africa, training in this highly complex skill is developing rapidly, especially against the backdrop of a multilingual and multicultural society. Little work has been done locally to evaluate which training works best in our context. In 1999, the Stellenbosch University Faculty of Health Sciences introduced a new curriculum that included considerably more communication skills training. The aim of this study was to assess and compare the communication skills used in the consultations of two groups of final-year medical students who had different levels of communication skills training in order to make recommendations on appropriate changes in this training.
Methods: Standardised doctor-patient interviews performed by students during the final-year examinations in 2003 and 2004 were videotaped. These were assessed by two independent, blinded evaluators using an abbreviated version of the Calgary- Cambridge communication guide for skills not done (0) and done (1). The data was analysed using STATISTICA 7.
Results: A total of 161 interviews were analysed. Both groups performed well (mean = 1) in listening to the opening question, encouraging the patients to tell their story, and demonstrating appropriate non-verbal behaviour. However, ending the session by summarising and clarifying the plan was poorly performed (mean = 0.4). The 2004 group was statistically significantly better in structuring the consultation by using signposting (p value = 0.02).
Conclusion: There are a number of influences on the effectiveness of communication skills training, including issues around language, culture and gender, student attitudes, the significance of communication skills training in the programme and, most importantly, the integration of this training into the curriculum as a whole. Merely adding more time to communication skillstraining does not seem to be the answer. Incorporating a wider range of training methods is also important. The results of this impact study acted as an impetus for innovative curriculum development in our faculty, leading to the development ofa comprehensive clinical model and a "golden thread" for communication skills in the curriculum to ensure the longitudinal integration of communication skills.
The role of educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals : original researchSource: South African Family Practice 49 (2007)More Less
The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas.
We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province, South Africa.
We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals.
Doctors felt that participation in relevant learning activities improved their competence, increased the levels of job satisfaction they experienced, increased their willingness to stay in a rural environment, and impacted positively on the quality of services provided. However, the success of educational strategies is heavily dependant on the local environment (context), as well as the practical applicability and clinical relevance of the activities (process).
Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals, however, this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities.
The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care.
Nosocomial infections in HIV-infected and HIV-uninfected children hospitalised for tuberculosis : original researchSource: South African Family Practice 49 (2007)More Less
Background: The interaction between tuberculosis and HIV-infected infection is well known and is responsible for the increase in the incidence of tuberculosis (TB) in sub-Saharan Africa over the last decade. This places a considerable extra burden on health services. The Brooklyn Hospital for Chest Diseases (BCH) is a non-acute TB hospital for the City of Cape Town, South Africa. The hospital has 60 children?s beds and approximately 140 paediatric admissions annually. This study, undertaken before the availability of antiretroviral drugs in the public sector in South Africa, documents the occurrence of nosocomial infections in HIV-infected and HIV-uninfected children at BCH.
Method: This retrospective case-control study evaluated the occurrence of nosocomial infections in (HIV)-infected children and age- and time of admission-matched HIV-uninfected children admitted to the BCH, Cape Town, South Africa between July 1999 and December 2001 for the treatment of tuberculosis (TB).
Results: Forty-seven HIV-infected children (mean age 40 months) and 47 HIV-uninfected children (mean age 41 months) were studied. The HIV-infected children, who were not receiving antiretroviral therapy because it was not yet available in the public sector, experienced 109 episodes of nosocomial infections compared to 22 episodes amongst those not infected with HIV (p = 0.001). Twenty-five nosocomial infections (23%) among the HIV-infected children, but only two (9%) among the HIV-uninfected children, were serious enough to require transfer to a tertiary care hospital for management. Pneumonia was the commonest nosocomial infection and occurred in 26 (56%) HIV-infected patients, of whom three died, but in only four (9%) HIV-uninfected children, none of whom died. An outbreak of varicella affected 10 HIV-infected (21%) and 9 HIV-uninfected children (19%). One HIV-infected child died of varicella pneumonia. Other common nosocomial infections encountered in HIV-infected and HIV-uninfected children respectively were upper respiratory tract infections (pharyngitis, tonsillitis or rhinitis) affecting 21 and four, otitis media in five and one, oral candidiasis in seven and zero, urinary tract infection in four and one and acute gastroenteritis in five and zero children. Five HIV-infected children (11%) died and four of the deaths were known to be due to nosocomial infection; only one HIV-uninfected child died from severe miliary TB.
Conclusion: Nosocomial infections occurring in HIV-infected children are a serious cause of morbidity and mortality in children hospitalised for the treatment of tuberculosis. Their impact could be reduced by the earlier introduction of antiretroviral treatment and by immunisation against certain of the infecting agents. Post-exposure prophylaxis for varicella could prevent or alleviate disease.
Author C.A. WrightSource: South African Family Practice 49, pp 4 –8 (2007)More Less
Introduction: The placenta is rarely sent for histopathological examination, despite its availability after delivery and the valuable contribution it may make to understanding adverse pregnancy outcome.
This may be due to reluctance on the part of surgical pathologists to examine the placenta, due to a number of reasons that are applicable globally, amongst which are limited exposure to placentas during their training and the very different terminology applicable to the pathology of this organ.
Why should the placenta be examined by a pathologist?: Globally there are 4 million neonatal deaths and another 4 million stillbirths annually, and the overwhelming majority occurs in low- and middle-income countries. In South Africa there is limited data available through the Perinatal Problem Identification Programme (PPIP). The data from 2000-2002 showed the commonest primary obstetric cause of perinatal death to be unknown.
Contribution of placental pathology: Histopathological examination of the placenta may provide information that may not be determined clinically. There is poor correlation between maternal indicators of infection and placental findings, and many placental causes of fetal and perinatal death may be clinically silent.
Placental examination is vital to the determination and timing of intrauterine events that may result in adverse pregnancy outcome and in doing so may assist in the medico-legal assessment of cases. Cerebral Palsy (CP) was until fairlyrecently attributed to intrapartum hypoxia, with liability borne by the clinicians and delivery units. Studies where the placenta was submitted for histopathology have shown that in less than 10% of cases of CP was intrapartum hypoxia the possible cause of brain damage. It is now widely accepted that multiple early and recent insults act together to increase the risk of brain injury at birth, and many of these can be identified by histopathological examination of the placenta.
Conclusion: The contribution that the placenta may make to the understanding of the cause and timing of events resulting in adverse pregnancy outcome, as well as the management of the neonate, the mother and future pregnancies is being recognized by obstetricians, neonatologists, pathologists and administrators of health care institutions and medical insurance companies
Author H.P. MeyerSource: South African Family Practice 49, pp 20 –25 (2007)More Less
According to a 1998 World Health Organization Survey of 26 000 primary care patients on five continents, 22% reported persistent pain over the past year. Part of the problem lies with some health-care providers who have failed to keep up with the advances in pain medicine and continue to follow the biomedical approach, which regards a specific pathway as the only source of pain. In this model, all pain is regarded as a warning signal of tissue injury, and if conservative treatment fails, some surgical technique will be able to correct the problem.
The modern paradigm of pain management has moved from this biomedical to the broader biopsychosocial approach, where pain mechanisms now integrate input from sensory, emotional and cognitive systems.
Author H.F. JordaanSource: South African Family Practice 49, pp 26 –29 (2007)More Less
Author M.R. MakwelaSource: South African Family Practice 49, pp 30 –31 (2007)More Less
Vaginal discharge in the prepubertal patient is a common symptom, and can be a source of distress for the caregiver and concern for the healthcare worker. Several factors predispose these patients to the development of recurrent vaginal discharge. Unless noticed by the caregiver, this problem can persist for long periods of time.
Making a diagnosis in the prepubertal patient requires physician skills different from those required for diagnosis in the adult population. The history may often be difficult to obtain, and at times inaccurate or inconsistent. Common anatomical variants have to be considered during examination. Sexual abuse of children continues to be a serious problem in our society. Vaginal discharge is often the only presenting symptom. A high index of suspicion is required in order to make a diagnosis. Common causes of vaginal discharge in this group of patients will be looked at. Physical examination techniques and treatment of specific causes will not be discussed here.
Author A. MoutonSource: South African Family Practice 49, pp 32 –33 (2007)More Less
Most women feel confident taking the modern combined oestrogen-progestogen oral contraceptive pill (COCPs) but myths about these drugs still persist. Most non-contraceptive health benefits of COCPs are not widely appreciated, in spite of much evidence. Controversy still exists over the association between COCP use and breast cancer. Although slightly more breast cancers are detected in current COCP users they are less advanced in stage and less aggressive in behaviour. This article discusses the non-contraceptive benefits and uses of hormonal contraception.
Source: South African Family Practice 49, pp 35 –40 (2007)More Less
Human rabies in South Africa is largely due to infection with the classical rabies virus (genotype 1), with the yellow mongoose the commonest vector except in KwaZulu-Natal, Eastern Cape, Mpumalanga and now Limpopo provinces where the dog is predominantly responsible for most bites. Rabies is always fatal in humans but can be prevented by timeous administration of post exposure prophylaxis (PEP). This article discusses an evidence-based approach to rabies management in South Africa.
Source: South African Family Practice 49 (2007)More Less
New study shows that extending prophylaxis with Clexane(R) (enoxaparin sodium injection) to five weeks is more effective than 10 days for reducing the risk of Venous Thromboembolism (VTE) in acutely ill medical patients with reduced mobility : press releaseSource: South African Family Practice 49 (2007)More Less
International speaker to address the importance of calcium supplementation in teenagers to ensure lifelong bone health : press releaseSource: South African Family Practice 49 (2007)More Less
Travel Medicine Conference, Friday 26 to Sunday 28 October 2007, Kopanong Hotel & Conference Centre Johannesburg, South Africa : press releaseSource: South African Family Practice 49 (2007)More Less