South African Family Practice - Volume 51, Issue 1, 2009
Volume 51, Issue 1, 2009
Author Gboyega A. OgunbanjoSource: South African Family Practice 51 (2009)More Less
The year 2009 starts with a bang with the reorganisation of the CPD section. This year, the focus is to present the CPD section of each issue of the journal with a main theme on which most of the articles will be based. The Jan / Feb 2009 issue is based on the main theme of diabetes mellitus. The article on the Management of Type 2 diabetes by Joshi S and Joshi P succinctly covers the treatment goals and guidelines for the management of Type 2 diabetes as recommended by the International Diabetes Federation and American Diabetes Association (ADA). It highlights the current approaches to therapy in a practical manner that the family practitioner can easily follow. The main stay of the current approaches includes lifestyle modifications, diet, oral hypoglycaemic agents and insulin therapy. The article concludes that physicians should be aware that cardiovascular risk is increased even before the diagnosis of diabetes. Hence it is important to embark on intensive treatment to reduce mortality in diabetic patients.
Source: South African Family Practice 51, pp 5 –9 (2009)More Less
Guidelines for care and treatment goals as recommended by the International Diabetes Federation and the American Diabetes Association (ADA) are presented, together with the recent consensus document from the ADA and the European Association for the Study of Diabetes. Targets for control are presented as therapeutic targets to be obtained.
The current approaches to therapy include lifestyle modifications, diet, oral agents and insulin therapy. An algorithm is presented as a practical approach to manage Type 2 diabetes. Some newer agents that will become available in the near future in our country are mentioned. This article outlines the pathophysiology of Type 2 diabetes, emphasising the roles of insulin resistance and insulin deficiency in its aetiopathogenesis. The liver, peripheral tissues and the pancreas are the three important role players in this condition.
Source: South African Family Practice 51, pp 10 –16 (2009)More Less
We have reviewed the use of oral agents in the management of Type 2 diabetes, together with their pharmacological mechanisms, indications, side effects and contra-indications. The principal oral agents available for use include metformin, sulphonylureas, non-sulphonylurea secretagogues (meglitinides), thiazolidinediones, and α-glucosidase inhibitors. More recently, DPP-IV inhibitors and glucagon-like peptide-1 agents have been registered for use in the United States and in Europe. They await Medicines Control Council registration for use in South Africa. This article will discuss the various oral hypoglycaemic agents, together with the newer modes of therapy, which are soon to become available in our therapeutic armamentarium in South Africa.
Healthy lifestyle interventions in general practice : part 4 : lifestyle and diabetes mellitus : CPDSource: South African Family Practice 51, pp 19 –25 (2009)More Less
Diabetes mellitus, in particular Type 2 diabetes, can be classified as a chronic disease of lifestyle. A lifestyle intervention programme is therefore an essential component of the primary and secondary prevention (management) of diabetes mellitus. The main indication for referral to a lifestyle intervention programme is any patient with either pre-diabetes or established diabetes mellitus. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are nutritional intervention, exercise training (minimum of 150 minutes at moderate intensity per week), psychosocial support and education. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2-3 months to assess progress and to re-set goals. Longer-term (5-6 months) intervention programmes are associated with better long-term outcomes.
Source: South African Family Practice 51, pp 26 –27 (2009)More Less
Risk of serious adverse cardiovascular events increases with advancing age and with higher blood pressure. Falls and other serious adverse events associated with postural hypotension also increase with age and with antihypertensive drug therapy. It is therefore important to know whether drug treatment improves not only cardiovascular outcomes, but also measures of net health which combine benefit and harm: total mortality and all patients with any serious adverse event. This Letter focuses on the best available evidence about drug treatment of elevated blood pressure in individuals over 79 years of age.
Author G.A. OgunbanjoSource: South African Family Practice 51, pp 30 –31 (2009)More Less
Traditionally, the model of the physician-patient relationship was rooted in the Hippocratic Oath that condoned paternalism. The current emphasis on autonomy and distributive justice has changed the relationship to such extent that one might argue that the Oath has become irrelevant. This article will discuss whether the obligations dictated by the Oath are specifically Western or not, what has changed in the current medical environment and what should replace this traditional Oath?
Author Pierre De VilliersSource: South African Family Practice 51 (2009)More Less
This will be my last editorial as the academic head of the Department of Family Medicine and Primary Care at Stellenbosch University. At the end of February 2009 I will be saying farewell to a great team of colleagues, students and administrative staff at my long time alma mater. Like Julius Caesar of ancient Rome, I know that this ''crossing of the Rubicon'' is a point of no return and it will hold inevitable consequences both for me and my former department. But I also remember how Caesar was slaughtered at the hands of his friends and colleagues on the senate floor, because he presumably wanted to be king and did not have the foresight to step down in time. He should have followed the example of Naas Botha who retired from rugby when he was on top of his game. Like Naas Botha I have decided that the best time to get out is whilst people still want you there.
Author W.M. PolitzerSource: South African Family Practice 51, pp 36 –38 (2009)More Less
Background: The aims and objective of this paper are to address controversial and contentious issues in Medical Practice which should be of universal interest to family practitioners.
Topics: The author reviews the Hippocratic Oath and its relevance to end-of-life decisions, abortion, renal dialysis and euthanasia.
Conclusion: The opinions expressed in the article are based on evidence and the author's opinion and will encourage lively emotional response from the readers in a multicultural South Africa
Source: South African Family Practice 51, pp 39 –41 (2009)More Less
Background: Obesity is a growing global health problem. In South Africa, more than half of the adult women are overweight and almost 30% are obese. The problems associated with obesity, such as diabetes, hypertension, thrombo-embolism and coronary heart disease, are well described in the non-pregnant population, but the condition itself holds specific risks during the ante-, intra- and postpartum periods of the pregnant woman. Of particular concern is the intrapartum period. Complications such as slow progress during labour and increased rates of caesarean section are best addressed proactively. For this reason certain sources advocate that all morbidly obese women be referred for evaluation of the pregnancy and planning of labour and delivery by an anaesthetist and a specialist obstetrician. The aim of this study was to determine whether morbidly obese women are at increased risk of adverse outcomes, compared to women with a normal body mass index (BMI).
Methods: A case control study design was used. In this study a normal BMI was defined as 20-25 kg/m2 and morbid obesity as a BMI of ≥ 40 kg/m2. The BMI was calculated from the weight and height measured at the booking visit.
The cases in this study comprised the first hundred morbidly obese women seen at the Obstetric Special Care Clinic in Tygerberg Hospital (TBH), a secondary and tertiary referral centre. The controls (n = 209) were women with normal BMIs and singleton pregnancies who booked as low-risk patients at the Bishop Lavis Midwife Obstetric Unit (MOU) during the same calendar period. A minimum ratio of 2:1 controls-to-case was used, with controls also matched for primi- or multiparity. Patients booking at the MOU with significant obstetric risk factors are referred to TBH for antenatalcare. These women were not considered as controls. However, low-risk women who met the inclusion criteria at booking and who subsequently developed risks or complications were included, as the selection was done according to findings at the booking visit.
The main outcomes to be determined were: ante-, intra- and postpartum maternal complications, rate of epidurals, and perinatal outcomes.
Results: Women in the morbidly obese group were significantly older (p < 0.001) and of higher parity (p < 0.001) than those with normal BMIs. There was no difference in the numbers of primigravidae. Significantly more women in the morbidly obese group had experienced at least one miscarriage (p = 0.002). In similar fashion, significantly more of the previous deliveries in the morbidly obese group had been by caesarean section (p < 0.001). Again, significantly more women in the morbidly obese group had previously experienced pregnancies complicated by hypertension (p < 0.001).
In the index pregnancies studied, morbidly obese women experienced more hypertension (p < 0.001), diabetes (p = 0.02) and urinary tract infections (p < 0.001) than controls. They underwent induction of labour more often (p < 0.001) and had a higher rate of caesarean delivery (p < 0.001). Epidural anaesthesia was planned for all morbidly obese patients, but only 14% received it. During delivery, perineal damage was more common in morbidly obese women (p < 0.001) and their babies were significantly larger (p < 0.001). There was one perinatal death.
Conclusions: Morbidly obese women experienced increased complications during pregnancy and childbirth. Due to the high rate of caesarean sections and the potential difficulties of emergency anaesthesia among these women, epidural anaesthesia during labour should be planned and administered as often as possible.
The relationship between psychosocial variables and measures of health status in fibromyalgia : original researchSource: South African Family Practice 51, pp 42 –45 (2009)More Less
Background: Fibromyalgia is considered to be a multifactorial condition in which a number of biological and psychological variables interact. However, the exact pathogenesis and effective treatment of fibromyalgia are still unknown.
In this study the relationship between psychosocial variables of self-efficacy, helplessness, perceived social support, and pain-related beliefs and several measures of health status of patients with fibromyalgia were examined.
Methods: Thirty-one patients diagnosed with fibromyalgia participated in the study. Patients diagnosed with concomitant rheumatological conditions were excluded from the study. Each patient was individually assessed by the same physician in terms of functional status and pain experience and then measured on psychosocial variables in a cross-sectional study. Correlations between these psychosocial and health status variables were calculated.
Results: Significant correlations were found between the psychosocial variables and health status. Consistent with previous research, self-efficacy was found to be the most important psychosocial variable in the present study, correlating with several measures of health status. Quality of social support and cognitive beliefs hardly showed any relationship with health status.
Conclusions: It is recommended that self-efficacy enhancement programmes be included in the treatment of patients with fibromyalgia. However, further research is still needed to investigate the effect of self-efficacy enhancement on the overall quality of life of these patients.
The clinical spectrum and cost implications of hospitalised HIV-infected children at Karl Bremer Hospital, Cape Town, South Africa : original researchSource: South African Family Practice 51, pp 46 –52 (2009)More Less
Background: HIV infection has become a common risk factor for hospital admission and a major contributor to childhood morbidity in South Africa. There remains a paucity of data describing the cost of hospitalisation of HIV-infected children in South Africa. The aim of this study was to describe basic demographics and clinical patterns as well as cost implications of the hospitalisation of HIV-infected children in the Karl Bremer Hospital, Cape Town, South Africa.
Methods: A prospective descriptive longitudinal study of HIV-positive paediatric admissions, matched with HIV-negative controls, was conducted. Patients were matched according to age, socio-demographic area and presenting symptoms. Questionnaires were used to elicit demographic and clinical information. Worksheets were used to record any costs incurred, which were calculated at rates applicable to 2001. This was done daily during admission. Data was statistically analysed in MS Excel and MS Access. Thirty HIV-positive children were identified, of which 23 could be matched with 23 HIV-negative children. HIV-positive children had a higher admission rate (2.09 versus 0.26 previous admissions, p = 0.000) and were also younger at the time of first admission to hospital (7.52 versus 13.78 months, p = 0.005). There is a statistically significant difference in duration of hospitalisation in the HIV-positive group when compared to the control group - duration of hospitalisation being longer in the HIV-positive group (7.91 versus 4.96 days, p = 0.005). Despite being treated for the same condition, there is a statistically significant difference in the cost incurred by children in the HIV-positive group (R6 203.16) when compared to the HIV-negative group (R3 901.96); p = 0.000.
Conclusion: This study shows a clear and statistically significant difference between the HIV-positive group and HIV-negative control group of children with regard to admission rate, age at first admission, duration of hospitalisation and cost incurred during hospitalisation. HIV-infected children in the pre-HAART (highly active anti-retroviral therapy) era were hospitalised more frequently and for longer periods than their HIV-uninfected counterparts. These findings seem to suggest that the cost of hospitalising HIV-positive children is significantly more than HIV-negative controls, which will increase the financial burden on already restricted health resources.
Quality of pharmaceutical print advertising in South Africa - assessment of reproductive health advertisements 2001 - 2005 : original researchSource: South African Family Practice 51, pp 53 –58 (2009)More Less
Background: Pharmaceutical advertising, in a variety of forms, has been shown to influence prescribing behaviour. Regulatory systems have therefore been concerned with the quality of advertising and compliance with either imposed or self-regulatory codes of practice. Although the South African Medicines Act provides for an enforceable code of practice, the draft version published in 2004 has yet to be put into effect. This study aimed to assess the quality of pharmaceutical advertisements for reproductive health products, published in South African medical publications over the period 2001 to 2005. Compliance with the draft code of practice was considered, as well as the usefulness of the code itself.
Methods: Half-page and larger print advertisements for reproductive health medicines were sought from two South African peer-reviewed and four non-peer-reviewed medical publications. Advertisements published in three consecutive months in 2001 to 2005 were selected. This period represented the period prior to legislation being developed and the period during which the code of practice was developed and published for comment. Details from each advertisement were captured independently by two reviewers using a pre-determined, pre-tested 60-question questionnaire. Differences were resolved by consensus. The questionnaire was pre-tested and adapted before being applied. Questions sought to identify characteristics of the advertisement that were indicative of quality relating to claims and evidence used in support of the claims, as well as adherence to the draft code of practice. The number of claims made in each advertisement was identified, and for each claim the evidence provided in the form of references was assessed.
Results: A total of 136 reproductive health product advertisements were retrieved from 105 medical publications. Only 63 advertisements were unique. On average each medical publication selected contained 1.3 reproductive health product advertisements. All but three advertisements were for registered orthodox medicines. A total of 191 'claims' could be discerned in advertisements placed in medical publications (average 3.0 'claims' per advertisement). Only 7/103 (6.8%) references cited in unique advertisements in medical publications could be retrieved in abstract form from Medline, and only 1/7 (14.3%) of these references could be retrieved in free full-text format. In total, 14/103 (13.6%) of the references cited in advertisements placed in medical publications were listed as ''data on file''. Compliance with the relevant general regulation was easier to judge, and seen more often, than was the case in respect of the more subjective elements included in the draft code of practice.
Conclusions: The quality of advertisements for reproductive health products placed in medical publications appears to fall short of at least some of the requirements of both existing and draft regulatory instruments. This may potentially have deleterious consequences for both prescriber and consumer behaviour. The draft code of practice is, however, often difficult to apply in an objective and consistent manner, and may be open to interpretation and therefore variable standards of quality.
Potential cost savings from generic medicines - protecting the Prescribed Minimum Benefits : original researchSource: South African Family Practice 51, pp 59 –63 (2009)More Less
Background: South Africa has followed a pro-generic policy since the introduction of the National Drug Policy in 1996. The selection processes in the public and private sectors have, however, remained largely disconnected, and at times contradictory. Medicines provided outside of hospitals accounted for 17% of medical aid spend in 2006, up 8.8% from the previous year. Of particular concern to funders has been the expenditure on the 27 chronic conditions listed as Prescribed Minimum Benefits. The Medical Schemes Act (No 131 of 1998) provides for the definition of Prescribed Minimum Benefits, which stipulate a package of services or care a medical scheme must provide for in its benefit design. There is pressure to reconsider these requirements in order to increase the affordability of medical scheme coverage. This study assessed the potential savings that would be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the Council for Medical Schemes (CMS).
Methods: All medicines listed in the 25 chronic diseases algorithms made available by the CMS were identified. Brand and generic versions were identified in the Monthly Index of Medical Specialties (MIMS, May 2006). Single exit prices inclusive of value added tax were obtained from the web site of the Pharmaceutical Blue Book and the cost per defined daily dose for one month was then calculated. Cost differentials, where available, were then identified for each medicine listed in the algorithms. Cost differentials for medicines within each algorithm were presented as the median of the difference between brand and generic medicines listed for that algorithm, and also as the median of differences between generic medicines for the same condition.
Results: Three of the algorithms (diabetes insipidus, haemophilia and hypothyroidism) list medicines for which no generic equivalent was available at the time of the study. The median cost differential between brand and generic equivalents for the remaining 22 chronic conditions ranged from 19.5% (for type 1 diabetes mellitus) to 97% (for Addison's disease). Across the entire chronic disease algorithm set, 80 medicines with generic equivalents were listed for 22 conditions. The median cost differential between brand and generic versions of these 80 medicines was 49.9% (interquartile range 32.0 to 78.5%). Of all generic medicines identified, 67.5% were more than 40% cheaper, per defined daily dose (DDD) per month, than the branded version. In 16 medicines the cost differentials between generic versions were 1% or less. Some correlation between the number of generics and the size of the cost differential was apparent (correlation coefficient 0.49). There were examples of high-cost differentials in highly competitive areas of the market.
Conclusions: An argument could be made for more closely aligning the process of developing the National Essential Drugs List and the development of the CMS algorithms. By being more specific about which medicines should be covered, needless expenditure on ''me-too'' agents of doubtful additional benefit could be avoided. Where clinically warranted, appropriate choices could be provided. Finality in respect of the pricing of medicines needs to be achieved. This applies not only to the dispensing fee but also to the proposed benchmarking process and the proposed differential between brand and generic medicines.
Source: South African Family Practice 51, pp 64 –67 (2009)More Less
Background: Healthcare workers at primary healthcare (PHC) clinics are frustrated by the fact that they do not receive replies to their referral letters to doctors. Referral letters act as permission slips to allow patients easy access to treatment by specialists at secondary and tertiary service levels and communicate reasons for referral. Reply to the referral letter is vital for continuity of care to be maintained and to enable comprehensive recording at PHC level. It has been found that poor feedback leads to poor follow-up care in the PHC setting. Previous research has investigated the influence of the method of communication, either by use of pro forma letters or by electronic feedback on answers. The study on which this article is based endeavoured to understand the receiving doctors' reasons for not replying to referral letters and the context contributing to this problem. If this matter could be resolved it would relieve frustration at PHC level and improve healthcare services in future.
Methods: A qualitative study method was used, as the purpose of this study was to understand and explore in depth doctors' context, perceptions and motivation for not answering referral letters. In-depth interviews were conducted with six purposefully selected doctors who all had more than one year's experience in their different departments. The exploratory question posed was: ''What factors are contributing to not replying to referrals from primary healthcare clinics?'' Interviews were tape-recorded and transcribed verbatim. Themes were identified using the Tesch method. Analysis was done independently by two coders, who afterwards reached consensus on identified themes. After analysis of each interview, reliability was further ensured by going back to the participants to verify that the interpretation represents an accurate description of the participant's view.
Results: The participants included one consultant and five registrars with between 18 months and 8 years' experience in their departments. According to participants, many reasons contributed to their not writing answers to referrals. The reasons for not replying to referral letters pertained to the working situation at the referral hospital and factors regarding the referrals themselves on the one hand and the hospital doctor's perceptions as to his / her role in the healthcare system and his / her perception that it is futile to answer referrals on the other.
Conclusions: There were multiple reasons for doctors not replying to referral letters. The referring personnel can address some of these reasons by ensuring accurate referrals on appropriate days, considering style preferences of the hospital doctors and by the use of pro forma letters. Hospital consultants can address other factors by giving attention to the socialisation of their juniors and by adjusting the referral system so that it does not rely on patients to courier letters. Further research needs to be undertaken in South Africa to assess the influence of various methods of communication in the referral system as regards the quality of communication between different levels of care.
Risk factors for anaemia in pregnancy in rural KwaZulu-Natal, South Africa : implication for health education and health promotion : original researchSource: South African Family Practice 51, pp 68 –72 (2009)More Less
Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in the rural population of KwaZulu-Natal (30% according to national and 57% according to the World Health Organization [WHO] definition of anaemia in pregnancy) is observed. The risk factors for anaemia, particularly during pregnancy, are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy, studies to assess the aetiological factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis, urinary schistosomiasis and HIV infection on anaemia in pregnancy.
Methods: A retrospective case-control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women, 100 of them with anaemia (haemoglobin less than 10 gm/dL according to the national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni Hospital. Both cases and controls were matched for age, parity and gestational age. Data were collected from the antenatal clinic and prevention of mother-to-child transmission of HIV (PMTCT) programme registers for cases and controls at their booking visit during the months of May, June and July of 2004. Univariate and multiple logistic regression were performed to analyse the data.
Results: Of the cases, 48% and 1% among the controls had intestinal helminthiasis, resulting in the odds ratio of 42 (p = 0,000 and 95% CI 9,96 - 176.59). The risk of anaemia was related to urinary schistosomiasis, as 27% of the cases compared to 1% of controls was found with anaemia. The odds ratio was 12 (p = 0,000 and 95% CI 3.58 - 41.02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting in the development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through the faecal-oral route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce the transmission of faecaloral diseases (e.g. intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are: 1) safe disposal of human excreta, 2) hand-washing practices with soap after defecation, and 3) maintenance of drinking water free from faecal contamination. Similarly, HIV infection increased the chance of developing anaemia in pregnancy twofold as HIV infection was more common among cases (56%) than among controls (37%), resulting in an odds ratio of 2.11 (p = 0,003 and 95% CI 1.123 - 3.21). The prevention of HIV infection and transmission can be achieved through the improvement of knowledge of these conditions. These can be achieved through health education and health promotion.
Conclusion: These findings confirm and conform to other studies on the association between anaemia in pregnancy and parasitic and HIV infections. Antenatal care should promote de-worming and education on personal hygiene and HIV (risk factors, mode of transmission, etc.). The provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all, including pregnant women.
A bibliometric analysis of research publications funded partially by the Cancer Association of South Africa (CANSA) during a 10-year period (1994-2003) : original researchAuthor C. AlbrechtSource: South African Family Practice 51, pp 73 –76 (2009)More Less
Background: The objective of this study was to establish the quantity and quality of research publications outputs by grant recipients of the Cancer Association of South Africa (CANSA) over a 10-year period (1994-2003).
Methods: Peer-reviewed publications in the PubMed database that were related to CANSA grants and were, published between 1994 and 2003 were counted per grantee in 2005, and the mean impact factor of all publications for 2005 was obtained from the Institute for Scientific Information (ISI).
Results: Over the 10-year period, 129 different researchers from 10 different institutions conducted 192 projects that yielded 570 relevant peer-reviewed publications that are recorded in the PubMed database. CANSA grants totalled R28.2 million and the mean impact factor of all the publications was 3.8. The number of publications per grantee, over the period analysed, varied considerably, from zero to 79, with 10% of the grantees publishing more than 10 (one per year). A significant group of 36% did not publish at all. Most of the studies (64%) concerned aspects of cancer biology and therapy, while only 26% of the projects involved issues relating to the prevention, epidemiology and social aspects of cancer.
Conclusions: Because grants from CANSA are partial and do not pay for the major components of most research projects, such as salaries, the data obtained here is insufficient to create a benchmark for the cost of an average, peer-reviewed cancer research publication in South Africa. Nevertheless, it can be concluded that, on average, a contribution of about R50 000 from CANSA (value from 1994 to 2003) contributed to the appearance of one peer-reviewed cancer research publication with an average impact factor of 3.8 in the period under study. The most popular subjects of research were cancer biology and treatment. In order to bring about more balance in the future, more attention needs to be focused on the prevention, early detection, epidemiology and social aspects of cancer.
Source: South African Family Practice 51 (2009)More Less
The aim of our study was to determine whether RCTs appearing in SA e-publications used the ITT principle, as recommended by the Consolidated Standards of Reporting Trials (CONSORT) statement. The reviewers were interested more in the handling of protocol violators with regard to the ITT principle. Ethical approval was not required for this study, since it was an online review.
Source: South African Family Practice 51, pp 78 –79 (2009)More Less
The letter reports on outcomes of a private HIV / AIDS clinic and questions its safety. The clinic (site 282) is a satellite to a PEPFAR (presidents emergency program for aids relief) funded and AURUM health supervised program. The clinic identifies itself from being different to the other programs in that it operates from within an established private Family Practice, has two specific doctors and limited counseling and no nurse support. In the rest of its content it has the same constraints as the government clinics. Using four recently published reports on HIV / AIDS programs it compares and comments on early outcome data. The conclusion is that provided good data are kept and improved with time, it would be safe to continue in this model.
Report on the 12th National Rural Health Conference hosted by the Beaufort West Community 18-20 September 2008 : letters : correspondenceAuthor Louis JenkinsSource: South African Family Practice 51, pp 80 –83 (2009)More Less
This conference was a healthy mix of clinical, advocacy, and caring issues, within the context of the health care team. It was well represented by most categories of staff, provinces, and a good number of students. Hopefully next year's conference will be building on the Beaufort West experience!
Author Chris EllisSource: South African Family Practice 51 (2009)More Less
My principle had been ambushed by the insidious onset of disease in a well known patient (and haven't we all been there). He knew the illness script of the patient but when the new disease script came along he didn't have the advantage of the newcomer who, in a flash, recognises the problem.