South African Family Practice - Volume 52, Issue 5, 2010
Volume 52, Issue 5, 2010
Source: South African Family Practice 52, pp 382 –390 (2010)More Less
Osteoarthritis (OA) is a common chronic degenerative joint disorder and a major cause of pain and disability, especially in the elderly. The prevalence is steadily rising due to an increase in life expectancy and certain lifestyle factors. OA is a complex dynamic process involving all tissues of the joint organ. Multiple risk factors are associated with the occurrence and progression of OA. There is extreme variability in presentation at different joint sites and between individuals. Management of OA involves a comprehensive approach consisting of preventative measures and numerous therapeutic modalities which should be tailored to individual needs. The family practitioner plays a vital role in the diagnosis of OA, the initiation of treatment and the ongoing monitoring of the condition.
Author Z. VallySource: South African Family Practice 52, pp 392 –395 (2010)More Less
South African family practitioners can expect to contend with rising rates of dementia as the aged segment of the population grows larger and HIV-related neuropsychiatric complications manifest with increasing prevalence. Family practitioners are often the first professional consulted by families concerned with a family member's suspected dementia. This fortunate position facilitates the early identification of cognitive difficulties, which, in turn, greatly increases the likelihood of optimal management. Dementia is best managed with a multidisciplinary-team approach that sees family practitioners fulfilling the role of key support to families and of the coordinators of multidisciplinary referrals and inputs. This article reviews the key diagnostic features of dementia and provides suggestions that may be utilised by physicians in the basic assessment of these features. It concludes with a summary of the most appropriate management plan to be adopted by family practitioners.
Author E.W. HennSource: South African Family Practice 52, pp 405 –409 (2010)More Less
Significant hormonal changes occur at the time of menopause and this has an impact on all oestrogen-sensitive tissue. The female lower urinary tract (LUT) is no exception. Decreasing levels of oestrogen characteristic of the menopause produce symptomatic, histological and functional changes of the vulva, vagina and lower urinary tract together. Examples of specific urogenital problems include urgency, urinary incontinence and susceptibility to urinary tract infection. Oestrogen therapy works by preventing or reversing urogenital atrophy and provides symptomatic improvement although it may need to be combined with other treatments for certain conditions such as incontinence. Oestrogen therapy requires time to become effective with vaginal preparations probably superior to systemic therapy. Prophylactic oestrogen therapy has not been shown to be clearly of benefit for specific types of urinary incontinence.
Source: South African Family Practice 52, pp 409 –413 (2010)More Less
Discerning between actual nail conditions and nail changes associated with systemic disease is a very important and interesting part of any clinical examination. This article provides a helpful clinical atlas of nail changes that may be associated with systemic disease and will assist the clinician to identify and verify these clinical signs. The article includes information on common nail changes like koilonychia, longitudinal and transverse grooves, nail pitting, clubbing, pincer nails, pterygia, splinter haemorrhages, nicotine-stained nails, cyanosis, jaundice and brittle nails. It also includes information on the -nychias (micro-, macro-, leuko-, pachy-, melano- and dyschromo-), onycholysis and onychoschizia, red lunulas, yellow nail syndrome, Muehrcke's white bands, Terry's nails and periungual fibromas (Koenen tumours).
Author J. KerSource: South African Family Practice 52, pp 417 –421 (2010)More Less
On average, one in four adults has hypertension. This figure is higher in certain regions of the world, and in certain areas within countries. Worldwide, however, the prevalence of hypertension is on the rise. The relationship between level of blood pressure and risk for cardiovascular events is linear and continuous. Nearly 75% of adults with other cardiovascular disease have hypertension as a comorbidity. Hypertension is associated with shorter overall life expectancy, as well as a shorter life expectancy free of cardiovascular disease. Hypertension can be said to be controlled or at goal if blood pressure is less than 140/90 mmHg, or less than 130/80 mmHg for those with diabetes, kidney disease or a previous vascular event (e.g. myocardial infarction, stroke, etc).
Author D. SmitSource: South African Family Practice 52, pp 424 –427 (2010)More Less
Patients regularly present to general practitioners complaining of red eyes. Sometimes the aetiology is obvious and prescribing the correct treatment is straightforward whereas, in other cases, it can be extremely difficult to pinpoint the exact cause, and deciding on appropriate treatment becomes problematic. The following quiz cases will illustrate several causes of red eye and highlight clues in italics that should prove helpful in making the correct diagnosis.
Author S.A. AdefemiSource: South African Family Practice 52, pp 428 –429 (2010)More Less
LH is a two-month-old baby girl seen in the outpatient skin clinic of the Family Medicine Department of the Federal Medical Centre, Bida, Nigeria. She had a single erythematous plaque on her scalp of five weeks duration. The lesion was noticed soon after shaving the hair following the eighth day for the naming ceremony. Shaving of the head was done by a local mobile barber in the community. The scalp lesion was initially tiny but progressively increased in size. There was no history of fungal infection in the parents or siblings and other family members. There was also no history of keeping pets in the family.
Author C. RogersSource: South African Family Practice 52, pp 431 –434 (2010)More Less
Presbyastasis is the result of age-related physiological changes in the three sensory systems and their central connections that contribute to balance. In all likelihood, presbyastasis is a complex condition involving many intertwined systems rather than a lesion within the vestibular system only, thus evaluation and management need to be holistic. Balance problems can have detrimental consequences and are associated with falls, loss of quality of life and psychological sequelae such as anxiety, depression and panic. Healthcare practitioners need increased awareness of the pathophysiology of presbyastasis and its possible impact.
Author Pierre J.T. De VilliersSource: South African Family Practice 52 (2010)More Less
The election of a new Council for the Academy of Family Physicians is taking place on 4 November 2010. It will be the first election under the new constitution of the Academy. Under the new constittion, there will be 18 Council members - a President and a Vice-President, 10 nominated members and six elected members. The Council will be confirmed at the AGM on 13 November 2010.
Author R. MashSource: South African Family Practice 52, pp 438 –445 (2010)More Less
In this paper the argument is presented that we can expect an increase in chronic diseases within developing countries such as South Africa and that this is largely due to changes in lifestyle, such as diet and exercise. While these lifestyle choices are ultimately made at an individual level, they are often constrained and shaped by powerful environmental and societal forces such as globalisation, urbanisation and mechanisation. These same changes in lifestyle are also intimately linked to increasing greenhouse gas emissions and the development of climate change. A diet more reliant on meat and refined and processed foods has a much higher carbon footprint. Reductions in physical activity are linked to increases in the use of motorised transport and further increases in greenhouse gas emissions. The emergence of chronic diseases and climate change are therefore connected and both stem from unhealthy overconsumption of resources. The emergence of these phenomena can be understood in terms of complexity theory as properties of a complex non-linear social system. Complex systems by their very nature are unpredictable and yet share certain typical characteristics. These characteristics of complex systems raise questions regarding how we can disturb the system to have healthier and more sustainable emergent properties. Four key areas to consider are disturbing the network, the technology, the social structures and rules and the meaning manifested in the system.
Personality profile and coping resources of family medicine vocational trainees at the University of Limpopo, South Africa : original researchSource: South African Family Practice 52, pp 446 –450 (2010)More Less
Background : Doctors are exposed to various stress factors in their personal and family lives, as well as in the workplace. Stress inherent to the responsibilities and challenges of the medical field may become a health hazard and threaten the well-being of the medical practitioner.
Methods : The aim of this study was to investigate the personality traits and coping resources that contribute to the wellbeing of medical practitioners. A cross-sectional study of 44 out of 45 (98% response rate) family medicine vocational trainees at the Medical University of Southern Africa (now known as the University of Limpopo) was conducted. A biographic questionnaire was utilised to obtain specific information regarding the participants. The principal researcher used the Coping Resources Inventory (CRI) questionnaire to assess coping resources, and the 16PF personality analysis (16PF) to establish a personality profile of the participants.
Results : The majority of participants (81.8%) indicated that they mainly experienced work-related stress. Thirty-two participants (72.72%) self-medicated. Fourteen participants (31.81%) claimed to experience burn-out and twenty (45.45%) reported fatigue. In terms of their coping resources, 24 male participants (54.54%) did not cope socially (p ≤ 0.008) and eight (18.18%) also did not cope physically (p ≤ 0.024).
Conclusions : The medical practitioners had a universal personality profile. They lacked insight regarding the symptoms they were experiencing that warranted management, e.g. depression and anxiety. The medical practitioners in this study did not utilise their social and physical coping resources optimally and reported poor help-seeking behaviour.
Evaluation of the clinical management of HIV-infected patients by private sector doctors in the eThekwini Metro, KwaZulu-Natal : original researchSource: South African Family Practice 52, pp 451 –458 (2010)More Less
Background : Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management. In South Africa, two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken, few have been done in the private sector in terms of the management of this disease. Therefore, a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors.
Methods : A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal, South Africa, with 190 private sector doctors who, in the first phase of the study, indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors.
Results : Eighty-five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors, 134 (78.5%) initiated therapy at CD4 count < 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p < 0.001). At initiation of treatment, 68.5% of the doctors saw their patients monthly and 64.3% saw them every three to six months, when stable.
Conclusion : The majority of private sector doctors were compliant with current guidelines for HIV management, hence maintaining an acceptable quality of clinical healthcare.
Retention of knowledge of and skills in cardiopulmonary resuscitation among healthcare providers after training : original researchSource: South African Family Practice 52, pp 459 –462 (2010)More Less
This study assesses the retention of core knowledge and skills among healthcare providers (HCPs) who attended a Basic Life Support (BLS) course. The format for teaching this course changed in 2006 and a review of the effectiveness and acceptability of the new course was considered vital. Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however, the knowledge and skills of HCPs in basic life support vary. International recommendations on the BLS course were that HCPs repeat the course every two years. However, no studies have been conducted in South Africa to determine the ideal time when HCPs should be re-evaluated to ensure that they retain adequate knowledge and skills. This study was conducted at a training centre in a hospital in KwaZulu-Natal, where a new format for training was introduced in 2006. Participants were HCPs who had completed a BLS course. The sample was taken sequentially from half of the annual intake of a BLS course three months after completion of the course. Data were collected using the accredited American Heart Association written test and the Critical Skills Checklist, and a further questionnaire was developed to collect variables such as demography and profession. Results indicate that skills retention was good and, although there was some fall-off in skills and knowledge, there was no significant difference between the scores at the end of the course and retest scores. Staff working in accident and emergency departments had more practical experience and their knowledge and skills retention was better than that of staff working in other areas of the hospital. Nurses performed nearly as well as doctors and are an important skills resource in the management of patients who need to be resuscitated. All participants were satisfied with the new format and had no suggestions on how to improve it.
The Phelophepa Health Care Train : a pharmacoepidemiological overview of the Western Cape in 2009 : original researchAuthor I. TruterSource: South African Family Practice 52, pp 463 –466 (2010)More Less
Background : The Phelophepa Health Care Train is the only primary healthcare train in the world. Phelophepa is an innovative initiative that attempts to make a positive difference to primary healthcare in rural South Africa. The primary aim of this study was to determine the epidemiological and prescribing statistics for Phelophepa during the period that the train was stationed in the Western Cape in 2009.
Methods : Phelophepa visited seven stations during the eight weeks that it was stationed in the Western Cape (between 6 April and 5 June 2009). Data were collected by workers and students on the train.
Results : A total of 4 026 prescriptions were dispensed by the pharmacy on Phelophepa during the eight weeks. The average number of items per prescription was 3.51. The average cost per prescription was R65,48 (average cost of R18,64 per item). Patients only paid R5,00 per prescription. There was an increase in the number of pulmonary diseases/infections as well as ophthalmic conditions (especially dry eyes). Common problems experienced during the outreach to schools were ear infections and chest infections. Common conditions identified in Caledon, for example, were musculoskeletal problems, genitourinary conditions, fungal infections and eye disorders. Medication is prescribed mainly by nurses and includes those listed in the Primary Healthcare Essential Drug List.
Conclusions : The statistics compiled by Phelophepa are a useful source of pharmacoepidemiological data about rural South Africa. It is recommended that more studies be conducted to detect especially epidemiological differences between regions visited, as well as changes over time.
Exposure to primary healthcare for medical students : experiences of final-year medical students : original researchSource: South African Family Practice 52, pp 467 –470 (2010)More Less
Introduction : Recognising the importance of primary healthcare in the achievement of the 1997 White Paper for the Transformation of the Health System and the Millennium Development Goals, the Faculty of Health Sciences of the University of the Witwatersrand introduced an integrated primary care (IPC) block. In a six-week final year preceptorship, medical students are placed in primary healthcare centres in rural and underserved areas. This article describes the experiences of medical students during their six weeks in the IPC block.
Methods : The study was qualitative, based on data collected from the logbooks completed by the students during the IPC rotation. A total of 192 students were placed in 10 health centres in the North West and Gauteng provinces in the 2006 academic year. These centres included district hospitals, clinics and NGO community health centres.
Results : The students reported that the practical experience enhanced their skills in handling patients in primary care settings. They developed an appreciation of primary healthcare as a holistic approach to healthcare. The students attained increased levels of confidence in handling undifferentiated patients, and became more aware of community health needs and problems in health service delivery.
Conclusions : Exposure to the IPC block provided a valuable experience for final-year students, as it is critical for orienting students to the importance of primary healthcare, which is essential for the realisation of targets identified in the national health policy.
Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal : original researchSource: South African Family Practice 52, pp 471 –475 (2010)More Less
Background : The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal, however, is limited. This study was, therefore, undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal.
Methods : A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence.
Results : A total of 171 doctors responded, with over 75% in practice for over 11 years and 78.9% indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6% of the GPs monitored adherence compared with 63.6% of the specialists (p = 0.016). The doctors used several approaches, with 60.6% reporting the use of patient self-reports and 18.3% reporting the use of pill counts. A total of 68.7% of the doctors indicated that their adherence monitoring was reliable, whilst 19.7% indicated that they did not test the reliability of their monitoring tools .The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks, SMSs, telephone calls to the patients, the encouragement of family support and the use of medical aid programmes.
Conclusions : Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence.
Iatrogenic HIV transmission in South Africa : evidence, estimates and moral perspectives : correspondenceSource: South African Family Practice 52, pp 476 –477 (2010)More Less
To the Editor: The risks of HIV transmission to patients exceed many health professionals' expectations in South Africa. Non-vertical HIV transmission to children is more common in cases where adherence to infection control guidelines is generally poor. Given the extent and seriousness of the HIV/ AIDS pandemic, the moral abhorrence of offering resource scarcity as justification for tolerating unsafe health care where appropriate oversight is clearly lacking must be brought to light.
Author Chris EllisSource: South African Family Practice 52 (2010)More Less
In the 18th century, as you well remember, Sir Horace Walpole coined the term "serendipity" for accidental discoveries. He had come across a fairy tale of the three princes of Serendip (which was the old name for Sri Lanka). They set off to travel the world and rarely found the treasures they were looking for but, by accident, came across equally happy discoveries.