South African Family Practice - Volume 55, Issue 5, 2013
Volume 55, Issue 5, 2013
Author Keymanthri MoodleySource: South African Family Practice 55, pp 410 –411 (2013)More Less
Healthcare provision in the 21st century heralds a new understanding of the concept of generalism. The underlying themes include empathy and engagement in patient care and an appreciation of limits as generalists, as well as professionalism. Generalism requires the "integration of healthcare services" as we work across "professional and organisation boundaries". The approach respects patient autonomy, especially as patient expectations rise. Patients value a holistic approach to care. Generalism supports cost-effective care across the health system.
Source: South African Family Practice 55, pp 415 –419 (2013)More Less
Atopy can manifest in childhood as infantile eczema (atopic dermatitis), allergic rhinitis and asthma. In practice, it is critical to identify the offending allergen in atopic individuals. This will not only influence therapeutic interventions, but may also have a significant impact on the individual's quality of life. The most common clinical test for allergy detection is the introduction of an allergen directly into the skin in the form of a skin-prick test. Skin-prick testing is recommended in the diagnostic workup for allergies because it is reliable, safe, convenient, inexpensive, minimally invasive, and has the advantage of multiple allergen testing in one, 15- to 20-minute, test. Skin-prick testing can be performed from birth onwards. Although there is a small risk of developing anaphylaxis, the test remains safe to perform in a consultation room or at the patient's bedside. Worldwide, a skin-prick test remains the test of choice for allergy because of its convenience and cost-effectiveness. A globally accepted guideline for skin-prick testing is still lacking and would be beneficial to both patient and physician.
Author M.J. LabuschagneSource: South African Family Practice 55, pp 421 –425 (2013)More Less
Because of various contributing factors such as exposure to ultraviolet (UV) light, especially UV type B radiation, and the high prevalence of human immunodeficiency virus (HIV) infection in South Africa, medical practitioners are often consulted by patients with conjunctival growths. However, the diagnosis of conjunctival lesions is challenging, and it may be difficult to clinically distinguish between benign and malignant lesions. The aim of this article is to present a synopsis of conjunctival growths, and propose a practical approach to making the correct diagnosis and implementing appropriate management.
Author Haley SmithSource: South African Family Practice 55, pp 431 –433 (2013)More Less
Insomnia is a common condition which includes trouble falling, or staying, asleep. This condition can range from being mild to severe, depending on how often it occurs, and for how long. The main focus of treatment for insomnia should be directed towards finding the underlying cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may be able to eliminate the insomnia. Treating the symptoms of insomnia, without addressing the underlying cause, is rarely successful. In the majority of cases, chronic insomnia can be resolved if its medical or psychiatric causes are identified, and treated appropriately.
Colds, flu and coughing : a review of over-the-counter nasal therapies in general practice : CPD articleAuthor J. Van SchoorSource: South African Family Practice 55, pp 435 –436 (2013)More Less
Nasal congestion due to the common cold occurs because of dilation of the blood vessels, leading to swelling of the nasal mucosal epithelium. This narrows nasal passages, which are further blocked by increased mucus production. Nasal sprays and drops are often recommended for the treatment of rhinorrhoea and nasal congestion associated with the common cold. This brief review discusses over-the-counter nasal therapies that are used to relieve rhinorrhoea and nasal congestion in adults and children.
An assessment of quality of care service provided to people living with HIV/AIDS by a secondary healthcare centre at Osogbo, Nigeria : original researchSource: South African Family Practice 55, pp 439 –444 (2013)More Less
Objective : The objective of this study was to assess the quality of service provided to people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) at a secondary healthcare centre at Osogbo, Nigeria.
Design : Descriptive cross-sectional study design.
Setting and subjects : People living with HIV/AIDS (PLWHA) at the State Hospital, Osogbo, Nigeria.
Outcome measures : Quality of the services rendered to PLWHA.
Results : A total of 304 PLWHA were interviewed. Their ages ranged from 16-60 years, with a mean age of 35.5 ± 8.8 years. There were 212 (69.7%) female and 92 (30.3%) male respondents, 248 (81.6%) were married and 108 (35.5%) had a tertiary education. Approximately half (148, 48.7%) rated the quality of the services rendered to them at the hospital as excellent, 132 (43.4%) rated it as good, and 24 (7.9%) as fair. None rated the services rendered as poor or very poor.
Conclusion : The results of this study showed a good relationship between PLWHA and healthcare workers in general. Education, training and re-training of the health workers should be an ongoing exercise.
Nutritional status of undergraduate healthcare students at the University of the Free State : original researchSource: South African Family Practice 55, pp 445 –452 (2013)More Less
Objectives : This study aimed to evaluate the lifestyle habits of South African students preparing for careers in health care that could influence the efficacy of their counselling practices on risk factors for noncommunicable diseases (NCDs) as future healthcare professionals.
Design : Cross-sectional descriptive study.
Setting and subjects : One hundred and sixty-one students (median age 21.5 years, 75.8% women) enrolled in the Faculty of Health Sciences at the University of the Free State.
Outcome measures : Anthropometry was measured and structured questionnaires administered to assess dietary and lifestyle habits.
Results : Many students were at risk of NCDs, with 19.8% being overweight or obese (body mass index > 25 kg/m2), 11.8% had a waist circumferences above gender-specific cut-off points, 98.1% consumed < 3 servings of vegetables/day, 58.4% consumed < 2 servings of fruit/day, 83% consumed < 2 servings of dairy products/day, 60% did not eat a beta-carotene-rich fruit or vegetable daily, 31% did not eat a vitamin C-rich fruit or vegetable daily, 62% never consumed legumes, 43% reported a high intake of fats and sweets, 11% smoked a median of 3.5 cigarettes/day and 63% consumed a median of three drinks of alcohol/day on a median of four days (95% weekend days) per month. Fifty-nine per cent were active and 39% were very active owing to busy class schedules, but only 32% participated in formal exercise and sports.
Conclusion : The poor dietary and lifestyle habits of most participants highlight the need to not just educate, but better empower these students to deal with the growing public health problem of obesity and related NCDs in the country.
Views of patients on a group diabetes education programme using motivational interviewing in South African primary care : a qualitative study : original researchSource: South African Family Practice 55, pp 453 –458 (2013)More Less
Objectives : This study was a qualitative assessment of a diabetes group education programme presented in community health centres of the Cape Town Metro District. The programme offered four sessions of group education and was delivered by trained health promoters using a guiding style derived from motivational interviewing. The aim of the study was to evaluate the programme by exploring the experiences of the patients who attended.
Design : This was qualitative research that utilised in-depth interviews. Thirteen patients who had attended the educational programme, and who each came from a different health centre in the intervention arm of a larger randomised controlled trial, were purposively selected. The interviews were audiotaped, transcribed and then analysed using the framework approach.
Setting and subjects : Patients with type 2 diabetes from community health centres in the Cape Town Metro District.
Results : Patients gained useful new knowledge about diabetes and reported a change in their behaviour, especially with regard to diet, physical activity, medication and foot care. The educational material was experienced positively and enhanced recall and understanding. Health promoters were competent, utilised useful communication skills and structured the material well. There were organisational and infrastructural problems, especially with regard to space within which the groups could meet, and communication of the timing and location of the sessions.
Conclusion : This study supports wider implementation of this programme, following consideration of recommendations resulting from patient feedback.
An assessment of organisational values, culture and performance in Cape Town's primary healthcare services : original researchSource: South African Family Practice 55, pp 459 –466 (2013)More Less
Objectives : Improving the quality of primary health care in South Africa is a national priority and the Western Cape Department of Health has identified staff and patient experience as a key component. Its strategic plan, Vision 2020, espouses caring, competence, accountability, integrity, responsiveness and respect as the most important organisational values. This study aimed to measure the personal values of staff, as well as current and desired organisational values.
Design : A cross-sectional survey used the cultural values assessment tool. Data were analysed by the Barrett Value Centre.
Setting and subjects : Staff and managers at five community health centres in the Cape Town Metropole.
Outcome measures : Personal values, current and desired organisational values, organisational entropy and organisational scorecard.
Results : In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience.
Conclusion : The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.
Prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care, Port Harcourt, Nigeria : original researchSource: South African Family Practice 55, pp 467 –472 (2013)More Less
Objectives : The study objectives were to determine the pattern of presentation of Lower urinary tract symptoms (LUTS) in the respondents, the prevalence of LUTS suggestive of BPH, and respondents' quality of life.
Design : A prospective cross-sectional study of 290 probability-sampled subjects, using the International Prostate Symptom Score (IPSS), which also measures quality of life, to determine patients' symptoms.
Setting and subjects : The study was conducted at the Family Medicine Clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. The subjects were middle-aged and elderly men that presented with LUTS.
Result : The mean age of the subjects was 62.50 ± 11.66 years. The age range was 40-100 years. The majority (39.7%) of the subjects were elderly. Bladder storage symptoms were the most experienced LUTS. The prevalence of LUTS suggestive of BPH was 72.2% using the IPSS, and 60% had an enlarged prostate that was diagnosed through a digital rectal examination. The prevalence of bothersome LUTS was 71.3%.
Conclusion : Different diagnostic methods for LUTS suggestive of BPH provided different prevalence values. The findings need to be interpreted with caution, as hospital-based studies have higher prevalence values than those of population-based studies.
Does the knowledge of the human immunodeficiency virus serostatus influence the clinical diagnostic proficiency of Kaposi's sarcoma? : original researchSource: South African Family Practice 55, pp 473 –476 (2013)More Less
Objectives : Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness. A spectrum of non-Kaposi's sarcoma clinical and histopathological mimickers contributes to the potential over- or underdiagnosis of Kaposi's sarcoma. The aim of this audit was to investigate the clinical diagnostic accuracy of Kaposi's sarcoma and to find out whether or not knowledge of the human immunodeficiency virus (HIV) serostatus influenced the clinical diagnostic accuracy.
Design : Cross-sectional study of 511 mucocutaneous biopsies.
Settings and subjects : All the biopsies were from African patients from the Limpopo province. The HIV seropositive status was known in 327 cases (64.2%). The clinical diagnosis, provided in 369 cases (72.2%) was compared with the biopsy. A Kaposi's sarcoma herpesvirus-positive immunophenotype on biopsy served as the diagnostic gold standard.
Outcome measure : Concordance or discordance between the clinical provisional diagnosis and the histopathological gold standard.
Results : The rate of provisional clinical diagnosis of non-Kaposi's sarcoma in biopsy-proven Kaposi's sarcoma was 18.1% in HIV-positive, and 39.5% in HIV unknown, serostatus (chi-square 11.8, p-value = 0.0006). The concordance between the clinical diagnosis and biopsy was 76.5% in the HIV-positive, and 49.9% in the HIV-unknown, cases (chi-square 16.9, p-value < 0.0001).
Conclusion : Knowledge of the patient's serostatus significantly improved the clinical diagnostic accuracy of Kaposi's sarcoma. Biopsy remains the diagnostic gold standard.
Integrating tuberculosis/HIV treatment : an evaluation of the tuberculosis outcomes of patients co-infected with tuberculosis and HIV in the Breede Valley subdistrict : scientific letterSource: South African Family Practice 55, pp 478 –479 (2013)More Less
Background : The Infectious Disease Clinic of Worcester Hospital introduced an integrated tuberculosis/human immunodeficiency virus (HIV) service in July 2009 to provide comprehensive management to patients who were co-infected with tuberculosis and HIV.
Method : In a retrospective cohort study that was carried out from 1 July 2009 to 31 March 2010, the tuberculosis outcomes of co-infected patients attending the Infectious Disease Clinic for antiretroviral (ARV) treatment and receiving their tuberculosis medication at the Infectious Disease Clinic, were compared with those of patients receiving ARV treatment at the Infectious Disease Clinic and tuberculosis treatment at their local clinic.
Results : Seventy-four per cent of patients completed their treatment and 26% were cured, with no defaults or deaths, in the tubercuolosis/HIV integrated cohort. Thirty-eight per cent completed their treatment, 45% were cured, 9% died and another 9% defaulted in the cohort receiving their tuberculosis treatment at a local clinic. This indicates that there was a significantly better tuberculosis outcome in the tuberculosis/HIV cohort (p-value < 0.05).
Conclusion : The significantly better tuberculosis outcome that resulted when tuberculosis and HIV services were integrated led to services being integrated in the Breede Valley subdistrict.
Author Chris EllisSource: South African Family Practice 55 (2013)More Less
A while ago, my receptionist came through to say that a patient had phoned our rooms in a panic and asked to see me as an emergency. I was very booked up, but said that I would fit her in just before lunch. She arrived early and was obviously anxious. It turned out that she had gone to the chemist and had had a cholesterol test. The result was 6 mmol and the chemist had told her it was "too high" and "above normal". She thought that she was going to have a stroke immediately and had come in for a check-up.