South African Family Practice - Volume 50, Issue 1, 2008
Volume 50, Issue 1, 2008
Source: South African Family Practice 50 (2008)More Less
Background: The Health Sector and the rendering of health services in South Africa have undergone substantial adjustment since the political change in 1994, filtering through to academic medicine. The managerial responsibilities of the Heads of Department at Medical Schools multiplied. In order to improve their management skills; decrease their frustration; and optimally utilize the highly skilled person-power available, this study endeavoured to establish a management model for use by experienced as well as new Heads of Department in a School of Medicine, measured against the background of good management practices.
Methods: A descriptive, explanatory survey comprising a literature review, a questionnaire survey and a Delphi process was performed. The literature study covered a few aspects, including assessing the possible needs of Heads of Department, exploring factors impacting on their environment, as well as the difference between management and leadership, and the difference between various management models that may be applicable to management in an academic setting such as a Medical School. The second part of the empirical study was the Delphi process, which involved six experts from the areas of management, health management, and education. A quantitative approach with open-ended questions was followed, focusing on measurement of experts feelings about these areas.
Results: Heads of Department are appointed in the academic environment with the primary focus on their educational achievements. Throughout the process, it was demonstrated that this is still relevant and needs to be part of the appointment process of Heads of Department in a School of Medicine. It was also indicated throughout this study that there is an increasing expectation from Heads of Department to take on sole responsibility for the management of their departments. In view of these developments, it was important to consider assisting them through establishing a management model, thus empowering them to manage their departments in the future. The main findings from the questionnaire to Heads of Department, the Delphi technique, and information obtained via the literature study enabled the researcher to make a recommendation on a management model that is flexible, individualized, relevant, and adaptable for Heads of Department at the School of Medicine at the UFS.
Conclusion: Resources and services are spread thin by challenges from political changes and other challenges such as the AIDS pandemic and tuberculosis. Emphasis has shifted from hospital-based care to primary health care adding another dimension to the management strategy of academic institutions. A management model, the PRIME model, was developed that is simple, flexible, allows for individuality, integration and efficiency and should be easy to implement. It adds quality to management tasks but also to lives. It embraces multi-tasking and still focuses on the key position of the leader, while allowing growth and development of new talent. It is adjustable and should be the model of choice to address the ever changing environment of health management. It is recommended that a future study be conducted evaluating the possibility of utilising the principles of the PRIME model in other Medical Schools in South Africa in order to assist them with the managerial problems they might be experiencing.
Factors influencing the development of practical skills of interns working in regional hospitals of the Western Cape province of South Africa : original researchSource: South African Family Practice 50 (2008)More Less
Background: Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task. It starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year.
Methods: Focus groups involving 25 interns with 11 months' experience from five regional hospitals were used. Six themes were identified. These were undergraduate training, the student's attitude, the intern's approach to learning skills, opportunities for interns in regional hospitals, backup and support, and personal growth in procedural skills.
Results: The majority of the participants found that their training at medical school prepared them adequately for the intern year. An obstacle to skills training at university was the structure of the teaching tertiary hospital, with its emphasis on rare diseases and lack of opportunities for hands-on experience. The amount of skills that were learned at university was related to the enthusiasm of the student.
Once the student had qualified and was employed in a regional hospital, opportunities to learn skills were available in excess. The benefit of doing an internship in a regional hospital was described as a fine balance between opportunities, responsibilities and backup. In all the focus groups, the interns remarked on the high level of responsibilities that they had to bear, but this spurred them on in the learning of skills. The relationship between intern and senior doctor was important when it came to learning procedures. In most hospitals, the junior doctors perceived the backup cover available to them as adequate.
Consensus existed as to the value of such an intern year and its importance in gaining procedural skills. At the start of the year, most interns experienced a lack of confidence, together with a sense of fear that they might not be adequately prepared to do the work expected of them. Confidence seemed to grow as the year progressed, and this was linked to experience and the successful completion of procedures, as well as adequate backup. It was found that, by the end of the year, graduates from different universities with varying emphasis on practical skills all performed at a similar level.
Conclusion: The findings of this study affirm the literature in suggesting that skills training at university needs to be standardised by the introduction of a core curriculum in procedural skills. Learning outcomes should be fashioned around the relevant competencies required in the pre-registration year. It is vital for the training of new doctors that the internship year be optimised in terms of opportunities and backup as part of a strategy to improve skills training. The value of regional hospitals in teaching junior doctors clinical skills is emphasised.
Author B.L. MeelSource: South African Family Practice 50 (2008)More Less
Background: The epidemiology of rape is a very complex issue that is difficult to research. The meaning of rape is different for different countries, religions, and socio-economic groups, and it involves both stigma and discrimination. Therefore, rape statistics are either not available or incomplete. This study was an attempt to highlight the problem of rape in the Mthatha area of the Eastern Cape Province in South Africa.
Objectives: To estimate the trend of sexual assault in the Mthatha area of South Africa.
Methods: This is a review of the Sinawe Centre's records of victims of sexual assault. The centre is the only official centre in this region that deals with cases of sexual assault.
Results: A total of 2 378 victims of sexual assault seen at Sinawe Centre over a period of six years (20012006). The average rate of sexual assault was 198 per 100 000 women a year. There was a tenfold increase of sexual assault from 39 per 100 000 women in 2001 to 417 per 100 000 women in 2006. Of the victims, 70.9% were children under the age of 20 years. In total, 46.3% were under the age of 16 years, and 22.9% were younger than 11 years. Children of five or younger represented 9.4% of the sexual assault victims. The least vulnerable age group (1.3%) is those between 46 and 50 years. The minimum cost for a successful conviction of a rape case is between R5 000 and R10 000, and, of course, does not account for the pain and suffering of the family involved.
Conclusion: The rate of sexual abuse is increasing in the Mthatha area of South Africa.
Clinical features of patients with systemic lupus erythematosus (SLE) attending the SLE outpatient clinic at Universitas Hospital in Bloemfontein, South Africa : original researchSource: South African Family Practice 50 (2008)More Less
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, a type of self-allergy, whereby the patient's immune system creates antibodies that attack the person's own body tissues instead of protecting the body from bacteria and viruses. In most cases the cause of SLE is unknown, although it is believed that many factors may be involved, including genetic predisposition and environmental factors such as excessive sun exposure, infections, antibiotics (especially those in the sulpha and penicillin groups), extreme stress, certain drugs, and hormones. Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American College of Rheumatology (ACR) has compiled a list of 11 symptoms or signs of which a person should have four or more to be classified as SLE. The genetic pool and environmental factors differ in different regions. The Free State and Northern Cape are known for a dry and sunny climate, as well as cold winters. The aim of this study was to determine the most common features of patients with systemic lupus erythematosus attending the outpatient clinic at Universitas Hospital in Bloemfontein, South Africa.
Methods: For this descriptive study, the study population included all patients attending the SLE clinic at Universitas Hospital diagnosed with SLE according to the ACR classification criteria. Patients were only included if they had at least one follow-up visit. Patients who had discoid lupus were excluded. Data were collected from patient files using a confidential and anonymous data form.
Results: Data were obtained from 76 patients: 71 females (94.7%) and five males (5.3%). African patients accounted for 61.3% of the study population, whites for 33.9%, Asians for 1.6% and coloureds for 3.2%. Patients most frequently had immunological (90.8%), mucocutaneous (86.9%), musculoskeletal (85.5%) and cardiovascular problems (77.6%).
Conclusion: Most of the findings correlate with similar studies worldwide. However, mucocutaneous manifestations and Raynaud's phenomenon were more prevalent in our study population. From this it can be deduced that the climate may play an important role. Further research needs to be conducted to investigate this hypothesis.
Evaluation of clinical medicine in the final postgraduate examinations in Family Medicine : original researchSource: South African Family Practice 50 (2008)More Less
Background: The Family Medicine Department, University of the Free State (UFS) recently supervised the MFGP assessments of the College of Medicine in South Africa (first sitting), as well as the final assessment of the M Med Fam programme of the UFS (second sitting). The examinations, which took place in October and November 2006, were subjected to an internal quality assurance evaluation with the view to improve the standard and reliability of the examinations.
Methods: All the candidates, as well as the examiners who participated in the MFGP and M Fam Med examinations, were included in the evaluation. Opinions were obtained from the students and examiners for each assessment on a structured data form directly after the examinations. A Smits blueprint was established for the written paper.
Results: The majority of the students assessed the OSCE as being fair, understood the questions and agreed with the time allocated per question. A broad variety of competencies were assessed in a structured manner, which enhances the reliability of the examinations. The examiners evaluated the OSCE as being well structured and fair, as well as testing for the competencies of a family physician. Good agreement was achieved between the two different sets of candidates and examiners, and similar marks were achieved despite the separate settings, thus enhancing the validity of the examinations. The structured oral was evaluated as being fair regarding the variety and relevance of the questions by all the candidates and examiners. The written paper was on a relatively high cognitive level and tested a broad spectrum of knowledge. Although it did not cover the entire module, skills and approaches necessary for problem solving were tested. If a student could master these problems, he / she should be able to manage other areas not covered in the paper.
Conclusion: The authors are of the opinion that the quality evaluation of clinical medicine in the final postgraduate examinations in Family Medicine held at UFS in 2006 showed it to be authentic, fair, reliable and objective, and that it assessed competencies for real-life situations, as well as the theoretical knowledge, attitudes and values required for a family practitioner.
Knowledge, attitudes and management of alcohol problems in general practice in rural South Africa : original researchSource: South African Family Practice 50 (2008)More Less
Background: There has been increasing emphasis on the role of primary health care in the prevention and management of alcohol-related harm. The aim of this study was to determine attitudes to and management of alcohol problems in general practice in rural South Africa.
Methods: A total of 61 general practitioners (GPs) were interviewed with the aid of a structured questionnaire (response rate 50%) in two rural districts.
Results: The results indicate that 51% of the GPs felt that alcohol is an important issue in general practice. GPs were able to discriminate accurately between cases of problem drinking and alcohol dependence. GPs who reported high levels of alcohol-related education and training were more prepared to counsel problem drinkers, expressed more therapeutic commitment in their role and reported more appropriate management of these patients than did GPs with lower levels of Continuing Medical Education (CME) experience. Alcohol problems are recognised as an important problem in general practice, and improved training could increase the identification and management of alcohol problems in primary care. GPs rated the most critical barriers to alcohol interventions as competency training, role endorsement, not being adequately reimbursed, health policy not supporting prevention and their own alcohol problem.
Conclusion: Alcohol problems are recognised as an important problem in general practice, and improved training, adequate reimbursement and health policy support could increase the identification and management of alcohol problems in primary care.
The practice of medicine at a district hospital emergency room : Middelburg Hospital, Mpumalanga Province : original researchAuthor L. NkombuaSource: South African Family Practice 50 (2008)More Less
Background: The aim of this study was to establish the type of clinical work done by the doctors in the emergency room at a district hospital in an underserved area. The findings of the study would assist the management in planning for training, recruitment and allocation of medical and nursing personnel.
Methods: This was a prospective and descriptive study undertaken in the emergency department of Middelburg Hospital in Mpumalanga Province, South Africa. The subjects were patients who presented to the emergency room during the period of the study, in January 2005.
Results: The findings of this survey show clearly that Middelburg Hospital in Mpumalanga receives patients with life-threatening and non-life-threatening conditions in the emergency room every day. The top diagnoses made during the one month of the study were assault-related injuries, motor vehicle accident-related injuries, respiratory tract infections, lacerations, soft tissues injuries, gastroenteritis, fractures, poisoning, hypertension and parasuicide.
Conclusion: The challenges of practising at a district hospital are that a practitioner has to be knowledgeable and skilful in a wide range of disciplines. To remain in touch with the changing environment of medicine, one has to keep on learning and sometimes attend refresher courses far away from the place of work. The rewarding part of the practice is that many junior doctors benefit from the experience of the senior colleagues, who teach them basic skills. A practitioner wishing to work at Middelburg Hospital should be skilful in managing common trauma patients, patients with complicated medical conditions, e.g. diabetes mellitus and hypertension, and in managing acute poisoning, respiratory infections and gastroenteritis. In other words, the practitioner must have adequate diagnostic and therapeutic skills.
Author Gboyega A. OgunbanjoSource: South African Family Practice 50 (2008)More Less
Welcome to the new look CPD section of the South African Family Practice journal. In each issue, six to eight CPD articles relevant to family practice will be presented in very reader-friendly formats with practical tips. The focus of the articles will be to present topics with current information that is evidence-based to support management decisions.
Author F.J. RaalSource: South African Family Practice 50, pp 7 –10 (2008)More Less
Atherosclerosis begins in childhood. Not uncommonly, the first presentation of atherosclerosis is sudden cardiac death. It therefore makes sense that risk-factor modification to prevent the development or delay the onset of atherosclerosis needs to begin early in life. Dietary intervention is the key component for the primary prevention of hyperlipidaemia. However, if diet and lifestyle fail to correct hyperlipidaemia, drug therapy may have to be considered. All children and adolescents with high-risk lipid disorders such as familial hypercholesterolaemia (FH), those with diabetes mellitus or other cardiovascular disease risk factors or with a family history of premature coronary artery disease should be considered for lipid-lowering therapy if diet and lifestyle intervention are ineffective. There are now numerous studies that have documented the safety and efficacy of statin therapy in both children and young adults. Based on these studies, it is now recommended that statin therapy be initiated in all male FH children from the age of ten years and at the onset of menses in females with FH. The initiation of statin therapy could be considered even earlier in FH children at high risk.
Author H.R. SchneiderSource: South African Family Practice 50, pp 13 –17 (2008)More Less
Upper gastrointestinal bleeding occurs commonly. Fortunately, severe life-threatening bleeding is less common, but can be catastrophic, particularly in the elderly patient with co-morbidity such as cardiac or respiratory disease. In order to reduce the risk of bleeding, it is necessary to examine the causes of bleeding and, where possible, modify the risk factors. This review will focus on the prevention of non-variceal upper gastrointestinal bleeding.
Source: South African Family Practice 50, pp 23 –27 (2008)More Less
The traveller who presents with fever on return requires a comprehensive assessment. This paper outlines the salient features in assessing these patients. A detailed history, examination and knowledge of diseases prevalent in the areas that were visited is essential if one is to arrive at a diagnosis and institute appropriate treatment or referral.
Malaria remains the first differential diagnosis in travellers returning from an endemic area irrespective of precautions taken.
The most common illnesses that result in a fever in travellers are presented and a resource list is provided.
Author W.G.J. KloeckSource: South African Family Practice 50, pp 29 –32 (2008)More Less
Manifestations of anaphylaxis may occur within seconds or minutes after exposure to a causative antigen. Almost any substance can be implicated as a potential precipitating agent. Reactions may be slow, progressive, or rapidly fatal within minutes. Any healthcare worker involved in the administration of medications or the care of patients, whether a doctor, dentist, nurse, paramedic or allied health professional, is ethically obliged to be able to appropriately manage the potential consequences of such an action - a life-threatening anaphylactic reaction.
Author D.G. Van ZylSource: South African Family Practice 50, pp 35 –39 (2008)More Less
Diabetic ketoacidosis (DKA) is the most frequent hyperglycaemic acute diabetic complication. Furthermore it carries a significant risk of death, which can be prevented by early and effective management. All physicians, irrespective of the discipline they are working in and whether in primary, secondary or tertiary care institutions, should be able to recognise DKA early and initiate management immediately.
Preventing osteoporosis in postmenopausal women : treatment approaches for family practitioners : CPDAuthor T.J. De VilliersSource: South African Family Practice 50, pp 41 –47 (2008)More Less
Osteoporosis is defined as a systemic skeletal disorder that reduces the strength of bone, resulting in an increased risk of fracture. Fractures occur, even if an individual is subjected to minimal trauma such as a fall from own body height. The most common osteoporotic fractures are fractures of the vertebrae, femur neck and distal forearm but other peripheral fractures also play an important role. Osteoporotic fractures are common and will affect at least a third of women over the age of 50 years. It not only leads to significant morbidity, but also increased mortality. Osteoporosis is an age-related disease. In view of expectations that life expectancy is on the rise, the scope of the problem and the burden of the disease will escalate in future. The incidence of osteoporotic fractures in South Africa has not been recorded and most of our calculations are derived from Europe and North America. A false impression has been created that Black South Africans are not prone to osteoporosis. It is true that ethnic Blacks have a lesser tendency to fracture at equivalent bone mineral density (BMD) values than do Europeans. This should however not distract from the fact that many Blacks suffer from the avoidable consequences of osteoporotic fractures. The prevention of osteoporotic fractures is a national priority for all our people. It is therefore obvious that the modern family physician needs to have a basic knowledge of the disease condition and a strategy for the prevention of fractures.
Source: South African Family Practice 50, pp 50 –52 (2008)More Less
In this post-modern world, there is a recognisable bent in the media to promote the idea of youth (read as synonymous with beauty and power) to the fullest. The result is that public perceptions of the normal bodily processes of aging are viewed as detrimental or unattractive. Since we are "social creatures", as Aristotle put it, the mediasation, for example, in magazines, TV, film, fashion, music, etc. of youth as ideal is bound to impact upon our individual ideas of 'what-is-good-for-me'. Since youth is viewed by society as a good, it is possible to understand an individual's desire to take advantage, when it is possible, of the cosmetic procedures that fortify this ideal. Moreover, since medical practitioners are part of the public, and no more or less swayed by such ideologies, it is also reasonable to assume that some will advantage themselves and take up the gauntlet of promoting youth, although perhaps in the more medical guise of 'remedying the ills of aging' in other words, enter the practice of cosmetic surgery.
Source: South African Family Practice 50 (2008)More Less
Caduet is a prescription drug that combines 2 medicines, Norvasc and Lipitor. Norvasc is used to treat high blood pressure (hypertension), chest pain (angina), or blocked arteries of the heart (coronary artery disease); Lipitor is used along with diet and exercise to lower high cholesterol. It is also used to lower the risk of heart attack and stroke in people with multiple risk factors for heart disease - such as family history, high blood pressure, age, low HDL-C, or smoking.
Author Pierre J.T. De VilliersSource: South African Family Practice 50 (2008)More Less
It is often said that the only constant thing in the universe is change. That indeed also applies to our discipline, family medicine. On 17 August 2007 regulations were promulgated making family medicine a medical specialty in South Africa, following the example of many other countries.
Author DeWet SwanepoelSource: South African Family Practice 50 (2008)More Less
Newborn hearing screening has seen tremendous growth in developed countries worldwide, having become the standard of public healthcare, with countries like the USA and UK screening nearly all newborns. Whilst the costs of universal screening for congenital or early onset hearing loss are significant they are offset by the tremendous gains afforded by early intervention in this common (2-6/1000) infant condition. Infants identified with hearing loss and receiving intervention within the first year of life are able to develop within the range of their normal hearing peers in critical areas of language, speech, cognition and education in stark contrast to late-identified children.
Author S. ReidSource: South African Family Practice 50, pp 62 –64 (2008)More Less
This is the story of a journey down a path of ideas and reflections about the role of music in the practice of medicine. It was stimulated, amongst other events, by a workshop entitled "The Arts in Medicine" presented at the 2007 'Network: Towards Unity for Health' conference in Uganda, by a team from the University of New Mexico. This led me to an article in the Annals of Family Medicine entitled "Jazz and the 'Art' of Medicine: Improvisation in the Medical Encounter" by Paul Haidet. But it is also informed, as many journeys are, by half a lifetime of experiences and unanswered questions, in my case, of medicine and of music as two separate and mutually exclusive activities. Medicine has taken the lion's share of my time and energy, and is clearly work for which I get paid, whereas music has been relegated to a hobby when time and energy allow. And I believe that there are many others in a similar situation - doctors or nurses or other health care professionals who are in fact very creative people, but for whom the demands and prerogative of the medical vocation has squeezed out music, art or other forms of expression, and relegated them to less central roles in their busy lives.
Co-morbidity of HIV, Hepatitis B, and Syphilis, among victims of sexual assaults in Transkei region, South Africa : letter : correspondenceAuthor Banwari L. MeelSource: South African Family Practice 50 (2008)More Less