South African Family Practice - Volume 57, Issue 6, 2015
Volume 57, Issue 6, 2015
Author Gboyega A. OgunbanjoSource: South African Family Practice 57 (2015)More Less
As we end the year 2015, you may be wondering the choice of this editorial in a Family Practice journal. The interest stems from a personal visit in mid-2012 to the National Centre for Nano-Structured Materials (NCNSM) located at the grounds of the Council for Scientific and Industrial Research (CSIR), Pretoria South Africa. The NCNSM focuses on the development of new materials using nanotechnology, and on the applications of nanotechnology in the manufacturing, energy and health sectors. This editorial focuses on the opportunities and possible risk(s) of nanotechnology.
Source: South African Family Practice 57, pp 4 –11 (2015)More Less
Background: Hypothyroidism is a common clinical condition confronting all healthcare practitioners yet there remains uncertainty about the optimal medication and optimum treatment targets. In addition, many patients remain symptomatic despite using recommended medications and attaining recommended treatment targets.
Methods: All endocrinologists in South Africa who consented to be part of the guideline process were assigned various aspects of the management of patients with thyroid disease. In each section the current literature was reviewed and the level of evidence was graded. This information was then presented at a guideline meeting. Where evidence was lacking a consensus among participants was adopted.
Results: This guideline provides 11 recommendations for the management of primary hypothyroidism, secondary hypothyroidism and subclinical hypothyroidism in adults.
Conclusions: This is the first South African guideline for the management of hypothyroidism in adults and represents a comprehensive review of the current literature in an attempt to provide evidence-based guidance for all healthcare practitioners regarding the many clinical aspects encountered when managing patients with hypothyroidism.
Author Jacky Van SchoorSource: South African Family Practice 57, pp 12 –15 (2015)More Less
Vasomotor symptoms, such as hot flushes and night sweats, are considered to be the cardinal symptoms of menopause, and are experienced by most women. The physiology of hot flushes is not fully understood, and is likely to reflect the interplay between multiple central and peripheral physiological systems. Reproductive hormones play an integral role, as evidenced by the onset of vasomotor symptoms during the dramatic reproductive hormone changes of the menopausal transition, and by the efficacy of exogenous oestrogen in the treatment of hot flushes. Menopausal hormone therapy with oestrogen, and with or without a progestogen, is the most widely studied and most effective treatment option for the relief of menopause-related vasomotor symptoms. It is also considered to be the standard of care for women with moderate to severe vasomotor symptoms.
Author Lynn LambertSource: South African Family Practice 57, pp 16 –20 (2015)More Less
Acne vulgaris is a common skin condition with a high prevalence in teenagers and young adults. It is a condition of the pilosebaceous follicles, resulting in comedones, papules, pustules or nodules which occur primarily on the face, but which may also present on other areas of the body. Although acne is not physically disabling, its psychological impact is highly significant, contributing to low self-esteem, depression and anxiety. As a result, there is a significant demand for effective acne therapies.
Author Robin GreenSource: South African Family Practice 57, pp 22 –23 (2015)More Less
Apart from medication to control asthmatic inflammation, the education of patients and parents is the most important therapeutic step in achieving asthma control and normal life. This is a critical, but sadly often neglected, activity. It can be stated with certainty that an asthmatic who does not know the information outlined in this paper will never be free of asthma symptoms. Education is important at every visit, and is not time consuming or difficult to perform. This plan is easy to remember and use.
Pharmacotherapy during pregnancy, childbirth and lactation : points and principles to consider (a 2015 update) : reviewSource: South African Family Practice 57, pp 24 –29 (2015)More Less
Pregnancy, childbirth and lactation pose unique challenges in terms of drug therapy. The pregnant mother and her unborn child are exceptionally vulnerable from a physiological, clinical and ethical standpoint. This warrants careful consideration with respect to a number of important aspects, which could firstly influence the decision to opt for drug therapy, and secondly, could influence the specific agent selected for each indication. The US Food and Drug Administration has introduced changes to the content and format of information presented in prescription drug labelling to assist healthcare providers when assessing benefit versus risk, and in the subsequent counselling of pregnant woman and nursing mothers who need to take medication. This change came into effect at the end of June 2015. This article provides an overview of these important aspects.
Source: South African Family Practice 57, pp 30 –33 (2015)More Less
Acute kidney injury (AKI) is a condition that is characterised by an abrupt reduction in kidney function, and is not limited to acute renal failure. However, it is potentially treatable. Failure to do so may result in death or progression to chronic kidney disease (CKD). AKI requires urgent management in order to ensure a better clinical outcome. Traditionally, AKI is classified according to aetiology, i.e. pre-renal, intrinsic renal and post-renal AKI. Clinical features depend on the age of the patient, the cause and related complications. Symptoms and signs may be non-specific, e.g. poor feeding and vomiting, or more specific, e.g. oedema, macroscopic haematuria and oliguria. The staging of AKI is based on the estimated glomerular filtration rate and urine output. AKI from any cause increases the risk of CKD developing, and vice versa. There are absolute indications for renal replacement therapy, e.g. anuria, whereas other patients can be managed successfully conservatively.
Author Chris EllisSource: South African Family Practice 57 (2015)More Less
In years gone by, the diagnostic process was an intellectual exercise in history taking and examination, then choosing the appropriate investigation. In the Medieval Ages, when I started practising, we performed X-rays and a few blood tests, and had a centrifuge and microscope in the consulting rooms. There were no ultrasounds or scans, and I was mostly confident of my assessments based on the history and examination.
Reasons for and perceptions of patients with minor ailments bypassing local primary health care facilities : researchSource: South African Family Practice 57, pp 333 –336 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1102538More Less
Introduction: Despite having access to several clinics and health centres in their local communities, numerous patients opt to go directly to hospitals for non-emergencies and minor ailments. Reasons for this include their perceptions of the quality of primary health care services, the attitudes and perceptions of health workers, opening hours of clinics, community involvement and participation, and drug and equipment availability as well as the quality of infrastructure. Perceptions of size, a lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed their local primary health care facilities.
Aim: This study aimed to identify the reasons given by patients presenting with minor ailments, for bypassing their local primary health care facilities in the Greater Tzaneen municipal area to Letaba Hospital.
Methods: A cross-sectional descriptive study was performed at Letaba Hospital over a three-month period, from 23 June 2008 to 15 August 2008, in which non-referred patients presenting with minor ailments were randomised and entered into the study on a voluntary basis. A preset questionnaire was utilised for data-collection purposes. A total of 293 participants were included in the study. The questionnaire aimed to determine the demographic profile of patients who present with minor ailments at hospital, to explore the reasons why these patients bypass their local clinics and to evaluate their knowledge, perceptions and attitudes regarding their local clinics.
Results: Most patients indicated that they came to the hospital because they wanted to be seen by a doctor, followed by the request to see a dentist. The study identified that patients expressed both positive and negative opinions concerning their local clinics.
Conclusion: Numerous factors influence the service-seeking behaviour of rural patients. Patients bypass their local clinics due to perceptions regarding the quality of health care services at the hospital. Improving the quality aspects of clinics and enhancing the services rendered will not only increase the utilisation of clinic services, but also reduce hospital overcrowding.
Integration of non-communicable chronic diseases (NCDs) and HIV/AIDS and mental health care through the involvement of chronically ill patients using empowerment evaluation : researchAuthor Claire Van DeventerSource: South African Family Practice 57, pp 337 –346 (2015)More Less
Background: The emphasis in health care in South Africa is gradually shifting to acknowledge the different roles patients have regarding their own care. There is, however, very little evidence of this practice and of related practical outcomes.
Methods: In the North West province, empowerment evaluation was used as the vehicle for patient engagement in integrating and improving services for chronically ill patients, namely those with non-communicable diseases (NCDs), HIV and mental illnesses at primary health care (PHC) clinics. This research was designed as an additional intervention in an ongoing quality improvement (QI) cycle, which had started in 2007. Empowerment evaluation shares many participatory action research qualities with an emphasis on collaboration, emancipation and the creation of new knowledge but with the additional aspect of evaluating and monitoring the processes that have been co-developed.
Results: After 62 visits to 9 facilities over a year and after capturing 332 patient and health worker opinions and ideas, many interventions were implemented leading to improved flow at clinics, a heightened awareness of good services, interesting performance-measuring tools and patient/staff teams that acknowledged their symbiotic strength. Objective measurements comparing clinics that had been exposed to the Integrated Chronic Disease Model (ICDM, which is explained in the article) and those with the collaborative patient/staff groups showed no significant difference in clinical outcomes or waiting times. However, waiting time had improved across one sub-district. This may be because the ICDM clinics have been functioning for four years and the research clinics for only one year. There have also been many external influences on the project, such as a number of new doctors appointed at clinics, under the National Health Insurance pilot project, a high turnover of staff, a new chronic drug policy, stable patients being able to access their medication at external 'pick-up points' and others.
Conclusions: It was found that the potential of patients and patient-staff collaboration are being under-utilised in a resource-strained sector where the harnessing of this potential might contribute positively towards QI in health.
The influence of family characteristics on glycaemic control among adult patients with type 2 diabetes mellitus attending the general outpatient clinic, National Hospital, Abuja, Nigeria : researchSource: South African Family Practice 57, pp 347 –353 (2015)More Less
Background: There is an increasing epidemic of diabetes worldwide with many patients not achieving set treatment targets. Family interventions in diabetes patient management, a proven adjunct, have not been fully integrated to patient care.
Method: A cross-sectional and descriptive study was conducted in the outpatient clinic of the Department of Family Medicine, National Hospital, Abuja. A total of 156 adult patients with type 2 diabetes were recruited between August and October 2012 with 145 (93%) completing the study. The Statistical Package for Social Sciences (SPSS) version 17.0 was used to enter and analyse the data.
Results: A total of 145 subjects (81 females, 64 males) were studied. Assessment of the relationship between the family characteristics and glycaemic control was significant for family functional status by APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), which represents the questionnaire categories and social support by the Modified Scale for Perceived Social Support (MSPSS), p-value < 0.000.
Conclusion: There was a significant relationship between family function and social support and glycaemic control among type 2 diabetic patients attending the general outpatient clinic in the National Hospital, Abuja, Nigeria.
Perspectives of undergraduate module convenors at a South African academic institution on medical student training in evidence-based health care : a qualitative study : researchSource: South African Family Practice 57, pp 354 –360 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1090689More Less
Background: The increasing disease burden in Africa requires medical graduates to have problem-solving abilities. Interviews were conducted to assess module convenors' perspectives on evidence-based health care (EBHC) teaching and learning.
Methods: Qualitative research methods were used. Faculty convening medical undergraduate teaching modules were purposively sampled. Data collection was done using focus-group or individual interviews. Trained interviewers conducted interviews. Investigators conducted data analysis and interpretation.
Results: Five focus groups and 10 individual interviews were conducted with convenors responsible for theory and clinical modules across various disciplines. Interviewees felt that EBHC teaching and learning were not optimal and indicated varying support for enhancing this. They identified various factors to be considered: contextual factors within the faculty (e.g. recognition for teaching), health sector issues (e.g. clinical workload), access to research, lecturer factors (e.g. competing priorities) and learners (e.g. motivation). They emphasised the key roles of lecturers as role models. Planning together to identify opportunities to integrate teaching and assessment, while ensuring coherence, clear explicit outcomes and promoting faculty development, was regarded as central to strengthening EBHC teaching and learning.
Conclusions: The perspectives of module convenors are key to informing strategies to enhance EBHC teaching and learning.
Potential barriers to focused antenatal care utilisation by HIV-positive pregnant women in Swaziland : researchSource: South African Family Practice 57, pp 361 –363 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1085223More Less
Background: Maternal mortality and human immunodeficiency virus (HIV) continue to be major challenges to the Kingdom of Swaziland. In the past, the government introduced focused antenatal care and integrated it with national strategies to reduce maternal mortality and the mother-to-child transmission of HIV. It was anticipated that individualised and integrated principles guiding the focused antenatal care model would enhance the quality of care received by pregnant women, consequently leading to high utilisation of the antenatal care services, a low rate of mother-to-child transmission of HIV and better pregnancy outcomes.
Method: The study used a qualitative, descriptive and exploratory design, with individual semi-structured, face-to-face interviews. A total of 18 interviews were conducted with 18 HIV-positive pregnant women who attended at least two antenatal care visits at a regional referral hospital.
Results: Seven potential barriers emerged from the thematic comparative content analysis of the participants' descriptions. These were long waiting hours, poor equipment, nonadherence by the nurses with the working hours, fragmented care, lack of privacy, the length of time spent with health professionals, and inadequate health education.
Conclusion: It is essential for healthcare providers to understand and address the factors which are viewed by HIV-positive pregnant women as being potential barriers to the use of focused antenatal care.
Practices employed by audiologists in the management of adult patients with multidrug-resistant tuberculosis in South Africa : researchSource: South African Family Practice 57, pp 364 –373 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1085222More Less
Introduction: Aminoglycosides used for treating multidrug-resistant (MDR) tuberculosis are ototoxic, leading to a need for audiological monitoring. While audiologists monitor ototoxicity, currently there are no guidelines on monitoring in the South African context. Therefore, the findings of this study might help to motivate the establishment of a more in-depth ototoxicity monitoring policy, which facilitates uniformity among audiologists managing patients with MDR tuberculosis. Therefore, the study aimed to describe the audiological practices employed by audiologists in the management of adult patients with MDR tuberculosis in South Africa.
Method: A descriptive survey design was used. A questionnaire was developed and included elements of the American Speech-Language and Hearing Association (1994) guidelines for monitoring ototoxicity. Ninety-three audiologists contributed data to this study. Descriptive statistics were used in the analysis of the data.
Results: Sixty-eight percent (%) of the respondents were aware of the international guidelines, 93% provided pre-treatment counselling and 87% conducted a baseline assessment. Nineteen per cent of the respondents conducted high-frequency audiometry, while 74% carried out a monthly evaluation, 72% performed a full audiological assessment after the cessation of the MDR tuberculosis treatment, and 96% conducted post-treatment counselling. Modifications to the international guidelines include not conducting speech and immittance audiometry, as well as testing certain frequencies. The reasons for these modifications include limited specialised equipment, time constraints, large caseloads and understaffed departments.
Conclusion: There are no explicit guidelines on ototoxicity monitoring in South Africa. Consequently, audiologists are having to modify the international guidelines. Thus, there is no consistency in managing patients with MDR tuberculosis. This highlights the need for South Africa to develop context-relevant ototoxicity monitoring guidelines to appropriately manage patients withMDR tuberculosis.
Perceptions of the HIV counselling and testing programme by patients in a rural regional hospital in South Africa : researchSource: South African Family Practice 57, pp 374 –380 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1080979More Less
Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have become a major public health challenge worldwide in the past few decades. The impact is felt in all sectors in South Africa, as in other parts of sub-Saharan Africa. Several health-related approaches have been adopted to facilitate an understanding of and reduction in the risk factors associated with HIV and AIDS. Following the demonstration of underperformance by the new voluntary counselling and testing (VCT) guidelines in South Africa, otherwise referred to as HIV counselling and testing (HCT), in providing practical suggestions on ways to optimally engage clients to ensure that testing for HIV is being performed, an evaluation to ascertain other patient-influencing factors on healthcare worker-initiated HCT was needed. Thus, the aim of this study was to describe patients' perceptions of the benefits of and barriers to HCT, and their willingness to test.
Method: One hundred and seventy-two patients referred for HCT were randomly selected over a three-month period. Data were collected by a research assistant using the modified standardised World Health Organization/ Health Global Access Project (HGAP) questionnaire.
Results: The majority of the participants demonstrated a good perception of the benefits of and barriers to HCT, and most reported good self-efficacy with regard to protecting themselves against HIV infection and preventing the acquisition thereof. However, only 74% were confident enough to test for HIV, while 28% reported being reluctant to notify their partners of their status if they tested positive, and 38% reported fear of healthcare workers showing discrimination as a barrier to HCT.
Conclusion: Despite excellent perceptions of the HCT programme, a significant association between participants' perceptions of HCT and their willingness to test for HIV was not reported (p > 0.05).
Understanding the challenges and opportunities encountered by the elderly in urban KwaZulu-Natal, South Africa : researchSource: South African Family Practice 57, pp 381 –386 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1078154More Less
Background: This article is based on research conducted by students at the University of KwaZulu-Natal as part of the course-work requirements in the research module in social work in students' final year of study. Although each student conducted only one interview, when combined, the rich data allowed students and lecturers (the authors of this article) to glean significant understandings pertaining to the needs and problems of the elderly in KwaZulu-Natal, South Africa.
Methodology: Qualitative paradigm using exploratory and descriptive designs and an interview guide.
Results and conclusion: The findings highlight the insecurity and vulnerability of the elderly, specifically pointing to their social and emotional neglect, with family members taking advantage of these positions of want; their living circumstances where they were exposed to crime and/or living in cramped conditions because of accommodating family members who did not have their own homes; uninvited grandparenting responsibilities; poverty and food insecurity suffered by them as well as unresolved health concerns. Finally, the article concludes with recommendations for both future research and services.