G Joubert

The profile of adult nephrology patients admitted to the Renal Unit of the Universitas Tertiary Hospital in Bloemfontein, South Africa from 1997 to 2006

BACKGROUND This paper reports a retrospective audit of new patients referred to the Renal Unit at Universitas Academic Hospital in Bloemfontein, South Africa for the decade 1997-2006. METHODS All the files kept in the Renal Unit were reviewed for the main clinical presentation, a definitive pathological diagnosis (if obtained), age, race and gender of the patients. No consultations from other disciplines were included. RESULTS One thousand two hundred and sixteen patients were included in the study. The main clinical presentations were as follows: chronic renal failure (CRF), 461 (37.9%); nephrotic syndrome, 203 (16.7%); hypertension, 161 (13.2%); and abnormal urinary findings, 128 (10.5%). The nephrotic syndrome was the most common indication for renal biopsy, and histological investigation revealed focal segmental glomerulosclerosis in 46 (3.8%) patients, minimal change in 23 (1.9%), membranoproliferative disease in 36 (3.0%) and membranous glomerular disease (MN) in 28 (2.3%). In CRF, hypertension was suspected in 236/461 (51.2%) cases but was proven histologically in only 13 (2.8%) patients. CONCLUSIONS Socio-political factors impacting on access to healthcare most likely had an influence on the referral pattern of patients during this period. The largest group of patients were referred to our institution late in their disease with CRF, often requiring renal replacement therapy, and a definitive diagnosis was seldom possible at that stage. With the limited availability of dialysis facilities, the need for early detection and preventative measures with regard to renal disease in this community is evident.

The prevalence of HIV amongst women with cervix cancer

About 1 500 women die of cervix cancer in South Africa each year. Cervix cancer is the commonest cancer amongst African women and the fourth commonest amongst white women in South Africa. In addition more than half a million people contract HIV in South Africa annually and South Africa has the highest number of people living with AIDS in the world. A cross-sectional study of women attending family planning clinics in Harare Zimbabwe found abnormal cervical cytology in 25.6% of HIV-infected women versus 6.7% in unaffected women. A case-control study in the Ivory Coast found that cervix cancer was associated with HIV infection for women under the age of 40. In Nairobi Kenya a case-control study indicated that cases of patients younger than 35 years with cervix cancer were more likely to be HIV positive than controls of similar age (odds ratio 2.6 p=0.043). HIV-positive women were more likely to have poorly differentiated tumours than HIV-negative women (odds ratio 3.1 p=0.038). However the same group of researchers found that the two- to three-fold increase in national prevalence of HIV in Kenya from 1989 to 1998 did not have a proportional effect on the incidence of cervix cancer. HIV-positive women presenting with cervix cancer were however significantly younger than HIV-negative women presenting with cervix cancer as has also been found in studies in Johannesburg and Durban. (excerpt)

Reasons for Suboptimal Learning in Medical Microbiology.

ABSTRACT Medical microbiology presents a challenge to undergraduate students, mostly due to its extensive content and complexity of unfamiliar terminology. In addition to a narrative review of the literature, we report findings on students’ motivation for and approach to learning in the Infections module of an undergraduate medical curriculum, and their perceived lack of retention of knowledge acquired in the module, as determined by a self-administered, anonymous questionnaire. When students experienced information overload, they reverted to performance goals and the wrong motivation for learning. Their focus turned primarily to being successful in tests and examinations, and they consequently adopted a surface approach to learning. Surface learning and memorisation of facts without understanding its content usually result in moderate retention of knowledge, which could handicap the development of clinical reasoning. However, the concern about students’ perceived poor retention of knowledge can be laid to rest – the prognosis is not discouraging after all.

Percutaneous Injuries in Doctors in the School of Medicine, University of the Free State: Prevalence, Reporting and Adherence to Precautionary and Management Procedures

Abstract Background: Despite the official precautionary measures against percutaneous injuries, incidents still occur. Consequently, it is possible that healthcare workers could contract infections like HBV, HCV, HGV (hepatitis B, C and G viruses) and HIV (human immune deficiency virus). The most serious problem lies in the fact that percutaneous injuries are often underestimated, resulting in non-reporting of the incident. The aim of this study was to determine the incidence of percutaneous injuries in doctors in the School of Medicine at the University of the Free State (UFS), whether the incidents were reported, and the reasons for non-reporting. The use of gloves during procedures was also evaluated. Methods: A mainly descriptive study design was used. Questionnaires were administered from October 2006 through January 2007 to collect information. Participants were selected randomly, and the respondents were divided into surgical and non-surgical groups. Results: The respondents fulfilled the following roles and/or functions in their respective departments of employment: 35 (67.3%) were registrars, 12 (23.1%) were specialists/consultants, four (7.7%) were medical officers, and one (1.9%) was exclusively involved in student training. Two of the respondents did not indicate their roles and functions in their respective departments. A total of 82 incidents of percutaneous injuries occurred. Although the surgical groups handled sharp objects more frequently per week than the non-surgical groups (p-value = 0.04), more incidents occurred in the non-surgical groups (p-value = 0.02). Only 39 (47.6%) of the incidents were reported, while 44.4% of the respondents were aware of the correct reporting procedures. The reasons given for the non-reporting of these incidents were “too busy” (58.1%), “did not think it was serious” (48.8%), and “was not aware of the reporting procedures” (7%). Only 13.7% of the respondents indicated that they always used gloves when drawing blood, 17.4% used them when injections were administered, and 22.4% used gloves during intravenous cannulation. However, 86.8% of the respondents wore gloves when they used a scalpel or any other incision object. The respondents (n = 51) suggested that the three most important precautionary measures to take into consideration when working with sharp objects were (i) the use of gloves (23/51; 45.1%), (ii) never recapping a needle (9/51; 17.6%), and (iii) keeping the container for disposing of sharp objects close at hand (6/51; 11.8%). Conclusions: Despite the risk of percutaneous injuries, non-reporting still occurs. Although the rate of reporting these incidents could be compared with international findings published in the literature, it remains too low. Drastic measures should be taken to ensure that physicians are informed of the hazards of percutaneous injuries, as well as of the appropriate mechanisms of reporting these incidents.

Profile of children diagnosed with cerebral palsy at Universitas Hospital, Bloemfontein, 1991-2001

Cerebral palsy is a term used for a group of non-progressive but often changing motor deficits, which are a result of a lesion of the brain occurring at an early developmental stage.

Brachytherapy for cervical cancer: guidelines to facilitate patient-centred care in a multidisciplinary environment

Objective: To establish patient-centred guidelines to assist multidisciplinary members in providing quality care for cervical cancer patients receiving brachytherapy. Design: A qualitative research design. Main measures: This prospective research study was conducted from July 2012 to March 2014 and constituted five stages. Stage 1: 28 one-to-one semi-structured patient interviews were conducted, stage 2: development of the proposed guidelines, stage 3: two focus group reviews of the proposed guidelines, stage 4: refinement of these guidelines by review by national heads of brachytherapy units and stage 5: presentation of the final guidelines. Results: Four main themes with sub-themes were identified from the patient interviews. Patients’ perspectives of care were integrated into the development process of the proposed guidelines. Guidelines were developed to address the practice setting and define the collective and exclusive roles and responsibilities of the radiation oncologists, radiation therapists and oncology nurses. Content validity, clarity and applicability of the guidelines were confirmed. Conclusion: Guidelines were established integrating the patient experience into the development process. They provide a framework that clearly defines the roles and responsibilities of each member of the multidisciplinary team. Members are encouraged to implement the guidelines to ensure that quality patient-centred care is delivered, rendering patient satisfaction.

An evaluation of the assessment tool used for extensive mini-dissertations in the Master's Degree in Family Medicine, University of the Free State

Abstract Background: Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time Master of Family Medicine (MFamMed) to a full-time Master of Medicine (Family Medicine) [MMed(Fam)] degree, with changes in the curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the postgraduate programme for Family Medicine, at the University of the Free State, and if necessary, to produce a valid and reliable assessment tool that is user-friendly. Method: An action research approach was used in this study, using mixed methods. Firstly, marks given by 15 assessors for four mini-dissertations using the current assessment tool were analysed quantitatively. In Phase 2, the regulation of the assessment bodies and the quantitative results of Phase 1 were discussed by assessors during a focus group interview, and data were analysed qualitatively. An adapted, improved assessment tool (Phase 3) was developed and re-evaluated in Phase 4. Results: The current assessment tool complied with the regulations of the assessment bodies. The scores allocated to specific categories varied with a median coefficient of variation of more than 15% in four of the possible 12 assessment categories. During the focus group interview, reasons for this were identified and the assessment tool adapted accordingly. During reassessment of the tool, individual assessors were identified as the reason for poor reliability. Conclusion: The current assessment tool was found to be valid, but was not reliable for all assessment categories. The adapted assessment tool addressed these areas, but identified lack of training and experience in the assessment of extensive mini-dissertations by certain assessors as the main reason for unreliable assessment.

Learning medical microbiology and infectious diseases by means of a board game: Can it work?

Innovative teaching and learning is increasingly becoming part of medical education. We report the evaluation of a medical microbiology board game, Med Micro Fun With Facts (MMFWF), based on Trivial Pursuit™ principles. The game was developed to stimulate medical students’ interest in microbiology and expose students to the subject content of an Infections module in an informal, yet healthy competitive way, involving active group dynamics. Members of staff in the medical curriculum participated in direct observation of the play process. The nominal group technique was used to identify their perception of the game as a learning tool. The game itself and the process of student play generated positive feedback from academic members of staff. Measured against the criteria of diffusion of innovation theory, the game fulfils criteria for an innovation to be accepted. Used as supplementary to formal lectures, MMFWF has the potential to enhance students’ learning experiences in medical microbiology.

Knowledge of sexually transmitted diseases and HIV/AIDS symptoms of women receiving termination of pregnancy, Bloemfontein

In 2002, we conducted a cross-sectional study to determine the profile of women seeking termination of pregnancy (TOP) in the Free State and to find out whether TOP was being used as a family planning method. The participants’ contraceptive use and termination of pregnancy profile have been described elsewhere. This letter describes the knowledge of STD and HIV/AIDS symptoms of women seeking TOP.

The prevalence of the diagnosis of increased intra-ocular pressure in a general practice

Glaucoma is one of the main causes of blindness. The disease occurs in 3% to 4% of all people over the age of 70 years. As many as 50% of patients suffering from this disease are unaware of their condition until a comparatively late stage, due to the asymptomatic nature of the disease.