South African Family Practice最新文献

{"title":"Central venous pressure line insertion for the primary health care physician.","authors":"Indiran Govender,&nbsp;Henry I Okonta,&nbsp;Olukayode Adeleke,&nbsp;Selvandran Rangiah","doi":"10.4102/safp.v65i1.5740","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5740","url":null,"abstract":"<p><p>Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e8"},"PeriodicalIF":1.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9813058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of care of patients with type 2 diabetes mellitus at a public sector district hospital.","authors":"Kelly J Fredericks,&nbsp;Mergan Naidoo","doi":"10.4102/safp.v65i1.5713","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5713","url":null,"abstract":"<p><strong>Background: </strong>Globally, diabetes mellitus (DM) remains one of the leading causes of mortality, with approximately 2 million deaths in 2019, the condition also contributes significantly to adverse health conditions and costs. The study aimed to describe the quality of care (QOC) rendered to patients with type 2 DM (T2DM) seeking care at Wentworth Hospital (WWH), a district hospital in KwaZulu-Natal province, South Africa.</p><p><strong>Methods: </strong>A descriptive cross-sectional design was used, and all patients living with T2DM on treatment who had accessed care for at least 1 year were included. Data were collected through structured exit interviews, and their clinical data were extracted from their medical records. Their knowledge, attitudes and practices were assessed using a 5-point Likert scale.</p><p><strong>Results: </strong>The mean age (standard deviation [s.d.]) was 59 (13.0) years and most (65.3%) were female, of African (30.0%) and Indian (38.6%) descent, with two-thirds (69.4%) obtaining a secondary school education. Their mean glycated haemoglobin (HbA1c) (s.d.) was 8.6 (2.4%). Over 82% had one or more comorbidity, while 30% had at least one DM-related complication. Generally, participants were pleased with the care received, but their knowledge and practices related to their T2DM was suboptimal.</p><p><strong>Conclusion: </strong>This study indicates that the QOC was suboptimal due to poor efficacy indicators, poor knowledge and lack of adequate lifestyle measures, despite the frequency of medical practitioner reviews.Contributions: This study identified gaps in QOC and will aid South African public sector policy-makers in devising quality improvement initiatives.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e9"},"PeriodicalIF":1.0,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single-centred retrospective observational analysis on mortality trends during the COVID-19 pandemic.","authors":"Omishka Hirachund, Camilla Pennefather, Mergan Naidoo","doi":"10.4102/safp.v65i1.5700","DOIUrl":"10.4102/safp.v65i1.5700","url":null,"abstract":"<p><strong>Background: </strong>South Africa experienced high mortality during the COVID-19 pandemic. Resources were limited, particularly at the district hospital (DH) level. Overwhelmed healthcare facilities and a lack of research at a primary care level made the management of patients with COVID-19 challenging. The objective of this study was to describe the in-hospital mortality trends among individuals with COVID-19 at a DH in South Africa.</p><p><strong>Methods: </strong>Retrospective observational analysis of all adults who demised in hospital from COVID-19 between 01 March 2020 and 31 August 2021 at a DH in South Africa. Variables analysed included: background history, clinical presentation, investigations and management.</p><p><strong>Results: </strong>Of the 328 participants who demised in hospital, 60.1% were female, 66.5% were older than 60 and 59.6% were of black African descent. Hypertension and diabetes mellitus were the most common comorbidities (61.3% and 47.6%, respectively). The most common symptoms were dyspnoea (83.8%) and cough (70.1%). 'Ground-glass' features on admission chest X-rays were visible in 90.0% of participants, and 82.8% had arterial oxygen saturations less than 95% on admission. Renal impairment was the most common complication present on admission (63.7%). The median duration of admission before death was four days (interquartile range [IQR]: 1.5-8). The overall crude fatality rate was 15.3%, with the highest crude fatality rate found in wave two (33.0%).</p><p><strong>Conclusion: </strong>Older participants with uncontrolled comorbidities were most likely to demise from COVID-19. Wave two (characterised by the 'Beta' variant) had the highest mortality rate.Contribution: This study provides insight into the risk factors associated with death in a resource-constrained environment.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e9"},"PeriodicalIF":1.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10318608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mastering Your fellowship: Part 4, 2023.","authors":"Mergan Naidoo,&nbsp;Klaus Von Pressentin,&nbsp;Tasleem Ras,&nbsp;Gert Marincowitz","doi":"10.4102/safp.v65i1.5762","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5762","url":null,"abstract":"<p><p>The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e8"},"PeriodicalIF":1.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9825968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa.","authors":"William Mhundwa,&nbsp;Gina Joubert,&nbsp;Thabiso R Mofokeng","doi":"10.4102/safp.v65i1.5663","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5663","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD). The prevalence of CKD among T2DM patients in Africa is 22.0%. The cut-off age for dialysing diabetic patients in the resource-limited state sector in South Africa is 50 years. Type 2 diabetes mellitus patients who develop CKD are likely to be excluded from chronic dialysis and rely on control of risk factors, including blood pressure and blood glucose levels, to prevent CKD progression. We aimed to determine the prevalence of CKD among T2DM patients attending the diabetes clinic at Pelonomi Academic Hospital, Bloemfontein.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, medical records of patients (January 2016 and December 2018) were reviewed to collect demographic and clinical information.</p><p><strong>Results: </strong>In total, 244 records were reviewed. Sixty-one (25.0%, 95% confidence interval [CI]: 20% - 30.8%) T2DM patients had CKD. The rate of CKD was slightly higher in males (n = 24/81; 29.6%) compared with females (n = 37/163; 22.7%). Most patients with CKD (n = 58; 95.1%) were 50 years of age. Only 17.8% of patients achieved a glycosylated haemoglobin (HbA1c) of 7.0%. Blood pressure was controlled in 14.3% of hypertensive patients. Renin-angiotensin-aldosterone system inhibitors were used by 78.6% of patients.</p><p><strong>Conclusion: </strong>A high prevalence of clinically significant CKD among T2DM patients with poor prospects of chronic dialysis in a resource-limited setting was observed. The risk factors for CKD development and progression should be adequately managed in T2DM patients.Contribution: This study emphasises the need for further research and innovation to improve outcomes of T2DM patients with CKD in resource-constrained settings.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e6"},"PeriodicalIF":1.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9596237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pearls and pitfalls of setting high-quality multiple choice questions for clinical medicine.","authors":"Mergan Naidoo","doi":"10.4102/safp.v65i1.5726","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5726","url":null,"abstract":"<p><p>Multiple choice question (MCQ) examinations have become extremely popular for testing applied knowledge in the basic and clinical sciences. When setting MCQ examinations, assessors need to understand the measures that improve validity and reliability so that the examination accurately reflects the candidate's ability. This continuing medical education unit will cover the essentials of blueprinting an exam, constructing high-quality MCQs and post hoc vetting of the exam. It is hoped that academics involved in assessments use the content provided to improve their skills in setting high-quality MCQs.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e4"},"PeriodicalIF":1.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of the new seizure diary in the Free State and Northern Cape.","authors":"Chika K Egenasi, Anandan A Moodley, Wilhelm J Steinberg, Gina Joubert","doi":"10.4102/safp.v65i1.5736","DOIUrl":"10.4102/safp.v65i1.5736","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a neurological disease affecting adults and children globally. A seizure diary is one of the self-management tools for tracking seizures. This study aims to ascertain the experience of a new seizure diary by persons completing the diary in the Free State and Northern Cape of South Africa.</p><p><strong>Methods: </strong>Adult patients with epilepsy attending Universitas Academic Hospital epilepsy clinic in Bloemfontein, clinics in Kimberley and the casualty department of Kimberley hospital (Robert Mangaliso Sobukwe hospital) received a new seizure diary. After using the diary for 6 months, participants (patients, relatives or caregivers) completed a questionnaire.</p><p><strong>Results: </strong>A total of 139 epilepsy patients received a new seizure diary; 67 previously diary-unexposed participants and 33 participants who had previous exposure to a seizure diary. The majority of participants, namely 91% of previously diary-unexposed and 84.9% of participants who had previous exposure to the seizure diary, understood the new seizure diary. Participants who had previous exposure to a seizure diary were predominantly very positive about the new diary because it had more information. However, 21.2% indicated that they preferred the old one because it was easier to complete.</p><p><strong>Conclusion: </strong>Patients, caregivers or relatives from both groups used the new seizure diary and provided important information about their experience with the new diary. Despite a few complaints about using the new diary, most participants who had previous exposure to a seizure diary preferred the new seizure diary.Contribution: This study explored participants' opinions of the new seizure diary.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e11"},"PeriodicalIF":1.2,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10187258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the collaborative care of patients with pelvic fractures in Tshwane, South Africa.","authors":"Ntombenkosi A Sobantu,&nbsp;Muziwakhe D Tshabalala,&nbsp;Verusia Chetty","doi":"10.4102/safp.v65i1.5705","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5705","url":null,"abstract":"<p><strong>Background: </strong>Pelvic fractures are complex injuries that lead to long-term disabilities and poor health-related quality of life (HRQoL). Even though pelvic fractures are known to be challenging to manage, there is limited information on guidelines and protocols to ensure that patients receive comprehensive and collaborative healthcare.</p><p><strong>Methods: </strong>A qualitative descriptive phenomenological approach was utilised to explore current practices and innovations of healthcare professionals (HPs) in Tshwane academic hospitals in the collaborative management and rehabilitation of patients with pelvic fractures, using semi-structured interviews. Thematic analysis was used to analyse data.</p><p><strong>Results: </strong>Six overarching themes were identified from the interviews with HPs: The biopsychosocial lens of the patient, limitations in approaches to care, contextual impediments to care, the team challenge; the biopsychosocial aspects of care and forging forward to improve care.</p><p><strong>Conclusion: </strong>A multidisciplinary approach is encouraged for the comprehensive management of pelvic fractures. However, a poor understanding of roles and poor referral structures challenge this approach. Further barriers to caring include staff shortages and limited resources. Healthcare professionals recommended interprofessional education and collaborative practice, student training and using standardised outcome measurement tools to improve care for patients with pelvic fractures.Contribution: This study lays a foundation to initiate conversations about the development of an interprofessional model of care for patients with pelvic fractures. Findings might inform health policies on the management of pelvic fractures. Healthcare professionals might apply strategies that enhance the quality of healthcare provided. Patients with pelvic fractures might receive quality interprofessional healthcare that promotes quality of life, post pelvic fractures.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e9"},"PeriodicalIF":1.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9589892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conjoint tobacco and alcohol use and depression among HIV-positive patients in Sedibeng, South Africa.","authors":"Kenneth E Akahilem, Olufemi B Omole","doi":"10.4102/safp.v65i1.5687","DOIUrl":"10.4102/safp.v65i1.5687","url":null,"abstract":"<p><strong>Background: </strong>Psychosocial challenges among human immunodeficiency virus (HIV)-positive patients may promote substance use disorders. This study explored the relationship between conjoint tobacco and alcohol use and depression symptoms among HIV positive patients in Sedibeng District, South Africa.</p><p><strong>Methods: </strong>In a cross-sectional study of 404 participants, a questionnaire collected information on sociodemography, tobacco and alcohol use and depression symptoms. Outcome measures included the prevalence of conjoint tobacco and alcohol use and its association with positive screen for depression.</p><p><strong>Results: </strong>The mean participant age was 43.2 years. Most completed secondary school (62.9%), were black (99.0%), female (65.8%), unemployed (53.6%) and on antiretroviral therapy (ART) for 1 year (97.8%). Current tobacco use was reported by 23.3% (n = 94) participants with most smoking cigarette (73.7%) and having low nicotine dependence (75.5%). Current alcohol use was reported by 43.6% (n = 176) participants, and 36.9% were categorised as harmful users. Only 7.7% (n = 31) participants screened positive for depression; the prevalence of conjoint tobacco and alcohol use was 19.6% (n = 79) and this was not associated with depression (p = 0.438). Harmful alcohol users were more than five times likely to report conjoint tobacco and alcohol use (p = 0.000), but women were less likely to report it (p = 0.000).</p><p><strong>Conclusion: </strong>Conjoint tobacco and alcohol use is common among patients with HIV infection. Although not associated with positive screen for depression, its relationship with harmful alcohol use reiterates the need for an integrated tobacco and alcohol use screening and treatment strategy in the HIV treatment programme in primary care.Contribution: To the authors best knowledge, this study is the first published study that explored the relationship between conjoint tobacco and alcohol use, and depression among HIV-positive patients in the South African primary care settings.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e7"},"PeriodicalIF":1.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9606128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks of Type 2 diabetes among older people living with HIV: A scoping review.","authors":"Nongiwe L Mhlanga,&nbsp;Thinavhuyo R Netangaheni","doi":"10.4102/safp.v65i1.5623","DOIUrl":"https://doi.org/10.4102/safp.v65i1.5623","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of antiretroviral therapy has enabled people living with human immunodeficiency virus (HIV) (PLWH) to live longer. With this longevity, there is the risk of developing age-related chronic conditions like Type 2 diabetes. Older PLWH have an increased risk of Type 2 diabetes mellitus (Type 2 DM) because of the natural physiological processes of ageing and risks posed by HIV infection and antiretroviral therapy use. The purpose of this scoping review is to describe risk factors associated with the development of Type 2 DM among older PLWH.</p><p><strong>Methods: </strong>The study adopted a framework for scoping reviews. The first step identified the research question, followed by identifying studies from three databases: PubMed, Mendeley and Cochrane Library. A total of 618 nonduplicate studies were screened, with a final selection of 15 full-text studies from 2012 to 2022. Data were extracted using the Souza (2010) data extraction tool and analysed numerically and with thematic content analysis.</p><p><strong>Results: </strong>Most studies were from Italy, with 60% being cross-sectional studies. On thematic analysis, the risks associated with Type 2 DM among older PLWH were long duration of HIV infection; the use of older-generation antiretroviral therapy; a high body mass index; the presence of hypertension and a lack of knowledge on modifiable risk factors for Type 2 DM.</p><p><strong>Conclusion: </strong>The identification of the risks that increase the likelihood of Type 2 DM among older PLWH facilitates effective screening and focused health education for older PLWH to reduce the development of Type 2 DM.Contribution: The findings of this study of excess risks of Type 2 DM specific to older PLWH complement risk factors of Type 2 DM in the general population. These excess risks facilitate case finding of older PLWH at risk of Type 2 DM especially in primary healthcare settings.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"65 1","pages":"e1-e10"},"PeriodicalIF":1.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9596236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}