South African Family Practice最新文献

{"title":"Risk factors for Carbapenem-resistant Enterobacterales infections: A case-control study.","authors":"Sibongakonke Mbele, Sandeep D Vasaikar","doi":"10.4102/safp.v67i1.6029","DOIUrl":"10.4102/safp.v67i1.6029","url":null,"abstract":"<p><strong>Background: </strong>Over years, concerning Carbapenem-resistant Enterobacterales (CRE) have advanced globally, posing a major threat to global health. Prior studies highlight previous antibiotic use and prolonged hospital stays as paramount risk factors for CRE infections. However, there are limited reports available with a focus on identifying risk factors for CRE infections by comparing CRE cases with controls. The aim is to evaluate factors associated with CRE infections among individuals admitted to hospitals in Mthatha.</p><p><strong>Methods: </strong>A retrospective case-control study among patients who attended Nelson Mandela Academic Hospital (NMAH) and Mthatha Regional Hospital (MRH), Eastern Cape, South Africa. Demographic, medical history and current hospitalisation factors were captured on clinical research forms. GraphPad Prism version 8 software was used for statistical analysis.</p><p><strong>Results: </strong>Out of the 226 participants with CRE infection, CRE cases were more likely than controls to be adults (51.9%, odds ratio [OR]: 1.34, 95% confidence interval [CI]: 0.72-2.55) and of male sex (54.9%, OR: 1.48, 95% CI: 0,87-2,45). Significant risk factors for CRE infections included underlying illnesses (OR: 2.55, 95% CI: 1.41-4.60, p = 0.002), urine catheterisation (OR: 5.40, 95% CI: 1.45-18.33, p = 0.01), intravascular devices (OR: 2.48, 95% CI: 1.06-6.03, p = 0.05) and prolonged hospital stay (OR: 1.87, 95% CI: 1.01-3.39, p = 0.048). CRE cases compared to controls were almost twice as likely to demise or have an extended hospital stay of more than one month. Klebsiella pneumoniae (62.6%) and Enterobacter cloacae (60.6%) were prevalent Enterobacterales associated with CRE.</p><p><strong>Conclusion: </strong>Significant risk factors for CRE infections are underlying illnesses, urine catheterisation, intravascular devices and prolonged hospitalisation.Contribution: The complicated nature of CRE infections highlights the importance of targeted interventions to mitigate their spread and impact on public health.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e10"},"PeriodicalIF":1.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400157","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":"Rationalising blood tests in a resource-limited emergency unit: A quality improvement project.","authors":"Renette Esterhuizen, Lilani I Tribelhorn, Danielle M J Thomas, Eugenne Elliott, Talat Habib, Arun Nair","doi":"10.4102/safp.v67i1.6067","DOIUrl":"10.4102/safp.v67i1.6067","url":null,"abstract":"<p><strong>Background: </strong>In resource-limited emergency settings, blood testing is crucial for diagnostics but can lead to financial strain and diagnostic challenges if used indiscriminately. This quality improvement project (QIP) aimed to identify commonly requested blood tests in an emergency department (ED), assess their appropriateness, and establish evidence-based guidelines for judicious use. This project was conducted during the family medicine rotation of interns at a tertiary hospital in a semi-urban area.</p><p><strong>Methods: </strong>The Plan-Do-Study-Act (PDSA) method was employed. Pre- and post-intervention data were collected. An educational intervention, featuring informative visual aids was implemented to help guide the medical practitioners in the unit on appropriate blood test ordering.</p><p><strong>Results: </strong>The intervention led to a significant 48.7% reduction in total daily blood tests ordered, with a notable decrease in full-panel requests and an increase in individual test ordering.</p><p><strong>Conclusion: </strong>Educational interventions, aimed at guiding blood test requests, can significantly reduce unnecessary testing. Long-term data collection is necessary to confirm sustained changes in practice.Contribution: Our findings indicate that clear, evidence-based guidelines for the judicious use of blood tests can positively impact test ordering, particularly in resource-limited settings, and suggest opportunities for further long-term studies.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e5"},"PeriodicalIF":1.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400140","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 guide for arterial line insertion for the South African primary care practitioner.","authors":"Indiran Govender, Henry I Okonta, Olukayode Adeleke, Sunday Okeke","doi":"10.4102/safp.v67i1.5976","DOIUrl":"10.4102/safp.v67i1.5976","url":null,"abstract":"<p><p>This article provides information on the reasons for inserting an arterial line, how to insert this line, the equipment required to insert an arterial line, and the possible complications that may arise from this procedure. It is hoped this information will guide primary care practitioners working in the South African environment and increase their confidence for inserting arterial lines.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e12"},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400111","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":"Factors associated with successful treatment outcomes among tuberculosis patients in a district municipality of Vhembe, Limpopo.","authors":"Busisiwe Mkhavele, Slindile Zondi, Lindiwe Cele, Mabina Mogale, Margeret Mbelle","doi":"10.4102/safp.v67i1.6030","DOIUrl":"10.4102/safp.v67i1.6030","url":null,"abstract":"<p><strong>Background: </strong>Treatment success rate is a critical indicator for monitoring the progress of tuberculosis (TB) treatment programmes at both the patient and population levels. It informs decisions about resource allocation and the effectiveness of TB control strategies. This study aimed to determine the level of TB cure rates and the factors associated with treatment success among TB patients receiving TB care in the Collins Chabane municipality, Limpopo province, South Africa.</p><p><strong>Methods: </strong>Medical records from April 2020 to March 2021 of 289 patients attending primary health care facilities, initiated on anti-TB treatment were reviewed. Descriptive statistics were used to analyse data and modified Poisson regression was used to determine factors associated with treatment success. Statistical software Epi Info was used for analysis.</p><p><strong>Results: </strong>Of the 289 TB cases, 282 (97.6%) were newly initiated on TB treatment. Of these, 37.0% were cured, followed by 29.0% who defaulted treatment, 22.3% who completed the treatment and 11.7% who died during treatment. The likelihood of successful treatment outcomes was significantly associated with marital status, supervised treatment and distance travelled to a health facility. A higher likelihood of success was observed among patients who were single and 27.0% of those had supervised treatments.</p><p><strong>Conclusion: </strong>Tuberculosis patients continue to die in the course of treatment. Supervised treatment is a predictor of successful treatment outcomes.Contributions: This study highlight the need for heightened advocacy for supervised TB treatment and increased effort to combat the death of patients while on TB treatment.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e7"},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400146","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 impact of the COVID-19 pandemic on forensic pathology services in Limpopo province, South Africa.","authors":"Thakadu A Mamashela, Samuel T Ntuli","doi":"10.4102/safp.v67i1.6038","DOIUrl":"10.4102/safp.v67i1.6038","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the effects of coronavirus disease 2019 (COVID-19) and the preventative measures taken, especially how they affect forensic pathology services in rural South Africa.</p><p><strong>Methods: </strong>This retrospective analysis includes referred post-mortem cases from all forensic pathology services in Limpopo province, comparing the period before the COVID-19 pandemic (01 January 2019 to 31 December 2019) with the pandemic period (01 January 2020 to 31 December 2020). Data analysis was performed using STATA 16.0 software (StataCorp; College Station, TX). Chi-square test was employed for comparison, with a p-value 0.05 deemed statistically significant.</p><p><strong>Results: </strong>Approximately 9319 cases were submitted for post-mortem examinations, with 4857 occurring before the pandemic and 4462 during it, marking an 8.1% decrease. There was a decrease in the number of unnatural death cases, while the instances of natural deaths rose. Cases under investigation saw a notable increase. There was a marked decrease in referrals for forensic examinations across all districts. In addition, except for one facility, there was a decline in the number of cases sent for autopsies at all facilities.</p><p><strong>Conclusion: </strong>In conclusion, forensic pathology services in this province had been severely disrupted by the COVID-19 outbreak and the lockdown that followed, especially in the tertiary hospital. It has led to new challenges for case management and necessitated changes to operating procedures.Contribution: It has required modifications to operational procedures and has introduced various challenges in case management.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e4"},"PeriodicalIF":1.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400189","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":"Primary health care strengthening through the lens of healthcare system thinking.","authors":"Ramprakash Kaswa, Klaus Von Pressentin","doi":"10.4102/safp.v67i1.6039","DOIUrl":"10.4102/safp.v67i1.6039","url":null,"abstract":"<p><p>Despite the strides made in healthcare, many countries still struggle to meet citizen healthcare needs, leading to global and regional health inequalities. The complex interactions between healthcare systems and disciplines present challenges for primary care providers and family physicians. Primary care providers must be equipped with tools and resources to effectively fulfil their duties, such as clinical governance, leadership and capacity building. This article focusses on various thinking approaches that primary care providers can employ, namely systems thinking, complexity science thinking and learning health systems thinking. We appreciate that individual styles and preferences, organisational culture and systemic realities influence multiple modes of thinking and decision-making. A range of modes of thinking and mental models will assist with tackling challenges and opportunities in the primary healthcare system. We hope this brief overview encourages readers to experiment with different ways of thinking to help facilitate innovative solutions.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e6"},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400135","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":"Final-year students' perceptions of online integrated primary care learning.","authors":"Aviva Ruch, Joel Francis, Ann Z George","doi":"10.4102/safp.v67i1.6034","DOIUrl":"10.4102/safp.v67i1.6034","url":null,"abstract":"<p><strong>Background: </strong>Integrated primary care (IPC) is a final-year medical subject at the University of the Witwatersrand, Johannesburg, South Africa. It focusses on primary health care training. The coronavirus disease 2019 (COVID-19) pandemic exacerbated existing decentralised training challenges, including standardisation and patient exposure. This study explored IPC students' experiences and perceptions of online learning during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This explanatory-sequential mixed-methods study was informed by the technology acceptance model, community of inquiry model and self-regulated learning theory. A cross-sectional online survey was followed by focus group discussions (FGDs) (n = 2 and n = 3, respectively). All 316 medical students in the 2021 cohort were eligible to participate. Closed-ended survey responses were analysed using descriptive and inferential statistics. Open-ended responses were analysed using content analysis. The FGDs were thematically analysed.</p><p><strong>Results: </strong>The survey response rate was 52% (n = 164/316). Most students found the online content easily accessible (93.3%) and logically organised (80.0%). The course structure and organisation, and the range of online activities offered were the main features that supported learning. The main challenges included the content not being comprehensive and the difficulty of learning patient management from online content. Suggested improvements related to the course design and ways students and instructors can maximise the affordances of the online course.</p><p><strong>Conclusion: </strong>Acknowledging the limitations of learning clinical content online, the participants felt the course supported their learning. Our findings suggest that well-designed online content can augment clinical learning.Contribution: This study contributes to the discourse on the value of online learning for clinical teaching.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400149","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 1, 2025.","authors":"Klaus B Von Pressentin, John M Musonda, Mergan Naidoo, Michéle Torlutter, Gert Marincowitz, Selvandran Rangiah, Zakariya Badat","doi":"10.4102/safp.v67i1.6024","DOIUrl":"10.4102/safp.v67i1.6024","url":null,"abstract":"<p><p>The series 'Mastering your Fellowship' provides examples of the question formats 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 aims to help family medicine registrars (and supervisors) prepare for this examination.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400119","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":"Cross-cultural adaptation: South African Gestational Diabetes Mellitus Knowledge Questionnaire.","authors":"Lorisha Manas, Tawanda Chivese, Ankia Coetzee, Magda Conradie, Linzette D Morris","doi":"10.4102/safp.v67i1.5826","DOIUrl":"10.4102/safp.v67i1.5826","url":null,"abstract":"<p><strong>Background: </strong>Many serious adverse events associated with gestational diabetes mellitus (GDM) can be mitigated by timely glucose control during pregnancy, achieved through education and lifestyle choices. The aim of this study was to translate and cross-culturally adapt and test the preliminary internal consistency and test-retest reliability of the South African English, Afrikaans and isiXhosa versions of the GDM Knowledge Questionnaire (GDMKQ).</p><p><strong>Methods: </strong>A prospective, observational study was conducted at a high-risk antenatal clinic in South Africa. Pregnant women ≥ 18 years with GDM were consecutively sampled. Semantic equivalence between the original and adapted versions was assessed. Face and content validity, internal consistency and test-retest reliability were evaluated.</p><p><strong>Results: </strong>The three SA-GDMKQ versions demonstrated good face and content validity. For internal consistency, Cronbach's alpha values were 0.534 for the Afrikaans version, 0.434 for the English version and 0.621 for the isiXhosa version. Test-retest reliability found kappa (standard error [s.e.]) values ranged between -0.03 (0.18) and 0.89 (0.13) for the English version, between -0.07 (0.18) and 0.53 (0.13) for the Afrikaans version and between 0.28 (0.18) and 0.87 (0.17) for the isiXhosa version. All versions of the SA-GDMKQ had a statistically significant (p  0.001) positive linear correlation between the total scores.</p><p><strong>Conclusion: </strong>The English, Afrikaans and isiXhosa SA-GDMKQ versions were found to be feasible and easy to comprehend, although lower internal consistency and test-retest reliability were displayed. Further validation of the psychometric properties of the English, Afrikaans and isiXhosa versions of the SA-GDMKQ among larger sample groups is however warranted.Contribution: This study adds to the knowledge around developing and using culturally appropriate questionnaires and outcome measures in research and clinical practice.</p>","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e10"},"PeriodicalIF":1.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400128","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":"'Gender affirming healthcare' is not what the family physician needs to know.","authors":"Janet Giddy, Allan Donkin, Reitze Rodseth","doi":"10.4102/safp.v67i1.6061","DOIUrl":"10.4102/safp.v67i1.6061","url":null,"abstract":"","PeriodicalId":22040,"journal":{"name":"South African Family Practice","volume":"67 1","pages":"e1-e2"},"PeriodicalIF":1.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400077","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}