MMed cohort supervision: A path out of the swamp?

The authors present the case for collaborative cohort supervision (CCM), including both master’s students and novice supervisors, as a possible way to rapidly increase the number of supervisors needed to address the recent implementation of a compulsory research component to specialist registration with the Health Professions Council of South Africa. Different models of CCM are discussed and possible pitfalls highlighted

How to write a research protocol

A research protocol is best viewed as a key to open the gates between the researcher and his/her research objectives. Each gate is defended by a gatekeeper whose role is to protect the resources and principles of a domain: the ethics committee protects participants and the underlying tenets of good practice, the postgraduate office protects institutional academic standards, the health authority protects provincial resources etc. The protocol must explicitly address the issues likely to be raised by these gatekeepers, demonstrating evidence of a clear understanding of the issues involved and that all components of the research plan have been addressed. The purpose of this paper is to add flesh to the skeleton provided in step six (‘write the protocol’) of the Biccard and Rodseth paper of 2014, orientated towards the first-time researcher working towards the MMed degree. Although occasional reference will be made to qualitative approaches, it is likely that the majority of these studies will be quantitative designs and these form the focus of this paper.Keywords: MMed, protocol, protocol design, research, research desig

Matchings on infinite graphs

Elek and Lippner (2010) showed that the convergence of a sequence of bounded-degree graphs implies the existence of a limit for the proportion of vertices covered by a maximum matching. We provide a characterization of the limiting parameter via a local recursion defined directly on the limit of the graph sequence. Interestingly, the recursion may admit multiple solutions, implying non-trivial long-range dependencies between the covered vertices. We overcome this lack of correlation decay by introducing a perturbative parameter (temperature), which we let progressively go to zero. This allows us to uniquely identify the correct solution. In the important case where the graph limit is a unimodular Galton-Watson tree, the recursion simplifies into a distributional equation that can be solved explicitly, leading to a new asymptotic formula that considerably extends the well-known one by Karp and Sipser for Erd\"os-R\'enyi random graphs.Comment: 23 page

The National Health Insurance, the decentralised clinical training platform, and specialist outreach

According to the Constitution of South Africa (SA), citizens living in remote areas are entitled to the same level of healthcare as those with access to tertiary hospitals. Specialist outreach has been shown to achieve this. When SA’s National Health Services Commission convened (1942 - 1944), Gluckman summarised: ‘Where the need is greatest the supply of hospitals is least.’ Primary healthcare (PHC) characterised the Kark’s Pholela Health Centre and was highly regarded. Although PHC underpins National Health Insurance (NHI) planning, both preventive and curative healthcare are needed. The KwaZulu-Natal (KZN) provincial Department of Health and the University of KZN College of Health Sciences’ 5-year plan for a decentralised clinical teaching platform (DCTP) is ambitious, requiring optimum co-operation between health department and university. Reservations can be addressed through sustained specialist outreach. Above all, the patient mustbe the chief beneficiary. The NHI and DCTP overlap with specialist outreach, but cannot do without it

The National Health Insurance, the decentralised clinical training platform, and specialist outreach

According to the Constitution of South Africa (SA), citizens living in remote areas are entitled to the same level of healthcare as those with access to tertiary hospitals. Specialist outreach has been shown to achieve this. When SA’s National Health Services Commission convened (1942 - 1944), Gluckman summarised: ‘Where the need is greatest the supply of hospitals is least.’ Primary healthcare (PHC) characterised the Kark’s Pholela Health Centre and was highly regarded. Although PHC underpins National Health Insurance (NHI) planning, both preventive and curative healthcare are needed. The KwaZulu-Natal (KZN) provincial Department of Health and the University of KZN College of Health Sciences’ 5-year plan for a decentralised clinical teaching platform (DCTP) is ambitious, requiring optimum co-operation between health department and university. Reservations can be addressed through sustained specialist outreach. Above all, the patient must be the chief beneficiary. The NHI and DCTP overlap with specialist outreach, but cannot do without it

Diabetic patients served at a regional level hospital: What is their clinical picture?

Objectives: We describe the demographics, diabetic characteristics,  diabetic control and complications in the diabetes service in Edendale Regional Hospital, Pietermaritzburg, in this study. Diabetes mellitus, together with its complications, is increasing at an alarming rate worldwide. Good glycaemic control translates into lower long-term complications andlonger life expectancy. Previous studies performed in both the public and the private sectors have demonstrated that there is suboptimal diabetic control in South Africa.Design: This was a retrospective database analysis. Datasheets were designed to ensure a comprehensive and standardised assessment of patients attending Edendale Hospitalfs diabetic clinic. Data were stored in a designed-forpurpose database.Subjects and setting: Data from 653 first-visit diabetic patients visiting Edendale Hospitalfs diabetic clinic between 1 October 2012 and 30 September 2013 were collected.Outcome measures: Glycaemic control, diabetic complications and target blood pressure were the outcome measures studied.Results: A total of 653 first-visit patients were seen, of whom 77.03% were female and 83.40% were type 2 diabetes patients. Only 36.33% of the type 2, and 49.07% of the type 1, diabetes mellitus patients, achieved a target blood pressure of . 140/80 mmHg. Only 1.23% of the type 1, and 11.18% of the type 2, diabetes mellitus patients, achieved optimal  glycaemic control, defined as haemoglobin (Hb)A1c . 7%. The mean HbA1c in the patients with type 1 diabetes mellitus was 11.82%, and 10.52% in the type 2 diabetes mellitus patients.Conclusion: This study showed the suboptimal control of both diabetes mellitus and hypertension in the clinic, together with high rates of diabetes complications. Obesity remains a major modifiable risk factor in both type 1 and 2 diabetes patients. Blood glucose control in this resource-limited setting was similar in those patients with home blood glucose monitoring versus those without it

Ground States for Exponential Random Graphs

We propose a perturbative method to estimate the normalization constant in exponential random graph models as the weighting parameters approach infinity. As an application, we give evidence of discontinuity in natural parametrization along the critical directions of the edge-triangle model.Comment: 12 pages, 3 figures, 1 tabl

Anaesthesia training for interns at a metropolitan training complex: does it make the grade?

Background: Most anaesthesia-related mortality that occurs in level 1 hospitals in South Africa is avoidable. Improving training during internship, and consequently the skills of community service officers, could lead to safer anaesthesia practices.Objectives: The objectives of the study were to determine whether or not the timing of the anaesthesia rotation during internship and other factors affected the outcome of the assessment at the end of the anaesthesia rotation, and to compare the perceptions of first- and second-year interns regarding their confidence levels at the end of their rotation.Method: We conducted a retrospective study that compared 298 intern assessments over a three-year period. It included the assessment of interns by senior doctors in respect of three cases, an overall assessment of the interns’ performance, and the number of cases carried out by them. In addition, a questionnaire was used to assess the interns’ confidence levels at the end of the rotation.Results: Little variation in the results was evident across comparisons of the year of internship, gender and age. Comparison according to university showed a slight variation. A wide variation in the number of obstetric cases (range 5–58) and endotracheal intubations (range 6–54) was observed. Over 80% of interns, regardless of the year, were confident enough to administer general anaesthesia and perform an endotracheal intubation. However, this perception of confidence by interns did not relate to the assessment of their competence.Conclusion: The variance in the ability of interns to perform anaesthesia could not be accounted for by the training year, institution of undergraduate study, age or gender. It is likely that the assessment technique used did not provide a true reflection of the acquired skills or longevity of knowledge by interns. Further research in this area is recommended.Keywords: anaesthesia, interns, training, standard

The value of internal medicine outreach in rural KwaZulu-Natal, South Africa

Background. Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)’s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care.Objectives. Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014.Methods. Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories.Results. During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged >40 years, but over half of inpatients seen were aged ≤40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%.Conclusions. The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised

Description and validation of a novel real-time RT-PCR enterovirus assay

Journal ArticleEnteroviruses are a leading cause of aseptic meningitis in adult and pediatric populations. We describe the development of a real-time RT-PCR assay that amplifies a small target in the 5' nontranslated region upstream of the classical Rotbart enterovirus amplicon. The assay includes an RNA internal control and incorporates modified nucleotide chemistry