99 research outputs found
Can the re-engineering of PHC and/or the introduction of community paediatricians be the solution?
Can the re-engineering of PHC and/or the introduction of community paediatricians be the solution?
No abstract available.References 1-11 is part of correspondence titled: Improved management of patients with osteoporosishttp://www.samj.org.zaam2013ay201
Rural district hospitals â essential cogs in the district health system â and primary healthcare re-engineering
The article by Le Roux et al. raises the question why it is so difficult to re-engineer primary healthcare (PHC) and why the results so far have been disappointing. They highlight the critical role of the district hospital as the hub from which all activities in the rural districts should be co-ordinated.
Design of new cold rolled purlins by experimental testing and Direct Strength Method
New cold roll formed channel and zed sections for purlins, namely UltraBEAMâą2 and UltraZEDâą2, have been developed by Hadley Industries plc using a combined approach of experimental testing, finite element modelling and optimisation techniques. The new sections have improved strength to weight ratio by increasing the section's strength through the use of stiffeners in the section webs. The European standard, Eurocode 3 [1], uses the traditional Effective Width Method to determine the strength of a cold formed steel member. However, the design of the new sections UltraBEAMâą2 and UltraZEDâą2 using this method is very complicated in calculating the effective section properties as these sections contain complex folded-in stiffeners. In addition, the incorporation of competing buckling modes such as distortional buckling of these sections can be difficult to analyse. To overcome difficulties of using Eurocode 3 or such a standard with the Effective Width Method for determining the strength of these sections, the Direct Strength Method is adopted in this paper. Four-point beam bending tests were carried out to determine the buckling and ultimate bending capacities of the UltraBEAMâą2 and UltraZEDâą2 sections. Results from both experimental testing and Finite Element analysis were initially used as validation for the design using the Direct Strength Method. The Direct Strength Method's results were then compared with the experimental test results for a broader data in which the UltraBEAMâą2 and UltraZEDâą2 sections had a range of different width-to-thickness ratios. It showed an excellent agreement between test and Direct Strength design values suggesting that the Direct Strength Method is a powerful tool for the design and optimisation of the new cold roll formed channel and zed purlins.N/
Effects of cold roll dimpling process on mechanical properties of dimpled steel.
In this paper, the effect of a dimpling process on the mechanical properties of the steel material was studied experimentally and numerically. Nano-hardness and tensile tests of steel samples prior to and after the dimpling process were conducted to evaluate the effects of the process on the mechanical properties. Numerical simulations of the dimpling process and tensile tests were done by Finite Element Analysis; they were used to quantify the amount of non-uniform plastic strains and residual stresses introduced and the manner, in which this was distributed through the sheet. The cold roll dimpling process resulted in developing the plastic strain and residual stress which could correlate to the modifications in the strength and stiffness of the dimpled steel when compared to plain steel originating from the same coil material. The simulation of the dimpling process and tensile tests of the plain and dimpled specimens predicted similar behaviour to the experimental measurements and tests.N/
Rural district hospitals â essential cogs in the district health system â and primary healthcare re-engineering
To the Editor : The article by Le Roux et al. raises the question why it is so difficult to re-engineer primary healthcare (PHC) and why the results so far have been disappointing. They highlight the critical role of the district hospital as the hub from which all activities in the rural districts should be co-ordinated. Le Roux et al. write from their own experience at rural hospitals. We agree that there are many examples of well-run public district hospitals with excellent reputations, which have contributed towards improved patient care together with improved health status of the community. Hospitals that have built up reputations as providers of excellent rural healthcare services in the past decades are Elim, Donald Fraser, Gelukspan, Manguzi, Bethesda, Mosveld, Mseleni, Rietvlei, Zithulele, and many more.http://www.samj.org.zaam2016Family Medicin
Changing priorities in maternal and perinatal health in Gert Sibande District, South Africa
Gert Sibande District is a predominantly rural district in Mpumalanga Province, South Africa (SA), with a population of just over
1.1 million. It has a high prevalence of HIV infection and pregnancy-related hypertensive disease. In 2010 the district was one of the
worst-performing health districts in SA, with a maternal mortality ratio of 328.0 per 100 000 births. Various programmes were introduced
between 2010 and 2017 to address major causes of maternal and perinatal morbidity and mortality in the district. The focus has been on
HIV-related morbidity, the direct obstetric causes of maternal and perinatal morbidity and mortality, and health systems strengthening.
During the period 2010 - 2017, there was a steady decline in institutional maternal mortality with a drop of 71% in maternal deaths over a
period of 6 years, from 328.0 per 100 000 births to 95.0. However, the ratio levelled off in 2016 and 2017, mainly as a result of a changing
disease profile. The stillbirth rate showed a decline of 24.4% over a period of 8 years. With perseverance, rapid response and evidence-based
strategies it was possible to more than halve the institutional maternal mortality ratio within 6 years. However, with the changing disease
profile, conditions such as hypertensive disease in pregnancy should be prioritised and new strategies developed to further reduce maternal
and perinatal mortality and morbidity.http://www.samj.org.zaam2020Family MedicineObstetrics and Gynaecolog
Cost effectiveness of clinical associates : a case study for the Mpumalanga province in South Africa
BACKGROUND : The National Department of Health of South Africa decided to start a programme
to train mid-level healthcare workers, called clinical associates, as one of the measures to
increase healthcare workers at district level in rural areas. Unfortunately, very little is known
about the cost effectiveness of clinical associates.
AIMS : To determine, on a provincial level, the cost effectiveness of training and employing
clinical associates and medical practitioners compared to the standard strategy of training and
employing only more medical practitioners.
METHODS : A literature study was performed to answer several sub questions regarding the
costs and effectiveness of clinical associates. The results were used to present a case study.
RESULTS : The total cost for a province to pay for the full training of a clinical associate is R
300 850. The average employment cost per year is R196 329 and for medical practitioners these
costs are R 730 985 and R 559 397, respectively.
EFFECTIVENESS : Clinical associates are likely to free up the time of a medical practitioner by
50â76%. They can provide the same quality of care as higher level workers, provided that
they receive adequate training, support and supervision. Furthermore, they seem more
willing to work in rural areas compared to medical practitioners.
CONCLUSIONS : The case study showed that training and employing clinical associates is
potentially a cost-effective strategy for a province to meet the increasing demand for rural
healthcare workers. This strategy will only succeed when clinical associates receive adequate
training, support and supervision and if the province keeps investing in them.http://www.phcfm.orgam2017Family Medicin
Education médicale et amélioration de sa qualité: une étude de cas au Mpumalanga, Afrique du Sud.
BACKGROUND : The short timeframe of medical studentsâ rotations is not always conducive to
successful, in-depth quality-improvement projects requiring a more longitudinal approach.
AIM : To describe the process of inducting students into a longitudinal quality-improvement project,
using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the
possible contribution of a quality-improvement project to the development of student competencies.
SETTING : Mpumalanga clinical learning centres, where University of Pretoria medical students did
their district health rotations.
METHOD : Consecutive student groups had to engage with a hospitalâs compliance with specific
steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and
Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation
(n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation
objectively structured clinical examination station (n = 139).
RESULTS : Activities in each rotation varied according to the needs identified through the application
of the quality-improvement cycle in consultation with the local health team. The development
of student competencies is described according to the roles of a medical expert in the CanMEDS
framework: collaborator, health advocate, scholar, communicator, manager and professional. The
exposure to the real-life situation in South African public hospitals had a great influence on many
students, who also acted as catalysts for transforming practice.
CONCLUSION : Service learning and quality-improvement projects can be successfully integrated in
one rotation and can contribute to the development of the different roles of a medical expert. More
studies could provide insight into the potential of this approach in transforming institutions and
student learning.CONTEXTE: La courte durée des roulements des étudiants médicaux ne favorise pas la réussite des
projets approfondis dâamĂ©lioration de la qualitĂ© qui nĂ©cessitent une approche plus longitudinale.
OBJECTIF : DĂ©crire le processus dâintronisation des Ă©tudiants dans un projet longitudinal
dâamĂ©lioration de la qualitĂ©, au moyen du thĂšme de lâInitiative des HĂŽpitaux amis de la MĂšre et des
BĂ©bĂ©s comme Ă©tude de cas; et examiner la contribution possible dâun projet dâamĂ©lioration de la
qualité au développement des compétences des étudiants.
LIEU : Les centres de formation clinique du Mpumalanga oĂč les Ă©tudiants mĂ©dicaux de lâUniversitĂ©
de Pretoria ont fait leurs roulements dans les districts sanitaires.
METHODE : Des groupes consĂ©cutifs dâĂ©tudiants ont dĂ», avec lâautorisation de lâhĂŽpital, sâengager
Ă suivre les mesures spĂ©cifiques des Dix Conditions pour le SuccĂšs de lâAllaitement maternel
qui est la norme de lâInitiative des HĂŽpitaux amis de la MĂšre et des BĂ©bĂ©s. Les sources de
données primaires comprenaient une présentation PowerPoint du groupe sur le terrain
(n = 42), un rapport Ă©crit du groupe (n = 42) et les notes des entrevues individuelles dans une station
dâexamen Clinique structurĂ© objectivement Ă la fin du roulement (n = 139).
RESULTATS : Les activitĂ©s de chaque roulement changeaient selon les besoins identifiĂ©s par lâapplication
du cycle dâamĂ©lioration de la qualitĂ© en consultation avec lâĂ©quipe de santĂ© locale. Le dĂ©veloppement
des compĂ©tences des Ă©tudiants est dĂ©crit selon les rĂŽles dâun expert mĂ©dical dans le cadre du
CanMEDS: collaborateur, promoteur de la santé, érudit, communicateur, gérant et professionnel.
Lâexposition Ă la situation rĂ©elle dans les hĂŽpitaux publics sud-africains a eu une grande influence
sur beaucoup dâĂ©tudiants, qui ont aussi Ă©tĂ© les catalyseurs du changement de pratique.
CONCLUSION : Lâapprentissage par le service et les projets dâamĂ©lioration de la qualitĂ© peuvent ĂȘtre
intĂ©grĂ©s avec succĂšs dans un roulement et peuvent contribuer au dĂ©veloppement des diffĂ©rents rĂŽles dâun expert mĂ©dical. Un plus grand nombre dâĂ©tudes pourra donner un aperçu des possibilitĂ©s
de cette approche et transformer les institutions et lâapprentissage des Ă©tudiants.http://www.phcfm.org/am201
âMaking a differenceâ â Medical studentsâ opportunities for transformational change in health care and learning through quality improvement projects
Background Quality improvement is increasingly becoming an essential aspect of the medical curriculum, with the intention of improving the health care system to provide better health care. The aim of this study was to explore undergraduate medical studentsâ experiences of their involvement in quality improvement projects during a district health rotation. Methods Student group reports from rotations in learning centres of the University of Pretoria in Mpumalanga Province, South Africa were analysed for the period 2012 to 2015. Interviews were conducted with health care providers at four learning centres in 2013. Results Three main themes were identified: (1) âSituated learningâ, describing studentsâ exposure to the discrepancies between ideal and reality in a real-life situation and how they learned to deal with complex situations, individually and as student group; (2) âFacing dilemmasâ, describing how students were challenged about the non-ideal reality; (3) âMaking a differenceâ, describing the impact of the studentsâ projects, with greater understanding of themselves and others through working in teams but also making a change in the health care system. Conclusion Quality improvement projects can provide an opportunity for both the transformation of health care and for transformative learning, with individual and âcollectiveâ self-authorship
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