An investigation into the dramatic increase in deaths from gastroenteritis during the summer of 2007/08 at National District Hospital, Bloemfontein, Free State

Introduction and background: Despite national guidelines and agreed upon admission and referral criteria for children in National District Hospital (NDH), Bloemfontein, the number of children admitted with gastroenteritis (GE) has increased dramatically since December 2007. From the previous year’s Child Healthcare Problem Identification Programme (Child PIP) data the increase in GE admissions was evident in NDH. During the preceding year, 123 children were admitted for GE and during the audit period 267. The number of deaths in NDH also increased from an average of 2.25 a month over the past 3 years to 10 a month during January and February 2008. Aim: The aims of the study were: to determine the causes of death of children in NDH; to determine the relationship between nutritional status, HIV disease, laboratory results, demographic data, time of admission, duration of admission and other diseases or conditions and GE child deaths in NDH;to determine whether doctors adhered to prescribed GE treatment protocols; to determine whether nursing personnel carried out doctors’ orders as prescribed; and to identify other factors that contributed to GE deaths. Methodology: A cross-sectional study design was used. All child deaths, as well as all children admitted with GE to Ward 3 in NDH from May 2007 to April 2008 were included in the study. The first author collected the information on a cause of death form, a data form and an audit tool. As part of the quality-improvement project, 10 items were assessed to determine whether doctors adhered to treatment protocols, and 10 items were assessed to determine whether nurses adhered to nursing orders and basic nursing care. Any other factors that contributed to poor care were also noted. Results: 1. Cause of death: During this period, 49 children died, 33 (67%) due to GE, 6 (12%) due to tuberculosis (TB), 5 (10%) due to septicaemia, 4 (8%) due to pneumonia and 1 (2%) due to congenital abnormalities. Only 4.1% of the children who died were considered as normal weight for age according to their Road to Health Chart (RTHC). Regarding HIV status, 82.5% of the children who died tested HIV positive. In total, 19.4% of allGE admissions died during this one-year period. 2. GE deaths: Demographic data such as gender and age did not influence the outcome of GE. As expected, severe malnutrition, HIV-positive status and severe dehydration all contributed statistically significantly to high mortality in GE. Severe abnormalities occurred in the laboratory results of most of the children who died and indicated the severity of their disease(s). No specific organisms were cultured from stool specimens and the quality of drinking water in Bloemfontein was declared safe for human consumption. 3. Other factors that contributed to GE deaths: Medical and nursing care were of a high standard and treatment protocols were followed. Pre-admission factors such as transport, non-availability of 24-hour medical services, non-initiation of emergency treatment before referral, and caregivers not realising the severity of the disease need urgent attention to prevent further deaths. Conclusion: GE contributed to 67% of deaths in the paediatric ward of NDH. Underlying poor nutritional status and/or HIV disease were present in 96% of the GE deaths. In more than nine out of ten cases the doctors and nurses in the hospital rendered medical care in accordance with standard guidelines. Pre-admission factors need to be addressed in order to prevent more deaths

Part 1: Medico-legal documentation South African Police Services forms, Department of Justice forms and patient information

Medical practitioners share the responsibility of action against crime by supporting the justice system. The best way for a medical practitioner to achieve this is by proper examination of victims and/or perpetrators, and completing the legal documents meticulously. This can be a frightening experience without proper formal training. Paper 1 addresses the role and responsibility of the medical practitioner and issues around consent, general information on the completion of the J88, as well as the perceived gold standard of medical information relayed to the courts. Medico-legal documentation is more than the compilation of a medico-legal report. The clinical notes are part and parcel of the documentation to protect  practitioners against negligence and malpractice investigations. Valid medico-legal consent differs from medical consent. Knowledge of legislation pertaining to child pornography and the practical and ethical aspects of photography is also necessary. Inappropriate completion of medico-legal documentation may necessitate the practitioner having to explain the documentation to make it understandable to the court

Part 3: Medico-legal documentation Practical completion of pages 2 and 3 of the J88 form

This is Part 3 of a three-part series on medico-legal documentation. Part 1 addressed the knowledge and skills necessary to complete a legal J88 document. Part 2 provided practical guidance on completion of the J88 form in the case of assault. This article will focus on pages 2 and 3 of the J88 document, which deals with the alleged sexual offences of both adults and children. The assumption may exist that the J88 is the only significant document with respect to medical findings in alleged rape and child sexual abuse cases, and that the court needs this information to make a decision on the medical aspects of a case. However, the court needs the information to be interpreted by a medical practitioner, who must indicate the significance of the findings, determine who should supply relevant additional information, and then place the entire picture in context. This article attempts to highlight the value of the relevant aspects, while raising awareness of an unscientific interpretation of clinical examination.Keywords: medico-legal documentation, J88 form, sexual offences, pages 2 and 3 of J88 for

Part 2: Medico-legal documentation Practical completion of pages 1 and 4 of the J88 form

This is Part 2 of a three-part series on medico-legal documentation. Part 1 addressed the knowledge and skills necessary to complete a legal J88 document. The aim of Part 2 is to give practical guidance on completion of the J88 form in the case of assault. Part 3 will address the sexual assault section of the J88 form. As a legal document, the J88 form must be completed accurately with regard to demographic information, including the time and date of examination, to assist with interpretation of the findings. The full names of the person examined appear on the SAPS 308 form, and must be confirmed by the patient and an identification document, if available. The name of the healthcare provider must be identifiable and contact details must be stated to assist with tracing, if necessary. A complete history is important because a differential diagnosis needs be considered, and the clinical findings must be consistent with the description of the incident in terms of time, mechanism of the injury and the place at which the incident took place, as these all add to the probability that the incident occurred as disclosed. The health worker has a dual responsibility with regard to both the health and medico-legal aspects pertaining to the patient and must record these in the clinical notes. Only medico-legal aspects are recorded on the J88 form. A top-to-toe, back-to-front examination must be performed methodically, since the person may be unaware of certain injuries. The healthcare worker must write a conclusion in the space provided. Support of the history with the clinical picture is the basis for the conclusion

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

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

#FeesMustFall2016: Perceived and measured effect on clinical medical students

Background. Medical students are under immense academic stress. Campus unrest can contribute to stress and influence academic performance, social behaviour, emotional stability and financial expenses.Objectives. To investigate the effects of #FeesMustFall2016 (#FMF2016) on the 2016 3rd-year (semester 6) clinical medical students at the University of the Free State (UFS), Bloemfontein, South Africa.Methods. In phase 1 of the project, anonymous questionnaires were completed by the clinical students who experienced physical test disruption during #FMF2016. Opinions regarding academic performance, financial expenses, behaviour changes and stress levels were gathered. The students also completed a formal post-traumatic stress screening assessment. In phase 2 of the project, the academic performance of these students was compared with that of students not affected by #FMF2016.Results. Of the target population of 138 students, 87.0% completed the questionnaires. Three-quarters of the respondents reported a negative effect on academic performance, and most did not believe that the delivering of lectures on Blackboard was a good way of training. Alcohol consumption increased in 31.9% of the students. Criteria for post-traumatic stress disorder (PTSD) were met in 12.7% of students. Compared with previous and later cohorts of students there were no clear differences regarding marks, but there was a tendency towards poorer performance and more failures the next year.Conclusions. Semester 6 medical students at UFS reported that the #FMF2016 protests had a negative effect on academic, social, financial and stress aspects. PTSD was present in 12.7% of students compared with 7.8% in similar populations.

Nonperturbative renormalization group approach to frustrated magnets

This article is devoted to the study of the critical properties of classical XY and Heisenberg frustrated magnets in three dimensions. We first analyze the experimental and numerical situations. We show that the unusual behaviors encountered in these systems, typically nonuniversal scaling, are hardly compatible with the hypothesis of a second order phase transition. We then review the various perturbative and early nonperturbative approaches used to investigate these systems. We argue that none of them provides a completely satisfactory description of the three-dimensional critical behavior. We then recall the principles of the nonperturbative approach - the effective average action method - that we have used to investigate the physics of frustrated magnets. First, we recall the treatment of the unfrustrated - O(N) - case with this method. This allows to introduce its technical aspects. Then, we show how this method unables to clarify most of the problems encountered in the previous theoretical descriptions of frustrated magnets. Firstly, we get an explanation of the long-standing mismatch between different perturbative approaches which consists in a nonperturbative mechanism of annihilation of fixed points between two and three dimensions. Secondly, we get a coherent picture of the physics of frustrated magnets in qualitative and (semi-) quantitative agreement with the numerical and experimental results. The central feature that emerges from our approach is the existence of scaling behaviors without fixed or pseudo-fixed point and that relies on a slowing-down of the renormalization group flow in a whole region in the coupling constants space. This phenomenon allows to explain the occurence of generic weak first order behaviors and to understand the absence of universality in the critical behavior of frustrated magnets.Comment: 58 pages, 15 PS figure

The Chiral MagnetoHydroDynamics of QCD fluid at RHIC and LHC

The experimental results on heavy ion collisions at RHIC and LHC indicate that QCD plasma behaves as a nearly perfect fluid described by relativistic hydrodynamics. Hydrodynamics is an effective low-energy Theory Of Everything stating that the response of a system to external perturbations is dictated by conservation laws that are a consequence of the symmetries of the underlying theory. In the case of QCD fluid produced in heavy ion collisions, this theory possesses anomalies, so some of the apparent classical symmetries are broken by quantum effects. Even though the anomalies appear as a result of UV regularization and so look like a short distance phenomenon, it has been realized recently that they also affect the large distance, macroscopic behavior in hydrodynamics. One of the manifestations of anomalies in relativistic hydrodynamics is the Chiral Magnetic Effect (CME). At this conference, a number of evidences for CME have been presented, including i) the disappearance of charge asymmetry fluctuations in the low-energy RHIC data where the energy density is thought to be below the critical one for deconfinement; ii) the observation of charge asymmetry fluctuations in Pb-Pb collisions at the LHC. Here I give a three-page summary of some of the recent theoretical and experimental developments and of the future tests that may allow to establish (or to refute) the CME as the origin of the observed charge asymmetry fluctuations.Comment: 4 pages, talk at Quark Matter 2011 Conference, Annecy, France, 23-28 May 201