A critical review of whether goals for treatment in type 2 diabetes mellitus as set out by the 2012 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines are being achieved in patients attending the diabetic clinic at Helen Joseph Hospital

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment for the requirements of the degree of Master of Medicine. Johannesburg, 2018.Background The risk of complications from T2DM is high. Complications reduce quality of life and place a large burden on our health system and economy. Achieving targets in our diabetic patients significantly reduces the morbidity and mortality of the disease. This study aims to assess whether patients at the Helen Joseph Academic Hospital Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes with the current hospital treatment protocols. Methods A Retrospective Clinical Audit was carried out at the Helen Joseph Hospital Diabetic Clinic. The files of 321 patients with T2DM for a duration of longer than five years and who were on insulin were reviewed. The following information was assessed: Glycated haemoglobin (HbA1c), Blood pressure, abdominal circumference and lipograms. Results The study population of 321 patients compromised majority black (44.6%) and coloured (34%) patients. The mean age amongst these patients was 59.4 years. This sample was predominantly female (62.3%). A large proportion of patients had concomitant Hypertension (89.1%) and dyslipidaemia (82.2%); with 91.2% fulfilling criteria for the diagnosis of metabolic syndrome. The majority of patients 56.3% did not exercise. A small amount partook in recreational activities that increase cardiovascular risk (smoking 12.5% and alcohol use 10.6%). Target HbA1c used for the purpose of this study was 7% or lower. The mean HbA1c in this study population was 9.5% (range 3.9 – 16.9%). Only 15.3% achieved the 7% target. The number of patients who achieved the target Blood Pressure of <140/90 was 72 (25%) (95% CI 20.2-30.5). LDL target was achieved in 22.6% and abdominal circumference 11%. Conclusions Despite adequate protocols and access to tertiary medical care, only a very small percentage of patients at the diabetic clinic are achieving proposed targets. Other audits have revealed a range of reasons for poor control in their patients. More comprehensive analysis is required to assess the reasons in this clinic if we are to address the problem with the urgency it requires. Ultimately, the goal is to offer the best treatment and quality of life to our ever increasing diabetic population.LG201

Anaesthesia and subglottic airway obstruction

In this article, we describe the anaesthetic management and laser excision of a subglottic tumour that caused upper airway obstruction. Stridor was the presenting feature. A good history and careful assessment will reduce the likelihood of erroneous or delayed diagnosis and will improve patient outcome.This case report highlights the use of target-controlled infusions and jet ventilation (high-pressure source ventilation) in the surgical excision of a subglottic tumour.Keywords: shared airway; jet ventilation; TIVA/TCI; laser excision; monitorin

Sustainable safety volunteerism in the Strand, Western Cape: Volunteer identity, motivation and socio-organisational experiences

There is a growing recognition of the relevance and even centrality of volunteerism to adequate collective responses to poverty, housing and the promotion of human rights and, more recently, safety. Volunteerism by members of poor global South communities within their own communities has, however, remained relatively neglected and undescribed. This study explored the motivations, benefits and socio-organisational experiences that a group of volunteers reported as a result of their participation in a safety-promotion project in two under-resourced communities in the Strand, in the Western Cape, South Africa. The focus of this safety-promotion project was to enhance women’s safety and health and to reduce risks of injury and violence through the implementation of safety-promotion strategies that target the prevention of priority injuries, particularly violence, traffic injury and burns. The study used a qualitative approach and is based on the completion of questionnaires and focus group discussions with volunteers and project staff. Data analysis involved the thematic analysis of the written responses by 28 volunteers and 4 project staff to a questionnaire comprising open-ended and focused questions that explored their experiences of volunteerism. The study also involved the analysis of the transcriptions of two focus group discussions subsequently held with these volunteers to clarify, further develop and verify emerging themes. The volunteers identified both self-oriented and socially altruistic motivations and benefits. These volunteers highlighted a hope and desire to advance social change and promote safety within their communities. Volunteer experiences reflected their enthusiasm to enhance both the human and social capital of their communities simultaneously. This study highlighted the development of a volunteer identity as a necessary component for the implementation of a sustainable, volunteer-based safety-promotion project.Keywords: Volunteerism, safety, identity, motivation, experience

Collective narratives catalyse cooperation

Humans invest in fantastic stories—mythologies. Recent evolutionary theories suggest that cultural selection may favour moralising stories that motivate prosocial behaviours. A key challenge is to explain the emergence of mythologies that lack explicit moral exemplars or directives. Here, we resolve this puzzle with an evolutionary model in which arbitrary mythologies transform a collection of egoistic individuals into a cooperative. We show how these otherwise puzzling amoral, nonsensical, and fictional narratives act as exquisitely functional coordination devices and facilitate the emergence of trust and cooperativeness in both large and small populations. Especially, in small populations, reflecting earlier hunter- gatherers communities, relative to our contemporary community sizes, the model is robust to the cognitive costs in adopting fictions

Why do religious cultures evolve slowly? The cultural evolution of cooperative calling and the historical study of religions

Collective representations are the result of an immense cooperation, which stretches out not only into space but into time as well; to make them, a multitude of minds have associated, united and combined their ideas and sentiments: for them, long generations have accumulated their experience and their knowledge. A special intellectual activity is therefore concentrated in them, which is infinitely richer and complexer than that of the individual. (Émile Durkheim, Elementary Forms of the Religious Life, [1912] 1965: 29)The languages and folkways of ancient peoples hold little relevance for us, except in one respect: the religions of the ancient world remain our religions. Though religions change, core features of the scriptures and rituals of the world's most popular religious traditions appear to have been conserved with remarkably high fidelity. We explain slow religious change from how religion facilitates cooperation at large social scales. At the end, we clarify how historians of religion, in collaboration with psychologists and computational biologists, might test and improve explanations such as ours.This research was supported by the John F. Templeton Foundation (Testing the Functional Roles of Religion in Human Society, no. 28745), the Royal Society of New Zealand ("e Cultural Evolution of Religion, no. 11-UOA-23

Employing complex responsive process (CPR) as a tool for organisational learning and transformation.

Thesis (M.Sc.Eng.)-University of KwaZulu-Natal, 200

Are type 2 diabetic patients meeting targets? A Helen Joseph Hospital Diabetic Clinic Audit

No Abstract

Navigating and Reimagining Community Engagement amidst COVID-19

Community engagement is a critical manifestation of a humanising approach on how to respond to various psychosocial and structural violence challenges in the context of a pandemic. Community engagement within the context of the current global coronavirus pandemic (COVID-19) requires creative and innovative responses. Institutions have had to reconfigure their community engagement due to restrictive measures instituted by governments to curb the spread of the virus. This paper aims to reflect on the conversations and experiences of community activist researchers in implementing creative ways of engagement to address pertinent psychosocial and structural violence issues affecting communities during COVID-19. Through a qualitative reflexive approach, we identified the following themes: (1) Challenges in community-engaged research during a pandemic; (2) Structural violence and psychosocial issues; and (3) Innovative opportunities to bridge gaps and confront community realities. The pandemic has produced challenges but has also allowed for opportunities to reimagine community engagement. It has created opportunities and novel ways of collaborating with multisectoral social actors to address the psychosocial challenges during the pandemic and to remain actively engaged with communities