Factors contributing to relapse of mental health care users treated for substance-induced psychotic disorder in a psychiatric hospital in Gauteng, South Africa

This study explored the factors contributing to relapse of mental health care users (MHCUs) treated for substance-induced psychotic disorder in a public psychiatric hospital in Gauteng, South Africa. A qualitative, explorative, descriptive and contextual research design was followed. The study was conducted at the outpatient department of the hospital. Participants were selected purposefully from MHCUs visiting the outpatient department for follow-up. Ten semi-structured interviews were used to collect data until data saturation occurred. The transcribed interviews and field notes were analysed using Tesch's method of qualitative data analysis. The researcher and an independent coder reached consensus on the categories, sub-categories and themes. Trustworthiness was ensured through application of the strategies of dependability, transferability, conformability, credibility and authenticity. The findings explicated the factors contributing to relapse of MHCUs treated for substance-induced psychotic disorder in a psychiatric hospital. These factors included psychological, physical and social factors. Recommendations were provided for psychiatric nurses in terms of therapeutic programme planning and involvement of the community and family in the management of MHCUs treated for substance-induced psychotic disorder.http://www.unisa.ac.za/Default.asp?Cmd=ViewContent&ContentID=24782http://reference.sabinet.co.za/sa_epublication/ajnmam201

The Knowledge of Nurses on the Management of Multidrug Resistant Tuberculosis at Primary Health Care Facilities: A Pilot Study

The decentralisation of the multidrug-resistant tuberculosis (MDR TB) programme to primary healthcare (PH) facilities in an Eastern Cape health district was implemented to improve the effectiveness of MDR TB services. Nurses working in TB units play a key role in M DR TB management; therefore, they should be equipped with updated knowledge. This study assessed the knowledge of PH nurses working in TB units regarding MDR TB management. A quantitative, cross-sectional descriptive study was conducted: data were collected using a structured questionnaire. Non-probability sampling was applied in this study. A convenience sampling technique was used and 25 of the 42 facilities were selected. Two nurses from each facility were recruited, resulting in 50 questionnaires being distributed. A total of 32 respondents completed the questionnaires. Descriptive statistics were used to describe the data. The overall scores were high with a mean knowledge score of 61%. Thirty eight percent of the nurses had been trained in MDR TB and only 28% did not know how to use an N95 mask. However, knowledge gaps were identified in respect of the management of side effects of MDR TB medication. Although most respondents demonstrated an efficient level of knowledge of MDR TB management, knowledge gaps were identified and recommendations were offered to address these gaps

Strategies to sustain a quality improvement initiative in neonatal resuscitation

Background: Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim: The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting: A maternity section of a district hospital in South Africa. Methods: The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results: The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion: These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s drive to attain the MDG4

Action research as sustainable healthcare quality improvement : advances in neonatal care emphasising collaboration, communication and empowerment

Neonatal resuscitation can save newborn lives when performed by competent staff in a setting that is adequately equipped and organised. To develop strategies to sustain quality improvement in neonatal resuscitation, an initiative was launched in a maternity section of a district hospital in Gauteng, South Africa, using Piggot-Irvine’s Problem Resolving Action Research model. The application of the Problem Resolving Action Research model, using multiple data collection and analysis techniques in three cycles, facilitated improvement and transformation towards sustainable changes related to neonatal resuscitation in the specific context. The changes included development of policies, improved infrastructure, enhanced teamwork and collaboration, empowerment and professional development of staff, and integrating theory in neonatal practice. The outcomes resulted in improved staff competency and reduced neonatal mortality and morbidity in the particular setting.https://journals.sagepub.com/home/arjahj2020Nursing Scienc

One-day workshops, a platform for continuous professional development of nursing staff in a neonatal intensive care unit

The neonatal field is constantly changing with the development of new evidence-based practice and technology. The purpose of this paper is to report on a research project that aimed to create a platform for continuous professional development to improve evidence-based neonatal practice using action research. Using Problem Resolving Action Research, a process consisting of plan, act, observe and reflect was applied by a steering committee. A nominal group discussion technique determined training priorities of nursing staff in a neonatal intensive care unit and questionnaires obtained demographic data of participants and information pertaining to workshops and professional development over a period of two years. The findings indicate that one-day workshops serve as a valuable platform to contribute to professional development to improve quality care in neonatal practice.https://journals.sagepub.com/home/aduhj2019Nursing Scienc

Short-term effectiveness and safety of HAART in the form of a generic fixed-dose combination of stavudine, lamivudine and nevirapine (Triviro) in HIV-1-infected adults in Zimbabwe

OBJECTIVES. To assess the effectiveness and safety of a twice-daily regimen of a generic fixed-dose combination (FDC) of stavudine, lamivudine and nevirapine (Triviro) in a cohort of Zimbabwean HIV-1-positive adults. DESIGN: A prospective, open-label, one-arm study of antiretroviral-naïve adults with CD4 counts <200 cells/μl. Fifty-three intention-to-treat (ITT) patients were enrolled and monitored for 4 months. SETTING: Three primary health care facilities in Zimbabwe. Outcome measures. Efficacy criteria included plasma HIV-1 RNA load, CD4 counts, patient weight and Karnofsky performance scores. Toxicity was assessed by clinical evaluation and laboratory tests. RESULTS: There was a significant 3.0 log10 decrease in viral load at weeks 8 and 16 for both groups. Viral loads ≤400 copies/ml were achieved in 96% of per protocol (PP) and 85% of ITT patients at 8 and 16 weeks. At 4 months 85% of the PP group and 76% of the ITT group achieved undetectable viral loads. There was a significant increase in median CD4 counts of 101 cells/μl for PP and 86 cells/μl for the ITT analysis. The number of PP patients with Karnofsky scores of 100 improved from 10 (21%) to 38 (81%) and BMI increased by an average of 1.15 kg/m2. Of the 134 adverse events recorded, 4 (3%) were severe. Of 16 adverse drug reactions in 10 patients, 13 were ascribed to nevirapine. One adverse reaction resulted in withdrawal from the study. CONCLUSION: The effectiveness and safety of Triviro was comparable to that seen with other formulations, and our results support the use of this FDC in Zimbabwe and elsewhere

Short-term effectiveness and safety of HAART in the form of a generic fixed-dose combination of stavudine, lamivudine and nevirapine (Triviro) in HIV-1-infected adults in Zimbabwe

OBJECTIVES. To assess the effectiveness and safety of a twice-daily regimen of a generic fixed-dose combination (FDC) of stavudine, lamivudine and nevirapine (Triviro) in a cohort of Zimbabwean HIV-1-positive adults. DESIGN: A prospective, open-label, one-arm study of antiretroviral-naïve adults with CD4 counts <200 cells/μl. Fifty-three intention-to-treat (ITT) patients were enrolled and monitored for 4 months. SETTING: Three primary health care facilities in Zimbabwe. Outcome measures. Efficacy criteria included plasma HIV-1 RNA load, CD4 counts, patient weight and Karnofsky performance scores. Toxicity was assessed by clinical evaluation and laboratory tests. RESULTS: There was a significant 3.0 log10 decrease in viral load at weeks 8 and 16 for both groups. Viral loads ≤400 copies/ml were achieved in 96% of per protocol (PP) and 85% of ITT patients at 8 and 16 weeks. At 4 months 85% of the PP group and 76% of the ITT group achieved undetectable viral loads. There was a significant increase in median CD4 counts of 101 cells/μl for PP and 86 cells/μl for the ITT analysis. The number of PP patients with Karnofsky scores of 100 improved from 10 (21%) to 38 (81%) and BMI increased by an average of 1.15 kg/m2. Of the 134 adverse events recorded, 4 (3%) were severe. Of 16 adverse drug reactions in 10 patients, 13 were ascribed to nevirapine. One adverse reaction resulted in withdrawal from the study. CONCLUSION: The effectiveness and safety of Triviro was comparable to that seen with other formulations, and our results support the use of this FDC in Zimbabwe and elsewhere