Defining Moments - An Autobiography

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Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool

This thesis uses experience gained from a large implementation trial in two rural districts of the Western Cape, South Africa, to address the needs of patients with non-communicable diseases (NCDs) and depression, and to identify solutions to those needs. The Primary Care 101 intervention supports and expands nurses' role in integrated care, in particular for NCDs. It comprises a comprehensive clinical management tool implemented in primary care services using educational outreach training. It was evaluated using a pragmatic cluster randomised controlled trial: 38 clinics in the Eden and Overberg districts of the Western Cape were randomised to receive the intervention or to continue with usual care. 4393 Patients were enrolled and four cohorts identified: hypertension, diabetes, chronic respiratory disease and depression. Patients were re-interviewed once, 14 months later. Primary outcomes for the trial were treatment intensification for the hypertension, diabetes and chronic respiratory disease cohorts, and case detection for the depression cohort. Multimorbidity, NCD care and their socioeconomic associations were assessed on the whole trial cohort (combining intervention and control arms) at baseline and follow-up. The results are presented in published papers. Baseline data revealed considerable multimorbidity and unmet treatment needs (Paper 1). Socioeconomic indicators such as education, and modifiable clinic-level factors such as adequate staffing and communitybased chronic medication collection services were associated with blood pressure control (Paper 2) and depression management (Paper 3). The intervention was shown to be feasible and safe but none of the four primary outcomes showed significant improvement (Paper 4). The thesis addresses the public health challenge of providing integrated chronic disease primary care in South Africa by: • Providing original evidence for high levels of NCD multimorbidity and unmet treatment needs. • Identifying modifiable factors that could improve care for these diseases. • Providing new evidence from South Africa to support the bidirectional relationship between poverty and depression. • Reporting evidence of the effectiveness of a novel intervention aimed at improving NCD care. The findings point to the need for improved strategies for NCD care, including equipping primary health care providers to manage the complexities of multimorbidity

Healers, Helpers and Hospitals (Volumes 1 and 2)

No Abstract

At the heart of healing

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The medicines regulatory system in South Africa - review and proposals for reform

No Abstract

Information Practices of Disaster Response Professionals: The Preparedness Phase

Objectives: This study describes the information practices of the various professions such as emergency management, public health, health and medicine, and public safety, involved in regional disaster preparedness groups. A thorough understanding of the similarities and differences between the professions in information seeking, use, and sharing, will further the development of high-quality information sources and information-sharing channels acceptable to all professions on the team. Methods: A qualitative descriptive study was undertaken. Twelve participants in the Pennsylvania Preparedness Leadership Institute (PPLI), a multi-disciplinary training program attended by members of the Pennsylvania Regional Task Forces, were recruited interviewed. Open-ended individual interviews were conducted at PPLI trainings and in participant workplaces. Interviews focused on information practice in the workplace, including preferences for information seeking and sharing, and barriers and facilitators to information access in the workplace. Analysis used Taylor's Information Use Environments model as an organizing framework. Findings: As Taylor's model states, information practice is shaped by the educational and training requirements for entry into each profession. Factors not included by Taylor but important to this study include volunteer experience in related fields, and overlap between personal and professional information practice on the Internet. Participants report heavy use of the Internet and email, but not of Web 2.0 social media. They value face-to-face meetings for building the social networks critical to disaster response. Only public health and medical professionals use peer-reviewed literature. All would like tools to filter incoming information, and more access to the "lessons learned" reports of other agencies engaged in similar work. Conclusions: There are differences between professions in information practice, but also commonalities that can be exploited to further information use in preparedness. Librarians can make a significant contribution to preparedness efforts by incorporating these findings into the design of information services and resources for disaster professionals. Public health significance: Improving information gathering and sharing practices for all disciplines on the disaster planning team is critical to reducing the impact of man-made and natural disasters on the health of the general public

Books

Adverse drug reactions International Reporting of Adverse Drug Reactions. Ed. by ClaMS Working Group. pp. 66. illustrated. SFr. 10. Geneva: WHO. 1990.Human anatomy Basiese Menslike Anatomie. Ed. by Linda de Jager. pp. 204. illustrated. Wetton: Juta. 1990

Prediction of amikacin dose requirements in neutropenic patients with haematological disease

This study reports on the use of an easily applied Bayesian forecasting programme (OPT; Clyde-soft) to predict amikacin dose requirements in 10 patients with haematological disease and neutropenic fever. OPT-determined dose adjustment achieved therapeutic drug levels for 80% of the peak and 94% of the trough measurements