Evaluating the rural health placements of the Rural Support Network at the Faculty of Health Sciences University of Cape

Objectives: The Rural Support Network (RSN) is an undergraduate student society that aims to raise awareness among the student body of the plight of rural health in South Africa, and organises individual and group placements in rural hospitals during vacations. This research aimed to evaluate these placements from the students' perspectives. Design: In-depth, face-to-face interviews were conducted with 10 students and nine placement-reflective reports were reviewed. The data were analysed and coded for key themes using a constant, comparative grounded theory approach. Setting: Faculty of Health Sciences (FHS) at the University of Cape Town. Subjects: Students who had been on RSN placements in 2010. Results: Students reported that the experience exceeded their expectations of learning new skills and observing and performing procedures. They gained significant insights into rural health care and were inspired to contribute to rural health in future. Their experiences helped them to gain confidence and an appreciation of the psycho-social aspects of patient care. The importance of community empowerment and of connecting and building relationships with communities was also emphasised. Challenges pertained to conflict within groups, incidents of unprofessional health care and being unable to help as much as they would have liked. Conclusion: The study highlights the impact that positive experiences of rural health may have on health science students' interest in, passion for, and commitment to practising in underserved rural areas. Students' key recommendations for the FHS included the development of a rural programme within the undergraduate curriculum. Better group composition and improved planning and co-ordination of placements by the RSN were also recommended

Barriers to cycling in informal settlements

A study was undertaken in October 2015 to determine the barriers to cycling mobility in Masiphumelele, a low-income community in Cape Town. An initial focus group discussion informed the design of a household survey of 100 residents on commuter cycling. This included a stated choice survey using Best-Worst Scaling (BWS) of the relative importance of 20 potential barriers to cycling mobility. Minibus taxis were the primary mode of household transport (93%); walking (44%), train (23%), bicycle (16%) and bus (11%) were important secondary modes. 32% of households owned at least one bicycle that is used for transport. 22% of participants reported that they cycle fairly often or regularly, primarily to save money (44%), keep fit and healthy (32%), and to save time (15%). 68% supported promotion of cycling mobility in Masiphumelele. Leading barriers to cycling identified by the BWS survey were concerns about road safety; inability to transport loads on a bicycle; inability to commute with a bicycle by train during peak commuting hours; and concerns about arriving late for work. Key recommendations for increasing cycling mobility in Masiphumelele are to actively promote the benefits of cycling, educate about road safety, teach cycling skills, make bicycles and spares more affordable, enhance the safety of the cycling environment, and to build local capacity.No paper, Abstract onlyPaper presented at the 35th Annual Southern African Transport Conference 4-7 July 2016 "Transport ? a catalyst for socio-economic growth and development opportunities to improve quality of life", CSIR International Convention Centre, Pretoria, South Africa.The Minister of Transport, South AfricaTransportation Research Board of the US

Career and practice intentions of health science students at three South African health science faculties

Background. The distribution and accessibility of healthcare professionals as well as the quality of healthcare services are significantly affected by the career choices of medical and other health science graduates.Objective. While much has been reported on the career intentions of medical students, little is known about those of their counterparts in the health sciences. This study describes the career plans of non-medical health science students at three South African health science faculties, and identifies some key motivating factors.Methods. A self-administered survey of first- and final-year health science students was conducted at the health science faculties of the universities of Cape Town, KwaZulu-Natal and Limpopo. All data were entered into EpiData software and exported for analysis using IBM SPSS Statistics 19.0.Results and discussion. The overall response rate was 47% (N=816). Over half of all respondents (57%, n=467) intended to work after completing their undergraduate studies, 38% (n=177) of these in a rural area. The most popular choices were private hospitals (58%, n=273), tertiary hospitals (53%, n=249) and private practices (51%, n=249). Thirty-two per cent (n=258) of respondents intended to further their studies. Just over half of all respondents intended to work in another country (51%, n=418), primarily motivated by career development, financial reasons and job opportunities.Conclusion. The findings demonstrate that health science students, similar to medical students, are influenced by a multitude of factors in making career choices. This emphasises the relevance to all health science disciplines of national strategies to address the maldistribution of healthcare professionals

How well do we teach the primary healthcare approach? A case study of health sciences course documents, educators and students at the University of Cape Town Faculty of Health Sciences

Background. The comprehensive primary healthcare (PHC) approach has been a lead theme in the University of Cape Town Faculty of Health Sciences(FHS) since 1994. A 2014 institutional academic review recommended that indicators be developed for monitoring and evaluating the PHC theme.Objective. To evaluate PHC teaching and learning of final-year health and rehabilitation sciences and medical students at three community-based education (CBE) sites of the faculty, two in Cape Town and one in a distant and largely rural district.Methods. Course documents were analysed for evidence and alignment of nine indicators of the PHC approach in the documented  learning outcomes, activities and assessments of final-year health sciences students. Clinical educators and students were interviewed to identify factors that facilitate or impede PHC teaching and learning on site.Results. Final-year health sciences disciplines engage inconsistently with PHC principles at the CBE sites. Alignment appears to be  strongest between learning outcomes and teaching activities, but the available data are insufficient to judge whether there is also strong alignment between outcomes and teaching, and formal graded assessment. PHC teaching and learning at the CBE sites are facilitated by good multiprofessional teamwork, educator rolemodelling and good infrastructural and logistical support. Language barriers, staff shortages and high workloads are significant and prevalent barriers.Conclusion. Strong faculty leadership is required to promote the PHC lead theme and to achieve better departmental and  multiprofessional collaboration in teaching the PHC approach. This study provides evidence from well-established CBE sites to inform future work and participatory action research in promoting the PHC approach in teaching and learning in the FHS

Evaluation of a nutrition supplementation programme in the Northern Cape Province of South Africa

AIM: This study aimed at assessing the effectiveness regarding implementation and impact of a take-home nutrition supplementation programme, the Protein Energy Malnutrition (PEM) Scheme, that targets malnourished pre-school children and pregnant and lactating women in the Northern Cape Province of South Africa. METHODOLOGY: In assessing implementation of the PEM Scheme, a cross-sectional descriptive study was undertaken over a 6-month period in the six regions of the Northern Cape Province. Interviews were conducted with programme managers and health personnel at clinics who were responsible for implementing the PEM Scheme. In assessing the impact of the PEM Scheme on growth, a retrospective review was done of the clinic records (including anthropometric data) of children enrolled in the PEM Scheme over a 1-year period. RESULTS: About 76% of the budget allocated to the PEM Scheme had been utilised over the 1-year period. The budget for the following financial year was based solely on food supplements purchased in the previous year. Coverage of malnourished pre-school children and eligible pregnant and lactating women for enrolment was estimated to be 50% and 60%, respectively. Eighty-five per cent of health facilities in the province participated in the PEM Scheme. Some of the main problems identified included: lack of training, inappropriate targeting of certain groups, incorrect application especially of discharge criteria for pregnant and lactating women, inadequate assessment for nutrition-related disease, inadequate nutrition counselling and no standardised monitoring. Of the 319 children enrolled over a year, the mean age was 16.2 (standard deviation 16.2) months, 41% had been low-birth-weight and 18% had been diagnosed with tuberculosis. Ten per cent of the children with a weight-for-age Z-score of <-2 moved into the normal Z-score range after being on the PEM Scheme for a mean duration of 8 months. There was an overall improvement in the weight-for-age Z-scores of 25% of the sample, with a significant difference between the mean weight-for-age Z-scores at enrolment and follow-up This was mainly related to significant improvement in the mean weight-for-age Z-scores of children <2 years. CONCLUSIONS: Numerous problems with the PEM Scheme have been identified which could have limited its impact. Recommendations are proposed for improving the effectiveness and impact of the PEM Scheme in the province

Developing indicators for monitoring and evaluating the primary healthcare approach in health sciences education at the University of Cape Town, South Africa, using a Delphi technique

Background. The Faculty of Health Sciences (FHS), University of Cape Town (UCT) adopted the primary healthcare (PHC) approach as its lead theme for teaching, research and clinical service in 1994. A PHC working group was set up in 2017 to build consensus on indicators to monitor and evaluate the PHC approach in health sciences education in the FHS, UCT. Objective. To develop a set of indicators through a Delphi technique for monitoring and evaluating the PHC approach in health sciences curricula in the FHS, UCT. Methods. A national multidisciplinary Delphi panel was presented with 61 indicators of social accountability from the international Training for Health Equity Network (THEnet) for scoring in round 1. Nineteen PHC indicators, derived from a mnemonic used in the FHS, UCT for teaching core PHC principles, were added in round 2 to the 20 highest ranked THEnet indicators from round 1, on recommendation of the panel. Scoring criteria used were relevance (in both rounds), feasibility/measurability (round 1 only) and application of the PHC indicators to undergraduate and postgraduate teaching and assessment (round 2 only). Results. Of the 39 indicators presented in the second round, 11 had an overall relevance score >85% based on the responses of 16 of 20 panellists (80% response rate). These 11 indicators have been grouped by learner needs (safety of learners – 88%, teaching is appropriate to learners’ needs and context – 86%); healthcare user needs (continuity of care – 94%, holistic understanding of healthcare – 88%, respecting human rights – 88%, providing accessible care to all – 88%, providing care that is acceptable to users and their families – 87%, providing evidence-based care – 87%); and community needs (promoting health through health education – 88%, education programme reflects communities’ needs – 86%, teaching embodies social accountability – 86%). Conclusion. The selected indicators reflect priorities relevant to the FHS, UCT and are measurable and applicable to undergraduate and postgraduate curricula. They provided the basis for a case study of teaching the PHC approach to our undergraduate students

Exon-array profiling unlocks clinically and biologically relevant gene signatures from formalin-fixed paraffin-embedded tumour samples

Degradation and chemical modification of RNA in formalin-fixed paraffin-embedded (FFPE) samples hamper their use in expression profiling studies. This study aimed to show that useful information can be obtained by Exon-array profiling archival FFPE tumour samples

Phosphatidylinositide 3-kinase (PI3K) and PI3K-related kinase (PIKK) activity contributes to radioresistance in thyroid carcinomas.

Anaplastic (ATC) and certain follicular thyroid-carcinomas (FTCs) are radioresistant. The Phosphatidylinositide 3-kinase (PI3K) pathway is commonly hyperactivated in thyroid-carcinomas. PI3K can modify the PI3K-related kinases (PIKKs) in response to radiation: How PIKKs interact with PI3K and contribute to radioresistance in thyroid-carcinomas is unknown. Further uncertainties exist in how these interactions function under the radioresistant hypoxic microenvironment. Under normoxia/anoxia, ATC (8505c) and FTC (FTC-133) cells were irradiated, with PI3K-inhibition (via GDC-0941 and PTEN-reconstitution into PTEN-null FTC-133s) and effects on PIKK-activation, DNA-damage, clonogenic-survival and cell cycle, assessed. FTC-xenografts were treated with 5 × 2 Gy, ± 50 mg/kg GDC-0941 (twice-daily; orally) for 14 days and PIKK-activation and tumour-growth assessed. PIKK-expression was additionally assessed in 12 human papillary thyroid-carcinomas, 13 FTCs and 12 ATCs. GDC-0941 inhibited radiation-induced activation of Ataxia-telangiectasia mutated (ATM), ATM-and Rad3-related (ATR) and DNA-dependent protein kinase catalytic subunit (DNA-PKcs). Inhibition of ATM and DNA-PKcs was PI3K-dependent, since activation was reduced in PTEN-reconstituted FTC-133s. Inhibition of PIKK-activation was greater under anoxia: Consequently, whilst DNA-damage was increased and prolonged under both normoxia and anoxia, PI3K-inhibition only reduced clonogenic-survival under anoxia. GDC-0941 abrogated radiation-induced cell cycle arrest, an effect most likely linked to the marked inhibition of ATR-activation. Importantly, GDC-0941 inhibited radiation-induced PIKK-activation in FTC-xenografts leading to a significant increase in time taken for tumours to triple in size: 26.5 ± 5 days (radiation-alone) versus 31.5 ± 5 days (dual-treatment). PIKKs were highly expressed across human thyroid-carcinoma classifications, with ATM scoring consistently lower. Interestingly, some loss of ATM and DNA-PKcs was observed. These data provide new insight into the mechanisms of hypoxia-associated radioresistance in thyroid-carcinoma

A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial.

BACKGROUND: BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS: RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT: invasive loco-regional control (ILRC); secondary overall survival. FINDINGS: Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION: Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial. FUNDING: Cancer Research UK, NIHR, MRC