Impact of the South African Mental Health Care Act No. 17 of 2002 on regional and district hospitals designated for mental health care in KwaZulu- Natal

Background. The South African Mental Health Care Act (the Act) No. 17 of 2002 stipulated that regional and district hospitals be designated to admit, observe and treat mental health care users (MHCUs) for 72 hours before they are transferred to a psychiatric hospital. Methods. Medical managers in 49 ‘designated’ hospitals in KwaZulu-Natal (KZN) were surveyed on infrastructure, staffing, administrative requirements and mental health care user case load pertaining to the Act for the month of July 2009. Results. Thirty-six (73.4%) hospitals responded to the survey; 30 (83.3%) stated that the Act improved mental health care for MHCUs through the protection of their rights, provision of least restrictive care, and reduction of discrimination; 10 (27.8%) had a psychiatric unit and, of the remaining 26 hospitals, 11 (30.6%) had general ward beds dedicated for psychiatric admissions; 16 (44.4%) had some form of seclusion facility; and 24 (66.7%) provided an outpatient psychiatric service. Seventy-six per cent of admissions were involuntary or assisted. Thirteen of the 32 (40.6%) state psychiatrists in KZN were employed at 8 of these hospitals. Designated hospitals expressed dissatisfaction with the substantial administrative load required by the Act. The Review Board had not visited 29 (80.6%) hospitals in the preceding 6 months. Conclusion. Although ‘designated’ hospitals admit and treat assisted and involuntary MHCUs, they do so against a backdrop of inadequate infrastructure and staff, a high administrative load, and a low level of contact with Review Boards

Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence

Objective: A review of systematic reviews of the effectiveness and feasibility of videoconference-based telepsychiatry services for resource constrained environments was conducted. Specifically with the aim of producing an evidence-based review of the effectiveness and feasibility of videoconference-based telepsychiatry services in resource constrained countries like South Africa.Methods: Eight key questions on telepsychiatry effectiveness and feasibility were identified and inclusion and exclusion criteria were developed. Review of citations from 2000-2011 from CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews (CCTR), Cochrane Controlled Trial Registry (CCTR), Database of Abstracts of Reviews of Effectiveness (DARE), unpublished abstracts through NEXUS and internet search engines (Google/Google scholar) was conducted. Results: Ten systematic reviews were included for review. Despite the methodological limitations and heterogeneity of the systematic reviews, there appears to be good evidence of effectiveness (reliability and improved outcomes) and feasibility (use, satisfaction, acceptability and cost) for videoconference-based telepsychiatry internationally. The application of this evidence in lower middle income countries is dependent on the integration of telepsychiatry into local health system contexts. Conclusion: Based on the evidence, resource constrained countries such as South Africa should be encouraged to develop telepsychiatry programs along with rigorous evaluation methods.Keywords: Videoconferencing; Psychiatry; Education; South Afric

A telepsychiatry model to support psychiatric outreach in the public sector in South Africa

The access of rural Mental Health Care Users in South Africa to specialist psychiatrists and quality mental health care is currently sub-optimal. Health professionals and planners working in psychiatry lack a well-defined and feasible outreach model to facilitate the delivery of services to remote and rural areas. In response to this challenge, a three-year action research telepsychiatry study was undertaken by the Departments of Psychiatry and TeleHealth at the University of KwaZulu-Natal, to develop a telepsychiatry outreach model based on local research and international evidence. The Model draws on needs and infrastructure assessments of the designated psychiatric hospitals in the province, a review of the published international evidence on telepsychiatry and videoconference-based education, and an evaluation of local clinical and educational telepsychiatry implementations in KwaZulu-Natal. The Model proposed is “virtual”, i.e. not bound to provincial or district referral patterns, aims not to add to the burden onthe current workforce and is intended to be integrated into psychiatry outreach services and policy. The Model should be subjected to in situ testing for validation and implementation. It is hoped that an implementation of this Model will improve the access of Mental Health Care Users to specialist psychiatry care.Keywords: Videoconferencing; Psychiatry; Model; Telepsychiatry; South Afric

Perceptions and Experiences of Healthcare Professionals Regarding Type 2 Diabetes Patient Education in Benin City, Nigeria

Background: The prevalence of type 2 diabetes is on the increase globally, characterised by severe complications which pose a burden on individuals, healthcare professionals and society. The study aimed at exploring the perceptions and experiences of healthcare professionals towards type 2 diabetes patient education. Method: The approach utilised was an explorative descriptive qualitative research approach. A multi-disciplinary group of healthcare professionals comprising of nurses, dieticians and social workers, in two health institutions participated in the focus group discussions. The discussions were recorded, transcribed and analysed manually using Tesch (1990) descriptive approach. Results: The identified themes included the composition of patient education on type 2 diabetes, challenges encountered during the practice of patient education and recommendations by the healthcare professionals. Conclusion: The healthcare professionals’ perceived that all healthcare professionals should be involved in patient education. Keywords: Experiences, Healthcare Professionals, Patients, Patient Education, Perception, Type 2 diabetes

Influence of Physiochemical and Watershed Characteristics on Mercury Concentration in Walleye, Sander vitreus, M.

Elevated mercury concentration has been documented in a variety of fish and is a growing concern for human consumption. Here, we explore the influence of physiochemical and watershed attributes on mercury concentration in walleye (Sander vitreus, M.) from natural, glacial lakes in South Dakota. Regression analysis showed that water quality attributes were poor predictors of walleye mercury concentration (R2 = 0.57, p = 0.13). In contrast, models based on watershed features (e.g., lake level changes, watershed slope, agricultural land, wetlands) and local habitat features (i.e., substrate composition, maximum lake depth) explained 81% (p = 0.001) and 80% (p = 0.002) of the variation in walleye mercury concentration. Using an information theoretic approach we evaluated hypotheses related to water quality, physical habitat and watershed features. The best model explaining variation in walleye mercury concentration included local habitat features (Wi = 0.991). These results show that physical habitat and watershed features were better predictors of walleye mercury concentration than water chemistry in glacial lakes of the Northern Great Plains

Resource tiered reviews – a provisional reporting checklist

AFJEM is committed to publishing review articles that will benefit acute care providers, independent of the resources available to them. As a result we have compiled a checklist aimed specifically at best evidence in the resource-restricted setting (Table 1). The aim is to guide authors in producing a report which is a combination between a clinical guideline and a systematic review. Best available evidence, using a transparent and systematic approach to find and evaluate relevant studies, is still key; but with additional focus on resource availability. In effect it will be more rigorous than a narrative review but less time-consuming than a systematic review or meta-analysis. In order to apply the content to different resource levels, authors are advised to start by describing the very best evidence available; then assume the resources for this level are not available and describe the next tier of evidence until all options are exhausted. For example, if we return to our patient with chest pain: the recommended treatment for a patient with STEMI is primary percutaneous coronary intervention; if this treatment is not available, then thrombolytics should be considered; if that is not available then antiplatelet therapy and anticoagulation should be used, and so on and so forth