The prevalence of skin scars in patients previously given intramuscular diclofenac injections attending the Pain Clinic at Universitas Academic Hospital, Bloemfontein, South Africa

Intramuscular (IM) diclofenac rarely causes scarring (reported incidence <0.05%). Some patients attending the Pain Clinic at Universitas Academic Hospital, Bloemfontein, South Africa, presented with scars that had developed after IM diclofenac injections. We investigated the prevalence of scars in patients at the clinic and how the injections had been obtained. Patients attending the clinic over a period of 9 months who said they had received diclofenac (N=131) were included. Information was collected using a questionnaire and physical examination. Data obtained from 118 patients who were certain that they had received diclofenac were analysed. Ninety-three patients (78.8%) indicated they had not been warned about the possibility that a diclofenac injection could result in scarring. Scarring had occurred in 10 patients (8.5%). Two-thirds of the patients who had obtained diclofenac from a pharmacy had never had a prescription for it. Four patients had required medical treatment for an ulcer or abscess, of whom two had undergone surgery. The risk of skin lesions associated with IM diclofenac is higher than reported previously. Contrary to regulations, diclofenac injections were often dispensed to patients without a prescription

Student review of doctor-patient communication skills training in a South African undergraduate medical programme

Background. Barriers to the training of doctor-patient communication in the South African (SA) context have been well explored through qualitative research at several SA medical schools. However, this aspect of training has not been reviewed in a systematic way by a large number of students. A student review of doctor-patient communication skills training in the undergraduate medical programme of a medical school in SA was obtained to improve training and identify further research needs. Objective. To investigate doctor-patient communication skills training in the undergraduate programme of a medical school in SA to identify shortcomings and further research needs. Methods. A descriptive, cross-sectional design was used. Data were collected through an anonymous questionnaire based on Harden’s extended vision of the curriculum. Printed anonymous questionnaires, distributed to all the fourth- and fifth-year undergraduate medical students, were analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory. Results. The sample comprised 106/132 fifth-year students (response rate 80.3%) and 65/120 fourth-year students (response rate 54.2%). Frequent training in history-taking was reported by >75% of students, while >60% reported infrequent training in breaking bad news. More than 50% of participants indicated that senior doctors seldom or never modelled patient-centred communication in the clinical teaching milieu. Students preferred experiential learning to didactic methods. Conclusion. Medical students want to see patient-centred communication unequivocally modelled in the clinical setting. A greater emphasis on practical training in context-specific communication skills is required. Positive role-modelling is needed in the clinical environment

Injury-related South African mortality in children, 1981 - 1985

Data on all registered deaths in children < 15 years in the RSA (excluding Transkei, Bophuthatswana, Venda and Ciskei) were analysed for 1981 - 1985. Variations in age, sex and population group pattern for different causes of injury were evaluated. Injury accounted for 8% of deaths in children < 15 years and was the leading cause of death between the ages of 5 years and 14 years (accounting for 43% of deaths). Motor vehicle accidents were the most important cause of injury deaths in all age groups except < 1 year, when accidental choking and suffocation resulted in more deaths. Drowning accounted for 19% of injury deaths and burns for 11%. In 14% of injury deaths it was not determined if the injury was accidental or purposefuUy inflicted. In all age and population groups deaths among boys outnumbered girls. The impact and pattern of injury varied considerably between age and population groups and reasons for these findings are discussed

Age of diagnosis of congenital hearing loss: Private v. public healthcare sector

Background. The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better.Objective. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city.Methods. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design.Results. Forty-eight children aged <6 years with disabling hearing impairment (DHI) were identified in the private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (p<0.0001; 95% confidence interval (CI) 0.99 - 2.0). The median age of diagnosis of CHL in the private healthcare sector was 3.01 years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (p<0.01; 95% CI 0.72 - 2.47). We also compared the median age of diagnosis of CHL in children from the private healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (p<0.01; 95% CI 0.41 - 1.56).Conclusions. Children in the Free State are diagnosed with CHL at a younger age in the private healthcare sector than in the public healthcare sector. With the social and economic benefits of early intervention in cases of DHI well established internationally, SA healthcare providers in both the public and private sectors need to develop screening, diagnostic and (re)habilitation services for children with hearing impairment

High dose-rate brachytherapy in the radical treatment of cervical cancer. An analysis of dose effectiveness and incidence of late radiation complications

Published ArticleWorldwide, uterine cervical cancer is one of the most frequently occurring cancers in women, with more than 80% of these cases occurring in developing countries. The South African screening policy and screening program, implemented in 2001, attempt to reduce this incidence of cervical cancer in South Africa. It is essential to treat these women with the best modalities available. This retrospective study focused specifically on the curative potential of radiotherapy administered to patients at the Oncology Department, Bloemfontein, since a new modality of high dose-rate intracavitary brachytherapy was implemented in 1994. Late radiation complications were also investigated

Student review of doctor-patient communication skills training in a South African undergraduate medical programme

Background. Barriers to the training of doctor-patient communication in the South African (SA) context have been well explored through qualitative research at several SA medical schools. However, this aspect of training has not been reviewed in a systematic way by a large number of students. A student review of doctor-patient communication skills training in the undergraduate medical programme of a medical school in SA was obtained to improve training and identify further research needs. Objective. To investigate doctor-patient communication skills training in the undergraduate programme of a medical school in SA to identify shortcomings and further research needs. Methods. A descriptive, cross-sectional design was used. Data were collected through an anonymous questionnaire based on Harden’s extended vision of the curriculum. Printed anonymous questionnaires, distributed to all the fourth- and fifth-year undergraduate medical students, were analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory. Results. The sample comprised 106/132 fifth-year students (response rate 80.3%) and 65/120 fourth-year students (response rate 54.2%). Frequent training in history-taking was reported by >75% of students, while >60% reported infrequent training in breaking bad news. More than 50% of participants indicated that senior doctors seldom or never modelled patient-centred communication in the clinical teaching milieu. Students preferred experiential learning to didactic methods. Conclusion. Medical students want to see patient-centred communication unequivocally modelled in the clinical setting. A greater emphasis on practical training in context-specific communication skills is required. Positive role-modelling is needed in the clinical environment

Parallel Unsmoothed Aggregation Algebraic Multigrid Algorithms on GPUs

We design and implement a parallel algebraic multigrid method for isotropic graph Laplacian problems on multicore Graphical Processing Units (GPUs). The proposed AMG method is based on the aggregation framework. The setup phase of the algorithm uses a parallel maximal independent set algorithm in forming aggregates and the resulting coarse level hierarchy is then used in a K-cycle iteration solve phase with a $\ell^1$-Jacobi smoother. Numerical tests of a parallel implementation of the method for graphics processors are presented to demonstrate its effectiveness.Comment: 18 pages, 3 figure

Utilisation of maternity services by black women in rural and urban areas of the Orange Free State

An epidemiological survey was undertaken to evaluate the utilisation of maternal services for black women in the Orange Free State. Two hundred and forty clusters were selected from the rural (farms) and urban (local authorities) black population and eight households were interviewed in each cluster. Information was gathered from 237 rural women (from 959 households) and 168 urban women (from 926 households) who had delivered a baby or aborted during the preceding year. Antenatal care was received by 71 % of the rural women and 87% of the urban women. Rural women delivered at home in 60% of cases while 37% delivered in hospitals. Only 23% of urban women delivered at home while 67% of their deliveries were conducted in hospitals. Nurses supervised deliveries in both instances in more than 60% of cases, but in rural areas traditional midwives managed 26% of the confinements. The conclusions are that the maternity service was largely provided by nurses and was predominantly limited to hospitals and homes. It is recommended that the quality of service be upgraded and more emphasis placed on midwife obstetric units

Ground Contact Time Imbalances Strongly Related to Impaired Running Economy

Running economy (RE) is defined as the oxygen consumption (VO2) or caloric unit cost required to move at a specific velocity and is an important performance marker. Ground contact time (GCT) has been associated with RE; however, it has not been established how GCT imbalances between feet impact RE. Purpose: Determine the relationship between cadence, GCT, and GCT imbalances and RE. Methods: 11 NCAA Division I distance runners (7 male) completed a graded exercise test on a treadmill to determine lactate threshold (LT) and VO2max. Body composition was also assessed via DEXA. Subjects ran with a heart rate monitor capable of measuring cadence, GCT, and GCT balance between feet. VO2 and respiratory exchange ratio were recorded over the last minute of the 5-minute stages. RE expressed as caloric unit cost (kcal·kg-1· km-1) was calculated for the stage determined to be just below the LT (prior to \u3e 4mmol/L) and was correlated with cadence, GCT, and GCT imbalance by Pearson correlations. Results: Pearson correlations between RE and the running dynamics measures were as follows: cadence (r = -.444, p = .171), GCT (r = .492, p = .125), GCT Imbalance (r = .808, p \u3c .005). An independent t-test revealed greater (p = .023) leg lean mass imbalances in runners with larger GCT imbalances compared to runners with smaller GCT imbalances. Conclusion: GCT imbalances are strongly related to impaired RE. Future research should determine how to improve GCT imbalances and if doing so improves RE