Ascorbic acid causes spuriously low blood glucose measurements

CITATION: Strijdom, J.G., Marais, B.J. & Koeslag, J.H. 1993. Ascorbic acid causes spuriously low blood glucose measurements. S Afr Med J, 83(1):64-65.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

The neural correlates of intimate partner violence in women

Objective: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV). Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result. Conclusion: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding

The role of educational strategies to reverse the inverse performance spiral in academically-isolated rural hospitals

The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province, South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence, increased the levels of job satisfaction they experienced, increased their willingness to stay in a rural environment, and impacted positively on the quality of services provided. However, the success of educational strategies is heavily dependant on the local environment (context), as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals, however, this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care. South African Family Practice Vol. 49 (7) 2007: pp. 1

Characterisation of Pinotage Wine During Maturation on Different Oak Products

The effect of oak contact on the phenolic composition, total antioxidant capacity (TAC) and colour of Pinotage wineswas investigated during maturation. Oak maturation included traditional treatments, such as new, second-fill andthird-fill barrels, as well as alternative treatments (oak chips, staves, extract and dust) applied in old barrels over aperiod of 28 weeks. Oak maturation using traditional and alternative treatments improved the objective colour ofPinotage wine by decreasing the L* value. Losses in TAC caused by decreased concentrations of monomeric phenoliccompounds (most anthocyanins, flavan-3-ols, flavonols and hydroxycinnamic acids) during oak maturation werenegated by increased concentrations of gallic acid and the formation of new oligomeric and polymeric pigments.Wine maturation in stainless steel containers also resulted in a decrease in anthocyanin content. The decreasein phenolic acid content for wines matured in stainless steel was less pronounced, while their flavan-3-ol contentremained stable. The new-barrel treatment had the most pronounced effect on all parameters. Oak maturation canbe used for the production of Pinotage wine when the retention of TAC is a high priority

Challenges to creating primary care teams in a public sector health centre: a co-operative inquiry

Background: Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) is situated in a large town and offers primary care to the rural Breede Valley Sub-District of the Western Cape. The management of the CHC decided to create dedicated practice teams offering continuity of care, family-orientated care, and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs. Methods: A co-operative inquiry group, consisting of two facility managers, an administrator, and medical and nursing staff, met over a period of nine months and completed three cycles of planning, action, observation and reflection. The inquiry focused on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care could be created within a typical CHC. Results: The CHC established three practice teams, but met with limited success in maintaining the teams over time. The group found that, in order for teams to work, the following are needed: A clear and shared vision and mission amongst the staff. The vision was championed by one or two leaders rather than developed collaboratively by the staff. Continuity of care was supported by the patients and doctors, but the CNPs felt more ambivalent. Family-orientated care within practices met with limited success. Integration of care was hindered by physical infrastructure and the assumptions regarding the care of "chronics". Enhanced practitioner-patient relationships were reported by the two teams that had staff consistently available. Significant changes in the behaviour and roles of staff. Some doctors perceived the nurse as an "assistant" who could be called on to run errands or perform tasks. Doctors perceived their own role as that of comprehensively managing patients in a consultation, while the CNPs still regarded themselves as nurses who should rotate to other duties and perform a variety of tasks, thus oscillating between the role of practitioner and nurse. The doctors felt responsible for seeing a certain number of patients in the time they were available, while the CNPs felt responsible for getting all the patients through the CHC. The doctors did not create space for mentoring the CNPs, who were often seen as an intrusion and a threat to patient privacy and confidentiality when requesting a consultation. For the CNPs, however, the advantage of practice teams was considered to be greater accessibility to the doctor for joint consultation. The identification of doctors and CNPs with each other as part of a functioning team did not materialise. Effective management of the change process implied the need to ensure sufficient staff were available to allow all teams to function equally throughout the day, to be cognisant of the limitations of the building design, to introduce budgeting that supported semi-autonomous practice teams and to ensure that the staff were provided with ongoing opportunities for dialogue and communication. The implications of change for the whole system should be considered, and not just that for the doctors and nurses. Conclusion: Key lessons learnt included the need to engage with a transformational leadership style, to foster dialogical openness in the planning process and to address differences in understanding of roles and responsibilities between the doctors and the CNPs. The unreliable presence of doctors within the practice team, due to their hospital duties, was a critical factor in the breakdown of the teams. The CHC plans to further develop practice teams, to learn from the lessons so far and to continue with the co-operative inquiry