A practice framework for the cooperative treatment of cancer between traditional health practitioners and radiation oncologists in KwaZulu-Natal province, South Africa

Background: Cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) is crucial for the continuity of care in the treatment of patients with cancer. However, scant information exists on how to co-ordinate cooperation between these health practitioners without interrupting the treatment of the patients. Aim: The study aimed to explore the practices of THPs and ROs in cancer treatment and ultimately derive a workable practice framework between these health practitioners in the KwaZulu-Natal (KZN) province. Setting: The study was conducted in selected districts, namely eThekwini, uThukela, Amajuba, uMkhanyakude, iLembe, uMzinyathi and uMgungundlovu, in KZN. Methods: A qualitative study by using a descriptive phenomenological approach was conducted to collect data from 28 THPs involved in the treatment of cancer and four ROs from public oncology hospitals. Focus groups and one-on-one semi-structured interviews by using open-ended questions were conducted to collect data from THPs and ROs, respectively. Framework analysis was used for data analysis to identify themes. Results: The study found that in KZN, THPs and ROs are working in parallel and that there are problems when patients seek cancer treatment from both health practitioners. Furthermore, the THPs and ROs work in an environment where there is no relationship, respect and trust, open communication and referral of patients by ROs to THPs. Both teams indicated that patients consult both traditional medicine (TM) and allopathic medicine (AM) by moving between the two health practitioners, resulting in interruptions in treatment. In addition, the study found that cooperation between THPs and ROs is understood as the provision of continuity care, where the parties work independently but share certain information of the patient on treatment, or as already being treated by each of them. The focus was on the type of relationship, enablers and common grounds for cooperation. Conclusion: The workable cooperative practice framework could be an inclusive health system where the parties work in parallel, with the patient being the main actor in the collaboration

Utilising the Healy and Jenkin’s Research Teaching and Curriculum Design Nexus to transform undergraduate nursing research communities of practice

In science, research is known to be a diligent systematic inquiry into nature and society or both. It assists in validating and refining existing knowledge and generating new knowledge. Lecturers and scholars have embraced the integration of evidence-based practice into the nursing education curriculum in numerous ways. Although the learning competencies necessary for research competencies amongst undergraduate nurses include an understanding of the basic concepts and processes of research methods, it does not adequately support student preparedness for the attainment of postgraduate research competencies. The design of this study adopted a qualitative, exploratory and descriptive course of enquiry that explored current pedagogical research practices amongst lecturers and supervisors. A case study approach utilising, specifically, a cross-case analysis helped provide a clear picture of institutional pedagogical practices related to the topic of inquiry and its implementation thereof. The cases from approved local, national and international higher education institutions formed the setting for the study. Lecturers facilitating and supervising undergraduate and postgraduate research studies comprised the target population of a purposive sampling selection. In this study, the authors utilised the Healey and Jenkins Teaching Nexus to show that the research engagement of students and nursing research communities of practice can be strengthened if embraced by sound pedagogical practices. The Nexus outlines four concepts that guide the pedagogical practice of the research module that promotes undergraduate students as researchers. The authors of this article concluded that it was necessary to engage students as producers and not merely as consumers of knowledge. In this study, the researchers also utilised the Nexus to show students’ engagement in fostering different teaching approaches to research knowledge acquisition

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin’s approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science

Frequency and reasons for missed appointments of outpatient mental health care users in the uMgungundlovu District

Background: Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms. Objectives: The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District. Method: This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics. Results: Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2–3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%). Conclusion: The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2–3 times

Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa

Background: Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated. Objectives: The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme. Method: Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch’s method was used to analyse the data. Results: Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students’ performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions. Conclusion: It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students

Assessments and improvement of filter media cleanliness in rapid gravity sand filters

Introduction: Rapid sand filtration is an essential unit process in the water purification process. It captures and removes coagulated and flocculated material and other suspended matter not removed during the preceding treatment processes. The pores in the filter bed gradually become clogged and the media progressively collects deposit through the continuous use and life of the filter. During normal operations cleaning is initiated by excessive head loss, deterioration in filtrate quality or when the predetermined time for a filter run has elapsed. Air scour, to remove deposit from filter media by vigorous agitation, and wash water, to remove this deposit from the filter bed, are applied. The combined action of air and water should quickly return the media to its original perfectly clean state for the cycle to continue. However, on inspection it is often found that filter sand on purification plants is unacceptably dirty and backwash systems are clearly incapable of cleaning the media to its initial state of cleanliness. It is at times possible to relate the dirty filter media to faulty designs or poor operating procedures, but often the reasons for the media deterioration remain elusive and the media becomes dirtier the longer it is in use. As there was an almost complete lack of published or agreed upon procedures to measure the cleanliness of filter media, rudimentary methods for measuring filter media cleanliness and backwash efficiency were developed. Thereafter filter media from full-scale treatment plants was analyzed with these methods at regular intervals to establish some benchmarks for these determinants. These methods were also applied during the laboratory and pilot plant phases of the project

Lived experiences of radiology caregivers during a health crisis: A COVID-19 case analysis

Background: Health crises have been linked with the exacerbation of pre-existing difficulties and the emergence of unique challenges, as evidenced by the impact of coronavirus disease 2019 (COVID-19) on health caregivers worldwide. Baseline data allow for reflection and preparation for any future health emergencies therefore giving impetus to phenomenological enquiries among the experiencers. Aim: This study aimed to explore the lived experiences of the eThekwini district frontline radiology caregivers during the COVID-19 pandemic. Setting: The study was conducted in public and private radiology departments in the eThekwini district of KwaZulu-Natal, South Africa. Methods: A qualitative, interpretative phenomenological analysis methodology was adopted in a multi-method data-collection context comprising semi-structured interviews and focus group discussions (FGDs) among 24 radiologists, radiographers, and radiology nurses obtained by non-probability sampling. Data were transcribed verbatim and analysed using an interpretative phenomenological approach. Results: Three superordinate themes emerged, namely: (1) duties and roles during the COVID-19 pandemic, (2) work-related challenges, (3) personal challenges. Conclusion: Frontline radiology caregivers experienced increased workload, staff shortages, salary cuts, personal protective equipment (PPE) shortages, non-recognition, poor managerial support, disrupted social relations, and poor work–life balance. This necessitates the need for the radiology departments to address staffing, infection prevention and control deficits, and invest in support interventions to assist frontline radiology caregivers during health crises. Contribution: The findings comprise baseline information that can be used for reflection and guiding radiology departments in preparing for any future health crises

Allopathic medicine practitioners’ experiences with non-disclosure of traditional medicine use

Background: A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. Aim: This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. Setting: This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. Methods: An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Results: Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients’ disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Conclusion: Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. Contribution: The study highlighted that patients do not disclose their TM use because of AMPs’ attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women.Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes).Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks’ gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant.Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy.Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies.Keywords: sFlt-1, PlGF, sEng, pregnancy, HIV

Xpert Ultra testing of blood in severe HIV-associated tuberculosis to detect and measure Mycobacterium tuberculosis blood stream infection: a diagnostic and disease biomarker cohort study

BACKGROUND: Mycobacterium tuberculosis bloodstream infection is a leading cause of death in people living with HIV and disseminated bacillary load might be a key driver of disease severity. We aimed to assess Xpert MTB/RIF Ultra (Xpert Ultra) testing of blood as a diagnostic for M tuberculosis bloodstream infection and investigate cycle threshold as a quantitative disease biomarker. METHODS: In this cohort study, we obtained biobanked blood samples from a large and well characterised cohort of adult patients admitted to hospital in Western Cape, South Africa with suspected HIV-associated tuberculosis and a CD4 count less than 350 cells per μL. Patients already receiving antituberculosis therapy were excluded. Samples were obtained on recruitment within 72 h of admission to hospital, and patients were followed up for 12 weeks to determine survival. We tested the biobanked blood samples using the Xpert Ultra platform after lysis and wash processing of the blood. We assessed diagnostic yield (proportion of cases detected, with unavailable test results coded as negative) against a microbiological reference, both as a function of markers of critical-illness and compared with other rapid diagnostics (urine lipoarabinomannan and sputum Xpert). Quantitative blood Xpert Ultra results were evaluated as a disease biomarker by assessing association with disease phenotype defined by principal component analysis of 32 host-response markers. Prognostic value compared to other tuberculosis biomarkers was assessed using likelihood ratio testing of nested models predicting 12-week mortality. FINDINGS: Between Jan 16, 2014, and Oct 19, 2016, of the 659 participants recruited to the parent study, 582 had an available biobanked blood sample. 447 (77%) of 582 met the microbiological reference standard for tuberculosis diagnosis. Median CD4 count was 62 (IQR 221-33) cells per μL, and 123 (21%) of participants died by 12-weeks follow-up. Blood Xpert Ultra was positive in 165 (37%) of 447 participants with confirmed tuberculosis by the microbiological reference standard, with a diagnostic yield of 0·37 (95% CI 0·32-0·42). Diagnostic yield increased with lower CD4 count or haemoglobin, and outperformed urine lipoarabinomannan testing in participants with elevated venous lactate. Quantitative blood Xpert Ultra results were more closely associated with mortality than other tuberculosis biomarkers including blood culture, and urine lipoarabinomannan, or urine Xpert (all p<0·05). A principal component of clinical phenotype capturing markers of inflammation, tissue damage, and organ dysfunction was strongly associated with both blood Xpert-Ultra positivity (associated with a SD increase of 1·1 in PC score, p<0·0001) and cycle threshold (r= -0·5; p<0·0001). INTERPRETATION: Xpert Ultra testing of pre-processed blood could be used as a rapid diagnostic test in critically ill patients with suspected HIV-associated tuberculosis, while also giving additional prognostic information compared with other available markers. A dose-response relationship between quantitative blood Xpert Ultra results, host-response phenotype, and mortality risk adds to evidence that suggests M tuberculosis bloodstream infection bacillary load is causally related to outcomes. FUNDING: Wellcome Trust, National Institute of Health Fogarty International Center, South African MRC, UK National Institute of Health Research, National Research Foundation of South Africa. TRANSLATIONS: For the Xhosa and Afrikaans translations of the abstract see Supplementary Materials section