Setting ART initiation targets in response to changing guidelines : The importance of addressing both steady-state and backlog

PKBackground: Target setting is useful in planning, assessing and improving antiretroviral treatment (ART) programmes. In the past 4 years, the ART initiation environment has been transformed due to the change in eligibility criteria (starting ART at a CD4+ count <350 cells/μl v. <200 cells/μl) and the roll-out of nurse-initiated management of ART. Objective: To describe and illustrate the use of a target-setting model for estimating district-based targets in the era of an expanding ART programme and changing CD4+ count thresholds for ART initiation. Method: Using previously described models and data for annual new HIV infections, we estimated both steady-state need for ART initiation and backlog in a North West Province district, accounting for the shift in eligibility. Comparison of actual v. targeted ART initiations was undertaken. The change in CD4+ count threshold adds a once-off group of newly eligible patients to the pool requiring ART – the backlog. The steady-state remains unchanged as it is determined by the annual rate of new HIV infections in previous years. Results: The steady-state need for the district was 639 initiations/month, and the backlog was ~15 388 patients. After the shift in eligibility in September 2011, the steady-state target was exceeded over several months with some backlog addressed. Of the total backlog for this district, 72% remains to be cleared. Conclusion: South Africa has two pools of patients who need ART: the steady-state of HIV-infected patients entering the programme each year, determined by historical infection rates; and the backlog created by the shift in eligibility. The healthcare system needs to build longterm capacity to meet the steady-state need for ART and additional capacity to address the backlog

Globalisation, neo-liberalism and vocational learning: the case of English further education colleges

Further education (FE) has traditionally been a rather unspectacular activity. Lacking the visibility of schools or the prestige of universities, for the vast majority of its existence FE has had a relatively low profile on the margins of English education. Over recent years this situation has altered significantly and further education has undergone profound change. This paper argues that a combination of related factors – neo-liberalism, globalisation, and dominant discourses of the knowledge economy – has acted in synergy to transform FE into a highly performative and marketised sector. Against this backdrop, further education has been assigned a particular role based upon certain narrow and instrumental understandings of skill, employment and economic competitiveness. The paper argues that, although it has always been predominantly working class in nature, FE is now, more than ever, positioned firmly at the lower end of the institutional hierarchy in the highly class-stratified terrain of English education

The profile of rheumatic heart disease at a tertiary hospital in KwaZulu-Natal, South Africa

Background: Rheumatic heart disease (RHD) is a disease of poverty and a significant public health concern in developing countries. There is little data on the profile of RHD in KwaZulu-Natal (KZN), South Africa. Objectives: To describe the demographic, clinical profile, and outcomes of RHD in patients referred to a tertiary cardiology facility in KwaZulu-Natal. Methods: This is a 5-year (2012 - 2016) retrospective analysis of all patients with RHD referred to the cardiology department at Inkosi Albert Central Luthuli Hospital (IALCH). A structured format was used to extract demographic, clinical, echocardiographic and outcome data of 981 eligible patients aged &gt;12 years. Descriptive analysis was used to report on quantitative data and logistic regression was used to identify significantassociations and independent variables. Results: The majority of patients were Black (87.9%); the median age was 24 years (IQR 15 - 36 years) and the female to male ratio was 2.3:1. Dyspnoea (92.2%) was the commonest presenting symptom and mitral regurgitation (56.4%) was the commonest valve lesion. The most frequent complications at presentation were atrial fibrillation (AF) (44.9%) followed by heart failure (HF) (28.6%). AF mostly affected the 41 - 60 year age group (OR 2.075, 95% CI 1.22 - 3.52, p=0.007). Compared to the adolescent group (13 -2 0 years), HF was less common in the 21 - 40 years and 41 - 60 years age groups (OR 0.455, 95% CI 0.286 - 0.723, p=001 and OR 0.495, 95% CI 0.288 - 0.852, p=0.011, respectively). Valve replacement was performed in 723 (88.4%) – (mitral valve 62.2%; aortic valve 4.8%; mitral and aortic valves 29%; 3 valve surgeries 4%) – of the 818 patients who had interventional procedures. The mortality rate was high at 20.1%. Mortality was highest in the younger patients (&lt;20 years of age) (p=0.016). Predictors of death were severe disease at a young age (OR 1.268, 95% CI 1.050 - 1.532, p=0.013) and double valve replacement (OR 1.521, 95% CI 1.009 - 2.229, p=0.045). Conclusion: RHD remains a significant cause of morbidity and mortality in KZN. HF during the teenage years reflects ongoing carditis with haemodynamic failure resulting in death if unoperated

Promoting patient autonomy: Perspectives of occupational therapists and nurses

Background. There has been a turn in the last decade towards autonomy in patient care. Promoting patient autonomy is required as a collaborative endeavour between the patient, healthcare professionals and the families and caregivers of patients. Our current discourse demonstrates patient autonomy as essential.Objective. To explore the concept of autonomy in nurses’ and occupational therapists (OTs)’ individual and collective practice as healthcare professionals.Methods. The study followed a qualitative explorative approach. Fourteen nurses and 12 OTs from 6 facilities in KwaZulu-Natal Province of South Africa were recruited into the study. Following ethical approval, and dependent on the availability of participants, data were collected via focus groups, triad and individual semi-structured interviews and qualitative questionnaires. Data were analysed using inductive thematic analysis per profession initially, and then later merged to develop themes.Results. Two major themes emerged that spoke to the deconstruction of autonomy and deterrents to the promotion of autonomy in clinical practice. An individualistic view of autonomy was embedded within the participants’ understanding of the concept. It included the patient’s right and ability to selfdetermine or direct treatment and various interventions, having appropriate guidance and the relevant information to make&nbsp; decisions, and opportunities to self-determine their course of treatment. Patient-related and organisational factors served as barriers to the promotion of autonomy.Conclusion. By analysing the experiences of autonomy in practice of these two professions, we may be able to establish new ways of understanding how professional practice can truly become patient-centred and transition from an individualistic understanding of autonomy towards viewing autonomy as relational

Safeguarding children in dentistry: 1. Child protection training, experience and practice of dental professionals with an interest in paediatric dentistry

* Few dental professionals with child protection training have experience of making referrals. * There is a wide gap in practice between recognising signs of child abuse and neglect and responding effectively. * This may indicate missed opportunities to save children from continuing abuse. * There is a need for improved child protection information, support and training for dental professionals. Abstract Following several highly publicised inquiries into the deaths of children from abuse and neglect, there has been much recent interest in the role and responsibility of all health professionals to protect children at risk of maltreatment. The findings of a postal questionnaire, sent in March 2005 to 789 dentists and dental care professionals with an interest in paediatric dentistry working in varied settings in the UK, are presented in a two-part report and discussed in the context of current multi-agency good practice in safeguarding and promoting the welfare of children. This first part explores reported child protection training, experience and practice. There was a significant gap between recognising signs of abuse and responding effectively: 67% of respondents had suspected abuse or neglect of a child patient at some time in their career but only 29% had ever made a child protection referral. The dental profession is alerted to the need to ensure necessary appropriate action to safeguard children is always taken when child abuse or neglect are suspected

Future-proofing imperatives for remote online teaching, learning and student support in the context of pandemic change and beyond: A case for South African higher education transformation

South Africa’s Plan for Higher Education identified equity and redress as key objectives guiding institutional transformation. This encompasses granting individuals fair opportunities to enter higher education and succeed therein. The COVID-19 pandemic which abruptly disrupted the 2020 academic year highlighted several challenges which have implications for student success. Academic continuity in the form of online learning was pursued by most higher education institutions. However, the remoteness of rural communities, which typifies the home environments for many South African students, threatened to exclude such students from online learning activities. The lack of access to digital devices as well as reliable internet connectivity in many of these communities impacted students’ ability to engage in online learning as well as access campus-based support services. The imposed lockdown therefore caused heightened anxiety and feelings of isolation from academic activities amongst the South African student population. Since access to on-campus support systems was no longer possible, student wellness and ongoing academic engagement was potentially compromised. Increasingly, the mental health cost of remote learning was becoming apparent, with higher education institutions compelled to rethink how student support services are delivered. In the absence of face-to-face support services during the hard lock-down period, the emergent need was to identify new ways of reaching out to displaced students who may be experiencing both academic and personal distress under conditions of daunting technological changes and virtual forms of engagement, social isolation, socio-economic disadvantage and psycho-social stressors. While blended learning and hybrid forms of holistic student support were accelerated by the advent of the Covid-19 pandemic, the blended approach has become an indelible reality of Higher Education that is here to stay. As such, reflections on how student support services at universities in South Africa have adapted and need to continuously evolve in the face of an uncertain world, is both timely and necessary if the goal of promoting equal access and success in Higher Education – for all - is to be fully realized

Belonging to a different landscape: repurposing nationalist affects

This is an article about the embodied, sensual experience of rural landscape as a site where racialized feelings of national belonging get produced. Largely impervious to criticism and reformation by 'thin' legal-political versions of multicultural or cosmopolitan citizenship, it is my suggestion that this racialized belonging is best confronted through the recognition and appreciation of precisely what makes it so compelling. Through an engagement with the theorization of affect in the work of Divya Praful Tolia-Kelly, I consider the resources immanent to the perception of landscapes of national belonging that might be repurposed to unravel that belonging from within. I suggest that forms of environmental consciousness can unpick the mutually reinforcing relationships between nature and nation, opening up opportunities for thinking identity and belonging in different ways, and allowing rural landscapes to become more hospitable places

The impact of marketisation on postgraduate career preparedness in a high skills economy

This study focuses on the consequences for high skills development of the erosion of the once clear demarcation between higher education and business. It contributes to the broader debate about the relevance of higher education for thewell-being of the society of the future. The research explores the effects of marketisation on the postgraduate curriculum and students’ preparedness for careers in public relations and marketing communications. Interviews with lecturers and students in two universities in the UK and Australia indicate that a tension exists between academic rigour and corporate relevancy. The consequences are a diminution of academic attachment to critique and wider social/cultural engagement, with a resulting impoverishment of students’ creative abilities and critical consciences. Subsequently, graduates of public relations and marketing communications, and to some extent those from other profession-related disciplines, are insufficiently prepared for careers as knowledge workers in a future high-skills economy