The effects of an educational intervention on the early management of oral lesions in the uMgungundlovu district in KwaZulu-Natal

Oral lesions that are associated with human immunodeficiency virus (HIV) infection are often the first clinical signs of an underlying infection. This study aimed to test primary healthcare (PHC) nurses’ knowledge and practices before and after an educational intervention on the detection and management of oral diseases, and in particular, those associated with HIV infection. A crosssectional study was conducted among PHC nurses who were employed in a range of clinical settings within the public sector (hospitals, clinics and nurse training colleges) in urban and rural areas in the uMgungundlovu Health District of KwaZulu-Natal. The convenience sample comprised 121 nurses who completed a self-administered questionnaire, undertook pre-education testing, were provided with educational material and underwent post-education testing. The obtained results showed that most nurses (90%) had received little or no undergraduate or postgraduate training in the examination, diagnosis or treatment of oral lesions. Analysis of the pre-education test results that pertained to the identification of a number of oral lesions revealed a mean correct response rate of 38.5%. Post-education results revealed a statistically significant (p-value < .0001) (24%) improvement to 62.4%. The provision of a basic education intervention can have significant effects on knowledge, treatment and referral patterns, and can lead to early diagnosis, treatment and improved quality of life for persons who are infected with HIV.Department of HE and Training approved lis

Adapting a community of practice model to design an innovative ethics curriculum in healthcare

The focus of healthcare ethics within the framework of ethical principles and philosophical foundations has always, in recent times, been the community, namely, the healthcare provider, the patient or, in research, the study participant. An initiative is thus described whereby a community of practice (CoP) model was developed around health ethics in health research, education and clinical care. The ethics curriculum was redesigned to include several components that are integrated and all embracing, namely, health research ethics, healthcare ethics, health personnel education in ethics and global and public health ethics. A CoP is a group who share a common interest and a desire to learn from and contribute to the community with their variety of experiences. The CoP is dynamic and organic, generating knowledge that can be translated into effective healthcare delivery and ethical research. It requires the collaboration and social presence of active participants such as community members, healthcare professionals and educators, ethicists and policy makers to benefit the community by developing approaches that adapt to and resonate with the community and its health - care needs. Philosophical principles constitute the foundation or underpinning of this innovative curriculum. Recommendations are presented that will continue to guide the consolidation and sustainability of the CoP.IS

The quadriceps angle and the incidence of knee injury in Indian long-distance runners

Objective. To investigate the incidence of knee injuries in runners and to determine the proportion of injuries involving abnormal quadriceps (Q)-angles. Design. One hundred male Indian runners between the ages of 25 and 65 years from 5 athletic clubs in Durban volunteered to participate in the study. The Q-angle was measured using a goniometer. Other relevant information was obtained using a validated questionnaire. The data were analysed by comparing measured Q-angles with ‘normal' values of Q-angles obtained from the literature. A paired t-test at a probability of 0.05 was used. Setting. Data were collected at club meetings. Main outcome measure. The primary outcome of the study was to determine the proportion of runners with abnormal Q-angles. Thereafter the rate of knee injuries in runners with abnormal Q-angles was determined. Results. Data from 88 runners were usable. Fifty-one per cent of the runners sustained knee injuries. Fifty-eight per cent of the sample had abnormal Q-angles. Sixty-seven per cent of the runners with abnormal Q-angles sustained knee injuries. Conclusion. More runners with abnormal Q-angles sustained knee injuries. There is a need to determine reference values for Q-angles for the South African population, the proportion of the population that present with abnormal Q-angles, and the reasons for this. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 9-1

Incisional Hernia: Experience in a single surgical unit

Background: Incisional hernias are a common problem in general surgery and they have a varied aetiology. The aim of this study was to document a single unit experience with the management of incisional hernias at King Edward VIII Hospital, Durban, South Arica.Patients and Methods: This was a prospective audit of incisional hernias in a single surgical unit from January 2001 to May 2004. All patients underwent open repair. Clinical data and intra-operative findings were documented.Results: A total number of 77 patients were seen of which 70 were female. Fifty three (68.8%) and 24 (31.2%) of patients underwent elective and emergency surgery respectively. A total of 56 patients had previously undergone gynaecological surgery compared to 21 who had undergone general surgery. There was a documented history of previous sepsis in 4 (7%) of patients. There was 1 sheath defect in 36 patients, 2 defects in 9 patients, 3 defects in 10 patients, 4 or more defects in 9 cases. In 55 patients the original suture could not be identified. Gangrenous bowel was present in 3 patients. Only 3 (3.9%) of the patients had a mesh repair. The rest (96.1%) underwent tissue repair. Morbidity rate was 17% and there were no deaths. Five patients needed management in the ICU. Hospital stay was 8 + 11 yearsConclusion: Most incisional hernias followed gynaecological surgery. There was no evidence of a nonabsorbable suture having been used at the original operation in over half of the patients. We recommend that meticulous technique is essential in closing the abdominal incision

Interleukin 1-Beta (IL-1) Production by Innate Cells Following TLR Stimulation Correlates With TB Recurrence in ART-Treated HIV-Infected Patients

BACKGROUND: Tuberculosis (TB) remains a major cause of global morbidity and mortality, especially in the context of HIV co-infection, since immunity is not completely restored following antiretroviral therapy (ART). The identification of immune correlates of risk for TB disease could help in the design of host-directed therapies and clinical management. This study aimed to identify innate immune correlates of TB recurrence in HIV+ ART-treated individuals with a history of previous successful TB treatment. METHODS: Twelve participants with a recurrent episode of TB (cases) were matched for age, sex, time on ART, pre-ART CD4 count with 12 participants who did not develop recurrent TB in 60 months of follow-up (controls). Cryopreserved peripheral blood mononuclear cells from time points prior to TB recurrence were stimulated with ligands for Toll like receptors (TLR) including TLR-2, TLR-4, and TLR-7/8. Multi-color flow cytometry and intracellular cytokine staining was used to detect IL-1β, TNF-α, IL-12 and IP10 responses from monocytes and myeloid dendritic cells (mDCs). RESULTS: Elevated production of IL-1β from monocytes following TLR-2, TLR-4 and TLR-7/8 stimulation was associated with reduced odds of TB recurrence. In contrast, production of IL-1β from both monocytes and mDCs following Bacillus Calmette-Guérin (BCG) stimulation was associated with increased odds of TB recurrence (risk of recurrence increased by 30% in monocytes and 42% in mDCs respectively). CONCLUSION: Production of IL-1β by innate immune cells following TLR and BCG stimulations correlated with differential TB recurrence outcomes in ART-treated patients and highlights differences in host response to TB

Balanced modified systematic sampling in the presence of linear trend

In the presence of linear trend, linear systematic sampling (LSS) is less efficient than stratified random sampling (STR) and more efficient than simple random sampling (SRS). Consequently, some authors have proposed modifications to the LSS design, which have shown to yield optimal results under certain conditions. In this paper, a further modified design, termed as balanced modified systematic sampling (BMSS), is proposed. BMSS is compared to various well-known modified LSS designs as well as LSS, SRS and STR. If half the sample size is an even integer, then BMSS is optimal. To obtain linear trend free sampling results for the other cases of the sample size, a BMSS with end corrections (BMSSEC) estimator is constructed. The results in this paper suggest that the proposed estimator performs better than all other estimators for odd sample sizes and even sampling intervals. Moreover, the proposed estimator is competitive for all other cases