Mastering your Fellowship

The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.Keywords: FCFP(SA) examination, Family Medicine registrar

Mapping the regulatory landscape of AI in healthcare in Africa

Introduction: Artificial intelligence (AI)-enhanced technology has seen unprecedented expansion in the recent past. This growth brings with it huge opportunities for the positive transformation of the economy, business, healthcare, and society. However, a critical question is whether, and to what extent, regulatory measures and mechanisms have been implemented to safeguard its design, development, and deployment. This paper offers a scoping exercise that maps the regulatory landscape of AI in healthcare (including health research) in certain African countries.Methods: This research is conducted across 12 African countries: Botswana, Cameroon, The Gambia, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe. As limited specific AI legislation is found in these African countries, and because AI is informed by ancillary regulatory frameworks, we include data protection, digital health, consumer protection, and intellectual property in our research. A scoping review method was applied with a manual search of digital libraries with search terms customised for each repository consisting of core search terms for the various topics, including, among others, “law,” “regulation,” “artificial intelligence,” “data protection,” “intellectual property,” and “digital health”.Results and discussion: Analysis of the data demonstrated that while in the African countries under investigation there is no sui generis AI regulation, recent developments were found in areas that inform AI adoption, including in digital health, data protection, consumer protection, and intellectual property. Our findings highlight the fragmentation of the African AI regulatory landscape and illustrate the importance of continued AI regulatory development to ensure that Africa is well positioned for future AI adoption in health

Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Funding: CANSA, Wits Faculty Research Committee Individual Research Grant, Carnegie Corporation Research Funding, Crowdfunding through Doit4Charity Backabuddy and the Ride Joburg Cycle Race.Background Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL. Methods Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan–Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors. Results  The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p = .53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p = .02). Conclusion In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.Publisher PDFPeer reviewe

Exploring issues of racism with white students through a literature-based course

The purpose of this study was to explore issues of racism with a class of white thirteen/fourteen year-olds through a year's course centred primarily around literature. How would their perceptions and frames of reference shape their responses and to what extent might the texts, which strongly indicted racism, encourage shifts in perspective? Drama, videos providing social context, as well as sessions with visitors, particularly black artists, were important elements. A survey to reveal racist perceptions was administered before and after the project to the whole year group. Apart from notes taken in class as a participant observer, my data was drawn from students' reading journals, responses to specific passages or items, transcripts of class and small group discussions, and interviews. While in initial conception my intended focus was to have been largely on the interaction between students and texts and their responses to other inputs, my lens rapidly widened to encompass the context of the classroom created by the English teacher. The result was to throw up sharply certain fundamental pedagogical issues for anti-racist teaching. Although the study was ethnographic and most of the data qualitative, part of the survey of racist perceptions was open to quantitative analysis. Both sets of data suggested the possibility of gender differences in responding to issues of racism. While there was evidence of students opening out to new perceptions, the study details some of the considerable difficulties of developing understanding of, and challenging, racism in a predominantly white context where rcperccption is not matched or reinforced by change in social structure. </p

Mastering your fellowship (Online)

The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written Final Part A of the FCFP (SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online

Leadership and branding in business schools: a Bourdieusian analysis

This paper explores the growth of corporate branding in higher education (HE) and its use by academic and professional managers as a mechanism for not only enhancing institutional reputation but also for facilitating internal culture change. It uses Bourdieu's framework of field, capital and habitus to analyse case studies of branding in two English business schools from the perspectives of academics, management and professional staff and students. The findings reveal a number of tensions and inconsistencies between the experiences of these groups that highlight the contested nature of branding in HE. In an era of rankings, metrics and student fees, it is suggested that branding has become an important means through which HE leaders and managers (re)negotiate the perceived value of different forms of capital and their relative positions within the field. Whilst branding operates at a largely ideological level it has a material effect on the allocation of power and resources within institutions. This is an important development in a sector that has typically privileged scientific capital and contributes towards an understanding of the ways in which leadership is ‘distributed’ within universities

Seroprevalence survey of anti-SARS-CoV-2 antibody and associated factors in South Africa: Findings of the 2020-2021 population-based household survey.

Population-based serological testing is important to understand the epidemiology and estimate the true cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to inform public health interventions. This study reports findings of a national household population SARS-CoV-2 serosurvey in people 12 years and older in South Africa. This cross-sectional multi-stage random stratified cluster survey undertaken from November 2020 to June 2021 collected sociodemographic data, medical history, behavioural data, and blood samples from consenting participants. The samples were tested for SARS-CoV-2 antibodies using the Roche ElecsysAnti-SARS-CoV-2 chemiluminescence immunoassay (CLIA) Total Antibody Test. The survey data were weighted by age, race, sex, and province with final individual weights benchmarked against the 2020 mid-year population estimates and accounted for clustering. Descriptive statistics summarize the characteristics of participants and seroprevalence. Logistic regression analyses were used to identify factors associated with seropositivity. From 13290 survey participants (median age 33 years, interquartile range (IQR) 23-46 years), SARS-CoV-2 seroprevalence was 37.8% [95% Confidence Interval (CI) 35.4-40.4] and varied substantially across the country's nine provinces, and by sex, age and locality type. In the final adjusted model, the odds of seropositivity were higher in women than in men [aOR = 1.3 (95% CI: 1.0-1.6), p = 0.027], and those living with HIV (self-report) [aOR = 1.6 (95% CI: 1.0-2.4), p = 0.031]. The odds were lower among those 50 years and older compared to adolescents 12-19 years old [aOR = 0.6 (95% CI: 0.5-0.8), p<0.001] and in those who did not attend events or gatherings [aOR = 0.7 (95% CI: 0.6-1.0), p = 0.020]. The findings help us understand the epidemiology of SARS-CoV-2 within different regions in a low-middle-income country. The survey highlights the higher risk of infection in women in South Africa likely driven by their home and workplace roles and also highlighted a need to actively target and include younger people in the COVID-19 response

SARS-CoV-2 seroprevalence and association with socio-and demographic characteristics among people 12 years and older (South Africa, 2021).

SARS-CoV-2 seroprevalence and association with socio-and demographic characteristics among people 12 years and older (South Africa, 2021).</p

Multivariate logistic regression model of factors associated with SARS-CoV-2 seropositivity among people 12 years and older (South Africa, 2021).

Multivariate logistic regression model of factors associated with SARS-CoV-2 seropositivity among people 12 years and older (South Africa, 2021).</p