An approach to the patient with a suspected tachycardia in the emergency department

Patients present to the emergency department with either an ongoing tachycardia or a history suspicious of a tachycardia. Either way, thetachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardiais not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If atachycardia is confirmed on an ECG, the clinician needs to classify it according to two variables: (i) regularity of the rhythm; and (ii) QRSwidth. This will allow a differential diagnosis to be made

Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control

Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description

Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial

Abstract Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care. Methods/design The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1:1:1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants. Discussion The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting. Trial registration NCT0201982

The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town : a quasi-experimental study

CITATION: Abbas, M., Mukinda, F. K. & Namane, M. 2017. The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town: A quasi-experimental study. African Journal of Primary Health care & Family Medicine, 9(1): a1242, doi:10.4102/phcfm.v9i1.1242.The original publication is available at https://phcfm.org/index.php/phcfmBackground: There is an increasing amount of blood sample rejection at primary health care facilities (PHCFs), impacting negatively the staff, facility, patient and laboratory costs. Aim: The primary objective was to determine the rejection rate and reasons for blood sample rejection at four PHCFs before and after a phlebotomy training programme. The secondary objective was to determine whether phlebotomy training improved knowledge among primary health care providers (HCPs) and to develop a tool for blood sample acceptability. Study setting: Two community health centres (CHCs) and two community day centres (CDCs) in Cape Town. Methods: A quasi-experimental study design (before and after a phlebotomy training programme). Results: The sample rejection rate was 0.79% (n = 60) at CHC A, 1.13% (n = 45) at CHC B, 1.64% (n = 38) at CDC C and 1.36% (n = 8) at CDC D pre-training. The rejection rate remained approximately the same post-training (p > 0.05). The same phlebotomy questionnaire was administered pre- and post-training to HCPs. The average score increased from 63% (95% CI 6.97‒17.03) to 96% (95% CI 16.91‒20.09) at CHC A (p = 0.039), 58% (95% CI 9.09‒14.91) to 93% (95% CI 17.64‒18.76) at CHC B (p = 0.006), 60% (95% CI 8.84‒13.13) to 97% (95% CI 16.14‒19.29) at CDC C (p = 0.001) and 63% (95% CI 9.81‒13.33) to 97% (95% CI 18.08‒19.07) at CDC D (p = 0.001). Conclusion: There is no statistically significant improvement in the rejection rate of blood samples (p > 0.05) post-training despite knowledge improving in all HCPs (p < 0.05).publishers versio

Consultation outcomes for musculoskeletal conditions at two Community Health Centres in Cape Town, South Africa

CITATION: Namane, M. K., Kalla, A. A. & Young, T. N. 2013. Consultation outcomes for musculoskeletal conditions at two Community Health Centres in Cape Town, South Africa. South African Family Practice, 55(4):380-384.The original publication is available at http://www.safpj.co.zaObjectives: To compare the proportion of patients with documented diagnoses and management plans when they presented with musculoskeletal complaints at two community health centres (CHCs) using two models of care: one with a rheumatology outreach service and the other with none. Secondly, to describe the profile of patients with rheumatoid arthritis (RA) who attended the CHC with the outreach service. Design: Cross-sectional. Setting: Heidelberg Community Health Centre and Vanguard Community Health Centre, Cape Town. Subjects: A group of 59 patients at each CHC were compared regarding engagement of their musculoskeletal complaints by doctors and clinical nurse practitioners (CNPs). Secondly, 24 RA patients who attended Heideveld CHC were profiled. Results: A comparison of the “overall engagement” between the two CHCs [risk difference (RD) -0.06, 95% confidence interval (CI): -0.17-0.05, odds ratio (OR) 0.79, 95% CI: 0.51-1.24, chi-square 0.82, p-value 0.36] was not significantly different. Comparison between doctors (RD -0.05, 95% CI: -0.05-0.08, OR 0.80, 95% CI: 0.46-1.40, chi-square 0.41, p-value 0.52) was also not significantly different. The comparison between the CNPs at the two CHCs was statistically significant (RD 0.30, 95% CI: 0.14-0.45, OR 8.37, 95% CI: 1.05-66.60, Fisher’s exact test 0.01), but the CI around OR was large. Patients with RA had a mean age of 60 years, an average of two co-morbidities and an average of three annual clinic visits. Eighty-three per cent resided in the drainage area of the clinic. Conclusion: There was no significant difference in engagement between the CHCs. The potential that CNPs seemed to show of being positively influenced by the outreach service should be further researched. Patients with RA had comorbidities that required management at primary healthcare level.http://www.safpj.co.za/index.php/safpj/article/view/3599Publisher's versio

Development and validation of a tool to measure patient experience in chronic disease care

Background: There is a global increase in the prevalence of non-communicable diseases and a growing understanding that patients need to be involved in their care. Patient experience should be assessed and the information used to improve on the planning and delivery of health services. Aim: This study described the development and validation of a patient-reported experience measure (PREM) tool which is appropriate for the South African context, to assess self-reported patient experience of chronic care. Setting: The study was conducted at four primary health care facilities in the Cape Town Metropole. Methods: This was a validity and reliability study with multiple phases to develop and determine the psychometric properties of a novel tool. It consisted of three phases, namely: Phase 1 – Consensus Validity; Phase 2 – Face Validity; Phase 3 – Reliability. Phase 1 consisted of an expert panel reaching consensus on a draft tool. Phase 2a consisted of qualitative semi-structured interviews and cognitive interviews. Phase 3 tested the internal consistency of the tool, the time necessary to complete, as well as floor and ceiling effects with 200 questionnaires. Results: The process described resulted in a final questionnaire with n = 10 items in three languages that was easily understood by patients. Internal consistency was determined with the overall Cronbach’s alpha 0.86. This PREM has been named Chronic Care Assessment of Patient Experience. Conclusion: Using best practice guidance in tool construction and validation, we delivered a PREM with the potential to improve the quality of care from the perspective of patients. Implementation studies are now required to determine how best to use this tool in routine practice