Azygos lobe in a South African cadaveric population

Knowledge of the prevalence, morphology and location of the azygos lobe is essential for diagnostic and surgical procedures of the lungs related to mediastinal pathologies, especially to minimize intraoperative vascular injuries, shock, possible thoracotomy and even the possibility of pulmonary torsion. Reports on the prevalence of the azygos lobe vary between 0.11% and 0.43%. The aim of the current study was to record the prevalence and morphological description of the azygos lobe in the South African cadaveric population. A total of 704 adult cadavers dissected over a ten-year period by students in the Department of Human Anatomy at the Medunsa Campus, University of Limpopo, were studied. The prevalence and dimensions of the azygos lobe were determined with a 95% confidence interval. Results indicate that an azygos lobe was present in the right lung in only four cases (prevalence 0.57%, 95% Confidence Interval [CI]: 0.2%-1.6%). The mean height and width were 6.7 cm (95% CI: 4.4-9.2) and 4.5 cm (95% CI: 3.7-5.2) respectively. Observations on the morphology of the azygos lobe showed that it was rectangular (n=3) and triangular (n=1) in shape with smooth margins. In conclusion, the azygos lobe is a rare anomaly in the South African cadaveric population. The present results are comparable with those reported in the literature for other populations. Future radiological studies on the azygos lobe on living subjects in South Africa will be useful for further understanding of this rare but significant anomaly.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1098-2353hb2013ay201

The impact of chronic pain on the quality of life of patients attending primary healthcare clinics

OBJECTIVES: The objective was to study the nature and magnitude of the impact of pain on the quality of life of patients with chronic pain. DESIGN: This was a descriptive, cross-sectional quantitative study. SETTING AND SUBJECTS: One thousand and sixty-six adult patients were screened between October and December 2010 in four primary healthcare clinics in south-west Tshwane. OUTCOME MEASURES: Patients reporting persistent pain for six months or longer were considered to be chronic pain patients (437, 41%), and were interviewed with regard to the impact of chronic pain on their quality of life using the Wisconsin Brief Pain Questionnaire. RESULTS: Four hundred and nineteen patients (95.9%, 95% confidence interval (CI): 93.6-97.6) of chronic pain patients reported that chronic pain impacted on their quality of life and functioning. Sixty-eight per cent of patients (95% CI: 63.3- 72.4) reported being severely adversely affected by chronic pain. Pain had a severe impact on sleep quality in 39.2% patients, walking ability (37.4%), routine housework (33.8%), mood (20.1%), interpersonal relationships (15.3%) and enjoyment of life (16.3%). The more intense the experience of severe pain was, the greater the impact of chronic pain on everyday life (p-value < 0.001). Equally, patients with better pain relief enjoyed a better quality of life (p-value < 0.001). CONCLUSION: A substantial proportion of patients attending primary healthcare clinics experience chronic pain which impacts on their lives in multiple and significant ways.http://www.sajaa.co.za/index.php/sajaaam201

Prevalence of chronic pain in patients attending primary healthcare facilities in south-west Tshwane

OBJECTIVES: Despite the significant biopsychosocial impact of chronic pain on the health and quality of life of an individual, as well as on healthcare utilisation, no published data are available on the prevalence of chronic pain in the South African primary healthcare context. The aim of this study was to investigate the prevalence and intensity of chronic pain in patients attending primary healthcare facilities in south-west Tshwane. DESIGN SETTING: A prospective, cross-sectional study was carried out in four primary healthcare clinics, situated in south-west Tshwane. SUBJECTS: The study was conducted on 1 066 adult patients, aged 18 years or older, over a nine-week period between October and December 2010. OUTCOME MEASURES: The prevalence and intensity of chronic pain was determined. RESULTS: Chronic pain prevalence was 41%. The confidence interval (CI) was 37.2-45.6. Chronic pain was most frequently experienced as lower back pain [prevalence 30.83% (CI: 19.56-42.09)] and joint pains [prevalence 23.48% (CI: 7.58-39.38)]. Chronic pain was significantly more prevalent with advancing age (p-value = 0.0014), in women than in men (p-value = 0.019), and in widowed and divorced patients, than in married and single patients (p-value = 0.0062). Patients with chronic pain reported their pain intensity over the previous month as maximum pain intensity (mean: 7.69 ± 0.99), minimum pain intensity (mean 2.54 ± 0.89), and average pain intensity (mean 4.57 ± 0.62). CONCLUSION: Chronic pain was highly prevalent in patients who attended primary healthcare facilities in south-west Tshwane. The intensity of pain was high in a significant proportion of patients.www.safpj.co.zaam201

Students’ perceptions of the instructional quality of district hospital-based training

BACKGROUND : An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria. AIM : To measure the students’ perceptions of the instructional quality of district hospitalbased training. SETTING : Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces. METHODS : A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results. RESULTS : The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year. CONCLUSION : Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement.http://www.phcfm.orgam2016Family Medicin

Students' perceptions of the instructional quality of district hospital-based training.

Background: An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria. Aim: To measure the students’ perceptions of the instructional quality of district hospitalbased training. Setting: Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces. Methods: A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results. Results: The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year. Conclusion: Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement. Keywords: clinical associates, evaluation of medical education, mid-level healthcare workers, rural learning centres, rural medical education, student satisfaction

Do health care providers discuss HIV with older female patients?

Background: The World Health Organization expressed concern that older people in Africa who are ignored and excluded from HIV-prevention programmes are increasingly being infected with HIV. Studies show an inadequate awareness of the risks of HIV in the older female population. Older women are more susceptible to HIV because menopausal changes, such as vaginal dryness and thinning, increase the risk of HIV infection through tears and abrasions during unprotected sex. Furthermore, progression from HIV to AIDS occurs faster in the older population. Older women need to understand how HIV is transmitted and how it can be prevented in order to protect themselves. It may be postulated that health care providers are reluctant to discuss HIV-related issues with older female patients. The aim of this study was to determine whether older women could recall receiving HIV-related information from health care providers. Methods: This was a prospective cross-sectional study among 100 women, aged 50 to 80, who attended the out-patient section at the Tshwane District Hospital during November and December 2006. Trained research assistants collected data in the patients’ mother tongue. A questionnaire was administered during face-to-face interviews. Results: Only 36% (95% confidence interval [CI]: 26.6% to 45.4%) of the respondents recalled receiving prior information regarding HIV from their health care providers. Of those, 19 (52.78%) said it was in the form of voluntary counselling and testing (VCT), and the remaining 17 (47.22%) received this information during general consultations. There was a statistically significant difference (p = 0.003; odds ratio [OR]: 0.26; 95% CI: 0.09–0.69) between their age stratification of 50 to 59 years and 60 to 80 years with respect to receiving information regarding HIV. In total, 23% of the respondents said they had been tested for HIV and most (n = 19; 82.61%) said they had received counselling. However, it is cause for concern that 17.39% (n = 4) of the respondents who had been tested could not recall receiving counselling. Conclusions: This study shows that older women are neglected regarding the provision of HIV-related information. HIV and its risks to older patients is not routinely part of patient care. VCT seems to be an effective solution. However, there are problems even within the VCT system, since some of the participants claim to have been tested for HIV, without receiving counselling. It is suggested that part of the challenge may lie in the mindset of health care providers. Family physicians need to become proactive in terms of their own practice as well as in terms of their engagement with other health care professionals and students

Quality improvement cycles that reduced waiting times at Tshwane District Hospital Emergency Department

BACKGROUND: Tshwane District Hospital is a level-one hospital, delivering services in the centre of Pretoria since February 2006. It is unique in location, being only 100m away from the tertiary hospital, Pretoria Academic Hospital. In South Africa, public sector emergency units are under enormous pressure with large patient numbers, understaffing and poor resources. TDH Emergency Department (ED) is a typical example. An average of 3900 patients per month visited this ED in 2006. Recurrent complaints and dissatisfaction shown by the patients, about prolonged waiting times before consulting the medical practitioners in the ED was one of the initial challenges faced by the newly established hospital. It was decided to undertake a quality improvement study to analyse and improve the situation, using waiting time as a measure of improvement. METHODS: A quality improvement team was chosen. A total of 150 waiting times of stable and unstable patients were evaluated. There were 50 waiting times for each month; May, September and December 2006. Waiting time was defined as the time from arrival of the patient in the unit until the start of the consultation by the medical practitioner. Surveys were done in May and September to analyse the problems causing prolonged waiting times. The plan of action included instituting a functional triage system, improving the process of up- and down-referrals to and from the tertiary hospital, easy access to stock, reorganisation of doctors’ duty roster, re-organisation of the academic programme, announcement to patients of waiting time, nurses carrying out minor procedures, improvements in the registration, enhancing laboratory delays and availability of protocols. RESULSTS: The median waiting times for stable patients were; May 2006: 545 minutes, September 2006: 230 minutes and in December 2006: 89 minutes. There was a significant difference among these waiting times for May, September and December 2006 (p < 0.000; Kruskal-Wallis test).The median waiting times for unstable patients were; May 2006: zero minutes, September 2006: zero minutes and in December 2006: 0.5 minutes. There was no difference among the waiting times of unstable patients for May, September and December 2006 (p=0.906; Kruskal-Wallis test). CONCLUSION: This quality improvement exercise identified and rectified problems causing prolonged waiting time for stable patients in the Emergency Department. This was done without compromising the time taken to see unstable patients. Similar strategies might be used in other hospitals to reduce the waiting time

Knowledge of and misconceptions about the spread and prevention of HIV infection among older urban women attending the Tshwane District Hospital, South Africa

BACKGROUND: Statistics around the world show a rapid increase in HIV infection in the older population. Many older women remain sexually active and are therefore exposed to heterosexual transmission of HIV infection. Older women are most likely considered respected opinion leaders within the families and communities and are likely to influence others’ attitudes and behaviours. An increase in knowledge through information plays a fundamental role and is a prerequisite for behavioural change that may prevent new HIV infections. The purpose of the current study was to assess the knowledge and misconceptions regarding the spread and prevention of HIV in older women attending the Tshwane District Hospital (TDH) in South Africa. METHODS: A prospective cross-sectional study of 100 women, aged 50 to 80 years, attending the TDH out-patient section during November and December 2006 was done. The levels of knowledge were determined by using a directed questionnaire. RESULTS: Eight per cent of the participants answered all the questions correctly, showing knowledge gaps in the remaining 92% (95% confidence interval: 86.7%–97.3%). Many participants were unaware of the protective effects of condom use, especially female condoms, and of HIV spread by anal transmission, the sharing of needles and blood transfusion. Three or more misconceptions were present in 48% of the participants, such as HIV spread by casual contact, the sharing of personal items, air-borne infection, mosquito bites, HIV testing and AIDS prevention or cure by traditional medicines or alternatives. Sixty-two per cent of the older women were found to have adequate knowledge (95% confidence interval: 52%–71.5%), knowing the basic concepts regarding HIV transmission. CONCLUSION: There is a significant need for HIV-related preventive health education in older women, not only to decrease potential high-risk behaviours, but also to reduce unnecessary feelings of anxiety and misconceptions. Family physicians, due to their unique role, might be able to use the present study in their practices in order to optimise the planning and structuring of awareness interventions and prevention programmes