A reflection on professional development of registrars completing a module in Health Care Practice

Background. A need for professional development in the training of registrars was identified by the School of Medicine, University of the Free State (UFS), Bloemfontein, South Africa, in 2007.Objective. To develop the module on Health Care Practice (HCP) (GPV703) to address these shortcomings.Methods. A quantitative study, enhanced by qualitative data, was conducted. A self-administered questionnaire that included a rating scale and open-ended questions was used. The quantitative responses were analysed using Microsoft Excel, and the qualitative data were edited, categorised and summarised.Results. The questionnaire was completed by 95% (n=38/40) of registrars. The quantitative questions, regarding the orientation session, content and applicability of the content of the module, showed satisfactory to very good responses. Of the 40 surveys collected from registrars, 77.5% (n=31/40) were completed by heads of department (HODs). The surveys showed a significant improvement in registrar competence: 17 were given an aboveaverage rating and 14 an average rating; there were no below-average ratings.Discussion. The module on HCP, which is part of the MMed programme, addressed aspects required by registrars to develop and/or enhance their skills, knowledge and professional behaviour with regard to ethics, practice management and patient communication. Registrars were generally satisfied with the content and presentation of the module. The open-ended questions raised concerns about aspects of patient communication and electronic learning. These need to be addressed to improve the quality of the module.Conclusion. The module on HCP (GPV703), as implemented by the UFS, is successful in addressing key aspects often neglected because of the strong clinical focus of a medical programme

Recommendations for the establishment of a clinical simulation unit to train South African medical students

Background. The burden of HIV and tuberculosis epidemics in South Africa (SA), Africa and developing countries in other parts of the world has an influence on the change in case mix. Shortages of beds in training hospitals and the need to train more healthcare professionals contribute to the saturation of the teaching platform. Clinical simulation as a tool to enhance the education and training of medical students in SA and recommendations in this regard were investigated.Objective. To obtain recommendations regarding the development of simulation training, assessment facilities and programmes, and determine whether simulation training could enhance medical education and training in the developing world.Methods. Qualitative research methods, including semi-structured interviews with international simulation experts and focus group interviews with heads of department and lecturers of the local medical school, were used to generate data.Results. A set of recommendations regarding the introduction of simulation training at an SA medical school was developed to improve patient safety, create a better training environment, and address the healthcare education challenges in SA hospitals.Conclusion. The incorporation of simulation into medical curricula and the development of clinical simulation training facilities for healthcare professionals in SA could bridge the gap currently experienced in health sciences education in the country. The recommendations outlined in our study may assist other medical training institutions in the developing world in setting up simulation training facilities

How we see ‘Y’: South African health sciences students’ and lecturers’ perceptions of Generation Y students

Background. Health sciences education in the 21st century must recognise the changing profile of students, which includes an understanding of thecharacteristics of Generation Y students (born between 1981 and 2000) as future healthcare professionals.Objective. To examine the perceptions of students and lecturers regarding Generation Y students in health sciences that might impact on teachingand learning in a South African setting.Methods. A quantitative research approach was used to determine undergraduate students’ and lecturers’ perceptions of Generation Y students in the Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. Anonymous questionnaires were used to obtain information.Results. The study population included students (n=616) and lecturers (n=71). Despite some shared perceptions about generational  characteristics, students and lecturers differed significantly on many issues. Unlike lecturers, students perceived themselves as being ambitious (not arrogant) and possessing superior cognitive skills. Despite desiring a  vibrant and stimulating learning environment, students wanted face-to-face contact with lecturers. Poor intergenerational communication also emerged as a pertinent issue.Conclusion. Identification of intergenerational issues that may impact on teaching and learning may contribute to developing novel educationalapproaches acceptable to both lecturers and students

Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol versus dual therapy in current and former smokers with COPD: IMPACT trial post hoc analysis.

This is the final version. Available from Elsevier via the DOI in this record. Data sharing: Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com.BACKGROUND: Smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). In IMPACT, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy significantly reduced moderate/severe exacerbation rates and improved lung function and health status versus FF/VI or UMEC/VI in COPD patients. This post hoc analysis investigated trial outcomes by smoking status. METHODS: IMPACT was a double-blind, 52-week trial. Patients aged ≥40 years with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomized 2:2:1 to FF/UMEC/VI 100/62.5/25 μg, FF/VI 100/25 μg, or UMEC/VI 62.5/25 μg. Endpoints assessed by smoking status at screening included rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 s, and St George's Respiratory Questionnaire total score at Week 52. Safety was also assessed. RESULTS: Of the 10,355 patients in the intent-to-treat population, 3,587 (35%) were current smokers. FF/UMEC/VI significantly reduced on-treatment moderate/severe exacerbation rates versus FF/VI and UMEC/VI in current (rate ratio 0.85 [95% confidence interval: 0.77-0.95]; P = 0.003 and 0.86 [0.76-0.98]; P = 0.021) and former smokers (0.85 [0.78-0.91]; P < 0.001 and 0.70 [0.64-0.77]; P < 0.001). FF/UMEC/VI significantly reduced time-to-first on-treatment moderate/severe exacerbation versus FF/VI and UMEC/VI in former smokers, and versus FF/VI in current smokers. Similar trends were seen for lung function and health status. Former smokers receiving inhaled corticosteroid-containing therapy had higher pneumonia incidence than current smokers. CONCLUSIONS: FF/UMEC/VI improved clinical outcomes versus dual therapy regardless of smoking status. Benefits of FF/UMEC/VI versus UMEC/VI were greatest in former smokers, potentially due to relative corticosteroid resistance in current smokers. CLINICAL TRIAL REGISTRATION: GSK (CTT116855/NCT02164513).GlaxoSmithKleinGlaxoSmithKlei

A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2

Summary Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles &lt;10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators (‘respirators’; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. Recommendations Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of ‘zero harm’, aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: 1. the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections; 2. the use of respirators that meet national and international manufacturing standards; 3. evaluation of all respirators, at the least, by qualitative fit testing; and 4. the use of respirators as part of a ‘package of care’ in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential

Seasonal Patterns of Body Temperature Daily Rhythms in Group-Living Cape Ground Squirrels Xerus inauris

Organisms respond to cyclical environmental conditions by entraining their endogenous biological rhythms. Such physiological responses are expected to be substantial for species inhabiting arid environments which incur large variations in daily and seasonal ambient temperature (Ta). We measured core body temperature (Tb) daily rhythms of Cape ground squirrels Xerus inauris inhabiting an area of Kalahari grassland for six months from the Austral winter through to the summer. Squirrels inhabited two different areas: an exposed flood plain and a nearby wooded, shady area, and occurred in different social group sizes, defined by the number of individuals that shared a sleeping burrow. Of a suite of environmental variables measured, maximal daily Ta provided the greatest explanatory power for mean Tb whereas sunrise had greatest power for Tb acrophase. There were significant changes in mean Tb and Tb acrophase over time with mean Tb increasing and Tb acrophase becoming earlier as the season progressed. Squirrels also emerged from their burrows earlier and returned to them later over the measurement period. Greater increases in Tb, sometimes in excess of 5°C, were noted during the first hour post emergence, after which Tb remained relatively constant. This is consistent with observations that squirrels entered their burrows during the day to ‘offload’ heat. In addition, greater Tb amplitude values were noted in individuals inhabiting the flood plain compared with the woodland suggesting that squirrels dealt with increased environmental variability by attempting to reduce their Ta-Tb gradient. Finally, there were significant effects of age and group size on Tb with a lower and less variable Tb in younger individuals and those from larger group sizes. These data indicate that Cape ground squirrels have a labile Tb which is sensitive to a number of abiotic and biotic factors and which enables them to be active in a harsh and variable environment

A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2.

SUMMARY: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. RECOMMENDATIONS: Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of 'zero harm', aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections;the use of respirators that meet national and international manufacturing standards;evaluation of all respirators, at the least, by qualitative fit testing; andthe use of respirators as part of a 'package of care' in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential