BackgroundSouth Africa aims to end all preventable deaths of children under the age of five as pa... more BackgroundSouth Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town.MethodsA retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from the Mitchells Plain District Hospital (MPH) to a specialised centre in the years 2016–2018. A data collection tool was used to extract information. Data were processed with Statistical Package for the Social Sciences 25 (SPSS) to produce descriptive statistics and to investigate associations between variables using the chi-square tests.ResultsThe study included 29 cases of suspected perinatal asphyxia. Ten cases (34.5%) had abnormal amplitude electroencephalograms (aEEGs) indicative of hypoxic ischaemic encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p = 0.005), lack of a doctor at the time of delivery (p = 0.004) and neonatal chest compressions (p = 0.044) were associated with abnormal aEEGs. Babies with Thompson score of equal to or more than 12 (p = 0.006), neonatal seizures (p = 0.036) and delayed arrival at referral hospital (p = 0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score equal to or more than 12 (p = 0.007) and the need for neonatal intubation at delivery (p = 0.016).ConclusionSignificant reversible factors were identified in the peri- and post-partum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.
Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 ma... more Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.
Contribution: This article contributes new thinking to developing EPAs for family medicine in an ... more Contribution: This article contributes new thinking to developing EPAs for family medicine in an effort to understand more authentic WPBA nationally.
The ‘Mastering your Fellowship’ series provides examples of the question format encountered in th... more The ‘Mastering your Fellowship’ series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.
African Journal of Primary Health Care & Family Medicine, Apr 25, 2023
This study aimed to investigate the applicability and feasibility of evidence-based CPG recommend... more This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). Setting: The PHC sector in South Africa (SA). Methods: Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. Results: Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. Conclusion: A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors. Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.
Global partnerships offer opportunities for academic departments in the health sciences to achiev... more Global partnerships offer opportunities for academic departments in the health sciences to achieve mutual benefits. However, they are often challenged by inequities in power, privilege and finances between partners that have plagued the discipline of global health since its founding. In this article, a group of global health practitioners in academic medicine offer a pragmatic framework and practical examples for designing more ethical, equitable and effective collaborative global relationships between academic health science departments, building on the principles laid out by the coalition Advocacy for Global Health Partnerships in the Brocher declaration.
The series, "Mastering your Fellowship", provides examples of the question format encountered in ... more The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help Family Medicine registrars and their supervisors prepare for this examination. Model answers are available online.
This section in the South African Family Practice journal is aimed at helping registrars in prepa... more This section in the South African Family Practice journal is aimed at helping registrars in preparing for the Fellowship of the College of Family Physicians (FCFP [SA]) Final Part A examination and will provide examples of the question formats encountered in the written examination: multiplechoice questions (MCQ) in the form of single best answer (SBA-Type A) and/or extended matching questions (EMQ-Type R); short answer questions (SAQ), questions based on the critical reading of a journal article (CRJ: evidence-based medicine) and an example of an objectively structured clinical examination (OSCE) question. Each of these question types is presented based on the College of Family Physicians blueprint and the key learning outcomes of the FCFP (SA) programme. The MCQs are based on the 10 clinical domains of family medicine, the SAQs are aligned with the five national unit standards and the critical reading section will include evidencebased medicine and primary care research methods. This edition is based on unit standard 1 (effectively manage themselves, their team and their practice, in any sector, with visionary leadership and self-awareness, to ensure the provision of high-quality, evidence-based care), unit standard 2 (evaluate and manage patients with both undifferentiated and more specific problems cost-effectively according to the bio-psychosocial approach) and unit standard 5 (conduct all aspects of health care in an ethical and professional manner). The clinical domain covered in this edition is ear, nose and throat (ENT). We suggest that you attempt to answer the questions (by yourself or with peers or supervisors) before finding the model answers online: http://www.safpj.co.za/. Please visit the Colleges of Medicine website for guidelines on the Fellowship examination: https://www.cmsa.co.za/view_exam.aspx?QualificationID=9.
(FCFP SA) Final Part A examination and will provide examples of the question formats encountered ... more (FCFP SA) Final Part A examination and will provide examples of the question formats encountered in the written examination: multiple-choice question (MCQ) in the form of single best answer (SBA-Type A) and/or extended matching question (EMQ-Type R); short answer question (SAQ), questions based on the critical reading of a journal (evidence-based medicine) and an example of an objectively structured clinical examination (OSCE) question. Each of these question types is presented based on the College of Family Physicians blueprint and the key learning outcomes of the FCFP (SA) programme. The MCQs are based on the 10 clinical domains of family medicine, the SAQs are aligned with the five national unit standards and the critical reading section will include evidence-based medicine and primary care research methods. This edition is based on unit standard one (critically reviewing new evidence and applying the evidence in practice, principles of self-care and leading a clinical governance team) and unit standard two (evaluate and manage a patient according to the bio-psycho-social approach). The domain covered in this edition is infectious diseases. We suggest that you attempt answering the questions (by yourself or with peers and/or supervisors) before finding the model answers online: http://www.safpj.co.za/. Please visit the Colleges of Medicine website for guidelines on the Fellowship examination: https://www.cmsa.co.za/view_exam.aspx?QualificationID=9.
Freeze-dried plasma b) Packed cells c) Ringers Lactate d) Voluven e) Whole blood Answer b) Discus... more Freeze-dried plasma b) Packed cells c) Ringers Lactate d) Voluven e) Whole blood Answer b) Discussion: The Advanced Trauma Life Support (ATLS) algorithms for managing shock changed in the 2018 edition after new data emerged that using more than 1.5 litres of isotonic resuscitation fluid is associated with increased mortality. Firstly, on presentation, it is important to recognise that this patient has Class III haemorrhagic shock from the clinical features present (See Table 1). The series, 'Mastering your Fellowship', provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellow of the College of Family Physicians South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.
The series, "Mastering your Fellowship", provides examples of the question format encountered in ... more The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online.
Background South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in... more Background South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. Methods This paper reports on the qualitative data generated from a mixed method...
BackgroundSouth Africa aims to end all preventable deaths of children under the age of five as pa... more BackgroundSouth Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town.MethodsA retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from the Mitchells Plain District Hospital (MPH) to a specialised centre in the years 2016–2018. A data collection tool was used to extract information. Data were processed with Statistical Package for the Social Sciences 25 (SPSS) to produce descriptive statistics and to investigate associations between variables using the chi-square tests.ResultsThe study included 29 cases of suspected perinatal asphyxia. Ten cases (34.5%) had abnormal amplitude electroencephalograms (aEEGs) indicative of hypoxic ischaemic encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p = 0.005), lack of a doctor at the time of delivery (p = 0.004) and neonatal chest compressions (p = 0.044) were associated with abnormal aEEGs. Babies with Thompson score of equal to or more than 12 (p = 0.006), neonatal seizures (p = 0.036) and delayed arrival at referral hospital (p = 0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score equal to or more than 12 (p = 0.007) and the need for neonatal intubation at delivery (p = 0.016).ConclusionSignificant reversible factors were identified in the peri- and post-partum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.
Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 ma... more Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.
Contribution: This article contributes new thinking to developing EPAs for family medicine in an ... more Contribution: This article contributes new thinking to developing EPAs for family medicine in an effort to understand more authentic WPBA nationally.
The ‘Mastering your Fellowship’ series provides examples of the question format encountered in th... more The ‘Mastering your Fellowship’ series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.
African Journal of Primary Health Care & Family Medicine, Apr 25, 2023
This study aimed to investigate the applicability and feasibility of evidence-based CPG recommend... more This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). Setting: The PHC sector in South Africa (SA). Methods: Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. Results: Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. Conclusion: A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors. Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.
Global partnerships offer opportunities for academic departments in the health sciences to achiev... more Global partnerships offer opportunities for academic departments in the health sciences to achieve mutual benefits. However, they are often challenged by inequities in power, privilege and finances between partners that have plagued the discipline of global health since its founding. In this article, a group of global health practitioners in academic medicine offer a pragmatic framework and practical examples for designing more ethical, equitable and effective collaborative global relationships between academic health science departments, building on the principles laid out by the coalition Advocacy for Global Health Partnerships in the Brocher declaration.
The series, "Mastering your Fellowship", provides examples of the question format encountered in ... more The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help Family Medicine registrars and their supervisors prepare for this examination. Model answers are available online.
This section in the South African Family Practice journal is aimed at helping registrars in prepa... more This section in the South African Family Practice journal is aimed at helping registrars in preparing for the Fellowship of the College of Family Physicians (FCFP [SA]) Final Part A examination and will provide examples of the question formats encountered in the written examination: multiplechoice questions (MCQ) in the form of single best answer (SBA-Type A) and/or extended matching questions (EMQ-Type R); short answer questions (SAQ), questions based on the critical reading of a journal article (CRJ: evidence-based medicine) and an example of an objectively structured clinical examination (OSCE) question. Each of these question types is presented based on the College of Family Physicians blueprint and the key learning outcomes of the FCFP (SA) programme. The MCQs are based on the 10 clinical domains of family medicine, the SAQs are aligned with the five national unit standards and the critical reading section will include evidencebased medicine and primary care research methods. This edition is based on unit standard 1 (effectively manage themselves, their team and their practice, in any sector, with visionary leadership and self-awareness, to ensure the provision of high-quality, evidence-based care), unit standard 2 (evaluate and manage patients with both undifferentiated and more specific problems cost-effectively according to the bio-psychosocial approach) and unit standard 5 (conduct all aspects of health care in an ethical and professional manner). The clinical domain covered in this edition is ear, nose and throat (ENT). We suggest that you attempt to answer the questions (by yourself or with peers or supervisors) before finding the model answers online: http://www.safpj.co.za/. Please visit the Colleges of Medicine website for guidelines on the Fellowship examination: https://www.cmsa.co.za/view_exam.aspx?QualificationID=9.
(FCFP SA) Final Part A examination and will provide examples of the question formats encountered ... more (FCFP SA) Final Part A examination and will provide examples of the question formats encountered in the written examination: multiple-choice question (MCQ) in the form of single best answer (SBA-Type A) and/or extended matching question (EMQ-Type R); short answer question (SAQ), questions based on the critical reading of a journal (evidence-based medicine) and an example of an objectively structured clinical examination (OSCE) question. Each of these question types is presented based on the College of Family Physicians blueprint and the key learning outcomes of the FCFP (SA) programme. The MCQs are based on the 10 clinical domains of family medicine, the SAQs are aligned with the five national unit standards and the critical reading section will include evidence-based medicine and primary care research methods. This edition is based on unit standard one (critically reviewing new evidence and applying the evidence in practice, principles of self-care and leading a clinical governance team) and unit standard two (evaluate and manage a patient according to the bio-psycho-social approach). The domain covered in this edition is infectious diseases. We suggest that you attempt answering the questions (by yourself or with peers and/or supervisors) before finding the model answers online: http://www.safpj.co.za/. Please visit the Colleges of Medicine website for guidelines on the Fellowship examination: https://www.cmsa.co.za/view_exam.aspx?QualificationID=9.
Freeze-dried plasma b) Packed cells c) Ringers Lactate d) Voluven e) Whole blood Answer b) Discus... more Freeze-dried plasma b) Packed cells c) Ringers Lactate d) Voluven e) Whole blood Answer b) Discussion: The Advanced Trauma Life Support (ATLS) algorithms for managing shock changed in the 2018 edition after new data emerged that using more than 1.5 litres of isotonic resuscitation fluid is associated with increased mortality. Firstly, on presentation, it is important to recognise that this patient has Class III haemorrhagic shock from the clinical features present (See Table 1). The series, 'Mastering your Fellowship', provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellow of the College of Family Physicians South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.
The series, "Mastering your Fellowship", provides examples of the question format encountered in ... more The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online.
Background South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in... more Background South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. Methods This paper reports on the qualitative data generated from a mixed method...
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