Steps walked whilst at work, by University of the Free State medical registrars: an exploratory study

Background: Doctors may have physical disabilities affecting their mobility. If they wish to specialise, they need information regarding mobility requirements for various specialities to help them select an appropriate speciality. No research has been published on the differences in physical activity demands in different medical specialities. Objective: The aim of this study was to compare the physical activity of medical registrars from six specialist departments at a South African academic hospital. The inference was that those specialities where registrars walked the most would be more challenging for those with physical disabilities, thereby limiting mobility. Methods: The number of steps walked from 07:00 to 16:00 each day was measured, using Yamax CW-701 pedometers. Kruskall-Wallis tests were used to compare the steps taken in different specialities with the level of significance set at 0.05. Results: Twenty registrars participated in the study. Significant differences in the number of steps walked per day were observed between those from different specialities (p < 0.001). Surgery, paediatric and internal medicine registrars walked the most steps per day (median of 5 991, and 5 880, 5 489, respectively). Anaesthesiology and radiology registrars walked a median of 4 521 and 3 926 steps, respectively. Registrars in obstetrics and gynaecology walked the least steps (median of 1 918). There was considerable variation in steps between participants within a department, and for the same participants on different days. Conclusion: Registrars appeared to be more physically active in some medical specialities than others, in terms of mobility. The wide intra-speciality variation is probably related to differing daily duties. Future studies should include types of work duties (e.g. sedentary vs high physical mobility), cover more specialities, and include more participants.

Burnout and associated factors in undergraduate medical students at a South African university

Background. Medical students are at risk of burnout owing to various challenges.Objectives. To investigate burnout and associated factors among undergraduate students at a South African medical school.Methods. In this cross-sectional study, findings of the Copenhagen Burnout Inventory (CBI), demographic data and information related to resilience were collected by means of an anonymous self-administered questionnaire. Associations between burnout subscales and various factors were determined.Results. Five-hundred students (preclinical, n=270; clinical, n=230) completed the questionnaire. CBI mean scores for preclinical and clinical students were 17.9 and 17.4 (personal), 22.3 and 21.9 (work related) and 24.8 (patient related; clinical students only), respectively. High scores on the subscale reflect low levels of burnout in related areas. Male students and students with high self-reported resilience and low stress had significantly lower burnout levels. White preclinical students had lower levels of personal and work-related burnout, and black clinical students had less patient-related burnout.High mean scores in all three burnout subscales indicated low burnout levels among students. Academic and personal stress, as well as perceived poor support from institutional structures, were associated with significantly higher personal and work-related burnout, but not patient-related burnout in clinical students

Simulation as an educational strategy to deliver interprofessional education

Background. Various educational methods are available to deliver interprofessional education (IPE) to prepare healthcare students for collaborative practice. One such method is simulation-based health education.Objectives. To identify current IPE methods used in undergraduate programmes in the Faculty of Health Sciences at the University of the Free State, Bloemfontein, South Africa, and to determine the opinions of module leaders on using simulation as a particular IPE teaching strategy.Methods. A quantitative, cross-sectional descriptive study design was employed. Structured interviews were conducted with 47 module leaders of the undergraduate programmes in the Faculty of Health Sciences. These programmes cover 66 modules in the Schools for Allied Health Professions (nutrition and dietetics, occupational therapy, physiotherapy and optometry), nursing and medicine.Results. At the time of the study, IPE activities were used in 29 (43.9%) of the modules, of which 17 (58.6%) were coincidental. Respondents' opinions on the potential use of simulation to address formalised IPE activities included the challenge of 'scheduling' (73.9%) and 'logistical and high cost issues' (19.6%). The most prominent advantage that was foreseen (41.3%) was better clarification of roles among the different professions.Conclusions. The module leaders had a positive attitude towards simulation and its potential use for IPE, with their major concern being logistical challenges. To improve role clarification, a scenario should be developed to engage students from all the relevant professions. The proposed type of simulation was to use standardised patients in a role-play scenario. The outcomes of these activities should be aligned with the principles of IPE

The use, knowledge and attitudes regarding hormonal contraceptive products of female first-year students in a Faculty of Health Sciences

Background: Effective contraception plays a major role in the economic advancement of women. New hormonal products offer more effective solutions with fewer side effects. This study aimed to assess the use, knowledge and attitudes regarding hormonal contraception of female first-year students across various health profession courses. Methods: A descriptive study was conducted during August to October 2017 targeting all female first-year students of the Faculty of Health Sciences at the University of the Free State. Results: Self-administered anonymous questionnaires were completed by 261 students (response rate 81.6%). At the time of the study, 29.6% of the study population reported using hormonal contraceptive products; 51.7% of users cited acne as the indication. Among users of hormonal contraceptives, combined oral contraception was the most commonly used (86.0%), and was regarded as the most effective (33.2%). A third of the students (36.2%) were aware that some medication could influence the effectiveness of combined oral contraception. Half (52.3%) had no knowledge of the subdermal implant and 34.8% did not know what an intrauterine system was. According to 28.2%, post-coital use of hormonal products is not an acceptable method of contraception. Almost 90% (87.3%) indicated that an education intervention regarding hormonal contraception is needed at the university. Conclusion: The study population lacks detailed and sufficient knowledge of critical aspects of contraception, such as relative effectiveness, and factors that affect these; long-acting reversible contraceptives; and emergency contraception. A formal education intervention is proposed

Congenital heart defects in children with cleft lips and/or palates at an academic hospital in central South Africa

Background: Globally, cleft deformities are the most common craniofacial anomalies and show an association with congenital heart defects. Little research on cleft lips and/or palates (CL/P) and congenital heart defects has been reported from Africa, and none from South Africa. In 2001, it was proposed that CL/P be listed as one of six priority conditions for monitoring and notification to South African health authorities. This goal of creating a national registry has not been achieved. A near-fatal anaesthetic incident following a missed cardiac lesion in a child with a cleft lip and palate prompted this study. Objectives: To describe the prevalence of congenital heart defects diagnosed in children with CL/P presenting for corrective surgery during the Smile Week over three consecutive years (2013­2015) at an academic hospital in South Africa. Methods: A retrospective, descriptive file review of 62 patients with CL/P was performed. Since 2013, echocardiography has been performed on all patients with CL/P. Results: Twenty-three, 21 and 18 patients were operated in 2013, 2014 and 2015, respectively. Of these patients, 85.5% (n = 53) had no clinical evidence of a cardiac defect, of which eight did have clinically significant cardiac defects on echocardiography. Sixteen patients (25.8%) in total (n = 16/62) with a cleft deformity had a clinically significant congenital heart lesion. Of the 16 patients with a cardiac defect on transthoracic echocardiography, only four had clinical evidence of cardiac defect. Therefore, sensitivity of clinical examination was 25%, whereas the specificity was 89.1%. Three of the four patients with a syndrome had a clinically significant echocardiographic finding. Conclusion: A national guideline for the preoperative care of patients with CL/P, including routine echocardiography, is needed. Furthermore, a national registry is required for patients with CL/P with associated congenital anomalies

Association between personality factors and consulting specialty of practice of doctors at an academic hospital in Bloemfontein, South Africa

Background. Studies found an association between personality types and field of specialty. The current study could assist aspiring specialists in deciding which specialty they are best suited for by comparing their own personalities with the results.. To explore the personality characteristics of doctors in three consulting and four surgical specialties at an academic hospital in Bloemfontein,South Africa.Methods. In this analytical cross-sectional study, questionnaires, including the Zuckerman-Kuhlman Personality Questionnaire, were handed out.Overall, 58 consultants and senior registrars from the departments of Family Medicine, Paediatrics and Internal Medicine (response rate 71.6%) and 70 consultants and senior registrars from surgical specialties (response rate 60.3%) participated.Results. Family medicine had the lowest median score for impulsive sensation seeking (21.1%) and aggression-hostility (11.8%), and highest for parties and friends (33.3%). Paediatrics scored highest for neuroticism-anxiety (44.7%) and aggression-hostility (23.5%). Internal medicine scored highest for sociability (25.0%) and isolation intolerance (37.8%), and lowest for neuroticism-anxiety (36.8%) and activity (47.1%). Overall, the consulting group scored lower than the surgical group for impulsive sensation seeking, aggression-hostility, sociability and activity, and higher for neuroticism-anxiety. Conclusion. The study identified personality types of some specialties, and revealed differences between characteristics of local specialists compared with findings from studies elsewhere

The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein

Background: Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries. Aim: This study sought to determine the causes of burn wounds among adults admitted to the Burn Wound Unit at Pelonomi Tertiary Hospital in Bloemfontein for treatment.Methods: This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire. Results: A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh.Conclusion: The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation

Background: We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma.Method: This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000­December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant).Results: Among 65 patients (mean age 50.9 years, range 37­69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26­69) years in the HIV-positive and 57.2 years (range 26­89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma.Conclusion: Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age

Intravenous paracetamol ­ waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex­Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa. Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol. Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21­ 32.3 mg/kg). Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required

Clinical Presentation of Infants Hospitalised with Pertussis

Background. Despite the widespread use of pertussis vaccine; there has been a resurgence of pertussis cases in developed and developing countries. South Africa lacks data regarding clinical presentation and healthcare impact of pertussis.Objectives. To describe the clinical presentation and healthcare impact in hospitalised infants with confirmed pertussis.Methods. This was a retrospective cohort study; conducted in Bloemfontein between April 2008 and September 2012. Infants with laboratory-confirmed pertussis (group 1; N=102); were compared with infants with a negative pertussis result (group 2; N=104) and infants with a lower respiratory tract infection of unspecified aetiology (group 3; N=104). The following data were extracted from the clinical records: demographics; presenting symptoms; paediatric intensive care unit (PICU) admission; length of stay in the general ward and PICU; overall hospital stay and outcome.Results. There were no significant demographic differences between the groups. A larger percentage of infants in group 1 (n=41; 40%) required PICU admission compared with group 2 (n=37; 36%) and group 3 (n=20; 19%). The median PICU stay of group 1 was longer (11 days) compared with group 2 (6 days) and group 3 (5 days). The presence of cough and post-tussive vomiting was significantly higher in group 1 than groups 2 and 3. There was no significant difference in mortality between the groups. Conclusion. Pertussis results in significant morbidity in infants. Measures to identify and manage this vaccine-preventable disease should be considered at a national level

The Profile and Management of Needle-Stick Injuries among Healthcare Workers in a Primary Health Sub-District in Mangaung from 2008 to 2011

Introduction: Through needle-stick injuries (NSIs); healthcare workers are exposed to hazards; including blood-borne pathogens. This study aimed to describe the profile and management of NSIs among healthcare workers in the Mangaung health sub-district. Methods: This descriptive study involved reviewing 2008 to 2011 records from healthcare workers who reported NSIs. Results: Thirty-four NSIs were reported. The highest percentage of NSI victims were professional nurses (38.2) and auxiliary nurses (14.7). The highest percentage of NSIs was related to administering injections (38.5). Ninety percent of NSI victims received antiretroviral (ARV) drugs and were tested for HIV within 72 hours. Only 5 repeated the HIV test after three months and 3 at six months post-exposure; while 3 completed ARV therapy prophylaxis. Conclusion: There is poor compliance with post-exposure prophylaxis guidelines; with even fewer NSI victims attending follow-up monitoring. This may have a bearing on compensation claims should these victims seroconvert

Suicide Cases Investigated at the State Mortuary in Bloemfontein; 2003-2007

Background: Up to 8 000 South Africans commit suicide annually. This study aimed to investigate the profile of suicide cases in Bloemfontein and the southern Free State province. Methods: A cross-sectional descriptive study was performed. Suicides in the Bloemfontein and southern Free State areas (Xhariep and Motheo districts) investigated at the state mortuary in Bloemfontein in 2003 to 2007 were included. Data were collected retrospectively by using a specially designed data-capturing form. Results: A total of 469 suicide cases were included in the study. The estimated suicide rate for this part of the Free State province was 10.9/100 000 of the population per year. The majority (82.1) of the victims were men. In total; 338 (72.1) of the victims were black; 122 (26.0) were white; five (1.1) were coloured and three (0.6) were Indian. The most common methods were hanging (262; 55.9); shooting (99; 21.1) and overdosing on pills (43; 9.2). Most cases (57.8) occurred in victims 21 to 40 years of age. Five (1.1) victims were children younger than 11 years of age; while 12 (2.6) were older than 65 years. More than half (267 cases; 56.9) of the suicide victims were unemployed. The majority (43.1) of suicides occurred in January to April of each year; with the highest incidence (67 cases; 14.3) in January. Conclusion: The rate of suicide and the profile of victims with regard to the variables investigated corresponded to findings reported from other studies. The information obtained could make a meaningful contribution to suicide-prevention programmes

Nutritional Status of HIV-Infected Adults on Antiretroviral Therapy and the Impact of Nutritional Supplementation in the Northern Cape Province; South Africa

Objectives: The study aimed to describe the nutritional status and determine the impact of current nutrition intervention strategies on weight changes in adult HIV-infected patients on antiretroviral (ARV) therapy.Design: A descriptive; prospective trial was performed. Setting: The investigation was conducted at ARV roll-out centres in Kimberley; Upington; Kuruman; Prieska and Springbok in the Northern Cape Province of South Africa. Subjects: Adult HIV-infected patients receiving ARV therapy were included in the study.Outcome measures: Each participants's body mass index (BMI) was determined before and after a four-month intervention period of nutritional supplementation with an instant; enriched maize product. Results: Data from 98 patients (mean age 39.7 years; standard deviation 8.9 years) were assessed. Prior to intervention; the median BMI was 20 kg/m2 (range 12.6-29.7 kg/m2); the patients from Kuruman had a greater incidence of underweight compared to the other towns; with a median BMI of 17.9 kg/m2. Of the 87 patients assessed during the final week; 49.4experienced weight gain and 40.2lost weight. Eighteen (20.7) patients gained more than 5of their baseline weight; which was significant. Only eight (9.2) patients lost more than 5of their baseline weight. Twenty-two patients who presented with a BMI 18.5 kg/m2 at baseline had a median weight gain of 1.13 kg during the intervention period; while the group with a BMI 18.5 kg/m2 presented with no change in median weight. Conclusions: Nutritional supplementation; provided according to provincial policy and combined with ARVs; nutritionally benefitted about half of the patients in the ARV programme in the Northern Cape

Nutritional Status of HIV-Infected Adults on Antiretroviral Therapy and the Impact of Nutritional Supplementation in the Northern Cape Province; South Africa

Objectives: The study aimed to describe the nutritional status and determine the impact of current nutrition intervention strategies on weight changes in adult HIV-infected patients on antiretroviral (ARV) therapy.Design: A descriptive; prospective trial was performed. Setting: The investigation was conducted at ARV roll-out centres in Kimberley; Upington; Kuruman; Prieska and Springbok in the Northern Cape Province of South Africa. Subjects: Adult HIV-infected patients receiving ARV therapy were included in the study.Outcome measures: Each participants's body mass index (BMI) was determined before and after a four-month intervention period of nutritional supplementation with an instant; enriched maize product. Results: Data from 98 patients (mean age 39.7 years; standard deviation 8.9 years) were assessed. Prior to intervention; the median BMI was 20 kg/m2 (range 12.6-29.7 kg/m2); the patients from Kuruman had a greater incidence of underweight compared to the other towns; with a median BMI of 17.9 kg/m2. Of the 87 patients assessed during the final week; 49.4experienced weight gain and 40.2lost weight. Eighteen (20.7) patients gained more than 5of their baseline weight; which was significant. Only eight (9.2) patients lost more than 5of their baseline weight. Twenty-two patients who presented with a BMI 18.5 kg/m2 at baseline had a median weight gain of 1.13 kg during the intervention period; while the group with a BMI 18.5 kg/m2 presented with no change in median weight. Conclusions: Nutritional supplementation; provided according to provincial policy and combined with ARVs; nutritionally benefitted about half of the patients in the ARV programme in the Northern Cape

The Appropriateness of the South African Thoracic Society's Guidelines for Antibiotic Treatment of Patients with Chronic Obstructive Pulmonary Disease Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25smoked previously and 56.3were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

The Antibiotic Susceptibility of Bacteria Isolated from Blood Cultures during Episodes of Neutropenic Fever in Patients with Acute Myeloid Leukaemia

Neutropenic fever (NF) is a common and life-threatening complication of high-dose chemotherapy in patients with acute myeloid leukaemia (AML). Induction chemotherapy may result in complete remission in approximately 50-70of AML patients but is associated with an increased risk of infection due to immune suppression by the disease itself or as a result of treatment. Chemotherapy causes neutropenia as well as defective chemotaxis and phagocytosis. Chemotherapy-induced mucositis often occurs throughout the gastrointestinal tract; facilitating spread of endogenous flora to the blood circulation; leading to NF. The aim of this study was to determine the spectrum of bacteraemic microorganisms isolated during episodes of NF (NFEs) in AML patients in the Haematology Unit of the Universitas Academic Complex (UAC); as well as antibiotic susceptibility profiles of these organisms. Duration of NF; the time-span between chemotherapy and onset of NF; and the efficacy of antibiotics administered to patients; were also investigated

Doctors' Use of Laboratory Tests in the Diagnosis and Treatment of Patients

The provincial health budgets in South Africa are under enormous pressure and; annually; budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses; followed by endocrine (27.8) and musculoskeletal (16.3) complaints or diagnoses. Between one and three tests were requested for most patients; i.e. 33and 15; respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1); urea and electrolytes (7.7); urine microscopy; culture and sensitivity (6.4); cholesterol (6.1); full blood count (5.7) and thyroid profile (TSH 4.6; T4 2.6and thyroid functions 2.3). In 70.4of cases; results were documented and; in 59.1; the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education; guidelines; feedback; leadership and redesign of requisition forms

Percutaneous Injuries in Doctors in the School of Medicine; University of the Free State: Prevalence; Reporting and Adherence to Precautionary and Management Procedures

"Background: Despite the official precautionary measures against percutaneous injuries; incidents still occur. Consequently; it is possible that healthcare workers could contract infections like HBV; HCV; HGV (hepatitis B; C and G viruses) and HIV (human immune deficiency virus). The most serious problem lies in the fact that percutaneous injuries are often underestimated; resulting in non-reporting of the incident. The aim of this study was to determine the incidence of percutaneous injuries in doctors in the School of Medicine at the University of the Free State (UFS); whether the incidents were reported; and the reasons for non-reporting. The use of gloves during procedures was also evaluated. Methods: A mainly descriptive study design was used. Questionnaires were administered from October 2006 through January 2007 to collect information. Participants were selected randomly; and the respondents were divided into surgical and non-surgical groups. Results: The respondents fulfilled the following roles and/or functions in their respective departments of employment: 35 (67.3) were registrars; 12 (23.1) were specialists/consultants; four (7.7) were medical officers; and one (1.9) was exclusively involved in student training. Two of the respondents did not indicate their roles and functions in their respective departments. A total of 82 incidents of percutaneous injuries occurred. Although the surgical groups handled sharp objects more frequently per week than the non-surgical groups (p-value = 0.04); more incidents occurred in the non- surgical groups (p-value = 0.02). Only 39 (47.6) of the incidents were reported; while 44.4of the respondents were aware of the correct reporting procedures. The reasons given for the non-reporting of these incidents were ""too busy"" (58.1); ""did not think it was serious"" (48.8); and ""was not aware of the reporting procedures"" (7). Only 13.7of the respondents indicated that they always used gloves when drawing blood; 17.4used them when injections were administered; and 22.4used gloves during intravenous cannulation. However; 86.8of the respondents wore gloves when they used a scalpel or any other incision object. The respondents (n = 51) suggested that the three most important precautionary measures to take into consideration when working with sharp objects were (i) the use of gloves (23/51; 45.1); (ii) never recapping a needle (9/51; 17.6); and (iii) keeping the container for disposing of sharp objects close at hand (6/51; 11.8). Conclusions: Despite the risk of percutaneous injuries; non-reporting still occurs. Although the rate of reporting these incidents could be compared with international findings published in the literature; it remains too low. Drastic measures should be taken to ensure that physicians are informed of the hazards of percutaneous injuries; as well as of the appropriate mechanisms of reporting these incidents."

Profile of Research Methodology and Statistics Training of Undergraduate Medical Students at South African Universities

Background: Medical practitioners need to have knowledge of statistics and research principles; especially with the increasing emphasis on evidence-based medicine. The aim of this study was to determine the profile of research methodology and statistics training of undergraduate medical students at South African universities in terms of which topics are taught; by whom teaching is done; when these topics are taught and how they are taught. Method: Respondents for this descriptive study were persons responsible for the teaching of statistics and research methodology at the eight medical schools in South Africa. They were identified by the head of each school who also gave permission for the school to participate. The respondents completed a questionnaire and checklist after giving informed consent. No response was obtained from one university. Responses were compared to international guidelines. Results: At five universities the material is taught in the first year; at one in the second year and one in the third or fourth year; depending on when it is selected as an elective. The material is reinforced in other modules in the medical programme at three universities. The persons responsible for teaching are mainly statisticians (six universities). Class sizes vary from 40 to 320 students with four universities having 200 or more students per class. At two universities the current course has been in place since 2003; at two since 2000; and at two since the 1970/80s. The following topics are taught at the majority of universities: study designs in medical research; exploring and presenting data; summarising data; probability; sampling; statistical inference; analysis of cross tabulation and critical reading. At four universities there are practical classes; three of these mainly for computer work. At three universities tutors are used; at two of these the tutors are postgraduate students in statistics whereas at one university registrars; doctors and researchers are used as tutors. Students at three of the universities complete a research project; at two of these the students complete the full research process from planning up to reporting; whereas the project at the other university focuses mainly on the analysis of data. Conclusion: Recommendations have been made regarding topics which should be covered and teaching methods which should be used at all universities. Doctors should be involved in the training to ensure clinically appropriate material and examples

Reasons for Doctor Migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons; medical professionals; often from sub-Saharan Africa; are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally; a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has; however; been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin; than the pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions; high levels of crime and violence; political instability; lack of future prospects; HIV/AIDS; and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals; source countries also face substantial monetary implications caused by the migration of doctors. The cost of training medical students is subsidised by the government; and could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who emigrated from South Africa. Methods: The investigation was conducted in 2005 as a descriptive study where the participants were primarily found by the snowball sampling method. The initial group of participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties; living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information; consent letters and questionnaires were either hand-delivered or e-mailed; and completed forms and questionnaires were returned via these routes. Participation was voluntary. Results: Twenty nine of 43 potential participants responded; of which 79.3were male and 20.7female between the ages of 28 and 64 years (median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985); and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4) were in private practice before they left; 27.5had public service appointments and 17.3were employed by private hospitals. Seventy nine percent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand; United Arab Emirates; Bahrain; United Kingdom; Canada; Yemen; and Australia. Forty one percent of respondents indicated that they would encourage South African young people to study medicine; although 75would recommend newly graduate doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2of the respondents; better job opportunities by 79.3; and the high crime rate in South Africa by 75.9. Only 50of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9) of the respondents indicated that they already had family abroad by the time they decided to emigrate. Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations; followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously; the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality healthcare; issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders