HIV-prevention measures on a university campus in South Africa ­ perceptions, practices and needs of undergraduate medical students

Background: Young adults such as university students are considered to be a key population for HIV-prevention efforts. This study aimed to determine the perceptions, practices and needs of undergraduate medical students regarding HIV-prevention measures available on campus. Methods: The research design was descriptive cross-sectional. Data were collected using an anonymous, self-administered questionnaire distributed to all 745 undergraduate medical students in the School of Clinical Medicine, University of the Free State, South Africa, of whom 470 responded (63.1%). Results: Almost half (45.5%) of all respondents across the five academic years had received information about available HIV-prevention measures on campus. Most reported that information had been received during lectures (59.7%) and only 24.2% from the local health clinic on campus. The findings also revealed that 14.2% of students had used at least one prevention measure in the past, while the majority of students (70.2%) used abstinence as an HIV-prevention measure. A large percentage of all the students (47.6%) had been tested for HIV before the start of the study. Two-thirds (67%) of students indicated that the current HIV-prevention services on campus were not sufficient. Conclusion: Medical students received HIV-prevention information as part of their curriculum but this was deemed not to be sufficient. This study suggests that tertiary education institutions should evaluate the effectiveness of strategies currently in place for the distribution and awareness of HIV-prevention measures and sexual health issues affecting students, using a student-centred approach

Assessment practices in undergraduate clinical medicine training: what do we do and how we can improve?

Background: Assessment should form an integral part of curriculum design in higher education and should be robust enough to ensure clinical competence. Aim: This article reports on current assessment practices and makes recommendations to improve clinical assessment in the undergraduate medical programme at the University of the Free State. Methods: A descriptive cross-sectional study design was used. Qualitative and quantitative data were gathered by means of open- and closed-ended questions in a self-administered questionnaire, which was completed by teaching and learning coordinators in 13 disciplines. Results: All disciplines in the undergraduate medical programme are represented. They used different assessment methods to assess the competencies required of entry-level healthcare professionals. Workplace-based assessment was performed by 30.1% of disciplines, while multiple-choice questions (MCQs) (76.9%) and objective structured clinical examinations (OSCEs) (53.6%) were the main methods used during formative assessment. Not all assessors were well prepared for assessment, with 38.5% never having received any formal training on assessment. Few disciplines (15.4%) made use of post-assessment moderation as a standard practice, and few disciplines always gave feedback after assessments. Conclusion: The current assessment practices for clinical students in the undergraduate medical programme at the University of the Free State cover the spectrum that is necessary to assess all the different competencies required. Multiple-choice questions and OSCEs, which are valid and reliable assessment methods, are used frequently. Poor feedback and moderation practices should be addressed. More formative assessments, and less emphasis on summative assessment, should be considered. Workplace-based and continuous assessments may be good ways to assess clinical competence

HIV testing at birth: Are we getting it right?

Background: Birth polymerase chain reaction (PCR) testing improves early detection of HIV and allows for early treatment initiation. National guidelines exist, but it is unknown whether these are being implemented correctly.Objectives: To determine whether HIV-exposed infants at the Mangaung University Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were scheduled and the percentage of mothers or caregivers who returned to collect the results.Methods: The study was a retrospective descriptive file audit (1304 files) of births from 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to HIV-positive mothers. The birth register was used to collect the infants' HIV PCR test barcodes. The birth and 10-week PCR results were retrieved from an electronic database at the Virology Department, University of the Free State.Results: In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%) HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result, 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested positive and 151 (96.2%) negative.Conclusion: The majority of HIV-exposed infants received a PCR test at birth; however, the clinic is below the national target (90%) for HIV testing. A record-keeping system of infants' visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive infants were started on antiretroviral treatment

Anxiety disorders: Psychiatric comorbidities and psychosocial stressors among adult outpatients

Background: Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting. Aim: To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein. Methods: In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia. Results: Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%). Conclusion: Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors

The association between the levels of burnout and quality of life among fourth-year medical students at the University of the Free State

Background: Society invests huge financial resources in training medical students. However, the academic and personal demands placed on these students can be taxing and may be detrimental to students' quality of life leading to high levels of burnout and academic dropout rates. Aim: To determine the association between the levels of burnout and quality of life among fourth-year medical students at the University of the Free State (UFS). Setting: School of Medicine, UFS, Bloemfontein. Methods: All fourth-year medical students in their first semester of the clinical phase were included. Data were collected using anonymous self-report measures. The Maslach Burnout Inventory (MBI) measured the levels of burnout according to three subscales (emotional exhaustion, depersonalisation and personal achievement), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) measured the quality of life. Results: Of the 121 enrolled fourth-year medical students, 91 (75.2%) completed the questionnaires. The MBI personal achievement subscale had the highest number of participants (n = 53; 58.2%) with high levels of reported burnout. Significant associations were found between the psychological health subscale of the WHOQOL-BREF and all three subscales of the MBI, in particular emotional exhaustion. Conclusion: An association exists between the levels of burnout and quality of life among fourth-year medical students. This information could be of value to medical schools as they are in a position to implement interventions that promote students' well-being

Inter-observer variability influences the Lugano classification when restaging lymphoma

Background: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. Objectives: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. Method: A total of 61 computed tomography scans in 21 patients were evaluated independentlyby four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. Results: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. Conclusion: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process

A profile of perceived stress factors among nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex, South Africa

Introduction: Nursing staff working with intellectually disabled in-patients experience unique stress factors that can influence their personal well-being and work performance. Objectives: To compile a profile of stress factors experienced by nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex (FSPC). Methods: This descriptive study included 89 nursing staff members from this environment. A questionnaire was used to collect socio-demographic information and determine personal and occupational stressors. The data were summarised by frequencies and percentages (categorical variables) and means or percentiles (numerical variables). Results: Most participants were aged between 46 and 55 (41.2%), female (93.2%) and black (93.2%), and 76.7% had children or dependant minors. The main stressors among participants were pressure providing financially for their children and dependant minors (71.2%), caring for them (39.4%) and fearing them moving away (25.8%). Occupational stressors included high workload (66.3%), lack of decision-making by superiors (58.1%), underpayment (53.5%), endangerment of physical health (52.3%) and safety (50.0%), working hours (51.2%), pressure of expectations from superiors (48.8%), uncertainty of employment (48.8%), work responsibilities (47.7%) and perceiving that skills and training were not appreciated. They experienced stress regarding health issues such as hyper- and hypotension (35.3%). Because of stress 34.5% of participants took leave, 34.5% developed depression and 14.3% had panic attacks. Conclusion: Most of the respondents experienced personal and occupational stress that influenced their health, which poses serious challenges for the management of the FSPC. Security should be upgraded, medical and psychological support for the staff and care facilities for their dependants should be provided, and financial problems experienced by these staff members should be addressed. The workload of the nursing staff at FSPC needs urgent attention. This can be done by means of a workforce analysis to determine minimum staffing levels for nursing

The feasibility of Determining the Position of an Endotracheal Tube in Neonates by using Bedside Ultrasonography Compared with Chest Radiographs

Background. Neonates in our neonatal intensive care unit (NICU) receive a large amount of radiation with X-rays (XRs) being done daily; even more often with reintubation; repositioning of endotracheal tubes (ETTs) and confirmation thereof; which has been our NICU policy for many years. Objective. To investigate the feasibility of determining the position of ETTs in neonates by using bedside ultrasonography (BUS); and to compare the results with those obtained from chest XR (CXR) findings. Methods. A prospective; cross-sectional study was done on intubated neonates in the NICU at Universitas Academic Hospital; Bloemfontein; to determine the position of ETTs by using BUS.Results. Thirty intubated patients included in this study had a median age of 13.5 days and a median weight of 1.6 kg. Ninety-three per cent of ETT placements were considered optimal when visualised by BUS; while 73.3 were considered to be placed optimally when CXR was viewed. When CXR and BUS findings were compared regarding optimal placing; the agreement was poor (?=0.10; 95 confidence interval -0.2 - 0.4). In four patients; the distance from the aortic arch to the tip of the ETT was outside the expected range of 1.5 - 2.2 cm: in two patients it was 1.5 cm (6.7) and in the other two 2.25 cm (6.7). BUS measurements were done mainly in extended head (53.3) or neutral (36.7) position. Conclusion. Although poor agreement between CXR and BUS findings was obtained; possibly because of handling of patients with secondary shifting of ETTs; BUS was found not to be comparable with CXR; but an alternative feasible method to determine the optimal position of ETTs in the trachea in neonates when using other reference points; with the added advantage of no radiation exposure

The Quality of Specimens Obtained By Fine-Needle Aspiration Biopsy: does Training Make a Difference?

Background: The aim of this study was to determine the outcome of a one-hour training session on the correct technique of fine-needle aspiration biopsy (FNAB) by assessing adequacy of FNAB specimens received from clinicians at an academic hospital.Method: Six clinicians were recruited and their FNABs assessed; six months prior to; and then again after; a one-hour training session in correct technique. Questionnaires were completed prior to the training session and after the subsequent six-month period; to determine the subjective assessment of the clinicians' perceived value of the training on their aspiration technique.Results: Five of the clinicians had never received training in FNAB technique. The adequacy of the aspirates for all six clinicians did not improve; although this was not statistically significant. They performed a median of 15.5 FNABs in the six months prior to training; and 13.5 FNABs in the six-month follow-up period. Five of the six clinicians subjectively perceived the quality of the aspirates to have improved; and all six recommended the training session to their colleagues.Conclusion: No improvement was noted after training; but the number of FNABs performed per clinician was suboptimal. Previous studies have shown that clinicians performing relatively few aspirates perform poorly; even if they have received adequate training. The fact that all six would recommend the training session to colleagues is encouraging; and the authors recommend that formal training in FNAB technique should be included in the undergraduate medical curriculum

The Prevalence and Perception of Obesity and its Association with the Lifestyle of Women at the Mangaung University Community Partnership Project Healthcare Centre; Bloemfontein

Background: This investigation was prompted by the increase of obesity in developing countries with the simultaneous increased risk of preventable noncommunicable diseases. We aimed to determine the prevalence of obesity among women serving a predominantly black peri-urban community; who visited a healthcare centre in Bloemfontein. We also wanted to establish their perceived weight status; and any correlation between obesity; level of education; employment status and monthly income.Method: A cross-sectional analytical design was used. In June 2007; clinic-attending women aged 18-50 years were selected by a systematic sampling method to participate in the study. A self-administered questionnaire investigated participants' socio-economic status; body image perception; psychological well-being; self-reported health status and physical activity. Body mass indices (BMIs) were calculated from weight and height measurements.Results: A total of 304 women completed the study; of whom 98 (32.2) were overweight and 134 (44.1) were obese; with a mean BMI of 30.1 kg/m2 [standard deviation (SD) 6.9 kg/m2]. More than half (53.4) of the obese women perceived themselves as not obese. Approximately 84 of the participants were educated to secondary level; or higher. A significant difference in the employment status of the obese and non-obese participants (26.9and 16.5 employed; respectively) was noted (p-value = 0.0013). The obese participants reported significantly less low self-esteem (29.5) than the nonobese participants (42.4) (p-value = 0.0250).Conclusion: The high prevalence of overweight and obesity; and the fact that 53.4 of the obese participants did not perceive themselves as such; poses a challenge for healthcare providers. Health-promotion strategies should aim to inform women about the health risks of overweight and obesity; and address misconceptions regarding perceived weight status

The criteria used by private general practitioners in Bloemfontein for the diagnosis and referral of asthma patients aged 6­15 years

Background:Participants in the study were general practitioners (GPs) in private practice in Bloemfontein, South Africa. Objectives: To determine and evaluate the criteria employed by GPs in Bloemfontein to diagnose and refer chronic and acute asthma patients aged 6­15 years and to investigate the actual diagnostic criteria used by GPs, as compared to the theoretical (i.e. textbook) criteria. Method: A descriptive study was performed. A questionnaire was designed to investigate which methods of diagnosis were employed by GPs with regard to childhood asthma. The questionnaire was distributed to GPs who fulfilled certain inclusion criteria and were selected by means of simple random sampling. Statistical analysis of data was done by the Department of Biostatistics, University of the Free State, and results were summarised as frequencies and percentages. Results: Certain elements were lacking with regard to the patients' histories taken by GPs. These included severity and frequency of attacks, as well as precipitating factors, such as smoking in the family and allergies. A worrisome number of GPs did not seem to be aware of the exact clinical picture of asthma in children and some failed to use the prescribed guidelines proposed for diagnosis of this condition in young patients. Most GPs indicated that they refer asthmatic children to private specialists, although this practice depended on the medical aid status of the patient's parents/guardian. Conclusion: As portrayed by the feedback obtained from these Bloemfontein-based GPs, it could be presumed that the diagnosis of asthma in children did not always meet the standard criteria

The Appropriateness of the South African Thoracic Society's (SATS) Guidelines for Antibiotic Treatment of Patients with COPD 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; 25 smoked previously and 56.3 were 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

Abstract: 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 50-70 of 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

Abstract: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. 33 and 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 2.6 and thyroid functions 2.3). In 70.4 of 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