Surgical infections at a regional hospital in Gauteng: reasons for delay to care and profile of pathology

Background: Present on arrival infection is a common indication for admission of surgical patients initially managed at primary care level. We aimed to describe the demographic and disease profile of patients presenting with infection requiring surgical management, describe determinants of patients' health-seeking behaviour, and identify barriers to care.Methods: A prospective descriptive questionnaire-based study was conducted at Edenvale General Hospital between February 2014 and October 2016. Minors were excluded. Results: Eighty-nine patients participated. Abscesses (26%), diabetic foot (22%), and cellulitis (16%) were the commonest categories of infection necessitating admission. The majority of patients were South African (88%), Black African (82%), males (58%), without medical aid (99%), who were not formally employed (58%), were from poor households (74%), inhabited some form of formal housing (90%), were in charge of decisions regarding personal health (80%), and first sought help at the primary care level (71%). Delay to presentation was noted in 69% of patients, and delay to referral in 46%. Age, race, history of diabetes, and main source of monthly income were significant variables in delayed presentation (p<0.05), and age and level of care on first contact in delayed referral (p<0.05) in the study sample. The most common reason for delay to presentation (84%) and referral (61%) was patients' belief that their problem would resolve spontaneously. Conclusions: Patients' socio-economic status, past medical history, demographics, level of first contact with the health care system, and perceptions of their own health contributed to delays in seeking and receiving care in the study sample. These delays may be addressed by interventions that target the availability, accessibility, acceptability and affordability of health care services

Recria de bovinos de corte mantidos em pastagem de aveia preta com diferentes ofertas de forragem, com e sem suplementação / Rearing of beef cattle grazing oats with different forage allowances, with or without supplementation

O objetivo deste estudo foi avaliar o desempenho de bezerros recebendo ou não suplemento energético, mantidos em pastagem de aveia preta (Avena strigosa Schreb) manejada sob duas ofertas de forragem. Foram utilizados 16 animais do grupamento genético Composto Marchangus Z (1/4 Marchigiana 1/4 Angus 1/2 Nelore), com oito meses de idade, castrados, e com peso médio inicial de 200kg. O delineamento experimental utilizado foi o inteiramente ao acaso, em um fatorial 2x2 (duas ofertas de forragem x dois manejos alimentares - com e sem suplementação de milho moído). Não houve interação significativa entre oferta e suplementação para nenhuma das variáveis. A oferta de forragem real ficou próxima do estipulado para 6 e 10% (5,95% e 9,07%, respectivamente). A oferta de 6% apresentou maior porcentagem de folha (57,0 contra 30,4%), menor porcentagem de colmo (43,0 contra 69,6%) e, consequentemente, maior relação folha/colmo (1,45 contra 0,45), resultando em pastagens de melhor qualidade (PB = 20,0 contra 13,6%) na menor oferta. A taxa de acúmulo diária foi maior (P<0,05) para oferta de forragem de 6% (34,2kg de MS/ha/dia) em relação à oferta de 10% (28,1kg de MS/ha/dia). A suplementação proporcionou maior ganho de peso médio diário (0,749 contra 0,594kg/dia) na recria de bezerros em pastagem de aveia preta IPR-61.

The objective of this study was to evaluate the performance of calves fed supplemented energy or not maintained in oat (Avena strigosa Schreb) managed under two forage allowances. Sixteen Marchangus (1/4 Marchigiana 1/4 Angus 1/2 Nelore) animals were used at eight months old and average initial weight of 200kg. The experimental design utilized was completely randomized in a 2x2 factorial (two forage allowances x two feeding - with and without supplementation of corn). There was no significant interaction between supply and supplementation for the variables. The real forage allowance was close to the expected from 6 to 10% (5.95 and 9.07%, respectively). The offer of 6% shows higher percentage of leaf (57.0 versus 30.4%), lower percentage of stem (43.0 versus 69.6%) and, consequently, higher leaf/stem ratio (1.45 versus 0.45), resulting in better forage (PB=20.0 versus 13.6%), in lower offer. The accumulated rate was higher (P<.05) for forage allowance of 6% (34.2kg of MS/ha/day) in relation to the offer of 10% (28,1kg of MS/ha/day). Supplemented animals showed higher average dairy weight (.749 versus .549kg/day).

Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa

Objective: The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards deinstitutionalisation. This article investigates patient and social work factors related to successful community placement; in the context of limited community care facilities. Method: Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions; and the most common type of interventions. Results: The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse; verbal or physical aggression; uncontrolled sexual activity); and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female; in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support. Conclusion: The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients; limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments

Ocorrência de siphonaptera em preá cavia aperea exerleben, 1777 (rodentia: caviidae) no Rio Grande do Sul, Brasil / Occurrence of siphonaptera in cavia aperea exerleben, 1777 (rodentia: caviidae) in the state of Rio Grande do Sul, southern Brazil

Due to limited knowledge of Siphonaptera fauna of the Cavia aperea (Brazilian guinea pig) in the State of Rio Grande do Sul, 43 specimens were examined. Six percent of the Brazilian guinea pigs were parasitized with Siphonaptera, which were identified as Polygenis (Neopolygenis) atopus and Polygenis (Polygenis) axius proximus (Rhopalopsyllidae), both with 2.3% of prevalence. P. (Neopolygenis) atopus and P. (Polygenis) axius proximus are reported for the first time on C. aperea in the State of Rio Grande do Sul, Southern Brazil.

Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

Objective: The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence; and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables; using two-way tables and Chi-Square or Fisher's Exact Tests. Results: The prevalence of violence among the long-term patients was 16. Fighting among patients was the most common form of violence (58). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay 12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. Conclusion: The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a disproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms; but more in their cognitive ability; coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement

Medical students' perceptions of their development of `soft skills' Part I : A qualitative research methodology

Background: Following the introduction of a new; integrated; problem-oriented undergraduate medical curriculum at the University of Pretoria (UP) in 1997; a research project was undertaken to study interpersonal skills; professional attitudes; teamwork; ethics and related topics - which have come to be known collectively as `soft skills'. This contribution is the first of two articles on the professional socialisation of medical students and their development of `soft skills'. It describes the particular qualitative methodology developed for; and applied to; the study of soft skills among medical students at UP. Methods: This paper describes the aim of the study; reasons for adopting a qualitative research approach to achieve this aim; the theoretical orientation underpinning the qualitative approach that we considered most suitable; the design; the sampling; the data management and analysis; and the methods that we deployed to ensure the credibility of the findings. Research Design: The aim of the study was to explore the subjective meanings that students attributed to soft skills; as they understood them. These subjective meanings involve the way students interact meaningfully with fellow students; lecturers and other individuals participating in the medical and clinical education programme; and the way they construct shared conceptualisations of soft skills and medical education in their lives and social world. A qualitative approach was considered most appropriate; as this study set out to uncover subjective and diverse meanings that do not necessarily amount to generalisable truths. The particular qualitative strategy or design used was that of an extended case study; or `casing'; within the modernist theoretical orientation of symbolic interactionism. Elements of process evaluation were incorporated into the design to account for the process of curriculum reform within which this study was embedded.We recruited participants for this study from two cohorts of students. The first group; who completed their studies in 2001; had followed the traditional curriculum; while the second group; who completed their programme in 2002; had followed the reformed curriculum. The data collection tools were face-to-face individual interviews; focused group interviews and solicited autobiographical sketches. The utilisation of more than one method or data source enabled triangulation or cross-checking of findings. We followed an inductive reasoning approach; which means that we did not search for data to test any hypotheses that had been formulated prior to commencing the study; but focused instead on building constructs that were grounded in or reflected intimate familiarity with the students' world. Conclusion:The modernist qualitative research approach enabled us to uncover; describe and illuminate the subjective points of view on soft skills as expressed by final-year medical students before and after curriculum reform. More specifically; by carrying out an extended case study we were able to perform a process evaluation of the curriculum reform in terms of soft skills and the professional socialisation of the students. This paper outlines how qualitative research methods enabled us to capture and explore aspects of the inner life (social worlds) of these students. Whether they would be the same; similar or different in another setting are questions for further exploration or research - questions prompted by our study in a manner that illuminates the qualities that may be inherent in these subjective meanings

Medical students' perceptions of their development of 'soft skills' Part II: the development of 'soft skills' through 'guiding and growing'

Background: This paper reports on medical students' views on the ways in which their `soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills; communication skills; and professional and ethical attitudes.Methods: As symbolic interactionism was used as the theoretical framework to guide the research; qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups; individual in-depth interviews and autobiographical sketches.ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught; but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that; in the end; they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators; fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed; as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups; except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect.The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between `being' and `becoming'. Instead of using the word `acquisition' of soft skills; `development' seemed to be more appropriate. The metaphor of `guiding' and `growing' also captures the development of these skills better than the terms `teaching' and `learning'. Conclusion: Teaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated

Medical Students' Perceptions of their Development of 'Soft Skills' - Part I: A qualitative Research Methodology

Background: Following the introduction of a new; integrated; problem-oriented undergraduate medical curriculum at the University of Pretoria (UP) in 1997; a research project was undertaken to study interpersonal skills; professional attitudes; teamwork; ethics and related topics - which have come to be known collectively as 'soft skills'. This contribution is the first of two articles on the professional socialisation of medical students and their development of 'soft skills'. It describes the particular qualitative methodology developed for; and applied to; the study of soft skills among medical students at UP.Methods: This paper describes the aim of the study; reasons for adopting a qualitative research approach to achieve this aim; the theoretical orientation underpinning the qualitative approach that we considered most suitable; the design; the sampling; the data management and analysis; and the methods that we deployed to ensure the credibility of the findings.Research Design: The aim of the study was to explore the subjective meanings that students attributed to soft skills; as they understood them. These subjective meanings involve the way students interact meaningfully with fellow students; lecturers and other individuals participating in the medical and clinical education programme; and the way they construct shared conceptualisations of soft skills and medical education in their lives and social world. A qualitative approach was considered most appropriate; as this study set out to uncover subjective and diverse meanings that do not necessarily amount to generalisable truths. The particular qualitative strategy or design used was that of an extended case study; or 'casing'; within the modernist theoretical orientation of symbolic interactionism. Elements of process evaluation were incorporated into the design to account for the process of curriculum reform within which this study was embedded. We recruited participants for this study from two cohorts of students. The first group; who completed their studies in 2001; had followed the traditional curriculum; while the second group; who completed their programme in 2002; had followed the reformed curriculum. The data collection tools were face-to-face individual interviews; focused group interviews and solicited autobiographical sketches. The utilisation of more than one method or data source enabled triangulation or cross-checking of findings. We followed an inductive reasoning approach; which means that we did not search for data to test any hypotheses that had been formulated prior to commencing the study; but focused instead on building constructs that were grounded in or reflected intimate familiarity with the students' world.Conclusion: The modernist qualitative research approach enabled us to uncover; describe and illuminate the subjective points of view on soft skills as expressed by final-year medical students before and after curriculum reform. More specifically; by carrying out an extended case study we were able to perform a process evaluation of the curriculum reform in terms of soft skills and the professional socialisation of the students. This paper outlines how qualitative research methods enabled us to capture and explore aspects of the inner life (social worlds) of these students. Whether they would be the same; similar or different in another setting are questions for further exploration or research - questions prompted by our study in a manner that illuminates the qualities that may be inherent in these subjective meanings