Recent advances in positron emission particle tracking: a comparative review.

Positron emission particle tracking (PEPT) is a technique which allows the high-resolution, three-dimensional imaging of particulate and multiphase systems, including systems which are large, dense, and/or optically opaque, and thus difficult to study using other methodologies. In this work, we bring together researchers from the world's foremost PEPT facilities not only to give a balanced and detailed overview and review of the technique but, for the first time, provide a rigorous, direct, quantitative assessment of the relative strengths and weaknesses of all contemporary PEPT methodologies. We provide detailed explanations of the methodologies explored, including also interactive code examples allowing the reader to actively explore, edit and apply the algorithms discussed. The suite of benchmarking tests performed and described within the document is made available in an open-source repository for future researchers.

An overview of Pneumocystis jirovecii pneumonia for the African generalist practitioner.

INTRODUCTION: Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in humans, which is more common among immunocompromised patients. Classically patients present with fever, non-productive cough, and dyspnoea. In the HIV-infected individuals the symptoms may be subtle at first, but gradually progress over several weeks. In the HIV-uninfected patient, however, the duration of symptoms is shorter and more severe, mainly due to the increased inflammatory response of the HIV-uninfected patient. METHODS: This article focuses on the diagnostic methods and then the management and prophylaxis principles of PCP by reviewing the best current practices and guidelines in Africa. CONCLUSION: This overview is presented by clinicians who have experience with PCP and is directed mainly at first-line healthcare providers.

Awareness of the ward based outreach team and the services offered by the programme in the tshwane health district, South Africa

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on theprinciples of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households.Methods: The study assessed the awareness of the WBOT and the servicesoffered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data werecollected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers. Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, 'Yes' and 'No'. A summary of the responses showed that the number of 'yes' responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) 'yes' responses and 698 (11.1%) 'no' responses.Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%

The management of snakebites in South Africa

Snake bites are common in southern Africa especially in the rural and remote areas. Although all snake bites are not venomous, people bitten by venomous snakes require urgent medical attention and many will require antivenom. In the healthcare facility,the type of toxin may be identified by the wound and presenting clinical features which then should be managed appropriately

Optimising the learning environment for undergraduate students in the department of family medicine at sefako makgatho health sciences university

Background: An important determinant of a medical student's behaviour and performance is the department's teaching and learning environment. Evaluation of such an environment can explore methods to improve educational curricula and optimise the academic learning environment.Aim: The aim is to evaluate the educational environment of undergraduate students in the Department of Family Medicine as perceived by students.Setting: This descriptive quantitative study was conducted with one group of final-year students (n = 41) enrolled in 2018, with a response rate of 93% (n = 39). Students were in different training sites at SMU.Methods: Data were collected using the Dundee Ready Educational Environmental Measure (DREEM) questionnaire. Total and mean scores for all questions were calculated.Results: The learning environment was given a mean score of 142/200 by the students. Individual subscales show that 'academic self-perception' was rated the highest (25/32), while 'social self-perception' had the lowest score (13/24). Positive perception aspects of the academic climate included: student competence and confidence; student participation in class; constructive criticism provided; empathy in medical profession; and friendships created. Areas for improvement included: provision of good support systems for students; social life improvement; course coordinators being less authoritarian and more approachable; student-centred curriculum with less emphasis on factual learning and factual recall.Conclusion: Students' perceptions of their learning environment were more positive than negative. The areas of improvement will be used to draw lessons to optimise the curriculum and learning environment, improve administrative processes and develop student support mechanisms in order to improve students' academic experience

Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level

The bird's-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems.Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes.Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities.Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems' performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital: A 12-month review.

BACKGROUND: Although the total number of stillbirths worldwide was estimated at 2.6 million in 2009, there is currently a dearth of literature on stillbirths in developing countries and rural settings, where the majority of such births occur. The 'Hands Up' Mortality and Morbidity Extraction Tool (HUMMET), developed at Lower Umfolozi War Memorial Regional Hospital (LUWMRH) in 2010, outlines a systematic approach to summarising individual cases of adverse perinatal outcomes. OBJECTIVES: To depict the HUMMET form by describing the detailed demographic and obstetric profile of patients who delivered a stillborn infant at LUWMRH, as well as risk factors associated with these stillbirths between 1 April 2014 and 31 March 2015. The findings add to a global initiative advanced by the Lancet series on stillbirths, aimed at raising awareness of stillbirth statistics in low- and middle-income countries. METHODS: A total of 310 detailed stillbirth case summaries of 305 patients were collected during the study period, representing 90% of the total number of stillborn infants delivered at LUWMRH. A retrospective audit of the HUMMET forms was conducted and the cases were further summarised in a Microsoft Excel spreadsheet that allowed for a univariate analysis of the variables. RESULTS: The stillbirth rate at LUWMRH is much higher than that at other regional hospitals owing to the number of at-risk referrals and emergency cases from surrounding clinics and district hospitals. Referrals were from local clinics (49%) and district hospitals (45%), 35% of stillbirths were due to abruptio placentae and a large proportion were associated with gestational hypertension, pre-eclampsia and/or eclampsia. Avoidable factors were predominantly a late patient response to reduced fetal movements and delays in transfer to hospital. Twenty percent of stillbirths were associated with inappropriate monitoring or management of the obstetric condition at the district hospital. CONCLUSION: The HUMMET form provides a systematic approach to analysing cases of perinatal morbidity and mortality in line with the requirements of the Perinatal Problem Identification Programme database, but provides more details on the circumstances and contributing factors. A repeat audit is recommended to determine whether interventions have been effective.

Knowledge; Attitude and Practices of Employers should they Discover that their Domestic Worker is HIV Positive

Background: Infection with human immunodeficiency virus (HIV) is an epidemic that has become the leading cause of morbidity and mortality in South Africa. HIV/AIDS threatens productivity; profitability and the welfare of employees and their families. Some employers insist on knowing the HIV status of their domestic workers; and there have been reports of discrimination and unfair dismissal when they are found to be infected. Methods: This qualitative study describes the knowledge; attitudes and practices of employers towards HIV-positive domestic workers in Rustenburg. In-depth interviews and a focus group discussion were conducted with 10 purposefully selected participants; all employers of domestic workers. Results: It was found that employers had reasonable knowledge about HIV and AIDS and positive views on accepting and accommodating an HIV-positive domestic worker. While they would not consider dismissal on the basis of HIV status; they were not aware of legal aspects related to HIV-positive domestic workers or how to offer support. They were also not aware of universal precautions to use to prevent HIV transmission. Conclusion : There is a need to provide more information to employers to ensure that HIV-positive domestic workers are reasonably accommodated in their work and have access to appropriate services

Depressive features among adult patients receiving antiretroviral therapy for HIV in Rustenburg district, SA

Background. Globally; it is estimated that depressive features occur in 15 - 36 of people suffering from chronic diseases and 60 of people with HIV/AIDS. A high prevalence of mental disorders among HIV-infected individuals has been shown in South Africa and other parts of sub-Saharan Africa. Untreated depression leads to poor adherence to treatment and poor quality of life for patients with chronic diseases.Methods. Using the Zung self-rating scale; we screened for depressive features among adult patients receiving highly active antiretroviral therapy (HAART) who attended primary healthcare facilities in the Rustenburg district of North West Province in South Africa during December 2009.Results. Among 117 participants; 81 (69.2 ) had mild depressive features; 2 (1.7) had moderate depressive features; 1 (0.9 ) had severe depressive features and 33 (28.2) did not have depressive features. Depressive features were more common in males (77.1) than in females (69.5); and were most common in patients taking the combination of efavirenz; lamivudine and stavudine.Conclusion. Depressive features seem to be common among adult patients receiving HAART and attending primary healthcare facilities in the Rustenburg district

Contraceptive knowledge and practices among pregnant females in Lower Umfolozi District War Memorial Hospital; KwaZulu-Natal

In South Africa there has been a decline in the proportion of women who have ever used contraception; while 30 to 50 of women present with unwanted and unplanned pregnancies. This study aimed to describe the contraceptive knowledge and practices among women aged 18 to 49; attending the antenatal clinic at LUDWM Hospital in KwaZulu-Natal; by means of a cross-sectional survey. The majority of the 286 respondents (76.6) were aged 18 to 29 years; 65.8 of the pregnancies were unplanned. Most (80.1) knew about injectable contraception. Condoms were used by 85.3; followed by injectable contraception (80) and oral contraceptives (62.5). Contraception was discontinued because of irregular vaginal bleeding (14) or weight gain (3.8). Of the women who planned for this pregnancy; 69 were using oral contraceptives. The general knowledge of modern contraception among the women was good; condoms were the contraception of choice; and most accessible. Employed women used emergency contraception and the withdrawal method more often than unemployed women. However; the most common forms of contraception used by both employed and unemployed women were condoms; oral contraceptives and injectable contraception. In this study the high unemployment rate; low education and limited access to modern contraception were associated with low contraceptive utilisation and high rates of unwanted pregnancies

Piloting a trauma surveillance tool for primary healthcare emergency centres.

OBJECTIVE: We aimed to pilot a trauma surveillance tool for use in a primary healthcare emergency centre to provide a risk profile of injury patterns in Elsies River, Cape Town. METHODS: Healthcare workers completed a one-page questionnaire capturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days. RESULTS: Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between the ages of 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence. CONCLUSION: Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities.