Gastro-intestinal stromal tumours (GISTs) - the Pretoria experience and a literature review.

AIM: To analyse the presentation and management of patients with gastrointestinal stromal tumours (GISTs) at Pretoria hospitals. DESIGN: A retrospective study was done in which all available clinical records of primary c-KIT positive GISTs were analysed. SETTING: Secondary and tertiary care institutions in Pretoria, including both private and public hospitals. Subjects. The population studied included all individuals treated at Pretoria hospitals from 17 July 2000 to 1 April 2009 who had a GIST confirmed with immunohistochemical c KIT staining. Patients with incomplete or inaccessible clinical records were excluded. Outcome measures. Patient demographics including gender, age and race; presenting symptoms and signs; results of special investigations; and treatment. RESULTS: Fifty-four cases were identified for inclusion in the study. The age of the subjects ranged from 15 to 83 years. The male-to-female ratio was 1.5:1. The organ most commonly affected was the stomach, and abdominal pain and weight loss were the most common presenting symptoms. Seventy-six per cent of the patients were treated surgically, and 24% received Imatinib. CONCLUSION: GISTs often present late with non-specific symptoms, and are frequently discovered incidentally. Large tumours tend to be malignant.

Health; Well-Being and Wellness: an Anthropological Eco-Systemic Approach

More than two decades ago; Fritjof Capra commended - and indeed advocated - a paradigm shift in health science and care. In his book The Turning Point (1982) he talks of a major shift from the preoccupation with micro-organisms to a careful study of the `host organism and its environment'; of `significant attempts to develop a unified approach to the mind/body system' in Western medicine; of `a new holistic paradigm' (as opposed to `the old biomedical paradigm') regarding the problem of health and healing; of `a holistic and humanistic approach to primary care'; and of `a holistic therapy' as opposed to `the traditional biochemical practice of associating a physical disease with a specific physical cause'. Our concern in this article is with the paradigm shift advocated by Capra in this book and the progress that has since been made

Personality and academic performance of three cohorts of veterinary students in South Africa.

To aid in selecting students for admission to undergraduate veterinary training, admissions procedures often take into account students' previous academic performance as well as the results of an interview. The study reported here investigated the relationship between personality and academic success. Students from three entry cohorts to the second year of study of a six-year BVSc program at the University of Pretoria completed the 16 Personality Factor Questionnaire. A meta-analytic approach was used to estimate the relationship between academic performance in two major final-year subjects and academic performance on entry, an interview score, and the personality factors. The study confirmed the value of previous academic performance and the interview in selecting students for the veterinary degree program. The findings also indicate that the inclusion of a measure of intellectual ability could be of value. The value of various personality characteristics in predicting good study habits and examination performance is highlighted by the study results: students were more successful if they were conscientious, emotionally stable, socially adept, self-disciplined, practical rather than imaginative, and relaxed rather than anxious. It appears worthwhile to consider including an appropriate personality questionnaire in the selection process to improve the accuracy of predictions of students' success. A sound personality make-up will not only increase the likelihood of academic success but should also be beneficial in the successful management of a veterinary practice and in enjoying veterinary science as a career.

Preoperative esophageal manometry does not predict postoperative dysphagia following anti-reflux surgery.

This prospective study was undertaken to determine the value of manometric studies in predicting postoperative dysphagia in patients undergoing laparoscopic Toupet fundoplication. Two hundred and twenty-nine out of 401 patients (57%) had preoperative dysphagia, and 26 patients had late postoperative dysphagia (6.5%). Eight patients who had no preoperative dysphagia developed dysphagia following surgery. There were no significant differences in esophageal motility for patients without postoperative dysphagia (n = 375) compared with those with postoperative dysphagia (n = 26). Among patients with postoperative dysphagia as a new symptom (n = 8), six had normal preoperative distal esophageal pressures, and none had esophageal hypomotility. In those with both pre- and postoperative dysphagia 15 of 18 had normal esophageal motility and hypomotility was only found in one. The positive predictive values of distal esophageal hypomotility and other measures for postoperative dysphagia are poor. In conclusion, preoperative manometry does not predict postoperative dysphagia following laparoscopic Toupet partial fundoplication.

Endovascular treatment of intractable epistaxis--results of a 4-year local audit.

OBJECTIVE: Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series. DESIGN: Retrospective review. SETTING: Unitas Interventional Unit, Centurion. METHODS: Case record review (57 procedures) and telephonic interviews (36 traceable respondents). OUTCOME MEASURES: A numerical audit of the success and complication rates for embolisation procedures performed during the 4-year period between July 1999 and June 2003. RESULTS: A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients during this period. Eight patients (15.7%) developed a re-bleed between 1 and 33 days after embolisation, of whom 5 were reembolised, giving a primary short-term success rate of 86.3% and secondary assisted success rate of 94.1%. Thirty-five of 36 respondents (97.2%) reported no further epistaxis during the long-term follow-up period of 1-47 months. The mortality rate was 0%, the major morbidity rate was 2% (1 stroke) and the minor morbidity rate was 25%. CONCLUSION: Our success and complication rates are acceptable and compare favourably with those reported in other large series.

Development of a health education booklet to enhance adherence to tuberculosis treatment.

Effective anti-tuberculosis chemotherapy was developed during the 1950's, yet four decades later the cure rates for tuberculosis (TB) worldwide remain unacceptably low. A major reason for the failure to eliminate TB is that many patients with active disease fail to take sufficient anti-tuberculosis medication to render a cure. This paper describes a project designed to involve clinic nurses in the process of exploring how TB patients experience their disease. Information obtained from the qualitative research process was used to develop a photonovel which can be used to supplement the education given to newly diagnosed TB patients.

How do health service managers respond to qualitative research?

During 1992 a qualitative evaluation of a government health service-run community health worker (CHW) project in South Africa found that project workers were doing good work despite serious structural shortcomings related to lack of community participation and inadequate integration of the project in the health district system. Recommendations were made to develop the project in order to enhance community involvement, to build closer integration between the project and the services offered at the health centre, and to collaborate with non-government CHW projects in neighbouring areas. The evaluation study was followed up one year later by interviews with health managers to determine their response to the evaluation. The managers reported that they had found the qualitative data valuable for understanding how clients perceived the health service, and for planning a more community-responsive service. Despite this, the recommendations from the evaluation were not implemented and political developments in the district resulted in the CHW project being closed down. It is concluded that qualitative evaluators need to carefully explore the political context of primary health care interventions in order that their research provides useful data for decision-making.

A shotgun marriage--community health workers and government health services. Qualitative evaluation of a community health worker project in Khayelitsha.

In 1988 the Western Cape Regional Services Council (RSC) initiated a community health worker (CHW) project in Khayelitsha in order to extend its preventive services to people in the community and promote 'community upliftment'. An evaluation of this project was undertaken in 1991 and 1992 in order to examine the potential of this local health authority-run CHW project to be an appropriate primary health care model. Qualitative research methods were used to explore the nature of the work done by the CHWs, whether they were accepted in their communities, and whether the project functioned as part of an integrated health service infrastructure in Khayelitsha. The CHWs were found to provide the basis for a potentially effective, community-responsive service. However, several structural problems mitigated against this service. Relations between the CHWs and nurses in all the formal public health services in the area were superficial and fraught with problems. There were significant differences and conflicting policies between the RSC's CHW project and other neighbouring non-government CHW projects, and these posed various threats to both the RSC and the non-government projects. One of the most serious of these differences was that the RSC project had no structures or plans for community involvement in the running of the project. Before a CHW project is initiated, several critical issues need to be carefully considered and discussed with all the relevant stakeholders. Furthermore, CHWs need to be flexible, and accountable to the communities in which they work. Before employing CHWs, formal public health authorities need to consider carefully whether they are able to meet these criteria.

Evaluation of a peri-urban community health worker project in the western Cape.

The South African Christian Leadership Assembly (SACLA) Health Project is a non-governmental organisation that runs a community health worker (CHW) programme in 4 peri-urban townships of Cape Town. A cross-sectional descriptive community survey was conducted in April 1990 to evaluate coverage and health education on oral rehydration solution (ORS) and to plan future preventive, promotive and development programmes. Research concepts and methods were made accessible to the CHWs through a training process designed to facilitate participation in every stage of the research. A multi-stage cluster sampling scheme was used, and the CHWs interviewed 822 residents. Coverage indicators showed that over 80% of all respondents had previously known about or consulted the CHW. The most common community problems related to water, filth and refuse, toilets, housing, unemployment and lack of community facilities. The most common health problems were generalised aches and pains, chest problems, skin problems, worms, and diarrhoea. An index developed to measure knowledge of ORS showed very few respondents had 'complete knowledge'. The community's expectations of the CHW included health education, attending to sanitation problems, providing a clean environment, organising community facilities, and helping with employment.

Village health workers become evaluators.

PIP: In October 1990, the authors conducted a training course in self- evaluation skills for the village health workers (VHWs) and clinic staff of the Ithuseng Village Health Worker Project based in Lenyenye, a village in South Africa's Northern Transvaal. The authors hoped that by enabling the health workers to evaluate their work, the staff would be better able to define the needs and goals of the overall project. During a 2-week period, the authors held 8 workshops dealing with: task analysis, goal clarification, prioritizing of tasks and goals, indicators of success, the design of evaluation questions and tools, data collection, the analysis of results, and the implications for future planning and evaluation. Having completed the workshops, the VHWs and the clinical staff conducted a community survey and a record view. Accustomed to providing information, the health workers found themselves in the position of having to ask for information, and part of the training course involved how to handle such a situation. Once the information had been collected, the health workers took part in collating the results. Throughout the training experience, the authors had to devise innovative teaching methods to overcome obstacles, such as the fact that some to the health workers could not read. They emphasize that the training course demonstrates that baseline health workers can learn evaluation skills that can help them in their every day work.^ieng