South African Family Practice最新文献

Under the leadership of the late Professor Sam Fehrsen, the Medunsa MPraxMed, which commenced in 1979, was an innovative programme offering doctors in South Africa the unique opportunity to be trained in family medicine within the context of their workplaces. This article describes its pedagogical approach that profoundly influenced a generation of family physicians. Eight shifts in learning arose out of the programme's development and iterative renewal. These included a focus on context and real-world application, greater autonomy for students with learning being focused on their needs, modelling the doctor-patient relationship in the educator-student relationship, facilitation of learning more than teaching, offering resources rather than courses, lecturers and students being co-learners and supporting reflective action. Most of the shifts in the Medunsa MPraxMed are now recognised as good educational practice underpinned by evidence, and are still necessary today.Contribution: Current postgraduate family medicine training programmes in South Africa and beyond are offered the opportunity to reflect on what they might learn from the past approaches of the Medunsa programme.

Background:  Despite being a preventable and curable disease, tuberculosis (TB) remains one of the deadliest infectious diseases, responsible for over a million deaths worldwide. Global efforts to eradicate TB were disturbed by the emergence of the coronavirus disease 2019 (COVID-19). Zimbabwe was not exempt from the scourge of this pandemic. Like other healthcare services that were disrupted, TB care services were affected. The objectives of this study were to explore the lived experiences of TB patients as they accessed and continued TB treatment during the COVID-19 period in Zimbabwe.

Methods:  An interpretative phenomenological analysis (IPA) was conducted. Fifteen TB patients accessing care at the four most populated primary healthcare facilities in Zimbabwe were purposively sampled and participated in the study. The sample size of 15 participants was determined by data saturation. Interpretative phenomenological analysis steps were followed in the data analysis process.

Results:  Three themes emerged: psychological effects (anxiety, fear, unintended disclosure, stigma, discrimination); support systems (healthcare facility, family, community); and TB service delivery gaps (delayed diagnosis, poor follow-up and support, inadequate health education).

Conclusion:  The study established that the COVID-19 pandemic affected TB service delivery and support, and follow-up with TB clients was not done. Insights from this study are crucial for strengthening the country's preparedness and response to future epidemics.Contribution: To facilitate continuity of TB care services, it is critical for decision-makers to develop context-specific intervention strategies and preparedness plans for use during pandemics and other public health emergencies.

Background:  Recent litigation in the United States - specifically the Texas Attorney General's lawsuit against the makers of Tylenol - has reignited global concern over the safety of paracetamol use during pregnancy and its alleged link to neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder (ADHD). Although South African clinical guidelines continue to endorse paracetamol as safe and essential during pregnancy, the legal implications of such international controversies warrant closer scrutiny.

Methods:  A narrative legal-ethical review was conducted, drawing on comparative legal frameworks, South African clinical guidelines and recent consensus statements. The article analyses the Texas Tylenol lawsuit, evaluates the evidentiary standards in South African versus US law and considers the ethical obligations of disclosure and risk communication. Sources include peer-reviewed literature, professional guidelines (e.g. Health Professions Council of South Africa [HPCSA] and South African Society of Obstetricians and Gynaecologists [SASOG]) and public health statements. No meta-analysis was performed.

Results:  The review found that while South African law requires a causal link for liability, international litigation can influence patient perceptions and clinical behaviour. South African guidelines continue to support paracetamol use in pregnancy, and adherence to these guidelines provides legal and ethical protection. However, practitioners may face increased patient anxiety, pressure to alter prescribing habits and the risk of defensive medicine. Ethical tensions arise between the duty to inform and the risk of fuelling misinformation.

Conclusion:  South African family practitioners must remain vigilant in their communication, documentation and reliance on evidence-based consensus.Contribution: By grounding clinical decisions in local guidelines and ethical reasoning, practitioners can navigate the challenges posed by global controversies while maintaining patient trust and legal defensibility.

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the FCFP (SA) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination. Model answers are available online.

No abstract available.

Tuberculosis (TB), particularly drug-resistant TB (DR-TB), remains a major public health concern in South Africa (SA), with children, adolescents, and pregnant and postpartum women (CAPPW) facing heightened risks because of biological and social vulnerabilities. This article highlights the importance of a multipronged prevention framework that combines infection control measures, psychosocial support, education, and nutritional supplementation, alongside pharmacological interventions such as Bacillus Calmette-Guérin (BCG) vaccination and tailored TB preventive therapy (TPT). Drawing on national guidelines and recent academic literature, the article provides an overview of current evidence and recommendations for TPT regimens (including 6H, 3HP, 3RH, 4R, 12H, and 6LFX) and their eligibility, safety considerations, drug interactions, and formulations suitable for CAPPW. By strengthening awareness and streamlining guideline-based prevention efforts, the article equips healthcare workers to make informed, patient-centred decisions to improve treatment outcomes and ultimately reduce TB transmission in high-burden settings.

Background:  Prehospital emergency medical services (EMS) may reduce morbidity and mortality. Trauma systems may improve survival. The objectives of this study were to determine response times of primary and secondary calls in the Limpopo province and to compare primary and secondary calls with international and South African standards. The goal is to make recommendations on improving policies governing the transportation of emergency patients, specifically addressing the transfer of major and polytrauma patients to tertiary facilities.

Methods:  A retrospective observational cross-sectional study of EMS transports to and from three EMS stations in the Limpopo province between 01 January 2020 and 31 December 2020. Data collection included demographics, medical category of patients, response, patient treatment and mission times.

Results:  The study included 1040 patients, with a similar distribution of male to female, most (62%) aged between 16 and 54 years. Medical cases constituted 30.5%, followed by maternity (25.6%), then trauma (20.7%). Primary calls constituted 79.9%, while secondary calls encompassed 20.1%. The mean response time of all patients was 28 min. The mean response time for trauma patients was 40 min, while for non-trauma patients, it was 24 min. In linear regression analysis, the type of call was found to be statistically significant in predicting response time with a p-value of 0.022.

Conclusion:  The mean response time overall and for trauma is far longer than international standards and longer than for non-trauma patients. Efforts should aim to reduce response time for trauma patients.Contribution: The research highlights the difference in response between trauma and non-trauma cases in a rural setting.

Background:  Hypertensive disorders of pregnancy (HDP), contribute greatly to maternal and perinatal morbidity and mortality, particularly in low-and middle-income countries (LMICs), undermining progress towards reducing maternal mortality. While magnesium sulphate is established for seizure prophylaxis, magnesium's physiological and epidemiological significance in HDPs is underexplored. This scoping review mapped current evidence on maternal magnesium homeostasis and HDP association.

Methods:  Electronic databases were searched for studies reporting maternal magnesium levels, magnesium physiology in pregnancy or, magnesium supplementation in HDP. Eleven studies met the eligibility inclusion criteria. Data was charted for study design, magnesium biomarkers, outcomes and contextual factors.

Results:  Observational evidence demonstrated lower magnesium levels among women with HDP against normotensive controls and linked low magnesium with adverse foetal outcomes. Mechanistic studies supported this, highlighting magnesium's role in endothelial function, vascular tone regulation and oxidative stress. Randomised trials evaluating magnesium supplementation showed inconsistent findings and were influenced by variations in formulation, dosage, timing and, underlying nutritional status. Contextual factors, such as HIV, obesity, renal function, and socioeconomic disadvantage, impacted magnesium homeostasis and HDP risk, particularly in LMICs.

Conclusion:  Magnesium insufficiency may contribute to HDP and adverse perinatal outcomes in LMICs, though causal pathways remain unconfirmed. Improved biomarker standardisation, mechanistic studies, and targeted supplementation trials in high-risk or deficient populations are needed.Contribution: This review highlights key inconsistencies in magnesium measurement, identifies contextual modifiers relevant to LMICs, and outlines priority areas for future research.

As breast cancer incidence increases and survival improves, an increasing number of breast cancer survivors (BCS) require long-term follow-up and support. Primary care providers play a central role in maintaining continuity of care, promoting endocrine therapy adherence, managing complications such as lymphoedema and supporting psychosocial well-being. This article aims to provide a structured approach to breast cancer survivorship care, aligned with national cancer care policies and guidelines and international best practices, focused on primary care integration. A case vignette aims to bridge theory and practice, contextualise decision-making and encourage patient-centred care as it relates to breast cancer survivorship in the South African context.

No abstract available.