South African Family Practice最新文献

Background:  The study qualitatively reviewed the Medical Practitioner Compassion Competency Questionnaire (MPCCQ). The revision aimed to extend the questionnaire and address the factor fission found within three subscales of the MPCCQ, namely, mindfulness, emotion recognition, and compassion action orientation.

Methods:  A literature review was conducted to inform the development of additional items for the questionnaire. Thereafter, 14 subject matter experts (SMEs) were asked to assess the items in the mindfulness, emotion recognition, and compassion action orientation subscales. Experts provided feedback in an open-ended format, allowing them to freely express any concerns or comments about each item. In addition, they rated each item's clarity and validity on a scale from 1 (not clear or valid) to 3 (clear and valid). Lawshe's content validity ratios were calculated to assess the level of consensus among the SMEs and to quantify the need for revision.

Results:  Eight items showed statistically significant disapproval from SMEs and were rewritten based on the qualitative feedback from the SMEs. In total, 30 items were amended according to SME suggestions along with previous qualitative data collected by Visser.

Conclusion:  The revised questionnaire aims to more accurately and comprehensively capture compassion competency in medical practitioners on the sub-dimensions identified by the original author, ultimately supporting the ongoing development of compassion competency measurement in medical practitioners.Contribution: In addition, this study contributes to the body of knowledge on qualitative methods for constructing behavioural observation scales.

Background:  Staff shortages in rural areas have led to unequal healthcare access in South Africa. The compulsory community service programme aims to address this disparity; but to be effective, it must encourage doctors to remain in rural facilities beyond their service periods. Identifying factors that influence their decisions to stay is crucial for developing strategies to improve rural doctor retention. The aim is to describe the important factors influencing Western Cape community service doctors' choice of whether they will seek employment in public rural practice.

Methods:  An observational cross-sectional study with correlational analysis was conducted using an internet-based questionnaire. This study was conducted on community service doctors who were employed in the Western Cape in 2022.

Results:  Eighty-six doctors participated, with 8% intending to work in rural practice in 2023 and 21% considering it in the future. Significant factors associated with rural practice intentions included rural upbringing (6.5 times more likely), rural internship placement (7.7 times more likely) and rural community service (3.5 times more likely). Key influences were personal safety, job satisfaction and mental health.

Conclusion:  The proportion of doctors considering rural practice remains low. Policy revisions should focus on preferentially enrolling medical students with rural backgrounds and placing community service doctors in rural areas, alongside efforts to create safe, satisfying work environments that support mental health.Contribution: This study enhances the understanding of retaining healthcare professionals in underserved rural areas, addressing primary healthcare challenges in the African context.

Myelodysplastic syndromes (MDS) are a group of blood disorders affecting the bone marrow resulting in cytopenia, blood cell dysplasia and an increased risk of progressing to acute myeloid leukaemia (AML). Myelodysplastic syndromes are more common in individuals older than 60 years, and those who have undergone radiation or chemotherapy in the past. Patients may be asymptomatic in the initial stages and can later develop fatigue, dyspnoea, frequent infections, petechiae, bruising and bleeding. Patients with persistent cytopenia (6 months) should be investigated further and referred to a haematologist if at high risk for MDS. The definitive diagnostic test for MDS is a bone marrow biopsy. Individuals with lower-risk MDS can be managed with blood transfusions, erythropoiesis stimulating agents, growth factors and lenalidomide (an immunomodulatory drug). Higher risk MDS patients have a median survival of less than three years, with stem cell transplant as the only cure. However, less than 10% of MDS patients receive this treatment because of the scarcity of donors. Primary care providers should also be aware of long-term side effects following a stem cell transplant. This article aims to increase awareness of MDS and stem cell transplants.

Vitamin C (ascorbic acid or ascorbate) plays an important role in regulating the health of the skin, promoting the differentiation of epithelial skin cells (keratinocytes) while contributing a notable role in the reduction of melanin synthesis, leading to antioxidative protection against solar-related skin damage. Vitamin C is only sourced from diet because humans have no ability to synthesise it in vivo. Routine dietary intake choices become key in maintaining the skin's integrity, preventing and treating some of the skin conditions encountered regularly by general practitioners and skin specialists alike. There is a strong association between vitamin C and the ageing process, skin pigmentation, control of certain skin diseases and a role in some skin cancers through antioxidation properties. Literature suggests that topical application of vitamin C in different forms of formulations has been demonstrated to have more clinical effect than oral intake.Contribution: This article spotlights the benefits of a vitamin commonly encountered in topical pharmaceutics, ingested as tablets or as part of our routine diet.

Background:  Integrating physical activity (PA) into rehabilitation practice is critical for promoting patient recovery and high quality of life. However, policy gaps, infrastructure constraints and resource limitations often hinder its effective implementation, particularly in public health care settings.

Methods:  An inductive thematic analysis of virtual individual semi-structured interviews with therapists was conducted via NVivo. Participants (N = 10) shared insights on their perspectives of integrating PA into rehabilitation practices regarding policy, infrastructure and development.

Results:  Ten subthemes emerged related to policy (two subthemes), infrastructure (four subthemes) and development (four subthemes) of PA in rehabilitation practice.

Conclusion:  While PA is essential for holistic patient care, therapists face systemic barriers that require policy reforms, interprofessional collaboration and investment in resources and infrastructure. Creative strategies currently mitigate these challenges but remain limited in scope of practice.Contribution: This article documents the need for policy development and resource allocation to better integrate PA into rehabilitation, whilst addressing key developmental and infrastructure gaps.

Unplanned and unwanted pregnancies in South Africa cost women, government and families enormous physical, emotional and socioeconomic stress. These are further aggravated by the high rate of sexual assault cases in South Africa. In a setting such as this, easy access to emergency contraception (EC) becomes a key intervention and health system imperative. Primary health care clinicians are at the forefront of health care provision in South Africa and need to be well equipped with the necessary knowledge on EC to make informed management decisions. This article seeks to provide information and improve awareness and confidence of primary care clinicians when providing EC.

Heart failure poses a significant global health challenge, with a considerable burden in Africa, where the annual mortality rate stands at 34%, twice the global average. Patients suffering from acute heart failure occupy numerous beds at the district level, and only a limited number can be referred for further evaluation and imaging at secondary or tertiary care facilities. Patients rely on their primary care physicians for the diagnosis and management of heart failure, as well as for identifying those who would benefit from referral to cardiology and formal echocardiography. This article discusses the significance of the new heart failure guidelines within the South African primary care public setting. It emphasises the importance of identifying risk factors and considers the value of access to family physicians, outreach clinic doctors, training on available adult primary care guidelines and telemedicine-supported cardiac ultrasound. Optimal medical therapy, which includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and spironolactone, has been shown to reduce readmissions and mortality rates. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a potent addition to conventional therapy and are currently being considered for inclusion in the National Essential Medicines List. Patients admitted to the hospital should not be discharged while experiencing persistent congestion, as this is associated with an increased risk of rehospitalisation, mortality and higher healthcare costs. Comprehensive patient education regarding medications, thorough follow-up during the six weeks post-discharge and linkage to primary healthcare are associated with decreased hospitalisation rates and improved outcomes.

Mindfulness has its historical roots in the teachings of the Buddha. The core of these teachings addresses the causes and relief of human suffering. It is a way of being with experience, through awareness of the present moment, in service of compassion and wisdom. Its universal applicability lies in the fact that it is an innate human capacity, which can be developed through practice. Mindfulness has moved into broader contemporary society through the emergence of mindfulness-based interventions (MBIs) over the last 50 years and an associated robust research base. Mindfulness-based pedagogy has been largely restricted to first-world countries although a 2-year training at Stellenbosch University has been an exception to this. Research based on the experience of graduates of this programme has resulted in a new, emergent curriculum that is more context- and trauma-sensitive, to better meet the challenges of the local setting, and to make learning how to share mindfulness with others more accessible, relevant and Afro-centric.

This study addresses the importance of post-exposure prophylaxis (PEP) in the context of sexual assault. Post-exposure prophylaxis serves as a critical intervention to reduce the risk of human immunodeficiency virus (HIV) transmission and unintended pregnancies for victim-survivors. Immediate access to PEP, emergency contraception and comprehensive medical assessments is essential for effective care. The study outlines the steps healthcare providers must take, including timely administration of prophylaxis, monitoring for side effects and offering psychosocial support to victim-survivors. It emphasises the need for follow-up visits to ensure ongoing care and the importance of implementing risk-reduction strategies until final infection outcomes are confirmed. Additionally, the role of standardised documentation, such as the J88 form, is highlighted for collecting evidence in cases of sexual violence, ensuring that healthcare practitioners understand their responsibilities in promoting justice. The study underscores the social obligation of healthcare professionals to combat gender-based violence, advocating for reporting mechanisms for child victims and appropriate referral pathways for positive test results. By prioritising the health and wellbeing of victim-survivors, the healthcare community can significantly contribute to their recovery and empowerment, ultimately fostering a supportive environment that addresses both medical and emotional needs following sexual assault.

Workplace-based assessment is increasingly crucial in the postgraduate training of specialists in South Africa, including for family physicians. A portfolio of learning allows a structured, flexible way to present evidence of learning. Portfolios are increasingly digitally based as e-portfolios. Portfolios are used for encouraging self-reflective learning, for transforming learning, and for gathering evidence of skills necessary for future employment. Portfolios support assessment for learning and assessment of learning. This necessitates registrar reflections, supervisor feedback and interaction, and linkages to entrustable professional activities (EPAs). The e-portfolio facilitates triangulation, aggregation and saturation of data points for the various EPAs to support clinical competency committees to make high-stakes evaluations of registrar portfolios. While the initial design and development costs are significant, operational costs become affordable when shared across all training programmes. The portfolio of learning has been a key priority in family medicine for almost 15 years. Initially, a paper-based portfolio was adopted to collect evidence of learning for the national exit-level outcomes. It was converted into an e-portfolio and implemented nationally through the coordination of the South African Academy of Family Physicians. In 2023, the e-portfolio was redesigned to gather evidence of learning for 22 EPAs, and a further revision took place in 2024. A portfolio of learning offers a valuable alternative to traditional assessment methods, allowing for a comprehensive understanding of registrars' growth over time.