South African Family Practice最新文献

英文中文

The exceptional potential in extending primary care exposure for South African medical interns 为南非医学实习生提供基层医疗服务的巨大潜力

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-04-23 DOI: 10.4102/safp.v66i1.5911

K. V. von Pressentin, A. Nair, Shane D. Murphy, Ramprakash Kaswa, Indiran Govender

No abstract available.

无摘要。

引用次数: 0

Palliative care in the emergency department: An observational study of doctors in KwaZulu-Natal 急诊科的姑息关怀：对夸祖鲁-纳塔尔省医生的观察研究

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-04-19 DOI: 10.4102/safp.v66i1.5860

Nagaleswari Sriranganathan, David Morris, Laura Campbell, Richard Hift

Background: The World Health Organization advocates the early, appropriate provision of palliative care (PC) to patients throughout the life course. Patient consultations to the emergency department (ED) have been recognised as opportunities to initiate or optimise their PC needs. This study aimed to assess the knowledge of and attitudes towards PC among doctors at emergency physician staffed EDs in KwaZulu-Natal, South Africa.Methods: A cross-sectional survey was conducted between November 2021 and February 2022 for doctors employed out at emergency physician staffed EDs in KwaZulu-Natal, South Africa, using the validated Palliative Care Attitude and Knowledge questionnaire. The variables assessed were the self-rated and basic knowledge and attitudes towards core domains of PC. Ordinal data were compared using the t-test or ANOVA as appropriate, using MedCalc® Statistical Software version 22.009.Results: Of the 39 participants, the scores for the knowledge questions showed that 15.3% participants had good knowledge, 53.8% had fair knowledge and 30.7% had poor knowledge. Participants had either favourable (58.8%) or an uncertain (41.0%) attitude towards PC. No correlation was seen between the knowledge and attitudes scores (Spearman’s rho = 0.13, 95% CI –0.19 to 0.43, p = 0.43).Conclusion: There appears to be a deficit in knowledge of PC among doctors in the ED and a need for in-service training in PC for emergency care physicians.Contribution: This study provides new knowledge around PC practices at EDs in KwaZulu-Natal, South Africa.

背景：世界卫生组织提倡在患者的整个生命过程中尽早为其提供适当的姑息关怀（PC）。在急诊科（ED）就诊的病人被认为是启动或优化其姑息关怀需求的机会。本研究旨在评估南非夸祖鲁-纳塔尔省有急诊科医生的急诊科医生对姑息关怀的认识和态度：在 2021 年 11 月至 2022 年 2 月期间，使用经过验证的姑息关怀态度和知识问卷对南非夸祖鲁-纳塔尔省由急诊科医生负责的急诊室外聘医生进行了横断面调查。评估的变量是对姑息关怀核心领域的自评、基本知识和态度。使用 MedCalc® 统计软件 22.009 版，酌情使用 t 检验或方差分析对序数数据进行比较：在 39 名参与者中，知识问题的得分显示，15.3% 的参与者知识良好，53.8% 的参与者知识一般，30.7% 的参与者知识较差。参试者对个人电脑的态度是好的（58.8%）或不确定的（41.0%）。知识得分与态度得分之间没有相关性（Spearman's rho = 0.13，95% CI -0.19-0.43，p = 0.43）：结论：看来急诊科医生对个人防护知识缺乏了解，急诊科医生需要接受个人防护方面的在职培训：本研究提供了有关南非夸祖鲁-纳塔尔省急诊室 PC 实践的新知识。

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引用次数: 0

Community-oriented primary care footprinting: An undergraduate programme experience 以社区为导向的初级保健足迹：本科生课程经验

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-04-18 DOI: 10.4102/safp.v66i1.5854

Anastasia E. Ugwuanyi

The Nelson Mandela Fidel Castro (NMFC) programme, a government initiative to address healthcare inequities in South Africa, focuses on the training of indigenous students to become competent healthcare practitioners. A collaboration combining training in a Cuban primary care, preventative system with integration in a South African institution within a quadruple disease burdened healthcare system. This article reflects on integration experience at the University of Witwatersrand, a programme pedagogically positioned within a workplace-based, situated learning framework. Since 2022, community-oriented primary care (COPC) projects became part of the integrated primary care and family medicine learning objectives. This article summarises the experience of the 2021–2022 cohort and calls for the strengthening of undergraduate medical education curricula with learning objectives reflective of social accountability.Contribution: This article spotlights work in the undergraduate space around teaching and experiential learning of community-oriented primary care in line with the journal’s scope.

纳尔逊-曼德拉-菲德尔-卡斯特罗（Nelson Mandela Fidel Castro，NMFC）计划是南非政府为解决医疗保健不平等问题而采取的一项举措，其重点是培训本土学生成为合格的医疗保健从业人员。该计划将古巴初级保健和预防系统的培训与南非医疗机构的整合结合起来，共同应对四重疾病负担的医疗保健系统。这篇文章反映了威特沃特斯兰德大学的整合经验，该课程的教学定位是基于工作场所的情景学习框架。自 2022 年起，以社区为导向的初级保健（COPC）项目成为初级保健和家庭医学综合学习目标的一部分。本文总结了 2021-2022 届学生的经验，并呼吁加强本科医学教育课程中反映社会责任的学习目标：这篇文章重点介绍了本科领域围绕社区导向的全科医疗教学和体验式学习所开展的工作，与期刊的范围相符。

引用次数: 0

Causes of stillbirths at Kgapane hospital, Limpopo province 林波波省 Kgapane 医院死产的原因

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-04-17 DOI: 10.4102/safp.v66i1.5863

G. Marincowitz, C. Marincowitz

Background: Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable.Objectives: this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths.Methods: File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths.Results: A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour ( 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing.Conclusion: Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy.Contribution: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths.

背景：死胎是一项全球公共卫生挑战，主要影响中低收入国家。目标：本研究回顾了 Kgapane 医院 4 年间的围产期临床审计数据，特别关注与死胎相关的因素：从2018年至2021年，对Kgapane医院及其集水区发生的所有死胎进行了档案审计。对这些审计数据进行分析，以确定与死胎相关的因素：研究期间，Kgapane 医院及其周边诊所共发生 392 例死胎，死胎率为 19.06/1000。在记录的 392 例死胎中，对 354 例产妇病例记录进行了审核。已查明的五种最常见的死胎原因是：妊娠期高血压疾病（29.7%）、无妊娠期高血压疾病的宫内发育受限（11.6%）、分娩窒息（7.1%）、早产（1000 克）（6.5%）和产妇感染（5.9%），包括艾滋病毒与未抑制的 VL、宫内感染、冠状病毒病（COVID）和梅毒。可作为改进策略基础的可改变因素应包括培训、及时转诊以及改善资源和人员配置：结论：了解死产的原因可以为改进策略提供指导，从而减少这种令人心碎的妊娠并发症：贡献：在农村医院工作的家庭医生也负责围产期护理。贡献：在农村医院工作的家庭医生也负责围产期护理，了解死产的相关因素将指导他们制定改进策略，以减少这些可预防的死亡。

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引用次数: 0

Registrars’ experience with research in family medicine training programmes in South Africa 注册医师在南非家庭医学培训课程中的研究经验

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-04-10 DOI: 10.4102/safp.v66i1.5907

Emcy Louw, R. Mash

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes.Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software.Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar–supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging.Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time.Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country.

背景：完成研究任务是南非专科培训的一项要求。难以完成研究任务会延误毕业和家庭医生的供应。本研究旨在探讨注册医师在家庭医学研究生培训课程中的研究经历：方法：探索性描述定性研究。极端个案目的性抽样从所有九个培训项目中选出了按时和未按时完成研究的注册医师。在进行了 12 次半结构式访谈后，研究达到饱和。在 ATLAS.ti 软件的辅助下，采用框架法进行数据分析：结果：教师和督导人员对先前学习的假设导致了一种不知所措和压力感。教学模块应更加标准化，并侧重于实际任务和技能，而不是说教式理论。冗长的省级和伦理程序，以及缺乏学术服务和财政支持等机构支持，都造成了延误。导师的专业知识非常重要，注册人员与导师之间的关系应该是建设性的、合作性的和积极响应的。个人的研究经历取决于选择一个可行的项目和是否有专门的时间。平衡个人、专业和学术责任具有挑战性：培训计划应修订研究教学并改进机构流程。导师需要更加积极响应，并具备足够的专业知识。需要省级支持，以简化审批程序并提供专门的研究时间：本研究强调了改进教学和完成研究的方法，以增加全国家庭医生的供应量。

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引用次数: 0

Interventions for Type 2 Diabetes reduction among older people living with HIV in Harare. 为减少哈拉雷地区感染艾滋病毒的老年人患上 2 型糖尿病而采取的干预措施。

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-03-26 DOI: 10.4102/safp.v66i1.5827

Nongiwe L Mhlanga, Thinavhuyo R Netangaheni

Background: Interventions for Type 2 Diabetes reduction among older people aged more than 50 years living with HIV (PLWH) are pertinent as they face excess risks amid a growing population of ageing PLWH.

Aim: To describe interventions for Type 2 Diabetes reduction among older people living with HIV in Harare Urban DistrictSetting: The study was conducted in a low socio-economic setting from five primary health care clinics in Harare urban District.

Methods: A qualitative multi-method approach was applied using an exploratory descriptive design and an integrative review literature. The exploratory descriptive study collected data from two purposively selected samples; (1) older PLWH and (2) nurses. Whittemore and Knafl's framework was used for the integrative literature review with articles from 2013 to 2023 selected. Data source triangulation was applied using Braun and Clark's content analysis framework. Ethical approval was obtained (14056739_CREC_CHS_2022).

Results: 23 older PLWH with mean age, 62 years, 9 nurses with an average of 6 years' experience and 12 articles comprised the three data sources. Key themes that emerged were that, screening should include; assessment from a younger age; assessment of HIV and ART-specific risks; diagnostic testing of Type 2 diabetes tests at ART initiation and routinely. Health education should provide information on adequate physical activity parameters and increased consumption of fruits and vegetables. Metformin may be considered as a pharmacological intervention where lifestyle interventions fail.

Conclusion: The proposed interventions suggest measures to reduce Type 2 Diabetes and mitigate excess risks faced by older PLWH.Contribution: Improved screening, health education and pharmacological interventions for older PLWH in primary health care settings enable Type 2 Diabetes reduction.

背景：在感染艾滋病毒的 50 岁以上老年人（PLWH）中采取减少 2 型糖尿病的干预措施具有现实意义，因为在感染艾滋病毒的老年人口不断增加的情况下，他们面临着更大的风险：研究在哈拉雷城区五个初级卫生保健诊所的低社会经济环境中进行：方法：采用探索性描述设计和综合文献综述的多种定性方法。探索性描述研究从两个特意挑选的样本中收集数据：(1) 老年 PLWH，(2) 护士。综合文献综述采用了 Whittemore 和 Knafl 的框架，选取了 2013 年至 2023 年的文章。采用布劳恩和克拉克的内容分析框架对数据源进行三角测量。结果：23 名平均年龄为 62 岁的老年 PLWH、9 名平均工作经验为 6 年的护士和 12 篇文章构成了三个数据源。得出的关键主题包括：筛查应包括：从年轻时就开始进行评估；评估 HIV 和抗逆转录病毒疗法的特定风险；在开始接受抗逆转录病毒疗法时进行 2 型糖尿病诊断检测，并定期进行。健康教育应提供有关适当体育锻炼参数和增加水果和蔬菜消费量的信息。在生活方式干预无效的情况下，可考虑将二甲双胍作为药物干预措施：建议的干预措施提出了减少 2 型糖尿病和降低老年 PLWH 面临的过高风险的措施：贡献：在初级卫生保健环境中改进对老年 PLWH 的筛查、健康教育和药物干预，可减少 2 型糖尿病。

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引用次数: 0

Medical interns’ training in family medicine at a district hospital and primary health care clinics in Middelburg, Mpumalanga 在姆普马兰加省米德尔堡的一家地区医院和初级保健诊所对实习医生进行家庭医学培训

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-03-26 DOI: 10.4102/safp.v66i1.5844

Lushiku Nkombua, Amir Rahimi

引用次数: 0

The views of family physicians on National Health Insurance in Gauteng Province, South Africa. 南非豪登省家庭医生对国民健康保险的看法。

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-03-25 DOI: 10.4102/safp.v66i1.5831

Shane D Murphy, Klaus Von Pressentin, Shabir A Moosa

Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI.

Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling.

Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level.

Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

背景：全民医保（UHC）在改善国民健康状况的同时，也解决了在获得优质医疗服务方面存在的社会不平等问题。在南非，地区卫生系统（DHS）是通过国家医疗保险（NHI）计划成功实现全民医保的关键。家庭医生（FPs）作为初级保健的倡导者，对地区卫生系统的运作和国家医疗保险（NHI）的实施至关重要：这是一项定性探索性研究，采用半结构化访谈的方式，探讨家庭医生对其所在地区的国家健康保险政策和实施情况的看法和参与情况。通过有目的的抽样，纳入了 10 名计生协员：大多数受访的计生协都没有参与政策制定或战略规划。国家医疗保险法案被视为一种缺乏明确计划的理论思想。家庭医生对政府机构中的腐败现象表达了一些担忧，这些腐败现象可能会在国家医疗保险的实施过程中显现出来。家庭医生认为他们在地区机构中得不到支持，也没有权力参与推广战略。由于家庭医生培训计划的设计以及他们在初级医疗层面的经验，他们能够为医疗系统面临的挑战提供有用的解决方案：结论：南非的医疗保健管理仍由国家和省级机构负责。要想成功实施 NHI，就必须将管理权下放到 DHS。需要让初级保健人员参与到国家医疗保险战略中来，将计划转化为初级保健层面的可行目标：本研究强调，在下放的人口与健康调查管理层面上，有必要让家庭保健人员作为主要行动者参与到国家健康保险战略的实施中来。

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引用次数: 0

Crafting a compelling curriculum vitae: Navigating the path to professional success. 撰写令人信服的简历：引领职业成功之路。

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-03-25 DOI: 10.4102/safp.v66i1.5920

Chantelle C Van der Bijl, Arun Nair, Klaus B Von Pressentin

No abstract available.

无摘要。

引用次数: 0

Using ChatGPT in family medicine and primary health care 在家庭医疗和初级保健中使用 ChatGPT

IF 1 Q3 Medicine

South African Family Practice

Pub Date : 2024-03-19 DOI: 10.4102/safp.v66i1.5895

Indiran Govender, John Tumbo, Sailesh Mahadeo

No abstarct available.

无弃权票。

引用次数: 0

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