The successful acquisition of clinical skills is essential to development and competence as a clinician. Clinical skills can be assessed in undergraduate education and in the workplace after graduation. Clarity about what is being assessed, and why, should support the development of any assessment process.
{"title":"An introduction to assessing clinical skills","authors":"Sophie Hill, R. Bregazzi","doi":"10.4314/ssmj.v16i2.6","DOIUrl":"https://doi.org/10.4314/ssmj.v16i2.6","url":null,"abstract":"The successful acquisition of clinical skills is essential to development and competence as a clinician. Clinical skills can be assessed in undergraduate education and in the workplace after graduation. Clarity about what is being assessed, and why, should support the development of any assessment process. ","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43050649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reflections from the first South Sudan malaria conference","authors":"Onyango Okech","doi":"10.4314/ssmj.v16i1.9","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.9","url":null,"abstract":"No Abstract.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Murete Sanare Lukumay, Jane Kokushubila Muzo, A. Kikula, Peter J T Wangwe, A. Pembe
Introduction: The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnancy and have not had a previous CS. Methods: We conducted a cross-sectional study at Muhimbili National Hospital from August to December 2018. The criteria for standard diagnosis of foetal distress, obstructed labour, arrested labour and cephalopelvic disproportion were adopted from peer groups publications based on local expert consensus. Data were analysed using a statistical package for social sciences (SPSS) version 20. Results: A total of 1,670 emergency CS’s were performed during the study period, 392 (23.5%) were women of Robson group 3, of these women 101 (25.8%) had foetal distress, 92 (23.5%) obstructed labour, 88 (22.4%) arrested labour and 64 (16.4%) cephalopelvic disproportion. The proportion of CS’s which met the criteria for standard diagnosis of indications for CS were 61.4% foetal distress, 52.2% obstructed labour, 58% arrested labour, and 45.3% CPD with total average of 55.1%. Conclusion: Generally, the standard criteria for audited indications of CS have been met by 55.1% during the study period. Thus, follow up, on the job training and updating about adherence to standard criteria for best practice are recommended.
{"title":"Indications for Caesarean Section for women of low obstetric risk - an audit","authors":"Murete Sanare Lukumay, Jane Kokushubila Muzo, A. Kikula, Peter J T Wangwe, A. Pembe","doi":"10.4314/ssmj.v16i1.3","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.3","url":null,"abstract":"Introduction: The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnancy and have not had a previous CS. \u0000Methods: We conducted a cross-sectional study at Muhimbili National Hospital from August to December 2018. The criteria for standard diagnosis of foetal distress, obstructed labour, arrested labour and cephalopelvic disproportion were adopted from peer groups publications based on local expert consensus. Data were analysed using a statistical package for social sciences (SPSS) version 20. \u0000Results: A total of 1,670 emergency CS’s were performed during the study period, 392 (23.5%) were women of Robson group 3, of these women 101 (25.8%) had foetal distress, 92 (23.5%) obstructed labour, 88 (22.4%) arrested labour and 64 (16.4%) cephalopelvic disproportion. The proportion of CS’s which met the criteria for standard diagnosis of indications for CS were 61.4% foetal distress, 52.2% obstructed labour, 58% arrested labour, and 45.3% CPD with total average of 55.1%. \u0000Conclusion: Generally, the standard criteria for audited indications of CS have been met by 55.1% during the study period. Thus, follow up, on the job training and updating about adherence to standard criteria for best practice are recommended.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45012468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of the study is to demonstrate the significance of damage control surgery in saving lives and possibly preventing permanent disability in a resource poor environment. This is because in resource limited settings, advanced treatment modalities such as external fixation and angiography with embolization are not available. Moreover, besides being expensive, these treatment methods for pelvic fractures require training and skills to perform. The retroperitoneal pelvic packing is easy to learn and, thus can be used in an emergency to save lives and prevent long-term problems in patients who have sustained life threatening pelvic injuries and severe haemorrhage. Therefore, specialist surgeons, especially those working in low- and middle income countries, should be encouraged to learn and consider retroperitoneal pelvic packing as a stabilization and definitive treatment in some cases of pelvic fractures.
{"title":"Retroperitoneal pelvic packing for an abdominopelvic gunshot injury","authors":"Koma Akim","doi":"10.4314/ssmj.v16i1.7","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.7","url":null,"abstract":"The objective of the study is to demonstrate the significance of damage control surgery in saving lives and possibly preventing permanent disability in a resource poor environment. This is because in resource limited settings, advanced treatment modalities such as external fixation and angiography with embolization are not available. Moreover, besides being expensive, these treatment methods for pelvic fractures require training and skills to perform. The retroperitoneal pelvic packing is easy to learn and, thus can be used in an emergency to save lives and prevent long-term problems in patients who have sustained life threatening pelvic injuries and severe haemorrhage. Therefore, specialist surgeons, especially those working in low- and middle income countries, should be encouraged to learn and consider retroperitoneal pelvic packing as a stabilization and definitive treatment in some cases of pelvic fractures.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45641785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samah O. Mohager, Abdelsalam M. Nai, R. Tonga, A. H. Abdallah, imad Mohamed Fadl Elmula
Cystic echinococcosis (hydatid disease) is a neglected tropical disease common in Asia, South America and Sub-Saharan Africa. It is a parasitic disease caused by larval stage of Echinococcus granulosus. The commonest organs affected by hydatidosis are the liver and the lung. Primary bone hydatidosis in humans is a rare disease accounting for 1–2% of echinococcosis cases. To our knowledge secondary hydatidosis of joints is uncommon and few cases of hydatid disease of the knee joint have been reported. We present a case of primary cystic echinococcosis of the knee joint occurring in a 43-year-old female presenting mainly as disabling right knee arthritis in the form of chronic (13 years) painful swelling, which ultimately led to her inability to walk. Imaging and histopathologic examination revealed cystic echinococcosis of the right knee joint. Subsequent pulmonary, liver and bone screening for primary lesions were negative. To our knowledge, this is the first ever report on primary knee hydatid disease. It is possible that pre-existing arthritis modulated the local environment of the knee, rendering it susceptible to hydatidosis. This should be taken into account in the differential diagnosis of arthritis particularly in endemic areas.
{"title":"Primary cystic echinococcosis presented as prolonged disabling knee osteoarthritis: a case report","authors":"Samah O. Mohager, Abdelsalam M. Nai, R. Tonga, A. H. Abdallah, imad Mohamed Fadl Elmula","doi":"10.4314/ssmj.v16i1.6","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.6","url":null,"abstract":"Cystic echinococcosis (hydatid disease) is a neglected tropical disease common in Asia, South America and Sub-Saharan Africa. It is a parasitic disease caused by larval stage of Echinococcus granulosus. The commonest organs affected by hydatidosis are the liver and the lung. Primary bone hydatidosis in humans is a rare disease accounting for 1–2% of echinococcosis cases. To our knowledge secondary hydatidosis of joints is uncommon and few cases of hydatid disease of the knee joint have been reported. We present a case of primary cystic echinococcosis of the knee joint occurring in a 43-year-old female presenting mainly as disabling right knee arthritis in the form of chronic (13 years) painful swelling, which ultimately led to her inability to walk. Imaging and histopathologic examination revealed cystic echinococcosis of the right knee joint. Subsequent pulmonary, liver and bone screening for primary lesions were negative. To our knowledge, this is the first ever report on primary knee hydatid disease. It is possible that pre-existing arthritis modulated the local environment of the knee, rendering it susceptible to hydatidosis. This should be taken into account in the differential diagnosis of arthritis particularly in endemic areas. ","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49310965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rolling back malaria in South Sudan: what have we missed?","authors":"Edward Eremugo Luka","doi":"10.4314/ssmj.v16i1.1","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.1","url":null,"abstract":"No Abstract","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45799928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph Lou K. Mogga, Stephen Loro, Stephen Gai, Moses Anyit, Robert Awu, Shaza Hadija, Jorum Aliti, Lawrence Biriwo, D. Ameh
Introduction: Many patients with diabetes mellitus are not attaining optimal glycaemic control, although the rate is unknown in South Sudan. Maintaining adequate glycaemic control is the most effective means of preventing complications associated with diabetes. This record review assesses the proportion of patients with diabetes on follow-up not adequately controlled using glycated haemoglobin (HbA1c) and describes associated factors. Method: This is retrospective cross-sectional review of electronic patient records from a private for-profit health facility in Juba, South Sudan. The study assesses follow-up HbA1c levels of type I (T1DM) and type II (T2DM) patients with diabetes 18 years and older. An HbA1c value of less than 7% was regarded as reflecting adequate control. Logistic regression was used to assess factors associated with inadequate control. From an unadjusted analysis, variables were retained for the adjusted analysis that were significant at the 95% confidence level. Crude and adjusted odds ratios (AOR) were reported. Results: Of the 291 patients assessed, 62.2% were male, mean age was 54 (SD =12.6) years, and the median body mass index (BMI) was 27.2 (IQR=24.5- 30). Those with hypertension were 28.5% and 35% had medical insurance. Overall, 60 patients (20.6%) achieved target HbA1c levels of <7%. One hundred patients had HbA1c levels between 7-10% and 131 had values of >10%. Independent predictors of non-achievement of target HbA1c were female gender, adjusted prevalence ratio, PR (95% CI) =1.18 (1.01-1.32); normal BMI, adjusted PR (95% CI) =1.41 (1.07-1.83) and having no medical insurance cover, adjusted PR (95%CI) =1.13 (1.10-1.29). Conclusion: About 80% of patients did not attain target HbA1c levels. Diagnosis of diabetes, care and treatment of patients with diabetes is not well organised in South Sudan leading to poor outcomes even in private clinics. Women and those without medical insurance cover are at greater disadvantage. We recommend better diagnosis and classification of patients with diabetes as well as reorganisation of care and treatment. We also recommend initiatives that will increase coverage of services to women and putting more people on medical insurance cover.
{"title":"Glycaemic control and associated factors in adult patients with diabetes mellitus, South Sudan, 2021","authors":"Joseph Lou K. Mogga, Stephen Loro, Stephen Gai, Moses Anyit, Robert Awu, Shaza Hadija, Jorum Aliti, Lawrence Biriwo, D. Ameh","doi":"10.4314/ssmj.v16i1.2","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.2","url":null,"abstract":"Introduction: Many patients with diabetes mellitus are not attaining optimal glycaemic control, although the rate is unknown in South Sudan. Maintaining adequate glycaemic control is the most effective means of preventing complications associated with diabetes. This record review assesses the proportion of patients with diabetes on follow-up not adequately controlled using glycated haemoglobin (HbA1c) and describes associated factors. \u0000Method: This is retrospective cross-sectional review of electronic patient records from a private for-profit health facility in Juba, South Sudan. The study assesses follow-up HbA1c levels of type I (T1DM) and type II (T2DM) patients with diabetes 18 years and older. An HbA1c value of less than 7% was regarded as reflecting adequate control. Logistic regression was used to assess factors associated with inadequate control. From an unadjusted analysis, variables were retained for the adjusted analysis that were significant at the 95% confidence level. Crude and adjusted odds ratios (AOR) were reported. \u0000Results: Of the 291 patients assessed, 62.2% were male, mean age was 54 (SD =12.6) years, and the median body mass index (BMI) was 27.2 (IQR=24.5- 30). Those with hypertension were 28.5% and 35% had medical insurance. Overall, 60 patients (20.6%) achieved target HbA1c levels of <7%. One hundred patients had HbA1c levels between 7-10% and 131 had values of >10%. Independent predictors of non-achievement of target HbA1c were female gender, adjusted prevalence ratio, PR (95% CI) =1.18 (1.01-1.32); normal BMI, adjusted PR (95% CI) =1.41 (1.07-1.83) and having no medical insurance cover, adjusted PR (95%CI) =1.13 (1.10-1.29). \u0000 Conclusion: About 80% of patients did not attain target HbA1c levels. Diagnosis of diabetes, care and treatment of patients with diabetes is not well organised in South Sudan leading to poor outcomes even in private clinics. Women and those without medical insurance cover are at greater disadvantage. We recommend better diagnosis and classification of patients with diabetes as well as reorganisation of care and treatment. We also recommend initiatives that will increase coverage of services to women and putting more people on medical insurance cover. ","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45918743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jjukira Vianney, I. Nakitende, Henry Kalema, Sylivia Namuleme, J. Kellett
Introduction: Anecdotal experience suggests that Ugandan patients complain infrequently of breathlessness. The Luganda language, spoken in Uganda, does not have one word to express breathlessness but uses various phrases. Therefore, many of these patients may not be able to express what they feel when they are breathless by a single English word. Our aim was to determine the frequency and severity of the symptoms captured by a Luganda translation of the Dyspnea-12 (D12) questionnaire, a well validated measure of different dimensions of breathlessness. Method: All alert non-pregnant adult patients fluent in Luganda who presented to the hospital’s combined outpatient and emergency department were asked to complete the D12 questionnaire. Results: Out of 466 patients, 137 (29.4%) had at least one D12 symptom. Patients’ D12 responses expressed as a numerical severity score was only weakly associated with a respiratory rate >20 bpm. Two questions (“My breathing requires more work” and “My breathing is uncomfortable”) identified >90% of patients likely to be breathless. Conclusion: For patients whose first language is Luganda a translation of the D12 questionnaire captures the symptom of dyspnoea.
{"title":"What words best capture the symptom of breathlessness in Uganda?","authors":"Jjukira Vianney, I. Nakitende, Henry Kalema, Sylivia Namuleme, J. Kellett","doi":"10.4314/ssmj.v16i1.4","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.4","url":null,"abstract":"Introduction: Anecdotal experience suggests that Ugandan patients complain infrequently of breathlessness. The Luganda language, spoken in Uganda, does not have one word to express breathlessness but uses various phrases. Therefore, many of these patients may not be able to express what they feel when they are breathless by a single English word. Our aim was to determine the frequency and severity of the symptoms captured by a Luganda translation of the Dyspnea-12 (D12) questionnaire, a well validated measure of different dimensions of breathlessness. \u0000Method: All alert non-pregnant adult patients fluent in Luganda who presented to the hospital’s combined outpatient and emergency department were asked to complete the D12 questionnaire. \u0000Results: Out of 466 patients, 137 (29.4%) had at least one D12 symptom. Patients’ D12 responses expressed as a numerical severity score was only weakly associated with a respiratory rate >20 bpm. Two questions (“My breathing requires more work” and “My breathing is uncomfortable”) identified >90% of patients likely to be breathless. \u0000Conclusion: For patients whose first language is Luganda a translation of the D12 questionnaire captures the symptom of dyspnoea. ","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49585354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A medical elective in Uganda","authors":"Madeleine Taylor","doi":"10.4314/ssmj.v16i1.8","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.8","url":null,"abstract":"No Abstract","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46361649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Participation in clinical practice is key to the development of clinical skills, and so the goal of clinical work is both to deliver healthcare and facilitate learning. Four factors shape learning in the workplace: safe access to practical experience; the role of talk in the workplace; teaching opportunities; and the learning climate. The challenge is to structure and carry out work so that support for learning is built into normal work routines.
{"title":"Teaching and learning in the clinical workplace","authors":"R. Bregazzi, S. Bussey","doi":"10.4314/ssmj.v16i1.5","DOIUrl":"https://doi.org/10.4314/ssmj.v16i1.5","url":null,"abstract":"Participation in clinical practice is key to the development of clinical skills, and so the goal of clinical work is both to deliver healthcare and facilitate learning. Four factors shape learning in the workplace: safe access to practical experience; the role of talk in the workplace; teaching opportunities; and the learning climate. The challenge is to structure and carry out work so that support for learning is built into normal work routines.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43599554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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