South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Tuberculosis (TB) is currently the leading cause of death from a single infectious agent worldwide. Patients who receive dialysis are particularly vulnerable to TB infection owing to immune dysfunction. Nonetheless, there is a paucity of incidence data on dialysis patients infected with TB in high-burden countries, such as South Africa (SA). ⋯ Dialysis patients in the Eastern Cape region of SA are at extremely high risk of acquiring TB, with an incidence rate 4.1 times that of the local population and >5 times that of the general SA population. Only informal housing and a history of hospitalisation were identified as positive risk factors for TB in this young population with a low HIV prevalence. Isoniazid prophylaxis in this high-risk group might be of benefit, but further studies are required to inform such treatment.
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Observational Study
Mind the message: Referral letter quality at a South African medical outpatient department.
Some patients need referral within the health system to achieve optimal care, and referral letters are an important part of this process. Healthcare practitioners often complain that referral letters lack information, are inaccurate, or direct patients to the wrong place. Poor communication affects patient experience and outcomes, has budgetary and service planning implications, and impacts on staff relationships and morale. ⋯ Most letters lacked important clinical information, probably because of a combination of factors: gaps in clinical knowledge of referring clinicians who service a population with a high burden of disease and complex pathology; under-resourced peripheral healthcare clinics; inadequate staff-to-patient ratios; and time constraints. A suggested focus for improvement is education at undergraduate and postgraduate level, which should emphasise preparation for community service, specifically highlighting techniques for preparing good-quality referrals.
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Glycated haemoglobin (HbA1c) has been used for decades as a measure of chronic glycaemia. A simple linear relationship between HbA1c values and mean blood glucose (MBG) has been identified and led to conversion of HbA1c values into estimated average glucose (eAG) levels, following the findings of the A1c-Derived Average Glucose (ADAG) Study Group. The intention was to help patients with diabetes mellitus (DM) understand their glycaemic control better, as eAG is reported in the same units as self-monitored glucose levels. However, factors other than glycaemia have been found to affect the relationship between HbA1c and MBG. ⋯ Our findings showed an imperfect relationship between MBG levels and HbA1c values. eAG significantly overestimated MBG, and this disagreement may cause confusion among both patients and clinicians. The risk of hypoglycaemic episodes may also increase if HbA1c and eAG alone are used to intensify therapy. We recommend that the use of eAG should be validated prior to implementation in clinical practice. It would be ideal to evaluate the relationship between average glucose and HbA1c in each individual patient in order to provide more personalised diabetes care.
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Previous work from KwaZulu-Natal (KZN) Province, South Africa, has suggested that public sector district hospitals are not providing adequate access to surgical care in the form of bellwether operations (caesarean section (CS), open reduction of fractures (ORF) and laparotomy). ⋯ Regional and tertiary hospitals are performing the bulk of non-obstetric bellwether operations in KZN. This imbalance has major implications for planning future delivery of surgical care in the province.
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There is little information on the financial return of investment when funding the tertiary education of healthcare professionals (HCPs) in South Africa (SA). ⋯ The analysis has shown that the cost of HCPs' education, where the annual pass rate is >90%, and >98% of graduates are employed, is an excellent investment. Consideration should be given to finding ways of improving the pass rate at institutions of higher learning and ensuring that graduates obtain meaningful employment if such returns on investment are to be seen on a national level.