South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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The South African (SA) medical internship training programme model was recently revised to extend training into the primary care platform. In this article, we reflect on the experiences of training under the new model from an intern perspective. We use these reflections to make recommendations to the Health Professions Council of SA on how to further improve the training model by implementing systems that guide and empower the intern doctor practising at a primary level of care.
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Tygerberg Hospital (TBH) is a tertiary-level hospital in Western Cape Province, South Africa, that provides healthcare to a large low- to middle-income population with services including centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region despite a high burden of communicable diseases, including HIV. ⋯ Use of a guideline-based approach to treating ACS in a low- to middle-income country setting yields mortality rates comparable to those in high-income countries. However, the lower-than-expected incidence rates of both STEMI and HR-NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and a relatively high proportion of STEMI, suggest potential under-recording of ischaemic heart disease in the region. The rate and outcomes of coronary artery disease (CAD) in people living with HIV were similar to those in people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.
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Medico-legal claims in the South African health sector have markedly increased since approximately 2007. This is noteworthy as money spent on these claims from the public health budget, is money which should have been spent on the healthcare priorities identified in the National Department of Health Strategic Plan. ⋯ This piece therefore discusses the causes of increased claims which include clinical errors, maladministration and mismanagement; the legal profession's contribution to the problem; legal developments and patient awareness as well as some other additional causes. Possible solutions are also offered such as those related to the NDOH and National Core Standards and Ideal Clinic initiative quality of care standards; improving the healthcare system and quality of care; better distinguishing between valid and invalid or fraudulent claims, the possible role of fit-for-purpose legislation and a reconsideration of compensation methods.