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Most patients with shoulder pain will initially visit their community health centre, private general practitioner or family physician, with various levels of experience in the assessment and management of shoulder conditions. Shoulder conditions will range from early, simple ailments that can be treated in the primary care setting, to post-traumatic injuries and complex pathologies requiring the expertise of an orthopaedic surgeon or a fellowship-trained shoulder surgeon. Correct assessment of the patient's shoulder condition at the index consultation is a prerequisite for appropriate management. This article sets out straightforward guidelines to help general practitioners confidently identify the patient's source of shoulder pain and initiate an appropriate management plan at primary care level. Criteria for urgent and elective referral for specialist care are also outlined.South Africa envisages a community-orientated approach to primary health care (PHC). Family physicians and primary care doctors have important roles to play in leading, implementing, supporting and maintaining community-orientated primary care (COPC). In this article, we define COPC, its key principles and approaches to implementing it in health services. Following this we describe the key competencies expected of family physicians and primary care doctors in leading and supporting its implementation; providing clinical support to the PHC teams and linking these teams to other parts of the health system, other sectors and the community. The required knowledge and skills underlying these competencies are also discussed and some specific tools included.No abstract available.The series, 'Mastering your Fellowship', provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP, SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination. Model answers are available online.Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague symptomatology and difficult correlation to specific organ pathology obscures clinical findings leading to incorrect diagnoses. Although most presentations of abdominal pain are benign, a significant number of patients have life-threatening conditions that require a meticulous approach to management in order to prevent morbidity and mortality.The skill in assessing patients presenting with abdominal pain is fundamental for all primary care doctors. This review will discuss an approach to the assessment and diagnosis of abdominal pain in the primary care setting.
Ototoxicity is damage to cells in the inner ear after administering a toxic drug, with a resultant hearing loss. Drugs used to treat illnesses such as cancer, tuberculosis, human immuno-deficiency virus (HIV) and infections are potentially ototoxic. South Africa has one of the highest rates of HIV and tuberculosis, and thus a potentially greater degree of the population is being affected by hearing loss from the medications used to treat these illnesses.
To determine the current status of research in ototoxicity, a systematic literature review was carried out to determine the focus areas of South African studies for the period 1989-2019. From the database search engines used (Science Direct, Ebscohost and Proquest), a total of 33 relevant articles were identified, including the themes of pharmacology, audiology and knowledge.
Studies were conducted in the three most resourced provinces in South Africa. Findings indicate that there is a need for educating doctors regarding ototoxicity and a delineation of the role of the audiologist in monitoring and management of ototoxic hearing loss. There is a resultant need for audiology training on the pharmacology of ototoxic medication, otoprotective strategies and adherence to recommended guidelines. This has implications for university audiology training programmes and curriculum planning. The need for development of South Africa-specific audiology guidelines was highlighted.
Whilst it is noted that there is a lack of resources for effective implementation of ototoxicity-monitoring protocols, it is also noted that there are measures and otoprotective strategies that can be put in place without additional resources.
Whilst it is noted that there is a lack of resources for effective implementation of ototoxicity-monitoring protocols, it is also noted that there are measures and otoprotective strategies that can be put in place without additional resources.Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a resy.The coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world, with devastating effects of the virus as well as the repercussions of the resulting 'lockdowns'. South Africa went into a national lockdown in March 2020 to mitigate the impact of the virus. This included a ban on the sales of tobacco and electronic cigarette products. The ban has been a highly contentious issue in South Africa, discussed worldwide, which has drawn many criticisms. The prevalence rate of smoking in South Africa was around 21.5%, with the Western Cape province having a prevalence rate of 39%. We compared the number of chronic obstructive pulmonary disease (COPD) presentations at a large regional referral hospital in the Western Cape province from January to August 2019 with the same period in 2020. Electronic emergency centre data showed a reduction of 69.28% in COPD presentations. To control for some confounders for the same period, we also reviewed patients presenting with urinary tract infections, which showed only a 30.60% reduction. This notable reduction in COPD presentations reduced service pressure of emergency centre and most likely benefitted patients' health. Further research and policies are needed to ensure ongoing reduction in the prevalence of smoking.
Living with diabetes is challenging, especially for adolescents at risk of poor glycaemic control. Understanding the illness perceptions of this group is important to be able to develop interventions for this growing population in need.
This study explored the illness perception amongst adolescents living with type 1 diabetes (T1D) and how these perceptions interacted with the management of T1D.
This study was conducted at a medical centre providing care for adolescents living with T1D in Parktown, South Africa.
A qualitative, explorative design with semi-structured interviews was followed. A non-random purposive sampling method was utilised. The illness perception amongst eight adolescents, aged 12-18 years, at risk of poor glycaemic control, was analysed through thematic analysis.
Two subthemes related to illness perception were generated, namely (1) illness perception of T1D is negative and (2) living with T1D leads to a sense of being different. Furthermore, two subthemes were generated in relation to how illness perceptions interacted with diabetes management, namely (3) management of T1D is challenging and (4) management of T1D is motivated by fear.
This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.
This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.
Caring in nursing helps patients feel better, whilst the absence of caring will affect patients psychologically, emotionally and physically.
The aim of this article was to explore and describe primary health care (PHC) professional nurses' and PHC nurse managers' perceptions of the developed strategies to facilitate effective caring for patients in PHC clinics.
This study was conducted in two PHC clinics in Ekurhuleni, an area east of the Gauteng province, South Africa.
The study used a qualitative, exploratory, descriptive and contextual design. In-depth individual phenomenological interviews were conducted with eight purposively selected PHC professional nurses working in PHC clinics and two PHC nurse managers supervising PHC clinics in Ekurhuleni. Giorgi's coding method was used to analyse the data.
Three themes were identified from the results of the exploration and description of PHC professional nurses' and PHC nurse managers' perceptions of the developed strategies. Selleck EGFR inhibitor The use of active listening skills, showing interest in what is being said, asking questions and providing constructive feedback that focuses on the issue were the most effective strategies in improving effective communication between PHC nurse managers and PHC professional nurses. The PHC professional nurses were encouraged to put patients' interests first whilst adhering to the ethical principles of nursing.
Although caring is considered as the core of nursing practice, PHC professional nurses and PHC nurse managers perceive that rendering effective caring for patients needs to be reinforced through the use of strategies that will enable change and improve clinical practice in PHC clinics.
Although caring is considered as the core of nursing practice, PHC professional nurses and PHC nurse managers perceive that rendering effective caring for patients needs to be reinforced through the use of strategies that will enable change and improve clinical practice in PHC clinics.
Human immunodeficiency virus (HIV) is a chronic illness and adolescents living with HIV (ALHIV) need the support of the whole family to self-manage (handle, direct and control) their chronic illness. Little is known about self-management amongst ALHIV in the context of the Eastern Cape, South Africa.
This study explored the self-management needs of ALHIV in the Nelson Mandela Bay area of the Eastern Cape to make recommendations that can be used in further research to develop a programme to support adolescents with self-management.
The study was conducted at two primary healthcare clinics in the Nelson Mandela Bay area of the Eastern Cape.
A qualitative descriptive design was applied. Thirteen adolescents between the age of 14 and 19 years were interviewed. The data were collected through individual interviews. Data analysis was done using the six steps described by Creswell.
Adolescents living with HIV have limited knowledge and understanding about HIV and sexual reproductive health. Some ALHIV lack self-regulation skills related to decisions about disclosure, managing stigma and emotions, taking treatment, effective communication and setting goals.
