Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420110011&lang=pt vol. 101 num. 11 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The illusive promise of circumcision to prevent female-to-male HIV infection</b>: <b>not the way to go for South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Inefficiency quantified by how many say 'they' instead of 'us'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Burnout of junior doctors and skills retention</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Akhenaten's mystery remains</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Death with integrity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Focus on the 'how' and start piloting NHI now - former UK health chief</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Vital foreign-qualified doctors face xenophobia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Caring for doctors is caring for the community - RuDASA</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Stabilise medical schemes, reduce NHI patient burden - Discovery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Medical ethics and the payment of fees before treatment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100010&lng=pt&nrm=iso&tlng=pt Whether it is ethically acceptable for doctors to require payment of fees before treatment depends on interpretation of the ethical rules of the profession, the circumstances of the doctor-patient relationship, the urgency of the patient's need for treatment, and whether refusal to treat before payment represents abandonment of a patient. <![CDATA[<b>The Consumer Protection Act</b>: <b>No-fault liability of health care providers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100011&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>Bryan Kies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100012&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>Deon Ronaldus Rautenbach (1950 - 2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100013&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>An Uneasy story : the nationalising of South African mission hospitals 1960 - 1976. a personal account</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100014&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>Supporting registration of child-focused clinical trials in Africa</b>: <b>The Child Strategy Project</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100015&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>Genetic profiling in breast cancer</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100016&lng=pt&nrm=iso&tlng=pt The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a consumer' in terms of the CPA, health care practitioners may find themselves as suppliers' or retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners. <![CDATA[<b>A reduction of necrotising enterocolitis at Groote Schuur Hospital nursery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100017&lng=pt&nrm=iso&tlng=pt Necrotising enterocolitis (NEC) is an gastro-intestinal emergency occurring almost solely in preterm, low birth weight infants. Mortality, morbidity and the complication rate are high. An increase in NEC at the Groote Schuur Hospital nursery in 2008 prompted a change of practice, resulting in a significant decrease in the condition. <![CDATA[<b>Purchasing of medical equipment in public hospitals</b>: <b>the mini-HTA tool</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100018&lng=pt&nrm=iso&tlng=pt The mini-health technology assessment (HTA) tool is valuable in assessing the quality of decisions regarding health technology management in South African public hospitals. The tool demonstrates the needs for improved decision-making and for developing an appropriate, customised instrument to support decision makers regarding medical device management. Health technology in South Africa has changed rapidly over the past two decades. Current challenges include the introduction of rapidly developing diagnostic technologies such as point-of-care testing (POCT) devices and national health insurance. The mini- HTA tool can play an important role in effective and efficient management of health technology in this setting. <![CDATA[<b>Tuberculosis in a South African prison</b>: <b>a transmission modelling analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100019&lng=pt&nrm=iso&tlng=pt BACKGROUND: Prisons are recognised internationally as institutions with very high tuberculosis (TB) burdens where transmission is predominantly determined by contact between infectious and susceptible prisoners. A recent South African court case described the conditions under which prisoners awaiting trial were kept. With the use of these data, a mathematical model was developed to explore the interactions between incarceration conditions and TB control measures. METHODS: Cell dimensions, cell occupancy, lock-up time, TB incidence and treatment delays were derived from court evidence and judicial reports. Using the Wells-Riley equation and probability analyses of contact between prisoners, we estimated the current TB transmission probability within prison cells, and estimated transmission probabilities of improved levels of case finding in combination with implementation of national and international minimum standards for incarceration. RESULTS: Levels of overcrowding (230%) in communal cells and poor TB case finding result in annual TB transmission risks of 90% per annum. Implementing current national or international cell occupancy recommendations would reduce TB transmission probabilities by 30% and 50%, respectively. Improved passive case finding, modest ventilation increase or decreased lock-up time would minimally impact on transmission if introduced individually. However, active case finding together with implementation of minimum national and international standards of incarceration could reduce transmission by 50% and 94%, respectively. CONCLUSIONS: Current conditions of detention for awaitingtrial prisoners are highly conducive for spread of drug-sensitive and drug-resistant TB. Combinations of simple well-established scientific control measures should be implemented urgently. <![CDATA[<b>Professionalism and the intimate examination - are chaperones the answer?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100020&lng=pt&nrm=iso&tlng=pt Complaints of sexual impropriety against health care practitioners are escalating. Professionalism in the practitioner-patient relationship and the role-based trust in health care do not allow crossing of sexual boundaries. Communication with patients is key to prevent erroneous allegations of sexual misconduct. The intimate examination is difficult to define. A chaperone present during an intimate examination protects the patient and practitioner and should be considered a risk reduction strategy in practice. <![CDATA[<b>A public health approach to the impact of climate change on health in southern Africa</b>: <b>identifying priority modifiable risks</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100021&lng=pt&nrm=iso&tlng=pt Anthropogenic climate change and anticipated adverse effects on human health as outlined by the Intergovernmental Panel on Climate Change (IPCC) are taken as givens. A conceptual model for thinking about the spectrum of climate-related health risks ranging from distal and infrastructural to proximal and behavioural and their relation to the burden of disease pattern typical of sub-Saharan Africa is provided. The model provides a tool for identifying modifiable risk factors with a view to future research, specifically into the performance of interventions to reduce the impact of climate change. <![CDATA[<b>Responding to climate change in southern Africa</b>: <b>the role of research</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100022&lng=pt&nrm=iso&tlng=pt Projections show that the effects of climate change in Africa will not be uniform over the region. The region is extremely vulnerable to climate change because of poverty, a high pre-existing disease burden, fragmented health services and water and food insecurity. Despite the consensus that locally relevant information is necessary to inform policy and practice related to climate change, very few studies assessing the association between climate change and health in southern Africa have been conducted. More comprehensive information is therefore urgently needed for the southern African region to estimate the health risks from projected future changes in climate. <![CDATA[<b>Is non-therapeutic aspirin use in children a problem in South Africa?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100023&lng=pt&nrm=iso&tlng=pt BACKGROUND: Aspirin should not be used in children except for specific therapeutic reasons. We report on a severely ill infant who had ingested aspirin contained in a traditional medicine and review 21 other patients with pre-admission non-therapeutic salicylate exposure. OBJECTIVES AND METHODS: We reviewed laboratory, clinical and poisons unit records to determine how many children were admitted to our hospital over an 18-month period with evidence of salicylate ingestion not prescribed for therapeutic reasons. We determined the source of the salicylate, elapsed time between ingestion and laboratory assay, morbidity and mortality and final diagnosis. RESULTS: Twenty-one children meeting our criteria, including 9 under 6 months of age, were admitted during this period. The most prevalent source of salicylate was over-the-counter (OTC) aspirin, but some had reportedly only been given traditional medicines. Nineteen were seriously ill, 4 died and 3 had severe brain injury. Two, initially diagnosed with Reye's syndrome, probably had inherited metabolic disorders. Only 2 patients had salicylate levels that at the time of measurement are normally considered toxic; however, the literature suggests that lower levels may exacerbate illness severity in young children. CONCLUSIONS: We found inappropriate use of OTC aspirin in children that requires explanation. There may be policy implications for the content and presentation of patient information; the incorporation of pharmaceuticals in traditional medicines merits further study. Salicylate toxicity should be considered in children with unexplained metabolic acidosis out of keeping with the severity of their acute illness. <![CDATA[<b>Baseline chest radiographic features of HIV-infected children eligible for antiretroviral therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100024&lng=pt&nrm=iso&tlng=pt BACKGROUND: South Africa's HIV mortality is primarily due to pulmonary disease. No evidence exists regarding a correlation between specific chest radiographic patterns and CD4 levels of immunity in HIV-infected children. OBJECTIVES: We aimed to determine the prevalence of specific radiographic features in HIV-infected children initiating antiretroviral therapy (ART) to develop a guideline of expected baseline radiographic appearances, and the radiographic features that predominate at specific levels of immune suppression (defined by CD4 percentage ranges), which would narrow the radiological differential diagnosis. METHOD: Retrospective review of the baseline chest radiographs of 92 consecutive paediatric outpatients initiating ART. RESULTS: Normal radiographs were reported in 54% of patients. Those with radiographic abnormalities had parenchymal disease (34%), mediastinal disease (22%) and pleural disease (1%). Parenchymal disease was predominantly air space (28%), and mediastinal disease was predominantly cardiomegaly (21%); lymphadenopathy was rare (1%). Radiological appearances of TB were seen in 9% of patients. A statistically significant association was shown between immune suppression and air space disease (p=0.049) with a relative risk of 0.46 (95% CI 0.24 - 0.88) for air space disease in immune-suppressed children. This association was independent of age. CONCLUSION: Baseline chest radiographs in paediatric outpatients presenting for initiation of ART are predominantly normal, but also demonstrate a significant number of pathological radiological features - primarily air space disease and cardiomegaly. The only statistically significant association between radiographic features and immune suppression was air space disease, which correlated with a higher level of immunity <![CDATA[<b>The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100025&lng=pt&nrm=iso&tlng=pt Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, a community and a societal level. <![CDATA[<b>Recommendations for the management of adult chronic myeloid leukaemia in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001100026&lng=pt&nrm=iso&tlng=pt INTRODUCTION: Chronic myeloid leukaemia (CML) is a chronic myeloproliferative disorder characterised by a chromosomal translocation between the long arms of chromosomes 9 and 22 resulting in the formation of the BCR-ABL fusion gene. The management of CML has undergone major changes over the past decade. Novel treatment approaches have had a dramatic impact on patient outcomes and survival. Nevertheless, these outcomes can only be achieved in the context of expert management, careful monitoring of disease response, appropriate management of adverse events and timeous adjustments to therapy when responses are not achieved within stated time frames. AIM: With the advent of novel treatments providing molecular responses, both the monitoring and management of CML have become more complicated. The aim of these recommendations was to provide a pragmatic yet comprehensive roadmap to negotiate these complexities. METHODS: Recommendations were developed based on local expert opinion from both the academic and private medical care arenas after careful review of the relevant literature and taking into account the most widely used international guidelines. About five meetings were held at which these recommendations were discussed and debated in detail. RESULTS: A comprehensive set of recommendations was compiled with an emphasis on diagnosis, investigation, treatment and monitoring of disease. Careful attention was given to circumstances unique to South Africa, funding constraints, availability and access to laboratory resources, as well as the effects of concurrent HIV infection. CONCLUSION: Most patients with CML can live a reasonably normal life if their disease is appropriately managed. These recommendations should be of value to all specialists involved in the treatment of haematological disorders.