Background: Statistical analyses are a key component of quantitative research in health sciences. Objectives: To review the instructions for authors on reporting and presentation of statistical ...methods by all health sciences journals based in South Africa. Methods: Health sciences journals based in South Africa that publish original quanti-tative research articles were identified using three sources, namely the list of accred-ited South African journals compiled by the South African Department of Higher Education and Training in 2022, relevant journals covered in Scopus, and web pages of major health sciences publishers in South Africa. The list was cross-checked against the listing of journals in Sabinet, an online database covering South Africa, under the category 'Collection: Medicine and Health'. The instructions for authors given by the journals were accessed through their websites. The form for recording data was based on items listed in the 'Statistical Analyses and Methods in the Published Literature' (SAMPL) guidelines. Results: All except one of the 52 journals could be located online. Of the 51, 13 (25%) made no mention of statistics in their instructions, and 11 (22%) made only a gen-eral statement regarding statistical content with no further guidance. The statistical item most frequently mentioned was the P value (45% of journals), whereas the rest of the items appeared in the instructions of 20% or fewer journals. Nine journals (18%) referred to the EQUATOR guidelines, mainly CONSORT (10%). Conclusion: Nearly half of the health sciences journals based in South Africa either did not mention statistics at all in their instructions for authors or made only a cur-sory reference to statistics. The study thus emphasizes that these journals, in their instructions for authors, need to cover in greater detail the reporting and presenta-tion of statistical methods in articles reporting quantitative research.
Peer review frequently improves a manuscript, but authors may consider some reviewer feedback negative, inappropriate or unclear. This study aims to summarise and analyse review comments received by ...authors.
This longitudinal study included all submissions of which the researcher was an author, reviewed by any journal during 2020-2022. First-round reviews were retrieved from emails and documents received by the authors or the faculty's medical editors or the journal platforms. A confidential datasheet with review items compiled from literature and the researcher's experience as author and reviewer was completed for each submission. Review comments were noted verbatim for subjective items such as rude or vague statements.
The 65 submissions received 118 reviews from 36 journals, mainly in the form of unstructured narrative reports (59%). The majority of first-round reviews (58%), including those for rejected submissions, contained some positive comments. Reviewers frequently (75% of reviews, 88% of submissions) required some expansion of information. Vague and incorrect statements occurred in 15% and 18% of reviews, respectively. Only two reviews contained statements that could be considered rude. The types of comments made were associated with the review format.
The majority of reviews contained some positive comments and rude comments were extremely rare. Reviewers frequently requested the expansion of information provided.Contribution: This study gives insight to authors, reviewers and editors regarding the type and tone of review comments. This could guide authors during manuscript preparation and authors, reviewers and editors during the review process.
Despite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, ...studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care.
Firstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding.
Out of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill.
The study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.
Cardiopulmonary resuscitation (CPR) improves immediate survival and survival to discharge in patients with cardiac arrest in hospital. Without frequent retraining in CPR, healthcare providers may ...lose their skills and knowledge earlier than the recommendation of CPR retraining every two years.
To determine the competencies of doctors at an academic hospital regarding CPR training, knowledge, experience and perceptions.
A custom-designed questionnaire reviewed by CPR providers was distributed to doctors to obtain information on CPR training, exposure to and perceptions of CPR retraining, and CPR knowledge. The knowledge component of the questionnaire comprised questions on basic, advanced cardiac, paediatric, neonatal and obstetric life support.
Of the 245 participants, 22.5% achieved competency (a mark of ≥ 80%) for the knowledge component of the questionnaire. The majority of participants had not undertaken retraining after two years, although 96.7% of participants felt that keeping up-to-date with CPR guidelines would improve patient outcomes. The most common reasons provided for not feeling confident in performing CPR were related to training.
Doctors at the academic hospital in this study are currently not adequately trained in CPR, which is reflected by their lack of CPR knowledge. Lack of training seems to be the most common reason for not feeling confident, and being too busy to attend these retraining courses was reported as the most common reason. It further seems that very few of the departments have CPR training for their doctors. A regular in-hospital CPR training program may improve doctor's CPR knowledge.
The importance of adequate choline intake during pregnancy has been well documented, but low intake is common. Total choline intake, main food sources of choline, as well as associations between ...choline intake and egg and dairy consumption were determined in a sample of pregnant women attending the high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa.
A cross-sectional study design was used. Trained fieldworkers collected dietary intake data using a validated quantified food frequency questionnaire (QFFQ), after which all food items were matched to foods in the USDA Database for the Choline Content of Common Foods (Release 2) to quantify choline intake. Logistic regression with backward selection (p < 0.05) was used to determine whether egg and dairy consumption were independently associated with a choline intake below the adequate intake (AI) level.
The median daily intake of choline was 275 mg (interquartile range 185 mg - 387 mg) (N = 681). Most participants (84.7%) consumed less than the AI of 450 mg/day for choline. Meat and meat products, cereals, eggs and dairy contributed mostly to choline intake. Food items that contributed most to choline intake included full-cream milk, maize porridge, brown bread, deep-fried potatoes and deep-fried dough (vetkoek). A choline intake below the AI was significantly associated with lower egg and dairy intakes (p < 0.0001 and p = 0.0002 respectively).
Most pregnant women in the current study had choline intakes below the AI. It is recommended that public health messaging targeted at pregnant women promote the consumption of foods that can significantly contribute to choline intake, such as eggs and dairy.
Sending radiographic images as instant messages have become a common means of communication between physicians, aiding in triaging and transfer decision-making in emergencies. While use of technology ...is increasing, this is not the case for the underserved or rural areas of South Africa with no picture archiving and communications system or advanced hardware in place. In these areas, the medical staffing population have nearly universal access to smartphones and could benefit from the ability to share images quickly and easily with trained radiologists. South African data on diagnostic reliability of smartphone captured radiology images is lacking. The objective of the study was to determine the accuracy and reliability of diagnoses made on radiologic images captured with smartphone compared to radiologic images on picture archiving and communication system(PACS).
A cross-sectional study was conducted with radiographs from June 2018 to July 2019 selected from the PACS system at Pelonomi Tertiary Hospital. Images were displayed on PACS computer screen and captured by principal researcher using a smartphone. Five radiology registrars received the images via WhatsApp® and reviewed them on smartphones. After three weeks, registrars viewed images in random order on PACS stations. McNemar's test was used to compare the diagnostic accuracy of smartphone vs PACS and Kappa values calculated for agreement. Reliability was assessed by analysing the results of different registrars and diagnoses separately.
135 X-rays, representative of common emergency conditions, were selected. For all registrars, PACS accuracy was generally higher than smartphone accuracy. The Kappa values all indicated fair to moderate agreement between smartphone and PACS diagnosis.
Capturing radiographic images using at least 12-megapixel smartphone and sharing them via WhatsApp® is a reliable method that can be used with a high degree of confidence in emergencies to aid clinical decision making. This method of viewing medical imaging is however not a substitution for images viewed on PACS.
Background: Neonatal jaundice affects one in two infants globally. The jaundice is the result of an accumulation of bilirubin as foetal haemoglobin is metabolised by the immature liver. High serum ...levels of bilirubin result in lethargy, poor feeding and kernicterus of the infant. Aim: The main aim of this article was to determine the prevalence of neonatal jaundice and secondly to explore its risk factors in healthy term neonates. Setting: Maternity ward, National District Hospital, Bloemfontein, South Africa. Methods: In this cross-sectional study, mothers and infants were conveniently sampled after delivery and before discharge. The mothers were interviewed and their case records were reviewed for risk factors for neonatal jaundice and the clinical appearance and bilirubin levels of the infants were measured with a non-invasive transcutaneous bilirubin meter. Results: A total of 96 mother-infant pairs were included in the study. The prevalence of neonatal jaundice was 55.2%; however, only 10% of black babies who were diagnosed with jaundice appeared clinically jaundiced. Normal vaginal delivery was the only risk factor associated with neonatal jaundice. Black race and maternal smoking were not protective against neonatal jaundice as in some other studies. Conclusion: More than half (55.2%) of healthy term neonates developed neonatal jaundice. As it is difficult to clinically diagnose neonatal jaundice in darker pigmented babies, it is recommended that the bilirubin level of all babies should be checked with a non-invasive bilirubin meter before discharge from hospital or maternity unit as well as during the first clinic visit on day 3 after birth.
The health and well-being of pregnant women can influence pregnancy outcomes and are closely associated with social support and experiences of stress. Poor nutrition predisposes to poor health with ...choline intake affecting pregnancy outcome. This study determined reported health, social support, and stress and how these factors are associated with choline intake in pregnancy.
A cross sectional study was performed. Pregnant women in their second and third trimesters attending a high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa, were included. Trained fieldworkers obtained information during structured interviews using standardised questionnaires. Logistic regression with backward selection (p < 0.05) was used to select significant independent factors associated with choline intake. Variables with a p-value < 0.15 in bivariate analysis were considered for inclusion in the model.
Median age and gestation in the sample (N = 682) were 31.8 years and 32.0 weeks, respectively. Most participants (84.7%) consumed less than the adequate intake (AI) of 450 mg of choline per day. Most participants (69.0%) were either overweight or obese. One in eight participants (12.6%) reported not having anyone that could help them in times of need, more than one third (36.0%) reported having unpayable debt and one in twelve (8.4%) reported experiencing physical abuse by their partners. Normotensive participants and those using anti-retroviral therapy (ART) (thus HIV-infected), were more likely to consume choline in amounts below the AI (p = 0.042 and p = 0.011, respectively). Logistic regression analysis showed that the odds of consuming choline in amounts below the AI were lower for participants that were not using ART versus those using ART, with an odds ratio of 0.53.
HIV-infected participants were more likely to consume choline in levels below the AI. This vulnerable group should be the focus of targeted efforts to improve choline intake.
Medical studies place students at risk for burnout. Resilience enables students to cope with adversity. Students' coping skills will ensure the well-being of future healthcare professisonals.
This ...study investigated resilience and coping among undergraduate medical students.
Undergraduate students at the University of the Free State medical school.
A cross-sectional study was performed. Quantitative data regarding resilience (Connor-Davidson Resilience Scale), coping strategies (Brief COPE questionnaire) and relevant information were collected by means of an anonymous self-administered questionnaire.
Five hundred students (pre-clinical
= 270; clinical
= 230; approximately 62% female) participated. Most students self-reported high resilience (84.6% pre-clinical; 91.8% clinical). Mean resilience scores were 72.5 (pre-clinical) and 75.4 (clinical). Clinical students had higher resilience scores, while black, pre-clinical, first-generation and female students scored lower.Academic stress was most prominent (> 85%) and associated with lower resilience scores. Most students used adaptive coping strategies (e.g. instrumental or emotional support) associated with significantly increased resilience scores. Students who used dysfunctional strategies (e.g. substance abuse) had significantly lower resilience scores.
Associations between resilience scores and year of study, gender, ethnicity, levels and type of stress varied. Academic pressure was a major source of stress. Adaptive coping strategies were associated with higher resilience scores.
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