Background Preceptors are key stakeholders in distributed health professions' education. They supervise students in the clinical setting to enable them to have a practical experience with patients, ...and they assess students' skills at the highest tier of clinical assessment. The university where this study was done conducts a distributed Bachelor of Clinical Medical Practice course on a distributed platform which is dependent on preceptors at the training sites. Understanding the perceptions of preceptors, as major stakeholders, regarding the student assessment they do will assist the faculty to provide better support and development that might be needed and assist in maximising the benefits of distributed training. Aim The aim of this study was to explore the perceptions of preceptors regarding assessing clinical associate students at district hospitals in the Bachelor of Clinical Medical Practice programme. Setting The study was conducted at a rural university in the Eastern Cape province of South Africa. Methods This was a qualitative study involving nine preceptors who were purposively selected from three district hospital training sites based on their involvement in assessing clinical associate students. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed. Results Four themes emerged from thematic analysis: assessment issues, preceptor issues, student issues and university support issues. Preceptors are committed and enthusiastic in training and assessing the clinical associate students but require input from the university in terms of training and ongoing support. Conclusion Lack of training threatens the validity of preceptor assessment. Academic institutions should train and support preceptors to enable them better to fulfil their roles.
Background Clinical associates (ClinAs) were introduced into South Africa as part of the remedy for the severe shortage of healthcare workers in rural areas. Walter Sisulu University (WSU) graduated ...100 ClinAs between 2011 and 2014. These ClinAs were expected to be based at district hospitals where they would work under the supervision of doctors, reduce the workload of doctors and increase access to healthcare in the Eastern Cape.Aim This study aimed to examine the role played by ClinAs in healthcare delivery in Eastern Cape district hospitals, and to determine whether the training of ClinAs adequately prepared them for this role.Setting The study was conducted in the Eastern Cape province of South Africa amongst ClinAs who graduated from WSU between 2011 and 2014, and healthcare workers from Madzikane KaZulu Memorial Hospital.Methods This was an exploratory cross-sectional mixed methods study with a convergent design. Surveys and in-depth interviews were conducted amongst ClinAs, nurses, doctors and one pharmacist. Both qualitative and quantitative data were analysed and reported.Results Clinical associates are seen to improve the workload of doctors, and to increase access to healthcare. Thirty-four percent of ClinAs were no longer contributing to healthcare in the Eastern Cape.Conclusion Clinical associates are making a significant contribution to access to healthcare in the Eastern Cape. Their supervision regimen needs to be revisited and factors that contribute to the attrition of ClinAs in the Eastern Cape need to be addressed.
In this study of 4758 HIV-1–serodiscordant heterosexual couples in Kenya and Uganda, daily antiretroviral prophylaxis (with tenofovir or emtricitabine–tenofovir) in the HIV-1–negative partner ...significantly decreased the risk of HIV infection.
The use of antiretroviral medications for the prevention of HIV type 1 (HIV-1) transmission is a promising strategy for reducing the spread of HIV-1.
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Antiretroviral treatment for persons infected with HIV-1 provides important clinical benefits and substantially reduces infectiousness.
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Antiretroviral prophylaxis is a potential HIV-1–prevention strategy for those not yet infected with HIV-1, administered either as postexposure prophylaxis after high-risk occupational or nonoccupational exposure or as preexposure prophylaxis in those with ongoing HIV-1 exposure.
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The rationale for antiretroviral prophylaxis in persons with ongoing exposure is based on its efficacy in infants exposed to HIV-1 during birth and . . .
Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., ...constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion.
We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis.
There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.
To assess the role of sexual relationships on levels and patterns of adherence to medication for pre-exposure prophylaxis against HIV.
We enrolled 1147 HIV-negative individuals in long-term ...serodiscordant relationships at 3 sites in Uganda from the Partners Pre-exposure Prophylaxis Study, a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir. We used generalized estimation equations to assess the effects of sexual relationships on low adherence (<80%) and on gaps in adherence.
Fifty-three percent were male, 51% were 18-34 years and 24% were polygamous. Participants who reported sex in the past month with someone other than their primary partner and with <100% condom use were more than twice as likely to have low adherence adjusted odds ratio (aOR) = 2.48, 95% CI: 1.70 to 3.62 compared with those who had sex with only their primary partners and 100% condom use. Using the same reference group, those who abstained from sex in the previous month had 30% increased odds of low adherence (aOR = 1.30, 95% CI: 1.05 to 1.62) and participants in nonpolygamous marriages who reported sex with both their primary and other partners and <100% condom use were almost twice as likely to be low adherers (aOR = 1.76, 95% CI: 1.01 to 3.08). At least one 72-hour gap in adherence was seen in 598 participants (54.7%); 23.2% had at least one 1-week gap.
Risk of low overall adherence was higher in participants who reported sex outside primary partnerships and suboptimal condom use, as well as in those who abstained from sex. Adherence gaps were common, potentially creating risk for HIV acquisition.
IntroductionIntrapericardial fibrinolysis has been proposed as a means of preventing complications of pericardial effusion such as cardiac tamponade, persistent and recurrent pericardial effusion, ...and pericardial constriction. There is a need to understand the efficacy and safety of this procedure because it shows promise.Methods and analysisWe aim to assess the effects of intrapericardial fibrinolysis in the treatment of pericardial effusion. We will search PubMed, the Cochrane Library, African Journals online, Cumulative Index to Nursing and Allied Health Literature, Trip database, Clinical trials.gov and the WHO International Clinical Trials Registry Platform for studies that evaluate the efficacy and/or safety of complete pericardial fluid drainage by intrapericardial fibrinolysis irrespective of study design, geographical location, language, age of participants, aetiology of pericarditis or types of fibrinolytics. Two authors will do the search independently, screen the search outputs for potentially eligible studies and assess whether the studies meet the inclusion criteria. Discrepancies between the two authors will be resolved through discussion and arbitration by a third author. Data from the selected studies shall be extracted using a standardised data collection form which will be piloted before use. The methodological quality of studies will be assessed using the Cochrane Collaboration's tools for assessing risk of bias for experimental studies and non-randomised studies, respectively. The primary meta-analysis will use random effects models due to expected interstudy heterogeneity. Dichotomous data will be analysed using relative risk and continuous with data mean differences, both with 95% CIs.Ethics and disseminationApproval by an ethics committee is not required for this study as it is a protocol for a systematic review of published studies. The results will be disseminated through a conference presentation and peer-reviewed publication.Review registration numberPROSPERO, CRD42014015238.
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