Videos are increasingly being used for teaching clinical skills in medical education. However, most reports on the effectiveness and benefits of videos in medical teaching have come from developed ...countries. Resource constraints in South African academic hospitals, together with increasing numbers, may apply pressure on the standard of clinical teaching. This study investigated the potential for using video demonstrations to replace the bedside teaching of introductory paediatric clinical examination skills to large groups of medical students. Sixty medical students were randomised to an experimental group that watched a video of a paediatric abdominal examination or to a control group that received a bedside tutorial on the same topic. Immediately afterwards, experienced assessors observed and scored the students in a clinical examination. Data were analysed for the non-inferiority of the video group scores within a 10% margin of the bedside group. Students’ and clinician educators’ perceptions of the two teaching methods and their views on how video instruction could be integrated into the clinical teaching programme were explored. Qualitative data were analysed thematically. The video teaching was non-inferior to the bedside teaching within the 10% margin and did not significantly affect the pass/fail or distinction rates. Students and clinician educators suggested that the videos be used for teaching basic concepts, allowing bedside tutorials to focus on applied learning. The findings have important implications for using video demonstrations to supplement the teaching of clinical skills to large groups of medical students across multiple variably-resourced settings.
Introduction
Globally, childhood poisoning, accounts for a significant proportion of emergency department admissions. There is a paucity of data from low- and middle-income countries on poisoning in ...children.
Objective
To describe the incidence, case fatality rate, and types of poisoning in children admitted to a tertiary-level hospital in Johannesburg, South Africa.
Methods
This was a retrospective descriptive study of children hospitalised with poisoning from January 2016 to December 2021 at Chris Hani Baragwanath Academic Hospital. Children were identified from a discharge summary database using ICD-10 codes that describe poisoning. Trends in incidence of poison exposure were reported.
Results
Of the 60,901 admissions during the study period, 2,652 (4.4%) children were diagnosed with poisoning. Most (71.3%) children were less than 5 years of age and 55% were male. The incidence of poisoning per 100,000 was highest at 108.4 (95% CI: 104.3–112.6) in 2019 and decreased to 77.3 (95% CI: 73.9–80.7) in 2020 and 59.6 (95% CI: 56.3–62.5) in 2021. Main causes of poisoning were organic solvents (37.6%), medications (32.9%), and pesticides (17.5%). The overall case fatality rate was 2.1%. In a multivariate analysis, poisoning secondary to pesticides (aOR: 13.9; 95% CI: 4.52–60.8;
p
< 0.001), and unspecified agents (aOR: 12.7; 95% CI: 3.27–62.8;
p
< 0.001) were associated with an increased odds of death.
Conclusion
We report a high prevalence of poisoning in children hospitalised in this tertiary-level hospital in South Africa. Public health measures to reduce the burden of organic solvents, medications and pesticide poisoning are urgently warranted.
Neonatal AKI (NAKI) remains a challenge in low- and middle-income countries (LMICs). In this perspective, we address issues of diagnosis and risk factors particular to less well-resourced regions. ...The conservative management pre-kidney replacement therapy (pre-KRT) is prioritized and challenges of KRT are described with improvised dialysis techniques also included. Special emphasis is placed on ethical and palliation principles.
We hypothesized that the prevalence of vertebral fractures would be low and that bone mineral density (BMD) would be less severely affected in a black South African (SA) population treated with ...glucocorticoids (GCs) than that reported in mainly white populations.
All children aged 5–17.9 years with chronic non-malignant illnesses who were on GCs (intravenous or oral) for greater than 3 months duration were evaluated. DXA scans were performed using a Hologic Discovery machine (Software version Apex 4.0.2) and the Hologic paediatric reference database. Whole body less head (WBLH) and lumbar spine (LS) bone mineral content (BMC) and density (BMD) Z-scores unadjusted and adjusted for height were calculated using the Zemel equation calculator.
Seventy-two patients (49% with renal, 24% with rheumatic, 14% with neurological, 11% with hepatic and 3% with respiratory conditions; mean age 11.6 ± 3.3 years, 57% boys, 92% SA black) were enrolled. The mean duration of GC treatment was 34.1 (±25.1) months. Mean WBLH and LS height adjusted BMD Z-scores were −1.2 ± 1.5 and −0.9 ± 1.0 respectively. Eleven percent of patients had a LS height adjusted BMD Z-score ≤ −2. The prevalence of vertebral fractures on lateral vertebral fracture assessment (VFA) was 15% (11 of 72 patients).
The prevalence of vertebral fractures (15%) in predominantly black children on GCs with chronic non-malignant illnesses is similar to that reported from North America suggesting that routine yearly DXA scans including VFA are warranted in this highly at-risk population.
•Prevalence of vertebral fractures in black South African children on GCs is 15%.•Majority of patients had 25(OH)D levels >30 nmol/L.•A quarter of the patients with vitamin D deficiency had a LS BMD Z score ≤ −2.•None of the vitamin D deficient patients had vertebral fractures.•Routine yearly DXA scans are thus warranted on all children treated with GCs.
A research report submitted to the Faculty of Health Sciences, University of ;
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of ;
Master of Medicine in ...Paediatrics, Johannesburg 2017
Introduction: ;
Multicystic dysplastic kidney (MCDK) disease is a common non-inherited developmental ;
anomaly, increasingly diagnosed antenatally. It is a single functional kidney associated with ;
increased risk of anomaly of the opposite kidney. ;
Methods: ;
A retrospective descriptive study of paediatric patients with MCDK disease was undertaken at a ;
secondary-tertiary level hospital from January 1986 to December 2015. ;
Results: ;
Over a 30 year period, 59 patients were identified; 36 (59%) were male and 31 (52.5%) were left ;
sided. Overall, 20 (33.9%) of cases were diagnosed antenatally, with an increased frequency of ;
cases diagnosed in the last decade (p=0.015). Eight (13.6%) had associated contralateral ;
abnormalities; none had reflux into contralateral kidney. ;
Conclusion: ;
The number of MCDK diagnosed was low but increasing, due to increased antenatal sonars in the ;
last decade. None of the patients had reflux into the contralateral kidney. The patients (only study ;
from Africa) showed similar demographics to the rest of the studies on MCDK.
XL2017
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