SUNScholar - Browsing by Author "Bezuidenhout, Juanita"

Browsing by Author "Bezuidenhout, Juanita"

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Building a research agenda in health professions education at a Faculty of Medicine and Health Sciences : current research profile and future considerations
(Health & Medical Publishing Group, 2014-10) Bezuidenhout, Juanita; Van Schalkwyk, Susan; Van Heerden, Ben; De Villiers, Marietjie
Background. To generate evidence in and for health professions education (HPE) that can enable reform and establish new relevance, a comprehensive HPE research foundation is required. Gaps identified in the sub-Saharan Africa (SSA) HPE literature should be addressed, while a need for more clarificatory and collaborative research to strengthen evidence has been expressed. Relatively few HPE centres exist in SSA. At Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS) the Centre for HPE was established in 2006, followed by an HPE Research Unit in 2011. Objectives. To determine and analyse the current status of educational research in the FMHS, thereby contributing to conversations around an HPE research agenda for Africa. Methods. A database of all HPE-related research was compiled, followed by a desktop analysis of all documents pertaining to current educational research projects in the FMHS in 2012, categorising projects according to: general information; sites where research was conducted; research focus; and research purpose. All data were recorded in an Excel spreadsheet and a descriptive analysis was performed. Results. There were 106 projects, mostly aimed at undergraduate programmes. More than half focused on teaching and learning, while a few focused on assessment. A number of projects were community-based or involved national and/or international collaborations. Only 20% of projects were classified as clarification research. Discussion. Educational research appears healthy in the FMHS, but more clarificatory and macro-projects are required. The profile of research is similar to the SSA profile. A research strategy relevant and feasible in our context has to be established with a shift to areas beyond our professional/ institutional boundaries, posing HPE questions of relevance to South Africa and the African continent.
Cytokines and tuberculosis : an investigation of tuberculous lung tissue and a comparison with sarcoidosis
(University of Stellenbosch. Faculty of Health Sciences. Dept. of Biomedical Sciences., 2005-12) Bezuidenhout, Juanita; Walzl, Gerhard; University of Stellenbosch. Faculty of Health Sciences. Dept. of Pathology. Anatomical Pathology.
The formation of granulomas at the site of antigen presentation in both tuberculosis and sarcoidosis is an essential component of host immunity for controlling inflammation. Granuloma formation is a complex process that also requires recruitment and activation of lymphocytes and macrophages to the site of infection and arrangement into a granuloma. It is dependant on the activation of especially IFNγ secreting CD4+ T cells, resulting in a Th1 profile. However, it is suggested that a persistently high IFNγ is responsible for the damage caused by granulomatous disease and that moderating cytokines, resulting in a Th0 profile, are necessary to down-regulate the IFNγ response to more appropriate levels later in the disease process, after the antigen has been effectively contained. I propose that: “Cytokine profiles determine clinical and histopathological phenotypes of disease. This thesis tests the hypothesis that it will be reflected by cytokine expression profiles in granulomas in different forms of tuberculosis and in sarcoidosis.” To examine this, biopsy tissue was obtained from patients with pulmonary cavitary tuberculosis, pleural tuberculosis in HIV sero-negative and sero-positive patients, and sarcoidosis. The diagnosis of tuberculosis or sarcoidosis was confirmed, granulomas were characterised as necrotic or non-necrotic, sarcoidosis cases were graded histologically and in situ hybridisation was performed for IL-12-, IFNγ-, TNFα- and IL-4-mRNA. In all patients with pleural tuberculosis, a Th0 profile was noted, while necrotic granulomas were more evident in HIV positive than HIV negative patients. There was a clear association between TNFα and necrosis in tuberculous granulomas that may be ascribed to the increased apoptotic activity of TNFα. An increase in IFNγ correlated with an increase in necrosis, supporting the theory that high IFNγ levels later in disease is detrimental. This effect may be enhanced by a strong presence of TNFα positive cells. An increase in both Th1 and Th2 cytokine mRNA in HIV positive patients supports the theory that an overproduction of cytokines may be a mechanism to compensate for the failure of another immune effector mechanism. Findings in pulmonary tuberculosis were similar to those in pleural tuberculosis. In all sarcoidosis cases the presence of a very strong Th1 and TNFα, but no Th0 response was confirmed. None of the differences in either the histological grading, or the clinical outcome of patients were reflected in the cytokine profile. It is possible that this profile does not reflect the histological grade of disease or that it may reflect various stages of disease. These findings support the theory that a strong Th1 presence later in disease, in conjunction with TNFα may induce fibrosis, as most of these cases showed signs of at least focal fibrosis. Numerous aspects, including a T helper response are involved in granulomatous inflammation. The earlier dogma of good, beneficial (Th1) versus evil, detrimental (Th2), is an oversimplification of a very complex process. It is clear that the effect of a cytokine depends at least partially on the stage of disease. The balance between the various cytokines, and the levels of these cytokines contribute to their role in resolution or disease progression. An early, pure Th1 response may be beneficial if effectively clearing the granuloma-inducing antigen. At this stage, a Th2 presence will be harmful as clearing of the antigen will not be as effective. In chronic disease where failure to remove the antigen results in progression of granulomas with subsequent necrosis and/or fibrosis, a proinflammatory Th1 response may be detrimental and minimising of this effect is needed. An overly strong presence of the various cytokines may also be detrimental, while lower levels will be beneficial.
Effect of curriculum changes to enhance generic skills proficiency of 1st-year medical students
(Health & Medical Publishing Group, 2016-05) Murdoch-Eaton, Debbie; Louw, Alwyn J. N.; Bezuidenhout, Juanita
ENGLISH SUMMARY : Background: Curriculum review is a dynamic, iterative process, and the effect of change may not always be wholly predictable. At Stellenbosch University, Cape Town, South Africa revision of the MB,ChB curriculum was undertaken to meet enhanced and changing educational and medical practice, and to provide opportunities to enhance optimal generic skills underpinning effective learning, implemented in 2008. Objective: To determine the extent to which the newly implemented revised curriculum had an effect on experience in necessary generic skills of students in their first year of study. Methods: Students provided annual formal end-of-module evaluation in addition to focus group interviews. Evaluation by teaching staff was conducted by individual in-depth interviews. A validated generic skills questionnaire completed at the end of each academic year monitored the effect on students’ generic learning skills experience. Results: Feedback from these different evaluation methods identified specific needs in the newly implemented revised curriculum, including contextualisation of interventions, unnecessary duplication of content and malalignment of assessment. This led to minor curriculum changes and an educational capacity-building programme. These responsive curriculum changes after evaluation had the intended positive effect on students’ self reported acquisition of generic learning skills. Conclusion: The objective of the curriculum evaluation was to monitor content output and the acquisition of crucial generic learning skills. Implementation of a revised curriculum combined with ongoing responsive changes aligned with careful multimodality evaluation can ensure that, in addition to scientific knowledge and skills, generic learning skills development of students is facilitated.
Exome sequencing in a family with luminal-type breast cancer underpinned by variation in the methylation pathway
(MDPI, 2017-02-22) Van der Merwe, Nicole; Peeters, Armand V.; Pienaar, Fredrieka M.; Bezuidenhout, Juanita; Van Rensburg, Susan J.; Kotze, Maritha J.
ENGLISH ABSTRACT: Panel-based next generation sequencing (NGS) is currently preferred over whole exome sequencing (WES) for diagnosis of familial breast cancer, due to interpretation challenges caused by variants of uncertain clinical significance (VUS). There is also no consensus on the selection criteria for WES. In this study, a pathology-supported genetic testing (PSGT) approach was used to select two BRCA1/2 mutation-negative breast cancer patients from the same family for WES. Homozygosity for the MTHFR 677 C>T mutation detected during this PSGT pre-screen step was considered insufficient to cause bilateral breast cancer in the index case and her daughter diagnosed with early-onset breast cancer (<30 years). Extended genetic testing using WES identified the RAD50 R385C missense mutation in both cases. This rare variant with a minor allele frequency (MAF) of <0.001 was classified as a VUS after exclusion in an affected cousin and extended genotyping in 164 unrelated breast cancer patients and 160 controls. Detection of functional polymorphisms (MAF > 5%) in the folate pathway in all three affected family members is consistent with inheritance of the luminal-type breast cancer in the family. PSGT assisted with the decision to pursue extended genetic testing and facilitated clinical interpretation of WES aimed at reduction of recurrence risk.
Finding a home for my professional soul
(Stellenbosch : Stellenbosch University, 2013-07) Bezuidenhout, Juanita
Juanita Bezuidenhout was born in Johannesburg and went to school in Johannesburg, Cape Town, Windhoek and Lichtenburg, where she matriculated. She obtained her MBChB degree from Pretoria University and her MMed and PhD degrees in Anatomical Pathology from Stellenbosch University. She is employed as a pathologist in the National Health Laboratory Service and as Deputy Director: Research in the Centre for Health Professions Education of the Stellenbosch University (SU) Faculty of Medicine and Health Sciences. She is a clinician-educator pursuing scholarship in anatomical pathology and teaching and learning, as demonstrated by a PhD in Anatomical Pathology; the Rector’s Award for teaching excellence; a FAIMER fellowship; her position as deputy editor of the African Journal for Health Professions Education; and her role as co-founder and co-director of the sub-Saharan FAIMER Regional Institute. She also has received a Teaching Fellowship, has published in the fields of pathology and education, and received international awards for conference presentations in education. In 2012 she led the College of Pathologists in the process of blueprinting assessment in all pathology disciplines and organised the first ever comprehensive education theme at IAP2012, a leading international anatomical pathology conference. Most recently she was awarded the regional award for excellence as a pathologist by the National Health Laboratory Service (NHLS). She has served as national and international examiner in anatomical pathology, and considers quality assurance as being essential to improving practice. She serves on committees of the Faculty, the University and nationally, specifically the Postgraduate Education and Training Committee of the Medical and Dental Professions Board of the Health Professions Council of South Africa (HPCSA). She believes in fostering a culture of collaboration in research, and in continuously improving the training and empowerment of students in their personal and professional development.
The impact of a faculty development programme for health professions educators in sub-Saharan Africa : an archival study
(BioMed Central, 2015-03) Frantz, Jose M.; Bezuidenhout, Juanita; Burch, Vanessa C.; Mthembu, Sindi; Rowe, Michael; Tan, Christina; Van Wyk, Jacqueline; Van Heerden, Ben
Background: In 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme. Methods: A retrospective document review, which included data about fellows who completed the programme between 2008 and 2011, was performed. Data included fellows’ descriptions of their expectations, reflections on achievements and information shared on an online discussion forum. Data were analysed using Kirkpatrick’s evaluation framework. Results: Participants (n=61) came from 10 African countries and included a wide range of health professions educators. Five key themes about the impact of the SAFRI programme were identified: (1) belonging to a community of practice, (2) personal development, (3) professional development, (4) capacity development, and (5) tools/strategies for project management and/or advancement. Conclusion: The SAFRI programme has a positive developmental impact on both participants and their respective institutions.
Mapping undergraduate exit-level assessment in a medical programme : a blueprint for clinical competence?
(Health & Medical Publishing Group, 2016-05) Tan, Christina Phoay Lay; Van Schalkwyk, Susan Camille; Bezuidenhout, Juanita; Cilliers, Francois
ENGLISH SUMMARY : Background. Assessment is an essential component of a medical curriculum. High-stakes exit-level assessment used for licensing and certification purposes needs to be sound. Even though criteria for evaluating assessment practices exist, an analysis of the nature of these practices is first required. Objective. To map current exit-level assessment practices, as described in institutional documentation. Methods. This descriptive interpretive study centred on the document analysis of final-phase study guides of the undergraduate medical programme at Stellenbosch University, Cape Town, South Africa. Results. The key findings were: (i) there is a diversity of methods and approaches to assessment in the final-phase modules; (ii) modules using similar assessment methods applied different credit weightings; (iii) similar assessment methods were described differently across the study guides; and (iv) study guides varied in the amount of information provided about the assessment methods. Conclusion. There is a diverse range of assessment practices at exit level of the MB,ChB programme at Stellenbosch University. This in-depth analysis of assessment methods has highlighted areas where current practice needs to be investigated in greater depth, and where shifts to a more coherent practice should be encouraged. Assessment mapping provides a useful reference for programme co-ordinators and is applicable to other programmes.
Pleural tuberculosis in patients with early HIV infection is associated with increased TNF-alpha expression and necrosis in granulomas
(Public Library of Science, 2009-01-19) Bezuidenhout, Juanita; Roberts, Teri; Muller, Liesel; Van Helden, Paul; Walzl, Gerhard
Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB). Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-γ, TNF-α and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-α and necrosis. This study demonstrates immune dysregulation which may include TNF-α-mediated immunopathology at the site of disease in HIV infected pleural TB patients. © 2009 Bezuidenhout et al.
Tuberculosis and phrenic nerve destruction
(Health and Medical Publishing Group (HMPG), 2007-08) Dempers, Johan J.; Bezuidenhout, Juanita; Schneider, Johann W.; Janse van Rensburg, Michele
ENGLISH ABSTRACT: Phrenic nerve palsy (PNP) is often associated with Mycobacterium tuberculosis-related expansile pneumonia, possibly because of nerve entrapment by healing fibrosis. Mohan and Jayaswal1 postulated that pressure on the left phrenic nerve by an enlarged hilar lymph node caused unilateral diaphragmatic paralysis in a 6-year-old boy who developed PNP during the course of pulmonary tuberculosis (PTB). Gie et al. described 6 childhood cases of PTB complicated by unilateral PNP. The children did not recover on antituberculosis drugs and steroids, or in 1 case, after surgical decompression. Therefore the theory of glandular compression alone does not adequately account for PNP as a complication of PTB. Our case, in which the fate of the phrenic nerve was confirmed, provides strong evidence that destruction of the phrenic nerve by the tuberculous inflammatory process is involved in the pathogenesis of diaphragmatic paralysis, which may influence the clinical management of these children.

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