Browsing by Author "Mash, R."
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- ItemThe case for behavioural change counselling for the prevention of NCDs and improvement of self-management of chronic conditions(Taylor & Francis, 2016) Murphya, K. M.; Mash, R.; Malan, Z.Brief behaviour change counselling (BBCC) that is integrated into routine health care has been shown to be effective in helping patients modify risk behaviours for non-communicable disease (NCD), improve self-management of chronic conditions, as well as produce clinically meaningful improvements in biological outcomes. Capacitating healthcare providers to effectively assist patients in lifestyle modification and self-management has been recognised by the South African Department of Health as an important strategic objective in its stated intention to ‘re-orientate’ the primary health care system to prevent NCDs more effectively and improve the quality of care for chronic conditions. However, primary care providers in South Africa are currently poorly trained for behaviour change counselling. The University of Stellenbosch, in partnership with the Chronic Disease Initiative for Africa (CDIA), has recently developed a training course for doctors and nurses that is offered as a CPD accredited course every year at the university. In addition, a resource package has been produced, consisting of a training manual and comprehensive patient education materials on smoking, diet, alcohol and physical activity. The approaches to behaviour change counselling that are taught in this course and described in the manual are Motivational Interviewing (MI) and the 5 A’s Clinical Practice Guideline.
- ItemEvaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa(Health & Medical Publishing Group, 2016) Mash, R.; Ugoagwu, A.; Vos, C.; Rensburg, M.; Erasmus, R.Background. Diabetes mellitus contributes significantly to the burden of disease in South Africa (SA). Monitoring of glycaemic control with glycosylated haemoglobin (HbA1c) is recommended, even though current laboratory-based testing does not support immediate clinical decision-making. Objectives. To evaluate the costs and consequences for quality of care by introducing point-of-care (POC) testing for HbA1c for patients with type 2 diabetes at community health centres in Cape Town, SA. Methods. A quasi-experimental study was conducted at two control and two intervention sites in the same sub-district. The DCA Vantage Analyzer (Siemens, Germany) for POC testing was introduced at the intervention sites for 12 months. Patients were randomly selected from the diabetes register at the intervention (n=300) and control (n=300) sites, respectively, and data were collected from patient records at baseline and 12 months. Focus group interviews were performed at the intervention sites. Technical quality and cost implications were evaluated. Results. POC testing was feasible, easy to integrate into the organisation of care, resulted in more immediate feedback to patients (p<0.001) and patients appeared more satisfied. POC testing did not improve test coverage, treatment intensification, counselling or glycaemic control. There was an incremental cost of ZAR2 110 per 100 tests. Compliance with quality control was poor, although control tests showed good reliability. Conclusion. This study does not support the introduction of POC testing for HbA1c in public sector primary care practice in the current context. POC testing should be evaluated further in combination with interventions to overcome clinical inertia and strengthen primary healthcare.
- ItemExamining the effects of a mindfulness-based professional training module on mindfulness, perceived stress, self-compassion and self-determination(Health & Medical Publishing Group, 2015-11) Whitesman, S.; Mash, R.Background. Mindfulness-based interventions (MBIs) have been shown to be effective in a wide range of health-related problems. Teaching and research with regard to MBIs have largely been conducted in the USA and Europe. The development of teachers of MBIs requires that they embody the practice of mindfulness and acquire pedagogical competencies. Stellenbosch University and the Institute for Mindfulness South Africa have launched a new and innovative training programme consisting of 4 modules, with a blend of residential retreats and e-learning. Internationally, this is the first study that specifically investigates the effects of mindfulness on the mental state of health professionals being trained to teach MBIs in their clinical practice. Objectives. To evaluate the first 9-week module in terms of its effect on mindfulness practice, self-determination, self-compassion and perception of stress. Methods. This is a before-and-after study of 23 participants, using 4 validated tools: Kentucky Inventory of Mindfulness Skills, Self-Determination Scale, Self-Compassion Scale, Perceived Stress Scale. Results. There were significantly increased scores (p<0.05) for all 4 aspects of mindfulness practice (observing, describing, acting with awareness and accepting without judgement) and self-compassion. There was also a significant decrease in the perception of stress, but no effect on self-determination scores, which were already high at baseline. Conclusion. Potential teachers of MBIs in South Africa demonstrated significant gains in their own mindfulness practice and self-compassion as well as decreased perception of stress during the first module of the training programme. Further research will follow as this group completes the entire programme.
- ItemFamily medicine in South Africa : exploring future scenarios(Taylor & Francis Group, 2017) Mash, R.; Von Pressentin, K.This paper reports on a workshop held at the 19th National Family Practitioners Conference in August 2016. The aim of the workshop was to describe possible future scenarios for the discipline of family medicine in South Africa and identify possible options for action. The workshop led a group of 40 family physicians from academic, public and private sector settings through a scenario planning process developed by Clem Sunter and Chantell Ilbury. After an overview of the current situation the participants reached a consensus on the rules of the game, key uncertainties, future scenarios and options for action. The main message was that the South African Academy of Family Physicians as a professional body needs to take a stronger role in advocating for the contribution of family medicine to government, health managers and the public.
- ItemGuidelines for the management of Chronic Asthma in adolescents and adults(S A Pharmaceutical Journal, 2007) Lalloo, U.; Ainslie, G.; Wong, M.; Abdool-Gaffar, S.; Irusen, E.; Mash, R.; Feldman, C.; O'Brien, J.; Jack, C.
- ItemGuidline for the management of acute asthma in adults: 2013 update(MED ASSOC S AFRICA, MED HOUSE CENTRAL SQ 7430 PINELANDS PRIV BAG X1,JOHANNESBURG, SOUTH AFRICA, 2013) Lalloo, U.; Ainslie, G.; Abdool-Gaffar, S.; Awotedu, A. A.; Feldman, C.; Wong, M.; Greenblatt, M.; Irusen, E.; Mash, R.; Naidoo, S. S.; O'Brien, J.; Otto, W.; Richards, G. A.
- ItemLeadership and governance : learning outcomes and competencies required of the family physician in the district health system(Taylor & Francis, 2016) Mash, R.; Blitz, J.; Mala, Z.; Von Pressentin, K.The South African National Development Plan expects the family physician to be a leader of clinical governance within the district health services. The family physician must also help to strengthen the services through leadership in all his/her other roles as a clinician, consultant, capacity-builder, clinical trainer and champion of community-orientated primary care. In order to deliver on these expectations the nine training programmes must ensure that they prepare registrars appropriately for leadership and clinical governance. Currently training programmes differ considerably in what they teach and in workplace-based training and assessment. This article reports on a national process to reach consensus on what training is required for family physicians in this area. The process outlined the key conceptual principles and competencies required for leadership, clinical and corporate governance; it culminates in a new set of learning outcomes for the training of family physicians.
- ItemMultimorbidity in non-communicable diseases in South African primary healthcare(Health & Medical Publishing Group, 2015) Lalkhen, H.; Mash, R.Background: Multimorbidity in non-communicable diseases (NCDs) is a complex global healthcare challenge that is becoming increasingly prevalent. In Africa, comorbidity of communicable diseases and NCDs is also increasing. Objectives: To evaluate the extent of multimorbidity among patients with NCDs in South African (SA) primary healthcare (PHC). Methods: A dataset obtained from a previous morbidity survey of SA ambulatory PHC was analysed. Data on conditions considered active and ongoing at consultations by PHC providers were obtained. Results: Altogether 18 856 consultations were included in the dataset and generated 31 451 reasons for encounter and 24 561 diagnoses. Hypertension was the commonest NCD diagnosis encountered (13.1%), followed by type 2 diabetes (3.9%), osteoarthritis (2.2%), asthma (2.0%), epilepsy (1.9%) and chronic obstructive pulmonary disease (COPD) (0.6%). The majority of patients (66.9%) consulted a nurse and 33.1% a doctor. Overall 48.4% of patients had comorbidity and 14.4% multimorbidity. Multimorbidity (two or more conditions) was present in 36.4% of patients with COPD, 23.7% with osteoarthritis, 16.3% with diabetes, 15.3% with asthma, 12.0% with hypertension and 6.7% with epilepsy. Only 1.1% also had HIV, 1.0% TB, 0.4% depression and 0.04% anxiety disorders. Conclusion: About half of the patients with NCDs had comorbidity, and multimorbidity was common in patients with COPD and osteoarthritis. However, levels of multimorbidity were substantially lower than reported in higher-income countries. Future clinical guidelines, training of PHC nurses and involvement of doctors in the continuum of care should address the complexity of patients with NCDs and multimorbidity.
- ItemThe prevalence of substance use and its associations amongst students attending high school in Mitchells Plain, Cape Town(Medpharm Publications, 2011-02) Hamdulay, A. K.; Mash, R.Purpose: In South Africa, there has been an increase in illicit drug trafficking and consumption and associated problems since the 1990s. Mitchells Plain in Cape Town is seen as a community battling with crime, gangsterism, unemployment, overcrowding, substance abuse and poverty. This study evaluated the actual prevalence of substance abuse amongst high school students in this community and factors associated with substance use. In particular, the study evaluated the use of tik (crystal methamphetamine), a relatively new drug.Method: A cross-sectional study was performed amongst 12 secondary schools in Mitchells Plain; Grade 8 and Grade 11classes were randomly selected to produce a sample of 438 learners. The students completed an anonymous questionnaire that contained enquiries on substance use, demographic and school performance details, and personal and sexual risks.Results: Lifetime and annual prevalence rates were: alcohol (50.6%/41.0%), tobacco smoking (49.7%/36.2%), cannabis(32.1%/21.1%), crystal methamphetamine (9.2%/4.6%), ecstasy (4.4%/2.7%), mandrax (2.1%/0.9%), solvents (3.0%/0.9%) and cocaine (0.9%/0.9%). Illicit substance use was significantly associated with age (OR 1.6; CI 1.2-2.2), substance use byother members of the household (OR 2.8; CI 1.2-6.3), carrying a knife (OR 10.9; CI 4.2-28.8), attempted suicide (OR 3.7; CI 1.4-9.5) and higher sexual risk (OR 1.6; CI 1.2-2.3). Conclusion: The prevalence of substance use amongst adolescent students attending high schools in Mitchells Plain, Cape Town, is high for all substances relative to national and international figures. Government officials, educators and health care workers are alerted to the need for more comprehensive interventions to prevent and treat substance abuse in this and similar communities. © SAAFP.