Access to health care for people with stroke in South Africa: a qualitative study of community perspectives.

BACKGROUND: Incidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures. METHODS: In-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective. RESULTS: PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS. CONCLUSIONS: Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services.

Adjuvants to improve aerial control of the citrus mealybug Planococcus citri (Hemiptera: Pseudococcidae) using entomopathogenic nematodes.

The citrus mealybug, Planococcus citri, is a highly destructive pest of citrus, occurring only in the aerial parts of plants. Humidity will be one of the key factors to consider when using entomopathogenic nematodes (EPN) as biological control agents. Different adjuvants can be added to suspensions of EPNs, to improve control as a foliar application. An aqueous suspension containing Heterorhabditis zealandica and 0.3% Zeba® significantly increased P. citri mortality by 22% at 80% relative humidity (RH) with a temperature cycle starting at 22°C for 14 h and 11°C for 11 h. The same polymer formulation was tested for Steinernema yirgalemense and mortality of P. citri increased by 21% at 60% RH and by 27% at 80% RH. The addition of Nu-Film-P® and Zeba® to H. zealandica suspensions did not significantly retard application run-off on citrus leaves. The combination of Nu-Film-P® and Zeba®, however, was able to significantly retard sedimentation, increasing the average number of nematodes deposited on 2-cm2 leaf discs by 10 nematodes. In an aqueous suspension, nematodes settle rapidly to the bottom, resulting in an uneven distribution of nematodes. Xanthan gum, at a concentration of 0.2%, was highly effective at retarding sedimentation, with 72% of the initial nematode number still in suspension after 1 h. Zeba®, at a concentration of 0.3%, despite not being as effective as Xanthan gum, nevertheless still retarded sedimentation significantly. This is the first report of the potential of Nu-Film-P® and Zeba® to improve EPN performance against P. citri when used above ground in citrus orchards.

Brain activity in predictive sensorimotor control for landings: an EEG pilot study.

Landing from a jump is related to predictive sensorimotor control. Frontal, central and parietal brain areas are known to play a role in this process based on online sensory feedback. This can be measured by EEG. However, there is only limited knowledge about brain activity during predictive preparation for drop landings (DL). The purpose is to demonstrate changes in brain activity in preparation for DL in different conditions. After resting, 10 athletes performed a series of DLs and were asked to concentrate on the landing preparation for 10 s before an auditory signal required them to drop land from a 30 cm platform. This task was executed before and after a standardized fatigue protocol. EEG spectral power was calculated during DL preparation. Frontal Theta power was increased during preparation compared to rest. Parietal Alpha-2 power demonstrated higher values in preparation after fatigue condition while lower limb kinematics remained unchanged. Cortical activity in frontal and parietal brain areas is sensitive for predictive sensorimotor control of drop landings. Frontal Theta power demonstrates an increase and is related to higher attentional control. In a fatigued condition the parietal Alpha-2 power increase might be related to a deactivation in the somatosensory brain areas.

Standardising evidence strength grading for recommendations from multiple clinical practice guidelines: a South African case study.

BACKGROUND: Significant resources are required to write de novo clinical practice guidelines (CPGs). There are many freely-available CPGs internationally, for many health conditions. Developing countries rarely have the resources for de novo CPGs, and there could be efficiencies in using CPGs developed elsewhere. This paper outlines a novel process developed and tested in a resource-constrained country (South Africa) to synthesise findings from multiple international CPGs on allied health (AH) stroke rehabilitation. METHODS: Methodologists, policy-makers, content experts and consumers collaborated to describe the pathway of an 'average' stroke patient through the South African public healthcare system and pose questions about best-practice stroke rehabilitation along this pathway. A comprehensive search identified international guidance documents published since January 2010. These were scanned for relevance to the South African AH stroke rehabilitation questions and critically appraised for methodological quality. Recommendations were extracted from guidance documents for each question. Strength of the body of evidence (SoBE) gradings underpinning recommendations were standardised, and composite recommendations were developed using qualitative synthesis. An algorithm was developed to guide assignment of overall SoBE gradings to composite recommendations. RESULTS: Sixteen CPGs were identified, and all were included, as they answered different project questions differently. Methodological quality varied and was unrelated to currency. Seven clusters, outlining 20 composite recommendations were proposed (organise for best practice rehabilitation, operationalise strategies for best practice communication throughout the patient journey, admit to an acute hospital, refer to inpatient rehabilitation, action inpatient rehabilitation, discharge from inpatient rehabilitation and longer-term community-based rehabilitation). CONCLUSION: The methodological development process, tested by writing a South African AH stroke rehabilitation guideline from existing evidence sources, took 9 months. The process was efficient, collaborative, effective, rewarding and positive. Using the proposed methods, similar synthesis of existing evidence could be conducted in shorter time periods, in other resource-constrained countries, avoiding the need for expensive and time-consuming de novo CPG development.

Measuring distress in South African children during burns dressing changes: A pilot study.

OBJECTIVES: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children's distress during burns dressing change. METHODS: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors-(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children's Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses' perspectives of child's distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children's distress levels during burns dressing change phases. RESULTS: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses' qualitative perspectives of child's distress. In combination, these tests were practical and sensitive to children's distress. DISCUSSION: South African children's distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.

Postural dynamism during computer mouse and keyboard use: A pilot study.

Prolonged sedentary computer use is a risk factor for musculoskeletal pain. The aim of this study was to explore postural dynamism during two common computer tasks, namely mouse use and keyboard typing. Postural dynamism was described as the total number of postural changes that occurred during the data capture period. Twelve participants were recruited to perform a mouse and a typing task. The data of only eight participants could be analysed. A 3D motion analysis system measured the number of cervical and thoracic postural changes as well as, the range in which the postural changes occurred. The study findings illustrate that there is less postural dynamism of the cervical and thoracic spinal regions during computer mouse use, when compared to keyboard typing.

Perceptions of the clinical competence of newly registered nurses in the North West province.

The clinical competence of newly registered nurses relating to the care of individual Clients, depends on their ability to correlate theoretical knowledge learned in the classroom with practice and the development of clinical skills. Its foundation lies in the ability to identify and solve problems that emanate from critical thinking, analytical reasoning and reflective practice. It is clear that the quality of clinical exposure plays a leading role in the development of nursing professionals. Nursing skills alone cannot ensure quality care of clients without the application of theory. Facilitation of this theory to practice therefore remains an essential component of nursing education. This study was aimed at identifying areas of incompetence of newly registered nurses (1998--2001) in the clinical area by determining the newly registered nurses' and professional nurses' perceptions of the competence of the newly registered nurses. A quantitative, non-experimental, descriptive survey was used to collect the data regarding the clinical competence of newly registered nurses (1998--2001). An in depth literature study was conducted to generate information that was used as basis for the study. For data collection two types of structured questionnaires were used to obtain information from the professional nurses and the newly registered nurses in identified hospitals in the North West Province. The professional nurses' sample consisted of (n=151) respondents and the newly registered nurses' sample of (n=67) respondents. An analysis of the data obtained from the study revealed that the shortage of staff, equipment and supplies negatively affect the competency of newly registered nurses. There is a discrepancy between what the newly registered nurses learned in the classroom and what they observe in the clinical area. Orientation programmes need to be reviewed and are often neglected due to staff shortages. Findings with regard to the newly registered nurses revealed that these nurses have sufficient theoretical knowledge but lack competency in basic nursing skills due to an inability to correlate theory to practice. Conclusions that can be drawn from this study are that there are many factors that impact negatively on the competency of the newly qualified nurses. These emanate from the clinical area, as well as during the education and development of newly registered nurses. Recommendations regarding the education and training of newly registered nurses and the clinical practice area have been made.

[Nursing students' perceptions of the factors in the field of general clinical experience which facilitate learning]. / Studentverpleegkundiges se persepsie van faktore in die algemene kliniese ervaringsveld wat leer fasiliteer.

Learning through clinical experience forms an integral part of student nurses' academic and professional foundation. The extent to which learning is facilitated for student nurses is determined by the structuring of the field of clinical experience as well as by student nurses' perception of the field of clinical experience. The purpose of this study is to determine student nurses' perception of factors in the field of general clinical experience which facilitate learning. Literature pertaining to factors in the field of general clinical experience which impact on the learning by students was studied. A descriptive, exploratory survey was done through the medium of a questionnaire completed by B.Cur-students. The results of this study indicate, despite the fact that student nurses experience some aspects pertaining to learning in the general clinical field negatively, their overall impression is positive and favourable. Factors restraining learning were identified. Recommendations are made to counter the restraining factors.

[Does she have time?]. / Het sy tyd?

The ward sister is expected to have an active role in the clinical teaching of the student nurse - but does she have the time? By effective planning of duty rosters and intentional delegation, it is possible to create learning experiences for student nurses, which, when combined with guidance and supervision by the ward sister or tutor, is worth more than formal clinical lectures.

Chemical composition of the pearl grey guinea fowl.

1. The growth of the chemical components of the body of the Pearl Grey guinea fowl from hatching till 127 days of age was evaluated in this study. 2. The Gompertz equation is suitable to describe the growth of the different chemical components over time. 3. Body and feather fat, respectively, were estimated by subtracting the predicted weights of all other components from those of body and feather weights. This leads to an overestimation of body fat content, and erroneous estimated values for feather fat.