Gauteng Health assets offered to settle mounting negligence claims

Gauteng Health has had to offer some of its assets to the sheriff for attachment in a bid to settle mounting legal claims for negligence at provincial and regional hospitals, reports Business Day.

Last year alone, the health department’s legal fees amounted to R569m and medico-legal claims have been piling up since 2009. As a result, legal fees have taken up the bulk of the department’s budget even into the new financial year.

The department’s budget increased from R37.6bn in 2016 to R40.2bn in 2017.

Spokesperson Khutso Rabothata is quoted in the report as saying that the department’s legal team had been working on crafting a plan to find a satisfactory way forward, possibly involving the sheriff. “The sheriff might attach items because there are some cases that still need to be paid off,” Rabothata said…..more

The Community Guide

The Guide to Community Preventive Services (The Community Guide) is a collection of evidence-based findings of the Community Preventive Services Task Force (Task Force). It is a resource to help you select interventions to improve health and prevent disease in your state, community, community organization, business, healthcare organization, or school.

Community Guide reviews are designed to answer three questions:

  1. What has worked for others and how well?
  2. What might this intervention approach cost, and what am I likely to achieve through my investment?
  3. What are the evidence gaps?

The Task Force issues findings based on systematic reviews of effectiveness and economic evidence that are conducted with a methodology developed by the Community Guide Branch.

The Task Force reviews intervention approaches across a wide range of health topics. The interventions are applicable to groups, communities, or other populations and include strategies such as healthcare system changes, public laws, workplace and school programs and policies, and community-based programs.

All of the intervention approaches are intended to improve health directly; prevent or reduce risky behaviors, disease, injuries, complications, or detrimental environmental or social factors; or promote healthy behaviors and environments.

The Community Preventive Services Task Force was established by the U.S. Department of Health and Human Services (DHHS) in 1996 to develop guidance on which community-based health promotion and disease prevention intervention approaches work and which do not work, based on available scientific evidence. The Centers for Disease Control and Prevention (CDC) is the DHHS agency that provides the Task Force with technical and administrative support.

Diagnostic and treatment interventions are not part of The Community Guide, nor are the clinical preventive services provided by a healthcare professional to an individual patient. Reviews of clinical preventive services can be found in The Guide to Clinical Preventive Services…… More

Community Tool Box


Learn A Skill: We offer a wide range of free information and tools to support you in your work.

TABLE OF CONTENTS: Browse 46 Chapters through which you can obtain more than 300 different sections providing practical, step-by-step guidance in community-building skills.

TOOLKITS: Access succinct guidance on 16 core competencies for community work, including how to conduct a community assessment, develop a strategic plan, write a grant, or evaluate your efforts…..more

Five simple tests to predict heart disease risk

Five simple medical tests together provide a broader and more accurate assessment of heart-disease risk than currently used methods, cardiologists at University of Texas Southwestern Medical Centre have found.


Background: Current strategies for cardiovascular disease (CVD) risk assessment among adults without known CVD are limited by suboptimal performance and a narrow focus on only atherosclerotic CVD (ASCVD). We hypothesized that a strategy combining promising biomarkers across multiple different testing modalities would improve global and atherosclerotic CVD risk assessment among individuals without known CVD.

Methods: We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA, n=6621) and Dallas Heart Study (DHS, n=2202) who were free from CVD and underwent measurement of left ventricular hypertrophy by electrocardiogram (ECG-LVH), coronary artery calcium (CAC), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hs-CRP). Associations of test results with the global composite CVD outcome (CVD death, myocardial infarction [MI], stroke, coronary or peripheral revascularization, incident heart failure or atrial fibrillation) and ASCVD (fatal or nonfatal MI or stroke) were assessed over > 10 years of follow-up. Multivariable analyses for the primary global CVD endpoint adjusted for traditional risk factors plus statin use and creatinine (base model).

Results: Each test result was independently associated with global composite CVD events in MESA after adjustment for the components of the base model and the other test results (p< 0.05 for each). When the five tests were added to the base model, the c-statistic improved from 0.74 to 0.79 (p=0.001), significant integrated discrimination improvement (0.07, 95% CI 0.06-0.08, p<0.001) and net reclassification improvement (0.47, 95% CI 0.38-0.56, p=0.003) were observed, and the model was well calibrated (χ2=12.2, p=0.20). Using a simple integer score counting the number of abnormal tests, compared with those with a score of 0, global CVD risk was increased among participants with a score of 1 (adjusted HR 1.9, 95% CI 1.4-2.6), 2 (HR 3.2, 95% CI 2.3-4.4), 3 (HR 4.7, 95% CI 3.4, 6.5) and ≥4 (HR 7.5, 95% CI 5.2-10.6). Findings replicated in DHS and were similar for the ASCVD outcome.

Conclusions: Among adults without known CVD, a novel multimodality testing strategy using ECG-LVH, CAC, NT-proBNP, hs-cTnT and hs-CRP significantly improved global CVD and ASCVD risk assessment.

James A de Lemos, Colby R Ayers, Benjamin D Levine, Christopher R deFilippi, Thomas J Wang, W Gregory Hundley, Jarett D Berry, Stephen L Seliger, Darren K McGuire, Pamela Ouyang, Mark H Drazner, Matthew J Budoff, Philip Greenland, Christie M Ballantyne, Amit Khera


What Are Gallstones?

gallstonesGallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile cholesterol and bilirubin in the gallbladder.

  • The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
  • The gallbladder is part of the biliary system, which includes the liver and the pancreas.
  • The biliary system, among other functions, transports bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

  • It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
  • Bile is stored in the gallbladder until needed.
  • When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process.

Using a human resource management approach to support community health workers: experiences from five African countries



Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance.


Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach.


CHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs.


This study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities.


Close-to-community Community health workers Human resource management DRC Ghana Senegal Uganda Zimbabwe

Metrics for Assessing Improvements in Primary Health Care

Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectives. Aspirational uses of metrics inspire evolving insights and iterative improvement, using a collaborative, developmental perspective. Performance metrics assess the complex interactions among primary care tenets of accessibility, a whole-person focus, integration and coordination of care, and ongoing relationships with individuals, families, and communities; primary health care principles of inclusion and equity, a focus on people’s needs, multilevel integration of health, collaborative policy dialogue, and stakeholder participation; basic and goal-directed health care, prioritization, development, and multilevel health outcomes. Environments that support reflection, development, and collaborative action are necessary for metrics to advance health and minimize unintended consequences…..more

The contribution of Physician Assistants in primary care: a systematic review



Primary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems.


Medline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care.


2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time.

Limitations: identification of a broad range of studies examining ‘contribution’ made meta analysis or meta synthesis untenable.


The research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs’ contribution to the international primary care workforce.


Physician assistants Family practice Physicians Family General practice Primary health care Review


9TH ANNUAL PAIN SYMPOSIUM: Saturday, 3 June 2017 hosted by the Department of Family Medicine  at the University of Pretoria (Accredited for 6 + 2 Ethics CPD points)

Dear All,

Just a reminder to register for the 9th Annual Pain Symposium on Saturday, 3rd June 2017 (see attached programme). We have had an excellent response to our first invitation and we currently have more than 100 confirmed registrations. We have ± 2 months to go to the Symposium and we again expect a “full-house”.

Please book early to avoid disappointment. We have an excellent list of speakers and all have confirmed their participation. Please note that Velocity Vision has been appointed as Symposium organizers and all registration and other related communication can be done with them as follows:

Please fax the registration form to Janice Candlish (Administrator / Conference Organiser). Contact details: Tel: 011 894 1278 | Fax: 086 724 9360 | For on-line registration please: CLICK HERE Enquiries: Prof Helgard Meyer: 012 373 1096 (Doris). Please note that the “early bird” registration fee of R950.00 closing date will be 30 April 2017.

Best regards and we hope to see you at our 2017 Annual Pain Symposium on Saturday 3 June 2017.

Prof Helgard Meyer, Department of Family Medicine, University of Pretoria

Exploratory Study of Rural Physicians’ Self-Directed Learning Experiences in a Digital Age.



The nature and characteristics of self-directed learning (SDL) by physicians has been transformed with the growth in digital, social, and mobile technologies (DSMTs). Although these technologies present opportunities for greater “just-in-time” information seeking, there are issues for ensuring effective and efficient usage to compliment one’s repertoire for continuous learning. The purpose of this study was to explore the SDL experiences of rural physicians and the potential of DSMTs for supporting their continuing professional development (CPD).


Semistructured interviews were conducted with a purposive sample of rural physicians. Interview data were transcribed verbatim and analyzed using NVivo analytical software and thematic analysis.


Fourteen (N = 14) interviews were conducted and key thematic categories that emerged included key triggers, methods of undertaking SDL, barriers, and supports. Methods and resources for undertaking SDL have evolved considerably, and rural physicians report greater usage of mobile phones, tablets, and laptop computers for updating their knowledge and skills and in responding to patient questions/problems. Mobile technologies, and some social media, can serve as “triggers” in instigating SDL and a greater usage of DSMTs, particularly at “point of care,” may result in higher levels of SDL. Social media is met with some scrutiny and ambivalence, mainly because of the “credibility” of information and risks associated with digital professionalism.


DSMTs are growing in popularity as a key resource to support SDL for rural physicians. Mobile technologies are enabling greater “point-of-care” learning and more efficient information seeking. Effective use of DSMTs for SDL has implications for enhancing just-in-time learning and quality of care. Increasing use of DSMTs and their new effect on SDL raises the need for reflection on conceptualizations of the SDL process. The “digital age” has implications for our CPD credit systems and the roles of CPD providers in supporting SDL using DSMTs.


Committee hears of NHI pilot problems

Stumbling blocks remain to effective testing of how the National Health Insurance will work at pilot sites.  Teething problems at provincial health departments, including a lack of co-ordination, poor planning and uncertainty in districts, remain stumbling blocks to the effective testing of how the National Health Insurance (NHI) will work at pilot sites.

The dire state of affairs was detailed in a Financial and Fiscal Commission presentation to Parliament’s portfolio committee on health and the standing committee on appropriations.

In 2015, Health Minister Aaron Motsoaledi introduced the NHI white paper. In February, the government announced that it would set up an NHI fund even though the white paper is considered a work in progress…..more

The Dr Atai Anne Deborah Omoruto Scholarship Award


This award is in the spirit of Atai’s leadership in family medicine in Africa, inspired by her dedication to the advancement of women physicians and women’s health in family medicine, and in tribute to Atai’s exceptional courage, selflessness, and commitment to her patients with Ebola both in Uganda and Liberia. She pioneered the establishment of family medicine program at Makerere University, Uganda and   was head of the family medicine department, Makerere University from 2004 to 2011. Atai was an executive member of the Wonca Working Party on Women and Family Medicine and was the recipient of Wonca 2016 Global Five Star Doctor Award in recognition of her extraordinary service as a family medicine leader over many years, her service to the people of Uganda, and her recent extraordinary leadership tackling the Ebola crisis in West Africa. Atai passed away in May, 2016.

Focus: The aim of the award is to support opportunities for African women doctors whose economic circumstances limit their ability to attend WONCA biennial conferences, particularly those women in their early career. The candidate for the Atai Omoruto Award should be an African woman family physician or family medicine resident in Africa, who demonstrates significant contributions in Africa, in any the following areas:

  • Leadership in Family Medicine at the institutional, local, or national level
  • Commitment to the advancement of women in family medicine
  • Clinical courage and selflessness in providing care to the most vulnerable populations

Process: A Potential candidate should submit:

  • a two-page essay stating how her attendance at the relevant conference (in the first instance, the WONCA Africa regional meeting in August 2017, including the WONCA Working Party on Women and Family Medicine preconference immediately before the regional meeting) will contribute to her ability to advance her work in some or all of the above three areas of achievement demonstrated by Atai

.      Evidence of need for funding in order to attend

  • a letter of support from a family physician familiar with her work
  • a curriculum vitae

Desirable: Evidence of high level achievement for those applicants in early career stages; evidence of work with disadvantaged peoples; breadth of activity within family medicine (e.g. teaching / research); prior involvement with WONCA activities.

Submission of Application: Application package should be submitted to Kerry Pert:

Application closing date: June 1, 2017

Risk scoring for the primary prevention of cardiovascular disease

Clinical effects of cardiovascular risk scores in people without cardiovascular disease

Review question

What is the evidence about the potential clinical benefits and harms of providing cardiovascular disease (CVD) risk scores in people without a history of heart disease or stroke?


Cardiovascular disease (CVD) is a group of conditions that includes heart disease and stroke. CVD prevention guidelines emphasise the use of risk scores, equations that use clinical variables to estimate the chance of a first heart attack or stroke, to guide treatment decisions in the general population. While there has been much attention to developing different types of CVD risk scores, there is uncertainty about the effects of providing a CVD risk score in clinical practice.

The aim of this systematic review was to assess the effects of evaluating CVD risk scores in adults without a history of heart disease or stroke on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours.

Study characteristics

We searched scientific databases for randomised trials (clinical studies that randomly put people into different treatment groups) that systematically provided CVD risk scores or usual care to adults without a history of heart disease or stroke. The evidence is current to March 2016. Funding for the majority of trials came from government sources or pharmaceutical companies.

Key results

We identified 41 trials that included 194,035 participants. Many of the studies had limitations. Low-quality evidence suggests that providing CVD risk scores had little or no effect on the number of people who develop heart disease or stroke. Providing CVD risk scores may reduce CVD risk factor levels (like cholesterol, blood pressure, and multivariable CVD risk) by a small amount and may increase cholesterol-lowering and blood pressure-lowering medication prescribing in higher risk people. Providing CVD risk scores may reduce harms, but the results were imprecise.

Quality of the evidence

There is low-quality evidence to guide the use of CVD risk scores in clinical practice. Studies had multiple limitations and used different methods to provide CVD risk scores. It is likely that further research will influence these results.


Architects designed this skyscraper attached to an asteroid to get around building restrictions

analemma-05cloudsaoManhattan is packed with towers, but the city still has height restrictions in various neighborhoods.

As a way to get around these mandates, New York firm Clouds Architecture Office has proposed an outlandish skyscraper that would hang from cables attached to an asteroid. Since the tower wouldn’t touch the ground, the designers say it would bypass maximum height restrictions. (Regardless, it’s doubtful the city has considered zoning laws for a floating building.)

Called the Analemma Tower, it would be the world’s tallest building — though, of course, there are no plans to construct it. Ostap Rudakevych tells Business Insider that the firm created the design to imagine what could be possible in the future…..more

Monitoring vital signs with artificial intelligence

mobile20medicineWireless patient monitors are being hooked up to a centralised artificial intelligence system by researchers who say the technology will be able to decide which patients need doctors’ attention first. Ageing societies in the West mean that overstretched staff are finding the crucial job of keeping tabs on patient vital signs increasingly difficult.

‘There’s a real burden of having to record vital signs frequently and accurately, which we struggle to meet,’ said John Welch, nurse consultant in critical care at University College London Hospitals (UCLH), UK. It means there is a desperate need to automate the essential job of keeping watch on patients, and raising the alarm if things become critical. ‘Many of the raw ingredients are in place … but there’s no-one pulling them together into one system,’ said Welch……more

Houses to be grown using plant-robot hybrids

002_braided20social20architectural20artifactsRobots and plants are being intricately linked into a new type of living technology that its creators believe could be used to grow a house. ‘The growth is for free, but we have to control the plants to grow in the shapes we want,’ explained Professor Heiko Hamann, from the University of Lübeck in Germany, who coordinates the EU-funded flora robotica project. The plants grow through a network of sensors, computers and 3D-printed robotic nodes that are connected to each other and constantly monitor the plants. The team uses a white plastic scaffolding with black strips woven into it to guide the growth. The strips contain LED lights and sensors that can cause plants to grow into pre-programed shapes…..more

How to Write Easy-to-Read Health Materials

Medical concepts and language can be complex. People need easily understandable health information regardless of age, background or reading level. MedlinePlus offers guidelines and resources to help you create easy-to-read health materials.

What are easy-to-read (ETR) materials?

ETR materials are written for audiences who have difficulty reading or understanding information. These materials can also benefit people who prefer reading easy-to-read information.

How do you create easy-to-read materials?

Writing ETR materials involves several important steps:

Step 1: Plan and Research….more

Diagnosis and management of dementia in LMICs

CITATION: Ferri CP, Jacob KS (2017) Dementia in low-income and middle-income countries: Different realities mandate tailored solutions. PLoS Med 14(3): e1002271. doi:10.1371/journal.pmed.1002271

‘The ageing of populations is the most significant social transformation of the 21st century [1] and has highlighted the importance of age-related conditions such as dementia, which has been recognised across regions, countries, and cultures. The number of people living with dementia has been increasing and is estimated to reach 75 million worldwide by 2030, with the majority of these individuals living in low-income and middle-income countries (LMICs) [2]. The assessment, recognition, and care of people living with dementia in LMICs are complex issues. Dementia is often seen as part of the ageing process, and even when recognized, there still remain problems related to stigma, lack of resources for the adequate care of people with dementia (PWD), variations in the way the condition is assessed and perceived, and how it is addressed in noncommunicable disease (NCD) policies and prevention strategies…

‘Dementia is under-recognised, underdisclosed, undertreated, and undermanaged, particularly in LMICs…

‘A strategy of employing community health workers to identify mental illnesses in general and dementia in particular in resource-poor settings has been recommended [9]; however, it has been found that this strategy leads to a very high false positive rate. The reasons for this rate include the fact that disorders with low prevalence at the community level cannot be diagnosed accurately unless a referral system is in place…’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare information – Join HIFA:  

MedBox: Free Resources

Screen Shot 2017-03-30 at 7.11.08 AMMEDBOX collates the increasing number of professional guidelines, textbooks and practical documents on health action available online today and brings these into the hands of humanitarian aid workers: when they need it, where they need it. MEDBOX is constantly updated. We are keen to receiving more documents, training materials and presentations relevant to improve the quality of health action!  MEDBOX is an independent platform providing information free of charge. ….more