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Koch GGV, Engel-Hills P, Friedrich-Nel H. Individual patient radiation dose tracking: Perceptions of radiographers in South Africa. Radiography (Lond) 2024; 30:1014-1020. [PMID: 38704978 DOI: 10.1016/j.radi.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Medical imaging examinations that make use of ionising radiation provide valuable information towards patient management. Literature suggests that there is a significant rise in the number of patient referrals for such examinations. The concept "individual patient radiation dose tracking" (IPRDT) is introduced to optimise radiation monitoring. Many countries across the globe explored and implemented methods to enhance and promote the justification and optimisation principles essential for patient radiation safety. In South Africa (SA), however, attention to IPRDT is limited. METHODS A qualitative research design was employed. Radiographers in the Western Cape Province of SA were purposefully sampled for participation in one-on-one, semi-structured interviews. Thematic analysis was applied to the transcribed interview data. RESULTS This paper presents a theme developed from the radiographer cohort of ten (10) participants. The theme: the need for creating awareness and implementing legislative support structures, was developed from the data, with the following supporting subthemes: 1) stakeholder awareness and 'buy-in' 2) continuous professional development and 3) mandated practice. CONCLUSION This study provides findings that are of value for patient radiation safety in SA by giving a voice to local stakeholders. Other countries that are conducting similar research investigations toward the integration of an IPRDT model, method, or framework, may also benefit from these findings. IMPLICATIONS FOR PRACTICE The effective integration of IPRDT into the clinical environment requires unison amongst the relevant stakeholders and clarity on the various professionals' roles and responsibilities. The findings of this study furthermore suggest the involvement of regulatory organisations for the provision of a mandated form of practice at national and international levels.
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Affiliation(s)
- G G V Koch
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa.
| | - P Engel-Hills
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa
| | - H Friedrich-Nel
- Central University of Technology, Free State, Faculty of Health and Environmental Sciences, Department of Clinical Sciences, South Africa
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Karera A, Engel-Hills P, Davidson F. Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers. Radiography (Lond) 2024; 30:560-566. [PMID: 38281318 DOI: 10.1016/j.radi.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers. METHODS A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9). RESULTS Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system. CONCLUSION Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges. IMPLICATIONS FOR PRACTICE There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.
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Affiliation(s)
- A Karera
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
| | - P Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
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Donkor A, Ayitey JA, Adotey PN, Ofori EO, Kitson-Mills D, Vanderpuye V, Opoku SY, Luckett T, Agar MR, Engel-Hills P. Mobile-Based Application Interventions to Enhance Cancer Control and Care in Low- and Middle-Income Countries: A Systematic Review. Int J Public Health 2023; 68:1606413. [PMID: 38125709 PMCID: PMC10732306 DOI: 10.3389/ijph.2023.1606413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Objective: To identify and appraise mobile-based application (mAPP) interventions that have been used to support cancer control and care in low- and middle-income countries (LMICs). Methods: Four electronic databases were systematically searched for studies that reported primary research findings related to mAPP interventions applied in oncology settings in LMICs. A narrative synthesis was performed using the Mhealth Index and Navigation Database as an analytical framework. Results: Twenty studies reporting 18 cancer control and care mAPPs were included in this review. Among these mAPPs, ten focused on prevention, screening and early detection of cancer, five provided information to optimise supportive and palliative care, two provided support to assist treatment-shared decision-making and one covered information for follow-up and survivorship care. Conclusion: Cancer mAPP interventions are gradually gaining attention in LMICs as they provide unique resources for empowering and strengthening the role of people with cancer in their own care. To enhance cancer control, a focus on prevention and early detection is important; however, more mAPP interventions related to cancer treatment, follow-up and survivorship are also needed to enable more cost-effective cancer care.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Doris Kitson-Mills
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Tim Luckett
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Meera R. Agar
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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Garba I, Engel-Hills P, Davidson F, Ismail A. Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study. J Med Imaging Radiat Sci 2023; 54:644-652. [PMID: 37596237 DOI: 10.1016/j.jmir.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. OBJECTIVE To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. METHODS Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. RESULTS The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. CONCLUSION The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.
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Affiliation(s)
- I Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa.
| | - P Engel-Hills
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa
| | - A Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Nigeria
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. Adv Health Sci Educ Theory Pract 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Minné D, Stromin J, Docrat T, Engel-Hills P, Marnewick JL. The effects of tea polyphenols on emotional homeostasis: Understanding dementia risk through stress, mood, attention & sleep. Clin Nutr ESPEN 2023; 57:77-88. [PMID: 37739736 DOI: 10.1016/j.clnesp.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/18/2023] [Accepted: 06/11/2023] [Indexed: 09/24/2023]
Abstract
Decades of research provide evidence that certain phytochemicals in tea (Camellia sinensis) and other herbal beverages are protective against the development of sporadic types of dementia in later life. Since tea drinking is an economical and widely adopted social-cultural practice across all age groups, it is an ideal product to target in designing low-cost dietary interventions for Alzheimer's Disease (AD), the most prevalent form of dementia. In this review, we focus on the protective roles of tea-derived polyphenols and other phytochemicals on mood, the stress response, attention, and sleep, in keeping with the perspective that many early neuropathological events in AD may stem, in part, from allostatic overload. This approach aligns with the perspective that many forms of dementia, including AD, begin to take root in the brain decades prior to symptom onset, underscoring the need for early uptake of accessible and viable lifestyle interventions. The findings reviewed here suggest that consuming green and oolong tea can improve mood and reduce overall stress. However, given the caffeine content in tea and its association with stress reactivity, the effects of daily whole tea consumption on the emotional state are likely dose-dependent with an inverted-U relationship to wellbeing. Plant-based beverages that are to be consumed in high daily quantities for health purposes and which are naturally free of caffeine, such as Rooibos, may be more appropriate as a dietary supplement for managing emotional regulation over the lifetime.
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Affiliation(s)
- Donné Minné
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa; Health and Wellness Sciences Faculty, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa.
| | - Juliet Stromin
- Psychology Department, University of Cape Town, Lover's Walk, Rondebosch, Cape Town, 7700, South Africa.
| | - Taskeen Docrat
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa.
| | - Penelope Engel-Hills
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa; Health and Wellness Sciences Faculty, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa.
| | - Jeanine L Marnewick
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Symphony Way, Bellville, Cape Town, 7535, South Africa.
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Engel-Hills P, Ibsen H, McDonald L. Exposing the benefits of a pedagogy of partnership in health professions education. Health SA 2023; 28:2329. [PMID: 37795150 PMCID: PMC10546219 DOI: 10.4102/hsag.v28i0.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background Literature indicates the need to prepare health professionals who are clinically competent and socially conscious. Engagement in community projects, as an extension of workplace learning, can build professional competence and social awareness. Aim To interrogate one such engagement; an emergency first aid responder training course was orchestrated by undergraduate students studying Emergency Medical Care. Setting The intervention was offered in response to a community need emerging from the research project being conducted in a community in the Western Cape, South Africa. Method Qualitative data were gathered as narrative texts from participants in the intervention and student reports about their learning experience. The data were interrogated through the application of reflexive thematic analysis and the theoretical lens of asymmetrical reciprocity. Findings The three themes that emerged were: from research to a student led intervention, deep authentic learning, and learning as a shared experience. Benefit accrued to the students and community through a partnership of asymmetrical participants. The community offered a learning experience while students offered desired skills acquisition to community members. Conclusion Through this interaction, students learnt respect for local knowledges, and gained enhanced social awareness, in a transdisciplinary partnership, that aimed to create a learning environment where academics, students, and community members are partners in a project delivered with a core value of social justice. Contribution A pedagogy of partnership describes an education model arising from community-based research that enabled a social programme intervention as a relevant learning project for health science students.
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Affiliation(s)
- Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Hilde Ibsen
- Department of Political, Historical, Religious and Cultural Studies, Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | - Llizane McDonald
- Department of Emergency Medical Care, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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Garba I, Engel-Hills P, Davidson F, Ismail A. Radiation dose management system in computed tomography procedures: a systematic review. Radiat Prot Dosimetry 2023:7130979. [PMID: 37078550 DOI: 10.1093/rpd/ncad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 05/03/2023]
Abstract
A systematic literature review was carried out to explore articles that reported the use of radiation dose management systems (RDMSs) in computed tomography (CT). The preferred reporting items for systematic review and meta-analysis flow chart were used to screen articles in PubMed, EBSCOhost, Web of Science, SCOPUS and Cochrane Library. A total of 1041 articles were retrieved and screened. After evaluation against criteria, 38 articles were selected and synthesised narratively. The results revealed that several RDMSs have been used in CT. The review also indicated that the use of RDMSs has promoted the implementation of diagnostic reference levels for dose optimisation. A RDMS, such as DoseWatch, is associated with compatibility challenges and failure in data transmission, while manual RDMSs are cumbersome and prone to data entry errors. Thus, a robust automated RDMS that is compatible with the different CT systems would provide efficient CT dose management.
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Affiliation(s)
- Idris Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Penelope Engel-Hills
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Florence Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Anas Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano 700001, Nigeria
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Karera A, Engel-Hills P, Davidson F. Radiographers' experiences of image interpretation training in a low-resource setting. Radiography (Lond) 2023; 29:590-596. [PMID: 37027946 DOI: 10.1016/j.radi.2023.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Radiographers extend their roles through formal and on-the-job training to keep up with clinical practice changes. One area of role extension that is now incorporated into undergraduate programmes is image interpretation, although the training provided may vary between institutions. This study explored the experiences of graduates from one higher education institution in a low-resource context with regard to their image interpretation training. METHODS A qualitative phenomenological research design was employed to investigate the experiences of ten radiography graduates who were purposively selected from one higher education institution. Individual semi-structured interviews were conducted with each participant after obtaining their informed consent. The interview recordings were transcribed and analysed using Atlas.ti Windows (Version 9.0) software, following Colaizzi's seven-steps of data analysis. RESULTS From the ten interviews conducted, teaching approach, clinical education, and assessment strategy emerged as areas of experience within the teaching and learning theme, while practitioner role modelling, skill utilisation, and industry impact were sub-themes under the paradoxical reality theme. The participants' experiences indicated a theory-practice gap in image interpretation among radiographers. CONCLUSION The participants' experiences reflected a misalignment in the educational process due to inadequacies in the teaching approach, clinical education, and assessment strategies. Participants encountered significant differences between their expectations and clinical realities during and after training. Image interpretation by radiographers was recognised as a relevant area for role extension in this low-resource setting. IMPLICATIONS FOR PRACTICE While these findings are specific to the experiences of the participants, conducting similar research in comparable contexts and implementing competency-based image interpretation assessments could help identify gaps and guide interventions to address shortcomings.
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Affiliation(s)
- A Karera
- Department of Radiography, School of Allied Health Sciences, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P.O Box 13301, Windhoek, Namibia.
| | - P Engel-Hills
- Faculty of Health and Wellness Sciences, Health Science Education Building, Symphony Way, Bellville, 7335, Western Cape, South Africa.
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Health Science Education Building, Symphony Way, Bellville, 7335, Western Cape, South Africa.
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10
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Johannes C, Moremi KE, Kemp MC, Whati L, Engel-Hills P, Kidd M, van Toorn R, Jaftha M, van Rensburg SJ, Kotze MJ. Pathology-supported genetic testing presents opportunities for improved disability outcomes in multiple sclerosis. Per Med 2023; 20:107-130. [PMID: 37194915 DOI: 10.2217/pme-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: Lipid metabolism may impact disability in people with multiple sclerosis (pwMS). Methods: Fifty-one pwMS entered an ultrasound and MRI study, of whom 19 had followed a pathology-supported genetic testing program for more than 10 years (pwMS-ON). Genetic variation, blood biochemistry, vascular blood flow velocities, diet and exercise were investigated. Results: pwMS-ON had significantly lower (p < 0.01) disability (Expanded Disability Status Scale) than pwMS not on the program (1.91 ± 0.75 vs 3.87 ± 2.32). A genetic variant in the lipid transporter FABP2 gene (rs1799883; 2445G>A, A54T) was significantly associated (p < 0.01) with disability in pwMS not on the program, but not in pwMS-ON (p = 0.88). Vascular blood flow velocities were lower in the presence of the A-allele. Conclusion: Pathology-supported genetic testing may provide guidance for lifestyle interventions with a significant impact on improved disability in pwMS.
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Affiliation(s)
- Clint Johannes
- Department of Internal Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - Kelebogile E Moremi
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine & Health Sciences, Stellenbosch University, & National Health Laboratory Service (NHLS), Cape Town, 7500, South Africa
| | - Merlisa C Kemp
- Department of Medical Imaging & Therapeutic Sciences, Faculty of Health & Wellness Sciences, Cape Peninsula University of Technology, Bellville campus, Cape Town, 7530, South Africa
| | | | - Penelope Engel-Hills
- Faculty of Health & Wellness Sciences, Cape Peninsula University of Technology, Cape Town, 7530, South Africa
| | - Martin Kidd
- Department of Statistics & Actuarial Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronald van Toorn
- Department of Pediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - Mariaan Jaftha
- Department of Medical Imaging & Therapeutic Sciences, Faculty of Health & Wellness Sciences, Cape Peninsula University of Technology, Bellville, 7530, South Africa
- Cape University Body Imaging Centre, Faculty of Human Biology, University of Cape Town, Cape Town, 7925 South Africa
| | - Susan J van Rensburg
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine & Health Sciences, Stellenbosch University, & National Health Laboratory Service (NHLS), Cape Town, 7500, South Africa
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Minné D, Marnewick JL, Engel-Hills P. Early Chronic Stress Induced Changes within the Locus Coeruleus in Sporadic Alzheimer's Disease. Curr Alzheimer Res 2023; 20:301-317. [PMID: 37872793 DOI: 10.2174/1567205020666230811092956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 10/25/2023]
Abstract
Chronic exposure to stress throughout the lifespan has been the focus of many studies on Alzheimer's disease (AD) because of the similarities between the biological mechanisms involved in chronic stress and the pathophysiology of AD. In fact, the earliest abnormality associated with the disease is the presence of phosphorylated tau protein in locus coeruleus neurons, a brain structure highly responsive to stress and perceived threat. Here, we introduce allostatic load as a useful concept for understanding many of the complex, interacting neuropathological changes involved in the AD degenerative process. In response to chronic stress, aberrant tau proteins that begin to accumulate within the locus coeruleus decades prior to symptom onset appear to represent a primary pathological event in the AD cascade, triggering a wide range of interacting brain changes involving neuronal excitotoxicity, endocrine alterations, inflammation, oxidative stress, and amyloid plaque exacerbation. While it is acknowledged that stress will not necessarily be the major precipitating factor in all cases, early tau-induced changes within the locus coeruleus-norepinephrine pathway suggests that a therapeutic window might exist for preventative measures aimed at managing stress and restoring balance within the HPA axis.
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Affiliation(s)
- Donné Minné
- Applied Microbial & Health Biotechnology Institute, Cape Peninsula University of Technology, Cape Town, 7535, South Africa
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, 7535, South Africa
| | - Jeanine L Marnewick
- Applied Microbial & Health Biotechnology Institute, Cape Peninsula University of Technology, Cape Town, 7535, South Africa
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, 7535, South Africa
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12
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Thomas H, Naidoo K, Engel-Hills P. Resilience from the perspective of diagnostic radiography students. Radiography (Lond) 2023; 29:56-61. [PMID: 36327515 DOI: 10.1016/j.radi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Resilience is a concept associated with the ability to overcome, adapt, and recover from stressors. The radiography profession is known to be stressful, and one can reason that radiographers must be resilient in order to cope with the clinical environment. Research shows there are varied understandings of resilience. However, little is known about the concept of resilience specifically as it relates to the perspectives of diagnostic radiography students within the clinical workplace. This paper reports on one aspect of a comprehensive study of resilience amongst radiography students. The objective of this paper is, therefore, to present the exploration of the concept of resilience drawing from the data gathered from first-year diagnostic radiography students. METHODS A qualitative, explorative, descriptive and contextual approach was adopted for this study. Qualitative data was collected through focus group interviews. A purposive sampling method was employed, selecting from first-year diagnostic radiography students at a University of Technology (UoT) in the Western Cape, South Africa. Interviews were audio-recorded transcribed and thematically analysed. Data was collected until saturation was reached. RESULTS The meaning of resilience as explained from the perspective of radiography students included three subthemes namely: (1) fundamentals of resilience; (2) external protective factors and (3) internal protective factors. CONCLUSION This study demonstrated that radiography students associated resilience with positive attributes. Furthermore, the study identified various resilience enhancement strategies to better support diagnostic radiography students in the clinical environment like supportive radiographers and talking to peers. IMPLICATIONS FOR PRACTICE The identification of resilience enhancement strategies is important as it will assist with the introduction of curriculum renewal initiatives tailored to support first-year diagnostic radiography students as they develop their resilience to stressors in the clinical environment.
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Affiliation(s)
- H Thomas
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa.
| | - K Naidoo
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa
| | - P Engel-Hills
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa
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Singh S, Engel-Hills P. Invited Peer Commentary: Research Site Anonymity in Context. J Empir Res Hum Res Ethics 2022; 17:565-572. [PMID: 36394587 DOI: 10.1177/19401612221138478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shenuka Singh
- Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Western Cape, South Africa
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Kemp MC, Johannes C, van Rensburg SJ, Kidd M, Isaacs F, Kotze MJ, Engel-Hills P. Disability in multiple sclerosis is associated with vascular factors: An ultrasound study. J Med Imaging Radiat Sci 2022; 54:247-256. [PMID: 36528497 DOI: 10.1016/j.jmir.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although multiple sclerosis (MS) is an immune-related disorder, pharmaceutical interventions targeting the immune system do not stop or reverse disability progression; the major challenge for this condition. Studies show that disability progression in MS is associated with vascular comorbidity and brain volume loss, indicating that a multi-targeted approach is required to prevent debilitation. The aim of the present study was to examine the associations between vascular ultrasound, disability, biochemistry and lifestyle data in people with MS (pwMS). METHODS Extracranial vascular ultrasound was performed on 51 pwMS and 25 age-matched controls. Sonographic interrogation determined carotid intima-media thickness (cIMT) and abnormal blood flow patterns. Disability was assessed using the Expanded Disability Status Scale (EDSS). Biochemical and lifestyle data were obtained for all participants. RESULTS The EDSS had a highly significant positive association with the cIMT of the right (r = 0.63; p = 0.001) and left (r = 0.49; p = 0.001) common carotid arteries and negative associations with the peak systolic blood flow velocity of the right vertebral artery (r = -0.42; p = 0.01) as well as end-diastolic velocity of the left internal carotid artery (r = -0.47; p = 0.01). These associations were significantly influenced by biochemical and lifestyle factors. Both cIMT and age showed significant associations with the EDSS. When cIMT was adjusted for age in a regression analysis, the association between the EDSS and the cIMT remained significant (p < 0.01), while the age association was reduced to being significant only at 10% (p = 0.06). There was no association between the use of MS medication and the EDSS (p = 0.56). CONCLUSION PwMS who had increased cIMT, a surrogate marker for atherosclerosis, and reduced carotid artery blood flow velocities were at risk for greater disability over and above the effect of aging. These findings provide important information for disease management and disability prevention in pwMS. Modification of diet and lifestyle may promote the unhindered flow of essential nutritional factors into the brain in pwMS.
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Thomas H, Naidoo K, Engel-Hills P. Diagnostic radiography students’ perspectives of resilience. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.10.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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16
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Adomako IA, Venter D, Sampane Donkor E, Engel-Hills P. Radiology imaging equipment and accessories as possible fomites of nosocomial pathogens. J Infect Dev Ctries 2022; 16:1174-1184. [PMID: 35905022 DOI: 10.3855/jidc.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/02/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Radiology is a technical service that provides medical imaging for all sectors of healthcare. Hospital-acquired infections (HAIs) is a major challenge in radiology and this is exacerbated in contexts where the healthcare system is unable to provide adequate funding and attention to effective infection control measures. The objectives of this study were to audit current cleaning procedures through the observation of practices in a radiology department, and to determine the types and numbers of nosocomial pathogens present on selected radiology imaging equipment and accessories before and after decontamination. METHODOLOGY In phase one we observed seven radiographers to audit cleaning procedures and practices. In phase two we collected swab samples from selected radiology imaging equipment and accessories and then cultured them for identification of microbes. RESULTS It was observed that radiographers partially practiced infection control measures. This was due to the absence of documented protocol for infection control procedures. Our results indicated that all the selected equipment and accessories were contaminated with microorganisms pre- and post-cleaning. The identified microbes were Staphylococcus aureus, Coagulase negative Staphylococci (CoNS), Bacillus species (spp.), Shigella spp., Shigella sonnei., Klebsiella spp., Salmonella paratyphi A (S. paratyphi A), Salmonella typhi (S. typhi), Providencia rettgeri, Enterobacter spp. and Citrobacter spp. and Methicillin resistant strains of Staphylococcus aureus (MRSA). CONCLUSIONS The research concluded that the recommended cleaning agents did not effectively reduce the number of microorganisms making the selected equipment and accessories fomites for nosocomial pathogens.
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Affiliation(s)
- Isaac Agyekum Adomako
- Cape Peninsula University of Technology (CPUT), Medical Imaging and Therapeutic Sciences; Cape Town, South Africa.
| | - Dalene Venter
- CPUT, Medical Imaging and Therapeutic Sciences Cape Town, South Africa
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Hudson L, Engel-Hills P, Davidson F, Naidoo K. Radiography lecturers' understanding of a socially responsive curriculum. Radiography (Lond) 2022; 28:684-689. [PMID: 35724473 DOI: 10.1016/j.radi.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. METHOD A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. RESULTS Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. CONCLUSION Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. IMPLICATIONS FOR PRACTICE Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.
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Affiliation(s)
- L Hudson
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Office H041, Ground Floor, New Science Building, Bellville Campus, Robert Sobukwe Road, Bellville 7530, South Africa.
| | - P Engel-Hills
- Faculty of Health and Wellness Sciences & Professional Education Research Institute, Cape Peninsula University of Technology, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - K Naidoo
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
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18
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van Rensburg SJ, van Toorn R, Erasmus RT, Hattingh C, Johannes C, Moremi KE, Kemp MC, Engel-Hills P, Kotze MJ. Pathology-supported genetic testing as a method for disability prevention in multiple sclerosis (MS). Part I. Targeting a metabolic model rather than autoimmunity. Metab Brain Dis 2021; 36:1151-1167. [PMID: 33909200 DOI: 10.1007/s11011-021-00711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
In this Review (Part I), we investigate the scientific evidence that multiple sclerosis (MS) is caused by the death of oligodendrocytes, the cells that synthesize myelin, due to a lack of biochemical and nutritional factors involved in mitochondrial energy production in these cells. In MS, damage to the myelin sheaths surrounding nerve axons causes disruption of signal transmission from the brain to peripheral organs, which may lead to disability. However, the extent of disability is not deterred by the use of MS medication, which is based on the autoimmune hypothesis of MS. Rather, disability is associated with the loss of brain volume, which is related to the loss of grey and white matter. A pathology-supported genetic testing (PSGT) method, developed for personalized assessment and treatment to prevent brain volume loss and disability progression in MS is discussed. This involves identification of MS-related pathogenic pathways underpinned by genetic variation and lifestyle risk factors that may converge into biochemical abnormalities associated with adverse expanded disability status scale (EDSS) outcomes and magnetic resonance imaging (MRI) findings during patient follow-up. A Metabolic Model is presented which hypothesizes that disability may be prevented or reversed when oligodendrocytes are protected by nutritional reserve. Evidence for the validity of the Metabolic Model may be evaluated in consecutive test cases following the PSGT method. In Part II of this Review, two cases are presented that describe the PSGT procedures and the clinical outcomes of these individuals diagnosed with MS.
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Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Ronald van Toorn
- Department of Pediatric Medicine and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Coenraad Hattingh
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clint Johannes
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kelebogile E Moremi
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Merlisa C Kemp
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
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van Rensburg SJ, Hattingh C, Johannes C, Moremi KE, Peeters AV, van Heerden CJ, Erasmus RT, Zemlin AE, Kemp MC, Jaftha M, Khine AA, Potocnik FCV, Whati L, Engel-Hills P, van Toorn R, Kotze MJ. Correction to: Pathology-supported genetic testing as a method for disability prevention in multiple sclerosis (MS). Part II. Insights from two MS cases. Metab Brain Dis 2021; 36:1183-1184. [PMID: 33909201 DOI: 10.1007/s11011-021-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Coenraad Hattingh
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clint Johannes
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Kelebogile E Moremi
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Armand V Peeters
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carel J van Heerden
- Central Analytical Facility (CAF), DNA Sequencing Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Merlisa C Kemp
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Mariaan Jaftha
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Aye Aye Khine
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Felix C V Potocnik
- Department of Psychiatry and Mental Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lindiwe Whati
- Genetic Care Centre, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Ronald van Toorn
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
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van Rensburg SJ, Hattingh C, Johannes C, Moremi KE, Peeters AV, van Heerden CJ, Erasmus RT, Zemlin AE, Kemp MC, Jaftha M, Khine AA, Potocnik FCV, Whati L, Engel-Hills P, van Toorn R, Kotze MJ. Pathology-supported genetic testing as a method for disability prevention in multiple sclerosis (MS). Part II. Insights from two MS cases. Metab Brain Dis 2021; 36:1169-1181. [PMID: 33710528 DOI: 10.1007/s11011-021-00712-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
In Part I of this Review we evaluated the scientific evidence for a Metabolic Model of multiple sclerosis (MS). Part II outlines the implementation of an adaptive pathology-supported genetic testing (PSGT) algorithm aimed at preventing/reversing disability in two illustrative MS cases, starting with a questionnaire-based risk assessment, including family history and lifestyle factors. Measurement of iron, vitamin B12, vitamin D, cholesterol and homocysteine levels identified biochemical deficits in both cases. Case 1, after following the PSGT program for 15 years, had an expanded disability status scale (EDSS) of 2.0 (no neurological sequelae) together with preserved brain volume on magnetic resonance imaging (MRI). A novel form of iron deficiency was identified in Case 1, as biochemical testing at each hospital submission due to MS symptoms showed low serum iron, ferritin and transferrin saturation, while hematological status and erythrocyte sedimentation rate measurement of systemic inflammation remained normal. Case 2 was unable to walk unaided until her EDSS improved from 6.5 to 4.0 over 12 months after implementation of the PSGT program, with amelioration of her suboptimal biochemical markers and changes to her diet and lifestyle, allowing her to regain independence. Genotype-phenotype correlation using a pathway panel of functional single nucleotide variants (SNVs) to facilitate clinical interpretation of whole exome sequencing (WES), elucidated the underlying metabolic pathways related to the biochemical deficits. A cure for MS will remain an elusive goal if separated from nutritional support required for production and maintenance of myelin, which can only be achieved by a lifelong investment in wellness.
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Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Coenraad Hattingh
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clint Johannes
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Kelebogile E Moremi
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Armand V Peeters
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carel J van Heerden
- Central Analytical Facility (CAF), DNA Sequencing Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Merlisa C Kemp
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Mariaan Jaftha
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Aye Aye Khine
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - Felix C V Potocnik
- Department of Psychiatry and Mental Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lindiwe Whati
- Genetic Care Centre, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Ronald van Toorn
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, National Health Laboratory Service (NHLS), Cape Town, South Africa
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Engel-Hills P, Winberg C, Rip A. Ethics "Upfront": Generating an Organizational Framework for a New University of Technology. Sci Eng Ethics 2019; 25:1705-1720. [PMID: 31564037 DOI: 10.1007/s11948-019-00140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
A powerful set of projections has constructed post-apartheid higher education in South Africa. Among these is the expectation that technikons (institutions similar to the British polytechnics) would become universities of technology, with a mission to drive the technology of national reconstruction and development. In this paper, one of the new universities of technology serves as a case study to explore organizational structure and to highlight the ethics of university management and leadership. Building a new university provides the opportunity to place ethics "upfront", rather than as an afterthought, by constructing an organizational framework that makes ethical issues integral to management and decision-making processes. In imagining the structure of a university of technology, the authors were inspired by future scripting methods developed by Bastiaan De Laat, and by Duncan Den Boer, Arie Rip and Sandra Speller. The research process firstly involved the identification of themes related to values and ethics through an analysis of the environment. These themes were incorporated into three scenarios of possible futures for this new university type. Using these scenarios, the ethical issues that emerged (according to how the university of technology might choose to organise itself), are compared with the original themes. Conclusions are then drawn with regard to management structures that are hierarchical and entrench compliance, or that are traditionally collegiate and expertise-based, or that might enable mutual appreciation and allow for leaders to emerge within any functional space at a university of technology.
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Affiliation(s)
- Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, P.O. Box 1906, Bellville, Cape Town, 7535, South Africa.
| | - Christine Winberg
- Professional Education and Research Institute, Cape Peninsula University of Technology, P.O. BOX 1906, Bellville, Cape Town, 7535, South Africa
| | - Arie Rip
- Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
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van de Venter R, Engel-Hills P, Stroud L. The Mmogo-Method: Application, Experiences, and Lessons Learnt in Researching Radiography Students' Experiences and Coping With Death and Dying. J Med Imaging Radiat Sci 2019; 50:359-364. [PMID: 31320273 DOI: 10.1016/j.jmir.2019.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to share the application, experiences, and lessons learnt regarding the value of the Mmogo-method that is a visual projective research method, in the context of exploring the experiences and coping of undergraduate diagnostic radiography students with death and dying patients in the workplace. METHODS Verbatim data were gathered during the debriefing phase of the adapted Mmogo-method technique from the participants. In addition, the reflective memos of the independent coder and interviewer were used as data sources. RESULTS The experiences of various stakeholders positively supported the use of the visual projective research method. The method enabled them to freely and openly verbalise their experiences of coping with death and dying in the workplace. Juxtaposing these was one experience of indifference. CONCLUSION The Mmogo-method provides rich data and enables an ethically and methodologically rigorous opportunity to obtain new insights into sensitive topics. It is recommended for consideration when researching sensitive topics.
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Affiliation(s)
- Riaan van de Venter
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa; Department of Radiography, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Penelope Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Louise Stroud
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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Herbert E, Engel-Hills P, Hattingh C, Fouche JP, Kidd M, Lochner C, Kotze MJ, van Rensburg SJ. Fractional anisotropy of white matter, disability and blood iron parameters in multiple sclerosis. Metab Brain Dis 2018; 33:545-557. [PMID: 29396631 DOI: 10.1007/s11011-017-0171-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Multiple sclerosis (MS) is a disorder related to myelin damage, which can be investigated by neuroimaging techniques such as fractional anisotropy (FA), a measure of microstructural white matter properties. The objectives of this study were to investigate (1) the relationship between FA and disability using an extremes of outcome approach, and (2) whether blood iron parameters were associated with FA and/or disability. Patients diagnosed with MS (n = 107; 14 males and 93 females) had iron parameter tests and disability determinations using the Expanded Disability Status Scale (EDSS). FA was recorded in 48 white matter tracts in 11 of the female patients with MS and 12 female controls. RESULTS In patients with high disability scores the mean FA was significantly lower (0.34 ± 0.067) than in the control group (0.45 ± 0.036; p = 0.04), while patients with low disability had mean FA values (0.44 ± 0.014) similar to controls (p = 0.5). Positive associations were found between FA and the iron parameters serum iron, ferritin and percentage transferrin saturation (%Tfsat) in all the white matter tracts. For % Tfsat, the associations were highly significant in 14 tracts (p < 0.01; r-values 0.74-0.84) and p < 0.001 (r = 0.83) in the superior fronto occipital fasciculus (LH). In the whole patient group a trend was found towards an inverse association between the EDSS and the %Tfsat (r = -0.26, p = 0.05) after excluding male gender and smoking as confounders, suggesting reduced disability in the presence of higher blood iron parameters. Additionally, significant inverse associations between disease duration and haemoglobin (p = 0.04) as well as %Tfsat (p = 0.02) suggested that patients with MS may experience a decrease in blood iron concentrations over time.
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Affiliation(s)
- Estelle Herbert
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Coenraad Hattingh
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Jean-Paul Fouche
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - Christine Lochner
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Susan J van Rensburg
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
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Abstract
Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.
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Affiliation(s)
- I Garba
- Department of Medical Radiography, Bayero University Kano, Kano, Kano State, Nigeria
| | - P Engel-Hills
- Department of Nursing and Radiography, Cape Peninsula University of Technology Cape Town, Cape Town, South Africa
| | - F Davidson
- Department of Nursing and Radiography, Cape Peninsula University of Technology Cape Town, Cape Town, South Africa
| | - A M Tabari
- Department of Radiology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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Mushosho EY, Ndlovu N, Engel-Hills P, Wyrley-Birch B. Presentation patterns of invasive cancer of the cervix: results from Parirenyatwa Oncology and Radiotherapy Centre, Harare, Zimbabwe 1998-2010. Cent Afr J Med 2011; 57:43-49. [PMID: 24968662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
MAIN OBJECTIVE The study sought to identify the presentation patterns of invasive uterine cancer of the cervix (CaCx) in Zimbabwe in terms of histology, stage of the disease, ages of patients and socio-economic status. DESIGN Retrospective study from 1998 to 2010. SUBJECTS All patients who registered for the first time with invasive CaCx over a systematically selected sample period of four years (1998, 2002, 2006 & 2010). SETTING The main referral Radiotherapy and Oncology centre in Harare the capital city of Zimbabwe. RESULTS Majority of patients (91.75%) presented with squamous cell carcinoma, 5.5% presented with adenocarcinomas and 2.75% presented with other types of histology. Late presentation was noted with the majority of the patients (89%) presenting with stage IIB and above. The common ages of patients at presentation were between 40 to 60 years. The majority of the patients (59.5%) were of low socio-economic status. CONCLUSION In the developed countries CaCx is reducing in frequency, presentation tends to be early, treatment effective and there is decreasing mortality rate from this disease. However in developing countries the situation is not as positive and the disease remains a major concern. This is shown by the presentation pattern of patients with invasive CaCx in Zimbabwe. The patients are shown to present with late stage disease of the squamous cell type, primarily in the age ranges of 40 to 60 years and with the majority of the patients belonging to the low socio-economic status group.
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Coffey M, Engel-Hills P, El-Gantiry M, Benjaafar N, Wilkinson K, Vikram B. A core curriculum for RTTs (radiation therapists/radiotherapy radiographers) designed for developing countries under the auspices of the international atomic energy agency (IAEA). Radiother Oncol 2006; 81:324-5. [PMID: 17126433 DOI: 10.1016/j.radonc.2006.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 08/23/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Mary Coffey
- Division of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland
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