Roles of clinical supervisors in the clinical training of radiography students in Zambia: a qualitative study

IntroductionClinical supervisors are responsible for the facilitation of practice-based learning for radiography students. However, literature is scarce on the roles of clinical supervisors in the clinical training of students in Zambia.ObjectiveThis study was aimed at identifying and exploring the roles of clinical supervisors in the clinical training of radiography students in Zambia.MethodsA qualitative design with unstructured interviews was used in this study. Ten individual interviews were conducted in July 2018 with clinical supervisors of radiography students working at the main clinical training and placement sites of the Lusaka and Copperbelt provinces of Zambia, respectively. All digital interview recordings were transcribed verbatim and analysed thematically.ResultsThree main roles of a clinical supervisor emerged: managerial, educational, and supportive. The managerial role deals with organising and managing clinical training resources. The educational role involves imparting knowledge and skills to students. The supportive role involves supporting students with social and learning problems. Findings show the inter-relationship of these roles to each other.ConclusionClinical supervisors need to understand their roles in order to develop and maintain their competences in the facilitation of practice-based learning. This could also help stakeholders to provide appropriate support to clinical supervisors.     

Direct susceptibility testing for multi drug resistant tuberculosis: A meta-analysis

Background

One of the challenges facing the tuberculosis (TB) control programmes in resource-limited settings is lack of rapid techniques for detection of drug resistant TB, particularly multi drug resistant tuberculosis (MDR TB). Results obtained with the conventional indirect susceptibility testing methods come too late to influence a timely decision on patient management. More rapid tests directly applied on sputum samples are needed. This study compared the sensitivity, specificity and time to results of four direct drug susceptibility testing tests with the conventional indirect testing for detection of resistance to rifampicin and isoniazid in M. tuberculosis. The four direct tests included two in-house phenotypic assays – Nitrate Reductase Assay (NRA) and Microscopic Observation Drug Susceptibility (MODS), and two commercially available tests – Genotype^® MTBDR and Genotype^® MTBDRplus (Hain Life Sciences, Nehren, Germany).

Methods

A literature review and meta-analysis of study reports was performed. The Meta-Disc software was used to analyse the reports and tests for sensitivity, specificity, and area under the summary receiver operating characteristic (sROC) curves. Heterogeneity in accuracy estimates was tested with the Spearman correlation coefficient and Chi-square.

Results

Eighteen direct DST reports were analysed: NRA – 4, MODS- 6, Genotype MTBDR^® – 3 and Genotype^® MTBDRplus – 5. The pooled sensitivity and specificity for detection of resistance to rifampicin were 99% and 100% with NRA, 96% and 96% with MODS, 99% and 98% with Genotype^® MTBDR, and 99% and 99% with the new Genotype^® MTBDRplus, respectively. For isoniazid it was 94% and 100% for NRA, 92% and 96% for MODS, 71% and 100% for Genotype^® MTBDR, and 96% and 100% with the Genotype^® MTBDRplus, respectively. The area under the summary receiver operating characteristic (sROC) curves was in ranges of 0.98 to 1.00 for all the four tests. Molecular tests were completed in 1 – 2 days and also the phenotypic assays were much more rapid than conventional testing.

Conclusion

Direct testing of rifampicin and isoniazid resistance in M. tuberculosis was found to be highly sensitive and specific, and allows prompt detection of MDR TB.     

Developing a Framework Strategy for Supporting Radiographers in the Clinical Supervision of Radiography Students in Zambia: A Mixed Methods Study

BackgroundClinical supervisors of radiography students play a key role in the facilitation of practice-based learning. However, there is a scarcity of evidence-based strategies to support clinical supervisors. This study aimed at exploring the level of support required by radiographers in order to develop a framework strategy for supporting clinical supervisors of radiography students in Zambia.MethodsThis study used an exploratory sequential mixedmethods approach. The qualitative phase was conducted first, and the findings were used to develop the questionnaire for the quantitative phase. The study population was radiographers working in the Lusaka and Copperbelt provinces of Zambia. For the first phase, data were collected from a purposive sample of 10 clinical supervisors of radiography students. For the survey, data were collected from 120 radiographers using a questionnaire. In the third phase, a group of experts validated the proposed framework using an online questionnaire. Qualitative data were analysed thematically and quantitative data using statistics.ResultsFour support areas were identified: training and education in clinical supervision, clinical training resources, human resources and relationships, and quality assurance programmes related to clinical supervision. These findings informed the development of a support framework strategy for clinical supervisors.ConclusionThis study has revealed that clinical supervision of radiography students requires coordinated support from stakeholders: schools of radiography, professional body, and radiology and hospital management. It is anticipated that the developed framework, when implemented, will enhance the experiences of clinical supervisors and improve the quality of clinical education.     

Rapid screening of MDR-TB using molecular Line Probe Assay is feasible in Uganda

Background  

About 500 new smear-positive Multidrug-resistant tuberculosis (MDR-TB) cases are estimated to occur per year in Uganda. In 2008 in Kampala, MDR-TB prevalence was reported as 1.0% and 12.3% in new and previously treated TB cases respectively. Line probe assays (LPAs) have been recently approved for use in low income settings and can be used to screen smear-positive sputum specimens for resistance to rifampicin and isoniazid in 1-2 days.     

Antibacterial activities of extracts from Ugandan medicinal plants used for oral care

Ethnopharmacological relevance

Medicinal plants are widely used for treatment of oral/dental diseases in Uganda.

Aim of the study

To investigate antibacterial activities of 16 commonly used medicinal plants on microorganisms associated with periodontal diseases (PD) and dental caries (DC).

Materials and methods

Pulp juice and solvent extracts (hexane, methanol and water) from the plants were tested against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia associated with PD and Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus associated with DC. Tests were done using agar well-diffusion (pulp juice) and agar-dilution (Solvent extracts) assays.

Results

Pulp juice from Zanthoxylum chalybeum and Euclea latidens showed activity against all the bacteria, Zanthoxylum chalybeum being most active. Hexane extract from aerial part of Helichrysum odoratissimum was most active (MIC: 0.125–0.5 mg/ml). Methanol extract from leaves of Lantana trifolia showed activity against all bacteria (MIC: 0.25–1 mg/ml).

Conclusion

Several of the tested plants showed antibacterial activities against bacteria associated with PD and DC, meriting further investigations.