1,720,988 research outputs found
A mixed methods analysis of clostridioides difficile infection and implementation of a quality improvement intervention in public sector hospitals in Cape Town, South Africa
No full textPhilosophiae Doctor - PhDBackground: Clostridioides difficile or Clostridium difficile infection (CDI), is a global health threat known for devastating outbreaks, high-cost complications, readmissions and mortality. While CDI is widely studied in high resource settings, existing literature neglects low resource settings. Prior to this study, no publications were available on the epidemiology of CDI and CDI patient outcomes in the secondary hospitals in the public healthcare sector — gaps this thesis addresses. No publications existed on provider awareness of CDI and CDI management workflow in sub-Saharan Africa. This thesis aims to a) determine baseline CDI patient characteristics, management of and contribution to mortality in SA, b) identify CDI perceptions and practices among healthcare providers in SA secondary hospitals, including facilitators and barriers to providing quality CDI care, and c) develop a CDI intervention and analysis thereof
Current practices of urinary tract infection management: An observational study at primary healthcare level
No full textMagister Pharmaceuticae - MPharmAntibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province
Current practices of urinary tract infection management: An observational study at primary healthcare level
Get PDFMagister Pharmaceuticae - MPharmAntibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province
Venous thromboembolism risk assessment and prophylaxis in selected public sector hospitals in the Cape Town metropole
No full textMagister Pharmaceuticae - MPharmBackground: Venous thromboembolism (VTE) is reported to be the leading
cause of death in hospitalised patients worldwide. Thromboprophylaxis
provides a well-established and evidence-based approach to preventing VTE.
This approach employs individualised patient risk stratification followed by
the provision of pharmacological and/or non-pharmacological prophylaxis.
Although various VTE risk assessment models (RAMs) are available, the
Caprini RAM offers an objective, evidence-based and validated approach to
risk assessment in hospitalised medical patients. Literature findings are
indicative of a trend towards both under- and inappropriate VTE prophylaxis
prescribing in this patient population. Together with the reported lack of
medical practitioner appreciation for VTE risk assessment, the necessity to
explore these aspects of practice is evident.
Methods: This study used a retrospective, cross-sectional study design. It was
conducted at one regional- and two district-level public hospitals in the Cape
Town Metropole in the Western Cape province of South Africa. Medical
folders of all adult hospitalised medical patients who were admitted to a
general medical ward between January and July 2020 were retrospectively
reviewed using a uniquely designed data collection tool. The data collection
tool included the 2013 version of the Caprini RAM, which was employed to
document VTE risk factors and assess overall VTE risk. Thromboprophylaxis
regimens prescribed as well as contraindications to pharmacological
thromboprophylaxis were also reviewe
Evaluation of the level of compliance of Veterinary medicine package inserts with Regulatory authority guidelines
Get PDFMagister Scientiae (Medical Bioscience) - MSc(MBS)Background: Veterinary medicines play an imperative role in the diagnosis, prevention and
treatment of animal diseases. Many veterinary stock remedies in South Africa are available to
the public without the intervention or supervision of a veterinarian or healthcare worker.
Therefore, the accompanying package insert with product information and directions for use is
central in promoting the safe and effective use of stock remedies. Information such as the
dosage, warnings, precautions and storage instructions are essential to assist the user in their
treatment decision-making. While local regulatory authority guidelines prescribe and control
the minimum information that should be available in the package insert or product label, it is
questioned whether the information contained in package inserts of products on the market
complies with these regulatory requirements.
Methodology: Using simple random sampling of veterinary stock remedies, 159 package
inserts or product labels from various animal health companies were selected and evaluated
against the prescribed labelling guidelines of the local regulatory authority responsible for the
registration and control of stock remedies. The contents of each package insert or label in the
sample were assessed for the presence of the prescribed information statements and were
accordingly classified as non-compliant, partially compliant or compliant.
Results: Among the 159 package inserts, 48 were for antimicrobials, 49 for ectoparasiticides,
44 for anthelmintics and the remaining 18 for endectocides. It was observed that none of the
package inserts met all of the criteria and that the package inserts were inadequate in many
aspects. The average percentage of compliance was 69.43%, with a range of 36.21% to 87.93%.
Conclusion: The study indicated that many package inserts do not fully comply with the
prescribed regulatory guidelines and that information related to the safe and appropriate use of
stock remedies is insufficient
Venous thromboembolism risk assessment and prophylaxis in selected public sector hospitals in the Cape Town metropole
Get PDFMagister Pharmaceuticae - MPharmBackground: Venous thromboembolism (VTE) is reported to be the leading
cause of death in hospitalised patients worldwide. Thromboprophylaxis
provides a well-established and evidence-based approach to preventing VTE.
This approach employs individualised patient risk stratification followed by
the provision of pharmacological and/or non-pharmacological prophylaxis.
Although various VTE risk assessment models (RAMs) are available, the
Caprini RAM offers an objective, evidence-based and validated approach to
risk assessment in hospitalised medical patients. Literature findings are
indicative of a trend towards both under- and inappropriate VTE prophylaxis
prescribing in this patient population. Together with the reported lack of
medical practitioner appreciation for VTE risk assessment, the necessity to
explore these aspects of practice is evident.
Methods: This study used a retrospective, cross-sectional study design. It was
conducted at one regional- and two district-level public hospitals in the Cape
Town Metropole in the Western Cape province of South Africa. Medical
folders of all adult hospitalised medical patients who were admitted to a
general medical ward between January and July 2020 were retrospectively
reviewed using a uniquely designed data collection tool. The data collection
tool included the 2013 version of the Caprini RAM, which was employed to
document VTE risk factors and assess overall VTE risk. Thromboprophylaxis
regimens prescribed as well as contraindications to pharmacological
thromboprophylaxis were also reviewe
Evaluation of the level of compliance of Veterinary medicine package inserts with Regulatory authority guidelines
No full textMagister Scientiae (Medical Bioscience) - MSc(MBS)Background: Veterinary medicines play an imperative role in the diagnosis, prevention and
treatment of animal diseases. Many veterinary stock remedies in South Africa are available to
the public without the intervention or supervision of a veterinarian or healthcare worker.
Therefore, the accompanying package insert with product information and directions for use is
central in promoting the safe and effective use of stock remedies. Information such as the
dosage, warnings, precautions and storage instructions are essential to assist the user in their
treatment decision-making. While local regulatory authority guidelines prescribe and control
the minimum information that should be available in the package insert or product label, it is
questioned whether the information contained in package inserts of products on the market
complies with these regulatory requirements.
Methodology: Using simple random sampling of veterinary stock remedies, 159 package
inserts or product labels from various animal health companies were selected and evaluated
against the prescribed labelling guidelines of the local regulatory authority responsible for the
registration and control of stock remedies. The contents of each package insert or label in the
sample were assessed for the presence of the prescribed information statements and were
accordingly classified as non-compliant, partially compliant or compliant.
Results: Among the 159 package inserts, 48 were for antimicrobials, 49 for ectoparasiticides,
44 for anthelmintics and the remaining 18 for endectocides. It was observed that none of the
package inserts met all of the criteria and that the package inserts were inadequate in many
aspects. The average percentage of compliance was 69.43%, with a range of 36.21% to 87.93%.
Conclusion: The study indicated that many package inserts do not fully comply with the
prescribed regulatory guidelines and that information related to the safe and appropriate use of
stock remedies is insufficient
Evaluation of rational use of medicines in public healthcare facilities
No full textMagister Pharmaceuticae - MPharmAccess to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine
Evaluation of rational use of medicines in public healthcare facilities
Get PDFMagister Pharmaceuticae - MPharmAccess to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine
Rational drug therapy monitoring in type 2 diabetes mellitus : using glycated haemoglobin as a guide for change in therapy
No full text>Magister Scientiae - MScType 2 diabetes mellitus is a progressive disease characterised by defects in insulin secretion, insulin action or both. Proper management of diabetes with appropriate drug and lifestyle interventions, guided by proper glycaemic monitoring has shown improved glycaemic control and a substantial decrease in morbidity associated with complications and mortality. Evidence-based guidelines for the appropriate management of diabetes, suggests the use of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) as monitoring indicators and have set targets levels that indicate appropriate glucose control. In the event of suboptimal control, actions steps to adjust pharmacotherapeutic treatment has been set out. Of the two aforementioned glycaemic monitoring indicators, HbA1c is termed the 'gold standard' as it provides the most comprehensive data i.e. it reflects both fasting and postprandial glucose concentrations over a 3 months period as compared to FPG which only show glucose levels for a few hours. The aim of this study was to describe the use of glycaemic monitoring indicators in patients with type 2 diabetes mellitus, classified as stable, treated at primary health care facilities in the Cape Town Metropolitan Region in South Africa. The study was a descriptive, retrospective and quantitative in design. Data were collected from patient medical records and included glycaemic monitoring tests and results as well as prescribing records for a maximum period of 18 months. The study comprised of 575 participants from five primary health care facilities in the Western Cape Metropole region. All participants had FPG results, while HbA1c results were recorded for 86% of participants at least once. More than 70% of participants with either a FPG or HbA1c result showed suboptimal glucose control i.e. were outside of the target range. In 181 opportunities for intervention in participants with HbA1c results outside target, 113 (62.4%) did not have any therapy adjustments, 19 (10.5%) had the total daily dose increased, 6 (3.3%) had total daily dose decreased, 9 (5.0%) had a step-up in regimen, 5 (2.8%) had a step down in regimen and 29 (16.0%) had a lateral regimen change. In 852 opportunities for intervention in participants with FPG results outside target, 609 (71.5%) did not have any therapy adjustments, 47 (5.5%) had the total daily dose increased, 18 (2.1%) had the total daily dose decreased, 16 (1.9%) had a step-up in regimen, 15 (1.8%) had a step down in regimen and 147 (17.3%) had a lateral change in regimen. This study has demonstrated that in the primary healthcare facilities investigated, FPG was the most often used gycaemic monitoring indicator, glycaemic monitoring of patients mostly show suboptimal glucose control and that opportunities to optimise pharmacotherapy in diabetes management are mostly missed
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