Serious Bacterial Infections in Febrile Young Children: Lack of Value of Biomarkers

Background. Serious infections in children are difficult to determine from symptoms and signs alone. Fever is both a marker of insignificant viral infection; as well as more serious bacterial sepsis. Therefore; seeking markers of invasive disease; as well as culture positivity for organisms; has been a goal of paediatricians for many years. In addition; the avoidance of unnecessary antibiotics is important in this time of emerging multiresistant micro-organisms. Objective. To ascertain whether acute-phase reactant tests predict positive culture results.Methods. A prospective; cross-sectional study over a 1-year period included all documented febrile childre nunder the age of 5 years (with an axillary temperature =38oC) who presented to Steve Biko Academic Hospital; Pretoria; with signs and symptoms of pneumonia; meningitis and/or generalised sepsis. Every child had clinical signs; chest radiograph findings; urine culture; blood testing (full blood count; C-reactive protein; procalcitonin) and blood culture results recorded. Results. A total of 63 patients were enrolled; all of whom had an axillary temperature =38oC. C-reactive protein; procalcitonin and white cell count did not predict the presence of positive blood culture or cerebrospinal fluid culture results; nor infiltrates on chest radiographs. No statistically significant correlations were found between the duration of hospital stay and the degree of fever (p=0.123); white cell count (p=0.611); C-reactive protein (p=0.863) or procalcitonin (p=0.392). Conclusion. Biomarkers do not seem to predict severity of infection; source of infection; or duration of hospitalisation in children presenting to hospital with fever. The sample size is however too small to definitively confirm this viewpoint. This study suggests that clinical suspicion of serious infection and appropriate action are as valuable as extensive testing

South African Private Practising Clinical Dietitians' Perceptions of the Relevance of Service-Specific Healthcare Marketing Principles and Communication Elements

"Background: South African dietitians are confronted with the challenge of effectively marketing themselves as a sound source of information on nutrition to both the public and other health professionals. The marketing initiative should focus on the promotion of both the profession itself and individual practices. The aim was to assess the perception of South African private practising clinical dietitians of the relevance of service-specific healthcare marketing principles and communication elements (within the ambit of Act 53 of 1974). The design was a descriptive cross-sectional survey in the quantitative domain. Convenience sampling was used (n = 79). Method: Data were collected by means of an electronic questionnaire. The response rate was low (16.8); and the results could not be generalised. Results: The dietitians seemed more focused on the science of nutrition; than on marketing their profession and individual practices. There was an overall awareness of the need for marketing in the dietetic private sector; but the importance and implementation thereof did not receive the amount of attention that it justifies. A number of service-specific healthcare marketing principles received ""slightly relevant"" or ""not relevant"" ratings.Conclusion: For the dietetic profession to reach its full potential in South Africa; and for dietetic private practices to be successful on all levels; dietitians need to focus more of their time and energy on business-related aspects such as marketing. By integrating the theory from the literature with the findings from the study; a profession-specific marketing flow diagram and recommendations could be proposed."