Antibiotic usage in a South African paediatric medical ward following the introduction of an antibiotic prescription chart.

Introduction: the global rise in antibiotic resistance (ABR), coupled with a dry pipeline for the discovery of new antibiotics requires the conservation of currently available antibiotics. Antimicrobial stewardship (AMS) interventions are being implemented to optimize antibiotic use including the use of antibiotic prescription charts. This study reviewed the use of antibiotics before and after the introduction of an antibiotic prescription chart in a paediatric medical ward of an academic tertiary hospital in Johannesburg. Methods: a cross-sectional retrospective review of patient records was conducted for patients admitted to a paediatric medical ward of an academic tertiary hospital over two study periods; before and after the introduction of an antibiotic prescription chart. Data were captured on a Microsoft® Excel (2010) spreadsheet and analyzed using Stata/IC 15.1 (StataCorp, USA). Results: antibiotic use decreased significantly by 7.04% following the introduction of the antibiotic prescription chart (p=0.027). Fields often left unfilled on the antibiotic prescription chart include age (100%), a record of renal function (GFR/CrCl) (97.46%), time of antibiotic prescribing (83.62%) and a record of culture and sensitivity results (80.17%). Conclusion: the findings of this study show an improvement in antibiotic use, the frequency of culture and sensitivity testing and documentation of relevant parameters after the introduction of the antibiotic prescription chart. The use of an antibiotic prescription chart is a practical way to achieve optimal antibiotic use and to encourage proper detailing of the clinical components necessary for antibiotic selection in a hospital setting in a developing country.

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa.

BACKGROUND: The use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. Standardisation of colistin dosing and more appropriate record-keeping practices were required to fully assess the optimal usage of colistin. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA). METHODS: This cross-sectional retrospective record review described adult and paediatric patients who received colistin intravenously from 01 May 2016 to 31 April 2017. Information from patient records were captured on a data collection tool and analysed using descriptive statistics. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand. RESULTS: A total of 43 patient records were reviewed. Acinetobacter baumannii was the most common organism isolated (85.2% adults and 62.5% paediatrics). Colistin was mostly prescribed for sepsis (18 adults and 15 paediatrics). Most adults (66.7%) received loading doses as recommended; however, there was a great variation in maintenance doses. Paediatric patients reviewed also showed varying dosing according to weight. The mean duration of colistin therapy was 10 days. Carbapenems were most commonly co-administered with colistin (58%). CONCLUSION: The findings suggested that although colistin usage was restricted in the hospital, it was not adequately monitored or controlled. Doses prescribed were made at the discretion of prescribing doctors and differed to currently accepted guidelines. Improved record-keeping practices related to the monitoring of colistin use were required.

Experiences of the homeless accessing an inner-city pharmacy and medical student-run clinic in Johannesburg.

BACKGROUND: Mental and physical health problems are both contributory factors and drivers of homelessness. Adding to this, the homeless encounter numerous barriers when accessing healthcare services. AIM: The aim was to determine the experiences of the homeless when accessing healthcare services and the reason why they visit Trinity Health Services (THS). SETTING: Trinity Health Services, a student-run clinic (SRC) based at an inner-city church in Johannesburg, South Africa, provides free acute healthcare services to the homeless. METHODS: This qualitative study comprised three focus group discussions (FGDs) with the homeless who access services provided by the church. Those who had previously visited THS on at least one occasion were invited to participate in FGDs. The FGDs were audio-taped and transcribed verbatim. The data were analysed thematically using Tesch's eight steps. RESULTS: Three themes were identified. The first theme, homelessness affecting health, explains how limited access to food, ablution facilities and shelter negatively impact their well-being. This led to the second theme, health needs, where tuberculosis, influenza, sexually transmitted diseases and dental infections were identified as ailments occurring frequently. The need for healthcare services was explicit, yet participants were reluctant when accessing healthcare services as they faced stigma and discrimination. The third theme, THS in addressing health needs, denotes the value of THS in the community it serves where they were treated with compassion and empathy. CONCLUSION: The needs of this homeless community as well as the role played by THS were clearly identified. However, THS provides limited services, and integration with existing healthcare services is essential.

Volunteering, health and the homeless - the cost of establishing a student-run primary healthcare clinic serving the inner-city homeless in South Africa.

BACKGROUND: Those who are homeless are more prone to communicable, respiratory and cardiovascular diseases and are less likely to access healthcare services. In South Africa there are no specific public healthcare services tailored to the needs of these communities, particularly if they are immigrants. Trinity Health Services is a student-run inner-city clinic providing free healthcare to the homeless of Johannesburg, South Africa. The clinic operates two nights per month and provides treatment for mainly acute conditions. The purpose of this study was to determine the costs of establishing and operating a student-run clinic for an indigent population. METHODS: This costing analysis used a mixed-methods approach combining an ingredients-based and top-down methodology. The costs, capital and recurrent, pertaining to the establishment and operating of the clinic as well as the cost of treatment per patient were identified and quantified from 1st January 2016 - 31st December 2017. RESULTS: The capital costs incurred in establishing the clinic were calculated to be £10,968.57 (ZAR 214157.08) and included building alterations, equipment purchased, installations, furniture, application for a pharmacy license, consumables and medications. The recurrent costs per annum were estimated at £17,730.72 (ZAR 346185.54) and comprised of overheads and maintenance, rental, personnel, pharmacy license, consumables and medication. The cost of treatment per patient, included medication dispensed and consumables used in the consultation, was estimated at £3.54 (ZAR 69.05) per visit. CONCLUSIONS: This study summarised the costs of establishing and operating a student-run clinic providing pertinent information essential to the sustainability of the service. It also provides a model for costs associated with free clinics in faith-based and university settings.

Learning experiences of medical and pharmacy students at a student-run clinic in south africa and the development of a framework for learning.

Background: Trinity Health Services (THS) is a free clinic that serves the homeless community of Braamfontein. The clinic is run by pharmacy and medical students registered in the Faculty of Health Sciences at the University of the Witwatersrand, assisted by academic staff. This setting provided an ideal space to document the interprofessional experiences between these two groups of students outside of formal lectures or clinical exposures. Therefore, the research question for this study was: What are the learning experiences of medical and pharmacy students working at an inner-city student-driven clinic? Methods: A convenience sampling method was employed. All students, who volunteered at the clinic on one or more occasion, were invited to participate in a discipline-specific focus group discussion (FGD). Four FGDs were held with between six and eight participants in each. The FGDs were facilitated by a faculty member not involved with the clinic. The recordings were transcribed verbatim and analyzed thematically, using Tesch's eight steps. Results: The following three themes emerged relating to learning experiences: "add more tools to your toolbox;" learning from supervisors and peers, and "we can really make a difference." These themes formed the framework for learning at THS. Patient care is placed at the core of the framework, and recognizing that learning occurs through serving, three learning outcomes were identified, namely health and homelessness; communication; clinical and communication skills as well as primary health care. Learning was facilitated through interactions with peers, supervisors, and interprofessional relationships. Discussion: The authentic learning experience led to development of accountability, communication, and responsibility. A framework emerged for learning from opportunities central to patient care.

A Profile of the Health of Homeless at an Inner City Primary Health Care Clinic in South Africa.

People who are homeless present for care with poor health status, influenced by their physical and social environment. Trinity Health Services is an interprofessional student-run clinic providing free health care to the inner city homeless of Johannesburg, South Africa. This descriptive survey profiled the disease conditions of the homeless through a retrospective review of patient files, documented on a predesigned case report form. The data were analysed using descriptive statistics. A total of 240 patient visits were reviewed from January-December 2016. Several patients reported consuming alcohol (n=76), smoking cigarettes (n=80) and/or using recreational drugs (n=17). Patients commonly presented with conditions related to the respiratory (n=56) and digestive systems (n=32). The clinic dispenses medication according to a restricted formulary where analgesics (n=93), antibiotics (n=33), antihistamines (n=25) and vitamins (n=20) were prescribed frequently. This study provided baseline information to which the clinic can tailor the services provided.

Pharmacy students' opinions and experiences working on board the Transnet-Phelophepa Health Care Trains.

OBJECTIVES: The Transnet-Phelophepa Health Care Trains provide primary healthcare services to patients in under-resourced rural communities across South Africa. Selected final-year pharmacy students work on the trains for 1 week. The aim of the study was to determine the experiences and document the work-based activities of pharmacy students engaged in. METHODS: A hyperlink to an online questionnaire was sent to 106 pharmacy students from five Pharmacy Schools (70.75% response rate). Both closed- and open-ended questions were included. Data were captured in Excel. KEY FINDINGS: Respondents expressed that their motivation to volunteer to work on the train was threefold: they wanted to help the community, experience this unparalleled work environment, as well as having heard positive responses from previous volunteers. Students were exposed to a variety of pharmacy-related activities; however, the majority of their time was spent dispensing. Although less than half (n = 33) found it difficult to communicate with patients, almost all responded that the translator helped them communicate with patients. A few saw this as an opportunity to learn a new language. The pharmacy staff was described as approachable, knowledgeable and willing to teach. Most respondents agreed that they were able to apply their knowledge and skills whilst working on the train (mean 4.52 ± 0.93; n = 75). CONCLUSIONS: Pharmacy students felt valued by the community and found it to be a rewarding experience while reporting to apply knowledge and information, improve their communication skills and work as part of a team.

Prolonged delivery of ciprofloxacin and diclofenac sodium from a polymeric fibre device for the treatment of periodontal disease.

In vitro analysis of drug release and antimicrobial activity of the coblended crosslinked polymeric fibre device (PFD) were investigated. The fibre loaded with ciprofloxacin and diclofenac sodium was comprised of alginate and glycerol crosslinked with barium cations. The pH dependent drug release was evident with ciprofloxacin and diclofenac sodium diffusing from the fibre at pH 4.0 compared to pH 6.8, where the fibre swelled and eroded resulting in zero-order drug release. Agar diffusion studies followed by minimum inhibitory assays were conducted to determine the antimicrobial activity of the device against Escherichia coli, Enterococcus faecalis, and Streptococcus mutans. The antimicrobial activity of the PFD was confirmed in both test assays against all test pathogens. The MIC ranges at pH 4.0 for E. coli, E. faecalis, and S. mutans were 0.5-0.8, 0.4-1.1, and 0.7-2.1 µg/mL, respectively. At pH 6.8, similar efficacies (0.3-0.5 µg/mL for E. coli and E. faecalis and 0.6-1.0 µg/mL for S. mutans) were observed. The effect of varying the plasticizer and crosslinking ion concentration on drug release profile of the fibers was further elucidated and conceptualized using molecular mechanics energy relationships (MMER) and by exploring the spatial disposition of geometrically minimized molecular conformations.

Modulation of the nano-tensile mechanical properties of co-blended amphiphilic alginate fibers as oradurable biomaterials for specialized biomedical application.

The modulation of the mechanical properties of monolithic fibers by plasticizing and crosslinking enables the dynamic control of the nano-tensile forces, thereby obtaining optimized Young's modulus and ultimate strain for specialized application in the treatment of periodontal disease. In this work, drug-loaded crosslinked and plasticized alginate fibers (cl-PAFs) were prepared by extrusion-gelification with the aim of designing oradurable biomaterials for placement within the periodontal pocket and provide prolonged drug delivery. Mechanical properties of drug-free cl-PAFs were determined using a nanoTensile™ 5000 instrument and subsequently optimized versus the quantity of plasticizer and crosslinker as formulation variables employing a Box-Behnken experimental design strategy. Mechanically optimized fibers obtained (Young's Modulus=314.04 MPa, yield stress=5.80 MPa, ultimate strength=10.05 MPa, ultimate strain=0.29 MPa and toughness=2.39 J cm(-3)) were loaded with the model drugs ciprofloxacin and diclofenac both individually and simultaneously. The Young's modulus of cl-PAFs loaded with either drug individually exhibited a steep decline. However, in the case of cl-PAFs loaded with both drugs simultaneously, Young's modulus regained the original value which may be attributed to the cohesive energy density, porosity and space filling. The effect of various formulation variables on the drug entrapment and release characteristics of the alginate fibers was elucidated at pH 4.0 and pH 6.8. Furthermore, a previously established atomistic computational model based on energy refinements was employed to mechanistically describe the fiber performance. The effect of varying the plasticizer and crosslinking ion concentration on Young's modulus and ultimate strain of the linear elastic polymer matrix and the performance of the ciprofloxacin and/or diclofenac loaded optimized fiber was elucidated and conceptualized using molecular mechanics energy relationships (MMER) via the geometrical conformation and positioning of the molecular architectures.