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Background. Knowledge, skills and desirable clinical practices in infection prevention and control (IPC) should be acquired during undergraduate medical training. Although knowledge and skills are learnt in the formal curriculum, attitudes and practices are assimilated by observation and modelling. We investigated whether undergraduate teaching and learning of IPC at Stellenbosch University adequately prepared graduates for medical practice. Methods. A situational analysis of IPC teaching was conducted, including development of IPC competencies, a curriculum review, an email survey of MB,ChB graduates and semistructured focus group or personal interviews with teaching faculty. Qualitative data were assessed using a framework analysis approach. Results. All graduate survey respondents who completed the IPC-related questions (n=180) agreed that teaching of IPC was important and most (156; 87.8%) felt that IPC teaching had adequately prepared them for practice. Despite this perception, graduates encountered difficulty implementing IPC best practice owing to lack of management support for IPC and resource constraints. Faculty members disagreed regarding the adequacy of IPC teaching and some were concerned that the curriculum failed to prepare graduates for medical practice. Graduates and faculty felt strongly that undergraduate IPC teaching and learning could be improved by addressing suboptimal IPC practices and lack of clinician role models for IPC at training institutions. Conclusion. IPC knowledge transfer appears adequate in most competency areas. However graduates struggled to implement IPC best practice in the clinical field. Undergraduate IPC teaching and learning could be enhanced by development of clinician role models for IPC and strengthened IPC practices in training institutions. [ABSTRACT FROM AUTHOR]

Background. Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates' competencies and the effects of their training on healthcare and population health in Africa. Method. This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates. Results. We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health systems and health leadership and management teaching was weak, and important public health competencies in human rights and health advocacy received little attention. Recent graduates said their training was 'adequate', but were unable to apply knowledge and skills to address health systems challenges within working environments. They wanted more integrated, practical, problem-based teaching in environments in which they would one day work, and their teachers to be role models for the competencies students were expected to acquire. This study is contributing to improvements to the medical curriculum at Stellenbosch University. [ABSTRACT FROM AUTHOR]

The study investigates the risk exposure to HIV infection among South African children aged 2-9 years served by public health services. Together with their biological mothers, 3471 children and were recruited from inpatient and outpatient children in the Free State Province. Blood samples were taken by professional nurses and a history taken of exposure factors associated with HIV transmission. DNA testing was used to confirm biological maternity where the child was HIV-positive and the mother HIV-negative. Mother-child pairs were stratified by mother's HIV status. Exposure factors related to the child's HIV status were examined in each stratum using a chi-square test. Independent factors were then included in a multiple logistic regression model. Having an HIV-positive mother was strongly related to HIV infection in children (OR: 310; 95%CI: 148-781). However, seven HIV-positive children had HIV-negative mothers. Transmission in this group was significantly associated with breastfeeding by a non-biological mother (OR: 437; 95%CI: 53-5020), being fed with expressed breast milk from a milk room (OR: 37.6; 95%CI: 6.2-259.0), dental injection history (OR: 31.5; 95%CI: 4.5-189.4) and visits to a dentist (OR: 26.9; 95%CI: 4.4-283.5). Although mother-to-child-transmission is shown to be the primary mode of HIV transmission in South African children, the few HIV-positive children infected by other modes of transmission suggest a potential risk of non-vertical HIV infections. These infections can be prevented through education and improved infection-control procedures. [ABSTRACT FROM AUTHOR]

Background. South Africa (SA) has a dire shortage of skilled infection prevention and control (IPC) practitioners with limited opportunities for IPC training, especially in rural areas. Methods. This quality improvement research-based case study surveyed healthcare workers' IPC training needs and measured the impact of a targeted IPC training intervention at four healthcare facilities in a rural sub-district in the Western Cape Province of SA. Transfer and implementation of IPC knowledge and best practice were evaluated at the participating facilities, both pre and post intervention. Results. Most survey respondents (239/271; 88.2%) practised in rural districts and reportedly received infrequent (either annual or no) in-service training in IPC (138/271; 51%). The IPC education intervention (five short courses) was attended by almost one-third of clinical staff (129/422; 30.6%) at the four rural healthcare facilities. The pre-intervention IPC assessment identified the following: poor knowledge and implementation of tuberculosis-IPC measures; limited knowledge of medical device decontamination; high rates of needle-stick injuries; low hand-hygiene compliance rates and poor compliance with personal protective equipment use. At the post-intervention assessment, IPC knowledge scores and hand-hygiene compliance rates improved significantly but some IPC practices were unchanged. Conclusion. A structured IPC training programme in rural healthcare facilities can improve healthcare workers' IPC knowledge, but has limited impact on clinical practice. [ABSTRACT FROM AUTHOR]

Comments on several issues related to medicine in Great Britain. Initiative to breast cancer trials; Side effects of adjuvant therapy for breast cancer; Decline of high density lipoprotein cholesterol concentrations in people with a high dietary sugar.

One hundred and ninety-nine strains of Haemophilus isolates were biotyped by Kilian's method and a modified API 10S strip and the results compared. One hundred percent correlation was found between the two systems. The ONPG test proved of value in differentiating between and when there was growth factor disc failure. [ABSTRACT FROM PUBLISHER]

One hundred and fifty Gram-negative bacterial strains including respiratory pathogens, such as Haemophilus influenzae and Branhamella catarrhalis, and Enterobacteriaceae with known resistance to beta-lactam and other antibiotics were tested in vitro for sensitivity to piperacillin, piperacillin/tazobactam (ratio 8:1), ceftazidime, ciprofloxacin and imipenem. A 16-fold or greater reduction in the MIC90 of piperacillin was achieved by the addition of tazobactam, in the respiratory pathogens, thus bringing them within the susceptible range. Among the Enterobacteriaceae, a 32-fold or greater reduction in the MIC90 was found for Providencia stuartii, Proteus mirabilis and Aeromonas hydrophila. When compared with the other three antimicrobials, the combination was found to be active against fewer species of multiply resistant Enterobacteriaceae, but equally effective against H. influenzae and B. catarrhalis. [ABSTRACT FROM AUTHOR]

Serious infections by methicillin-resistant staphylococci, 26 caused by Staphylococcus aureus and two by coagulase-negative staphylococci, were treated with teicoplanin 200–800 mg daily, in eight cases supplemented with another antibiotic. The overall rate of clinical cure or improvement was 75%, and that of bacterial eradication 67%. [ABSTRACT FROM PUBLISHER]

Fifty-four patients were treated with intravenous ampicillin and sulbactam in an open study of intra-thoracic and intra-abdominal infection. Thirty-one were treated with 500 mg each of the combination 6-hourly while 23 patients were given 1 g of ampicillin and 500 mg of sulbactam, 6-hourly. Thirteen of fourteen (93%) patients with severe respiratory tract infection and 22/26 (85%) patients in the intra-abdominal infection group responded clinically and bacteriologically. Seven patients with clinical sepsis (but not confirmed bacteriologically) improved on therapy. 50/55 (91%) clinical isolates from this study were eliminated. An increase in MIC was found in two cases. There were minimal side effects, pain at site of injection being the commonest complaint. [ABSTRACT FROM PUBLISHER]

Fifty-four patients were treated with intravenous ampicillin and sulbactam in an open study of intra-thoracic and intra-abdominal infection. Thirty-one were treated with 500 mg each of the combination 6-hourly while 23 patients were given 1 g of ampicillin and 500 mg of sulbactam, 6-hourly. Thirteen of fourteen (93%) patients with severe respiratory tract infection and 22/26 (85%) patients in the intra-abdominal infection group responded clinically and bacteriologically. Seven patients with clinical sepsis (but not confirmed bacteriologically) improved on therapy. 50/55 (91%) clinical isolates from this study were eliminated. An increase in MIC was found in two cases. There were minimal side effects, pain at site of injection being the commonest complaint. [ABSTRACT FROM AUTHOR]

An intravenous formulation of Augmentin was used as sole chemotherapy in the treatment of patients with severe infections. Fourteen of 17 assessable patients (82%) responded satisfactorily including six with bacteraemia. Adverse reactions occurred in 38% of patients but in all but one, withdrawn due to diarrhoea, were trivial. There was no significant intolerance. [ABSTRACT FROM AUTHOR]

Antibiotic resistance of haemophili was studied as part of an epidemiological survey on the distribution of biotypes of Haemophilus influenzae and H. parainfluenzae from various clinical isolates. Biotype II H. influenzae was the commonest biotype isolated but biotype III yielded the most frequent antibiotic resistance. Resistance to ampicillin (15.1%) was commonest, followed by sulphonamide, tetracycline, trimethoprim and chloramphenicol. Multi-resistant strains were found including one capsular type b (biotype III) strain. H. parainfluenzae biotype I was the commonest isolate but biotype II was most frequently resistant to antibiotics. The resistance pattern followed that of H. influenzae except for chloramphenicol to which resistance was commoner than for trimethoprim. [ABSTRACT FROM AUTHOR]

Twenty-seven patients with infections caused by amoxycillin-resistant bacteria were treated with oral Augmentin, a formulation of amoxycillin with the β-lactamase inhibitor clavulanic acid. The infections treated were gynaecological sepsis (11), intra-abdominal sepsis (10). cellulitis (4) and bronchopneumonia (2). , either alone or in combination with other pathogens, was isolated from ten patients, being identified as a primary pathogen in four patients (and presumed to be the pathogen in a further four). Three patients were bacteraemic. The overall cure rate was 85% (23 of 27 patients), the remaining patients being assessed as improved. There were no treatment failures. The cure rate in infections involving . was 80%, and that in staphylococcal infection 87·5%. Augmentin was well tolerated, two patients developing a penicillin rash (7·5%) and two mild nausea (7·5%). Augmentin is a safe and effective alternative to conventional antibiotics in those patients with invasive soft tissue infection in whom oral therapy is appropriate. [ABSTRACT FROM PUBLISHER]

A comparison of cefuroxime 750 mg 8-hourly im and co-trimoxazole 3 ml 12-hourly im in the treatment of severe respiratory tract infections, was under taken. Twenty patients in each group were treated for at least 5 days with the respective antibiotics. No statistically significant difference was found between the two groups. [ABSTRACT FROM PUBLISHER]

A formulation of amoxycillin and potassium clavulanate (Augmentin) was used to treat eight patients with intra-abdominal and pelvic sepsis caused by mixed aerobic and anaerobic bacteria and, in one case each, by and alone. Six patients were cured and two improved. These results encourage further studies with Augmentin in mixed or anaerobic sepsis. [ABSTRACT FROM PUBLISHER]

We conducted a prospective, multi-centre, open, randomized study in 11 UK hospitals to compare iv meropenem 1 g tds with the combination of iv cefotaxime 1 g tds and iv metronidazole 500 mg tds in patients with serious infections. One hundred and sixty-one patients were enrolled, of whom 131 were clinically evaluable (meropenem, n = 68; cefotaxime/metronidazole, n = 63). The most common infections were subsequent to intra-abdominal pathology (meropenem, n = 77%; cefotaxime/metronidazole, n = 75%), and were usually accompanied by septicaemia (meropenem, n = 61%; cefotaxime/metronidazole, n = 53%). The incidence of a satisfactory clinical response was similar in the two groups at the end of treatment (93% for meropenem; 92% for cefotaxime/metronidazole) and up to 8 weeks later (96% for meropenem; 93% for cefotaxime/metronidazole). Satisfactory bacteriological response (success or presumed success) was recorded at the end of therapy in 86% of meropenem and 88% of cefotaxime/metronidazole patients. Adverse events were reported in 32% of meropenem and 25% of cefotaxime/metronidazole patients, and most were mild or moderate and did not require discontinuation of therapy. Twenty-one patients (ten meropenem and 11 cefotaxime/metronidazole) died during the trial, underlining the severity of the infections being treated in this group of patients. None of the deaths was thought to be related to study therapy. [ABSTRACT FROM AUTHOR]

Comments on several medical issues in Great Britain. Fear on myocardial infarction; Audit of a surgical firm using the microcomputer; Random trial of prophylactic daily aspirin in male doctors; Use of varicella vaccine; Dietary management of gastroenteritis.

Presents several research on medical sciences. Occurrence of liver failure deaths in children during treatment with valproate; Management of loiasis with high microfilaraemia and renal disease; Use of captopril in treating renal failure of the kidney.

Presents a case report on a new born baby with pseudomonas sepsis after water birth. Microbial contamination in water births; Need for a regular microbiological surveillance of the birthing tub system; Significance of strict policies on infection control.