South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Practice Guideline Guideline
Management of community-acquired pneumonia in adults.
To revise the existing South African community-acquired pneumonia guideline in the light of the following factors: Increased incidence of HIV infection in South Africa Emerging antibiotic resistance Introduction of new antibiotics International trends based on evidence published since the previous guideline. The main aim of the guideline is to recommend an initial choice of antibiotics in patients with community-acquired pneumonia encompassing the following subgroups: (i) adults without co-morbid illness; (ii) the elderly and/or those with associated co-morbid illness, including patients with concomitant human immunodeficiency virus (HIV) infection; and (iii) patients with severe pneumonia. ⋯ The guideline was updated by a working group of the South African Thoracic Society, which included members of the Antibiotic Surveillance Forum of South Africa. Reference was made to the recently updated international guidelines from the UK, Canada and the USA.
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To describe the costs of establishing and operating a home-based care (HBC) project providing palliative care for people with AIDS (PWA), and to project the full costs to the health care system of extending this care model. ⋯ Providing palliative HBC to PWAs in their last year of life using the ICHC model costs R2 840 per patient per year. Even with this level of HBC input, patients still incurred hospital costs of R2 522 and primary care clinic costs of R1 154 per patient per year. HBC costs are increased in rural areas where a vehicle is required for staff transport. HBC shows considerable potential to deal cost-effectively with growing palliative care needs in the face of the AIDS epidemic, but we need to understand better the true extent to which HBC can substitute for hospitalisation.
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To assess feeding methods chosen by mothers of babies who spent time in a neonatal unit. Factors influencing this decision were investigated. ⋯ Infants with a lower weight and gestational age, who stayed in the unit longer, were less likely to be breast-fed after discharge from the neonatal unit. The mothers' experience in the unit did not seem to alter their choice of feeding method decided upon before delivery. This suggests that efforts to promote breast-feeding in the neonatal unit were either ineffectual or inadequate. In order to remedy this situation it is necessary to keep the mother-infant pair together (lodger mothers) and to promote breast-feeding before and after delivery. It would also be necessary to train staff in the management of lactation problems.