Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary-level hospital in South Africa.

OBJECTIVES: The design and implementation of an antibiotic intravenous (iv) to oral switch therapy (IVOST) guideline in a Third World health setting. METHODS: The guideline was developed and integrated into daily practice by a ward pharmacist over a period of 7 weeks. Patients were switched once they were deemed clinically stable according to IVOST criteria. The final decision to switch was left to the attending physician. One pre- and two post-implementation audits (150 patient medical records per audit) were compared. RESULTS: Implementation of the IVOST guideline was successful in increasing (P<0.0005) the number of patients switched from 16% (19/119) pre-implementation to 43.9% (47/107) immediately after implementation; however, the change was not sustained 3 months after implementation (20.8%; 25/120). The intervention was also successful in decreasing the overall duration of iv therapy (P<0.0005) from 7.2 ± 3.5 days pre-implementation to 5.2 ± 3.0 days immediately post-implementation. The change was not sustained 3 months after implementation (6.5 ± 3.5 days). CONCLUSIONS: Despite the challenges encountered in a Third World environment, an antibiotic IVOST guideline can be successfully implemented. Continual, active integration of the guideline into daily practice by a ward pharmacist is essential if positive IVOST outcomes are to be maintained.

Food choice of tactile defensive children.

OBJECTIVE: We explored whether tactile defensive children have picky eating habits because fussy or picky eaters are a general problem to parents and different health professionals. METHODS: Children (n = 62) of both sexes, ages 3 to 10 y, were assigned to an experimental tactile defensive (TD) group (n = 29) or a control non-TD group (n = 33). A questionnaire on eating habits was compiled and given to parents for completion during personal interviews (children were screened with a checklist and evaluated for tactile defensiveness with the Winnie Dunn Caregiver profile questionnaire). RESULTS: This research confirmed that the eating habits and food choices of TD and non-TD children differ significantly. TD children had a fair to poor appetite. They hesitated to eat unfamiliar foods, did not eat other people's houses, and refused certain foods because of the smell and temperature. They also had a problem eating vegetables. They often gagged and/or bit their inner lips and cheeks. The results showed a definite difference in the limited selection of foods that TD children chose and a pronounced aversion toward textures or consistencies, smells, and temperatures of food as compared with integrated children. CONCLUSIONS: Fussy or picky eaters should evaluated more widely than to treat only the feeding problem. Tactile or oral defensiveness can be treated. This report underlines the team approach of health professionals.