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You searched for +publisher:"Stellenbosch University" +contributor:("Cotton, Mark Fredric"). Showing records 1 – 2 of 2 total matches.

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Stellenbosch University

1. Dramowski, Angela. Determinants of healthcare-associated infection among hospitalized children.

Degree: PhD, Paediatrics and Child Health, 2017, Stellenbosch University

ENGLISH SUMMARY: Healthcare-associated infection (HAI) is the most frequent complication of hospitalization resulting in suffering, excess mortality and increased healthcare costs. Although paediatric HAI burden and impact is well-described in high-income countries, it is largely unquantified in Africa. Our research aimed to: (i) comprehensively describe the epidemiology and impact of HAI and HA-bloodstream infections in an African cohort of hospitalized children; (ii) establish appropriate HAI surveillance methods for our setting; (iii) investigate selected local determinants of paediatric HAI (including healthcare worker HAI-related knowledge, attitudes and practices, isolation facility utilization and terminal cleaning practices). In a retrospective analysis of paediatric bloodstream infection trends at Tygerberg Hospital, we reported the highest estimate of HA-bloodstream infections rates among African children to date. HIV-infection, HA-bloodstream infection, fungal and Gram-negative pathogens were important predictors of bloodstream infection-associated mortality. We conducted prospective clinical surveillance in paediatric wards and the intensive care unit at Tygerberg Children’s Hospital. HAI incidence (31/1000 patient days) exceeded published rates in high and low-middle income countries, with highest infection density in the paediatric intensive care unit (94/1000 patient days). Children experiencing HAI events were young (median 8.4 months), more likely to be malnourished, HIV-exposed uninfected or HIV-infected and to have pre-existing co-morbidities. Hospital-acquired pneumonia, bloodstream and urinary tract infections predominated. The increased odds for HAI in HIV-exposed uninfected and HIV-infected children is a novel association. Two-thirds of in-patient mortality was associated with HAI and patients with any HAI event had a 6-fold increase in crude mortality. Patients experiencing HAI had 3-fold higher rates of re-hospitalization within 30 days. Direct costs of HAI were substantial; mean duration of hospitalization, bed availability, antimicrobial consumption and laboratory investigation usage were significantly impacted by HAI. Although prospective clinical HAI surveillance is considered the reference standard, its use in Africa is limited by lack of resources and expertise. We compared the performance of three alternate HAI surveillance methods (point prevalence surveys [PPS], laboratory surveillance and tracking of antimicrobial prescriptions) using the prospectively collected paediatric HAI dataset as the reference standard. Although repeated PPS, laboratory and antimicrobial prescription tracking were demonstrated to be feasible HAI surveillance methods, a combination of laboratory-antimicrobial surveillance achieved best sensitivity (85%) and positive predictive value (97%), and required fewer resources to perform. South African paediatric healthcare facilities should individualise HAI surveillance, selecting a method suited to available resources and practice context. We identified a… Advisors/Committee Members: Cotton, Mark Fredric, Whitelaw, Andrew, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health..

Subjects/Keywords: Healthcare-associated infection  – Costs; Nosocomical infections  – South Africa; Children  – Hospital care; Healthcare-associated infection  – Epidemiology; Healthcare-associated infection  – Surveilance method; Healthcare-associated infection  – Risk factors; UCTD

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Dramowski, A. (2017). Determinants of healthcare-associated infection among hospitalized children. (Doctoral Dissertation). Stellenbosch University. Retrieved from http://hdl.handle.net/10019.1/101389

Chicago Manual of Style (16th Edition):

Dramowski, Angela. “Determinants of healthcare-associated infection among hospitalized children.” 2017. Doctoral Dissertation, Stellenbosch University. Accessed April 12, 2021. http://hdl.handle.net/10019.1/101389.

MLA Handbook (7th Edition):

Dramowski, Angela. “Determinants of healthcare-associated infection among hospitalized children.” 2017. Web. 12 Apr 2021.

Vancouver:

Dramowski A. Determinants of healthcare-associated infection among hospitalized children. [Internet] [Doctoral dissertation]. Stellenbosch University; 2017. [cited 2021 Apr 12]. Available from: http://hdl.handle.net/10019.1/101389.

Council of Science Editors:

Dramowski A. Determinants of healthcare-associated infection among hospitalized children. [Doctoral Dissertation]. Stellenbosch University; 2017. Available from: http://hdl.handle.net/10019.1/101389


Stellenbosch University

2. Innes, Steven Eugene Vere. Lipoatrophy in HIV-infected children on antiretroviral therapy.

Degree: PhD, Paediatrics and Child Health, 2013, Stellenbosch University

Bibliography

ENGLISH ABSTRACT: Introduction: Lipoatrophy is a common adverse effect of stavudine and this effect is strongly dose-dependent. Stavudine remains the most commonly used paediatric antiretroviral drug in sub-Saharan Africa, yet when the current study began in 2009, the prevalence and severity of lipoatrophy in children on antiretroviral therapy in sub-Saharan Africa had never been studied. The development of lipoatrophy may have serious and far-reaching consequences for patients and their families. The off-label stavudine dosing method, prescribed to children whose caregivers do not have access to a refrigerator, in which the contents of an adult capsule is mixed into tap water, has potential for over-dosing or under-dosing. In addition, children on stavudine continue to be exposed to a disproportionately high dose out of line with the reduced adult dose. Aims: 1. a) To investigate the prevalence and risk factors for lipoatrophy in HIV-infected children in Southern Africa b) To identify a simple anthropometric screening tool to detect early lipoatrophy in children 2. To validate the off-label stavudine dosing method prescribed to children whose caregivers do not have access to a refrigerator, with a view to reducing the recommended dose and thereby the side-effects. Methods: 1. a) We recruited pre-pubertal children on antiretroviral therapy from a family HIV clinic in our facility. Lipoatrophy was identified by two experienced paediatric HIV clinicians using a standardized grading scale. A dietician performed dietary assessment and anthropometric measurements. Previous antiretroviral exposures were recorded. A subset of recruits received Dual-Energy X-ray Absorbtiometry scanning. b) Anthropometric measurements in children with and without lipoatrophy were compared using multivariate linear regression adjusting for age and gender. The most discerning anthropometric variables underwent Receiver Operating Characteristic curve analysis to identify the most appropriate diagnostic cut-off. 2. a) Accuracy of the standard off-label stavudine dosing method was investigated using high-performance liquid chromatography to recover active drug from solutions made up using the prescribed method. This was compared to the stated drug content of the capsules. b) Bioavailability was investigated by performing a randomized crossover pharmacokinetic study wherein healthy HIV-seronegative adult volunteers received one of two generic stavudine capsule formulations, either intact or mixed in water using the prescribed method. Plasma stavudine concentrations were assayed by liquid chromatography tandem mass spectrometry. Results: 1. a) Prevalence of lipoatrophy was 36%, and incidence was 12% per person-year. Adjusted odds ratio for developing lipoatrophy was 1.9 (CI: 1.3–2.9) for each additional year of accumulated exposure to standard-dose stavudine. b) Baseline biceps skin-fold thickness correlated well with maximum lipoatrophy grading score at any site, giving a partial correlation coefficient of 0.33…

Advisors/Committee Members: Cotton, Mark Fredric, Rosenkranz, Bernd, Rabie, Helena, Zollner, Ekkehard Werner, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health..

Subjects/Keywords: Pediatrics; Dissertations  – Pediatrics; Lipoatrophy  – HIV-positive children  – Risk factors; HIV positive children  – Treatment; Antiretroviral agents  – Risk factors; Stavudine  – Therapeutic use; Pediatrics and Child Health

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Innes, S. E. V. (2013). Lipoatrophy in HIV-infected children on antiretroviral therapy. (Doctoral Dissertation). Stellenbosch University. Retrieved from http://hdl.handle.net/10019.1/79864

Chicago Manual of Style (16th Edition):

Innes, Steven Eugene Vere. “Lipoatrophy in HIV-infected children on antiretroviral therapy.” 2013. Doctoral Dissertation, Stellenbosch University. Accessed April 12, 2021. http://hdl.handle.net/10019.1/79864.

MLA Handbook (7th Edition):

Innes, Steven Eugene Vere. “Lipoatrophy in HIV-infected children on antiretroviral therapy.” 2013. Web. 12 Apr 2021.

Vancouver:

Innes SEV. Lipoatrophy in HIV-infected children on antiretroviral therapy. [Internet] [Doctoral dissertation]. Stellenbosch University; 2013. [cited 2021 Apr 12]. Available from: http://hdl.handle.net/10019.1/79864.

Council of Science Editors:

Innes SEV. Lipoatrophy in HIV-infected children on antiretroviral therapy. [Doctoral Dissertation]. Stellenbosch University; 2013. Available from: http://hdl.handle.net/10019.1/79864

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