Postgraduate Portal

Department of Medicine, Faculty of Medicine & Health Sciences, Stell. Univ.

Vertical Menu

Adult Infectious Diseases Unit

Introduction

Contact numbers and email addresses

Nursing staff:

  • Nursing station - 4592
  • Vivienne O’Brien    - 4842 / vobrien@pgwc.gov.za

Adult doctors:

  • Jantjie Taljaard - 083 419 1452 / 9645 / jjt@sun.ac.za
  • Michele Zeier - 082 784 6605 / 5230 / mdz@sun.ac.za
  • Astrid Sadler - 078 444 9541 / 4591 / sadler@sun.ac.za
  • Philip Botha - 083 3063246 / 9594 / prb@sun.ac.za
  • Marije van Schalkwyk - 079 6724398 / 5230 / 9483 / marije@sun.ac.za
  • Gert van Zyl - 083 3089285 / 9691 / guvz@sun.ac.za
  • Francois Cilliers - 084 6511360 / fjc@sun.ac.za
  • Monique Andersson -082 7096152 / andersson_m@sun.ac.za

 Psychiatrist:

  • Eloïse Reid - 083 3081177 / 5911 / cecilreid@mweb.co.za

Pharmacist:

  • Annerie du Plessis - 6131 / amduples@pgwc.gov.za Siegfried Kipping - 6131 / skipping@sun.ac.za

Clerk:

  • Dottie Phillips - 5229
  • Ferdie van Schalkwyk- 5229

Data capturers:

  • Gloria (? Surname)- 5229
  • Liesel de Villiers - 5229 / ldv@sun.ac.za

Data manager:

  • Marina la Grange - 9483

Social worker:

  • Nocawe Frans - bleep

Counselors:

  • 6155/4567

Doctor rooms:

  • K 81 4589 (1st room)
  •  K 79 4588 (2nd room)
  •  K 77 5230 (3rd room)
  •  K 75 4591 (4th room)
  •  K ? ? (5th room)

Welcome to the Infectious Diseases Unit and the Family Clinic for HIV. Read carefully through this manual and please ask if anything is unclear. We hope that you will enjoy your time with us.

1. OUTPATIENT MANAGEMENT GUIDELINE

The main emphasis of our clinic:
A. Assessment for antiretroviral therapy
B. Initiating and monitoring antiretroviral therapy
C. Diagnosis and management of ART related adverse events
D. Diagnosis and treatment of HIV/AIDS related diseases
E. Participation in ongoing research projects

A. Assessment for antiretroviral therapy

The clinic follows the Western Cape ARV protocol. You can download this at http://web.uct.ac.za/depts/epi/artrollout/. This 63 page protocol dates back to 2004. Adjustments are to be announced soon. More up to date is the AFA clinical guidelines, to be found at www.aidforaids.co.za

In summary, consider the following for urgent initiation:

Adults:
• All adults with a CD4 < 100 cells/uL
• All adults with unexplained (after investigation) ongoing loss of weight.
• All pregnant women qualifying for ART.
• All adults recently hospitalised with an HIV-linked condition (including TB).

Children:
• All children under 2 years of age
• Any child over 2 years with a CD4<15% or a CD4 count <100
• All children with unexplained (after investigation) ongoing loss of weight.
• All children recently hospitalized with an HIV-linked condition (including TB).
 
 Other patients qualifying for ART should also not experience unnecessary delays in initiation.

NOTES ON ASSESSMENT FOR ART

(For detailed information see the National/Provincial ART Roll out Protocol)
Assess patients in three to four sessions (with 1 – 2 week intervals)
 

First visit:

  • COMPLETE HISTORY AND PHYSICAL EXAMINATION!
  • Diagnose and treat all minor and major medical problems that are present
  • Give special attention to:
    • Possible underlying, undiagnosed TB
    • Psychological problems – depression, denial of diagnosis, anxiety disorders etc.
    • Family planning (double barrier is recommended i.e. condom and depot/pill)
    • Stress the importance of disclosure and a ART treatment supporter
    • Alcohol and/or drug abuse
    • Assess level of knowledge regarding HIV infection, AIDS and ART
      • Explain natural progression of the disease without treatment
      • Explain the meaning and use of CD4 counts and Viral loads
      • Explain the beneficial effect of ART on the clinical progression and laboratory parameters
      • Explain the limitations (cannot cure) and possible side-effects of ART
  • Do the following baseline investigations:
    • BMI (if less than 18.5 please refer for nutritional support with dedicated form)
    • Urine dipstix (nurse will do this)
    • Bloods: FBC & Diff, Creatinine, CD4 count (if last result >3 months ago), ALT, RPR, HBsAg, HIV serology if none previous registered(make sure that you use the right request form! Virology and Microbiology samples on separate forms),
    • CXR, (TB sputum, CRP only when necessary)
  • Refer to family planning clinic at 2nd floor where applicable
  • Refer for PAP smear where applicable (all HIV infected woman must have annual PAP smears)
  • Refer to social worker/psychiatry/psychology where applicable
  • Remind patient to bring in his/her treatment supporter on next visit
  • Make comprehensive notes and fill in the data capture sheet

Second visit:

  • See counselor with treatment supporter (Not for doctor unless unresolved medical issues)

Third/Fourth visit:

  • Manage unresolved medical problems
  • Review blood results and CXR
  • Again assess knowledge and give information
  • See counselor
  • Discuss patient’s readiness for HAART with counselor and/or colleagues
  • Show patient tablets and review dosing schedule and side effects
  • When ready, initiate. See following paragraph.

B. Initiating and monitoring antiretroviral therapy

Initiation in the clinic

Do not start anyone on ART who is not well informed regarding the disease and the medications or who is not willing to commit to lifelong chronic therapy.
Review the counselors note to make sure no obstacles are identified and at least 3 sessions are done.
When you start a patient, be sure to explain all tablets and dosing to patient.
Sign treatment contract/consent form, give contact details and write script for appropriate regime
Prescribe a pillbox.
Write “Start ARV’s” on routine slip, in order to have to patient seen by the nurse for administration and adherence preparation.
Make sure the datasheet is circled at ‘commencing treatment’ and note the correct regimen.

Initiation in the ward

Only exceptional cases will start ARV’s during admission, to be discussed with the consultant.
Doctors need to:

  1. Put sticker in the counselling book in front AND write referral form to counsellor with history details to have the counsellor come to the ward for proper counselling.
  2. Notify the pharmacy when they start a patient, on 6131
  3. Fill in ‘first visit’ datasheet for the database when patients are put on ARV’s that will be followed up in the clinic after discharge. At least 1 follow up visit in our clinic after discharge!

Follow-up visits

2 weeks for safety bloods where applicable
4 weeks for pill count, doctors visit (check ALT), safety bloods, counselor

Safety Bloods

CD4 and VL every 6 months on 6,12,18,24,36 etc months on ARV’s. Please be precise in calculating these, as we need to report on accurate months and the clinic is evaluated by the % of patients getting their bloods checked on time.

If the patients regimen includes:
NVP – ALT on week 0,2,4,8 and every 6 months when clinically suspect
AZT – FBC on month 0,1,2,3 and every 6 months when clinically suspect, the nurses could do a cheaper finger prick Hb if this is all you need.
TDF – Creatinine on month 0,1,2,3 and every 6 months
LPV/r – Cholesterol, Triglycerides and Glucose month 0 and every 6 months

Check ALT/LFT’s when pt is also on TB treatment as many toxicities are due to concurrent treatment.

C. Diagnosis and management of ART related adverse events

If adverse events are diagnosed by you, make sure you notify this correctly on the datasheet. See Chapter 5.
Also you need to fill in the adverse events form for processing by the pharmacy.
For current guidelines concerning the management of adverse events, see the protocol as mentioned in the AFA clinical guidelines.

D. Diagnosis and treatment of HIV/AIDS related diseases

For current guidelines concerning the management of HIV/AIDS related diseases, see the protocol as mentioned in the AFA clinical guidelines.
Be aware of the possibility of developing IRIS. Especially when starting patients with a very low CD4 count. Make sure you let the patient come back for monthly follow up the first three months on treatment. High risk patients could need to be seen every 1-2 weeks in the starting months. Discuss concerns in management with your experienced colleagues.

E. Participation in ongoing research projects

Good data collection is the backbone of good research. Every time you see a patient, the datasheet needs to be filled out precisely. More on this in chapter 4.
Make sure you ask what studies are currently recruiting patients at our clinic. You will have to select eligible patients and obtain their consent for participation on the go. The study forms are available in each room.

2. GENERAL CLINIC MATTERS

Work environment

The motto of the family clinic is to give a friendly, effective and comprehensive service to the patient and their families living with HIV/AIDS
The success of any antiretroviral programme (or any other chronic disease programme) relies heavily on an excellent doctor-patient relationship. The first contact with the patient and their family is therefore essential to build a good foundation. Please greet your patients by hand and introduce yourself personally. (If you respect your patients, they will respect you)

All workplaces have their etiquette. Make sure you observe the following rules:

  1. Each consulting room is equipped with a PC belonging to the HIV Research Unit and not the hospital. Their use is strictly reserved for use by the doctors working at the clinic. Login procedures differ for the rooms. Consult a colleague on how to log in.
  2. Always do a Microsoft Windows Shutdown before leaving the clinic. Computers left on overnight or over weekends remain logged in, are a security risk and shorten the life span of the units. Also, a PC that is seldom restarted slows down over time.
  3. Do not uninstall the antivirus or antispam software.
  4. Do not change any default settings, such as the default browser, as it will then change for all the user profiles on the PC. This will cause colleagues not to be able to log into Disalab or iSite.
  5. Do not save your documents on the DESKTOP, as it slows down the PC.
  6. Close the windows before you leave the clinic as the dust from Parow Industrial Area is harmful to computers.
  7. Lock the door of the room when you leave.
  8. Secure you personal valuables e.g. cell phone or laptop by locking them in a drawer or cabinet.
  9. Do not take any key from the clinic cabinets or doors home.
  10. Please keep your desk tidy. It is unfair to expect the nursing personnel to clean up the desks for the doctors. File forms in their designated folders.

Our patient population

Here is a list with general remarks that will help you defining whether patients are to be seen in our clinic.

Catchment area

The R300 is the eastern border, N2 southern, Vanguard western and Voortrekker road northern border of our catchment area. Make sure you refer primary patients out to their designated ARV clinic if they do not live within these borders. Student hostel addresses inside these borders are also accepted as our patients.

Pregnant patients

Pregnant patients must get their ARV’s at their designated ARV site. Exceptions are made when medical reasons exist to be addressed at TBH and when time is short.

Private GP’s exist that we could refer private patients to:

Dr Neil Davids, Koeberg (Milnerton) 021 5101569
Dr Christo Bester, Parow Medicross, tel work: +27-21-930 5580, fax work: +27-866 014559
Dr Andre Marais, Parow Medicross,
Dr Basil Petersen, Tokai, 0217157063
Dr Emile Reid (Physician Specialist), Durbanville Medi-Clinic

Prescribing ARV’s > 1 month

Mrs Ford will approve ARV’s up to 2 months. More needs approval from Mr Groenewald in the admin block and needs to be motivated.

ARV’s over the SA border

Up to 1 month stock can be taken over the border. More than this needs a formal script and accompanying drs letter to obtain approval from Ella Tshabangu, 021-3120376, Law Inforcement. A request with travel itinerary, passport copy and prescription can be submitted to her by fax 012 312 3165/3114, formal letter to be awaited and handed over to pharmacy when collecting meds.

3. NOTES FOR ROTATING REGISTRAR

1. Outpatient duties

  • Monday: General internal medicine OPD - please be there by 08h30
    (You may leave OPD temporarily to join the infection control ward round starting in A5 Unit from 11h00 to 12h00)
  • Tuesday – Thursday: HIV family clinic - please be there by 08h00 and be available until 16h00. The general rule is that all doctors stay till all patients are seen. Check with the nurses and doctors of the day if all issues are sorted out before you leave.

2. Inpatient duties

  • Assess and regularly follow-up patients:
    • who are officially referred to you by the firm for an ID opinion
    • admitted directly from the ID clinic during your call (clinic Dr’s will give you a name, ward and number for follow up whenever they admit a patient)
  • Patients seen by you remain yours during follow up in ward and clinic. In case of leave / absence you are to hand them over personally to the person on call.
  • Always make sure that patients who are on ART have enough tablets and confirm the script with the pharmacy (arrange telephonically with ART pharmacist 6131), especially upon discharge. Make sure the ward doctor is updated on regimen changes at all times.
  • Please keep your referral book (recommended) up to date. Referred patients must be followed up daily (excluding weekends) with notes in the ID-sub folder.
  • All patients on ART must receive a detailed summary (in English) of the admission and future management plan on discharge from the hospital. It is the responsibility of the ID Registrar to make sure that this is done adequately.
  • All consultations, e.g. ward patients and telephonically discussed patients, handled by you need to be registered on the IDCS database. Forms are obtainable in the doctors rooms and data office. Completed forms can be left in the bottom tray in the folder cabinet at the nurses’ station for the data capturer to collect.
  • When seeing an HIV related ward referral, give special attention to a multidisciplinary approach. Involve the counselor, social worker, dieticians and special units where applicable.
  • Starting ARV’s in the ward:
    • As a rule we prefer not to start with ART in the hospital as outcome re adherence is unknown in this group. It is always better to treat the underlying acute disease and later initiate ART when the patient is more stable and able to comprehend the implications of lifelong ART.
    • A reason for considering ART initiation as an inpatient may include prolonged hospital stay planned (>2 weeks) in a patient who has a disease with very poor prognostic outcome like Lymphoma, Disseminated Kaposi’s, Invasive Cervical Ca or MDR tuberculosis.
    • Once decided that ARV’s will be started in hospital, there is no need to delay initiation of therapy for example awaiting counseling. Counseling and initiation of therapy may commence simultaneously.
    • All patients started in the ward must be seen by a counselor during their stay. Fill in the standard referral form and leave this with the patient sticker in the counselors book at nursing station
    • When prescribing the ARV’s, make sure you write the script yourself and immediately notify the ARV pharmacist on 6131.
    • Patients started on the ward for the first time must visit the clinic on the day of their discharge and should as a rule always get their follow-up visit at our clinic (irrespective of their area of residence). Once stable they must be referred out to their nearest ARV clinic.
    • The person starting the ARV’s must fill in first visit data form, and give it to the data capturers.

3. Academic meetings and ward rounds

  • The following ward rounds and meetings must always be attended if you have no clinic duties:
    • Monday: - Business meeting and M&M (8h00 – 8h30)
      • - ICU Antibiotic round (11h00 – 12h00)
      • - Blood culture meeting (12h00 – 13h00)
      • - Pathology meeting (16h00 – 17h00)
    • Tuesday - Khayelitsha day hospital Ward Round (13h00 – 14h00)
    • Wednesday - Blood culture meeting (12h00 – 13h00)
    • Thursday - ID Journal Club (13h00 – 14h00)
      • - Micro plate round (14h00 – 14h30)
      •  - ID Grand Round (14h30 – 15h45)
      • - Internal medicine Academic meeting (16h00 – 18h00)
    • Friday - Weekly Academic meeting (08h30 – 09h30)
      •  - End of week ward round (09h30 – 10h30)
      •  - Blood culture meeting (12h00 – 13h00)
      •  - Groote Schuur ID Case discussions (14h00 – 15h00)
  • You are expected to lead the Thursday Journal club on behalf of Adult ID
    • - usually 2 – 3, preferably original articles on any topic related to ID can be discussed (interesting reviews, meta analysis, case studies, reports etc may also be discussed – first check with consultant)
    • - Journals to consult: NEJM, The Lancet, Clinical Infectious Diseases, AIDS, The Lancet Infectious Diseases, Current opinion in ID, The international Journal of Tuberculosis and Lung Disease.
  • You may also be asked to present case studies or topic reviews at:
    • - Monday Pathology meeting
    • - Thursday Internal Medicine meeting
    • - Friday Academic Meetin
    • - Friday GSH meeting

4. On call

  • The registrar and senior registrars share on-call duties. A monthly roster is distributed for calls and clinic duties.
  • You are also expected to help out with F1 calls. Please consult the relevant firm for their on-call list.
  • Leave:
    • Please inform the clinic team of your intentions to take leave during your stay in the unit well in advance (as soon as the registrar’s rotation schedule is available).
    • Leave will only be allowed if we can assure a critical mass of 4 doctors in the clinic from Tuesday to Thursday.
    • We cannot approve more than 2 weeks of leave (including study & exam leave) during your 3 month rotation through ID.
    • It is your responsibility to complete your leave request form, to get it signed by the relevant people and to hand it in with Me Marina Ackerman on the 3rd floor clinical building.
    •  If you are scheduled to lead the journal club or do a case presentation during the time that you are on leave please arrange someone to stand in for you.

5. Research activities

  • Research (independent & contract) are continuously being conducted in the clinic (see Study file for more info on current studies). We expect you to actively assist in these projects while you are with us. Everyone involved will receive appropriate academic acknowledgement.
  • Additionally it is highly recommended that you prepare a case study or scientific letter for publication during your rotation.
  • If you are interested in doing your MMed project in Infectious Diseases, please speak to one of the consultants for guidance.
  • Recommended textbooks:
    • Harrison;s Principles of Internal Medicine
    •  Mandell’s Principles and Practice of Infectious Diseases (library)
    •  Oxford Handbook of HIV Infection – SA Edition
    • The Clinical Practice of HIV Medicine – D Spencer

4. NOTES FOR ELECTIVE STUDENTS

  • Make sure you have read this manual completely, to be aware of all dynamics in the clinic.
  • In order to be able to accommodate visiting students with enough patient contact time, we have no more than 2 students visiting our clinic at a time.
  • All clinic doctors are prepared to have you sit in during their clinic sessions. But be aware that during busy clinic days there might not be much time to give training or explain detailed patient management. Please ask permission before you follow a doctor or sit in a room.
  • You are free to ask any questions considering patient management. It would usually be more appropriate to wait until the patient has left the room before asking questions. Do not interrupt the conversation the doctor has with the patient unnecessary.
  • Please address the patients with respect. As HIV is a sensitive subject, make sure you do not come across judgmental or astonished. We try to create an atmosphere that is free from stigma and prejudice. The patient is not to be embarrassed. It might be necessary for the Dr to ask you to leave the room at times.
  • Be on time for the academic meetings and ward rounds. Schedule of meetings is mentioned in previous chapter.
  • Students that are visiting can be involved in research when previously indicated. Your study will be supervised by one of the clinic doctors. All questions concerning this project should be discussed with that supervisor.
  • It is expected that you will accompany the doctor on call on their daily ward rounds and consultations.

5. DATA SHEET INSTRUCTION

Please read the following guidelines carefully. The quality of our research as well as the reporting to Province and our sponsors depends heavily on the completeness of the data sheet. About 40 entries need to be made or checked each visit. When presented data is correct, please tick behind it, as this will mean you have looked at it and checked is. Make sure no open spaces are left when handing back the folder to the nurse or clerk. Make sure the visit date is correct and please write legible.

All listed entries need to be marked according to the following guidelines:

The cursive details are automatically generated and seldom require extra input. Just check for changes regularly.

1. Visit date:
date of patient visit when datasheet is filled in. Check that nr 6 is accurate.

2. Visit Status:

a. Screening Visit during Work-up for ART
b. Commence ART Only marked when first ART is started that day
c. Follow up Reg 1 Follow up visit within first regimen: 1a, 1b, 1c
d. Follow up Reg >1 Follow up visit on second or salvage regimen with previous virological failure in history
e. Follow up Off ART Follow up after treatment stop or interruption
f. Unscheduled Unbooked additional visit, for whatever reason
g. New ART patient First visit for work-up for ART
h. New patient - not ART First visit for non ART referral
i. Follow up - not ART Normal follow up visit for non ART condition
j. Missed appointment Marked by nurse when patient did not show

3. Study patient:

  • Circle ‘Yes’ when included in study and mention study details
  • Circle ‘No’ when not in study

4. Pt’s ARV’s issued at TBH:

  • Circle ‘Yes’ when pt gets ARV’s from TBH clinic, incl study
  • Circle ‘No’ when pt gets ARV’s from other site
  • Circle ‘N/A’ when pt is not on ARV’s

5. Initial ART Start Date: Add in from first visit data sheet, please fill in when blank. This is the first ever ARV starting date, no matter the history.

6. Months on Roll Out: Number of months (28d) calculated from Initial ART Start Date. Note that after >3 months interruption this is recalculated from 0 and safety bloods are decided on this amount.

7. Months on Regimen: Number of months(28d) calculated from start date current regimen

  • Please check if the date you see the patient is the correct follow up date. Otherwise the number of months mentioned here is not correct!

8. Current ARV’s: Last mentioned ARV’s in point 39

9. Previous ARV’s: Last regimen before current regimen

10. Telephone: Add in from first visit data sheet, please fill in when blank /correct when changed

11. ID nr: Add in from first visit data sheet, please fill in when blank / correct when changed

12. Address: Add in from first visit data sheet, please fill in when blank / correct when changed

13. ART drug compliance:

  • 100 - (number of pills brought back /Total issued pills) x 100%
  • To be registered by nurse, please fill in when blank, see nurse notes

14. LABS:

  • Weight chart and CD4 chart are updated automatically.
  • When last CD4 is not mentioned properly, please fill in value, sample date and month on RollOut accordingly.
  • Only mention other lab results when not available in Disalab.

15. Weight: To be registered by nurse, please fill in when blank, see nurse notes

16. Length: To be registered by nurse, please fill in when blank, see nurse notes

17. BMI is automatically calculated when weight and length are provided, refer to dietician when appropriate.

18. Pregnant:

  • Circle ‘Yes’ when pregnant and mention gestation in weeks
  • Circle ‘No’ when not pregnant

19. HIV related conditions:

  • Mention if started/ continued/ ended on this visit date.
  • These are conditions part of the following list. Please mention accordingly to be captured accurately:

ADEM

Dermatitis

Infections, Multiple and severe

Pneumocystis pneumonia

Anaemia: Hemolytic

Dermatitis, Seborrhoeic

Isosporiasis

Pneumonia, Lymphoid interstitial

Anaemia: Refractive

Diarrhoea: Unexplained > 1 month

Kaposi Sarcoma

Pneumonia, Recurrent, Rx Responsive

Angular cheleitis

Fever - Unexplained, persistent

Leishmaniasis, Visceral

Pregnancy

Aplastic anaemia

Fungal nail infections

Leukoplakia: Oral Hairy

Primary HIV Infection

Apthous ulcer

Gingivitis - Necrotising

Lineal gingival erythema

Rectal Fistula, Acquired

Arterial Occlusion

Gullain Barré Syndrome

Lung Disease: Chronic Suppurative

Recto / Vesico-vaginal fistula

Bacterial infections, Severe & recurrent

Hepato and or splenomegaly

Lymphadenopathy, persistent

Recurrent sinusitis

Candidiasis: Oesophagitis

Herpes simplex - Recurrent

Lymphoma, Burkitt's

Salmonella Septicaemia, Recurrent

Candidiasis: Oral

Herpes simplex lesions > 1 month

Lymphoma, Cerebral

Sexually transmitted Disease (STD)

Candidiasis: Oral, refractive

Herpes varicella: Systemic

Lymphoma: Hodgkins

Thrombocytopaenia, Unexplained

Candidiasis: Other

Herpes Zoster

Lymphoma: Non Hodgkins

Tinea corporis, cruris, et al

Candidiasis: Urogenital

Histoplasmosis

Malignancies, Other / Unspecified

Toxoplasmosis

Castleman's Disease

HIV Cardiomyopathy

Malnutrition - Moderate, unexplained

Tuberculosis: Abdominal

Cerebrovascular Event

HIV Cholangiopathy

Molluscum Contagiosum - New

Tuberculosis: Disseminated Extrapulmonary

Cervical Carcinoma - Invasive

HIV Encephalopathy

Molluscum contagiosum - Severe

Tuberculosis: Extrapulmonary (MDR)

Cervical Dysplasia - Cancer

HIV Nephropathy (HIVAN)

Mucocutaneous conditions: Minor

Tuberculosis: Localised Extrapulmonary

Cervical Dysplasia - High-grade (CIN II or III)

HIV Retinopathy

Mycobacterial Infection: Other

Tuberculosis: Lymphadenopathy

Cervical Dysplasia - Low-grade (CIN I)

Human Papilomavirus infection - Extensive

Mycobacterium avium-complex

Tuberculosis: Meningitis

Cervical Dysplasia - Unknown

Idiopathic Thrombocytopaenic Purpera (ITP)

Neuropathy, Peripheral

Tuberculosis: Pericarditis

Chronic/recurrent suppurative otitis media

Immune Reconstitution Syndrome: CMV

Neutropenia, Unexplained

Tuberculosis: Pulmonary

Condylomata accuminata

Immune Reconstitution Syndrome: Cryptococcosis

Oral ulceration - Recurrent

Tuberculosis: Pulmonary (MDR)

Cryptococcus Meningitis

Immune Reconstitution Syndrome: Histoplasmosis

Other Invasive Mycoses

URTIs, Recurrent

Cryptococcus systemic other disease

Immune Reconstitution Syndrome: HVZ

Papular Pruritic Eruption (PPE)

Verruca Planus

Cryptosporidiosis

Immune Reconstitution Syndrome: Other/Not known

Parotid enlargement

Wasting syndrome

Cytomegalovirus Infection

Immune Reconstitution Syndrome: PCP

Periodontitis - Necrotising

Weight loss < 10% BW

Demyelination: Spinal Cord

Immune reconstitution Syndrome: TB

PML

Weight loss > 10% BW

 

Immune Reconstitution Syndrome: Toxoplasmosis

 

 

 

  • When condition is not in the list, list under ‘Other conditions’ and request addition to the list by emailing the data manager at lgm@sun.ac.za

20. Other Conditions:

  • These are conditions captured literally as stated by doctor.
  • Mention if started/ continued/ ended on this visit date.
  • Mention Allergies here!
  • When no more space is available, please make sure that ended conditions are properly marked as ended.

21. Previous Conditions:

  • These were previously mentioned in the left column, but end date was marked and condition was subsequently shifted to the right column. When additional conditions need to be added, mention end date accordingly, e.g. previous surgery, pregnancy.

22. Prophylaxis:

  • Circle CTX when pt is on daily Co-trimoxazole, irrespective where provided
  • Circle INH when pt is on daily INH only to prevent active TB (rare)
  • Circle FLU when pt is on daily Fluconazole

23. Months on TB treatment: Mention number of months on TB treatment at this visit

24. TB Status:

  • Tests negative Recent (< 2 months) test results negative
  • Not suspected No current TB symptoms
  • MDR Diagnosed MDR TB
  • Regimen 1 On TB Regimen 1
  • Regimen 2 On TB Regimen 2
  • Non standard Regimen On non standard TB Regimen
  • Awaiting results Tests recently (<2 months) taken, awaiting results

Regarding point 22-24: make sure ALL the current not acute medication is listed in the Chronic Medication Sheet with accurate start and stop dates and intended duration. This sheet is provided in the patient ID folder.

25. ART related side effects:

  • These are conditions captured literally as stated by doctor.
  • Please use list below when applicable:

Abdominal pain

Jaundice

Other skin rash

Anaemia

Lactic acidosis

Pancreatitis

Diarrhoea

Leucopenia

Pancytopaenia

Dislipidaemia

Lipodystrophy

Peripheral neuropathy

Drug interaction

LRTI

Pruritus

Exfoliative dermatitis

Macrocytosis

Renal stones

Gynaecomastia

Nausea and GIT upset

URTI

Hepatitis

Neuropsychiatric

Worsening PPE

Hyperlactataemia

Neutropenia

 

  • Mention if started/ continued/ ended on this visit date.
  • Mention grade of severeness

26. Condom use: Circle appropriate status

27. Breastfeeding: Circle appropriate status

28. Other contraception: Circle appropriate status. Remember EFV is teratogenic.

29. Marital status: Circle appropriate status

30. Last PAP smear:

  • Circle ‘Never’ when no PAP smear is ever done
    Circle ‘N/A’ when male or total hysterectomy
    Circle ‘Unknown’ when done < 1 year but no results known
  • Mention date of last PAP smear
  • When result is abnormal, list findings at ‘HIV related conditions’

31. Alcohol Use and Drug Abuse:

  • Circle appropriate status
  • Keep circling ‘Previous abuse’ when applicable, to highlight risk

32. Doctor’s Name: Always mention your name!! This is legally required.

33. Physician’s Notes:

  • Use space appropriately
  • Write legible
  • Mention newly prescribed drugs
  •  Use backside of page when additional space needed, make sure you use the carbon paper accordingly.

34. Assessment:

  • Mention all current clinical issues under investigation
  • Check ‘Conditions’ and update accordingly

35. Plan for Next Visit:

  • Mention To-Do-List for next visit
  • Bear in mind another doctor might be seeing this patient

36. Next Dr Appointment: Mention next visit date to see Doctor again

37. To do next visit:

  • Mention who patient is to see next visit, so nurse will manage visit accordingly
  • Mention investigations to do next visit
  • ‘Pharmacy only’ is only applicable to ‘Pharmacy-list patients’

38. Labs requested today:

  • Circle appropriate test, to insure the next visit the result will be checked
  • Write after ‘Other’ any requested test not mentioned in the list

39. ART changed today:

  • Mention ‘No’ when no change has been made
  • Write down new regimen when change has been made

40. Patient Type Code: Mention appropriate code as listed on backside of data sheet

41. Date and Clinic patient transferred: Mention transfer date and transfer clinic


Enjoy your time at ID!

The ID team

 

 

Copyright © 2012. All Rights Reserved.