Many clinicians perceive intravenous (IV) antibiotics as inherently more effective than their oral counterparts. However, randomised controlled trials (RCTs) have demonstrated that oral antibiotics are clinically equivalent to IV antibiotics for many severe bacterial infections. This includes pneumonia, skin and soft tissue infections, pyelonephritis, intra-abdominal infections, osteoarticular infections, bacteraemia and infective endocarditis. When clinically appropriate, oral treatment is more patient-friendly, cost-effective and environmentally friendly. But we still use the IV route much more than necessary. To address a historical practice that is often unwarranted, thisTherapeutics Letterreviews evidence from RCTs and compares the advantages and disadvantages of oral and IV antibiotics. We suggest criteria to determine when oral therapy is appropriate.

Hearing loss in children has a profound impact on development. It negatively affects speech production, language acquisition, social interaction and early cognitive growth. These challenges influence emergent literacy if undetected and untreated. This study aimed to determine the referral rate and potential prevalence of hearing loss among Grade R learners in the Qumbu Circuit Management Centre (CMC). Nine primary schools located in Qumbu CMC, a rural area within the O.R. Tambo Inland District of the Eastern Cape province, South Africa. A quantitative, cross-sectional design was used. Out of 215 schools, 10 were conveniently selected using Slovin's formula. From these, 259 Grade R learners aged 5-6 years were randomly selected to participate. Hearing screening followed the minimum standards for school-based screening set by the Professional Board for Speech, Language, and Hearing Professions in October 2018. Data were analysed using Statistical Package for Social Sciences (SPSS) version 27. Screening outcomes revealed that 25.5% of the learners presented with ear-related conditions requiring referral for further diagnostic evaluation and management. Conditions on findings included wax impaction and otitis media. The study revealed a notable referral rate and potential prevalence of both temporary and permanent hearing loss among learners in Qumbu CMC. These results emphasise the importance of regular screening, early detection and timely intervention in underserved rural communities.Contribution: This study provides baseline data to guide future research and inform planning for hearing healthcare in the Eastern Cape.

South Africa has implemented several health improvements to strengthen primary health care (PHC). Despite that, there is an increasing number of patient complaints that may affect job satisfaction among healthcare providers, especially nurses. This study explored how patient complaints can impact job satisfaction of nurses in the PHC clinics, Ehlanzeni District, Mpumalanga, South Africa. Professional nurses from three PHC clinics in Ehlanzeni District, Mpumalanga, South Africa, were recruited. A qualitative, exploratory and descriptive design was utilised. Eleven professional nurses were recruited purposively at the three selected PHC clinics until saturation was reached. Semi-structured, individual interviews were conducted, transcribed verbatim and analysed thematically using Saldana's coding methods. Five major themes and sub-themes emerged: perceived staff attitudes and patient complaints, work environment stressors, emotional impact on nurses, communication challenges and recommended strategies for improvement. Primary health care nurses reported that patients' complaints often stemmed from long waiting, insufficient staff and a lack of communication; however, these were reflected as staff failures, leading to reduced morale and confidence. Most reported patient complaints relate to negative staff attitudes, often compounded by systemic issues such as staff shortages, inadequate material resources and long waiting times. This study brings to the fore that patient complaints should be understood within the broader systemic context, as they can significantly influence nurses' job satisfaction.Contribution:This study contributes empirical evidence to the under-researched area of the impact of patient complaints on nurses' morale in the South African context.

Adolescents living with human immunodeficiency virus (HIV) aged 10-19 years account for 1.7 million globally, with 82% residing in sub-Saharan Africa. Older adolescents (15-19 years) assume greater responsibility for their own care, often leading to reduced adherence, lower retention, and poorer health outcomes. Understanding the role of healthcare workers (HCWs), key stakeholders in the HIV care continuum, is essential to strengthening transition practices and health system responses. To describe HCWs' perspectives on transition practices for adolescents living with HIV in the Cape Town Metropole, South Africa. Six public primary health facilities in the Cape Town Metropole, South Africa. A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with 16 HCWs and analysed thematically. Healthcare workers identified challenges to optimal transition (theme 1), including delayed disclosure, low adolescent readiness, and inconsistent transition processes. Health service responses (theme 2), such as youth clubs and provider-adolescent relationships, were supportive but unevenly applied. Gaps and recommendations (theme 3) included improving youth club management and ensuring system-wide support to enhance engagement and continuity of care. Successful transition to adult HIV care requires structural and psychosocial support mechanisms. Healthcare workers play a critical role and should be supported to consistently implement adolescent-friendly services during and post-transition.Contribution:This study offers system-level insights to inform policy, HCW training, and integrated models of care tailored to adolescents living with HIV in primary health settings in South Africa.

Stigma experiences challenge Type 1 Diabetes Mellitus (T1DM) adolescents. Such an impact causes complications in their self-management behaviour and identity formation. To critically synthesise, analyse, interpret and reflect on research regarding the experiences of T1DM adolescents and stigma through identifying the types of stigma experienced and the impact they have on T1DM adolescents. Three scholarly databases were used to identify scientific data, which was subjected to a screening process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method of extraction and analysis. One hundred and nine articles were scanned, yet 14 eligible articles were included in the review. Using thematic analysis, the experiences of T1DM adolescents and stigma were consolidated, improving our understanding of the interactive nature of stigma. T1DM adolescents experience social, enacted, internal and self-stigma. These experiences result in suboptimal T1DM self-management and the non-disclosure of a T1DM diagnosis. Negative effects associated with stigma experiences are linked to challenges in T1DM identity integration and decreased wellness. A diagram was developed to explain the continuous interactive nature of stigma. Stigma experiences may have a negative impact on adolescents in the absence of support structures and appraisal strategies.Contribution:Within a primary care setting, practitioners are empowered to comprehend the stigmas experienced by T1DM adolescents. Through this knowledge, adolescents may be educated to cope with such experiences without compromising their T1DM self-management or their psychosocial development. Academically, the model can assist future researchers in understanding the relationships that exist between stigmas while informing opportunities for interventions in curbing the effects of stigma.

No abstract available.

Given the increased complexity of healthcare needs, evidence-informed practices are needed, now more than ever. Combining the best available research evidence, the perspectives of patients and communities, and the voices of healthcare workers in guiding policy and practice is essential. All of us involved in providing and strengthening family medicine and primary care need to be good consumers (users) of research, and some will be good producers (doers) of research. In both using and doing research, a helpful starting point is evidence synthesis - a form of secondary research that collates primary research on the same research question. This short report outlines when and how to incorporate evidence synthesis into doctoral work, highlighting methodological considerations, ethical principles and reporting standards. Practical tips and decision points are provided to support relevance, rigour and impact. Thoughtful integration of evidence synthesis - whether by using existing reviews or conducting new ones - enables doctoral researchers to contribute meaningfully to evidence-informed primary care practice and policy.

Design science research (DSR) transforms how healthcare researchers create digital innovations by treating artefacts as knowledge repositories rather than mere technical solutions. It provides a problem-solving paradigm that creates artefacts embodying prescriptive knowledge about solving classes of problems, complementing quality improvement methodologies. Through its systematic approach, DSR equips healthcare researchers with methods for building digital health innovations, using quality improvement concepts as reference points to facilitate understanding and adoption. The methodology presents philosophical foundations distinguishing design sciences from natural sciences, five artefact types (constructs, models, methods, instantiations, design theories), and a six-phase framework (problem identification, objectives, design, demonstration, evaluation, communication). Systematic problem investigation transforms vague complaints into measurable problems amenable to designed solutions. This paradigm distinguishes itself as one where the artefact is the knowledge contributor. While quality improvement produces innovations solving problems, DSR produces artefacts embodying prescriptive knowledge about solving classes of problems. Both methodologies innovate; the distinction lies in knowledge representation. The DSR approach treats artefacts as knowledge repositories containing extractable design principles, while quality improvement focuses on demonstrating improved outcomes. Methodological synergies strengthen both approaches through complementary evaluation frameworks and iterative refinement. Practical considerations include maintaining methodological rigour through transparent documentation, addressing AI integration challenges, ensuring sustainability, and avoiding common pitfalls. African healthcare contexts particularly benefit from DSR's orientation, with resource constraints demanding solutions addressing complex socio-technical challenges while contributing to global design knowledge. Future research should establish DSR training programmes and develop artefact repositories for systematic knowledge transfer, positioning African researchers as contributors to healthcare's digital transformation.