Premier Teaching Hospital Research Articles

A cross-sectional study on awareness and perceptions regarding taxation and health warnings and factors influencing decreased consumption of sugar sweetened beverages among medical students of Bhopal, India with respect to future implementation of such policies

Background: Consumption of excessive sugar sweetened beverages (SSBs) has been linked to non-communicable diseases. It is imperative to understand the perceptions regarding taxation and health warnings amongst the medical students, since they are important stakeholders and as there is some evidence that the government may introduce these soon. Objective was to document the awareness and perceptions about taxation and health warnings on SSBs and the predictors of decreasing consumption of SSBs with regards to their future implementation.Methods: This cross-sectional study was conducted among all the undergraduate medical students of a premier teaching hospital of central India during October and November 2019. A web-based self-administered semi-structured questionnaire was used for data collection using Kobo toolbox. Data were analysed using the SPSS software version 24 (IBM SPSS).Results: About three fourths of the study participants were not aware of any taxes on SSBs and had never seen any health warning on SSB packaging. Multivariable logistic regression analysis showed that those aged ≥ 20 were not in favour of decreasing SSB consumption if health warning is present. Participants who were females, whose fathers were professionals, had consumed SSB in the previous seven days, were aware of taxes and those with inadequate sleep were not in favour of decreasing SSB consumption if taxes are increased.Conclusions: There is a need to include health education regarding the harmful effects of consumption of SSBs and to make aware of the benefits of the taxes and warning labels beginning from school days and continued during medical schools.

Lower Limb Amputations in Nigeria

ABSTRACT Background: The most common indication for lower limb amputations in Nigeria is not known. Almost all studies on amputations in Nigeria considered lower and upper extremities together and report varying leading indications. Major lower limb amputation imposes a significant health burden on the patient and deserves effort at its prevention. The aim of the present study was to determine the predominant indication and patterns of lower limb amputations from a Nigerian premier teaching hospital to enable appropriate preventive recommendations. Materials and Methods: The operative records of patients who underwent lower limb amputation surgeries in the premier University of Nigeria Teaching Hospital, east of Nigeria, between January 2013 and December 2017 were retrospectively analyzed for the indications, levels of amputations, and patient characteristics. Results: Ninety-three unilateral lower limb amputations were performed within the 5-year period. There were 52 (55.9%) males with an M:F ratio of 1.3:1. The mean age of the patients was 52.23 years. Trans-tibial amputation was more commonly performed (51.6%), followed by trans-femoral (45.2%). Diabetic foot (DF) gangrene constituted the dominant indication (57%) and accounted for 54.8% of all the major amputations. The next common indication was tumors (19.3%). Foot gangrene from diabetes and from nondiabetic peripheral arterial diseases (10.8%) accounted for 67.8% of the indications. Conclusions: Major lower limb amputations predominate from this study, with peripheral vascular diseases (PVDs), especially due to diabetes mellitus, being the leading cause. Appropriate public health advocacy on DF complications and establishment of comprehensive multidisciplinary foot-care services, capable of prevention, diagnosis, and treatment of early DF lesions, will help reduce the incidence of DF gangrene. This measure will, no doubt, lower the high rate of major lower limb amputations.

Use of mobile technologies for care of internal medicine clients in Nigeria’s premier teaching hospital

Purpose The purpose of this study was to examine how cost, network and technology factors affect the use of mobile technologies for clients’ care in internal medicine department in Nigeria’s premier teaching hospital, the University College Hospital, Ibadan. Design/methodology/approach The study adopted a survey design covering a cross-section of medical doctors, pharmacists, nurses and medical laboratory technologists in the Department of Internal Medicine. A questionnaire guided data collection. Findings There is a high level of consciousness and use of mobile technologies for meeting healthcare needs of internal medicine clients in the University College Hospital, Ibadan and medical practitioners are deploying the technology most. However, there is no similar evidence of consciousness and use of wearable health-care technologies and solutions. The hospital makes some provision for mobile technology support for relevant medical staff and purposes. However, about three in 10 of the respondents reported that they use their own funds to recharge hospital-provided mobile phones means. Research limitations/implications The study focusses only on one institution but the result reflects the situation in other hospitals, University College Hospital, Ibadan, Nigeria being the major supplier of health and medical human resources in the country. Practical implications The hospital requires undertaking institutional assessment of mobile service need and consumption for clients’ care and thereafter make adequate provision to match the need. Furthermore, the institution could work out various forms of collaboration with mobile technology operators in the country to subsidise the cost of the use of telephones for clients’ care as part of their corporate social responsibility. Social implications The institution could work out collaboration with mobile technology operators in the country to subsidise cost of mobile client care as part of the philanthropic and corporate social responsibility of telecom companies. Originality/value This study focusses mainly on internal medicine and has implication for a more proper understanding of adult deployment of mobile phones for client care.

Royal Perth Hospital airway & head and neck anesthesiology fellowship

Royal Perth Hospital airway & head and neck anesthesiology fellowship

A study of diabetic foot patients in a tertiary care premier teaching hospital

Aim: To analyze diabetic foot patients treated in surgical ward of tertiary care teaching hospital and evaluate the surgical outcomesMethods & Materials: A descriptive retrospective analysis was carried out in Department of Surgery of St John’s Medical College, Bangalore, India. The study period was from July 2014 to December 2014. Statistical analysis was done using SPSS 18.0. The study was approved by the institution ethics committee.Results: A total of 30 male patients were studied. Right foot was most commonly affected in 63.5% of the cases. Type 1 diabetic foot complications were the most common complications in this study accounting for 76.7% followed by type 3 diabetic foot complication (20%). The most common lesion seen was Wet gangrene (40%) followed by abscess (20%) both of which accounted for 60% of the cases and belonged to type 1 diabetic foot complication (P

Kidney transplant in sensitized patients: A case series from a premier teaching hospital in Malaysia

BackgroundKidney transplantation is associated with improved survival as opposed to long-term dialysis in end-stage renal disease (ESRD) patients. In Malaysia, due to the limited number of cadaveric and compatible living related renal transplant (LRRT), there is a need to explore the potential of transplant with ABO-incompatible and positive donor specific antibodies (DSA). This report describes a case series of sensitized patients undergoing kidney transplant. ObjectiveThe aim of this study is to assess the immediate graft function (IGF), graft functions at the 1st month, 3rd month, 6th month and 12th month post-transplant. Graft functions were assessed using serum creatinine, protocol biopsy (at 1st, 3rd, 6th and 12th months post-transplant) and DSA level. MethodsData was collected from all sensitized kidney transplant done at the University Malaya Medical Center (UMMC) between February 2016 and April 2017. ABO-incompatible kidney transplant will be excluded from this study. The patient's progress and outcome (kidney function) are fully documented. ResultsFive patients were analyzed for this report. The first two patients developed antibody-mediated rejection (ABMR) immediately, post-transplant. Learning from initial experience, we have adopted our own desensitization protocol and subsequent to that, all three patients had IGF. Three out of five patients have borderline rejection on protocol biopsy but did not require pulse with methylprednisolone or intensification of immunosuppression. Three patients had negative preformed DSAs at 3-month post-transplant. ConclusionDesensitization protocols may help to overcome incompatibility barriers in live-donor renal transplantation. Based on our experiences we have adopted a protocol that comprises of intravenous rituximab, plasma exchange and intravenous thymoglobulin.

Case—Miller Pain Treatment Center

On a cool Saturday morning Dr. Keith Weems walked briskly down the hallway toward the main entrance to Eastern Hospital (JHH). He was on his way to visit in-patients in several wards as part of his duties as the pain specialist on call for that weekend. However, his mind kept drifting to issues he was facing as the new manager of the Miller Pain Treatment Center in the neighboring Eastern Outpatient Center (E-HOC). Dr. Weems had been working as part of the Eastern system for several years. However, he recently merged his successful private practice into the Miller Pain Treatment Center and was appointed as its director. In so doing he moved from a setting where he was the clear boss to one in which he was dealing with a collection of more established doctors already set in their ways. He also had to figure out how to improve the care delivery process in this environment, which considered itself to be part of the premier teaching hospital in the world. After reviewing the operations and meeting the staff he was coming to grips with the fact that this new setting was much more complex than his old practice in a myriad of ways. Additionally, between treating outpatients and in-patients, managing the clinic, teaching medical students, and conducting research, it was clear that the complexity of the job mirrored the complexity of the operating environment. However, he was confident that he could find ways to get this larger clinic to surpass the success of his old, simpler practice. The online spreadsheet supplement is available at https://doi.org/10.1287/ited.2017.0176cs .

Pattern of Inpatient Dermatology Consultations in a Tertiary Care Centre from Northern India.

The importance of dermatology inpatient consultation is of significant importance yet is not well documented. To retrospectively analyse the spectrum of dermatology inpatient consultations from the various departments and to document the most commonly occurring dermatological disorders from each speciality. This study was done in an 800 bedded premier teaching hospital in Ludhiana, Punjab, North Western India. It was an audit of inpatient referrals to the dermatology department from January 2014 to August 2014. We analysed the spectrum of dermatological disorders in relation to the various specialities, demographic profile and age groups. The data was entered in Microsoft Excel and analysed using SPSS Version 21. Descriptive statistics, frequency and proportions were used. Of the 559 in-patients, 60% were males. The majority of the patients belonged to age group 51-60 years (25.9%). The departments most commonly requesting for dermatology consultations were Medicine (27.7%), Neurology (9.7%), Cardiology (8.8%), Urology (7%), Haematology (6.4%), Nephrology (6.1%), Intensive Care Unit (ICU) (5.4%), General Surgery (5.2%), Orthopaedics (5%), Gynaecology and Neurosurgery (2.9%) and Paediatrics (2.7%). The commonest dermatological diagnoses for which consultations were sought were eczematous dermatitis (12.9%), superficial dermatophytosis (12.3%), drug reactions (8.9%) and viral skin infections (8.5%). Dermatology consultations offer a significant role in diagnosis and management of the in-patients from various clinical speciality departments. There is a significant need of inter-departmental dermatology consultations which help to decrease morbidity and improve the quality of the patient's hospital stay. Knowledge about the pattern of dermatoses in the inpatients can help the primary clinician to recognize when to seek dermatology consultation on a priority basis.

It's only infection prevention, but infection prevention is all we have.

Catheter associated urinary tract infections (CAUTI) are supposedly a very common cause of nosocomial infection in the Intensive Care Unit (ICU).[1] Pyuria and bacteruria are, however, inevitable in every patient who has a Foley's Catheter in place for a few days. It is, therefore, difficult to separate catheter associated bacteruria from true CAUTI.[2] In our country, ventilator associated pneumonia and central line associated blood stream infections (CLABSI) remain the main bug bears in the ICU. Many of the episodes of CAUTI occur after the patient has been transferred out of the ICU after removal of the catheter (especially if the catheter has been removed prematurely and the patient needs re catheterization). Even so, the incidence of true CAUTI is probably over estimated. In this Issue Jain et al.[3] have studied the knowledge and attitude of doctors and nurses towards prevention of CAUTI in a Tertiary Care Hospital. Irrespective of the true incidence of CAUTI, this is an important study. The focus of this study was CAUTI, but the findings of this study are a reflection of the knowledge and attitudes of Health Care Workers (HCW) toward prevention of any nosocomial infection. If a similar study were done about hospital acquired pneumonia or about CLABSI, it is unlikely that the results would be any less depressing. It is interesting to note that the HCW were reasonably good at identifying effective methods of preventing urinary tract infections. They however were very poor at identifying the noneffective methods (metal cleaning, bladder wash, prophylactic antibiotics, etc.). Many useless, expensive and potentially harmful practices are unfortunately therefore still being followed in many ICUs in our country. This is also probably the reason why many other useless practices such as fumigation, removal of foot wear, restriction of visitors, etc., continue to be popular. This study was conducted in a tertiary care hospital, one shudders to think of the results of a similar survey in smaller hospitals. It is a small mercy that HCW in the ICU performed slightly better than the others. This is probably because intensive care is the only speciality, which gives some importance to infection prevention. It is also heartening to note that most of those surveyed recognized that infection prevention should be a priority. They also recognized the importance of education. Preventive medicine has never got the importance it deserves in the medical and nursing curriculum. It is the “Cinderella,” the neglected step sister. This needs to change. Preventive medicine needs a godmother, “Cinderella” needs to be transformed. Infection prevention should be part of the curriculum at both under graduate and postgraduate level (irrespective of specialty). There should be at least one question related to infection control in the qualifying examinations. While seeking renewal of registration, it must become mandatory for a physician to have attended at least one continuing medical education on infection prevention each year. Hospitals must dedicate a minimum of 1-day each year to re-educating and re training their staff in infection prevention. Unfortunately, increased knowledge does not always translate into better practice. In a study performed in a premier teaching hospital in India, doctors scored better than nurses in knowledge of infection prevention practices, but performed much worse when it came to practice of these measures.[4] In a study from South India, after an education program, in spite of an increase in knowledge scores, doctors were the least compliant of the HCW in infection control practices. Several studies have shown that doctors are the worst offenders when it comes to hand washing.[5] Why do doctors have such a poor attitude towards infection control? A major share of the blame must go to the senior doctors. The average age of the respondents in this study was quite low, the results would probably have been more dismal if more senior personnel had been surveyed. Junior doctors and even other HCW tend to copy the behavior and attitudes of the Senior doctors. Unfortunately until recently Senior doctors have been very poor role models at least as far as infection prevention is concerned. Fortunately, intensive care is a relatively young specialty with relatively younger more enlightened leaders. It is their responsibility to lead by example.[6] In these days of “Bad Bugs, No Drugs,” infection prevention is all we have.

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm.

Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardio- and renovascular protection benefits. To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p < 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p < 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.

Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria

To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria. Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria. A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index. Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review. Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P < 0.0001). Two hundred and twenty-six medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the major consequences of non-adherence. Potentially harmful drug-disease interactions were the most frequent medication use-related problems arising from self medication (40.4%). Potentially harmful medication use-related problems are frequently encountered among medical outpatients in Nigeria. The institutionalization of medication use review and the devolution of this task to pharmacists may prove beneficial in optimizing outcomes of medication use in Nigeria.

Condom use among antiretroviral therapy patients in Ibadan, Nigeria

While antiretroviral treatment (ART) has improved the health status of people living with HIV, new challenges to their sexual and reproductive health (SRH) needs and their ability to prevent secondary HIV infections have risen. This study aimed to determine the level and factors that affect condom use among ART-experienced patients at the premier teaching hospital in Nigeria. This longitudinal study involved patients who initiated treatment at the University College Hospital, Ibadan, Nigeria, between January and December 2006. Sexually active patients who had received treatment for at least six months and had not defaulted on clinic follow-up schedules were studied. Data on socio-demographic characteristics and condom use were extracted from clinic records. Chi square test and logistic regression were employed to determine factors associated with condom use. The study involved 866 patients, specifically, 306 (35.3%) men and 560 (64.7%) women aged 40.7 (SD 7.6) and 33.3 (SD 6.5) years respectively. Condoms usage before treatment and at last clinic visits was 14.0% and 43.3% respectively. Overall reports of condom use at specified periods were as follows: 1-6 months (33.0%); 7-12 months (37.3%) and above 12 months (53.8%). Patients in a marital union and those with higher education were more likely to use condoms. Condom use is significantly influenced by marital status and educational level. Although condom use increases together with follow-up time, the level can be improved. Primary and secondary prevention efforts targeting high-risk sexual behaviour among ART patients need to receive greater and continual attention.

Pharmacists´ participation in the documentation of medication history in a developing setting: An exploratory assessment with new criteria

To assess the impact of pharmacists' participation on the frequency and depth of medication history information documented in a developing setting like Nigeria. The study consisted of two phases. The first phase was a baseline cross-sectional assessment of the frequency and depth of medication history information documented by physicians in case notes of systematic samples of 900 patients that were stratified over 9 Medical outpatients Units at a premier teaching hospital in south western Nigeria. The second phase was an exploratory study involving 10 pharmacists who conducted cross-sectional medication history interview for 324 randomly selected patients. 49.2% of patients, whose medication history were documented at the baseline, by physicians, were males; while 50.3% of patient interviewed by pharmacists were male. Mean age (SD) of males and females whose medication histories were documented by physicians and pharmacists were 43.2 (SD=18.6), 43.1 (SD=17.9) years and 51.5 (SD=17.6), 52.1 (SD=17.4) years respectively. The frequency of medication history information documented by pharmacists was significantly higher for twelve of the thirteen medication history components (P < 0.0001). These include prescription medicines; over the counter medicines; source of medicines; adverse drug reactions; allergy to drugs, allergy to foods, allergy to chemicals; patient adherence; alcohol use; cigarette smoking; dietary restrictions and herbal medicine use. The depth of medication history information acquired and documented by pharmacist was significantly better for all the thirteen medication history components (P<0.0001). Pharmacists' participation resulted in significant increase in frequency and depth of medication history information documented in a developing setting like Nigeria. The new medication history evaluation criteria proved useful in assessing the impact of pharmacists' participation.

Laboratory Monitoring of Hematological and Hepatic Parameters in Ambulatory Patients Receiving Alpha-Methyldopa in a Nigerian Tertiary Care Setting

The objective of the study is to assess the frequency and comprehensiveness of laboratory monitoring of hematological and hepatic parameters in ambulatory Nigerian hypertensive patients on methyldopa therapy. A retrospective cross sectional study was conducted between 1(st) February and 31(st) March 2007 at the Medical Outpatient Clinic of a 900-bed premier teaching hospital located in Ibadan, Nigeria. 260 case notes of hypertensive patients, out of the 1178 case notes of patients who had been prescribed at least 250 mg of methyldopa for at least 2 months, were reviewed. 22.1% of the hypertensive patients were on methyldopa alone or in combination with other anti-hypertensives for a mean period of 26.8+/-2.3 months (Range: 2-36 months). Overall, red cell count was prescribed and conducted in only 15.4% (40) of cohort. Only 4.2% (11) of patients had follow-up red cell count done after one month of methyldopa therapy; 9 out of these patients had marked reduction of red blood cells. Only 2.3% of cohort had baseline Liver Function Test (LFT) before start of methyldopa therapy and Alanine Transaminases and Aspartate transaminases levels were elevated in all patients. No patient had subsequent LFT prescribed and conducted particularly within 6-12 weeks of use of methyldopa. Direct Anti-Globulin Test was neither prescribed nor conducted in any of the cohort before and after commencement of methyldopa therapy. In conclusion, laboratory monitoring of ambulatory hypertensive patients on methyldopa therapy particularly for possible hematological and hepatic toxicities is less than optimal. The consequent therapeutic benefit of continuing considerable prescription and use of methyldopa in Nigeria is less likely to be realized without proper monitoring to preclude possible methyldopa-use related harms.

Keir Waddington, Medical education at St Bartholomew's Hospital 1123–1995, Woodbridge, Boydell Press, 2003, pp. xii, 464, illus., £45.00 (hardback 0-85115-919-2).

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