Resident Doctors Research Articles

Surgical residents as “second victims” following exposure to medical errors in a tertiary health training facility in Nigeria: a phenomenology study

IntroductionThe “second victim” phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the “second victim” phenomenon and the support they had following medical errors.MethodsThis is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding.ResultsThere were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as ‘stressful’. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate.ConclusionThe “second victim” phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively.

Risk Factors for the Musculoskeletal Pain Based on the Computer Ergonomics Related Practices among Medical Professionals

Background: With The fast growing world, in Bangladesh also getting increased usage of digital connectivity has led to a rise in online activities and also rise in the musculoskeletal (MSK) pain among the professionals.Objective: We investigating the relationship between MSK pain and discomfort among resident doctors because of computer ergonomics related issues.Materials and Methods: The study collected computer ergonomics related information from 227 resident doctors who had used computer for at least one year. Along with descriptive statistical tools, this study addressed essential test of hypothesis and administered a binary logistic regression model to identify the risk factors of MSK pain among resident doctors.Results: The prevalence of neck pain and lower back pain was estimated over 50% whereas more than one-third faced pain in one or both eyes as well as in their upper back. The different sorts of ergonomics significantly associated with different types of MSK pain. The faculty type- taking break, awkward posture, the shoulder placement had significant impact on the pain in one or both eyes. Besides, having gap between leg and seat as well as monitor placement were the significant predictor of neck pain. In addition, wrist not straightening was not the only risk factor for lower back pain and faculty type, device type, gap between legs and seat, Not having an armrest were the risk factors for upper back pain.Conclusion: The computer ergonomics related practices are the fundamental codes for the medical professionals to avoid MSK pain and hence specific practice safeguards for specific pains.
 KYAMC Journal Vol. 14, No. 01, April 2023: 19-24

Study of Knowledge, Attitude, and Practice of Prescribing Generic Medicines by Resident Doctors at a Tertiary Care Teaching Hospital

ABSTRACT Context: In this era of rapidly rising health-care costs, generic medications offer a more cost-effective alternative to branded medications. Aims: The main objective of this study is to evaluate junior (resident) doctors’ knowledge, attitude, and practice regarding the prescription of generic medications in a tertiary care teaching hospital. Settings and Design: It is an observational, cross-sectional study held at a tertiary care teaching hospital. Materials and Methods: An online, prevalidated questionnaire was used for this study. Results: A total response of 102 resident doctors was recorded. 75.70% (78) of the participants responded positively that generic medicines are cheaper than branded medicines. 68.90% (71) of participants had knowledge regarding Jan Aushadhi Yojana and generic medicine stores. About 90.30% (93) of participants positively suggested conducting a training program to increase the awareness regarding generic medicines and 86.40% (89) of participants suggested promoting the use of generic medicines. However, 26.20% (27) of participants had not read any article on generic medicines and 30.10% (31) participants disagreed with the substitution of a branded drug with a generic medicine by pharmacists. Sixty-five percent (67) of the participants preferred to prescribe generic medicines and 79.60% (82) of participants suggested that they are willing to encourage the patients to use generic medicines. Conclusions: Our study found that the resident doctors were well-versed in the idea of generic medications and their advantages. However, promoting training initiatives, setting up workshops, running journal club meetings, continuing medical education, etc., need to be planned to boost the number of prescriptions for generic drugs.

Neonatal seizures in a tertiary care hospital: clinical presentation and outcome

Background: In the neonatal period, seizures emerge as the most apparent warning sign of neurological disorder and are most common in the first 10 days of life. The true incidence of newborn seizures is difficult to ascertain since clinical detection of neonatal seizures is challenging. Growing research suggests that newborn seizures impair neurodevelopmental outcome and may increase the risk of cognitive, behavioral, or epileptic consequences in adulthood. Methodology: The Neonatal unit of the Paediatrics Department at the Jalalabad Ragib-Rabeya Medical College Hospital in Sylhet served as the site of this cross-sectional study. This study was conducted between July 2013 and December 2013. There were 100 newborns who had seizures participated in the study. After written consent, a thorough history was taken and complete physical examinations were done. Every seizure episode that was reported by the mother and later examined by the resident doctors documented clinically. Results: Most neonates (74%) who experienced seizures were between 1 and 3 days old, and most of them were male children (63%). 40% of newborns cried right away, whereas 60% of them had a history of delayed crying. During the first three days of life, 83% of infants experienced seizures. More than half (57%) of newborns required resuscitation, and 100% of them had weak reflexes. Different types of seizures were observed in neonates. Among them 67% of patients had subtle seizures, 13% had tonic-clonic seizures, 10% had focal clonic seizures, and 10% had tonic seizures. Total 86% of the patients were discharged following treatment. Conclusion: First three days of life and male babies are more prone to seizures. Neonatal mortality is largely caused by newborn seizures.

Smartphone Use Among Resident Physicians: Prevalence and Risk Factors in Clinical Practice

Personal mobile phone has become an integral part of our lives. In the medical field, the growing popularity of medicine applications allows more rapid communication among healthcare professionals and quick access to helpful information, which facilitates and improves patient care practice. The use of smartphones during work activities by healthcare professionals can cause a lack of attention and errors while carrying out health procedures. The result might be an increased threat endangering the safety of patients. The purpose of the present study was to investigate the level of nomophobia (a psychological condition regarded as a fear of being detached from mobile phone connectivity) and its correlations with the use of smartphones in clinical practice, distraction due to personal use and policies regarding mobile phones use in a sample of resident doctors of a University of Southern Italy. A cross-sectional study was carried out on 204 hospital residents divided into three areas depending on their duties: clinical, surgical, and services. Two tools were used: nomophobia questionnaire (NMP-Q) and a composite questionnaire investigating smartphone use in the specific healthcare setting. Sixty percent of participants were affected by a moderate level of nomophobia and 10% by a severe degree, jeopardizing both the work and social relationships of young doctors. Smartphone use can certainly represent a helpful support tool for clinical practice; consequently, we believe it would be appropriate to find instruments to screen smartphone dependence or compulsive use to further prevent, early diagnose or treat this detrimental disorder for health professionals.

Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India.

Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals. This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used. More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS. Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended. Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023;27(7):493-502.

Evaluation of Hypertension Patient Management During Family Medicine Trainee Education

Objective: Hypertension (HT) is a systemic disease manifested by high blood pressure and is a major health problem, common in the community and the cause of serious complications. Control of blood pressure levels is an essential step in reducing omit complications. The aim of the study is to evaluate the impact of face-to-face HT training on the HT knowledge and awareness of the family medicine resident doctors and to understand their needs.
 Materials and Methods: Our study was planned in a descriptive-cross-sectional research design. Just before and after the face-to-face training, participants were given a questionnaire developed by researchers based on two documents: the Turkish Hypertension Consensus Reports published in 2019, and the Hypertension Diagnosis and Treatment Guidelines published by the Turkish Endocrinology and Metabolism Society in 2022.
 Results: In our study, we observed the effect of face-to-face education on 15 sub-categories of HT as an intervention research model. In the post-training evaluation, 12 of the 15 sub-categories involved theoretical questions, and three were case-based evaluation questions. The goal was to answer 50% or more of the questions correctly, and it was observed that, after the training, in five of the fifteen sub-categories, this target was generally achieved.
 Conclusion: Face-to-face training is effective in increasing knowledge and awareness, and evaluation capacity, which are two important elements of HT administration in primary care. A detailed examination of 15 sub-categories related to HT revealed the categories that were better in terms of effect size. Our study also detailed the effects on sub-categories related to HT management (such as resistance to first-stage HT management), which reveal interesting and somewhat unexpected results.

Predictors of burnout among resident doctors in a Nigerian teaching hospital.

Burnout is a psychological syndrome resulting from exposure to chronic work-related stress. There are, however, a few works of literature on burnout among trainee doctors in Nigeria. To determine the prevalence of burnout and its predictors among resident doctors across 16 medical specialties and/or subspecialties. The University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. A cross-sectional study was conducted among 176 resident doctors between October 2020 and January 2021. The survey included the Proforma and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP). The mean age of participants was 35.10 (SD 4.07) years. The prevalence of burnout was 21.6% for high emotional exhaustion (EE), 13.6% for high depersonalization (DP), and 30.7% for low personal accomplishment (PA). Being a younger resident doctor aged 31-35 (OR = 3.715, 95% CI [1.270 - 10.871]) was the only significant predictor for the EE. Predictors of DP included the age group 31-35 years (OR = 7.143, 95% CI [2.297 - 22.216]), duty hours >50 hours per week (OR = 2.984, 95% CI [1.203 - 7.401]), and presence of work-related stress (OR = 3.701, 95% CI [1.315 - 10.421]). A good relationship with colleagues negatively predicted low PA (OR = 0.221, 95% CI [0.086 - 0.572]). High levels of burnout are prevalent among resident doctors, comparable to international studies. Therefore, the government and other relevant stakeholders must drive legislation and formulate policies toward addressing the work-related factors associated with burnout in the Nigerian healthcare industry. This study highlighted the determinants of burnout among Nigerian resident doctors, which necessitates targeted interventions to address them.

Evaluating the efficacy of chatGPT in near-peer simulation for resident doctors in the emergency department

Introduction: Near-peer teaching is gaining popularity as a newer teaching tool, as it improves the learner’s comprehension, targets the right audience and promotes familiarity with the clinical situation and enhances critical thinking.(1) This study was initiated to evaluate the efficacy of chatGPT in near-peer simulation using AI-enabled scenarios in the residency training programme of an emergency department. (2) Methods: ChatGPT an LLM was asked to generate clinical scenarios as per prompts given to evaluate its efficacy in generating real-time and realistic scenarios with information on stepwise approach and critical treatment decisions for the patient. Results: In our study, ChatGPT was able to successfully generate real-time and realistic scenarios based on the prompts given with detailed treatment approaches and critical decisions for all patients/scenarios given, serving as a successful tool to consider in near-peer education using simulation enabled by AI. CONCLUSION: Near-peer simulation training was found to be a valuable method of teaching residents for increasing hands-on experience, skill assessment, confidence in diagnosis and practical thinking. Integration of AI into near-peer simulations aids in creating a wider range of scenarios with prompt treatment decisions.

Current trends and possible solutions for delay in patient discharge: observations from a tertiary care paediatric hospital in Mumbai

Delay in discharge of the patient reduces bed availability in any healthcare organization. In spite of advancement in medical systems and hospital management, delay in patient discharges still exist. Hence, there was a need to evaluate factors contributing to the delay in an exclusive paediatric hospital. A study of patient discharges from a private and a general ward was undertaken at a tertiary care paediatric hospital in Mumbai, between September-October 2021. A total of 60 discharges, 30 from each ward were analysed. The time from discharge order given by the consultant to that of the patient leaving the hospital and the reasons for delay were recorded by the investigators. The hospital followed a policy of 180 min for a discharge. The mean duration of discharge in the general ward was 153.18±34.60 min and whereas it was 165.41±62.29 min in the private ward. However, 28% discharges in general ward and 43% discharges in private ward were delayed with a mean of 5.23±10.04 and 20.66±26.88 min respectively. Time taken for billing and making of discharge sheet contributed to the maximum delay in both wards. Though the mean discharge time in both wards was found to be within the standards, a significant proportion were still delayed. We suggest a multidisciplinary team consisting of administrators, nurses, resident doctors and consultants to help ease the overall burden on the healthcare system.

Spanish mental health residents' perspectives about residency education on the genetics of psychiatric disorders: A cross-sectional survey.

Despite compelling evidence that some patients with a psychiatric diagnosis could benefit from genetic assessment, genetic testing for psychiatric patients is underutilized. Few studies have reported psychiatric genetics training for mental health specialists, and such research is especially lacking in Spain. We aimed to gather the opinions of Spanish mental health residents, including resident intern nurses (RINs), doctors (RIDs) and psychologists (RIPs). A short survey was prepared by an expert team and distributed to all mental health residency centers in Spain during the first semester of 2021. Of the 2028 residents, 18% responded. Participants were mainly females (71%), in their first year of residency (37%) and within the 27-31-year age range. While participants received little theoretical (13.4%) and practical (4.6%) training on average, RIDs had the most affirmative responses. Notably, RINs and RIDs were interested in genetics during residency (>40%) and strongly believed (85.0%) that genetics training using both theoretical and practical methodologies should be incorporated into residency training. However, RIPs were less interested (20%), and only 60% believed that genetics training should be incorporated. Spanish mental health residents, although interested in genetics in psychiatry, receive little training on this topic. They strongly believe that genetics training using theoretical and practical methodologies should be incorporated.

Sluggish cognitive tempo (Cognitive Disengagement Syndrome) symptoms are more associated with a higher risk of internet addiction and internet gaming disorder than ADHD symptoms: A study with medical students and resident doctors

Background & AimsThe purpose of this study was to examine the relationships between Attention Deficit Hyperactivity Disorder (ADHD), Sluggish Cognitive Tempo (SCT), demographic factors, and Internet Addiction (IA) and internet gaming disorder (IGD) among medical students and resident doctors. MethodsThe study included 274 medical students and resident doctors. (Ages:18–35, 70.4% female). Fisher exact test, Contingency Table analyses, Mann Whithey-U Test and structural equation model-path analysis were used for analysis. The Sociodemographic Information Form, ASRS Scale, Barkley SCT Scale, Young Internet Addiction Test-Short Form and The Digital Game Addiction Scale were utilized to collect data. ResultsIn the sample, 48 participants (17.51%, 22 female, 26 male) were classified as having a high-risk internet gaming disorder (IGD+), while 53 participants (19.3%, 37 female, 16 male) were classified as having a high-risk internet addiction (IA+). SCT Scale Daydreaming and Sluggishness scores, as well as ASRS Scale Inattention and Hyperactivity/Impulsivity ratings, were all substantially higher in high-risk groups (for all, p < 0.05). Instead of age, there was no difference between high and low-risk groups, but men had a significantly greater rate of high risk- IGD (%32.1 vs. 11.4; p = 0.001).Path analysis revealed that while older age has a substantial negative effect (β = −0.37, p = 0.001) on increased risk of IA, Inattention (β = 0.19, p = 0.028), Daydreaming (β = 0.62, p0.001), and Sluggishness ( β = 1.12, p0.001) had significant positive effects. On the other hand, results revealed that male gender (β = 5.08, p0.001), IA scores (β = 0.21, p0.001), and only Sluggishness ( = 0.52, p = 0.002), but not Inattention, Hyperactivity/impulsivity, or Daydreaming, have positive effects on greater risk of internet gaming disorder (IGD). Conclusion & ImplicationsOur study is the first to show that SCT symptoms increase the risk of Internet addiction and Internet Gaming Disorder even when ADHD symptoms are controlled. To date, many research have highlighted the necessity of ADHD treatment when evaluating IA and IGD. However, SCT symptoms have a greater impact on people who are predisposed to these behavioral addictions, and despite high comorbidity rates, various treatment approaches for ADHD and SCT are effective. SCT should be kept in mind when assessing treatment-resistant individuals with IA and IGD.

Burden of COVID-19 on Mental Health of Resident Doctors in Poland.

BACKGROUND The study aim was to assess the prevalence of depression, anxiety, stress, and insomnia among resident doctors in Poland during the COVID-19 pandemic. MATERIAL AND METHODS The online anonymous survey was conducted among Polish resident doctors attending obligatory specialization courses organized by the Center of Postgraduate Medical Education between 2020 and 2021. The psychological impact of COVID-19 was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The sleep problems were assessed using the Insomnia Severity Index (ISI). RESULTS Among 767 resident doctors participating in the study there were substantial levels of depression (14.7% mild, 26.2% moderate, 10.8% severe, and 9.5% extremely severe), anxiety (9.0% mild, 20.6% moderate, 8.3% severe, and 11.5% extremely severe), and stress (16.4% mild, 20.9% moderate, 15.7% severe, and 5.7% extremely severe), as well as substantial incidence of insomnia (58.0%), (38.3% subthreshold, 17.9% clinically moderate, and 1.7% clinically severe). Female doctors, physicians working directly with COVID-19 patients, and those who had COVID-19 themselves were at higher risk of depression, stress, and anxiety. Sleep disorders were more prevalent among doctors in surgical specializations, as well as those working directly with COVID-19 patients. CONCLUSIONS The COVID-19 pandemic in Poland appears to have negatively affected doctors' mental health. High levels of depression, anxiety, stress, and insomnia indicate that systemic solutions are needed. A spectrum of interventions should be explored to mitigate further strain on the physicians' psychological health in the post-pandemic work environment. It is necessary to focus on groups at particular risk, such as women, front-line doctors, doctors in health crisis, and residents in selected fields of medicine.

Competency and Level of Confidence of Emergency Residents When Dealing with Ocular Emergency Cases in Saudi Arabia

Patients with ocular emergencies often visit emergency doctors before they visit an ophthalmologist. Therefore, emergency physicians must have adequate knowledge for preliminary diagnosis. We aimed to assess emergency resident doctors’ training in managing eye emergencies, as well as their level of confidence, competence, and equipment use skills in dealing with ocular emergencies. This cross-sectional, multicenter, questionnaire-based study included all emergency resident doctors in the Western, Central, and Eastern regions of Saudi Arabia. In total, 181 emergency residents were enrolled. Moreover, 28.2% received adequate training in the management of eye emergencies, and 72.2% reported that they received training from senior emergency medical staff. Overall, 14.9% of residents expressed confidence in handling emergency eye cases, compared with 66.3% who expressed less confidence. The prevalence of residents demonstrating confidence in the management of emergency eye cases was significantly high among those who received instructions on how to use an ophthalmoscope (p &lt; 0.001), those who had been taught to use the slit lamp (p &lt; 0.001), and those who expressed confidence in using the slit lamp (p &lt; 0.001). We advise integrating basic ophthalmic clinical skills into emergency resident training programs to help gain greater insight, reduce the workload of ophthalmic services, and provide proper emergency eye care.

Perceptions of resident physicians on the development of the cardiology resident program during the COVID-19 pandemic in Lima, Peru

To describe the perceptions of resident doctors about the development of their training program during the pandemic in the city of Lima - Peru.Through a cross-sectional study, a questionnaire was applied to seventy-eight cardiology residents in the last two years of training in the specialty. The perceptions about the accompaniment and support of the universities in the educational venues, for the development of the training program in cardiology during the pandemic, were evaluated.Regarding the support provided for their training, the items evaluated showed shortcomings above 60%, where permanent supervision was lacking in 90.0% of the residents. Regarding compliance with the rotations, the residents only received supervision in 24.4%, observing that they did not manage to carry out adequate rotations in 80.8% of the cases. The courses of the curricular plan were adequately developed in 92.5% of the cases, and the actions for the health of the resident were very low, highlighting that only in 9.0% of the cases did the university inquire about the state of health of the resident.The development of the cardiology residency training program during the pandemic presented important shortcomings, showing that the deficiencies were accentuated compared to previous studies.

The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India.

Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.

Study of knowledge, attitude, and practices of child care physicians toward nutritional vitamin D deficiency in pediatric population

Objectives: Nutritional Vitamin D deficiency (NVDD), commonly seen in infancy and childhood, is a nutritional epidemic. Practicing child care physicians have different approaches to the diagnosis and treatment of nutritional Vitamin D deficiency in children. This study aims to assess the knowledge, attitude, and practice of clinical diagnosis, investigations, and treatment of NVDD in infants and children among child care physicians from a teaching institute. Material and Methods: A cross-sectional study was conducted to assess knowledge, attitude, and practice of NVDD among resident doctors, consultants and faculty members working in a teaching hospital by convenience sampling method. The study was based on a pretested questionnaire which was administered by a single investigator on all the study participants. Twelve questions formulated to assess the knowledge, was scored as 0 (0%) to 14(100%) and ten questions regarding attitude and practices with possible responses as agree, disagree, or neutral was scored as 0 (0%) to 20 (100%). Data were analysed with statistical software, STATA, version 10.1,2011. Descriptive statistics included summary measures such as frequency and percentages to summarize qualitative variables and categorical responses. Inferential statistics included P-values generated from hypothesis testing procedures. Results: There were 96 participants including 46 residents. Forty-seven (49%) of them scored more than 11 out of 14 while 49 (51%) participants scored between 7 to 10 out of 14 on the knowledge part of the questionnaire. Interestingly nobody scored less than 7 out of 14. Sixty (62%) participants scored more than 15 out of 20 and nearly 19 (2%) physicians scored less than 10 out of 20 in the attitude and practice part of the questionnaire. On intergroup comparison between consultant pediatricians and residents on knowledge regarding NVDD showed no significant difference except for knowledge regarding cumulative therapeutic dose of cholecalciferol (p value 0.025). There were more attitude and practice gaps in this group of respondents although it was not statistically significant. Conclusion: This study identifies gaps in the knowledge, attitude and practice of child care physicians about NVDD in infants and children. Knowledge gaps regarding definition and change in treatment protocol of NVDD and inconsistency in clinical identification, diagnosis, treatment, and prevention protocols across all groups of physicians.

Perception of Medical Error Among Resident Doctors at the University College Hospital (Uch), Ibadan

To enhance the standard of patient care, it is necessary to look into the complex issue of resident doctors' perceptions of medical error at tertiary hospitals. To foster a culture of safety in medical practice, medical mistake must be addressed in Nigeria, where it is a major contributor to patient mortality and morbidity. Therefore, this study aimed to determine the perception of medical error among resident doctors in the University College Hospital, Ibadan. In order to choose a sample of 302 resident doctors from a pool of 515 at the University College Hospital (UCH), a two-stage sampling approach was used. The research methodology used in this study was a cross-sectional survey employing a pretested self-administered semi-structured questionnaire. At the 0.05 level of significance, data were analyzed using descriptive statistics as well as inferential statistics like chi-square 228 (75.5%) of the responders were men, and 74 (24.5%) were women. Approximately 33.4% of the respondents were pre-part 1, 64.9% of resident doctors were post-part 1, and 1.7% were post-part 2 of their fellowship tests. The majority of responders (82.1%) had between one and three years of resident doctor experience. A majority (70.2%) of the respondents reported that misdiagnosis generally often occur in a medical setting. About 40.4% of the respondents said that delayed diagnosis is the most common type of medical error in the institution. There was a statistical significant association between the frequency of occurrence of delayed diagnosis and the departments of the resident doctors (X²=16.892, P&lt;0.001). A majority (62.3%) of respondents reported that high work load, ill-equipped facility, work environment, patient factor and institutional factors influence their daily medical practice. Most (88.1%) of the respondents believed prevention of medical error is very crucial in the healthcare system. About 31.5% of the respondents indicated that continuous education on preventing and managing medical error was not adequately provided for resident medical doctors. The institution needs to invest in better-equipped facilities that will support high-quality patient care, continue medical education to advance medical knowledge and skills related to medical error, deploy more medical personnel to lessen the burdensome workload on current staff members, and establish proactive error avoidance strategies for the management of medical malpractice. This will thus improve the quality of healthcare delivery and reinforce possible standards of care that are evidence-based against medical error.

Image-guided radiotherapy (IGRT) in Lombardy, Italy: a survey by the Lombardy section of the Italian Association of Radiotherapy and Clinical Oncology (AIRO-Lombardy)

ABSTRACT Background Image-guided radiation therapy (IGRT) has changed clinical practice. We proposed a survey to radiotherapy centers in Lombardy to picture the current clinical practice of its use. Research design and methods The survey consisted of 32 multiple-choice questions, divided into five topics: type of hospital, patients treated in 2019, number of LINACs; presence of protocols and staff involved in IGRT; IGRT in stereotaxis; IGRT in non-stereotactic treatments; availability of medical and technical staff. Results Twenty-seven directors answered (77%). Most centers (74%) have produced protocols to ensure uniformity in the IGRT process. The most widely used IGRT modality (92%) is cone-beam CT. Daily IGRT control is favored for prostate (100%), head and neck (87%), and lung (78%) neoplasms. The resident doctors can always perform supervised IGRT matching in only six centers. Radiation therapists perform IGRT controls only for some sites in 12 cases (44%) and always in 9 cases (33%). Radiation oncologists are present in real time, in most cases. Conclusions Today, IGRT can be considered standard practice but at the price of more time-consuming procedures. A balance between a fully physician-controlled process and an increased role for specifically trained RTTs is actively being sought.

Study on needle stick injury in a tertiary-level government teaching hospital

Background and Objective: A safe injection does not harm the recipient, nor does it expose the provider of injection at risk and, does not result in the generation of hazardous waste. The study was performed with the aim to assess the knowledge, attitude and practice (KAP) about needle stick injury (NSI) with respect to biomedical waste management rules 2016 among staff of a government tertiary care teaching hospital. Methodology: It was a cross-sectional descriptive study conducted in the clinical care areas of a tertiary care government teaching hospital. The study was conducted from June 2019 to June 2020. Institutional ethics committee approval was attained before taking up the study. A study sample of 407 was calculated by applying the population proportion to size formula to each stratum and was drawn among the resident (academic) doctor, staff nurse, paramedical staff and housekeeping staff of the institute. The results were analysed statistically. Results: Out of 407 study participants, 91 (22.4%) were resident (academic) doctors, 122 (30%) were staff nurses, 23 (5.7%) were paramedical staff and 171 (42%) were housekeeping staff, respectively. Regarding the knowledge aspect, most of the study participants were unaware of the safe injection practices such as not to recap the needle and to use a needle cutter to discard the used needle immediately and NSI. The overall KAP mean score of the study participants was 0.43 out of 1, 2.7 out of 3 and 0.73 out of 1, respectively. Conclusion: The attitude and practice aspect concerning the approach to NSI was found to be better for the housekeeping staff and nursing officers when compared with the resident doctors.