Determining Factors for the Choice of Medical Career among the Final Year Medical Students of a Private University in Nigeria

Background: Medical education worldwide is more expensive compared to other university courses due to the structure of the training into two phases: basic medical sciences and clinical sciences, each with extensive syllabuses and involves an array of professionals in various specialties. The burden of medical education was largely borne by the government in Nigeria until recently when the private sector forayed into the provision of tertiary education including medical education. Methods: The study was a cross‑sectional survey study. All 94 final year medical students of Afe Babalola University, Ado‑Ekiti, a private sector‑owned university in South Western Nigeria, were invited to participate in the study. The institutional ethical approval was sought and obtained (ERC/2020/04/07/364A). Structured self‑administered questionnaires were used to collect relevant data. Participation in the study was voluntary and confidential. The data obtained were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Eighty‑three (88%) final year medical students participated and returned completed questionnaires out of 94 students. Further analyses  were on the number of the respondents (n = 83). Fifty‑seven (68.7%) of the respondents were female, whereas 26 (31.3%) of the respondents were male. The mean standard deviation age was 23 (1.6) years, and the age ranges between 20 and 30 years. Parental influence and personal interest were the two most important factors that influenced the decisions for medical education. Fifty‑seven (68.7%) of the respondents prefer to practice outside Nigeria, 25 (30.1%) respondents will like to practice in Nigeria but in urban areas, whereas only 1 (1.2%) of the respondents will prefer to practice in a rural area. Conclusion: The choice of medical education and future specialty is multifactorial but the most important factors are personal interest and parental influence. The choice of where to practice is mostly determined during the undergraduate program, and it tends toward continuous emigration of doctors to developed countries. Keywords: Medical education, medical students, Nigeria, postgraduate specialty, private universit

Pattern of Skin Cancers in a Tertiary Medical Center in Southwest Nigeria

Background: Skin cancers are the most common malignancies in the western world, and their incidence is increasing globally. However, the data about the pattern in sub-Saharan Africa are limited. This study evaluates the pattern of primary skin malignancies in a tertiary medical center located in a sub-urban area. Methods: The histo-pathological records of patients managed for malignancies from January 2012 to December 2020 were retrieved from the pathology department of a tertiary medical center in Ekiti State, Southwest Nigeria. All primary skin cancers seen within this study period were extracted from the records and then reviewed retrospectively. Results: The male-to-female ratio of primary skin malignancies was 1:1.06, and the mean age of patients was 57.2 ± 17years. All patients were black Africans who were mainly of the Yoruba ethnicity (97.2%). Squamous cell cancer had the highest frequency (34.7%), followed by melanoma (27.8%), dermatofibrosarcoma (12.5%), and basal cell carcinoma (11.1%). The most commonly affected anatomic region is the lower limbs (50.6%). Conclusion: The pattern of primary skin cancers seen in black Africans differ from that of Caucasians: however, larger community-based studies in our environment is recommended to provide more conclusive information about the pattern of skin cancers

Surgical Outreach as a Tertiary Hospital’s Corporate Social Responsibility: Shall we do more?

Introduction: The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria. Methods: A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would‐be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. Across-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3‐point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0. Results: One hundred and fifty‐eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme. Conclusions: Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

INTUSSUSCEPTION -A RARE SURGICAL OCCURRENCE IN SCHOOL AGE CHILDREN

A case of a 12yr old female student who presented with a week old history of abdominal pain, vomiting, and bloodstained stool and was diagnosed by ultrasonography and barium enema to have intussusception (ileocolo colic variety). Idiopathic cause, a diagnosis of exclusion was made at surgery. She was managed successfully and subsequently followed up at the clinic.</jats:p

Pattern of Skin Cancers in a Tertiary Medical Center in Southwest Nigeria

Background: Skin cancers are the most common malignancies in the western world, and their incidence is increasing globally. However, the data about the pattern in sub-Saharan Africa are limited. This study evaluates the pattern of primary skin malignancies in a tertiary medical center located in a sub-urban area.&#x0D; Methods: The histo-pathological records of patients managed for malignancies from January 2012 to December 2020 were retrieved from the pathology department of a tertiary medical center in Ekiti State, Southwest Nigeria. All primary skin cancers seen within this study period were extracted from the records and then reviewed retrospectively.&#x0D; Results: The male-to-female ratio of primary skin malignancies was 1:1.06, and the mean age of patients was 57.2 ± 17years. All patients were black Africans who were mainly of the Yoruba ethnicity (97.2%). Squamous cell cancer had the highest frequency (34.7%), followed by melanoma (27.8%), dermatofibrosarcoma (12.5%), and basal cell carcinoma (11.1%). The most commonly affected anatomic region is the lower limbs (50.6%).&#x0D; Conclusion: The pattern of primary skin cancers seen in black Africans differ from that of Caucasians: however, larger community-based studies in our environment is recommended to provide more conclusive information about the pattern of skin cancers.</jats:p

Oncology practice in the COVID-19 pandemic: a report of a Nigerian expert panel discussion (oncology care in Nigeria during the COVID-19 pandemic)

Since the first case of COVID-19 and its progression to a pandemic, healthcare systems the world over have experienced severe difficulties coping with patient care for both COVID-19 and other diseases most especially non communicable diseases like cancer. These difficulties in Low- and middle-income countries (LMICs), especially in Sub-Saharan Africa including Nigeria, are myriad. These LMICs are already bedeviled by weak health systems, ill equipped cancer treatment centers, with outdated machines and grossly inadequate numbers of oncologists required to treat patients with cancer. As a result of these challenges coupled with unclear guidelines on how to manage cancer patients in the wake of the COVID-19 pandemic, 11 key Nigerian opinion leaders had a consensus meeting to identify challenges and possible workable solutions on continuing cancer care during the COVID-19 pandemic. The discussion highlighted ethical issues, barriers to continuing cancer care (such as lockdown, fear of contracting disease, downscaled health services) and resource constraints such unavailable personal protective equipment. Yet, practical solutions were proffered such as necessary protective measures, case by case prioritization or de-prioritization, telemedicine and other achievable means in the Nigerian setting