Prioritizing lectures on end of life care in a Nigerian Medical School: final year medical students' perspectives

No AbstractKeywords: End-of-life Care, Palliative Care, Dying & Death, Medical Students, Nigeri

Team Ward Rounds for Quality Improvement in Patient-Centred Care: An 'Acute Care for Elders' Unit Experience

Patient-centred care is a core value in Geriatrics and requires effective  communication between patients and multi disciplinary professionals. Accurate and timely implementations of care plans are also important to achieve desired  outcomes. The Acute Care for Elders (ACE) Unit in University of Benin Teaching  Hospital (UBTH), Nigeria admits older adults with multiple medical morbidities under the care of consultant physicians on call, and a geriatrician who oversees unit activities. Patients and their relatives require support to effectively communicate their healthcare needs to multiple managing teams. Care coordination was alsorequired. In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of lapses in implementation of patient care plans, amongst which documentation andmedication errors were the leading. Our interventions included communication with patients, between members of the multi disciplinary geriatrics team, and with doctors in other managing teams. We conclude that daily multidisciplinary team rounds are feasible in Nigeria and useful for service evaluation and quality improvement in patient care. The rounds enabled the identification of the most pressing targets for quality improvement in patient-centred care: improved documentation and reduction in medication errors.Key words: Ward rounds, Quality improvement, Patient centred care,   Multidisciplinary teams, Geriatrics, Nigeri

Bilateral cortical blindness with Anton–Babinski syndrome in an elderly Nigerian woman: Challenges for tertiary prevention

Anton–Babinski syndrome (Anton's syndrome) is well described in the scientific literature even though it is a rare neurological condition. Most publications have highlighted the anatomy, neurophysiology, and pathology of visual anosognosia, which is the hallmark of the syndrome. We are not aware of any published report of cortical blindness with Anton's syndrome from Africa. We report a catastrophic complication of severe hypertension in an elderly Nigerian woman who was on follow-up for stroke, chronic heart failure, diabetes mellitus, and glaucoma. She developed bilateral cortical blindness with Anton's syndrome as a complication of severe hypertension, following 3 weeks of missed medications. This report highlights some challenges of tertiary prevention in this elderly woman without health insurance, who before becoming blind, had been largely dependent on family members' goodwill for her medical care

Letter to EditorPhysician heal thyself

Click on the link to view the letter.Nigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

A Comparison of Two Instruments for the Assessment of Legibility of Prescriptions in a Developing Country

Purpose: To compare the utility of a rating and visual analogue scale for the assessment of legibility in prescriptions Methods: A sample of fifty randomly selected prescriptions from a tertiary hospital in Benin City, Nigeria was assessed by five independent assessors - three doctors and two pharmacists using a rating scale and a 100 mm visual analogue scale. Rating scores were allocated as: 0 - completely illegible; 1 - barely legible; 2 - moderately legible; 3 - clearly legible, and 4 - print. Visual analogue scores were measured in millimetres. Results: Rating and visual analogue scores were skewed. The median rating score by doctors and pharmacists were 2.0 and 3.0, respectively. Median visual analogue scores were 59.5, 67.0, 55.0, 51.5 and 46.0 mm, respectively. Inter-quartile ranges (rating scores) were 2.0 – 3.0 for both doctors and pharmacists except for one pharmacist whose inter-quartile range was 1.0 – 2.3; inter-quartile ranges (visual analogue scores) were 49.3 – 63.0, 59.8 – 71.0, 31.0 – 65.5, 40.8 – 62.0, 43.0 – 55.5 mm, for the five independent assessors. The pharmacists’ scores using either scale were significantly positively correlated (rs = 0.900; 2-tailed p = 0.05); one doctor’s scores were negatively correlated (rs = -0.308). Conclusion: The findings support the utility of both instruments in the assessment of handwriting but suggest that there may be important differences between doctors and pharmacists using either method

A Comparison of Two Instruments for the Assessment of Legibility of Prescriptions in a Developing Country

Purpose: To compare the utility of a rating and visual analogue scale for the assessment of legibility in prescriptions Methods: A sample of fifty randomly selected prescriptions from a tertiary hospital in Benin City, Nigeria was assessed by five independent assessors - three doctors and two pharmacists using a rating scale and a 100 mm visual analogue scale. Rating scores were allocated as: 0 - completely illegible; 1 - barely legible; 2 - moderately legible; 3 - clearly legible, and 4 - print. Visual analogue scores were measured in millimetres. Results: Rating and visual analogue scores were skewed. The median rating score by doctors and pharmacists were 2.0 and 3.0, respectively. Median visual analogue scores were 59.5, 67.0, 55.0, 51.5 and 46.0 mm, respectively. Inter-quartile ranges (rating scores) were 2.0 – 3.0 for both doctors and pharmacists except for one pharmacist whose inter-quartile range was 1.0 – 2.3; inter-quartile ranges (visual analogue scores) were 49.3 – 63.0, 59.8 – 71.0, 31.0 – 65.5, 40.8 – 62.0, 43.0 – 55.5 mm, for the five independent assessors. The pharmacists’ scores using either scale were significantly positively correlated (rs = 0.900; 2-tailed p = 0.05); one doctor’s scores were negatively correlated (rs = -0.308). Conclusion: The findings support the utility of both instruments in the assessment of handwriting but suggest that there may be important differences between doctors and pharmacists using either method

Mainstreaming the private health sector in the response to COVID-19 : Facility readiness assessment for screening services in Edo state, Nigeria

Introduction: The COVID-19 pandemic presents an opportunity for the Nigerian health system to harness the potentials available in the private sector to augment the capacity within the public health system. This survey was carried out to assess private facility readiness in providing screening services in Edo State. Methods: This was a descriptive cross-sectional study carried out among private facilities in Edo state. Facilities were selected using stratified sampling technique. Data was collected using adapted questionnaires and an observational checklist. Facility readiness was assessed using the Nigeria Centre for Disease Control recommendations for screening. Parameters were scored and overall scores were converted to proportions. Facilities that scored 70% and above were adjudged to be ready while facilities that scored 69% and below were adjudged to be not ready. Results: A total of 252 health facilities were assessed, comprising 149 (59.1%) hospitals/clinics, 62 (24.6%) pharmacies and 41 (16.3%) laboratories. One hundred and forty-two (95.3%), 60 (96.8%) and 41 (100.0%) hospitals/clinics, pharmacies and laboratories, respectively had hand hygiene facilities. However, overall facility readiness assessment scores for screening services were low with only 51 (34.2%) hospitals/clinics, 2 (3.2%) pharmacies and 2 (4.9%) laboratories achieving high enough scores to be adjudged ready for screening services. Conclusion: Overall facility readiness of the private health sector to provide screening services in Edo State was assessed to be low. The government and facility owners will need to ensure that screening services are improved in all facilities to help mitigate community spread of COVID-19.publishedVersionPeer reviewe