Pattern of Ophthalmic Consult from the Ear, Nose and Throat Ward of a Tertiary Hospital

Objective: To study the pattern and indications for ophthalmicreferral of patients with otorhinolaryngology problems.Method: A retrospective study of patients who were admittedinto the Ear, Nose and Throat (ENT) ward of the UniversityCollege Hospital, Ibadan and had ophthalmic referral betweenJuly 2000 and June 2004. The parameters evaluated were thedemography of the patient, indication for ophthalmic consult,and the contribution of the ophthalmologist towards themanagement of the patient.Results: Reports on 26 patients on whom ophthalmic consultswere sent were available for review. This accounted for 3%of the patients admitted during the period under review.Fourteen (53.8% ) of the consults were sent on account ofproptosis and 7 (26.9%) for complaints of poor vision. In 12(46.2%) of these patients, the otorhinolaryngologicaldiagnosis was sinonasal tumour. The ophthalmologist madepositive contributions to the management of 20 (76.9%) ofthe patients. These included the use of lubricants/protectiveshield (6 [23.1%]), tarsorrhaphy (3 [ 11.5%]), antiglaucomamedication (2[7.7%]) and cataract extraction (2[7.7%]).Conclusion: Proptosis ranked highest for ophthalmic consultfrom the ENT ward in this review. Close collaborationbetween subspecialties should be encouraged when managingvisually-threatening conditions. There is also the need for astandard referral protocol

Demographic and clinical profile of patients with juvenile onset open angle glaucoma in southwestern Nigeria

Background: This was a non-comparative, retrospective review of patients diagnosed with juvenile open angle glaucoma (JOAG) in the eye clinic of a tertiary hospital in southwestern Nigeria.Objective: To document the demographic characteristics, clinical features and treatment outcome of the patients diagnosed with JOAG.Materials and Methods: Data were extracted from the clinical record of patients diagnosed with JOAG in the eye clinic of the University College Hospital, Ibadan, Nigeria, between January 2001 and December 2005. Such data included the basic demographic data, the clinical characteristic of the patients and the outcome of their treatment.Results: Twenty-nine patients were reviewed, which represents 3.4% of all newly diagnosed glaucoma patients seen in the out-patient section of the eye clinic of the University College Hospital, Ibadan, over the period reviewed. Eight (27.6%) patients were aged 20 years and below. The mean age was 25.1 ± SD 6.0 years. Eighteen (62.1%) had visual acuity of 6/18 or worse in the better eye at the time of presentation. The mean intraocular pressure (IOP) of the patients at presentation was 32.3 ± SD 15.2 mmHg. Eight (27.6%) patients defaulted within 6 months of presentation. The mean IOP for the 21 patients who were followed up on treatment for a mean period of 9.6 months was 17.0 ± SD 6.0 mmHg.Conclusion: Most patients with JOAG in this review presented with advanced form of the disease. Early detection through parent-driven school eye health program and community-based case detection could help in reducing the scourge arising from JOAG among our population

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. METHODS: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. DISCUSSION: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. TRIAL REGISTRATION: ISRCTN79330571 (Controlled-Trials.com)

A Review of the Effect of 5-Flurouracil on the Outcome of Trabeculectomy in Ibadan

Aim: To retrospectively assess the outcome of trabeculectomy performed using an intraoperative sponge soaked in 5-fluorouracil (50 mg/ml). Methods: Trabeculectomy with an intraoperative sponge soaked with 5-fluorouracil (5-FU) was performed in 21 eyes of 14 patients. The reduction in intraocular pressure (IOP), complications and variations in visual acuity were noted. Results: The mean preoperative IOP was 31.5 ± 10.6 mmHg. The mean postoperative IOP was 7.3 ± 5.7mmHg on the second postoperative day and 17.5 ± 9.8mmHg at 3 months. Postoperative complications were mostly transient, with 33% of eyes requiring postoperative antiglaucoma therapy to reduce IOP. Visual acuity improved postoperatively in 3 eyes, worsened in 9 eyes and remained the same in 9 eyes. Conclusion: Even though a small study, an intraoperative sponge soaked with 5-FU seems to be a safe and effective adjunct to trabeculectomy. Key Words: 5-flourouracil, trabeculectomy, glaucoma, Nigerian Nigerian Journal of Ophthalmology Vol.12 (1) 2004: 14-1

Patients' perception of the quality of eye care at the university college hospital, Ibadan

Objective: To determine patients&#146 perceptions about the quality of care and possible factors that may prevent adequate utilization of services at the study centre and therefore make recommendations for improvement in service utilization. Materials and methods: A cross sectional survey of patients from the Eye Clinic and Eye Ward of the University College Hospital, Ibadan, was carried out using a standardized questionnaire between May and June 2001. Results: A total of fifty respondents were interviewed: 33 (66%) were male, while 17 (34%) were female. Their ages ranged from less than 10 years to more than 80 years, with a mean age of 46.5 years. The majority of the patients (78%) lived within Ibadan, while 22% lived outside Ibadan. Over half of the respondents (56%) were gainfully employed. Others included retirees (20%) and students (20%). Thirty-eight of the respondents (88%) experienced some obstacles before and/or on presentation at the hospital. Notable obstacles to the optimal use of facilities include: frequent strikes embarked on by hospital workers (66% of respondents), long wait before seeing the eye doctor as reported by 36% of respondents; high cost of services 8%, fear of the outcome of surgery reported by 12% of those who had surgery; and the unfriendly attitude of some staff. Recommendations by respondents for improving the quality of health service delivery include: provision of more equipment in the eye clinic (68%) and the employment of more eye doctors (64%). Other suggestions include reduction in the cost of surgery and other services (12%), and the need for records staff and nurses to be more humane and show understanding to patients, especially those from out of town (4%).Keywords: quality, care, barrier, obstacle, cost, serviceNigerian Journal of Ophthalmology Vol. 13 (1) 2005: 11-1

Service uptake in UCH, Ibadan: a time flow study

Objective: To determine the time flow of service uptake as assessed by patients in the eye clinic of UCH with the view of identifying delays in service uptake, the reasons for such delays and ways to improve services. Materials and methods: Patients attending the eye clinic of the University College Hospital (UCH) were selected consecutively and interviewed using a semi-structured questionnaire on the amount of time they spent waiting for the various services at the eye clinic and reasons for any perceived delays in receiving the services. For under-aged children, their guardians were interviewed. Results: A total of 42 patients were interviewed, out of which 22 (52.4%) were male. The age range was 5 to 75 years. All the patients were referred, with 78.1% coming from the general outpatient department of the hospital. They spent between 30 minutes and 2 hours waiting to get their referral letters. Delay was believed to be due to the large number of patients relative to the small number of doctors. Services with extended time flow in the eye clinic include delayed first consultation due to long appointment dates (1 to 6 months in 45% of patients studied), need for repeated visits before doctor is seen (2 visits by 78.6% of patients), prolonged waiting for nursing procedures (1 to 3 hours by 11.9%), waiting for doctor's consultation (1 to 3 hours by 21.4%), and waiting to pay to the cashier (10 minutes to 1 hour). Reasons for delay include: insufficient number of doctors, few functioning equipment and the poor attitude of some staff. Other services with extended time flow include prolonged surgical bookings of between 1 week and 6 months, mainly due to industrial action by staff, lack of sterile linen due to broken down boiler, unsatisfactory laboratory results, unresolved medical problems or financial constraints. Conclusion: Services in the eye clinic of UCH are perceived by patients to be associated with extended time flow due mostly to the insufficient number of trained staff and functioning equipment, recurrent industrial action and the poor attitude of some staff, which gives rise to patient dissatisfaction and complaints. There is the need to employ more eye doctors to provide functioning equipment, to re-educate/re-orientate all staff in the eye clinic and in UCH, and in fact, in all public health institutions, to provide a more patient-friendly environment through an attitudinal change, and to ensure accessible, affordable and acceptable health care. Nigerian Journal of Ophthalmology Vol. 13(2) 2005: 49-5

Patency of the Ductus Arteriosus in Newborns: Experience in a Special Care Baby Unit

A prospective cohort study of infants admitted into the Special Care Baby Unit, University College Hospital, Ibadan, has revealed a 24.5 per cent prevalence of patency of the ductus arteriosus (PDA) among 97 infants, who were admitted over a six-month period. The major factor predisposing to PDA was prematurity (p=0.014). A higher incidence of PDA (35 per cent) was found among the preterm infants, and of these preterm infants, the very low birth weight (VLBW) infants were found to be more highly susceptible to PDA (p = 0.028). The mean birth weight of the preterm infants who developed PDA in the study was 1447g, while that of those preterm infants without PDA was 1835g. There was no relationship between the sex of the infants and the development of PDA. A strong association was however, found between respiratory distress and PDA (