Base Deficit as an Indicator of Significant Blunt Abdominal Trauma

Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma patients. Base deficit (BD) has been proposed as an early available tool alongside focused assessment with sonography for trauma (FAST) in the screening of patients suspected to have BAT and also to help guide the selective use of CT scan. Objective: To determine the use of BD as an indicator of significant BAT. Methods: This was an observational study carried out at the Kenyatta National Hospital from February to May 2015. Patient with suspected BAT admitted into Accident & Emergency were enrolled. Data collected included clinical assessment, BD, FAST findings, CT-scan, and laparotomy were recorded. Data was analyzed using SPSS 17.0. Comparison of mean values of BD between different groups of patients (discharged from A&E, managed conservatively or operated) was performed using ANOVA. Results: Patients who had significant abdominal injury had sensitivity and specificity of 82.98% and 65.91 % respectively at BD of -4.15.The PPV and NPV were 56.52% and 87.88 % respectively. At this cut-off point, AUC was 0.863 (p=0.037). Conclusion: Due to high NPV, BD could rule out significant abdominal injuries but can also predict need for exploratory laparotomy when less than -6.85.Key words: Base deficit, Blunt abdominal trauma, Predictor

Communication in Surgery for Patient Safety

One of the cardinal pieces of the Hippocratic Oath is “do no harm”; yet, even in the very best of contexts, errors, at times fatal, do occur as was reported by the Institute of Medicine. Surgical procedures are known to cause the majority of serious adverse events. The Joint Commission report indicates that 60% of serious adverse events are caused by the lack of physician-patient communication. Some of the factors that make surgical processes prone to medical errors include the number of steps and people involved and the fact that the interventions intended for the healing are often in themselves invasive and can also complicate. The involvement of more than one discipline and individual requires communication that is clear, understandable, culturally sensitive, and contextually relevant. One of the center pieces of quality care is its patient-centeredness. This refers to providing service that is not only respectful but also responsive to individual patients involving them in the decisions, ensuring their values and preferences are taken into consideration. It also demands that the care giver provides the patients with relevant and understandable information to enable them in the decision-making and make informed choices

Correlation between receptor status and presence of axillary lymph node metastasis in breast cancer in Kenya

Background: Breast cancer survival is linked to early detection, and timely and appropriate treatment. Survival depends on the stage and biological behaviour of the tumour. It is unclear how different molecular subtypes impact on axillary node involvement.Objective: This study sought to determine the correlation between hormonal receptor status with axillary nodal status in breast carcinoma.Methodology: A cross sectional study was carried out at Kenyatta National Hospital surgical wards and histopathology laboratory. Patients with a histological diagnosis of breast cancer, scheduled to undergo a modified radical mastectomy, were recruited. Data collected included age at diagnosis, parity, menopausal status, clinical examination findings, stage of the disease clinically and pathologically, and hormonal receptor status. Data were analyzed using SPSS version 21.0.Results: We enrolled 79 women with invasive breast carcinoma. Mean age was 48(SD=14.5) years. Most (48.1%) presented with stage III tumour. Most tumours (58.2%) were luminal A. Correlation between molecular type and nodal involvement was not significant. Luminal B was significantly present in those above 50 years (p=0.011).Conclusion: The most common molecular type of breast cancer was luminal A, but luminal B disease which was prevalent in women more than 50 years old was the only molecular subtype that had a positive correlation with axillary nodal status.Keywords: Breast cancer, Axillary lymph nodes, Molecular subtypes, Hormonal receptor status, HER-2 statu

Nurturing Medical Professionalism in the Surgical Community

Introduction: The teaching of professionalism worldwide is changing for effectiveness. Our aim was to explore the reflection of the surgical teaching community in a Kenyan context on how professionalism can be effectively inculcated through the socio-cultural concept of activity theory.Methods: A sequential mixed-methods study was conducted among clinicians and students within the surgical community of the University of Nairobi from March to December 2014. . Individual interviews and focusgroup- discussions were conducted using grounded theory methods. A survey of the resultant views was performed through a pre-determined questionnaire which utilized a 4-point Likert scale for response ranging from “strongly agree” to “strongly disagree”. Factor analysis was used to analyze the responses to the survey. Internal reliability was determined by Cronbach’s α.Results: Four themes emerged from the interviews; change of values, regulation, enabling environment and formal curriculum. In the survey, the participants strongly agreed with strengthening mentorship (77.5%) and a teaching facility (74.7%) with a rewarding or recognition (69.5%). The reliability test of the items showed a Cronbach’s α of 0.827.Conclusion: This study demonstrates that the participants would like to see a different and transforming path in inculcating professionalism through changing values and enabling environment among others.Key words: Nurturing, Medical professionalism, Surgical communit

Contribution of Professor Saidi to Surgical Education in Kenya

Surgical education in Kenya has grown over the last 40 years from just one medical school to three and from being offered by university to now a combination of university and collegiate system. While the traditionally technical skills were the main focus in surgical training, non-technical skills such as interpersonal communication,professionalism,system-based learning, problem based learning and leadership skills have come to be core competencies. Apprenticeship was the method for training in technical and non-technical skills, but today there is explicit curriculum with various methods of training for both technical and non-technical skills. Professor Saidi contribution to the surgical education in Kenya was from traditional aspects as well as newer aspects. His contribution to the transition from just skills training to the 21st century competency-based training, from basics to technology-based interventions cannot be overemphasized. This article is in memory of his contribution to surgical education in Kenya

Operative Exposure of a Surgical Trainee at a Tertiary Hospital in Kenya

Background. Psychomotor domain training requires repetitive exposure in order to develop proficiency in skills. This depends on many training factors in any training institution. Objective. This study sought to look at the operative exposure of surgical trainees in a tertiary hospital in a developing country. Design and Setting. This was a six-month retrospective study performed in one surgical firm at Kenyatta National Hospital. Patients and Methods. The files of all patients admitted to the unit at that time were retrieved. The demographics, diagnosis at admission, need for surgery, and cadre of operating surgeon among others were recorded. Scientific Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results. The study cohort was 402 patients of the 757 patients admitted in the study period. The average age was 36.7 years, a female to male ratio of 1 : 2.5. The majority (69.7%) of patients required surgery. Trauma was the most common reason for admission (44.5%). Year 2 residents received the most clinical exposure. Consultant was available in only 34.5% of the cases. Conclusion. The junior residents performed the vast majority of procedures with an unsatisfactory amount of supervision from the senior residents and faculty

Academic global surgical competencies: A modified Delphi consensus study.

Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively

Academic global surgical competencies: A modified Delphi consensus study

Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively