Informed-Consent Taking Procedure for Elective Surgery in Gaza strip: Patient's Satisfaction with Doctor's Communication

BACKGROUND : Widespread dissatisfaction and mistrust exists among patients in the Gaza Strip towards doctors. A sense of a lack of sufficient information regarding diagnosis, risks and benefits of interventions and subsequent management plans is present among patients. All of these areas are considered essential components in the surgical consent process. A gap between patients’ actual understanding and that perceived by doctors has been shown to exist in different settings.1 Unfortunately, no former study has been done on this topic in the Gaza-Strip.   OBECTIVES : This study aims to assess the satisfaction of patients in Gaza with the information provided to them during the consent process prior to an invasive procedure and compare this to the current practice and attitudes of surgeons.   METHODS : A five-section self-designed questionnaire was administered using convenience sampling to the first 60 patients and first 60 surgeons who met the selection criteria in the two hospitals in the Gaza Strip: Al-Shifa Hospital and the European Gaza Hospital.   FINDINGS : Among the surgeons surveyed, 55% answered that informed consent should be obtained by doctors only, 3% thought that it can be obtained by nurses only, while 45% stipulated either doctors or nurses can obtain it. In total only 38% of those healthcare professionals taking the consent from the patient, actually performed the procedure. During consent procedures, 73% of surgeons reported providing written documents 30% drawings explaining the procedure, 3% giving videos or animations and 8% suggesting website links for more information. The survey of patients revealed that only 25% of surveyed surgeons identified themselves to their patients, and 12% asked for the patients’ signature without a complete discussion of the intervention. Around 35% of surgeons depended on verbal communication only. Surgeons identified barriers for best practice as time constraints, as well as lack of hospital policies and informational resources. However, 87% of surgeons believed that informed consent has an impact on patient wellbeing. A total of 90% of surveyed patients thought they received the right treatment and were satisfied. While 43% of patients prefer to travel overseas to get treatment, 77% of these because of a perceived lack of medical equipment and facilities

Mechanical bowel preparation before elective colorectal surgery in the Gaza Strip: a survey of surgical practice

Background Many surgeons believe that postoperative complications and anastomotic leakage after colorectal surgery can be reduced by preoperative mechanical bowel preparation (MBP). We surveyed the practice of surgeons in the Gaza Strip, occupied Palestinian territory, and compared this with best available evidence for use of MBP. Methods A five item questionnaire was given to the seven most senior surgeons who did almost all surgeries in the European Gaza Hospital and the Al-Shifa Hospital (the two main hospitals in the Gaza Strip). We searched the Cochrane Library for relevant evidence using the search terms "colonic" or "colon", or "colorectal electives surgery" in combination with "mechanical bowel preparation". Findings All seven surgeons stated that they routinely prescribe MBP before elective colonic or rectal surgery. Two surgeons used MBP only for left colonic surgery; the other five surveyed

Silent Case of Pediatric Osteoarticular Tuberculosis: A Case Report and Review of the Literature

Introduction: Tuberculosis (TB) is one of the most prevalent infectious diseases globally, often presenting with nonspecific symptoms that can obscure diagnosis, especially when it manifests in uncommon sites such as osteoarticular tuberculosis (OA-TB). Case presentation: We report a rare case of a 9-year-old male diagnosed with right knee tuberculosis after enduring severe symptoms for several months. Despite multiple negative biopsies and aspirates during initial debridement surgeries, a biopsy taken 6 months later confirmed the presence of Mycobacterium tuberculosis (MTB). The patient was subsequently treated with debridement and anti-tubercular therapy. Conclusion: This case underscores the critical need to consider tuberculosis in patients presenting with chronic bone pain to avoid misdiagnosis, particularly in the developing world. The atypical presentation of osteoarticular tuberculosis in this young patient emphasizes the need for healthcare professionals to recognize subtle symptoms. Advanced imaging studies like MRI and microbiological evaluations, including site biopsies, are essential for accurate diagnosis. Increased awareness and collaborative research are crucial to improving the understanding and management of pediatric osteoarticular tuberculosis and extrapulmonary tuberculosis