Diagnostic accuracy of chest radiograph interpretation by graduate radiographers in Uganda

Background. Radiographers are increasingly being called on to take on new roles, such as X-ray film interpretation in imaging departments. In Uganda, where this study was conducted, there are just >40 radiologists in a population of ~40 million. In many hospitals, especially in rural areas, clinicians often rely on radiographers to obtain an opinion to assist with proper patient  management. Therefore, Ugandan radiographers are being trained in basic radiographic interpretation to address the shortage of radiologists. Objective. To determine the diagnostic accuracy of graduate radiographers in interpreting chest radiographs. Methods. This was a cross-sectional retrospective study involving 57 graduate radiographers who were provided with 53 randomly selected chest radiographs to interpret. The validation of a radiographer’s interpretation of a radiograph was aided by the opinion of two senior radiologists. SPSS version 25 software (IBM Corp, USA) was used to analyse the findings and the radiographer’s performance was assessed using the receiver operating characteristic (ROC). The mean abnormality location sensitivity, overall radiographer sensitivity, specificity and false-positive rates were calculated. Results. The radiographers’ diagnostic accuracy was high. The abnormality location sensitivity was 88.7%, overall sensitivity 76.6%, specificity 79.7% and false-positive rate 20.1%. Conclusion. The study demonstrated that radiographers, if trained, can accurately report on chest radiographs to an acceptable  standard

Uncollected Radiographs in a National Hospital with Low Resources

Background: Communication between clinicians and radiologists is commonly through reports written by radiologists. It is important this information gets to the clinicians if it is to be utilized. Many radiographs remain uncollected in Mulago Hospital X-ray Department. The aim of this study was to establish if uncollected radiographs in Assessment Center x-ray unit had pathology and reports.Methods: This was a retrospective descriptive study carried out from October to December 2005 at Mulago Hospital in Kampala. A radiologist looked at 699 x-ray envelopes recording all data in a precoded questionnaire. EPI –INFO and SPSS 10 were used for analysis.Results: The CXR accounted for 71.2% of requested examinations. Most radiographs had pathology; reports were written within 24hours. Reasons for no reports written included non-diagnostic radiograph (66%), no clinical history (17%), and non-labeled radiograph (3.8%) among others.Conclusion: Most uncollected radiographs in Assessment Center X-ray unit in Mulago Hospital had pathology and reports, which the referring clinician did not receive

Experience with ultrasound of the knee joint at Mulago Hospital, Uganda

Background: The knee is prone to various pathology. Mulago Hospital records of 2001/2002 show that an average of 432 patients with knee joint disorders are seen in orthopaedic and rheumatology outpatient clinics out of a total of 5400 patients annually. For a long time the only mode of radiological investigation for these patients has been x-rays of the knee joints and this meant that limited information was got about the soft tissue component of the knee. Advances in technology with high frequency transducers, power Doppler ultrasound and extended field of view function have facilitated the progressive development of musculoskeletal sonography (MS). In developing countries like Uganda, where advanced imaging modalities like MRI are unaffordable and not readily available, ultrasound U/S serves as an efficient substitute in trained hands. This study was aimed at describing the sonographic pattern of knee joint pathology at Mulago Hospital in patients with knee joint symptoms.Methods: A cross sectional descriptive study of the sonographic pattern of knee joint pathology was performed at Mulago Hospital from July 2004 –February 2005. A total of 107 consecutive patients referred to the Radiology department with knee joint pathology were studied. The patients’ socio-demographic data, clinical history and physical examination were recorded. Sonography of the knees was done using U/S machines [ATL-HDI 1500, Sonoace [Medison] SA8800 & SA9900] with high frequency linear transducers (7-12 MHz) The sonographic appearance of joint fluid, synovitis , loose bodies, bursae and cysts, tendon, mensci and ligament pathology were recorded. The data was entered in the computer using Epi-data soft ware and analysed using the SPSS version 10.Results: A total of 107 patients had their knee joints evaluated with U/S. The age range was from 2 months to 80 years. The mean age was 38.0 and median 36 years. The commonest presenting symptoms were painful swelling of the knee 55(51.4%), pain 39 (36.4%), swelling and inability to move were 6 (5.6%). Sonographic features revealed osteoarthrosis was the most frequent 22(59.5%), loose bodies were 7 (18.9%) and fractures 2(5.4%).Conclusion: U/S can ably evaluate the pathology of menisci, ligaments, tendons and muscles. The majority of the knee joint pathology disorders were as a result of the degenerative disease. In view of the fact that MRI is not readily available and is expensive, U/S goes a long way in contributing to the diagnoses of knee joint pathology in a low resourced countries like Uganda

Problem based learning: tutors’ views 5 years after implementation at a sub-Saharan University

Background: Curriculum evaluation is key to continuous assurance of quality of education.Objectives: To assess the teachers’ perceptions on how well student teaching and learning activities were conducted at an institution that had practiced PBL for five years.Methods: A cross sectional descriptive study. 150 teachers from 23 departments at the College of Health Sciences participated in the study. A 25 item self-administered questionnaire was used to collect data. Activities evaluated included; students assessment, self-directed learning, feedback and clinical exposure. Data were entered in epi data and analysed using SPSS. Ethical approval was obtained.Results: The participants’ average teaching experience was eight years. The PBL/COBES approach mostly achieved the aim of producing self-directed and lifelong learners. Half of the teaching staff actively provided regular feedback about the learning and teaching activities they were involved in. Early clinical exposure was widely accepted as a highly rewarding appropriate teaching and learning strategy. COBES activities were well organized although involvement of College staff was low.Conclusion: PBL/COBES program was successfully executed and had high acceptance among Faculty. The biggest challenge was getting all staff to provide regular feedback. Self institutional curriculum review can be done cheaply and quickly to provide feedback for continual curriculum improvement.Key words: Problem Based Learning, Evaluation, Curriculum, Universit

Student and tutor perception of a new problem based learning curriculum at Faculty of Medicine, Makerere University

Background: The Makerere University Faculty of Medicine started the implementation of the Problem Based Learning/Community Based Education and Service curriculum for incoming students in the academic year 2003/2004. It undertook an intense preparatory period of 2 years before implementation, which included sensitizing, and training tutors to take their new role. Objectives: To evaluate student and tutor perception of the New PBL Curriculum at the Faculty of Medicine and to evaluate tutors perception of how well the students were doing.Methods: The study was at the end of the first semester, after seventeen weeks of the new curricula implementation. A 19-item questionnaire was self-administered by the students. An open discussion led by one of the investigators followed that questionnaire filling session. A 5-point likert scale was used to rate the different aspects. A different questionnaire was administered to the 35 academic staff that had tutored the twenty tutorial groups of eight to ten students each. The data collected from the two questionnaires was analyzed using SSPS software. The Faculty Research Committee approved the study.Results: Out of 180 students, 135 students filled in the questionnaire. In addition 25 tutors out of 35 filled in their questionnaire. The tutors’ facilitation of the tutorials was rated highly by the students. Students’ rated their (students’) participation in the tutorial process as excellent. The students rated access to learning resources as inadequate and they were anxious as to whether they were learning enough. On the other hand the tutors were satisfied with the depth and scope of the discussions by the students. The majority of the tutors thought it was the right move to introduce PBL. They were however concerned about sustainability of the novel educational reform (PBL).Conclusion: The students perceived the new method as acceptable. They expressed anxiety and uncertainly as to whether they were learning enough. And whereas the students were not sure they were learning enough, the tutors were satisfied with the depth of knowledge exhibited by the students. To sustain the reform tutors’ concerns and fears ought to be addressed

Strategies from the 2000–01 Ebola outbreak in Uganda

AbstractBackgroundAn outbreak of Ebola virus disease was reported from Gulu district, Uganda, on Oct 8, 2000. Over a period of 3 months, the outbreak spread to two other parts of the country, namely Mbarara and Masindi districts. Response measures included surveillance, community mobilisation, and case and logistics management. Three coordination committees were formed: the National Task Force (NTF), the District Task Force (DTF), and the Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism, and international relations. This study documents this experience and draws lessons that are of interest to the rest of the world.MethodsThe international response was coordinated by the WHO under the umbrella organisation of the Global Outbreak and Alert Response Network. A WHO and Centers for Disease Control and Prevention case definition for Ebola was adapted and used to capture four categories of cases: alert cases, suspected cases, probable cases, and confirmed cases. Guidelines for identification and management of cases were developed and disseminated to people responsible for surveillance, case management, contact tracing, and information, education, and communication.FindingsFor the duration of the epidemic that lasted to Jan 16, 2001, 425 cases with 224 deaths were reported throughout Uganda. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12·6 cases per 10 000 inhabitants when the contacts of all cases were considered, and was 4·5 cases per 10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2·5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared free of Ebola on Feb 27, 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was of huge importance. The NTF and the corresponding district committees worked closely in the harmonised implementation of the mutually agreed programme. Community mobilisation using community-based health workers, cultural and religious leaders, and Members of Parliament was effective in transmitting information to the public.InterpretationPast experience in epidemic management shows that, in the absence of free availability of information to the public, rumours that are unhelpful to epidemic control efforts prevail and spread quickly. During this outbreak in Uganda, rumour was managed by frank and open discussion of the epidemic, daily updates, fact sheets, and press releases. Information was regularly disseminated to communities through mass media and press conferences. Community mobilisation and transmission of information to the public was critical in controlling the epidemic. All levels of the community spontaneously demonstrated solidarity and response to public health interventions—even in areas of relative insecurity, where the number of rebel abductions dropped considerably during the outbreak.FundingNone

The sonographic pattern of diseases presenting with scrotal pain at Mulago hospital, Kampala, Uganda

Background: Scrotal pain is a common presentation in the male patient. There is a wide overlap of symptoms and signs making differentiation at clinical diagnosis difficult. Ultrasound has been documented to improve the accuracy of diagnosis of scrotal diseases. This study was aimed at determining the sonographically detectable diseases in patients with scrotal pain, describe their sonographic appearances and to relate the diseases to the sociodemographic and clinical characteristics of the patients presenting at Mulago hospital.Patients and Methods: This was a Cross sectional descriptive study done at Mulago Hospital, between May 2003 and March 2004. Consecutive patients with scrotal pain referred for ultrasound evaluation and consented were scanned using an ATL HDI 1500 machine model 2000 with a 5-12 MHz linear probe.Results: Of the seventy-three patients, 19 had acute epididymitis, 19 chronic nonspecific epididymitis, 12 testicular torsion, and 7 tuberculous epididymo-orchitis diagnosed at ultrasound. The entire epididymis was more often involved and there was no significant difference in pattern of involvement in acute and tuberculous epididymitis except that the frequency of calcifications was significantly higher in tuberculous  epididymo-orchitis lesions than in those of either acute epididymitis  (p=0.0017) or chronic epididymitis (p=0.0017).Testicular torsion was more  common in adolescents and young adults. Acute epididymitis was seen in all age-groups and was associated with anomalies of the genitourinary tract at the extremes of age and sexual activity in young adults. Clinical assessment had low accuracy in diagnosis of cause of scrotal pain.Conclusion: Scrotal ultrasound gave added information in the diagnosis of patients with scrotal pain. This expedites proper patient management and reduces morbidity. Infections and testicular torsion are the commonest cause of scrotal pain at Mulago hospital. Tuberculous epididymo-orchitis is still a problem at Mulago Hospital

Is a PhD a necessary requirement for lecturers in a`Medical School? Report of a survey

Background: Makerere University introduced a new policy1 on the minimum qualification for appointment to a lecturer teaching position and eligibility for subsequent promotions. The highlight of the policy is a requirement for a PhD or equivalent as the minimum qualification necessary for appointment to a lecturer position and above.As a result of this policy fewer and fewer members have shown interest or indeed joined the Faculty of Medicine teaching staff roll.Objectives: This study set out to investigate the perception of the faculty and the impact of the policy on staffing.Methods: Literature review, oral and a questionnaire interviews were used to gather data. Participants included current members of teaching staff (of biomedical sciences and clinical disciplines) postgraduate students and visiting overseas academic staff and adjunct staff employed by the Ministry of Health at teaching hospitals.Data collected was analyzed and summarized in tabular form.Results: A PhD or equivalent is required as a minimum qualification to join academic positions at lecturer level and above at Faculty of Medicine and subsequent promotion to higher positions. There was a significant lag in promotions and recruitment in the Faculty of Medicine compared to counterparts employed by the Uganda Ministry of Health at the teaching hospitals. Participants expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from other universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions.Conclusion: Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion.University policy makers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as minimum requirement for teaching at a Medical School

Radiation Safety Awareness among Radiation Workers and Clientele At Mulago Hospital, Kampala, Uganda.

Background: All x-ray utilization in human medicine leads to exposure of the patient and personnel to radiation. Although the quantity is low in diagnostic examinations, special attention should be given to this fact in order to minimize unnecessary exposure for both groups. Exposureto ionizing radiation cannot be avoided in a medical imaging facility. Twenty-two radiation workers and fifty patients responded. The main objective of the study was to determine the level of radiation safety awareness among radiation workers (Personnel) and clientele at Mulago hospital.Methods: Subjects were interviewed using two different questionnaires each one tailored to the radiation workers and the patient (clientele). Fifty patients and twenty-two radiation workers responded. Their views were assessed using structured questionnaires. The data was analysedusing SSPS package.Results: Fifteen (68.2%) reported that they had had a sensitization introduction about radiation safety before they started working with radiation. . 18 (81.8%) thought that the radiation safetymeasures taken at the work place were inadequate. It was noted that radiation workers were well informed about radiation safety, but that the patients expressed ignorance on the subject and many were convinced that x-rays were dangerous.Conclusion: There is need for sensitization of the public on radiation safety and to allay their fears about radiation. The radiation workers should do this before patients are worked on. This requires good communication skills on the part of the radiation workers. There is also need for radiation workers to have introductory seminars on radiation safety before they start working with radiation. They also need continuous education and update on radiation safet

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum.Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively.Results: Radiologists’ and students’ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated.Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM