Assessment of the willingness of doctors to work at coronavirus disease-19 treatment center

Objectives: The Coronavirus disease 2019 (COVID-19) pandemic is currently ravaging the entire world. Doctors as well as other healthcare workers as front-liners in tackling this disease are at a higher risk of exposure to the virus and its potential consequences. The objectives of this study were to assess the knowledge of doctors on the mode of transmission of the virus, to assess their willingness and readiness to work at the COVID-19 treatment center, to identify factors that affect their willingness to work at the treatment center, and to assess their knowledge on infection prevention and control (IPC) practices.Materials and Methods: All medical doctors who attended the COVID-19 sensitization and preparedness meeting with the management of Federal Medical Centre, Owo, Ondo State Nigeria, were recruited into the study after an informed consent was obtained. Study period spanned from the beginning of April 2020 to middle of June 2020. A structured, pre-tested questionnaire was administered to collect relevant information.Results: A total of 112 doctors that were in attendance had the questionnaires administered to them; however, 106 (94.64%) questionnaires were returned. Out of these, 64.2% had correct knowledge of the mode of transmission of COVID-19. We observed that only 34.9% of doctors were willing to work in the treatment center while 1.9% were indifferent. The perceived lack of adequate training and insufficient personal protective equipment (PPE) for staff were major reasons why some doctors were not willing to work in these centers. Fifty percent of the participants got the correct meaning of donning and doffing and three quarters of them had good knowledge of IPC practice.Conclusion: We found in our study that a substantial number of doctors were unwilling to work in COVID-19 treatment areas due to a number of factors including perceived inadequate PPE and inadequate knowledge. The factors that would influence their willingness to work in COVID-19 treatment center were more training, provision of inducement or extra allowances and life insurance schemes. We recommend that in addition to putting emphasis on training, re-training, and providing appropriate equipment, special inducement allowance, and life insurance for healthcare workers might be helpful to encourage them to work in COVID-19 treatment centers

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever

BACKGROUND: Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago-the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. METHODOLOGY: We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. RESULTS: A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. CONCLUSIONS: This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level

Economic burden, impact, and consequence of adverse drug reactions among medical inpatients in clinical practice

Background: An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high prevalence. Aim: The main aim of this study was to adequately evaluate the economic burden, impact, and consequence of ADRs among adult medical inpatients in clinical practice, to highlight the pattern of medications most frequently involved in ADRs, and to estimate the economic cost implication of treating ADRs in such clinical practice setting. Methods: The patients admitted into the adult medical wards of a Nigerian university teaching hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, out of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median: 46 years). Most ADRs were mild and moderate in 21 (41.2%) cases and 24 (47.1%) cases, respectively. Severe ADRs occurred in 2 (3.9%) cases, while four (7.8%) cases were fatal ADRs. The economic cost implication of treating ADRs was ₦ 161,668.00 ($1243.60), equivalent to about 1.9$24.38 ± $48.84), while the mean ADR treatment cost per admitted medical inpatient was ₦ 318.87 ($2.45). The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the antidiabetic drug – insulin use causing neuroglycopenic symptoms and nonsteroidal anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. Conclusions: The economic burden, impact, and consequence of ADRs were significantly high among these adult medical inpatients. In this study, ADRs increase patients' morbidity, mortality, cost of health care, and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care, and continuous monitoring must be implemented during the course of treating patients with these drugs to optimize their clinical efficacy and prevent the occurrence of ADRs in them

Pattern of medications causing adverse drug reactions and the predisposing risk factors among medical in-patients in clinical practice: A prospective study

Background: Pharmacological interventions sometimes carry inherent significant risks which include adverse drug reactions (ADRs), drug interactions (DIs) and other consequences of inappropriate medication use. An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used in man for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high incidence and prevalence. Aim: The main aim of this study was to evaluate and highlight the pattern of medications most frequently involved in ADRs and the predisposing risk factors among adult medical in-patients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven (507) patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). The drugs most frequently involved in ADRs were insulin in 14 (27.5%) patients, Non-steroidal Anti-inflammatory drugs in 10 (19.6%) patients, antihypertensives in 8 (15.7%) patients, antimalarials in 5 (9.8%) patients, herbal medications in 4 (7.8%) patients and antibacterials in 3 (5.9%) patients. Furthermore, four (4) fatal ADRs were observed during the study; in which herbal medications caused two (2) deaths, sulfadoxine/pyrimethamine combination (maloxine®) caused one (1) death, and Iron dextran caused one (1) death. The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the Antidiabetic drug-insulin use causing neuroglycopenic symptoms and Non-steroidal Anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. The elderly age group (≥ 65 years), presence of polypharmacy (taking more than 5 different pharmacologically active medications by a particular patient at the same time) and the presence of multiple comorbidities in a particular patient are clinically proven and significant risk factors found to be associated with and predisposed adult medical in-patients to ADRs in this study. Conclusion: The negative health burden and consequences of ADRs with the predisposing risk factors were significantly high among these adult medical in-patients. In this study, ADRs increase patients morbidity, mortality and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care and continuous monitoring must be implemented during the course of treating patients with these drugs in order to optimize their clinical efficacy and prevent the occurrence of ADRs in them

Prevalence of vitamin B deficiency among metformin-treated type 2 diabetic patients in a tertiary institution, South-South Nigeria

Background: The risk of chronic metformin pharmacotherapy to cause vitamin B 12 deficiency and its associated medical complications has been of immense concern among diabetic patients. Some studies have postulated that vitamin B 12 deficiency is highly prevalent among chronic metformin-treated adult diabetic patients. Aim: This study aimed to determine the prevalence of vitamin B 12 deficiency among metformin-treated and metformin-naïve type 2 diabetes mellitus patients. Materials and methods: This was a case-control, prospective, analytical, observational study of 200 adult participants (100 per group) attending the Endocrinology, Medical Out-patients Clinic of Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. The participants’ serum vitamin B 12 levels were determined using an immunoassay technique. Data were presented using tables and charts. Chi-square test was used to compare non-continuous proportional variables. Results: The prevalence of vitamin B 12 deficiency was 41% and 20% among metformin-treated and metformin-naïve type 2 diabetes mellitus groups, respectively (p = 0.001). Borderline vitamin B 12 status was present among 59% of metformin-treated group and 80% of metformin-naïve group (p = 0.001). Neither metformin-treated nor metformin-naïve groups had normal serum vitamin B 12 levels. Conclusion: The prevalence of vitamin B 12 deficiency was significantly high in diabetics, especially the metformin-treated patients. We advocate for vitamin B 12 supplementation among this group of patients in order to prevent the occurrence of vitamin B 12 deficiency complications such as macro-ovalocytic anemia, impaired immunity with hypersegmented neutrophils, peripheral neuropathy and subacute degeneration of the spinal cord