Review of article palliative care in Nigeria: Challenges and prospects

Background: Health workers seek to cure ailments with surgery, medication and occasionally radiotherapy .In resource constrained settings such as that prevalent in Nigeria however, patients often present with late stage diseases where it is not practical to expect cures . Palliative care seeks to ease the suffering of the many patients who cannot be cured against the back drop of late presentation of patients with life limiting illnesses. It is a relatively new concept in medical practice in Nigeria and has yet to be fully integrated into patient care while encountering limited successes and impediments by health practitioners ,policy makers and occasionally clients.Method: This is a review article on of various policies and publications concerning Palliative care in Nigeria using different search engines such as Pubmed and Google.Conclusion: Palliative care implementation in Nigeria is still a work in progress with limited availability in health facilities in the country.Key words: Palliative care, Pain relief, Oral morphin

Prevalence of postdural puncture headache among caesarean section patients in North Central Nigeria

Spinal anaesthesia is now a popular choice for Caesarean sections in Africa but one of the draw-back is the development of post-dural puncture headache (PDPH) and it could be quite distressing to a mother. Identifying risk factors and reducing the prevalence is pertinent. This study sought to determine the prevalence of PDPH among patients who underwent Caesarean sections in a tertiary hospital in Jos, Plateau State, Nigeria and some of its possible associated factors. Method: It was a prospective study of all Caesarean sections done under spinal anaesthesia between November 2016 and June 2017. Spinal anaesthesia was performed on 236 parturients using Quincke-type needles sizes 23-26G. In the postoperative period, all the patients were followed-up to determine the incidence, onset, and severity of post-dural puncture headache. Epi-info version 7 was used for data analysis. Results: The prevalence of PDPH was 22.03%. Most of the parturients who developed PDPH in our study were of mild to moderate intensity using the numeric rating scale. Twenty six (11%) had mild, while 11 (4.7%) had moderate intensity of headache and which was resolved with treatment. Conclusion: The prevalence of PDPH is high in the obstetric population especially with the use of traumatic Quincke-type needles. Deliberate efforts must be made to reduce its occurrence by acquiring of small calibre pencil-point needles and training staff on how to use it

Potential uses of AI for perioperative nursing handoffs: A qualitative study

OBJECTIVE: Situational awareness and anticipatory guidance for nurses receiving a patient after surgery are keys to patient safety. Little work has defined the role of artificial intelligence (AI) to support these functions during nursing handoff communication or patient assessment. We used interviews to better understand how AI could work in this context. MATERIALS AND METHODS: Eleven nurses participated in semistructured interviews. Mixed inductive-deductive thematic analysis was used to extract major themes and subthemes around roles for AI supporting postoperative nursing. RESULTS: Five themes were generated from the interviews: (1) nurse understanding of patient condition guides care decisions, (2) handoffs are important to nurse situational awareness, but multiple barriers reduce their effectiveness, (3) AI may address barriers to handoff effectiveness, (4) AI may augment nurse care decision making and team communication outside of handoff, and (5) user experience in the electronic health record and information overload are likely barriers to using AI. Important subthemes included that AI-identified problems would be discussed at handoff and team communications, that AI-estimated elevated risks would trigger patient re-evaluation, and that AI-identified important data may be a valuable addition to nursing assessment. DISCUSSION AND CONCLUSION: Most research on postoperative handoff communication relies on structured checklists. Our results suggest that properly designed AI tools might facilitate postoperative handoff communication for nurses by identifying specific elevated risks faced by a patient, triggering discussion on those topics. Limitations include a single center, many participants lacking of applied experience with AI, and limited participation rate

The Effects of Working Condition of Teacher’s Performance in Temeke Public Secondary Schools

This study intended toassess the effects of working condition on teacher’s performance in Temeke secondary schools. It specifically aimed at examining the effects of reward system on teacher’s performance in public secondary schools, effects of involving teacher’s performance. This also aimed to investigate the effects of recognition of teacher’s performance and; to evaluate the effects of the promotion on teacher’s performance in the Temeke Municipality. Data were collected in four secondary schools namely, Temeke, Toangoma, Wailes and Saku using questionnaire method. The information gathered from 98 teachers were analysed using regression analysis method. It was found that the majority of the respondents (55%) have an experience of 6 to 14 years serving in government schools. However, regression analysis showed that written recognition lead to positive change and positive significant effect in teachers’ performance. It concluded that all forms of recognition has a significant effect on teachers’ performance when it goes hand in hand with financial benefit on time. Meanwhile, transport allowance bring insignificant contribution to teachers’ performance. This study used both Expectancy and Herzberg’s two-factor theory to determine the significant and insignificant effects of teacher’s performance. Furthermore, the study recommended the provision of salary increment, promotion of teachers and creation of conducive physical environment of schools for effective teachers’ performance

Experience in the use of epidural anaesthesia

Background: Epidural anaesthesia is applicable for a wide range of surgical procedures and offers distinct advantages over general and spinal anaesthesia. It is however underutilised in our environment. We report a one year experience in the use of this technique. Our objective is to describe a one year experience in the use of epidural anaesthesia with emphasis on the scope and safety in our institution. Method: A retrospective study of all patients that had epidural anaesthesia over a one year period for different procedures. Case notes and anaesthetic records were studied and analysed using EPI info 3.2.1. software. Results: Thirty two patients had epidural anaesthesia over the period. Majority (18cases) were caesarean sections (56.3%). There were 9 general surgical cases (28.1%), four gynaecologic (12.0%) and one orthopaedic (3.1%) cases. Of the five complications observed (15.6%), only two could be traced to the technique of anaesthesia and the lone mortality (3.1%) was unconnected. Conclusion: We conclude that epidural anaesthesia is applicable to a wide range of procedures within and across disciplines in our practice and is both easy to performand safe. Key words: epidural anaesthesia, scope, safety, our practice

Perception and experience of menopause among primary school teachers in Jos North, north central Nigeria

Background: As life expectancy increases,most women spent a larger part of their lives in the post-menopausal state,with part of this during the peak of their career for working class women. Perception, attitude and experience of the menopause and its transitional period may differ from one female population to the other.Objective: The objective of this study was to determine the perception and experience of menopause among a group of educated Nigerian career women, and how menopausal symptoms affect their family relationship and work performance.Method: This was a cross sectional study.Two hundred and twenty five post menopausal primary school teachers in Jos North were administered structured questionnaires.The information obtained were analysed using Epi info 2002 statistical software.Results: Most of the women (99.1%) felt that menopause was a natural process of aging.The most frequently reported symptoms were low backache or muscle pains (72.9%),poor memory or forgetfulness (63.6%),hot flushes (51.1%) and tiredness (49.8%). Over half (55.6%) of the women were sexually active with 84.8% of them reporting reduced libido.Over half (56%) of the women studied felt that menopause negatively affected their work performance.Only 8% of the women had heard of hormone replacement therapy.Conclusion: Post-menopausal primary school teachers in Jos North have a positive perception of menopause. Menopausal symptoms are also common and this negatively affects work performance in quite a number of them.Keywords: Perception,Experience,Menopause,Primary school teacher

Review Article: Clinical risk management: time for a paradigm shift in medicare in Nigeria?

Introduction: Medical practice In Nigeria is faced with a myriad of challenges to patients, medical practitioners and the institutions that they render services in. These include but are not limited medical errors and malpractice that can lead to litigation, exposure to highly infectious diseases when medical practitioners interface with patients and the attendant liabilities that government and private health institutions may have to pay out.Objectives: To describe the role of clinical risk management in health care management and evaluate risk management practice policies in medical care in NigeriaMethodology: A systematic review of literature on risk management, policy that concern medical risks/management documents and articles was conducted. Keywords used in the search were clinical guidelines, and risk management in Nigeria. Reviewed documents contained information on risk management internationally and where available, in Nigeria. Searches were conducted on the Cochrane Library, PubMed and African Journals On line. Publications were also sourced from cited references and reports. The search engine used was Google.Results: NationalPolicies that provide direction in clinical risk management in Nigeria are lacking even against the background of medical errors that lead to mortalities and morbidities.Conclusion: There is a need for leadership to be provided by healthcareKeywords: Clinical risk management, Medical risk management, Health car

Pregnancy outcome among patients with sickle cell disease in Jos, north central Nigeria

Background: With advances in management, education, awareness and improved nutrition, men and women with sickle cell disease are enjoying an improved quality of life well into adulthood, when they elect to plan a family. As a result, sickle cell disease is a common haemoglobinopathy encountered during pregnancy in Nigeria. Reports from other parts of the country have documented increased maternal andperinatal morbidity and mortality, but none has been reported from Jos.Materials and Methods: A retrospective review of pregnancy outcome in patients with sicle cell disease managed at the Jos University Teaching Hospital, Jos over a 5year period was carried out. Data extracted from patients' case files were analysed using simple statistical methods with Epi info 2002 statistical software.Results: Case files of patients with sickle cell disease in pregnancy during the period under review were retrieved. The mean maternal age was 25.1±3.9 years. The mean gestational age at booking or first presentation was 19.3±7.7 weeks. The antenatal complications included anaemia (62.9%), vaso-oclusive (bone pain) crisis (58.1%), intra uterine growth restriction (45.7%), pregnancy induced hypertension and malaria 25.7% each. The maternal and perinatal mortality rates were 53 and 384 per 1000 live births respectively.Conclusion: Pregnancy in sickle cell disease patients is associated with high maternal and perinatal morbidity and mortality as reported in other parts of the country. The importance of early presentation for antenatal care and a call for preconception care is made.Keywords: Pregnancy, outcome, sickle cell, disease, Jo

A decade of instrumental vaginal deliveries in Jos University Teaching Hospital, North Central Nigeria (2007–2016)

Background: Instrumental vaginal deliveries are witnessing a steady decline despite its usefulness in improving obstetric outcomes in resource‑limited settings. This decline in instrumental deliveries is enhanced by dearth of information on good outcomes thereby making its use unpopular among younger generations of obstetricians. The study was aimed at determining the rate of instrumental deliveries and associated outcomes in Jos University Teaching Hospital (JUTH).Materials and Methods: This study was a 10‑year retrospective hospital‑based study carried out between January 2007 and December 2016 in JUTH which compared the use of vacuum extractors and forceps to effect vaginal deliveries and the delivery outcomes encountered following such deliveries.Results: Of the 16,614 deliveries during the study period, 71 were instrumental vaginal deliveries with an incidence of 0.4% for the study period. Vacuum accounted for 97.2% of the deliveries and forceps 2.8%. Prolonged second stage was the indication for instrumental delivery in 85.9% of parturients and there were no significant differences in Apgar scores between babies that had instrumental deliveries and those that did not. Age and parity were not significantly associated with instrumental deliveries. The instrumental delivery rates were, however, significantly lower than earlier reports from this center, and that globally recommended.Conclusion: Instrumental vaginal deliveries are fast declining in JUTH and the few instrumental deliveries carried out showed a faster decline in forceps deliveries. Efforts have to be made to revive the art of instrumental vaginal delivery in the center to save it from extinction.Keywords: Complications; forceps; instrumental vaginal delivery; North Central Nigeria; outcomes; trends; vacuum deliver

Female genital mutilation: opinion of outpatients of a department of obstetrics and gynaecology in north central Nigeria

Background: Female genital mutilation is known to exist especially in developing countries like Nigeria. This study aimed to determine women's views on aspects of female genital mutilation, types of female genital mutilation, reason for and attitude towards female genital mutilation.Method: A Pretested questionnaire was administered to women attending the antenatal clinic in Jos University Teaching Hospital from October 2013 to February 2014. The data obtained were analysed using SPSS version 20Result: The prevalence of FGM from this study was 21.9%. In total, 429 respondents (97.9%) reported the existence of FGM at the time of the interview. Majority of respondents [(283) 66.0%] said that the clitoris was the main part removed. The main reason given for genital cutting was to prevent sexual promiscuity in sexual practice, and was the response of one hundred and thirty two (30.8%) of the women, while thirty five (8.2%) women responded that it was done to preserve virginity. Three hundred and eighty four(89.5%) were aware of the campaign against female genital mutilation and two hundred and ninetyeight (69.5%) were in support of the legislation against FGM. Seventy nine(18.4%) were not in support of the legislation out of which nineteen (24.1%) feel that to stop is to interfere with the norm.Conclusion: Female genital cutting/mutilation is still practiced in our environment and some of the women knew the negative reproductive health consequences of FGM and had experienced them during sexual intercourse and childbirth. However, with regard to stopping FGM, majority had not taken any steps towards stopping the practice. There should be public enlightenment about the dangers of FGM and policies against this harmful practice should be enforced