Choice of Future Career amongst Medical Students in Enugu, Nigeria: Implications for Anaesthesia

Background Despite its central role in modern healthcare delivery, anaesthesia has failed to attract adequate medical manpower in most developing countries. As a result, majority of anaesthetics are performed by non-physician practitioners. Objectives In this study, we examined the factors influencing choice of future career by medical student inEnugu, Nigeria and the implications for anaesthesia. Methods We distributed questionnaires to medical students in the last two years of their training at the University of Nigeria, Enugu, asking them to indicate in order of priorities three specialties they will most likely consider for future career. They were also requested to state fourmost important factors influencing their choice. Results All 195 completed forms were returned; 64%were males and the average age of the respondents was 25.1 years. One hundred and eighty students (93%) agreed to specialise, 1 did not while 12 were undecided. Only 1% of the students chose anaesthesia as their first choice. The other specialties like surgery (29%), paediatrics (14%), public health (14%), obstetrics and gynaecology (12%), radiology (11%), internal medicine (5%) and ophthalmology (5%) were considerably of more interest to them. Ability to pursue other hobbies (40%), academic and research opportunities (23%), availability of training post (10%), career progression (10%), earning potential (9%) and influence of a role model (6%) were the factors affecting career decisions among the students. Conclusion This study has highlighted a very low level of interest for anaesthesia amongst Nigerian undergraduates. It also showed that ability to pursue other hobbies, availability of posts as well as academic and research opportunities are the main influencing factors in the choice of future specialty.We call for urgent measures be put in place tomake anaesthesiamore attractive to youngmedical graduates.KeyWords: Career Choice,Anaesthesia,Medical Students, Priorities

Perinatal outcome of preterm cesarean section in a resource-limited centre: A comparison between general anaesthesia and subarachnoid block

Background: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria.Objective: The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and subarachnoid block (SAB) with the aim to ascertain any difference in outcome between the two methods.Materials and Methods: Aretrospective observational study of consecutive preterm cesarean deliveries at the University of Nigeria Teaching Hospital from May 1999 to April 2008. Data entry and statistical analysis utilized the SPSS statistical package for the social sciences, 2008 version 15.0 for windows (SPSS Inc, Chicago IL, USA). Chi.square test was done to determine statistical significance and P . 0.05 were considered to be significant at 95% confidence interval. The delivery characteristics were compared by logistic regression analysis to ascertain any associated confounding effect on perinatal outcome in those exposed to either anesthetic technique.Results: There were 7568 deliveries and 1961 cesarean sections giving a cesarean section rate of 25.9%. A total of 236 cesarean sections were for preterm deliveries giving a preterm cesarean section rate of 3.1%. Of these, 151 women delivered under GA while SAB was used in 85 cases. The mean gestational ages for preterm cesarean sections were 33.2 ± 2.6 weeks and 33.8 ± 2.2 weeks for those who had GA and SAB respectively. The mean Apgar scores were 6.4 ± 3.1 and 7.6 ± 3.1 at 5 min for GA and SAB respectively. There were 24 stillbirths (15.9%) in cesarean deliveries done under GA and 7 stillbirths (8.2%) in women who had SAB (P = 0.09). Twenty-two (14.6%) babies delivered through GA and 14 (16.4%) delivered under SAB, died within 1 week of delivery (P = 0.7). There were more babies with low Apgar scores in parturient delivered under GA (P = 0.0004). More preterm babies delivered under SAB were discharged from the New Born Special Care Unit within 10 days of delivery (P = 0.006). Hypertensive disorders, though not statistically significant was the most common  indication for preterm cesarean delivery among those with GA and SAB. No maternal death occurred during the study period.Conclusion: The study infers a strong association between anesthetic technique and immediate Apgar scores and outcome of resuscitation following preterm cesarean section. This however, failed to translate into higher differences in perinatal mortality.Key words: General anesthesia, perinatal.outcome, preterm cesarean section, subarachnoid bloc

Project OPUS: Development and evaluation of an electronic platform for pain management education of medical undergraduates in resource-limited settings

Introduction Pain is a very frequent symptom that is reported by patients when they present to health professionals but remains undertreated or untreated, particularly in low-resource settings including Nigeria. Lack of training in pain management remains the most significant obstacle to pain treatment alongside an inadequate emphasis on pain education in undergraduate medical curricula, negatively impacting on subsequent care of patients. This study aimed to determine the effect of a 12-week structured e-Learning course on the knowledge of pain management among Nigerian undergraduate medical students. Methods Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis. Results A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z = 11.3, p<0.001, effect size = 1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations. Conclusion e-Learning approaches to pain management education can enhance traditional learning methods and may increase students’ knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible. Methods: Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis. Results: A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z=11.3, p<0.001, effect size=1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations. Conclusion: e-Learning approaches to pain management education can enhance traditional learning methods and may increase students’ knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible

Herbal medicine use by surgery patients in Hungary: a descriptive study

BACKGROUND: The popularity of non-conventional treatments, especially the consumption of herbs is showing an increasing tendency all over the world. The consumption of herbal medicines might cause several complications during perioperative care. METHODS: The survey was conducted at the First Department of Surgery of Semmelweis University and focused on the demographics of patients consuming herbal medicines who had undergone elective surgery between July 1(st) 2014 and February 28(th) 2015. A one-page questionnaire, that the patients filled in individually and anonymously, was used. The response rate was 17.3 %. RESULTS: Out of the 390 patients who filled in the questionnaire, 7.2 % (28 patients) used herbal medicines, 3.6 % (14 patients) of them two weeks prior to their hospitalization. The other 3.6 % (14 patients) took herbal medicines sometime in the past. The majority of those who have ever consumed herbs are women (18/28), have completed secondary or tertiary education (23/28), more than half of them suffer from tumorous diseases and only a quarter of them (7/28) informed their physician about their use of herbal medication of their own accord. CONCLUSIONS: Attention must be paid to the exploration of herb consumption habits of surgery patients during the preoperative examinations in order to avoid potential side effects, complications or drug interactions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12906-015-0890-2) contains supplementary material, which is available to authorized users

Selected Abstracts from NSA 2014

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Unanticipated Quadraplegia in an Unconscious Mechanically Ventilated Traumatic Head Injured Patient

Objective&nbsp; A significant number of unconscious patients who present to the emergency department as a result of Road TrafficAccident (RTA) or fall have a major injury to the Cervical Spine. This case highlights the problems of identification of such injuries in the unconscious. CaseReport An unconscious young adult was admitted from the accident and emergency into the intensive care unit with a clinical impression of traumatic head injury. Neck collar was applied and the airway secured with an orotracheal tube. Following positive pressure ventilation for about tenminutes, the patient suddenlywoke up to full consciousness and started shaking his head violently and uncontrollably, necessitating his tracheal extubation. He then complained of his inability to use or feel his limbs. Radiological investigation revealed complete dislocation of first (C1) and second (C2) cervical vertebra; a crack in the left temporal skull and a contused left lung.Hewas re-intubated about 20minutes laterwhen his respiratory efforts began to weaken, and ventilated under propofol sedation. He gradually became ventilator dependent, with collapse of cardiovascular and respiratory systems and died on thirteenth day of admission. Conclusion Cervical Spine injury should be suspected in all unconscious patients following trauma. Key Words: Cervical Spine Injury, Quadriplegia, Mechanical Ventilation

Learning about cardiac arrest from 'Dr. Google': a pre- and peri-pandemic infodemiology study in Nigeria

Introduction: the coronavirus pandemic and associated lockdowns restricted movement with non-essential hospital trips discouraged to prevent spread of the virus. Disruption of medical services can lead to increased seeking of medical advice and symptom management online. With COVID-19 known to worsen existing cardiovascular disease or precipitate a new one, we sought to explore online search trends of the Nigerian public regarding cardiac events before and during the COVID-19 pandemic. Methods: using Google Trends™, relative search volume for the terms 'cardiac arrest', 'heart attack', and 'heart arrest' were analyzed for the periods 27th February to 30th September in 2019 and 2020 respectively. Descriptive statistics, Mann-Whitney U test for relative search volume, search terms comparison in both years and Kendall´s correlation coefficient for examining relationships between time frames and search terms were used. Results: searches for terms 'heart attack' (p<0.001) and 'heart arrest' (p=0.01) were higher in 2020 compared to 2019, with a correlation between searches for 'cardiac arrest' and 'heart arrest' (p<0.001) and between 'heart attack' and 'heart arrest' (p=0.01). There was a strong positive correlation between search for 'heart attack' in 2019 and 2020 (tau b=0.35, p<0.001); and a moderate positive correlation for 'heart arrest' (tau b=0.13, p=0.01). Conclusion: increased online activity relating to cardiac arrest was recorded during the early months of the pandemic when compared to the year prior. Notable increases in search activity aligned with the timing of heart-related illnesses and deaths of Nigerian celebrities during the pandemic. Further understanding of health-related online search activity in Nigeria could inform the development of health promotion interventions and support health-related information seeking for cardiovascular diseases

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

PURPOSE: We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS: A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS: There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION: The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries