[show abstract][hide abstract] ABSTRACT: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors.
Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11.
Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked.
Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.
The Nigerian postgraduate medical journal 09/2011; 18(3):191-6.
[show abstract][hide abstract] ABSTRACT: Brodie's abscess is not a common variant of subacute osteomyelitis; however, when it does occur, the presentation is atypical and usually late. This study aimed to describe the mode of presentation of Brodie's abscess and evaluate the results of surgical treatment in a resource-poor setting.
Over a five-year period, we retrospectively reviewed 20 patients who presented to two tertiary health institutions in south western Nigeria with clinical and radiological features of Brodie's abscess.
Brodie's abscess accounted for just 2 percent of all patients with osteomyelitis. Most patients were adults (mean age 21.5 +/- 7.8 years) and males (75 percent). In the series, the tibia was involved in 50 percent of the cases, the femur in 30 percent, and the radius and fibula each in 10 percent. The diaphyseal part of the long bones was affected in 65 percent of the patients and the metaphysis, in the remaining patients. The average size of the cavities was 3.0 +/- 0.8 cm. 65 percent of the isolates yielded Staphylococcus aureus. All patients were treated by curettage of the abscess cavities, cancellous bone grafting and antibiotics. All patients had satisfactory outcomes, with complete incorporation of the grafts and new bone formation in the cavities. No patient reported any recurrence.
Patients with Brodie's abscess respond well to surgical curettage of the abscess, cancellous bone grafting and antibiotic therapy.
Singapore medical journal 06/2011; 52(6):436-9. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: Little work has been done on patients' satisfaction with hospital care in Nigeria. This prospective study was done to identify factors affecting patients' satisfaction with emergency care in a teaching hospital in Nigeria. This study was carried out among adult patients who had received care at the Accident and Emergency unit of the hospital. We used the priority index (calculated by combining the mean score on all items and correlated weight) to identify areas of emergency services in need of urgent improvement. There were 250 respondents; 147 males and 103 females. Six (6.4%) patients declined to answer the questionnaire. Time to surgical intervention was the item with the highest priority for change. This was followed by three indicators of caregiver conduct: showing genuine concern by health workers, attitude of nurses, and courtesy by health workers. Females rated all indices of satisfaction lower than males. Surgical and gynecological patients were also less satisfied with their care than their medical and trauma counterparts. The results from this study provided necessary data to guide changes needed to improve patient satisfaction in the A&E. Our findings suggest that improving speed of access to surgery and enhancing interpersonal skills of healthcare givers are areas that need to be prioritized.
International emergency nursing 10/2010; 18(4):203-9.
[show abstract][hide abstract] ABSTRACT: To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them.
Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection.
Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8-20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0-3.8 hours) for those who did not develop a wound infection (p>0.01).
In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections.
Journal of Wound Care 10/2010; 19(10):432-8. · 1.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background
Countries with no formal prehospital care system have a high inter-hospital referral rate with patients being referred late to tertiary hospitals. Objective is to determine which of the four trauma scores is most useful in predicting mortality and to determine the optimal cut-off point for predicting mortality for each score.MethodologyIn a prospective study, all patients with severe trauma (ISS>16) presenting in the Accident and Emergency were included in the study. The scores were calculated using standard methodologies. Their ability to discriminate between survivors and non-survivors in the casualty was compared using the receiver operative characteristic (ROC) curves.ResultsThere were 12 (6.5%) deaths among the 186 patients included in the study. The area under the curve (AUC) of each of the scores were: Kampala Trauma Score (KTS)=0.914, Revised Trauma Score (RTS)=0.883, the Triage Revised Trauma Scores (tRTS)=0.881 and Glasgow coma scale (CGS)=0.880. Pairwise comparison of the scores did not show any significant difference in the performances of the scores. The various optimal cut-off point for discriminating between survivors and non-survivors for the scores were: KTS=12, RTS=5.7, tRTS=9 and GCS=9.Conclusion
While the KTS and the RTS performed better than the CGS in predicting mortality in the casualty, this performance was not statistically significant. We therefore suggest that, because of its widespread usage and ease of use, the CGS should be used by hospitals in deciding which patient to refer to tertiary hospitals. Patients with CGS scores of ≤9 should be transferred to tertiary centres; and those already in tertiary centres should be admitted to the ICU for special care
[show abstract][hide abstract] ABSTRACT: Despite being the second most common cause of road traffic injuries (RTIs) in Nigeria, no study had examined the peculiarities of motorcycle crash site characteristics in Nigeria. We examined and interviewed 363 motorcycle RTI patients in three tertiary hospitals in southwest Nigeria. All the motorcycles are small with capacities between 80 and 125cm3. 68.9% of the patients sustained their injuries while working or going to work and 23.4% on their way to school. 176 (48.5%) of the crashes were with moving vehicles and in 83 (22.3%) cases, either the motorcycle or the other vehicle is moving against the traffic. 37.8% of all crashes occurred at junctions with no roundabout versus 5% at junctions with roundabout. Some risky practices of the patient included carrying more than 2 persons (15.02%), travelling without headlight at night (31.7%) and not wearing helmets (96.5%). This study showed that risky behavior among motorcycle riders, chaotic traffic and road design faults accounted for most of the motorcycle crashes. The implications for the prevention and control of motorcycle injuries were discussed.
Accident; analysis and prevention 04/2009; 41(2):294-8. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: In Nigeria, owners of commercial minibuses commonly modify them by adding an extra row of seats and passengers also seat four abreast rather than the recommended three abreast. The modified minibuses carry nineteen passengers rather than the recommended twelve passengers. One such vehicle was fully occupied and had a head-on collision with a truck. Eight of the nineteen occupants sustained nine posterior dislocations of the hip joint.
We compared the seating space and the leg room of a similarly modified vehicle to an unmodified one.
The legroom had been reduced from 120 cm in the unmodified vehicle to between 60 and 70 cm in the modified vehicle. We postulate that the tighter seating space forced the limbs into adduction and the shorter legroom caused the limb to more readily strike the seat in front, causing the hips to dislocate posteriorly.
We recommend that the authorities put a stop to uncensored vehicle modifications to reduce hip injuries.
[show abstract][hide abstract] ABSTRACT: Cancellation of cases on the scheduled day of surgery leads to an inefficient utilisation of scarce hospital and patient's resources. Identifying the causes of such cancellations will assist in taking steps to avoid them.
This is a retrospective study spanning 10 years. Record was taken of all patients who had orthopaedic surgery at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria. The age, sex, type of operation, whether or not the surgery was ever postponed or cancelled, the duration and reasons for such postponements and the duration of admission were collated and analysed.
Five hundred and fifty two (40.8%) of the 1,353 orthopaedic patients scheduled for surgery experienced cancellation. The most common reasons were attributable to the hospital (48.7%) mainly due to infrastructural breakdown (28.7%) and procedural lapses by hospital personnel (20.0%). Self cancellation by patient (37.8%) followed and was mainly due to financial constraints (25.6%). Upper respiratory tract infections were responsible for the cancellation in 8.6%. These delays were responsible for more than 30% of the duration of admission in 93 (16.8%) patients.
The incidence of postponement of cases on the scheduled day of surgery is still high. Most of the causes are preventable. Better infrastructural facilities, enhanced interdepartmental communication and improved attitude to work would reduce the rate and thus enhance utilisation of theatre space.
The Nigerian postgraduate medical journal 04/2007; 14(1):42-5.
[show abstract][hide abstract] ABSTRACT: Pre-hospital care in developing worlds has been found to be grossly deficient compared to high income countries. The pre-hospital care given to road accident victims attending the casualty departments of four tertiary level hospitals in South Western Nigeria was assessed using a one-page pro-forma. 1996 patients with injuries from road crashes were seen in the hospitals, only 172 had any form of pre-hospital care, just 160 were transported in ambulances and none had any form of organized pre-hospital care. The mean arrival time in the hospital after crashes was 93.6 minutes and there was a high rate (29.5%) of inter-hospital referral. For every Revised Trauma Score (RTS), the Probability of survival (Ps) of the patients was higher than the Ps of patients from high income countries.
Annual proceedings / Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine 02/2005; 49:93-100.
[show abstract][hide abstract] ABSTRACT: Age is often a marker for co-morbid illness that may complicate attempts at surgery, hence careful preoperative assessment and vigorous treatment of the pre-operative medical condition with adequate post-operative supports are needed for safe surgery. In our series, a fifteen months study period, six hundred and Ninety five patients were operated upon out of which forty four patients were 65 years old and above (6.3% ); Age ranged between 65 years and 80 years (mean age of 70 years). The patients with medical problems were sixteen (36.4% ) out of which urinary tract infection was the most common (43.8% ). The most common anaesthetic technique was spinal anaesthesia in 45.5%, the most common operative procedure was herniorrhaphy (36.4% ); followed by prostatectomy (26.5% ). Three of the patients presented with wound infection; mortality was 2.3%, which occurred in a patient who died of multiple organ failure.
The Nigerian postgraduate medical journal 07/2004; 11(2):71-4.
[show abstract][hide abstract] ABSTRACT: Motorcycles have become a very popular means of transportation in Nigeria. This paper is a hospital based study of limb injuries resulting from motorcycle accidents in an urban centre in Nigeria.
All patients reporting to the emergency department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with limb injuries resulting from motorcycle accidents between June 1998 and May 1999 were selected for this prospective study.
One hundred and fifteen (79.3%) out of the 145 victims of motorcycle accidents that reported to the hospital had injuries involving their limbs. The Male: Female ratio was 2.8:1. The mean age was 31.9 +/- 16.7 (S. D.) years, and 20-29 years; the most commonly involved age group. 42.2% were due to collision with automobiles, 22% pedestrian while 8.7% were collisions between motorcycles. The use of protective/safety devices was practically non-existent. Seventy-six (66.1%) patients had lower limbs injuries, 25 (21.7%) patients had upper limb injuries while the remaining 14 (12.2%) injured both upper and lower limbs. The tibia was the most commonly fractured bone (32 patients, 27.8%) followed by the femur (25 patients, 21.7%). Eighty-six patients (74.8%) with fractures were managed by close reduction and splinting. Eighteen (15.7%) patients had internal fixation.
Motorcycle accident is an important cause of limb injuries in the developing worlds. Motorcyclists need to be encouraged to use protective/safety devices.
West African journal of medicine 01/2004; 23(1):42-7.
[show abstract][hide abstract] ABSTRACT: The pattern of gunshot injury in the Ife-Modakeke communal clash between March 3 and May 23, 1999 was analyzed in this study.
The history was recorded for each patient presenting at the hospital with gunshot injuries from the clash. Each was examined and followed up through subsequent treatment in the wards and clinics.
The study included 185 patients. The male-to-female ratio was 22.1 to 1, and 45.9% of the patients ranged in age from 21 to 30 years. The mean age was 28.3 +/- 11.2 years, and the mortality rate was 8.6%. There were 120 warriors and 65 noncombatants. Government workers and students made up most of the noncombatants (42.5%), whereas drivers and farmers constituted the vast majority of the warriors (23.3%). Injury to the lower limbs was the most commonly seen injury (54.6%). Sustained fractures and femoral fractures were the most common fracture (n = 100, 54.1%). Head and colonic injuries were the greatest cause of mortality.
For civilian gunshot injuries, morbidity and mortality rates are high in the less developed countries because of inadequate prehospital and hospital care. Efforts should be made to improve these facilities.
The Journal of trauma 11/2003; 55(4):626-30. · 2.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: This is a retrospective study of limb amputations in Ile-Ife, Nigeria during a thirteen-year period (1987-1999). 82 patients were studied with a mean age of 35 +/- 22 years. 63 of the patients were adults, while 19 patients were children aged 15 years and below. Trauma was indicated as a reason for amputation in 60 patients (73.4%). Road traffic accident with peripheral vascular compromise was the single most common reason for amputation (41.7%). Forty-seven of the 82 patients had lower limb amputations, while the others were in the upper limbs. There was delay in performing amputation in some patients due to refusal to accept the procedure in 10(12.1%), logistics in 5(6.1%) and lack of finance in 3 (3.7%). The average healing time of the amputation stump wounds was 47 +/- 36 days. In 68.3% of cases, there was wound infection and the wound healing time was 63 +/- 45 days, much longer than than the general average. Other complications were flap necrosis, gas gangrene, osteomyelitis of the bony stump, and tetanus. Six patients died from sepsis and one from chronic renal failure, a hospital mortality rate of 8.5%. Prosthesis could not be fitted in any of the patients during the hospital admission and only three of the diabetic patients attended follow up clinic for up to two years; others absconded within 3 months of discharge from hospital. It will be possible to reduce the rate of amputation and improve the quality of life of patients with amputation if more attention is placed on accident prevention and injury control.
Nigerian journal of medicine: journal of the National Association of Resident Doctors of Nigeria 01/2002; 11(3):118-21.
[show abstract][hide abstract] ABSTRACT: To evaluate the management of limb injuries sustained from motorcycle accidents.
Consecutive 115 patients managed for limb injuries secondary to motorcycle trauma over a one-year period were prospectively studied.
There were 115 patients out of which seventy-six (66.1%) sustained injuries to the lower limbs, 25 (21.7% to the upper limbs, while 14 (12.2 %) injured both the upper and the lower limbs together. Seventy-nine (68.7%) patients had fractures of which 24 (30.4%) were open. There was no organized pre-hospital care, a high referral rate and long injury-treatment intervals. Treatment was by closed manipulation and splintage with casts (57.6%), tractions (30.4%), and external fixation (5.4%); 18 patients had elective ORIF. The complication rate for cases was 71.3% while 4 (3.5%) patients died.
Management of motorcycle injuries is still difficult in developing countries. Attention needs to be paid to provision of organized trauma care to improve outcomes.
Nigerian journal of medicine: journal of the National Association of Resident Doctors of Nigeria 17(1):53-6.