Pratique chirurgicale et sécurité du patient à l'hôpital régional et à l'hôpital protestant de Ngaoundéré

Introduction. La check-list (CL) a montré son efficacité pour réduire les complications chirurgicales dans plusieurs pays du monde où elle a été implémentée. Notre travail avait pour but d'étudier sa valeur à Ngaoundere et l'intérêt de son implémentation dans nos hôpitaux. Son objectif était d'identifier à l'aide de la CL les moyens de prévention et/ou de gestions des erreurs indésirables dans le cadre de la sécurité chirurgicale des patients. Matériels et méthodes. Nous avons mené une enquête descriptive rétrospective et prospective, en utilisant un questionnaire de type audit CL. Les paramètres évalués étaient les moyens de prévention utilisés, le type d'erreurs ou d'événement indésirable grave (EIG) observés et les raisons à l'origine de ces EIG dans un gran hôpital public de Ngaoundere et dans un grand hôpital privé de Ngaoundere. Résultats. 38 personnels ont participé à l'étude. 28,95% de ces personnels utilisaient comme moyen de prévention « la dénonciation » et 57,89% des personnels « l'archivage ». Le personnel a déclaré comme principaux EIG: les effets néfastes de l'administration des drogues, les hémorragies postopératoires, les pertes de fonction respiratoire, les infections postopératoires, et les allergies. Les principales raisons à l'origine de ces EIG étaient comme la communication défectueuse (67,47%), le manque d'outil de surveillance (25,52%) et la fatigue (12,38%). Conclusion. L'examen du type d'EIG et des raisons à l'origine de ces EIG laisse penser que la check-list opératoire, par sa facilitation de la standardisation du travail d'équipe peut améliorer la sécurité du patient chirurgical à Ngaoundere

Pattern of Adult Surgical Admissions at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State-a 2 Year Review

BACKGROUND: It is important to know the pattern of disease in any environment as this information is useful in planning intervention strategies. There is however a paucity of studies on the pattern of surgical diseases in Nigeria. We therefore aim to document the pattern of surgical diseases in adult surgical in- patients at the Niger delta University Teaching Hospital, Okolobiri, Bayelsa State. METHODS: All adult surgical patients admitted into the wards at the Niger delta University teaching hospital between January, 2010 and December, 2012 were retrospectively studied. RESULTS: A total of597 adult surgical in- patients were studied. There were 438 (73.5%) males and 158 (26.5%) females. The mean age of patients was 42.9± 18.2 years. The commonest diagnostic category was trauma 31.7%. This was followed by gastrointestinal conditions 20.6%, external hernias 16.1%, malignancies 8.2%, genitourinary conditions 7.7%, leg ulcers 6.5%, soft tissue infections 3.0% and others 6.2%. We observed a mortality rate of 7.5% which was highest among patients with malignancies at 24.5%. CONCLUSION: Trauma was the commonest cause of surgical admission while the percentage of deaths was highest in patients with malignancies

Paediatric urolithiasis in northern Nigeria

Background. The incidence of paediatric urolithiasis varies according to geographic areas. In Nigeria, there is paucity of literature on urinary stone diseases in childhood. Materials and Methods. In the period between January 1993 and December 2003, 67 Nigerian children with urinary stones were retrospectively reviewed. Results. There were 63 (94.0%) boys and 4 (6.0%) girls. The mean age at presentation was 6.9 years. Thirty one (46.3%) were in the age group less than 5 years. The commonest presenting symptoms were dysuria 42 (62.7%) and abdominal pain in 30 (44.8%). Pulling on the penis is characteristically present in 26 (38.8%) patients. The stones were located in the lower tract in 57 (85.1%) cases. Anatomic obstruction along the urinary tract was responsible for stone formation in 12 (17.9%) patients. Sixteen (23.9%) patients had associated urinary tract infection. All the stones analyzed were mixed and 75% contained urate. In 7 (10.4%) patients the stones were passed spontaneously. Open surgical technique was employed in the remaining 60 patients. There was no death recorded. Post-operative complications occurred in 15 (25.0%) of the operated patients. The commonest complications were wound infection 3 (5.0%) and vesicocutaneous fistula in 3 (5.0%) patients. The average duration of hospital stay was 16.0 days. Conclusion. In our practice lower tract stones are common and congenital urinary tract obstruction is the commonest identifiable cause for stones. The age and sex distribution and chemical composition are in keeping with historic and endemic stones. Early detection and treatment of urinary tract obstruction will further reduce the durden of stones disease