STAGED VERSUS SIMULTANEOUS APPROACH IN COMPLEX BILATERAL TOTAL KNEE REPLACEMENT: EXPERIENCE FROM TERTIARY INSTITUTION IN NIGERIA.

Background: Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to undertake the replacement of both knees in one sitting i.e. simultaneous bilateral total knee replacement (SMTKR) or to undertake this as a staged bilateral total knee replacement (STTKR). The decision is made harder by the presence of severe coronal and sagittal plane deformities and associated bone loss. We present our results of treating such patients with a focus on a trilogy of cost, complication and functional outcome following SMTKR. Methodology: A retrospective review of 31 patients who presented with bilateral knee arthritis. 19 underwent SMTKR and 12 underwent STTKR. Data on the trilogy of complication, cost and functional outcome were collected and analysed. Results: Our cohort of patients was overwhelmingly female in both groups at overall F/M = 30/1. Patients in the SMTKR group were slightly younger at a mean of 65 years compared to 69 years in the STTKR group. Mean Oxford Knee Score (OKS) improved significantly in all groups, mean of 54 in SMTKR and 56 in the STTKR groups. There was one fatality in the STTKR from upper GI bleeding and 1 revision for bone graft failure. The overall cost is less with SMTKR. Summary: SMTKR is a safe and effective undertaking in properly selected patients with bilateral end-stage knee arthritis with severe deformities. Significant experience is however needed to successfully tackle complex deformities and such procedures should be undertaken by experienced arthroplasty surgeons.

The experience of women following caesarean section in a tertiary hospital in SouthEast Nigeria.

OBJECTIVE: To explore maternal experience following caesarean section. METHODS: The study was a cross-sectional prospective study involving 250 women. RESULTS: The mean age of the study population was 27.2 ± 5.5 years with fifty-three per cent (53.1%) of the women between the ages of 20-9 years. Majority of the participants (67.1%) were multiparous and 37.4% of the parturient had secondary school education. The majority (67.1%) were in social class 3-5. Emergency caesarean section accounted for 74.5% of the caesarean section and the commonest indication was foetal distress. One hundred and forty-four participants (59.3%) were satisfied with their caesarean section experience which was significantly associated with health care attention and foetal outcome. More than half of the study population would not accept caesarean section when indicated in a future pregnancy. The health care attention [AOR 0.53, 95% CI (0.32, 0.88)] and maternal age [AOR 3.05, 95%CI (1.43, 6.49)] were significant predictors. CONCLUSION: Majority of the women were satisfied with their caesarean section experience which is influenced by the hospital care and foetal outcome. Improvement in maternal caesarean section experience through quality health care is important in increasing uptake when indicated.

The perception of health professions on causes of interprofessional conflict in a tertiary health institution in Abakaliki, southeast Nigeria.

BACKGROUND: Interprofessional conflict in university teaching hospitals in Nigeria is on the increase. This study was aimed at assessing the health professions' perception of factors responsible forconflict. METHODOLOGY: A cross-sectional descriptive survey among six health professions. RESULTS: The perceived causes of conflict include differential salary between doctors and others, physician intimidation and discrimination of other professions, "inordinate ambition" of the other professions to lead the health team, and envy of the doctor by the other professions. Doctors differed significantly from the other professions on the role of each of these in causing conflict. Mutual respect for each other's competence, proper remuneration and clear delineation of duties for all, and other groups appreciating the salary differential between them and doctors were perceived as means of resolving the conflict. While all accepted mutual respect and proper remuneration as effective, other health workers differed significantly from doctors on the effectiveness of appreciating salary differential between them and doctors in resolving the conflict. CONCLUSION: Differential salary between the doctor and the other health workers is the main factor perceived to cause interprofessional conflict. The government and all health professions should accept, and maintain the relativity in salary differential between doctors and other health professions.

The Perception of Health on Causes of Inter professional Conflict in a Tertiary Health Institution in Abakaliki; Southeast Nigeria

"BACKGROUND: Interprofessional conflict in university teaching hospitals in Nigeria is on the increase. This study was aimed at assessing the health professions' perception of factors responsible for conflict. METHODOLOGY: A cross-sectional descriptive survey among six health professions. RESULTS: The perceived causes of conflict include differential salary between doctors and others; physician intimidation and discrimination of other professions; ""inordinate ambition"" of the other professions to lead the health team; and envy of the doctor by the other professions. Doctors differed significantly from the other professions on the role of each of these in causing conflict. Mutual respect for each other's competence; proper remuneration and clear delineation of duties for all; and other groups appreciating the salary differential between them and doctors were perceived as means of resolving the conflict. While all accepted mutual respect and proper remuneration as effective; other health workers differed significantly from doctors on the effectiveness of appreciating salary differential between them and doctors in resolving the conflict. CONCLUSION : Differential salary between the doctor and the other health workers is the main factor perceived to cause interprofessional conflict. The government and all health professions should accept; and maintain the relativity in salary differential between doctors and other health professions."

Concurrent use of multiple antenatal care providers by women utilising free antenatal care at Ebonyi State University Teaching Hospital, Abakaliki.

Observation has revealed that women who book at Ebonyi State University Teaching Hospital, Abakaliki, concurrently use multiple antenatal care givers (formal and non-formal). This study was therefore conducted to identify the other sources of antenatal care for the women and to examine them in relation to their socio-demographic characteristics. A total of 200 antenatal women chosen from two randomly selected booking clinics were interviewed using a structured questionnaire. The results show that 25% and 30.5% respectively from the two clinics were concurrently using formal and unorthodox ANC givers. Age and education were significantly related to the practice (p < 0.0002 and p < 0.02 respectively). These findings suggest that free services alone may not be enough to make women attend ANC in the hospital. A larger study, especially investigating patient's perspective of the quality of care, is recommended.

Pregnant Nigerian woman's view of her prenatal sex determination.

A questionnaire survey was conducted among 1000 pregnant Nigerian women to identify their knowledge and perception of prenatal sex determination using ultrasonography. Eighty-one per cent of the respondents were aware of the technology. Knowledge of it was associated with high parity and education. However, only 64% of respondents desired to know the sex of their fetus. Younger age, low parity and less number of existing male children influenced this desire. There was no indication of considering possible abortion of the fetus if the identified sex was not the desired one. It is suggested that as there seem no grave sequelae of revealing the sex of the fetus, sonologists should not withhold this information from mothers if they so desire.