Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria.

Purpose: Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers. Participants and Methods: We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%. Results: Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs. Conclusion: A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Racial and Socioeconomic Disparities in the Utilization of TKA Among Patients with Posttraumatic Knee Osteoarthritis: Estimates from the United States National Inpatient Sample, 2011-2018.

Advanced posttraumatic osteoarthritis (PTOA) of the knee is a cause of substantial disability, particularly in younger individuals, and the treatment of choice is total knee arthroplasty (TKA). Racial and socioeconomic disparities exist in the use of TKA, but, to our knowledge, there have been no studies examining these disparities among patients with PTOA. Methods: We performed chi-square and logistic regression analyses on data from the Nationwide Inpatient Sample (NIS). The outcome of interest was the rate of TKA utilization, and the primary predictors were racial/ethnic group and insurance status. The regression models were adjusted for age, sex, household income, and Charlson Comorbidity Index (CCI). Results: The odds of receiving TKA for Black patients (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.48 to 0.62) and Hispanic patients (OR = 0.53; 95% CI, 0.46 to 0.62) were lower compared with White patients. Patients with Medicare (OR = 0.51; 95% CI, 0.46 to 0.57), those with Medicaid (OR = 0.48; 95% CI, 0.42 to 0.55), and those who self-paid (OR = 0.91, 95% CI: 0.14 to 0.25) had significantly lower odds of TKA compared with those with private insurance. Conclusions: Black and Hispanic patients are less likely than White patients to utilize TKA, and patients with private insurance are more likely to utilize TKA. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy.

BACKGROUND: Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers' knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy. METHODS: This study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses. RESULTS: Face validity indicated that the questionnaire was quick to complete (10-15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546-0.897 (all P<0.001) and percentage agreement of 80-98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections. CONCLUSION: The designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses.

Goitre-Related Factors for Predicting Difficult Intubation in Patients Scheduled for Thyroidectomy in a Resource-Challenged Health Institution in North Central Nigeria.

BACKGROUND: Airway management problems may arise when intubating patients with goitre scheduled for thyroidectomy. Goitres are not uncommon in sub-Saharan Africa, thyroidectomy being the main treatment. The aim of this study was to determine incidences of difficult intubation (DI), failed intubation (FI) and predictors of DI using a modified intubation difficulty score (IDS). METHODS: One hundred and twenty-five consenting patients with goitre scheduled for thyroidectomy were recruited. Goitre-related factors (GRF) of duration of illness, diagnosis, neck circumference, tracheal deviation and narrowing and retrosternal extension were recorded as well as Mallampati classification and BMI. At intubation, modified IDS was determined for each patient. Patients with modified IDS ≤ 5 were categorized as easy intubation group (E), and those with modified IDS >5 were categorized as difficult intubation group (D). The GRF of all patients in group D were compared with matched patients in group E. RESULTS: Incidence of DI was 13.6% with 2 (1.6%) cases of failed intubation. Comparing groups D and E, duration of illness was 4.28 ± 3.78 years in group D versus 7.44 ± 7.63 years group E, p = 0.1353. Neck circumference was 41.42 ±5.30 cm in group D versus 37.43±2.68 cm in group E, p = 0.0200. Tracheal deviation, narrowing and retrosternal extension, and surgical diagnosis were not significantly different among both groups. CONCLUSION: Incidence of DI was 13.6% and that of FI was 1.6%. Neck circumference was found to be a predictor of difficult intubation in goitre patients scheduled for thyroidectomy using the modified IDS.

Fluoroscopic-guided sacroiliac, joint injections for treatment of chronic axial low back pain in a tertiary Hospital in Nigeria: a preliminary study.

BACKGROUND: The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria. DESIGN: This was a prospective observational interventional study. SETTING: The study was carried out at a tertiary hospital in Nigeria. PARTICIPANTS: Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and. INTERVENTIONS: Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention. MAIN OUTCOME MEASURES: Pain relief and functional improvement were the main outcome measures. RESULTS: The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively. CONCLUSION: Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain. FUNDING: Not declared.

Unilateral Lower Extremity Pain Due to Malignancy Managed With Cordotomy: A Case Report.

Cancer pain management is comprehensive, and it generally begins with pharmacotherapy in a step-wise approach per analgesic guidelines established decades ago by the World Health Organization. This analgesic ladder involves the prescribing of co-analgesics, adjuvants, and opioids, with each step depending on pain severity. Although the majority of cancer pain responds to this strategy, there exist patients who do not respond adequately or experience significant side effects or intolerance to pain medications. It is in these patients whom clinicians consider interventional approaches. One approach to manage unremitting unilateral malignant pain includes evaluation for cordotomy, which is an approach that has been effective in such cases. We present a patient with breast cancer metastatic to the pelvis, with associated severe pelvic and right lower limb pain. Due to progressive disease, her pain worsened despite aggressive opioid dose escalations. She ultimately underwent percutaneous left anterolateral cervical cordotomy for malignant right leg pain, resulting in complete resolution of leg pain. We propose that, in select patients with neoplasm-related pain, cordotomy may prove very effective. LEVEL OF EVIDENCE: V.

Opioid prescribing habits of physicians in Kwara State, Nigeria.

OBJECTIVE: Although opioid analgesics are effective in the treatment of moderate to severe acute, cancer and chronic non-malignant pains, they are under-prescribed in Nigeria. The objective of this study was to assess the prescription pattern of opioids among physicians in a north central State, Nigeria.. DESIGN: This was a descriptive cross sectional study. SETTING: The study was conducted at the International Association for the Study of Pain (IASP)-sponsored workshops on pain and palliative care at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. PARTICIPANTS: These were physicians at the monthly workshops organized by the Pain and Palliative Care Unit of the hospital between August 2011 and July, 2012. INTERVENTIONS: Pre-tested semi-structured questionnaires were used to obtain responses to questions on pain management including opioids utilization in the various hospitals of the 114 participants. MAIN OUTCOME MEASURES: The main outcome measure was opioid prescription by the participants. RESULTS: Out of the 114 questionnaires distributed, 113 were returned with complete information giving a response rate of 99.1%. The mean age of the respondents was 42.0±10.8 years. Although 97.3% of the respondents reported that pain was a frequent complaint in their practice, 69.5% of those who reported seeing patients with moderate to severe pain on a daily basis rarely or never prescribed opioid analgesics. The reasons given for poor opioid prescription were fear of respiratory depression (86.8%), fear of addiction (85.1%) and non-availability (28.9%). CONCLUSION: Opioid prescription rate for patients with moderate-severe pain is low possibly due to myths and misconceptions about their adverse effects. FUNDING: International Association for the Study of Pain (IASP) Initiative for Improving Pain Education Grant awarded to Dr. K.W. Wahab in 2011.

Fluoroscopic-guided supra-scapular nerve block in the management of shoulder pain in a Nigerian Teaching Hospital: Report of five cases.

Shoulder pain complaints are common in our environment. The disorder can occur among the young active age group or in the older patients as a result of degenerative changes with its attendant limitations of the function of the affected upper limb, hindrance of the performance of activities of daily living, and reduced quality of life. The traditional oral analgesics, physiotherapy, and intra-articular corticosteroid injections are seldom ineffective at providing the desired pain relief and functional improvement at the shoulder joint. We investigated the role of fluoroscopic-guided supra-scapular nerve blocks (SSNBs) in patients with shoulder pain who failed to respond to the routine conservative management. With the patient lying prone and the C-arm fluoroscope placed in anterior-posterior position, the scapula notch was visualized and a 22G spinal needle was directed toward the nerve. The mixture of local anesthetic agent and steroid was injected as close to the nerve as possible after negative aspiration. Fluoroscopic-guided SSNB can produce substantial pain relief and improved range of movement in patients with painful shoulders. The procedure is safe, well tolerated, and can be done on a day-case basis.

Introducing interventional pain services in a large african teaching hospital: challenges and opportunities.

There is a need for interventional pain management in the developing world; however, there are many barriers to the introduction of interventional pain therapies. This brief report describes one approach to the introduction of interventional pain medicine to a Nigerian teaching hospital. Although many barriers exist, interventional pain medicine can be brought to the developing world, as demonstrated in this case series.