Successful Treatment of Well-Developed Accessory Lower Limb Associated with Spinal Dysraphism.

Accessory lower limb with spinal dysraphism are amongst the rarest known anomalies. We successfully managed a 5-months old female infant with surgical ablation of the accessory lower limb and repair of the associated large lipomyelomeningocele. A comprehensive review of the relevant literature was undertaken and presented herein. A classification system for accessory lower limb is also proposed.

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC).

BACKGROUND: The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. METHODS: This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. RESULTS: Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. CONCLUSION: The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.

Qualitative study of Nocebo Phenomenon (NP) involved in doctor-patient communication.

BACKGROUND: Doctor-patient communication has far reaching influences on the overall well-being of the patients. Words are powerful tools in the doctor's armamentarium, having both healing as well as harming effects. Doctors need to be conscious about the choice of their words. This study aimed to determine the frequency and pattern of Nocebo Phenomenon (NP) un-intentionally induced by the communication of surgeons and anesthetists through the course of various interventional procedures such as surgery, anesthesia, and crucial communication encounters with their patients. METHODS: The study was carried out by the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over six months period. All residents and faculty members serving at our institute in various surgical and anesthesia departments constituted the study population. A questionnaire was employed as the data collection tool. RESULTS: Significant proportions of the doctor-patient communications under scrutiny entailed NP. It was more frequently observed in association with female gender of the involved professionals, residency status versus faculty position, and shorter professional experience (i.e. <5 years). Although the participants endorsed the fact that the choice of their words influenced the well-being of their patients, none of them were actually aware of the concept of NP. CONCLUSION: NP existed in the clinical practice of the surgeons and anesthetists during their communication with patients. It was more frequently found among females, residents and professionals with less than five years of working experience. There is need to create awareness among these professionals about the subtle negative messages conveyed by such communication and alert them that the nocebo effects have negative repercussions on the clinical outcomes of their patients. The professionals should be formally educated to avoid nocebo words and phrases.

Active hepatitis C infection and HCV genotypes prevalent among the IDUs of Khyber Pakhtunkhwa.

Injection drug users (IDUs) are considered as a high risk group to develop hepatitis C due to needle sharing. In this study we have examined 200 injection drug users from various regions of the Khyber Pakhtunkhwa province for the prevalence of active HCV infection and HCV genotypes by Immunochromatographic assays, RT-PCR and Type-specific PCR. Our results indicated that 24% of the IDUs were actively infected with HCV while anti HCV was detected among 31.5% cases. Prevalent HCV genotypes were HCV 2a, 3a, 4 and 1a. Majority of the IDUs were married and had attained primary or middle school education. 95% of the IDUs had a previous history of needle sharing. Our study indicates that the rate of active HCV infection among the IDUs is higher with comparatively more prevalence of the rarely found HCV types in KPK. The predominant mode of HCV transmission turned out to be needle sharing among the IDUs.

Pattern of satisfaction among neurosurgical inpatients.

OBJECTIVE: To measure satisfaction among patients receiving indoor neurosurgical care and analyse the profile of the dissatisfied patients. DESIGN: Cross-sectional study. PLACE AND DURATION: This study was undertaken at the Department of Neurosurgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from March to April 2005. PATIENTS AND METHODS: A total of 133 patients were included in the study by convenience sampling technique. All the patients, who received indoor care for a minimum of 24 hours and were discharged home, were included in the study . Patients who remained hospitalized for more than 4 weeks and those not consenting to participate were excluded. A questionnaire was used for the study that covered five fundamental areas of hospital care i.e. availability and behaviour of the staff, communication of information, residential and management issues. A five-point response scale was used to rate responses to the questions in each of these areas. The demographic profile of the patients and respondents, mode of admission, diagnosis, operation and duration of hospitalization were also recorded. The average of the responses to the questions in each of the five areas was taken as the fundamental area score (FAS) and the average of all these individual area scores was taken as the patient satisfaction score (PSS). Overall satisfaction index (OSI) was measured by calculating the average of PSS, willingness to return score and willingness to recommend score. RESULTS: Response rate was 100 %. Generally, patients were satisfied with care and rated various areas favourably. Behaviour of the staff was the highest rated area (95% score) while management was the lowest rated area (86.97% score). Dissatisfaction was more frequent among the young, the educated, the male and the relatives. The PSS was 91.32 %. Willingness to return score was 97.89% while willingness to recommend score was 95.48 %. The OSI was 94.89 %. CONCLUSION: Analysis of patients' dissatisfaction over specific aspects of health care serves to identify areas that could be improved by simple interventions, hence, patient satisfaction surveys should be conducted on regular basis in order to utilize patients' critical feedback for achieving service excellence and improved quality of care.