DENTAL RESIDENTS' PERCEPTION OF LEARNING ENVIRONMENT: EXPERIENCE OF A NIGERIAN TRAINING INSTITUTION.

BACKGROUND: Learning environment has been described as crucial in determining the success of medical and dental education. Continuous evaluation of this environment will help in maximizing the learning opportunities of the training program. OBJECTIVE: To assess the resident doctors' perception of their learning environment at a teaching hospital in Nigeria. METHODS: The DREEM questionnaire was administered to participants undergoing residency training in the faculty of Dental Surgery at the University College Hospital, Ibadan. RESULTS: Thirty-nine resident doctors participated in the study (23 Males, 16 Females), mean age (±SD) was 35.7 (±4.22) ranging from 28 years to 46 years. Mean global score (±SD) was 105.3 (±26.8), 52.7%, out of a maximum of 200. The mean global score according to gender was significantly higher among males than females. The overall perception of the training environment by residents is more positive than negative and the male gender appears to have a more positive perception than the female gender. However, this perception is borderline as the environment was perceived as having many problems and residents' perception of their learning environment is mostly negative. Attention of the institution and trainers should be drawn to possibilities of combating the problem areas for better outcome of residency training in our environment.

ATTITUDES OF MEDICAL STUDENTS TOWARDS TAKING PART-TIME JOBS: A STUDY AMONGST FIRST YEAR CLINICAL STUDENTS OF THE COLLEGE OF MEDICINE, UNIVERSITY OF IBADAN.

BACKGROUND: Student part-time jobs are employments taken up by students while in school. Students in tertiary institutions do engage in part-time jobs because of the associated benefits. Some of these benefits include work experience, independence, financial support, and job satisfaction. Different studies have reported different attitudes towards taking part-time jobs among university students. OBJECTIVE: To determine the attitudes of medical students in their first clinical year of study at the University of Ibadan medical school towards taking up parttime medical jobs within the university hospital. METHOD: This study was a descriptive cross-sectional study conducted among medical students in their first clinical year of study. Eighty one first clinical - year medical students were recruited to participate in this study. All participants were interviewed using a self-administered questionnaire to obtain information on bio-data, scholarship benefit status, level of satisfaction with monthly income, choices of part-time jobs, and the factors that might informed choice of a part-time job. No questionnaire was discarded because all were correctly filled. Data collected was coded, entered, and analysed using the SPSS version 16 software. Analyses of all variables were done using descriptive statistics. RESULTS: The mean age of the 81 respondents was 20.8 (±1.6) years and 51.9% were males. A higher proportion of the male respondents were studying on scholarship (57.1%), compared to that of the females (31.6%). Respondents studying on scholarship had a higher level of financial satisfaction. Over 90% of the participants supported the idea of part-time medical job creation for medical students. The majority of the respondents (64.2%) prefer to take up the job position of research assistantships. The amount of wages to be earned was the most predominant factor considered among the male respondents in their decision for taking up a part-time medical job, while opportunity to learn new skills was the most predominant factor considered by the females. CONCLUSION: Medical students had a positive attitude towards combining work and study.

AN AUDIT OF ORAL AND MAXILLOFACIAL PROCEDURES UNDER GENERAL ANAESTHESIA AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN, NIGERIA.

BACKGROUND: Operating theatre time management is a constant source of tension among the healthcare professionals responsible for the use of the facility. It is important that all effort should be geared at optimal utilization of available resources and minimization of waste. AIM: To appraise time management, frequency and duration of surgical procedures, frequency and determinants of blood transfusion in oral and maxillofacial surgery. DESIGN OF THE STUDY: Prospective clinical study. SETTING: The University College Hospital, Ibadan. Nigeria. METHODOLOGY: This was a cross-sectional study of consecutive patients who had maxillofacial surgical procedures. Information was collected on number of cases scheduled per list, number of cases done per list, each patient's biodata, time intervals between patient arrival and departure from operating theatre, route and duration of intubation, type of surgical procedure, surgical time, preoperative and postoperative packed cell volume estimations, volume of blood loss and the frequency and volume of blood transfusions. RESULTS: The main points of delay were identified as the patient wait at the theatre reception and in the operating suite before intubation. Mandibulectomy procedures were the longest procedures with approximately five (5) hours, followed by maxillectomy with four (4) hours and maxillofacial trauma with three and a half (3.5) hours. Maxillectomy procedures had highest transfusion probability. The surgical time and the estimated blood loss significantly determined whether a patient would be transfused or not. The nasotracheal was the commonest route of intubation while cleft surgeries were the most frequent procedures performed followed by trauma surgeries. Majority of the patients were not transfused and two units of blood was the most frequent transfused volume for a patient. CONCLUSION: The main areas of delay have been identified as patients' waiting periods before the surgical procedures. The reasons why these delays occur need to be investigated and addressed to have an optimally functional facility. Reservation of blood for maxillofacial surgical procedures should be based on the anticipated need for blood transfusion for the particular procedure.

MANAGING TEMPOROMANDIBULAR JOINT DISLOCATION IN IBADAN: A REVIEW OF 11 CASES.

AIM: The study presents a case series which evaluates the presentation, management and outcome of TMJ dislocation in a tertiary health centre in Nigeria. MATERIALS AND METHODS: Case review of 11 patients with TMJ dislocation seen in the University College Hospital (UCH) Ibadan over a period of 10 years. The criteria for the diagnosis of TMJ dislocation were based on history, clinical examination and radiologic findings. RESULTS: Mean age of patients was 44.4 years (SD +/-15.9years); age range was 25-65 years with 4 males and 7 females. Aetiology was trauma in 4 cases, wide mouth opening in 6 cases and unknown in a patient. There were 7 acute presentations, 2 recurrences and 2 chronic presentations; bilateral anterior presentation in 10 cases, unilateral (right) anterior presentation in 1 case. 4 of the acute cases were successfully managed using the Hippocrates manoeuvre, 1 had the manoeuvre under GA, and 2 had spontaneous reduction. All recurrent cases were successfully managed with the Hippocrates manoeuvre and IMF. Fifty percent of the chronic cases were successfully managed with the Hippocrates manoeuvre. Follow up was ≤ 2 weeks in 7 of the cases. CONCLUSION: The pattern of presentation of TMJ dislocation in the above named hospital was anterior dislocation, the female gender predominance, aetiology of wide mouth opening, as well as early presentation. A conservative method of management - the Hippocrates manoeuvre - was effective in most cases irrespective of duration of dislocation. Most patients had a poor attitude to follow up.

EXPERIENCE WITH IMPACTED FOREIGN BODIES IN THE MAXILLOFACIAL REGION AT A NIGERIAN TEACHING HOSPITAL.

BACKGROUND: The maxillofacial region has a complex anatomy and is replete with orifices and tissue dead spaces which could harbor foreign bodies. It is important to identify a foreign body impaction when it occurs, as it can be a source of persistent pain, infection and suppuration, it could also further migrate to adjacent regions of the body. The aim of this study is to report the clinical presentation, the prevalence, diagnosis, management and outcome of maxillofacial foreign body impaction in Ibadan, Nigeria. METHODOLOGY: This is a prospective clinic based epidemiological study carried out at the Department of Oral and Maxillofacial surgery, University College hospital, Ibadan, Nigeria. Data of all the patients presenting with foreign body impaction department from January 2008 to July 2013 were recorded into a proforma. The data which included demographics, type of foreign body impaction, predisposing factors, clinical presentation, diagnosis, treatment provided and outcome were analyzed using IBM SPSS version 19. RESULTS: A total of 5571 patients presented in the clinic during the study period with 16 of the patients presenting with foreign body impaction in the maxillofacial region prevalence rate of 0.29% There were 8 (50%) males and 8 (50%) females with male/female ratio of 1:1.The age ranged from .. to .. with a mean age of 21.89+/-17.047years. Iatrogenically displaced tooth 4 (25%) was the commonest foreign body impacted in the maxillofacial region while the submandibular region 3 (18.8%) was the commonest site. Majority 6 (40%) of the patients had retrieval of the foreign body under local anaesthesia. CONCLUSION: Foreign body impactions in the maxillofacial region are not common and are varied in nature. Their management is straightforward when they are impacted in an accessible and superficial site otherwise their diagnosis could be difficult and their management more challenging.

Evaluation of pedestrian road traffic maxillofacial injuries in a Nigerian tertiary hospital.

UNLABELLED: Background: Walking is the most basic form of mobility and forms an important part of daily activities; however, walking could often be associated with risks. This is more so when pedestrians share a common space with motorized vehicles especially in developing countries. Despite the frequency of road traffic crashes (RTC) related pedestrian injuries in many developing countries, there is a dearth of documentation of maxillofacial injuries in victims of pedestrian road traffic crashes. The aim of this study was to determine the causes, frequency, pattern, severity, concomitant injuries and outcome of pedestrian maxillofacial injuries observed at a tertiary trauma centre in Nigeria. METHOD: Pedestrian victims of RTC were prospectively recruited from among all maxillofacial trauma patients seen at the Accident and Emergency department and the Department of Oral and Maxillofacial Surgery of the University College Hospital, Ibadan between April 2011 and November 2011. Ethical approval was obtained from the UI/UCH Joint Ethics Review Board before the commencement of the study and informed consent was obtained from participants. Patients' demography, the crash events, types of maxillofacial injuries, and concomitant injuries were recorded. Severity of maxillofacial injury was estimated based on the Maxillofacial Injury Severity Scale (MFISS). RESULTS: Forty-six participants (22.9% of all victims of road traffic crashes seen within the study period) were victims of pedestrian RTC. Pedestrian RTC occurred in all age groups with almost 40% of the victims in their 1st and 2nd decades of life. The most severe MFISS was observed in the 21 - 30 year age group while the least severe injury observed was in the 71 - 80 years age group. Thirty participants (65.2%) were hit by a car or minibus while fourteen (30.4%) were knocked down by a motorcycle. Two (4.4%) were hit by a truck. Soft tissue injury was the most common maxillofacial injury and head injury was the commonest concomitant injury observed. The median MFISS score of victims of motorcycle was 4.0 while the median scores for victims of car/minibus pedestrian RTC was 9.0. The most severe maxillofacial injury was seen in victim of car/minibus pedestrian crashes. Seventeen percent (8) of the victims had a fatal outcome. Conclusion: Pedestrian RTC resulting in maxillofacial injuries are common in the studied environment. It is particularly common among the 11 -20 year age group and victims are usually hit by cars/minibuses. These injuries are often severe and fatal outcome is not infrequent. Therefore, definitive preventive measures are imperative.

Evaluation of correlations between socio-demographics and oral health seeking among patients

Background: It is commonly reported that individuals at higher socioeconomic class have greater health awareness culminating in better care-seeking from orthodox facilities. It is yet to be ascertained whether this reflect in attitudes of patients toward seeking oral health care. Aim: This study was designed to evaluate the effect of certain socio-demographic indices on oral health care-seeking in an urban society where adequate facilities are available. Methods: A one point observational study of the patients attending the Dental Clinic of the University College Hospital; Ibadan; was conducted using a questionnaire which sought to document the levels of education; income; marital status and the oral health seeking practice of the patients. The appropriate treatments for individual patients were also documented. Results: One hundred and three patients participated in the study that spanned three months (1st April- 30th June; 2006). Fifty-six (54.4) of the patients were males while 47(45.6) were females with age range of 19-85 years and average of 39 years. Eighty-six (83.4) patients had at least secondary school education of which 65 (63.1) actually had tertiary education. There was no significant correlation between oral health seeking behaviour and level of education; level of income; and marital status. Seventy -four (71.8) of the patients had tooth extractions while the remaining patients had non-surgical treatments. The reasons for preponderance of surgical treatment needs were discussed. Conclusion: Although a larger proportion of the dental patients were well educated and had better income; this did not reflect in their oral health seeking behaviour

Indications for the removal of impacted mandible third molars at Ibadan--any compliance with established guidelines?

The removal of impacted lower third molars has been a subject of controversy among dental practitioners since the turn of the twentieth century. A yet unresolved aspect of the controversy is the definition of appropriate indications for surgical extraction. Clinical guidelines have long been established but the effectiveness of adoption of the guidelines is still to be proved in our environment. A retrospective observational study of the indications for extractions in oral surgery clinic of the University College Hospital (UCH), Ibadan was conducted with the aim of identifying the common indications and to verify the level of compliance with established guidelines. There were 294 extractions out of which the indications for 268 cases were recorded. We found that pericoronitis constituted the most frequent indication 190 (33.6%) recurrent, 36 (13.4%) acute cases] while apical periodontitis 70, (26.1%) was next most frequent. Prophylactic extractions were performed in 34 (12.7%) cases. Other indications such as pulpitis 19, (7.1%), dental caries 13, (4.9%), dentoalveolar abscess (4, 1.5%), orthodontic reason (1, 0.3%) and tooth fracture (1, 0.37%) were also recorded. Compliance rate with NIH criteria and NICE guidelines were 87.3% and 73.9% respectively. We recommend that prophylactic extractions be discouraged while guidelines should be adequately emphasized for effective clinical practice.