Patients' satisfaction with cancer pain treatment at adult oncologic centers in Northern Ethiopia; a multi-center cross-sectional study.

BACKGROUND: Patient satisfaction is an important indicator of the quality of healthcare. Pain is one of the most common symptoms among cancer patients that needs optimal treatment; rather, it compromises the quality of life of patients. OBJECTIVE: To assess the levels and associated factors of satisfaction with cancer pain treatment among adult patients at cancer centers found in Northern Ethiopia in 2023. METHODS: After obtaining ethical approval, a multi-center cross-sectional study was conducted at four cancer care centers in northern Ethiopia. The data were collected using an interviewer-administered structured questionnaire that included the Lubeck Medication Satisfaction Questionnaire (LMSQ). The severity of pain was assessed by a numerical rating scale from 0 to 10 with a pain score of 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain Binary logistic regression analysis was employed, and the strength of association was described in an adjusted odds ratio with a 95% confidence interval. RESULT: A total of 397 cancer patients participated in this study, with a response rate of 98.3%. We found that 70.3% of patients were satisfied with their cancer pain treatment. Being married (AOR = 5.6, CI = 2.6-12, P < 0.001) and being single (never married) (AOR = 3.5, CI = 1.3-9.7, P = 0.017) as compared to divorced, receiving adequate pain management (AOR = 2.4, CI = 1.1-5.3, P = 0.03) as compared to those who didn't receive it, and having lower pain severity (AOR = 2.6, CI = 1.5-4.8, P < 0.001) as compared to those who had higher level of pain severity were found to be associated with satisfaction with cancer pain treatment. CONCLUSION: The majority of cancer patients were satisfied with cancer pain treatment. Being married, being single (never married), lower pain severity, and receiving adequate pain management were found to be associated with satisfaction with cancer pain treatment. It would be better to enhance the use of multimodal analgesia in combination with strong opioids to ensure adequate pain management and lower pain severity scores.

A rare case of descending colonic volvulus presenting as large bowel obstruction 19 years after sigmoidectomy and descending colorectal anastomosis.

Introduction and importance: Large bowel obstruction is a common surgical emergency worldwide. Large bowel obstruction secondary to descending colonic volvulus is an extremely rare condition with only few reported cases worldwide. Its extreme rarity is due to its retroperitoneal location and lack of mesentery. Case presentation: A 75-year-old male patient with a history of sigmoidectomy and end-to-end descending colorectal anastomosis 19 years previously, presented with failure to pass faeces and flatus of 1 day duration with associated colicky abdominal pain, distension and vomiting. The abdomen was distended but soft and non-tender. Digital rectal examination showed an empty and ballooned rectum. The intraoperative finding was of a 360° counter-clockwise rotated descending colon. Detorsion and extraperitonealization of the descending colon was performed and the patient was successfully discharged. Clinical discussion: Volvulus is a twisting of a segment of bowel along its own mesentery. Sigmoid volvulus and caecal volvulus accounts for up to 90% and less than 20% of cases, respectively. Descending colonic volvulus is described in very few case reports. Diagnosis is clinical and confirmed by imaging. Conclusion: Descending colonic volvulus is a surgical emergency and an extremely rare cause of large bowel obstruction. Surgical management options include extraperitonealization of the descending colon, diversion colostomy or resection and primary end-to-end anastomosis.

Incidence and Factors Related to Prolonged Postoperative Cognitive Decline (POCD) in Elderly Patients Following Surgery and Anaesthesia: A Systematic Review.

Aim: The aim of this systematic review is to explore the current literature to provide evidence regarding the incidence and risk factors of prolonged POCD in elderly patients following cardiac and non-cardiac surgical interventions. Methods: The PubMed and Google Scholar databases were searched using appropriate keywords and search engines for adequate evidence from studies meeting the inclusion criteria so as to reveal the end-point, which was the presence of prolonged POCD in elderly patients following surgery and anaesthesia. The incidence of POCD at different time intervals and the variables predicting the occurrence of POCD were analysed. Results: The results of 23 articles covering 5077 patients (3694 non cardiac and 1383 cardiac surgeries) were carefully analysed. POCD occurs from the first postoperative day and lasts for potentially long periods. The incidence of POCD in this review ranged from 2.2% to 35.7%. More specifically, it ranged from 2.2% to 31.5% in non-cardiac surgeries and 11.8% to 35.7% in patients who had undergone cardiac surgeries. Some of the independent risk factors (predictors) for the development of POCD were advanced age, high concentration of neuroinflammatory mediators detectable in plasma, low SpO2, longer anaesthetic and surgical duration, and depth of anaesthesia. Conclusion: This review can only provide limited evidence of prolonged POCD (more than a year) and further research that involves better study designs, larger samples, involving longer follow-up, and at different sites (multicentre) is highly advised. This in turn may help researchers and clinicians to discover the actual causes and risk factors and develop appropriate preventive and treatment protocols to tackle POCD in the ageing surgical population.

Quality of anesthetist communication with surgical patients in the perioperative setting: a survey at an academic tertiary referral hospital in Ethiopia.

BACKGROUND: Effective communication is a fundamental step in providing best medical care and recognized as vital component of clinical anesthesia practice. Poor communication adversely affects patients' safety and outcome. The objective of this study was to investigate the quality of anesthetist communication from patients' perspectives at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia. METHODOLOGY: A descriptive cross-sectional study was conducted on 423 surgical patients from April 1, - May 30, 2021. Perioperative patient-anesthetist communication (PPAC) was measured by using 15-items Communication Assessment Tool graded by 5-points Likert scale. Data collection was executed during postoperative time as the patients were optimally recovered from anesthesia. The collected data were cleaned and descriptive analysis was performed. RESULTS: A total of 400 (94.6% response rate) patients included and 226 (56.7%) were female. The median (IQR) age was 30 (25 - 40) years. Three-hundreds and sixty-one (90.3%) patients had reported good PPAC and 39 (9.8%) reported poor PPAC. The median (IQR) of PPAC scores was 53.0 (48.0 - 57.0) and range from 27 to 69. Highest mean score was observed for the item "Talked in terms I could understand" (4.3 ± 0.7). Lowest mean scores were observed for the item "Checked to be sure I understood everything" (1.9 ± 0.9). Patients who had underwent emergency surgery, no previous anesthetic exposure, had significant preoperative anxiety, no history of previous hospital admission, and moderate-severe preoperative pain were found to have poor PPAC compared to their counterparts in the proportions of 82.1%, 79.5%, 69.2%, 64.1%, and 59.0% respectively. CONCLUSIONS: There was good PPAC in our hospital from patients' perspective. However, there should be improvements in checking the degree of understanding of the delivered information, encouraging to question, disclosing next steps and involving in decision-making. Patients who underwent emergency surgery, had no previous anesthetic exposure, had clinically significant level of preoperative anxiety, had no history of previous hospital admission, and had moderate-severe preoperative pain were found to have poor PPAC.

Current patterns of care at adult emergency department in Ethiopian tertiary university hospital.

BACKGROUND: The complexity and demands of emergency healthcare service are continuously increasing, and it is important to regularly track the patterns of care at the emergency department (ED). METHODOLOGY: A retrospective study was conducted at the ED of the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from April 1 to June 30, 2021. Ethical approval was obtained from the Emergency and Critical Care Directorate of UoGCSH. Data was collected from the emergency registry and descriptive analysis was performed. RESULTS: A total of 5232 patients have visited and triaged at the ED. All patients who visited the ED have received triage service within 5 min of arrival. The average length of stay at the ED was 3 days. About 79.1% of patients have stayed at the ED beyond 24 h, and the unavailability of beds at admission areas was responsible for 62% of delays. Mortality rate at the ED was 1.4%, and male to female ratio of death was 1.2 to 1. Shock (all types combined), pneumonia with/without COVID-19, and poisoning were the leading causes of death at the ED which were responsible for 32.5%, 15.5%, and 12.7% of deaths respectively. CONCLUSIONS: Triage has been done within the recommended time after patient arrival. However, many patients were staying at the ED for an unacceptably prolonged time. Unavailability of beds at the admission areas, waiting long for senior clinicians' decisions, delays in investigation results, and lack of medical equipment were the causes of delayed discharge from the ED. Shock, pneumonia, and poisoning were the leading causes of death. Healthcare administrators should address the lack of medical resources, and clinicians should provide timely clinical decision and investigation results.

Knowledge and attitude towards pediatric pain management among nurses at Ethiopian tertiary hospitals; a multi-center study.

BACKGROUND: Pain is the most disturbing and annoying symptom experienced by children. However, it obtains poor attention in low- and middle-income countries particularly. The objective of this study was to assess knowledge, attitude and factors associated with pediatric pain management among nurses in tertiary hospitals in Northwest Ethiopia. METHODOLOGY: A multi-center cross-sectional study was conducted from March 1 to April 30, 2021. The knowledge and attitude of nurses were measured by using Nurses' Knowledge and Attitudes Survey regarding Pain (P-NKAS). Descriptive and binary logistic regression analyses were performed to determine factors associated with knowledge and attitude. The strength of the association was presented by using adjusted odds ratio with 95% confidence interval and p-value < 0.05 was considered as statistically significant. RESULT: A total of 234 (86.03% response rate) nurses were included and 67.1% of nurses had good knowledge and 89.3% had favorable attitudes towards pediatric pain management. The factors associated with good knowledge were having Bachelor's Degree and above [AOR = 2.1, P = 0.015], having in-service training [AOR = 2.4, P = 0.008] and favorable attitude [AOR = 3.3, CI = 0.008]. The nurses who demonstrated good knowledge [AOR = 3.3, P = 0.003] and those who had Bachelor's Degree and above [AOR = 2.8, P = 0.03] were found to have favorable attitude. CONCLUSION: The nurses who were working in pediatrics care areas had good knowledge and favorable attitude towards pediatrics pain management. However, improvements are needed to eradicate misconceptions; particularly, on pediatrics pain perception, opioid analgesia, multimodal analgesia, and non-pharmacologic pain therapies. Nurses who had higher level of education, in-service training, favorable attitude were found to be knowledgeable. Furthermore, nurses who had higher levels of education and knowledge were found to have favorable attitude.

Breakthrough pain among cancer patients at oncology units in Northern Ethiopia; a multi-center study.

Background: Breakthrough cancer pain (BTCP) is a transient exacerbation of pain that affects the length of hospitalization and quality of life of patients. The objective of this study was to determine the prevalence and factors associated with BTCP among cancer patients at oncology units in Northern Ethiopia in 2022. Methods: A multi-center cross-sectional study was conducted from April to June 2022. After obtaining ethical approval, data were collected prospectively from 424 adult cancer patients admitted to oncology units. Breakthrough cancer pain was assessed by the numeric rating scale. Descriptive and binary logistic regression analyses were performed to determine the factors associated with BTCP. The strength of association was described in adjusted odds ratio (AOR) with 95% confidence intervals and variables with a P-value < 0.05 were considered to have a statistically significant association with BTCP. Result: The prevalence of BTCP among cancer patients was 41.5%. The factors that were found to be associated with BTCP were colorectal cancer (AOR: 7.7, 95% CI: 1.8, 32.3), lung cancer (AOR: 6.9, 95% CI: 1.9, 26.0), metastasis (AOR: 9.3, 95% CI: 3.0, 29.1), mild background pain (AOR: 7.5, 95% CI: 2.5, 22.6), moderate background pain (AOR: 7.0, 95% CI: 2.2, 23.1), severe background pain (AOR: 7.1, 95% CI: 2.2, 22.8), no analgesics taken for background pain (AOR: 5.1, 95% CI: 2.8, 9.3) and uncontrolled background pain (AOR: 3.3, 95% CI: 1.8, 6.1). Conclusion: The prevalence of BTCP was high. Colorectal cancer, lung cancer, the presence of metastasis, the presence of background pain, not taking analgesics for background pain, and uncontrolled background pain were significantly associated with BTCP.

Assessment of pre-anesthesia machine check and airway equipment preparedness: A cross-sectional study.

Background: Anesthesia Equipment malfunction is one of the most common factors contributing to intraoperative surgical patient morbidity and mortality. It is impossible to give anesthesia without proper anesthesia machine checks and airway equipment preparation. Therefore, all anesthesia professionals should make sure that the anesthetic machine and equipment are working correctly. Method: An institutional-based prospective observational study was conducted at the University Comprehensive Specialized Hospital, Operation rooms, from April 10, 2020 to May 10, 2020. About 90 anesthetists were working regularly in the operation theater both emergency and elective patients. Those include; 26 Msc holders, 17 MSc students, 7 BSc anesthetists, and 40 graduating BSc students. These descriptive data were presented with frequency, percentage, and table. Result: The overall compliance rate was 87%. Whereas; 12.46% of clinicians have not met the standard. Out of standards that were not performed, 25.81% were not available from the setup. Conclusion: The result shows that there was poor compliance with anesthesia machine check and equipment preparation before anesthesia in the operation theater according.

Perioperative Respiratory Adverse Events Among Pediatric Surgical Patients in University Hospitals in Northwest Ethiopia; A Prospective Observational Study.

INTRODUCTION: Perioperative respiratory adverse events (PRAEs) are frequent among pediatrics surgical patients and are accountable for 3/4th of perioperative critical incidents and 1/3rd of cardiac arrests. OBJECTIVE: Assess the prevalence and factors associated with PRAEs among pediatric surgical patients in University Hospitals in Northwest Ethiopia, 2020. METHODOLOGY: After ethical approval obtained prospective observational study was conducted among 210 pediatric surgical patients. Perioperative respiratory adverse events were defined as the occurrence of any episode of single/combination of coughing, breath holding, hypoxemia, laryngospasm and bronchospasm. Bivariate and multivariate binary logistic regression analyses were performed and variables with p < 0.05 at 95% confidence interval were considered as statistically significant. RESULTS: The prevalence of PRAEs was 26.2% (CI: 20.5-30.9%). A total of 129 episodes of PRAEs were occurred and of them, 89 (69.0%) were occurred in the postoperative period. Desaturation was the predominant adverse event which was observed 61 (47.3%) times. Age <1 year (AOR: 3.6, CI: 1.3-10.0), ASA ≥ 3 (AOR: 5.2, CI: 1.9-22.9), upper respiratory tract infections (URTIs) (AOR: 7.6, CI: 1.9-30.2), secretions in the upper airway (AOR: 4.8, CI: 1.4-15.9) and airway related surgery (AOR: 6.0, CI: 1.5-24.1) were significantly associated with PRAEs. CONCLUSIONS: Prevalence of PRAEs was high among pediatric surgical patients; the postoperative period was the most critical time for the occurrence of PRAEs and desaturation was the commonest PRAE. Age <1 year, URTIs (recent or active), secretions in the upper airways, ASA ≥ 3 and airway related surgery were significantly associated with PRAEs. Clinicians should perform effective risk assessment, preoperative optimization and preparation for the management of PRAEs.

Prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University hospital in Northwest Ethiopia; a cross-sectional study.

BACKGROUND: Anemia is the most common hematological finding in surgical patients. One-third of surgical patients were anemic during preoperative assessment. The presence of preoperative anemia was found to be related with increased morbidity, mortality, length of hospital stay, intensive care unit admissions and postoperative infections. OBJECTIVE: To determine the prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020. METHODS: After obtaining an ethical approval, hospital-based cross-sectional quantitative study was conducted from June to August 2020 in University of Gondar Hospital. Full blood count within two weeks of preoperative period was considered valid if there were no any factors that affect the hematologic system Descriptive statistics, cross-tabulations and binary logistic regression analysis were performed to identify factors associated withpreoperative anemia. The strength of the association was presented using AOR with 95% confidence interval and p-value < 0.05 was considered as statistically significant. RESULT: A total of 185 patients enrolled with 100% response rate. We observed preoperative anemia in 36.8% patients. The multi-variable binary logistic analysis showed that ASA II and III [AOR: 3.8, CI: 1.6-9.2], recent prior surgery [AOR: 3.3, CI: 1.3-8.5], history of malignancy [AOR: 9.4, CI: 2.0-43.4], orthopedic procedure [AOR: 11.2, CI: 4.0-31.6] and gynecologic procedure [AOR: 5.2, CI: 1.7-14.5] were significantly associated with preoperative anemia. CONCLUSION: The prevalence of preoperative anemia was high and ASA ≥2, recent prior surgery, history of malignancy, orthopedic surgery and gynecologic procedure were significantly associated with preoperative anemia. We recommend to clinicians to aim prevention, early detection and treatment of preoperative anemia among adult patients scheduled for major elective surgery to reduce risk of anemia and related adverse outcomes.