COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector. Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges. Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria. Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail. Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables. Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail. Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

RésuméLe contexte: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. Dans un pays en développement, comme Le Nigeria, qui avait déjà une myriade de problèmes de fonds et d'équipements dans le secteur de la santé. Objectifs : Cette étude vise à examiner les défis rencontrés par le personnel des établissements de radiologie et comment ils ont relevé les défis. Paramètres et conception: une section descriptive étude des installations de radiologie au Nigeria. Sujets et méthodes: Radiologues de neuf établissements publics et de quatre établissements privés qui ont participé aux patients COVID-19 ont été invités à remplir des questionnaires sur les défis rencontrés et leurs stratégies d'adaptation. Les réponses ont été envoyées par courrier électronique. Analyse statistique utilisée: Les données des réponses ont été analysées à l'aide de Microsoft Excel pour Mac 2011 et présentées sous forme de figures et de tableaux. Résultats: La majorité des établissements publics 7 (77,8 %) et privés 4 (100 %) ne disposaient d'aucun équipement dédié uniquement aux patients COVID-19. Sept (77,8 %) établissements publics se sont plaints d'un personnel inadéquat, d'une faible disponibilité des équipements de protection individuelle (EPI) 8 (88,9 %), et le manque de technologie pour la visualisation à distance 7 (77,8 %). La peur d'une infection croisée était un défi dans l'un des établissements 1 (11,1 %). Faire faceles stratégies adoptées comprennent la réduction de la circulation dans le service en décourageant les patients sans rendez-vous et en annulant les cas non urgents, en réservant les cas suspects/confirmés pour des périodes plus légères, en utilisant un vieux film pour les écrans faciaux et un tissu pour les masques faciaux, la formation du personnel sur COVID-19 et mesures préventives et l'envoi de rapports aux médecins par courrier électronique. Conclusions: Il y a eu beaucoup de défis pendant la COVID-19 crise, les hôpitaux publics étant confrontés à plus de défis que les établissements privés. Les défis comprenaient entre autres l'insuffisance la force du personnel et le manque de technologie pour la visualisation à distance. Certains ont été surmontés grâce à l'éducation et à la production de masques faciaux/boucliers utilisant des matériaux recyclés. Mots-clés: défis, les stratégies d'adaptation, COVID-19, Nigeria.

Perspectives of Nigerian doctors on the practice of rebates, fee-splitting, and kickbacks

Background: Fee splitting is a global pandemic in the health-care industry, whereby financial and nonfinancial inducements are offered to health-care practitioners in exchange for guaranteed patient referral, continuous patronage, or preferential usage/prescription of the payer's products. Methods: We surveyed 280 medical doctors from August 2017 to October 2017 to assess their knowledge, perception, and attitude toward fee-splitting using self-administered questionnaires.Results: The majority (89%) of our respondents indicated that they were aware of the existence of fee-splitting in the Nigerian health-care industry. About 34% accept rebates, while 70% admitted to knowing other colleagues who accept rebates. The amount received as rebates was ≤20% of the cost of an investigation. More than half of the respondents (52%) opined that the practice is a nationwide phenomenon. An astonishing 78% of respondents either did not know (61%) or asserted wrongly (17%) that the practice is not a violation Nigerian Medical Council rules. Only 46% affirmed that the practice is unethical. Compared to private hospitals, fee-splitting is less in public hospitals. Sixty-one percent noted that other health-care workers (besides physicians) are also involved. The primary allures of fee-splitting were a quest for an extra source of income (64%), poor/irregular salaries (60%), ignorance of its illegality (56%), and greed (47%). The identified deleterious consequences were unnecessary investigations/procedures, inflated health-care cost, quackery, delayed treatment/prolonged hospital stay, beclouded clinical judgment, and negative public perception.Conclusion: Stricter regulatory enforcement and continuous ethics education are needed to disrupt the widespread fee-splitting culture

Reference Ranges of Fetal Cerebral Lateral Ventricle Parameters by Ultrasonography.

Objectives This study was done to evaluate the normal fetal cerebral lateral ventricle dimensions with transabdominal ultrasonography. The atrial width (AW), ventricle-to-choroid measurement (V-C), ventricle-to-hemisphere ratio (VHR), and combined anterior horn measurement (CAHM) were taken. Methods This was a cross-sectional study involving 400 normal singleton pregnant subjects whose gestational ages were between 14 and 40 weeks. Transabdominal sonography was performed to obtain the values of the fetal cerebral lateral ventricle (FCLV) parameters. Data were reported as mean ± standard deviation (SD) for continuous variables. The degrees of correlation between FCLV parameters and the estimated gestational age (EGA) were obtained using Pearson's correlation. Regression equations were used to generate the reference limits for the FCLV measurements. Results The values of AW, V-C measurements and CAHM increased with advancing gestation. The mean values of the AW, V-C and CAHM from 14 to 40 weeks increased from 6.60 ± 0.94 mm to 9.75 ± 0.07 mm (R2 = 0.114), 0.80 ± 0.00 mm to 1.90 ± 0.14 mm (R2 = 0.266), and 6.95 ± 0.06 mm to 23.07 ± 4.02 mm (R2 = 0.692) respectively, while the mean VHR decreased from 61.20 ± 1.60% to 42.84 ± 2.91% (R2 = 0.706) over the same period. Conclusion The AW, V-C, and CAHM increase, while VHR decreases with advancing gestation.

Reference Ranges of Fetal Cerebral Lateral Ventricle Parameters by Ultrasonography / Intervalos de referência para parâmetros do ventrículo lateral de cérebros fetais por ultrassonografia

Abstract Objectives This study was done to evaluate the normal fetal cerebral lateral ventricle dimensions with transabdominal ultrasonography. The atrial width (AW), ventricle-tochoroid measurement (V-C), ventricle-to-hemisphere ratio (VHR), and combined anterior horn measurement (CAHM) were taken. Methods This was a cross-sectional study involving 400 normal singleton pregnant subjects whose gestational ages were between 14 and 40 weeks. Transabdominal sonography was performed to obtain the values of the fetal cerebral lateral ventricle (FCLV) parameters. Data were reported as mean standard deviation (SD) for continuous variables. The degrees of correlation between FCLV parameters and the estimated gestational age (EGA) were obtained using Pearson's correlation. Regression equations were used to generate the reference limits for the FCLV measurements. Results The values of AW, V-C measurements and CAHM increased with advancing gestation. The mean values of the AW, V-C and CAHM from 14 to 40 weeks increased from 6.60 0.94 mm to 9.75 0.07 mm (R2 = 0.114), 0.80 0.00 mm to 1.90 0.14 mm (R2= 0.266), and 6.95 0.06 mm to 23.07 4.02 mm (R2= 0.692) respectively, while the mean VHR decreased from 61.20 1.60% to 42.84 2.91% (R2 = 0.706) over the same period. Conclusion The AW, V-C, and CAHM increase, while VHR decreases with advancing gestation.

Resumo Objetivos O presente estudo objetiva avaliar as dimensões do ventrículo lateral de cérebros fetais por meio de ultrassonografia transabdominal. Foram medidos a largura do átrio (LA), a medida do ventrículo ao coroide (V-C), a razão ventrículo/ hemisfério (RVH), e a medida dos cornos anteriores combinados ( CAC ). Métodos Estudo transversal com 400 grávidas de único feto com idades gestacionais entre 14 e 40 semanas. Sonografias transabdominais foram realizadas para obter os valores dos parâmetros do ventrículo lateral de cérebros fetais (VLCF). Dados foram apresentados em média desvio padrão para variáveis contínuas. Os graus de correlação entre parâmetros de VLCF e idade gestacional estimada foram obtidos usando a correlação de Pearson. Equações de regressão foram usadas para gerar as referências-limite para medidas de VLCF. Resultados Os valores de LA, medida do V-C e CAC aumentaram com o avanço da gestação. Os valores médios de LA, V-C e CAC de 14 a 40 semanas aumentaram de 6,60 0,94 mm a 9,75 0,07 mm (R2 = 0,114), de 0,80 0,00 mm a 1,90 0,14 mm (R2 = 0,266), e de 6,95 0,06 mm a 23,07 4,02 mm (R2 = 0,692), respectivamente, enquanto a RVH média diminuiu de 61,20 1,60% para 42,84 2,91% (R2 = 0,706) no mesmo período. Conclusão A LA, V-C, e CAC aumentaram, enquanto a RVH diminuiu com o avanço da gestação.