Perceptions of undergraduate allied health students of the clinical learning environment and clinical educators' attributes at the University of Ghana

Background. Clinical education is a vital aspect of the education of health sciences students and consists of two components, i.e. the clinical learning environment and supervision.Objectives. To determine the undergraduate allied health sciences students' perceptions regarding clinical educators' attributes and the clinical learning environment.Methods. This cross-sectional study included 169 undergraduate students, randomly recruited from various allied health professions programmes of the University of Ghana. The McGill clinical teacher evaluation tool and the clinical learning environment inventory were used to determine students' perceptions of clinical educators' attributes and the clinical learning environment, respectively. The Kruskal-Wallis test and independent t-tests were used to test for relationships between students' level and programme of study and their perceptions. The level of significance was set at 95%.Results. Of the 169 participants, there were 99 (58.6%) male students, 79 (46.7%) third-year students and 82 (48.5%) medical laboratory science students. Only 16 (9.5%) participants indicated visits by lecturers during clinical rotations. The third-year students had a statistically significant perception of their clinical learning environment (p=0.000), while the differences between perceptions of clinical learning environment among the various programmes were also statistically significant (p=0.028), but not for clinical educators' attributes (p=0.261).Conclusion. Allied health sciences students have positive perceptions of their clinical learning environment and clinical educators' attributes. More frequent visits by lecturers to students during clinical rotations may ensure that student innovation is achieved in accordance with their classroom tuition

Readiness of allied health students towards interprofessional education at a university in Ghana

Background. Interprofessional education (IPE) is an important academic approach for preparing healthcare students to provide patient care in a collaborative team environment, which improves patient care outcomes and increases patient satisfaction. IPE has been shown to eliminate segmented education between healthcare professionals, and thus renounces hierarchies, misperceptions and miscommunications.Objectives. To determine the readiness of allied health students towards IPE.Methods. This was a cross-sectional study that involved 299 second- to fourth-year allied health students recruited from various departments at the University of Ghana, Accra, Ghana. The Readiness for Interprofessional Learning Scale was used to obtain data regarding readiness of allied health students towards IPE. Data obtained were analysed using SPSS version 22 (IBM Corp., USA). Differences between groups based on the levels and programmes of study, respectively, were determined using one-way analysis of variance (ANOVA). Results. The majority of participants (n=155; 67.7%) had previous experience in the health environment. The overall response of allied health students' readiness towards IPE was high. This readiness did not differ between the different levels of study (p=0.985) and the various programmes of study (p=0.726). Conclusion. The study revealed that allied health students value teamwork and collaboration and appear ready for participation in IPE activities. Formatively planning IPE activities may be helpful in developing multidisciplinary teamwork

The Efficacy of intracorpus spongiosum anesthesia in internal urethrotomy for anterior urethral strictures

Objective: To critically evaluate the effectiveness of glans and intracorpus spongiosum anesthesia in performing internal urethrotomy for anterior urethral strictures. Patients and Methods: In this prospective study; 43 patients with anterior urethral strictures underwent visual internal urethrotomy under intracorpus spongiosum anesthesia. A small amount of eutectic mixture of local anesthetic (EMLA; Astra Zeneca) was applied to the glans penis as a topical anesthetic. Fifteen minutes later; 3 ml of 2plain lidocaine was injected into the glans and routine internal urethrotomy was performed. The effectiveness of the anesthesia was evaluated by asking the patient to indicate his level of pain using the visual analogue scale. Results: Internal urethrotomy was successfully completed in 39 patients (91); 4 cases were unsuccessful; two on account of bleeding and the other two because the strictures were found to be impassable. No procedure was abandoned on account of severe pain. The pain scores reported by patients ranged between 0 and 4; with an average of 1.6. Conclusion: Criteria indicating sufficient pain therapy (using the numerical visual analogue scale) are pain levels of 3 or less. In the study 98of patients met this criterion providing evidence of the efficacy of this method. In areas where anesthetic services are limited; this technique provides a cheap; safe and effective alternative

The antibody responses to adult-worm antigens of Schistosoma haematobium, among infected and resistant individuals from an endemic community in southern Ghana.

Antibody responses to antigens from adult Schistosoma haematobium were investigated in an endemic community in Ghana, using microplate-ELISA. The results of a survey of egg output in urine and of a questionnaire-based investigation of water-contact activities were used to select 'endemic normal' (EN) and patently infected (PI) individuals as subjects. The plasma levels of antibodies reacting with the adult-worm antigens were determined and compared and the correlations between these levels and the age, water-contact index and egg output of each subject were evaluated. Compared with the EN subjects, the PI generally had higher levels of anti-worm IgG and IgE but lower levels of anti-worm IgA. When the data for the EN and PI groups were combined, the levels of anti-worm IgG and IgE were found to be positively correlated with egg output and with each other. Whichever the antibody class considered, levels of anti-worm antibodies were never negatively correlated with egg output. These results indicate that anti-worm IgE and IgG could be used as markers to reflect current infection intensity, and that anti-worm antibodies may not act as protective antibodies in the natural course of urinary schistosomiasis.

Is osteitis pubis associated with the use of bone anchors in urinary continence operations?

We studied 130 patients who underwent either a vaginal needle suspension procedure or a pubofascial sling procedure with Mitek titanium bone anchors to determine the association of osteitis pubis with bone anchoring in these procedures. Fifteen patients complained of postoperative suprapubic pain; five cases were due to wound infections and another five were associated with tying the suspension sutures too tightly. We suggest the use of the term 'periostitis pubis' to describe the remaining five patients who suffered suprapubic pain. We found no radiological evidence of osteitis pubis in any patients.

Prevalence of early childhood caries at Harris County clinics.

Nursing caries has been found to be positively associated with children from families of low socioeconomic status. The Harris County Health Department (HCHD) serves a population consisting predominately of low-income, low-educational-level clients who reside in the suburban areas surrounding Houston, Texas. The purpose of this study was to determine the prevalence of early childhood caries and nursing caries among patients of the HCHD dental clinics. The study method was a retrospective chart review of all patients seen at the HCHD dental clinics within the two years before the study. There were 135 children in the sample, with a mean age of fifty-seven months. About half of the children had a quarter (five or more) of their primary teeth filled or decayed. The prevalence of early childhood caries was 76 percent and 44 percent of the children were classified in the group with nursing caries. The prevalence of early childhood caries and nursing caries among patients from low socioeconomic families is still high.

Impact of HIV on the practice of dentistry in Houston, Texas.

Texas ranks fourth in the nation in the number of documented HIV-infected and AIDS cases. The city of Houston has the highest prevalence of HIV-infected and AIDS cases in Texas. Dental health personnel have an ethical and legal obligation to provide dental services for HIV-infected persons. The purpose of this study was to assess the impact of HIV on the practice of dentistry in Houston. The study population was all dentists with a current Houston practice address registered with the Texas State Dental Board. A 41-item questionnaire was mailed to a stratified random sample of 500 dentists in Houston. The questionnaire covered four main areas: demographics, knowledge, attitudes, and behavior. About three-quarters of the dentists said they had treated an AIDS or HIV+ patient. Sixty percent of the dentists were not aware that breastmilk is a mode of transmission of HIV. There was a significant correlation between "ever treated" an HIV+ patients and "willingness to treat" an AIDS or HIV+ patient (p < 0.01). The experience of treating HIV-infected patients has a greater impact than knowledge alone in influencing dentists' behavior towards AIDS/HIV+ patients.

Upper urinary tract stones in Accra, Ghana.

Fifty-one patients with newly diagnosed upper urinary tract stones were seen at the Korle Bu Teaching Hospital, Accra over an 8 years period from September 1985 to August 1993. Their mean age was 40.1 years (range 20-61 years). The sex ratio was 36 males to 15 males. During the same period 3, 217, 135 patients (both adults and children) attended the hospital's clinics. Thus putting the incidence of upper urinary tract stone at 2 per 100,000. On presentation 37 patients had solitary stones, 11 had multiple stone and 3 had partial or complete staghorn calculi. A total of 71 stones were seen; 30 were renal and 35 ureteric. The etiology of the stone disease was established in only 10 cases (20%). Urinary stasis was a predisposing factors in 5 patients, urinary infection in 3 others and hyperuricaemia and uricosuria in another 2. Stones from 29 patients that were removed at surgery or passed spontaneously were analysed chemically. Of these 25 (86%) consisted of calcium oxalate and/or calcium phosphate, 3 (10%) consisted of magnesium ammonium phosphate and 1(4%) contained only uric acid.

One-stage transverse distal penile/preputial island flap urethroplasty for urethral stricture.

The rich blood supply of the penis, derived from three longitudinal arterial and venous pedicles and numerous transvesical anastomoses allows the raising of a full thickness skin graft obliquely underneath the glans and around the penis. An island flap, which can be as long as 15 cm, is isolated but its blood supply is preserved by cleaving the connective tissue underneath the basic flap. The vascularised island flap is then rotated towards the zone of urethral replacement either in the form of a flap or a tube which can extend as far as the membranous urethra. 150 cases have been operated with this pedicle flap as a one-stage operation. No cases of necrosis were observed, even in the presence of fistulae or periurethral abscesses. A post-operative proximal stricture was observed in 10% of cases and was treated by internal urethrotomy. One third of these failures had to be reoperated with no major difficulties. Two pre-existing urethrocutaneous fistulae also had to be reoperated.

Priapism: experience with the caverno glandular shunt.

Twenty cases of Priapism were managed surgically over a 3-year period with the A1-Ghorab modification of the caverno-glandular shunt. The procedure was simple and short. Except for post-operative bleeding in 2 patients, no major complications were encountered. Post-operative potency rate of 39 per cent was achieved. Late presentation and repeated previous episodes may have contributed to this low potency rate.

Internal optical urethrotomy: a report of fifty-one cases treated under local anaesthesia.

Over the 15-month period beginning from October 1985, internal optical urethrotomy was successfully performed under local anaesthesia on 51 patients with urethral stricture. The procedure was well tolerated and 48 patients were discharged home on the day of operation. A urethral catheter (18 or 20F Foley) was left indwelling for one week post-operatively. Subsequently patency was assessed by check catheterisation using size 18F Nelaton Catheter, weekly for 6 weeks, and then at 3 monthly intervals. Thirty-nine patients have been followed up regularly for 3 to 15 months. Six patients restrictured (failed check catheterisation). The remaining 33 (84.6%) have retained urethral patency with no additional treatment.

A modified perineal approach to reconstruction of membranous urethra for stricture.

Difficulty in obtaining perineal exposure of the membranous urethra in cases of traumatic stricture led to the development of the combined perineosuprapubic and transpubic approaches. Use of the standard perineal incision for perineal prostatectomy with division of the urogenital diaphragm in the midline from behind up to and encircling the urethra, and temporary suturing of the flaps of the urogenital diaphragm that are created to the lateral edges of the skin incision provides good exposure of the membranous and proximal bulbous urethra, thus, making reconstruction easier. This approach should minimize the need for the transpubic or perineosuprapubic approaches. It has been used for urethroplasty in 12 patients with traumatic membranous strictures, 5 with traumatic bulbomembranous strictures, 7 with post-gonococcal strictures involving the proximal bulbous and distal membranous urethra, and 1 with a bulbomembranous urethral rupture.

One-stage penile/preputial island flap urethroplasty for urethral stricture.

A 1-stage urethroplasty for urethral stricture with a vascularized island of distal penile or preputial skin, which is relatively hairless, is described. The results of 27 patients treated since August 1981 are reviewed.

One-stage penile/preputial cutaneous island flap urethroplasty for urethral stricture: a preliminary report.

A 1-stage urethroplasty for urethral strictures is described using a transverse distal penile or preputial island of skin as a flap, which is supplied axially by the superficial external pudendal vessels. This portion of the skin is hairless and the pedicle is constructed so that the skin can reach anywhere from the external meatus to the prostatic urethra for reconstruction as a patch or tube. In 10 cases reviewed urethroscopically for intervals of 5 weeks to 6 months there was 100 per cent graft take with no stenosis at the anastomotic sites and no permanent fistula. There was 1 residual stricture owing to incomplete excision of the original stricture and 3 fine hairs were seen in 2 new urethras. Mucous membrane or mucocutaneous bridges occurred in 4 patients owing which were divided easily.

Vascular access for haemodialysis for renal failure in a developing country.

One thousand two hundred and thirty-five haemodialyses have been performed on 92 patients with renal failure. The mean number of dialyses per patient was 13.42 and the survival rate was 60.9%. One hundred and six arteriovenous shunts (98 of arm, 7 of ankle, and one of groin) were created. Three arteriovenous fistulae of arm were created in 2 patients with chronic renal failure. All the operations were performed under local or regional block anaesthesia. The mean shunt complications were clotting (27.4%), bleeding (17.9%) and infection (13.2%). The complications associated with the fistulae were non-function, heart failure, infection, aneurysmal dilatation and bleeding. One death from heart failure was attributable to arteriovenous fistula. It is recommended that patients with renal failure requiring haemodialysis in developing countries should have shunts or fistulae created under regional anaesthesia to avoid the problems of general anaesthesia in uraemic patients.

Acute renal failure in tropical Africa.

Between 1972 and 1975, 55 adult patients with acute renal failure were admitted to the renal unit of Korle Bu Hospital. Fourteen patients died, giving an overall death rate of 25%. Massive intravascular haemolysis after a short febrile illness was the commonest cause of acute renal failure. Clinically these patients presented with blackwater fever but in only one could Plasmodium falciparum malaria be confidently diagnosed. In half the patients various bacterial and viral infections (especially typhoid) could be incriminated as causing this blackwater fever syndrome. The incidence of glucose-6-phosphate dehydrogenase deficiency was 22.5%, but we could not confirm the impression of a greater predisposition to acute renal failure in patients with this enzyme defect.