Dear All,
I wish to pose a question to HIFA2015 members as it is still a big concern to me. How can we ensure that health information is utilized at the point of generation for evidence based decision making to improve the quality of care in our health care systems particularly in developing countries? In Kenya, scenarios of a patient being sent to pharmacy for drugs after being seen by the clinician and a prescription is written, only to find that the drugs are out of stock, is common. This is common at the public hospitals. If only the information on the drugs available was circulated to different clinicians seeing the patients by the beginning of the day, the patient would have saved a lot of suffering queuing for drugs only to be disappointed that they are not available. Clinicians will only prescribe for the available drugs if they had the information. This has its impact on the quality of care and also on services offered to our clients especially in the public hospitals.
Beatrice Muraguri HIFA2015 profile: Beatrice Muraguri is Health Information Officer with the Ministry of Health, Nairobi, Kenya.
MAY I add that the same scenario exists in Nigerian hospitals and patients and their relatives sometimes have to visit several pharmacies at huge expense, stress and waste of valuable time to buy medications or equipment. Why? Especially when each hospital can determine what drugs are in stock, are low in stock and finished thereby requiring replacement.
I have now sent our Chief Pharmacist at the National Hospital, Abuja, a list of the common drugs I might require in Neurosurgery for procurement. I know what drugs I need , they know what drugs my patients are likely to require, so hopefully we will get it right.
Comments and opinions please.
Biodun Ogungbo
Monday, 14 December 2009
Sunday, 13 December 2009
Friday, 13 November 2009
trauma care in abuja: a time to wake up
the management of trauma patients in abuja is appalling. there is a complete lack of understanding of the concepts of advanced trauma life support. even the tenets of basic life support are not applied in patient management. many trauma patients are simply not reviewed not treated and turned away, sent to the nearest big general hospital without proper management. and many die on the way in hearses otherwise called ambulances. they are really better called 'taxis'. some hospitals actually use taxis or even relatives cars to send patients between facilities. this is wholly not acceptable. we must work together to preserve life at every step.
what we need to do? we need to work together. its really simple. resuscitate the patient. sort out any problems with airway, breathing and blood pressure. put in an intravenous line or two and put up fluids. if hypotensive give a plasma expander. stop any immediate accessible bleeding. investigate in trauma as much as you can safely. get a skull x-ray, cervical x-ray and chest or long bone x-rays as necessary. get as much information as you can and then transfer. let the other hospital have as much information as possible so they know where to start from in continuing the care of the patient.
resuscitate: investigate: transfer. Simple
Saturday, 24 October 2009
On the issue of burr holes done by general surgeons
Since having some interaction with general surgeons who have on occasion had to manage patients with head injury in Abuja, I have come to realise that there is more to this than meets the eye.
Many of the surgical interventions are actually unnecessary and frankly dangerous with more harm than good being done. The interventions are often inadequate and increase the morbidity and mortality for the patient. I wont advocate for a stop to the performance of such procedures but I will insist that anyone hoping to perform such procedures must be properly informed, educated and taught how to do it before embarking on this. At least in Abuja. I cannot influence what happens elsewhere.
The key problem at first glance is 'wrong' diagnosis. It is imperative to relate the clinical history and the clinical examination to the imaging. All three: history, examination and imaging results must tally. The diagnosis must be correct. The importance of any imaging feature must be interpreted in the line of the patients clinical presentation and the condition. There have been patients in good clinical condition and those in extremis who have had burr hole performed unnecessarily. In those cases who were going to die anyway, it was a waste of time and resources, BUT in those who were good grade patients, it led to increase morbidity and eventual mortality. A real waste of life.
The problem I have seen in a few cases is the radiological diagnosis. The radiologists report what they see. They often fail to relate it to the clinical condition of the patient. Often in acute cases, the reporting radiologist was not actually there when the patient was being scanned and is reporting the scan hours later. Its not their job to then prescribe treatment or advice on such an issue.
Let me give you an example. Young woman with mild to moderate head injury.. gcs 12 to 13/15. Scan reported as showing an acute subdural hematoma. Surgeon decides to offer burr hole to remove subdural. Patient then had to be ventilated in ITU post operatively. Patient died of complications of treatment: surgical and anaesthetic. I review scan and note a thin film of subdural.... not surgical..... no need to have had a burr hole.... maybe patient may still be alive if left alone?? The radiologist did not inform about size of the clot and its significance just that there is a subdural clot. Surgeon did not relate size to clinical condition of the patient.
Another example. Young man with head injury..gcs 3/15 right from the start. Intubated for a scan which shows an acute subdural clot and temporal lobe contusions. Surgeon offers burr hole drainage of the subdural. Patient died in ITU days later. I review the scan and note a small film of subdural but more important significant lobar contusions. Patient may have benefited from a decompressive craniectomy and removal of the contusions if anything needed to be done. I actually would not have offered any intervention given the poor clinical state at presentation. Radiologist did not emphasise the small subdural and the more important contusions. Surgeon failed to appreciate what was really important in the clinical presentation and imaging.
May I finish this diatribe by saying categorically, that burr holes are for chronic subdural collections only. They cannot be used to treat an acute extradural hematoma, an acute subdural hematoma or an intracerebral hematoma especially in untrained hands.
The teaching of general surgeons will commence in Abuja in earnest working with these basic principles: Know the patient, read the scan, discuss with the radiologist and then ask advice of a neurosurgeon before making any attempts at a burr hole drainage. Do burr hole ONLY for a chronic subdural hematoma or perhaps for a brain abscess. Burr holes cannot treat an acute subdural or an extradural hematoma. Certainly not with a Ghajar guide.
Many of the surgical interventions are actually unnecessary and frankly dangerous with more harm than good being done. The interventions are often inadequate and increase the morbidity and mortality for the patient. I wont advocate for a stop to the performance of such procedures but I will insist that anyone hoping to perform such procedures must be properly informed, educated and taught how to do it before embarking on this. At least in Abuja. I cannot influence what happens elsewhere.
The key problem at first glance is 'wrong' diagnosis. It is imperative to relate the clinical history and the clinical examination to the imaging. All three: history, examination and imaging results must tally. The diagnosis must be correct. The importance of any imaging feature must be interpreted in the line of the patients clinical presentation and the condition. There have been patients in good clinical condition and those in extremis who have had burr hole performed unnecessarily. In those cases who were going to die anyway, it was a waste of time and resources, BUT in those who were good grade patients, it led to increase morbidity and eventual mortality. A real waste of life.
The problem I have seen in a few cases is the radiological diagnosis. The radiologists report what they see. They often fail to relate it to the clinical condition of the patient. Often in acute cases, the reporting radiologist was not actually there when the patient was being scanned and is reporting the scan hours later. Its not their job to then prescribe treatment or advice on such an issue.
Let me give you an example. Young woman with mild to moderate head injury.. gcs 12 to 13/15. Scan reported as showing an acute subdural hematoma. Surgeon decides to offer burr hole to remove subdural. Patient then had to be ventilated in ITU post operatively. Patient died of complications of treatment: surgical and anaesthetic. I review scan and note a thin film of subdural.... not surgical..... no need to have had a burr hole.... maybe patient may still be alive if left alone?? The radiologist did not inform about size of the clot and its significance just that there is a subdural clot. Surgeon did not relate size to clinical condition of the patient.
Another example. Young man with head injury..gcs 3/15 right from the start. Intubated for a scan which shows an acute subdural clot and temporal lobe contusions. Surgeon offers burr hole drainage of the subdural. Patient died in ITU days later. I review the scan and note a small film of subdural but more important significant lobar contusions. Patient may have benefited from a decompressive craniectomy and removal of the contusions if anything needed to be done. I actually would not have offered any intervention given the poor clinical state at presentation. Radiologist did not emphasise the small subdural and the more important contusions. Surgeon failed to appreciate what was really important in the clinical presentation and imaging.
May I finish this diatribe by saying categorically, that burr holes are for chronic subdural collections only. They cannot be used to treat an acute extradural hematoma, an acute subdural hematoma or an intracerebral hematoma especially in untrained hands.
The teaching of general surgeons will commence in Abuja in earnest working with these basic principles: Know the patient, read the scan, discuss with the radiologist and then ask advice of a neurosurgeon before making any attempts at a burr hole drainage. Do burr hole ONLY for a chronic subdural hematoma or perhaps for a brain abscess. Burr holes cannot treat an acute subdural or an extradural hematoma. Certainly not with a Ghajar guide.
Sunday, 4 October 2009
poverty is a big issue
The one thing that is creating a problem at the moment is poverty and the inability of some patients to afford the costs of investigations and treatment. Radiology especially CT and MRI scans are expensive and surgical treatment is also very expensive for many. Real patients with real problems and significant risks of increased morbidity and mortality are seen without ability to pay for treatment. It saddens.
What can we do and how can one help? How many free treatments can one afford to give out before you stop being able to help even anyone? What ways can we device to help? Because we do have to do something. And fast.
First, we perhaps should encourage the development of charities, the involvement of charities in care and establish specific foundations and endowments to fund some investigations and operations. We should also perhaps encourage and set up support groups for conditions such as stroke, tumours and trauma. The charities and groups could seriously help to inform, educate and generate much needed funds for particular projects.
Involving well meaning members of the public in specific projects for hospital development and endowments is important and should be actively encouraged. All hands need to be on deck especially in preventive measures to reduce the incidence of many conditions. We need to actively educate doctors and nurses and then the general public on ways to prevent some preventable diseases.
What can we do and how can one help? How many free treatments can one afford to give out before you stop being able to help even anyone? What ways can we device to help? Because we do have to do something. And fast.
First, we perhaps should encourage the development of charities, the involvement of charities in care and establish specific foundations and endowments to fund some investigations and operations. We should also perhaps encourage and set up support groups for conditions such as stroke, tumours and trauma. The charities and groups could seriously help to inform, educate and generate much needed funds for particular projects.
Involving well meaning members of the public in specific projects for hospital development and endowments is important and should be actively encouraged. All hands need to be on deck especially in preventive measures to reduce the incidence of many conditions. We need to actively educate doctors and nurses and then the general public on ways to prevent some preventable diseases.
Wednesday, 9 September 2009
What do you think? Can we find sponsors to buy these?
This is open to discussion, thoughts and opinions.
Neurosurgical Equipment Presented by the World Federation of Neurosurgical Societies' Foundation
Neurosurgical Equipment Presented by the World Federation of Neurosurgical Societies' Foundation
With this Basic Set of Neurosurgical Instruments, WFNS, together with Aesculap, has initiated a worldwide project. It provides an attractive platform for sponsoring adequate neurosurgical instruments in countries that are in great need of such equipment.
This set of instruments can be used for the most common neurosurgical procedures. We hope to find numerous sponsors who will purchase this Basic Set of Neurosurgical Instruments and thereby support physicians in economically challenged countries who are devoted to neurosurgery and neurosurgical patients.
Professor Temitayo Shokunbi (Ibadan) has done a lot in getting many of these basic sets for different hospitals in Nigeria. It is important for all neurosurgeons to actively find sponsors and identify hospitals in which these basic sets would be of real advantage and save lives.
Along with the Basic Set of Neurosurgical Instruments, the WFNS Foundation also provides basic neurosurgical training for general surgeons who must render such services in developing countries. I think we should also start training general surgeons in basic neurosurgery; they already attempt procedures especially simple burrholes and just require some hands on experience to be better; second, teaching the young surgeons may stimulate some to take up neurosurgical training.
Biodun
Tuesday, 8 September 2009
I was over at IMPLANTS INTERNATIONAL office and factory this afternoon. This is a company based in Thornaby, on Teeside, in the United Kingdom, manufacturing implants related to trauma, orthopedics and spine. The range of products is wide and the expertise/ quality of the products cmparable to any other big players in the field. Some of the products especially related to spine and neurosurgery are as shown: anterior cervical plates, artificial cervical discs, cages and lateral mass screws. Further, the company manufactures pedicle screw fixation screws and implants for most joints in the body.
I was well impressed and pleasantly surprised by what I saw.
The key information is that the company can support and supply all we might need to manage our patients with degenerative and traumatic spinal lesions. The company has a wide range of products from cervical to sacrum and prosthesis for joint replacements.
Its exciting times ahead with the possibility and the ablity to offer our patients comprehensive and affordable surgery obviating the need to travel to India, South Africa or even Britain for quality care. We can now do all the operations locally and increase our acceptance by a sceptical Nigerian public.
I am particularly looking forward to working with this company and Drs, Opadele, Nasiru and Adeolu in providing a comprehensive spine service in Abuja.
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