Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria.

OBJECTIVES: The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria. METHODS: A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted. RESULTS: Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p < 0.05). CONCLUSIONS: Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.     

Evaluation of Neurofeedback Training in the Treatment of Parkinson's Disease: A Pilot Study

We assess the effects of EEG biofeedback training on levodopa-induced dyskinesia (LID) in patients with Parkinson's disease (PD) using a sham feedback controlled study design. Nine subjects were randomized into either a treatment group or control group and underwent 24 sessions of either active feedback training or sham feedback. The training protocol aimed at increasing 8–15 Hz activity while inhibiting excess 4–8 Hz and 23–34 Hz activity at the C3-C4 derivation. There were no statistically significant differences baseline to post-active neurofeedback training as compared to sham feedback training in primary outcome measures assessing change in dyskinesia severity, nor in secondary outcome measures assessing change in clinical features of PD. Nonsignificant trends were observed in subjects’ PD home diaries indicating a decrease in the severity of motor fluctuations. Baseline to post-training comparisons of secondary outcome measures in quantitative EEG analysis showed significant interaction effects within and between frontal and posterior regions, accompanied by decreases in 25–30 Hz (high beta) relative power, cross spectral power and phase resets per second activity, and significant increases in 8–12 Hz (alpha) relative power, cross spectral power, and coherence activity. These results indicate that EEG biofeedback training can affect the spectral EEG topography of individuals with PD and LID and that training to increase 8–15 Hz activity and decrease 23–34 Hz activity may have been associated with a nonsignificant decrease in dyskinesia severity and an improved sense of well-being.     

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria

Background

Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care.

Objectives

To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome.

Methods

A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011.

Results

Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%).

Conclusions

The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice.     

Simultaneous Bilateral Reconstruction of the Axilla with Posterior Arm Flap in Recurrent Hidradenitis Suppurativa

Introduction  Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods  Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results  A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had settled well in all patients, causing no significant morbidity. Conclusion  Radical excision of axillary hidradenitis must be considered early on presentation. After wide excision, simultaneous bilateral reconstruction with posterior arm flap is a simple and reliable technique with an excellent patient-reported outcome.     

Conductive Polymer for Elevated Temperature Applications Based on Sodium Sulfosuccinate Coupled Poly(ethylene glycol)s

Sodium sulfosuccinate coupled poly(ethylene glycol) (PEG) (S–PEG–SS) conductive polymers for hot melt adhesives are synthesized from PEG, maleic anhydride, and sodium hydrogen sulphite using a one‐pot three‐step reaction. Infrared spectroscopy and ¹H NMR spectroscopy are used to characterize the molecular structure and to determine the yield of esterification. S–PEG150–SS has the highest yield of esterification, whereas S–PEG2000–SS provides the lowest yield of esterification. Gel permeation chromatography and shear viscosity measurements are applied to characterize multiple condensation products and to describe the viscoelastic properties. The results reveal that the viscoelastic properties and the conductivity depend on molar mass of esterified PEG, on the degree of condensation, and on the concentration of ions.     

Clinical skills: an evidence-based approach to preoperative fasting

The procedure of fasting from midnight until induction of anaesthesia arose from concern that patients could regurgitate during induction of general anaesthesia when the pharyngeal and laryngeal refluxes are depressed. In this situation, the contents of the stomach do not come out of the patient's mouth, but go up into the oesophagus and trachea and are drawn back down into the lungs. This can damage the lungs, causing chemical inflammation, a condition referred to as aspiration pneumonitis or Mendelson's syndrome, a serious although rare complication of general anaesthesia. For many years, preoperative fasting has been a traditional practice for reducing this risk, but patients are being fasted for considerably longer than the evidence indicates is necessary. This article considers the current evidence for preoperative fasting times and examines why patients are still being subjected to prolonged preoperative fasting. Based on the evidence presented, recommendations are made regarding this aspect of care.