Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya.
Background. Psychomotor domain training requires repetitive exposure in order to develop proficiency in skills. This depends on many training factors in any training institution. Objective. This study sought to look at the operative exposure of surgical trainees in a tertiary hospital in a developing country. Design and Setting. This was a six-month retrospective study performed in one surgical firm at Kenyatta National Hospital. Patients and Methods. The files of all patients admitted to the unit at that time were retrieved. The demographics, diagnosis at admission, need for surgery, and cadre of operating surgeon among others were recorded. Scientific Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results. The study cohort was 402 patients of the 757 patients admitted in the study period. The average age was 36.7 years, a female to male ratio of 1 : 2.5. The majority (69.7%) of patients required surgery. Trauma was the most common reason for admission (44.5%). Year 2 residents received the most clinical exposure. Consultant was available in only 34.5% of the cases. Conclusion. The junior residents performed the vast majority of procedures with an unsatisfactory amount of supervision from the senior residents and faculty.
The main aim of the study was to evaluate the incidence of redisplacement of distal radial
fractures in children aged between 6 and 15 years and factors contributing to it at the
Kenyatta National Hospital.
'If This was a prospective study carried over eight months from the 22nd June 2005 to 28th
February 2006.0ne hundred patients were recruited. The fracture was reduced by the
plaster technicians, the usual personnel who reduce these fractures at casualty; reduction
was acceptable if the dorsal or volar angulation was less than 20°. The patients were then
followed up in the fracture clinic in the next two weeks with another x-ray. It was
determined at this point whether there was presence of healing or redisplacement.
Redisplacement was regarded as the presence of dorsal volar angulation of greater than
20° or translation greater than 50%. The end point of the study was at week four, x-ray of
the distal forearm either showed evidence of redisplacement or evidence of healing at
week four in other remaining patients. The data was collected and entered into statistical
package for social sciences (SPSS) 12.0 version.
It was analyzed using odds ratio, Fisher's exact test and Chi-square test where
appropriate. The difference within the variables was taken to be significance if the p
value was less than 0.05.
One patient had fracture of both distal radial bones making the total number of fractures
to be 101. Thirty-seven of which were female and thirty four sustained their fractures as a
result of involvement in games. Ninety two fractures involved the metaphysis and nine
were in the distal third of the radial diaphysis, sixty five were complete fractures while
thirty two were torus and only four were greenstick fractures. Fifty nine were angulated
(fifty eight dorsal and one volar) and forty two were non-angulated. There were fifty nine
displacements, (fifty six dorsal, one volar and two bayonet apposition) and forty two nondisplaced
fractures. There were fifty one fractures with no translation of one fragment on
the other, thirty five fractures having less than 50% translation and fifteen having greater
than 50% translation. Fifty four fractures were judged to be as a result of bending forces
and fifteen as a result of shear forces and thirty two as a result of compression forces.
Ninety nine patients got below elbow cast while only one had above elbow. Twenty two
patients were given analgesics/sedation at reduction while seventy eight had the reduction
under no analgesia! sedation.
At week two nine (seven patients did not turn up and two did not have check x- rays)
patients were not accounted for; and at week four another nine patients (five did not turn
up and four did not have check X rays) were not accounted for. At week two, thirteen
fractures redisplaced and were remanipulated, and at week four two of the thirteen
remanipulated at week two maintained their reduction but four other fractures which had
not redisplaced at week two redisplaced making them fifteen all of whom were admitted
for operative reduction.
In consideration of the whole population seen with isolated distal radial fractures, the
incidence of redisplacement would be 14.1% at week two and 18.1 % at week four, but
considered as a percentage to the complete and greenstick (which are the fractures at risk
of red isplacement) it would be 20.3% at week two and 21.9% at week four. The
determinants of redisplacement were; angulation with a p value of 0.021, translation with
a p value of 0.009 , completeness of fracture with a p value of 0.004, displacement with a
p value of 0.006 and imperfect reduction with p value of 0.003 .
The incidence of redisplacement of isolated distal fracture in children 6-15 years as seen
in this study is comparable to international figures. The factors contributing to
redisplacement are completeness of the fracture, initial displacement, translation and
imperfect reduction. These factors constitute risk factors to redisplacement of the
The clinical outcome of thyroidectomy may be influenced by among other things, the experience of the surgeon performing the procedure. Furthermore, auditing of any surgical procedure helps in monitoring the safety of the procedure in the hands of the operator. Objective This study is an audit of outcome of thyroidectomy performed by the author within the first 18 months of qualification from a local residency program. It aims to record the outcomes as baseline to facilitate future personal and institutional trends of thyroid disease, prevalent in the area. Setting Kapenguria District hospital in Kenya. The author was posted to this facility immediately after completion of surgical residency at the University of Nairobi. Design This was a retrospective audit from April 2007 to September 2008 Patients The patients who underwent thyroidectomy by the author from April 2007 to September 2008. The period was divided into three separate six month blocks of time (A-April to September 2007, B-October 2007 to March 2009, and C- April to September 2008. Main outcome measures Complications and length of stay. Results Thirty nine patients underwent thyroidectomy during this period. The most common type of goiter was multinodular goiter (69.2%, 27) while the most common type of surgery was total thyroidectomy (35.9%, 14). The number of days in hospital did not differ across the periods- 1.92 for period A, 1.75 for B and 1.07 for C. Two complications occurred during period A and were associated with total thyroidectomy Conclusion Subtotal and total thyroidectomy can be safely performed by general surgeons qualifying from our local training institutions. Institutional audits are important to document future improvements in outcomes.
Enteric fever is endemic in developing countries and frequently complicates with ileal perforation. Surgical intervention for the perforation is the usual treatment but attendant rate of postoperative complications high. It is unclear what the spec- trum of enteric fever perforations is in rural hospital practice in Kenya, where the diagnosis most often in intraoperative. To describe the surgical experience of typhoid perforations at a rural district hospital in Kenya. This was a retrospective chart review of patients who underwent laparotomies for peritonitis at the Kapenguria District Hospital in Kenya between April 2007 and October 2009. Data abstracted from patient files included demographics, presenting symptom, duration of symptoms, investigations (Widal and/or stool culture), operative management, complications, length of stay, and death. Widal test was indicative when titer was 1:160 for “O” antigen or above. Antimesenteric longitudinal perforation was assumed to be a complication of enteric fever. The data were analyzed using SPSS version 16.0.The results are presented in frequency tables, bar charts and pie charts. Of the 50 files retrieved with diagnosis of peritonitis, 21(42%) were found at operation to have had ileal perforations. Of these 15(71.5%) had resection and primary anastomosis, 2(9.5%) had refreshening and anastomosis (simple anastomosis) and 4 (19%) had ileostomy. Male to female ratio was 4:1, majority were aged 6-15 years (38.1%). Wound infection was 8(38.1%), enterocutaneous fistulae were 7(33.3%), while 7(33.3%) required second laparotomy and 4(19%) were referred due to complications which could not be managed at this level. Mortality was 3(14.3%) and average length of stay was 17days. Morbidity and mortality arising from typhoid ileal perforation is high in this environment making it a major challenge in a resource poor environment. Prevention by use of protocols is highly recommended