LETTERS TO EDITOR
Assessment of attitude in KAP study: A comment on: A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria Sir, This is in reference to the article, ‘A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria’ published in Niger Med J 2014;55:106-10.1 The authors have worked well in direction of assessing attitude and knowledge of doctors in three teaching hospitals in Nigeria to CP. However, I have a few concerns regarding the questions used to assess knowledge, attitude and practice component in this KAP Study.
level of consultants. Those who had special training on pain management will have further edge on answering the knowledge questions and will be better in practising the chronic pain management. Hence, clubbing such variegated participants together for arriving at mean scores does not seem justifiable. Kanica Kaushal Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Address for correspondence: Dr. Kanica Kaushal, Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh, India. E-mail: [email protected]
REFERENCES 1. 2.
Sanya EO, Kolo PM, Makusidi MA. A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria. Niger Med J 2014;55:106-10. KAP Survey Model [Internet]. Available from: www. medecinsdumonde.org/pdf. [Last accessed on 2014 Apr 3].
Access this article online Quick Response Code:
www.nigeriamedj.com
Knowledge is one’s capacity for imagining and one’s way of perceiving.2 Attitude is an intermediate variable between the situation and the response to this situation. It helps explain that among the possible practices for a subject submitted to a stimulus, the subject adopts one practice and not another. Practices or behaviours are the observable actions of an individual in response to a stimulus.2 For example in Table 2, the authors have mentioned the questions as, ‘Gender affects pain perception’, ‘Appropriate for patients to request for additional pain medication’ and ‘Majority of chronic pains are undertreated in Nigeria’ to assess the attitude of physicians attitude towards chronic pain. These questions actually tell us about the knowledge of physicians and not their attitude.1 Similarly in Table 3, asking about ‘Goal of chronic pain management’ give us the attitude parameter of the physicians and not the practice component as given by the authors.1 Furthermore, 58% of participants were resident doctors, 36.4% medical officers and 8.64% consultants, and only few (23.3%) had received formal training on pain. However, the point of concern is that the level of knowledge will vary from the resident doctors or medical officers to the
Website:
DOI: 10.4103/0300-1652.140393
Percutaneous closure of atrial septal defect and persistent fossa ovalis: Nuances with implications The management of atrial septal defect (ASD) via percutaneous closure has been with us for about four decades with some successive modifications in order to achieve perfect closure and improve patient outcome. Therefore, there is no ambiguity whatsoever on surgical versus percutaneous procedures.1 Importantly, not all ASD is treated by percutaneous closure technique, and not even the secundum septal defect whose anatomy is properly adapted for percutaneous closure is universally treated with such (percutaneous occlusion) technique. Thus in
Nigerian Medical Journal | Vol. 55 | Issue 5 | September-October | 2014
Page | 441
Letters to Editor
describing the treatment of ASD, it is imperative to clearly state what treatment option is adopted; either medical approach (of which percutaneous closure is included) or surgical. And as percutaneous therapies are gradually replacing surgical repair of ASD (secundum defect), proper preoperative assessment of the patient and the anatomy by using echocardiography cannot be overemphasised.2 Complications resulting from the use of the percutaneous closure ranges from minor to life-threatening and potentially fatal as such long-term follow-up is necessary to completely estimate the safety and efficacy of the devices.2,3 The knowledge of the potential complications of device closure and their predictors will help in reducing their future occurrence.3 In some of the defects like sinus venosus defect, the proper application of surgical option is associated with low morbidity and mortality. 4 However, there is the requirement of cardiopulmonary bypass carrying some risk and complications like sinus node dysfunction and venous obstruction.4 In conclusion, neither percutaneous nor surgical procedures are used exclusively in all settings. The choice of procedure rests on proper patient assessment and determination of the type of lesion present is important as this would ensure optimal outcome. Kelechi E. Okonta1,2, Emmanuel O.Ocheli1, Francis U. Iregbu3
Address for correspondence: Dr. Kelechi E.Okonta, Department of Surgery, Division of Cardiothoracic Surgery, University of Port Teaching, Port Harcourt, Nigeria. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
Adiele DK, Chinawa JM, Arodiwe IO, Gouthami V, Murthy KS, Eze JC, et al. Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review. Niger Med J 2014;55:126-9. Yared K, Baggish AL, Solis J, Durst R, Passeri JJ, Palacios IF, et al. Echocardiographic assessment of percutaneous patent foramen ovale and atrial septal defect closure complications. Circ Cardiovasc Imaging 2009;2:141-9. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the management of adults with Congenital Heart Disease: Executive Summary: A report of the American College of Cardiology/American Heart Association task force on Practice Guidelines. (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 2008;118:2395-45. Okonta KE, Sanusi M. Superior sinus venosus atrial septal defect: Overview of surgical options. Open J Thorac Surg 2013;3:114-22. Access this article online Quick Response Code:
Department of Surgery, Division of Cardiothoracic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, 2 Department of Surgery, Division of Cardiothoracic Surgery, 3 Department of Paediatrics, Division of Paediatric Cardiology, Federal Medical Centre, Owerri, Nigeria
Website: www.nigeriamedj.com
1
DOI: 10.4103/0300-1652.140395
Announcement
Android App A free application to browse and search the journal’s content is now available for Android based mobiles and devices. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is compatible with all the versions of Android. The application can be downloaded from https://market.android.com/details?id=comm.app.medknow. For suggestions and comments do write back to us.
Page | 442
Nigerian Medical Journal | Vol. 55 | Issue 5 | September-October | 2014
Copyright of Nigerian Medical Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Assessment of attitude in KAP study: A comment on: A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria Sir, This is in reference to the article, ‘A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria’ published in Niger Med J 2014;55:106-10.1 The authors have worked well in direction of assessing attitude and knowledge of doctors in three teaching hospitals in Nigeria to CP. However, I have a few concerns regarding the questions used to assess knowledge, attitude and practice component in this KAP Study.
level of consultants. Those who had special training on pain management will have further edge on answering the knowledge questions and will be better in practising the chronic pain management. Hence, clubbing such variegated participants together for arriving at mean scores does not seem justifiable. Kanica Kaushal Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Address for correspondence: Dr. Kanica Kaushal, Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh, India. E-mail: [email protected]
REFERENCES 1. 2.
Sanya EO, Kolo PM, Makusidi MA. A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria. Niger Med J 2014;55:106-10. KAP Survey Model [Internet]. Available from: www. medecinsdumonde.org/pdf. [Last accessed on 2014 Apr 3].
Access this article online Quick Response Code:
www.nigeriamedj.com
Knowledge is one’s capacity for imagining and one’s way of perceiving.2 Attitude is an intermediate variable between the situation and the response to this situation. It helps explain that among the possible practices for a subject submitted to a stimulus, the subject adopts one practice and not another. Practices or behaviours are the observable actions of an individual in response to a stimulus.2 For example in Table 2, the authors have mentioned the questions as, ‘Gender affects pain perception’, ‘Appropriate for patients to request for additional pain medication’ and ‘Majority of chronic pains are undertreated in Nigeria’ to assess the attitude of physicians attitude towards chronic pain. These questions actually tell us about the knowledge of physicians and not their attitude.1 Similarly in Table 3, asking about ‘Goal of chronic pain management’ give us the attitude parameter of the physicians and not the practice component as given by the authors.1 Furthermore, 58% of participants were resident doctors, 36.4% medical officers and 8.64% consultants, and only few (23.3%) had received formal training on pain. However, the point of concern is that the level of knowledge will vary from the resident doctors or medical officers to the
Website:
DOI: 10.4103/0300-1652.140393
Percutaneous closure of atrial septal defect and persistent fossa ovalis: Nuances with implications The management of atrial septal defect (ASD) via percutaneous closure has been with us for about four decades with some successive modifications in order to achieve perfect closure and improve patient outcome. Therefore, there is no ambiguity whatsoever on surgical versus percutaneous procedures.1 Importantly, not all ASD is treated by percutaneous closure technique, and not even the secundum septal defect whose anatomy is properly adapted for percutaneous closure is universally treated with such (percutaneous occlusion) technique. Thus in
Nigerian Medical Journal | Vol. 55 | Issue 5 | September-October | 2014
Page | 441
Letters to Editor
describing the treatment of ASD, it is imperative to clearly state what treatment option is adopted; either medical approach (of which percutaneous closure is included) or surgical. And as percutaneous therapies are gradually replacing surgical repair of ASD (secundum defect), proper preoperative assessment of the patient and the anatomy by using echocardiography cannot be overemphasised.2 Complications resulting from the use of the percutaneous closure ranges from minor to life-threatening and potentially fatal as such long-term follow-up is necessary to completely estimate the safety and efficacy of the devices.2,3 The knowledge of the potential complications of device closure and their predictors will help in reducing their future occurrence.3 In some of the defects like sinus venosus defect, the proper application of surgical option is associated with low morbidity and mortality. 4 However, there is the requirement of cardiopulmonary bypass carrying some risk and complications like sinus node dysfunction and venous obstruction.4 In conclusion, neither percutaneous nor surgical procedures are used exclusively in all settings. The choice of procedure rests on proper patient assessment and determination of the type of lesion present is important as this would ensure optimal outcome. Kelechi E. Okonta1,2, Emmanuel O.Ocheli1, Francis U. Iregbu3
Address for correspondence: Dr. Kelechi E.Okonta, Department of Surgery, Division of Cardiothoracic Surgery, University of Port Teaching, Port Harcourt, Nigeria. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
Adiele DK, Chinawa JM, Arodiwe IO, Gouthami V, Murthy KS, Eze JC, et al. Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review. Niger Med J 2014;55:126-9. Yared K, Baggish AL, Solis J, Durst R, Passeri JJ, Palacios IF, et al. Echocardiographic assessment of percutaneous patent foramen ovale and atrial septal defect closure complications. Circ Cardiovasc Imaging 2009;2:141-9. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the management of adults with Congenital Heart Disease: Executive Summary: A report of the American College of Cardiology/American Heart Association task force on Practice Guidelines. (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 2008;118:2395-45. Okonta KE, Sanusi M. Superior sinus venosus atrial septal defect: Overview of surgical options. Open J Thorac Surg 2013;3:114-22. Access this article online Quick Response Code:
Department of Surgery, Division of Cardiothoracic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, 2 Department of Surgery, Division of Cardiothoracic Surgery, 3 Department of Paediatrics, Division of Paediatric Cardiology, Federal Medical Centre, Owerri, Nigeria
Website: www.nigeriamedj.com
1
DOI: 10.4103/0300-1652.140395
Announcement
Android App A free application to browse and search the journal’s content is now available for Android based mobiles and devices. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is compatible with all the versions of Android. The application can be downloaded from https://market.android.com/details?id=comm.app.medknow. For suggestions and comments do write back to us.
Page | 442
Nigerian Medical Journal | Vol. 55 | Issue 5 | September-October | 2014
Copyright of Nigerian Medical Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
