RESUMEN
BACKGROUND: Undetected and unaddressed anxiety negatively affects performance in clinical learning environments. AIM: The aim was to investigate the anxiety provoking situations in clinical dental care delivery among students of preclinical and clinical years and house officers. SUBJECTS AND METHODS: A 38-item modified Moss and McManus clinical anxiety questionnaire, general health questionnaire-12 (GHQ-12) and the Zung self-rating anxiety scale were the data collection tools. RESULTS: Of the 84 recruited, 79 completed the study giving 94.0% (79/84) response rate. The median age of the participants was 25 years with 50.6% (40/79) being 20-25 years. Gender distribution revealed that males constituted 60.8% (48/79) of the participants. House officers constituted 29.1% (23/79), clinical students 36.7% (29/79), and preclinical students 34.2 (27/79) of the participants. The top anxiety provoking situations using the modified Moss and McManus clinical anxiety questionnaire were extracting wrong tooth 3.24 (1.06), inability to pass examination 3.32 (1.01), achieving examination requirement 3.19 (1.01), fracturing a tooth 3.08 (0.98) and accidental pulp exposure 2.96 (1.04). Getting diagnosis wrong, help in faint episode, not developing radiograph properly and coping with children were the anxiety provoking situations that showed statistically significant difference in the 3 studied training stages of dentistry. Bonferroni post-hoc analysis significant difference was in the preclinical and clinical students' pair for getting diagnosis wrong, not developing radiograph properly and coping with children while house officers/clinical students and house officers/preclinical students' pairs were for help in faint episode. Overall, 2.5% (2/79) had severe, 69.6% (55/79) moderate, 26.6% (21/79) mild clinical anxiety while 1 (1.3%) of the participants expressed no clinical anxiety. CONCLUSION: Data from this study revealed that the clinical anxiety of moderate severity was prevalent among the studied dental healthcare students. The anxiety-provoking situations were also found to be majorly similar in preclinical, clinical and post-graduation clinical stages of dental training stages in Nigeria.
RESUMEN
BACKGROUND: Missed appointments are common in psychiatric practice. It compromises quality of care, results in poor treatment outcomes and drains financial resources. In Nigeria, where mental health services are poorly organized, missed appointments and its resultant consequences may be burdensome. AIM: This study sought to determine the prevalence and factors (sociodemographic and clinical) associated with missed clinic appointments at a regional psychiatric hospital. SUBJECTS AND METHODS: A study on a cohort of patients attending the Outpatient Clinics for the first time between June and September 2011 was conducted. We interviewed each participant at their first presentation then tracked through case records to determine adherence to scheduled first clinic appointments after 4 weeks. A questionnaire was used in eliciting sociodemographic characteristics, clinical variables, and patient/caregiver satisfaction with treatment. Descriptive statistics were used to summarize the data and inferential statistics to test associations using the SPSS 16. RESULTS: Three hundred and ten patients were recruited over the study period. The prevalence of missed first appointment was 32.6% (101/310). Participants who were single (P = 0.04), living alone (P < 0.01) or aggressive (P < 0.01) were more likely to miss their first appointment. However, having received previous treatment for a psychiatric illness (P = 0.02) and having comorbidity (P = 0.05) was associated with less likelihood to miss a first appointment. A binary logistic regression analysis showed that having received previous treatment independently predicted a less likelihood to miss first appointment (P = 0.03). CONCLUSION: Quite a proportion (32.6%) of patients attending outpatient clinics miss scheduled clinic appointments. Receiving previous psychiatric care predicted adherence to scheduled appointment.
RESUMEN
BACKGROUND: High dose antipsychotic prescribing is common in psychiatric care, despite a lack of its benefit from research evidence. While several studies have explored the prevalence and factors associated with high dose antipsychotic prescribing, no such report has emanated from a developing country like Nigeria. AIM: The aims of this study were to determine the prevalence of high dose prescribing among in-patients at a tertiary psychiatric hospital and to determine the pattern of antipsychotic drugs prescribed. MATERIALS AND METHODS: An audit of in-patients at a regional tertiary psychiatric facility was carried out. We examined case notes and conducted oral interviews where necessary, on all patients receiving antipsychotics using a proforma designed for the study. RESULTS: The prevalence of high dose prescribing was 38% (65/171) using a prescribed daily dose/defined daily dose ratio of 1.5. The rate of antipsychotic polypharmacy was 7% (12/171). The atypical antipsychotic, olanzapine was the most commonly prescribed antipsychotic in monotherapy. Predictors of high dose prescribing were diagnoses (P = 0.04), polypharmacy (P = 0.04), a history of previous in-patient care (P = 0.02), and use of anticholinergic drugs (P = 0.01). CONCLUSIONS: High dose prescribing was common among in-patients audited. Further studies are needed to examine factors that promote "high dose" prescribing.