EVIDENCE BASE NURSING I. II.

Clinical Question Citation Spectrum of musculo-skeletal disorder in sickle cell disease

Rufai A Balogun , Dike C Obalum* , Suleiman O Giwa , Thomas O Adekoya-Cole , Chidiebere N Ogo ,George O Enweluzo Balogun et al. Journal of Orthopaedic Surgery and Research 2010, 5:2 http://www.josr-online.com/content/5/1/2

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Study Characteristics y Patients included

In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a oneyear period

Interventions compared
Sickle cell anemia (SCA) is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculoskeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study.

Outcomes monitored
The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting hemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculoskeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and a vascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%)of sites affected. Lesions involving the spine were rare 11 (0.

Does the study focus on a significant problem in clinical practice?

Yes, the study focuses on a significant problem in musculo-skeletal and because this work aims to prospectively document the musculo-skeletal disease burden among SCA patients.

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Methodology/ design it was conducted over a 12-month period between June 2000 and May 2001 at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. LUTH is one of the foremost tertiary hospitals in Nigeria. y Methods used The focus groups in this study are the patients with SCA which is common disease in Nigeria y Design it was y Setting The study was conducted in Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. y Data sources We gathered the data on the internet specifically on EBSCOHOST.COM y Subject selection Inclusion criteria They included SCA patients only Exclusion criteria They excluded non SCA patients. y Has the original study been replicated? There is no report that the study had been replicated. y What were the risks and benefits of the nursing action or intervention tested in the study? Risks: The patient will not experience any risks in conducting this research Benefits: The study will help SCA patients to their know their illness Results of the study
The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculoskeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years.

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Authors conclusion or recommendation

This study has shown that osteomyelitis remains the most common musculo-skeletal presentation of SCA and occurs predominantly in patients below the age of 10 years. The predominant presentation in adolescents is AVN, with majority of them presenting in the late stage. Multiple presentations are seen in all groups and this calls for a detailed assessment of SCA patients by health care professionals in order to avoid cases of missed diagnosis.

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Applicability y Does the study provide a direct enough answer to your clinical question in terms of type of patients intervention and outcome? Yes. It provides the direct enough answer to clinical question because it providing adequate knowledge about Sickle cell disease patient to help them know their illness and how to to do about it y Is it feasible to carry out the nursing action in the real world? Yes, It is feasible to carry out because it is affordable, available, and health promotive intervention to the client Reviewers Conclusion y Safety o y Acceptability y Effectiveness and Appropriateness The datas and information from the study are well accepted in the medical field since it is actual and existing.

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