I started interviewing patients yesterday. This may not seem like much, but it indicates that my very small project addressing perceptions of lumbar puncture (aka spinal tap aka LP) in Kampala, has begun! This is the project I originally came to work on in January 2009. Doing the right thing by applying to the Institutional Review Boards (research ethics committees, aka IRB) kept this project in limbo for a year and a half, but I now have approval from the University of Minnesota, the Infectious Diseases Institute, Makerere University, Mulago Hospital, and the Uganda National Council for Science and Technology. With a few letters and a nice research ID card, myself, two other medical students who are helping for a couple weeks , and a hired interpreter, went over to Ward 4A to start collecting data and interviewing patients and their family members about meningitis, LPs, assessing their medical knowledge (or lack of) and decision-making processes. We are also going to measure how long patients are in the hospital before (or if) they get a) an LP b) treatment c) a definitive diagnosis, and how they fare, whether or not they live and how long they were in the hospital. Ultimately, we want to use the information from the interviews to develop educational materials for patients and their families explaining meningitis and the spinal tap procedure and also to educate physicians as to why patients refuse and what they can do to prevent it from happening. Yay!
This project, aptly named “Perceptions of Lumbar Puncture for the Diagnosis and Treatment of Meningitis in Kampala, Uganda,” came to fruition just as so many other projects are also speeding up. I am currently collecting data from Mulago Hospital Records and the Microbiology department to see trends of a certain kind of fungal meningitis seen mostly in AIDS patients, Cryptococcal Meningitis (CM), over the past ten years. The deal is, drug therapy for AIDS became widely available in Uganda in 2004 and so we want to see whether the rates of CM have decreased since then because theoretically, more patients would have been on treatment and less would be sick. But on the Infectious Disease Ward at Mulago, we see a ton of CM and so we are checking out this theory. Another future project based on this would be that once we get the rates (by month and year), we could compare it to weather data and check the seasonal variation of the disease.
The Infectious Diseases Institute now has a low-tech kind of EMR (Electronic Medical Record), and a few databases tracking patient data. They want to cross-check these databases – specifically the pharmacy, clinic, and laboratory data – and find the real rates of certain infections that are common. A friend of mine has done this for Tuberculosis, and I will do this for CM. The public health courses I am taking right now through the University of Minnesota – Introduction to Epidemiology and Biostatistics – have definitely given me a better sense of what I am looking for and how to go about designing these new projects.
The big clinical trial that I am preparing for (the COAT trial) is chugging along. Last week we submitted many documents to be transformed into database-friendly forms to be barcoded and uploadable. There is this new program through the National Institutes of Health called DataFax, that scans all of our completed patient documents and automatically enters the info into a database. It may sound boring, but is going to save us a lot of time and prevent a lot of missing documentation. We also find out in April whether the trial will be funded and will have a better idea of when it could start.
Grant recently finished developing a bunch of documents for the neurocognitive assessment project that will be starting in March or April. Although we work together in the same office, we don’ t usually “work” on the same things. But his project will share patients with the COAT trial so we have been working together a bit to make sure it all flows together. Sometimes this can cause tense moments, as neither of us like being told what to do, and both of us are always right.
Our evenings have been pretty busy lately, but not like they normally are. We are making a concerted effort not to go out during the week. This isn’t too tough considering I have basketball practice two nights a week and my online public health courses take up the rest of the nights. And Grant makes it easy for me to get work done because he is busy playing poker, either at the casino or online. But we still manage to keep up with the Kampala crowd and accommodate visitors from all over. There is always a birthday celebration or going away party, rugby to watch and pork joints to patronize, and now that we have been here awhile we have house-warmings and baby showers to attend!
No comments:
Post a Comment