Perception of care by cancer patients attending outpatient clinics in Trinidad and Tobago

OBJECTIVE: To analyze perceptions of the care by cancer patients towards improved oncology service delivery at outpatient clinics. DESIGN AND METHODS: This cross-sectional study collected and analyzed data on perception of care using a self-administered questionnaire from a convenience sample of cancer patients attending 6 public and private hospitals between June and December 2013 in Trinidad and Tobago. RESULTS: Over a third of the outpatients (720/2018), including 30 children participated. M:F was 1:2.1. Most (91%) were >40 years old with peak age between 61-70 years. More than one half waited >1 month to seek medical attention and one fifth started treatment >3 months after diagnosis. About 75% rated their overall care as very good and attributed this to the warm and friendly staff, and 90% would recommend the institution to others. Respondents complained about long waiting times, late receipt of blood results, delayed treatment because of equipment breakdown and no drugs, being seen by a different doctor at each visit and cramped waiting room space. CONCLUSION: The authorities should address the complaints of respondents and maintain the friendliness and warmth of the staff. A public awareness communication strategy should be implemented to promote early detection of cancer and early referral for specialist medical attention.

A study of pharmacist intervention in patient care at institutional and community pharmacies [abstract]

The objectives of the study are: (1) To demonstrate the various types of pharmacist therapuetic interventions encountered in institutional and community pharmacies in Trinidad. (2) To identify the prevalent drug-related problems in therapeutic interventions. (3) To investigate the use of a more detailed form to document intervention in the provision of pharmaceutical care. The study used a detailed form to record the therapeutic interventions. It was conducted over a three-month period. The collected data were transcribed to a Patient Care Intervention (PCI) form with relevant categories for drug-related problems. It was analyzed and presented as frequencies on graphs and tables. From a total of 289 interventions, 174 interventions were collected from an institutional pharmacy and 115 from community pharmacies. Nineteen percent of the interventions were due to unclear instructions or no instructions to the patients, of which 92 percent were from the community pharmacies; 17 percent accounted for dosing problems where excessive was 9 percent and sub-therapeutic 8 percent; 6.9 percent were due to wrong choice of drug or dosage form. Others accounted for 55 percent of the interventions of which 92 percent were due to out-of-stock medications. The study showed that there is a variety of significant drug-related problems on prescribing. It highlighted the need for pharmacist intervention, thorough documentation of the interventions, effective pharmacist-physician communication and improved inventory management in order to achieve positive outcomes of patient medication therapy. Due to the limitations of the study, it is recommended that a further study should be done and it should include the pharmacoeconomic aspect of the interventions. (AU)

The development of a community-based comprehensive mental health service delivery system for the Cayman Islands (1989-2001)

This paper reviews the development of mental health services in the Cayman Islands throughout a twelve-year period (1989 to 2001). I was appointed the resident consultant psychiatrist to the islands in 1989, after which time a consultative process between the Ministry of Health, Senior Management of the George Town Hospital and myself allowed the development and establishment of a comprehensive community-based mental health service delivery system (MHSDS), specifically designed to suit the needs of the Cayman Islands. The framework for the service is outlined, and the concerns and objectives of the MHSDS are discussed, along with short-term and long-term goals. (AU)

HIV/AIDS and children in the English-speaking Caribbean

This unique book provides an overview and informed discussion of HIV/AIDS as it impacts children and adolescents in the English-speaking Caribbean. With contributions from noted HIV/AIDS experts in Jamaica, Trinidad, Barbados and Grenada, it examines the biopsychosocial, environmental, spiritual and policy issues that affect HIV/AIDS prevention/service delivery issues for Caribbean youths (AU)

Quality of care of hypertension in three clinical settings in Jamaica

To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patients, aged > 30 years, attending a public general clinic (PUBMC) (n=500), a special hypertension clinic (SPMC) (n=119) and a private group general clinic (PRMC) (n=137), for more than one year, were reviewed. Duration of follow-up varied among clinics with the longest mean follow-up at PRMC (10.8 years) compared to 6.1 years and 4.7 years at the PUBMC and SPMC respectively. Mean age was greatest at the PUBMC (60 yrs) compared to 53 years in the SPMC and 50 years in the PRMC (p < 0.001). Sex distribution differed among clinics with 15 percent men in the PUBMC, 34 percent in the SPMC and 54 percent in the PRMC (p < 0.001). Over 92 percent of patients had blood pressure (BP) recorded at least once in the 12-month review period. Hypertension was defined as being prescribed antihypertensive medication in clinic records. By this definition 98 percent SPMC patients were hypertensive, compared to 87 percent PUBMC and 80 percent PRMC. Using BP < 160 / 95mmHg, the PRMC was 0.57 (0.34-0.97) compared to the other two clinics after adjustments for age, clinic type, duration of follow-up and gender. Only age was a significant covariate with older patients at greater risk of poor control. Only 18 percent of hypertensives were controlled to BP < 140 / 90mmHg with no difference among clinics. Diuretics were the commonest agent used at the PUBMC (76 percent) and SPMC (86 percent) followed by a-methyldopa, 41 percent and 27 percent, respectively. These agents were less commonly prescribed at the PRMC than at the other clinics (45 percent diuretics and 8 percent a-methyldopa, p < 0.001 for both agents compared to other clinics). PRMC used more angiotensin converting enzyme inhibitors 38 percent, compared to SPMC 23 percent and PUBMC 1 percent (p < 0.001). Between 9 percent and 15 percent of patients at the PUBMC and PRMC had recorded data on smoking and alcohol use compared to 69 percent at the SPMC. A record of body weight was found in 99 percent at SPMC compared to 82 percent at PRMC and 33 percent at PUBMC (p < 0.001). Surveillance for complications differed for proteinuria (PRMC 33 percent, PUBMC 15 percent, SPMC 15 percent) and fundoscopy (PUBMC 0 percent, PRMC 3 percent, SPMC 43 percent). These results show very limited adherence to recommended hypertension treatment guidelines in all three settings.(Au)

Spinal Injuries at the University Hospital of the West Indies

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85 percent of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernisation of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilisation and transport, prompt resuscitation, the standardisation of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalisation of a well-coordinated and rehearsed Spine team.(Au)

Managing an ophthalmic practice in the twenty-first century

There is a growing demand on the Caribbean Ophthalmologist to address issues of practice management in an increasingly competitive environment. The forces emanate from the patient population, information technology and the opthmalmic market place. A paradigm shift from ophthalmologist centred care delivery to patient centred delivery is necessary for success. One must remain sensitive and responsive to changes in the field. Apart from clinical acumen and surgical skill, one must understand principles of business, accounting and taxation. Some major issues at the point of delivery are: ambience, efficient appointment system, prompt follow-through, accessibility, quality information, quality support staff and appropriate technology. Group practice offers many advantages. (AU)

Knowledge, attitude and practice towards risk reduction of typhoid in Western Jamaica

The study was conducted to determine the knowledge, attitude and practice in relation to risk reduction of typhoid in two selected communities in Western Jamaica. It also examined the knowledge, attitude and practice of health of providers at the primary and secondary levels relative to prevention, patient care and control of typhoid fever. Two sets of questionnaires were designed to collect the necessary data. A total of 150 responses were obtained from the two selected communities and 52 from health workers. There were almost equal numbers of male and female the community respondents (76 males and 74 females) while, female was the dominant gender in the health care respondents (40/52). The modal age group was 40-49 years in both groups. The study revealed that: (1) The unavailability of clean safe water was one of the important issues. (2) There was no statistically significant difference between communities relative to knowledge. (3) Most respondents with good/fair knowledge had good/fair attitude. (4) Both community members and health workers were knowledgeable, obtained good attitude scores but the practice was not concommitant with their knowledge. (5) Most community members indicated confidence in the work and worth of the health providers. Some recommendations are made to foster the transition between knowledge and desired behaviour change (Au)

Insane patients and their insanities

This book addresses the following issues:-(1)What the medical meaning of insanity is,(2)What the causes of insanity are, (3)What common types of insanity exist in the general population, how these are diagnosed by the psychiatrist, what the principles of their treatment are,and (4) What current trends of or factors promote or frustrate insanity management in the society.(AU)

Ataxia Telangiectasia: A case report

The case of an eight year old girl with Ataxia Telangiectasia (AT) is described. She presented at seven years of age with gait problems and was found to have the neurological, dermatological and immunological features characteristic of AT along with a history of frequent sino-pulmonary infections. This report highlights the refractory nature of the disease, the difficulties in medical management, and the problems posed by late diagnosis which can comprise patient care. This is a rare inherited form of ataxia which has not been previously reported in West Indian literature. (AU)