Patient perception of the utility of the preanesthetic clinics in a Caribbean developing country.

BACKGROUND AND OBJECTIVES: Perception of the patients regarding the utility of the Preanesthetic Clinics and flow time in clinics has not been widely studied in the developing world. The present study aims to study this aspect. METHODS: A self-administered 15-item questionnaire survey was conducted among patients attending the Preanesthetic Clinics at a tertiary care teaching hospital in Trinidad. The questionnaire was also distributed to the patients attending the General Surgical Clinic for comparison. Another questionnaire was distributed among the staff of the Preanesthetic Clinic. Patient demographics including age, gender, and educational status and American Society of Anesthesiologists physical status were noted. Other data recorded were patient flow time and details of attending staff. RESULTS: Of the 220 patients who attended the Preanesthetic Clinics, 92.7 percent participated in the study. The reliability of the questionnaire was supported by Cronbach's alpha coefficient (0.67). The median time for referral from the surgical clinic to Preanesthetic Clinic was 50 days, median waiting time in the clinic was 2.7 hours, and the median waiting time for surgery after acceptance in the clinic was 13 days. The patients' opinions regarding the benefits of the clinic, length of the waiting time was independent of their age and educational status. Patients felt that attending the Preanesthetic Clinic was beneficial and not costly to them, although the waiting times were found to be longer. CONCLUSIONS: Patients perceive that attending the Preanesthetic Clinic has been useful before the surgical procedure and the care they received in the clinic was satisfactory.

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35 percent, 47 percent, and 55 percent in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95 percent confidence interval (CI) = 1.2 - 3.9; p= 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95 percent CI = 1.4 - 10.6; p= 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95 percent CI = 1.8 - 6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence if C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk. (AU)

Outpatient management of the painful crisis in homozygous SS disease: trends and outcomes - abstract

The painful crisis of sickle cell disease is a major cause of recurrent morbidity normally managed by hospital admission. The MRC Laboratories Sickle Cell Unit has been exploring possiblities of outpatient management and the experience in a day care centre over a one-year period (1/4/95 - 31/3/96) is reviewed. During this period 597 painful crises of sufficient severity to require narcotic analgesia among 292 patients with homozygous sickle cell (SS) disease received treatment. Attendances within a 7-day period were arbitrarily considered the same crisis and those separated by more than 7 days as separate crises. There were 146 (50 percent) males and ages ranged from 3.3 - 50.1 years. Single painful crises occurred in 169 patients, 2 crises in 54, 3 - 5 crises in 66, 6 - 9 crises in 9, and more than 9 crises in 4 patients. A cyclical model was found to fit both the monthly attendances and meteorological temperature data for the same period. Fever exceeded 39§C in 11 patients (3 acute chest syndrome, 1 Haemophilus influenza septicaemia, 1 infected leg ulcer; 6 had sterile blood cultures and no apparent cause other than painful crisis). By 3pm patients were given the option of admission or discharge. 25 patients (8.9 percent) with 30 crises were admitted to hospital and 267 patients (91.4 percent) with 567 crises were discharged with oral analgesia. It is proposed that outpatient management of painful crises is feasible, selected by the great majority of patients, and can markly reduce demands on inpatient services. (AU)

The painful crisis of homozygous sickle cell disease: clinical features

The details of onset, perceived precipitating factors, associated symptoms, and pain distribution in the painful crisis of homozygous sickle cell (SS) disease have been prospectively recorded in 183 painful crises in 118 patients admitted to a day-care centre in Kingston, Jamaica. Painful crises developed most frequently between 3 p.m. and midnight, most commonly affected patients aged 15-29 years, affected the sexes equally, and were not obviously influenced by menstrual cycle. Of the perceived precipitating factors, skin cooling occurred in 34 percent, emotional stress in 10 percent, physical exertion in 7 percent, and pregnancy in 5 percent of women of child-bearing age. Cold as a precipitant was not less common in patients with more subcutaneous fat. Pain affected the lumbar spine in 49 percent, abdomen in 32 percent, femoral shaft in 30 percent, and knees in 21 percent. There was a highly significant excess of bilateral involvement in limb and rib pain. Recurrent painful crises occurred in 40 patients but showed no evidence of involving similar sites on successive occasions. Abdominal painful crises were associated with abdominal distention in 18 ( 31 percent) and with referred rib pain in a further 15 (26 percent) of crises. Fever was common even in apparently uncomplicated painful crises, suggesting that fever is characteristic of the painful crisis itself after and not necessarily indicative of infection. Following investigation and treatment in a day-care centre, over 90 percent of patients returned home (AU)

Tardive dyskinesia in outpatients on depot phenothiazine

Two hundred and thirty-two psychiatric outpatients on depot fluphenazine decanoate for more than six months were examined for Tardive Dskinesia (TD), using the AIMS rating scale, and the prevalence rates of TD at different criteria of severity were assessed. The prevalence rates ranged from 7 percent for patients with severe TD to 45 percent for patients with any degree of TD. The sex distribution of patients with TD showed no bias but the female patients were significantly older than the male patients. Increases in prevalence rates of TD were associated with the combination of an anticholinergic anti-Parkinsonian drug with the depot neuroleptic, and with the concommitant use of an oral neuroleptic with the depot preparation. Implication of these findings for the long-term management of schizophrenia are discussed (AU)

Drug utilisation and compliance in an ambulatory population in Barbados - abstract

A pilot survey was conducted to determine use of medicines and patient compliance with therapeutic regimes. A questionnaire was used by interviewers to obtain the relevant information. One hundred respondents were chosen randomly from all parishes in Barbados, and those from group II were selected from medical outpatient prescriptions (one in every five) filled during part of the month of August, 1988 at the Queen Elizabeth Hospital. The data showed no significant overall difference in the prevalence of noncompliance (<90 percent of tablets taken) between group I (44 per cent) and group II (40 percent). However, the degree of non-compliance within certain therapeutic categories was very severe in both groups (zero for six patients in group II). Compliance with antihypertensive medication was particularly bad (24.9 percent) for tablets taken in the non-hospital group (group I). Hoarding was noted for the six (6) patients (with zero compliance) in group II. The cost of drugs wasted as a result of non-utilization for these six (6) patients was $296.00. There was no significant difference between the groups with respect to communication with health-care providers. More than half claimed to have asked drug-related questions of physicians. There was no significant difference between the groups with regards to the reading of the label correctly and knowing the indications for the drugs prescribed. Very few patients knew the names of their medication, although the number who knew the names of their medication was slightly higher in group II. The study shows a very wide spectrum of compliance and medication use. Further and larger stdies are indicated to define reasons for the differences observed and to identify areas for education to promote better compliance (AU)

A supplementary feeding programme for the management of severe and moderate malnutrition outside hospital

Eighty-seven children with moderate and severe malnutrition were treated by means of a supplementary feeding programme in Trinidad. The programme resulted in an average weight increase similar to that obtained by other authors in Nutrition Rehabilitation Centres and Supervised Supplementary Feeding Programmes elsewhere, over a similar period of time. The weight increase, however, is slow when translated into improvement of reference weight for age. Close supervision resulted in a somewhat faster rate of improvement but increase excessively the cost of rehabilitation. Supervision and education of the mothers carried out by Community Aides did not result in continued improvement after discontinuation of the supplement. However, there was a significant improvement in the quality of the diet given to the supervised children four months after the food supplement and supervision had been discontinued. (Summary)

The leg ulcer problem in Jamaica

Leg ulcers represent a great problem in Jamaica. Due to the lack of hospital beds it cannot be overcome on the basis of in-patient care. The main types of ulcers are discussed and simple methods of ambulatory treatment described. Every effort should be made to prevent an acute ulcer from becoming chronic. Frequent daily dressings with Eusol until the ulcer is clean, and then occlusive type of compressive bandages is, in our opinion, the best method of out-patient treatment. Even a large percentage of chronic ulcers can be cured with this regime. Only a small proportion of cases, carefully selected, may require surgical treatment. The importance of protecting patients with ulcers against tetanus is emphasized (AU)

Some problems in the ambulatory treatment of tuberculosis

A study was made of 127 patients suffering from tuberculosis who were discharged from the Sanatorium after varying periods of treatment. An attempt was made to determine the extent to which patients took drugs at home and the reasons for failure to co-operate analysed. Difficulty in ingesting P.A.S. was not a major factor although it played a part. Inadequate instruction about the need for continuation of treatment seemed to be responsible for a large number failing to take drugs regularly (AU)

An example of effective disease control in a tropical mining community

An account is given of the methods used during the period 1943-46 to effect a transformation in the individual and environment health standards of a small mining community at Kwakwani settlement on the Berbice River, British Guiana. The health standards which obtained prior to control measures being introduced are outlined and the systems of record-keeping as also of compulsory medical examination and treatment used are described. Directly measured improvements are stated in the form of general morbidity, malaria, hookworm and filaria infection rates and reference is made to the various directions in which the environmental standards of the community were raised. In particular the ways in which the social welfare of the community was catered for are mentioned with special reference to the formation of a health commitee from among the employees themselves. It is concluded that the results obtained demonstrated the effectiveness of giving balanced attention to the requirements of both preventive and curative medicine and that the disease control methods used are well worthy of emulation among settlement communities elsewhere in the tropics (Summary)