Characterization of the patients who attended the admission, diagnosis and emergency clinic (CIDU) of the dentistry service of a higher education institution in southwestern Colombia - 2015 / Caracterización de los pacientes que acudieron a la clínica de ingreso, diagnóstico y urgencias (CIDU) del servicio de odontología de una institución de educación superior del suroccidente colombiano - 2015

Aim: To characterize the patients who came to the Insitute, Diagnosis and Emergency Clinic (ICID) of the dentistry service of an institution of higher education in southwes-tern Colombia during the year 2015. Materials and methods: We reviewed 772 patient admission formats, consolidated the data in a database and selected socio-demographic variables of clinical interest.Results: It was found that 63% were female patients, the main reason for consultation is oral rehabilitation with 30%, the most frequent medical precedent was surgery with 57%, 33% of men at the clinical examination presented values of arterial hypertension, but only 13% reported it; while 25% of women presented HTA, but 15% reported it and the treatment of choice was oral rehabilitation with 42%. Conclusions: We found important aspects related to the reason for consultation, medical history and the relevant specialty for its treatment, as well as the importance of education and awareness of systemic compromised diseases such as arterial hypertension.

Objetivo: Caracterizar a los pacientes que acudieron a consulta a la Clínica de Ingreso, Diagnóstico y Urgencias (CIDU) de las clínicas odontológicas de una institución de educación superior del Suroccidente Colombiano durante el año 2015. Materiales y Métodos: Se revisaron 772 formatos de ingreso de pacientes, se hizo el consolidado en una base de datos y se seleccionaron variables sociodemográficas y de interés clínico.Resultados: Se encontró que el 63% fueron pacientes femeninos, el motivo de consulta principal fue la rehabilitación oral con 30%, el antecedente médico que más se repitió fue el de cirugías con 57%, 33% de hombres al examen clínico presentaron valores de hipertensión arterial (HTA), pero solo 13% de ellos lo reportaron; mientras que 25% mujeres presentaron valores de HTA, sin embargo, fueron 15% quienes lo reportaron y el tratamiento de elección fue rehabilitación oral con un 42%. Conclusiones: Se encontraron aspectos importantes relacionadas con el motivo de consulta, antecedentes médicos y la especialidad pertinente para su tratamiento, así como se evidenció la importancia de la educación y concientización de enferme-dades de compromiso sistémico como el caso de la HTA.

Evaluation of hospital dietic services in seven Caribbean countries

OBJECTIVE: To improve the delivery of dietic services in hospitals in the Caribbean, an assessment was carried out of the extent to which nutrition intervention was included in the medical management of patients. METHODS: The documentation of the nutritional intervention at secondary care facilities was the focus of a medical record audit of hospitalised patients. Medical records from 491 patients in 88 wards from 15 hospitals in Monsterrat, Jamaica, Guyana, British Virgin Islands, Grenada, Dominica and St. Vincent were audited. In each hospital at least 20 percent of the medical records of inpatients were audited. The medical records were randomly selected from each ward and were audited for selected anthropometric data, height and weight measurements, laboratory and clinical data, diagnosis, diet prescription and documentation of a "nutrition note" by dietetic personnel as well as nutrition-specific information in the "progress notes" and "nurses notes". RESULTS: The provision of nutrition intervention was relatively low or not adequately documented by any category of the relevant health care staff (medical, nursing and dietetic) in any of the countries. Except for anthropometric data, there was adequate baseline information (diagnosis, laboratory and clinical data) to initiate nutrition intervention. The absence of a diet prescription by the physician in more than 50 percent of the records in most countries indicated that insufficient attention is being paid to the contribution of nutrition in the delivery of medical care. Of the 15 hospitals assessed, 8 were operating without a professional dietitian or nutritionist. CONCLUSIONS: While primary prevention remains a main focus, we must provide adequate care and rehabilitation for those already afflicted. The study shows that there is a clear need to strengthen the nutritional care offered to hospitalized clients in the Caribbean so as to facilitate their early rehabilitation and quick return to productivity in society. At the forefront of realizing this goal is the availability of adequate resources in nutrition, specifically, human resources. (AU)

The challenge of designing a database for auditing surgical in-patients

Surgical audit is imperative in modern practice, particularly in the developing world where resources are limited and efficient allocation important. The structure, process and outcome of surgical care can be determined for quality assurance or for research. Improved efficiency and reduction of morbidity and mortality are additional goals which may be accomplished. However, computerization, medical staff cooperation and the availability of dedicated staff are among the hurdles which may be encountered. We report the challenge of designing and establishing a database for auditing surgical inpatients in a developing country and the difficuties which were encountered.(AU)

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires: collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20 percent were dependent on care. 74 percent were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40 percent of the study population were known to be hypertensive, and another 13 percent had an elevated blood pressure on examination. Diabetes mellitus was present in 15 percent. 20 percent had a visual acuity of 0.1 or below, and 10 percent had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50 percent of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We suggest the development of a programme oriented approach of primary health care for the elderly to support this.(AU)

Identifying maternal deaths in developing countries: experience in Jamaica

Multiple sources were used to idenify maternal deaths and their causes in a study out in Jamaica. These sources of information included a review of all deaths of women aged 12 to 49 years and included those occurring in hospitals (on maternity, surgical and medical wards and in casualty departments); reported to coroners' offices and the police; on whom post-mortems were carried out at hospital, public morgues and for the Ministry of National Security; obtained from interviews with public health staff in all parishes and which were registered with the Registrar General's Department. Some 193 maternal deaths were identified giving a maternal mortality rate of 10 per 10 000 live births. No one source independently identified all maternal deaths. Hospital in-patient records yielded 133 deaths (69 percent), death certificates 74 (38 percent). Deaths due to certain causes were far more likely to be identified from particular sources, e.g., those due to clinical mismanagement (complications of anaesthesia and blood transfusion) from hospital in-patient records; while deaths from ruptured ectopic pregnancy were more likely to come from coroners', police and morgue records. It is concluded that using multiple sources to identify maternal deaths in developing countries is an effective method to identify all maternal deaths. (AU)

Perinatal mortality in Curacao, Netherlands Antilles

The Perinatal Mortality Rate (PNMR) is considered to be an indicator of perinatal health. To ascertain the validity of the perinatal mortality statistics in Curacao, medical records and death certificates were reviewed over a five year period. Using a birth weight of 1,000 gm as a cut-off point, 366 foetal and first-week deaths were recovered from the statutory death certificates. Using similar criteria, 19 perinatal deaths, identified in the medical records, were not registered as such on the death certificates (registration failure 4.9 percent). Hence, the revised annual PNMR ranged from 19.0 to 31.2 per 1,000 births during the period 1979-1983. Additionally, the contribution of low birth weight (LBW)(<2,500gm) to perinatal mortality was examined during 1984-1985. LBW was associated with 68.6 percent of all perinatal deaths using a birth weight of 500gm as truncation point. However, it is argued that the high proportion of LBW to perinatal mortality is not the result of an adverse birth weight distribution of the Curacao population (AU)

Primary health care delivery in Carriacou, Grenada

The people of Carriacou utilize curative more than preventative services. Over a four month period of study a total of 1349 patients made encounters at the District Medical Officer's clinics. Most of the encounters were for problems which required treatment e.g. circulatory system diseases, respiratory system diseases, musculo-skeletal system diseases. Other clinics, including the chronic disease, dental, dressing clinics and casualty, were also involved in curative work. However, the low percentage of check-ups (2.2 percent), the limited number of Pap smears done (91 or 5.7 percent of females over 15 years old), the poor immunisation status and low contraceptive use all express the need for preventive care. The distribution of health problems in this lesser developed country appears to be similar to more developed countries. Problems which tend to affect developing countries such as infective and parasitic disease are not a cause of significant morbidity on this island. These illnesses rank seventh in the list of most common diseases. Hypertension, upper respiratory tract infections, and dyspepsia are among the three most common health problems. The position dyspepsia occupies is unlike findings in other countries. This may be the result of dietary factors, alcohol abuse or excessive use of aspirin. The problem needs further investigation. There appears to be rational drug prescribing in Carriacou. No prescriptions were written for more than three drugs during the study and 3.4 percent of prescriptions were for three drugs. Poly-pharmacy is avoided. Compared to some more developed countries there is limited use of psychotropic drugs. There is a need for back-up services in instituting health measures. This is brought out by the cessation of clinics at times when the health personnel assigned to certain duties is absent. Immunisation was one such activity that was affected. Carriacou has great potential to become a healthier nation in the Caribbean. One must, therefore alert health planners of the need for: (1) Upgrading the present system of disease reporting (2) Health education programs (3) Cancer screening activities (4) Improved maternal and child health activities (AU)

Problem solving at the record office: Victoria Jubilee Hospital

Identifies the following problems which the Victoria Jubilee Hospital faces in compiling an accurate medical record system: 1) change of names given at birth, or honest mistakes made about their names; 2) registration under maiden name or former married name after remmarriage; 3) second registration of child under name of different fathers after claiming loss of registration slip; 4) registration under name of different person. Discusses attempts by the hospital to solve the problem through tighter security of records, retention of records for at least ten years and requesting proof of baptismal and school records from registered mothers. (AU)

Home-based paediatric records and communications in St. Lucia

The use of a home-based paediatric record is examined in the home, child health clinics and hospital, as a means of communicating health information. The usefulness of the record is examined in the various situations in which the child is met. Problems identified in the various settings are described, and suggestions are made as to how they may be reduced. After three years in use, the home-based paediatric record in St. Lucia has been judged a success over the clinic-based record system (AU)