Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the patients.

Attitudes of patients and staff to the implementation of an open door policy in a psychiatric unit of a general hospital [Abstract]

OBJECTIVE: To document the changing attitudes of staff and patients to the implementation of an open door policy (ODP) in the custodial psychiatry unit at the University Hospital of the West Indies. METHOD: The implementation of the changing therapeutic activities between October 2000 and January 2001 was followed using qualitative methods. Patients, their relatives and staff were interviewed around the time of implementation of each changing activity, and their attitudes documented. Patients attitudes to the transformed ward were sampled from May 2001 using the Verona Satisfaction Scale. The ODP had five separate components. The first was the opening of the main gate of the ward, which took place in October 2000. This was followed by a rationalization in stages of patients clinical status and their assignment to specific therapeutic activities. The implementation of daily therapeutic community group meetings was followed shortly afterwards by the implementation of an art therapy programme and other occupational activities. The opening of the Occupational Centre was the final phase of the programme in June 2001. RESULTS: The initial response of staff members to the opening of the main gate was angry and hostile with acts of passive resistance. Patient response was cautious but favourable, and they soon took advantage of leaving the ward unacompanied. Demarcation of the patients into groups of clinical severity soon allowed the staff to rationalize therapuetic activities for the patients. Both staff and patients were cooperative to this change. Implementation of the therapuetic community group meetings had a profound resocializing effect on patients and staff. Finally, the implementation of the art and activity therapy was warmly received by the patients, and proudly acclaimed by the staff. Analysis of the Verona Satisfaction Scores indicated a general acceptance and appreciation by the patients. CONCLUSIONS: The general consensus has been that the ward atmosphere was positively transformed by the ODP with patients being more satisfied with their care and being less hostile in their interactions with staff. Staff have cooperated with the changes, and have expressed appreciation of the benefits derived from the process. (AU)

Patients' desire for peri-operative information: Jamaican attitudes

The desire for peri-operative information has been examined in patients from other countries. This study was undertaken to assess the peri-operative information needs in Jamaican patients and to compare them to those from other populations. A questionnaire examining the desire for information about impending anaesthesia was administered to 93 patients awaiting elective surgery at the University Hospital of the West Indies. Responses were assessed across age and gender, and were compared to results from five industrialized countries. Although Jamaican patients expressed a desire for information concerning anaesthesia and surgery, they did not regard it as their right to get information, and this was the most important factor in the Jamaican sample providing a significantly less positive response than patients from other nations (p < 0.01 versus each country). Information priority was given to practical aspects of anaesthesia and post-operative outcome - morbility, pain and the consumption of food and drink. Meeting the anesthetist was high on the list of desires. Female patients were 1.9 (Confidence Interval 1.4, 2.5) times more likely to express a positive desire for information. There were no age-related differences.(Au)

Questionnaire detection of problem drinkers among acute medical admissions

The study was designed to determine the prevalence of alcoholism/problem drinking among emergency medical admissions. Of 203 emergency admissions to two medical wards, 18 percent were found to be problem drinkers, using the brief Michigan alcoholic screening test (MAST) questionnaire. Problem drinking was found in 31 percent of males and 5 percent of females. Most drinking was done with friends (77 percent) and at the "rum shop" (62 percent). Fifty-one percent of problem drinkers started between the ages of sixteen and twenty years. Seventy per cent of all problem drinkers had a first degree family relative who drank compared to 28 percent of non-drinkers. A high prevalence of alcoholism (48 percent) was found among smokers. Housestaff detected just over half of male (56 percent) and female (60 percent) alcoholics who were MAST-positive. Medical diagnoses among MAST-positive patients were gastrointestinal (cirrhosis, pancreatitis and hepatitis) in 32 percent, neurological (delirium tremens, seizures and subdural hematoma) in 27 percent and cardiovascular (cardiomyopathy, heart failure and dysrhythmias) in 16 percent. The detected level of problem drinking is likely to cause significant morbidity, and allows an important opportunity for intervention. The use of questionnaire methods to screen for alcoholism needs further evaluation in the region.(AU)

Casualty transit time for 100 adult walk-in patients at the University Hospital of the West Indies

The Casualty Department of the University Hospital of the West Indies (UHWI) has evolved in an ad hoc manner over the last decade, and questions regarding its appropriateness and effectiveness as an emergency department persist. This study of 100 systematically-selected patients attempts to assess time utilization during transit, as dictated by the present system of patient management. Time to first contact averaged 2 hr 38 min (158 min). The mean total time was 3 hr 46 min (226 min) and mean total waiting time was 3 hr 10 min (190 min), versus a mean total utilized time of 19 min. Actual contact time withcasualty officers averaged only 8.3 min. Referrals to specialist services constituted 11 percent of the sample, and overall mean waiting time for specialists was 2 hr16 min (136 min) with a mean contact time of 48 min. Given that the mean total time of 3 hr 46 min is not inordinately long in a public health health system such as ours, the recommendation is being made for a modified coding and triage system to reduce time to first contact for more urgent cases (AU)

Health education: patients' perception

Two hundred and six mothers of children under 5 years of age attending pediatric helth services in Jamaica were interviewed to determine their perceived and preferred source of health education. The seven topics of health education which were surveyed were family planning, breast feeding, infant feeding, oral rehydration solution, growth chart, prevention of accidents, and immunization. Mothers perceived nurses as their main providers of health information. However, they named doctors as their preferred source for health information in most of the topics surveyed. Assessment of mothers' knowledge of the growth chart, in those who had received specific education about this, revealed that 88 per cent had an inadequate understanding of a curve falling through the percentiles. this study highlights the importance of providing doctors and nurses with the necessary training and motivation to fulfil their role as health educators. (AU)

An assessment of the nutritional status of hospitalised patients and the awareness thereof by the medical personnel in the management of these patients

Research indicates that a large percentage of hospitalised patients in the United States and England suffer from protein energy malnutrition (P.E.M.) but this condition is usually undiagnosed. The study aimed to investigate the situation at a rural Jamaican hospital by firstly determining the nutritional status of the patients and secondly, assessing the awareness of the doctors of nutrition, in the management of their patients. The sample comprised 297 patients (108 medical, 90 surgical and 99 paediatric) consecutively admitted to the hospital during the three month study period. The investigator assessed the nutritional status using four standard anthropometric measurements viz:- weight, height, mid upper arm circumference (M.U.A.C.) and triceps skinfold thickness (T.S.F.) within twenty-four hours of admission. In addition, the patients' hospital notes were examined and records made of the nutritional management requested for each patient. Signs and symptons suggestive of malnutrition and biochemical analyses carried out or requested, were also recorded. These were used as an indication of the awareness of nutrition on the part of the attending physician. Of the 207 patients on whom anthropometric measurements were taken, 51 (38percent) adult patients from the medical and surgical wards, and 32 (43 percent) of the paediatric cases, were wasted to some degree. In addition, 25 (42 percent) of the paediatric patients measured were underweight and 8 of the adult patients were overweight. Of the 19 cases of obesity found among the adults, 15 were females. Triceps skinfold thickness were especially low among the adult population, 100 (72 percent ) having values below 60 percent of the reference used. Arm muscle circumference were high for those patients. Five of the moderate to severely malnourished adults (those under 80 percent weight for height) suffered from neoplastic diseases. Apart from this, malnutrition was not related to any specific diagnostic category. Signs and symptoms suggestive of malnutrition were infrequently mentioned in the patients' physical examination notes. A quarter of the adult patients were examined for oedema (mostly from the medical wards) while paediatric patients were checked for diarrhoea (28 percent ), vomiting (38 percent ) and dehydration (32 percent ). While pallor was examined for on all three wards to the same extent (42 percent ), anorexia was mentioned only in the dockets of nine patients. Thirty-eight (11 percent ) patients had no diet prescribed in their hospital notes. Generally, dietary prescription was based primarily on the patients' diagnosis but age and physical condition were also considered. Prescribed diets were usually appropriate for the patients in terms of the recorded diagnoses. However, with respect to nutritional status as derived from the study, the diets were incorrect in several cases. No diets were prescribed for the nutritional rehabilitation of malnourished patients. This study suggests that although P.E.M. is common in hospitalised patients, inadequate attention is paid to nutritional status in patient management (AU)

A study of casualty/ambulatory services and their role in the delivery of primary health care at the Princess Margaret Hospital, Nassau, N.P., Bahamas

Recommendations are made as to how the service provided could be improved. (AU)