Challenges of starting a refractive surgery centre [abstract]

The challeneges of starting a refractive surgery practice in Trinidad and Tobago will be discussed including the financial aspects such as obtaining finance, negotiating best deals and the various ways of saving start up cost. The attitudes of patients regarding local versus foreign expertise and the resultant impact will be addressed. The methods of dealing with various market forces including colleagues and patient financing will be debated. (AU)

Most successful practice building pearls [abstract]

Buying into a practice does not assure one's success. A successful practice is built and the investment in your training demands your best effort at "Brand Name" development. THE PHYSICIAN: -introduce and present your self to sources of referral; -be responsive; -communicate; -what's your gimmick? THE AMBIENCE: -Location; -A plesant purpose-built office layout; -Facilitate patient flow; -Image is important; -Use technology (Computerized system) THE STAFF: -You get what you pay for; -Inferior staff never leave; THE SERVICES -Control appointment system; -Plan 6 to 12 months ahead; -Information brochures; MARKETING: -Brand Name development; - Use the subtle media; -Develop own strategies; -Niche markets; -Feed back to sources; -Use of the Internet. (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)

Medical education, women's status, and medical issues' effect on women's health in the Caribbean

At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influence treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction of health policy if aid or educational programs are to be effective.(AU)

Considerations for implementing an antibiotic policy in hospital practice

An antibiotic policy should aim for the safe, effective and economical use of antimicrobial drugs, and to prevent their indiscriminate use and development of resistant bacterial strains. The term 'antibiotic' is used as a general term for all antimicrobial drugs. Antibiotics prescriptions should be based on clinical evidence of bacterial infection, preferably substantiated by appropriate laboratory culture and sensitivity tests. Viral infections are not an indication for antibiotic prescriptions. Patient factors to be considered for choice and dose of an antibiotic are age, pregnancy, lactation, renal and hepatic impairment. Immunodeficient patients should receive only bactericidal drugs. Severity of infection determines the route of administration. Duration of therapy should not exceed five days, unless specifically prescribed by the physician. An antibiotic should, if started as an empirical therapy not be changed before a minimum of three days trial. Prescriptions of drugs such as aztreonam, imipenem, vancomycin, piperacillin and amphotericin are to be restricted due to cost and toxicity and should be reviewed by the microbiologist (AU)