Performance of a pediatric ambulatory anesthesia program – a developing country experience

BACKGROUND:  The aim of this study was to evaluate the performance of a pediatric ambulatory anesthesia program in a tertiary care teaching hospital in a developing country. METHODS:  Data on all pediatric patients (<16 years of age) scheduled to have elective day-care surgery during a 1 year period from January 1999 to December 1999 were collected retrospectively. An audit form was used to determine the specialty of the procedures, anesthesia techniques, postoperative analgesia, perioperative complications, unplanned admissions and outcomes with respect to morbidity and mortality. RESULTS:  A total of 763 pediatric ambulatory surgical procedures were performed during the year of 1999. The procedures included general surgery, ENT, orthopedic and plastic surgery. The most common procedure was inguinal hernia repair followed by umbilical hernia repair, adenotonsillectomy and circumcision and 96% of the patients had general anesthesia. There were only three unplanned admissions (0.4%); one for a surgical reason and two for anesthetic reasons. There was no serious morbidity or mortality in any patient. CONCLUSIONS:  Performance of pediatric day-care anesthesia has been good in our day-care unit and we have a successful ambulatory surgery program, despite the limitations of a developing country.

Paediatric nosocomial urinary tract infection at a regional hospital

From a total of 26,603 admissions to the paediatric wards, 1360 paediatric nosocomial urinary tract infections (PNUTI) were identified during a 5-year retrospective chart review at the SFGH. The ages ranged from 3 days to 13 years, with 46 percent boys and 54 percent girls. The highest rates of PNUTI per service per 100 admissions were seen in the nursery (11.28) followed by paediatric surgery (2.89) and paediatric medicine (2.86). Although the greatest number of PNUTI occurred in the nursery, comparison between the years was not statistically significant. About 90 percent (1218 of 1360) of PNUTI occurred in catheterized patients. No documentation was found specifying the type of catheterization (intermittent or continuous). About 90 percent (1210 of 1360) of isolates were single organisms with Escherichia coli, Proteus mirabilis, Klebsiellla spp. and group B streptococci accounting for a total of approximately 70 percent of all pathogens. However, the composition of the most common isolate in each service differed. The most common isolate in the nursery was E. coli, in the paediatric medical and surgical services the most common isolates were Klebsiella spp. and Proteus mirabilis, respectively. Proteus mirabilis was isolated predominantly from boys with structural abnormality of the urethral tract. No PNUTIs were complicated by bacteraemia. The antibiotics with least effectiveness (in increasing order) for UTIs were cephalexin, ampicillin, trimethoprim, co-trimoxazole and tetracycline. The most effective antibiotics were nalidixic acid, gentamicin and amoxicillin-clavulanic acid.(AU)

Significance of polymicrobic bacteriuria in a teaching hospital in Trinidad

OBJECTIVE: To compare microbial prevalence (mixed versus pure), define microbial combination in mixed urine cultures among inpatients and outpatients to identify factors that might allow a more objective interpretation of polymicrobic urine cultures. DESIGN: Case series. SETTING: The study involved inpatients (hospitalized) and outpatients (those attending outpatient clinics and the accident and emergency department) of the San Fernando General Hospital in southern Trinidad. MAIN OUTCOME MEASURES: Prevalence rates of bacterial isolates in mixed and pure cultures of urine specimens were determined using standard techniques and Kirby-Bauer disc diffusion methodology. RESULTS: The results showed that of 5,089 urine specimens, 1,491 (29.3 percent) yielded positive cultures. Of these positive cultures, 524 (35.1 percent) revealed significant polymicrobic bacteriuria. Eighty five percent yielded two organisms 13.2 percent had three organisms and 1.8 percent had four organisms. Repeat cultures 157 patients revealed the same organisms in only 57.3 percent of them. Almost all of the repeat cultures were from patients with in-dwelling Foley catheters. E. coli was the most common single isolate (42.8 percent), while Klebsiella, Enterobacter and Proteus organisms were most often encountered in mixed cultures. All isolates were relatively sensitive to routinely used antibiotics for urinary pathogens. CONCLUSION: The prevalence rate of polymicrobic bacteriuria at our institution was 10.2 percent. More than 65 percent of positive cultures were from patients with Foley catheters on open drainage (inpatients) and closed drainage (outpatients). Most were men with out-flow obstruction who either refused surgery, were unfit for surgery, or had to wait long periods to be booked for surgery. No cases developed bacteremia secondary to bacteriuria. All urinary isolates were susceptible to routinely used antimicrobial agents.(Au)

Molecular and clinical epidemiology of endemic acinetobacter antiratus infections in an urban teaching hospital - abstract

Acinetobacter anitratus is an important nosocomial pathogen with an environmental reservoir. An increased rate of isolations from hospitalised patients prompted this study. Infections were identified in 62 of 81 patients (76 percent), aged 2 months to 95 years in whom A. anitratus was isolated. Seventy-one episodes occurred in the summer and spring versus 10 in the winter and fall of 1990 to 1992 (p<0.0000001). Thirty percent of the patients had pneumonia, 7 percent had peritonitis, and urinary tract infections occurred in 23 percent of patients. The organism was also isolated from deep abscesses and cases of tracheobronchitis. The use of ventilators and continuous ambulatory peritoneal dialysis were significant contributors to the occurrence of infection (OR 11.5, p<0.0004; p<0.000005, respectively). Other features included recent antibiotic use (70 percent), recent hospitalisation (37 percent), Foley catheters (69 percent), total parenteral nutrition (39 percent), angiography (37 percent), chest tubes (25 percent), tracheostomy (23 percent) and epidural anaesthesia (9 percent). Ninety-seven percent had underlying illnesses, 63 percent had major surgery and 34 percent were immunosuppressed. Fifty-five percent of the patients acquired the organism in ICU, and 12 (15 percent) patients died. DNA fingerprinting, using pulsed-field gel electrophoresis (PFGE) of the whole cell DNA digested with Sma 1, revealed 6 PFGE banding patterns among 27 isolates (8 isolates with a common pattern were clustered in the Surgical ICU) and distinct patterns in 44. A.anitratus causes device-associated nosocomial infections in severely ill patients with marked seasonal variation (AU)

Twenty five years of teaching: the Faculty of Medical Sciences of The University of the West Indies in Barbados: an address

Paper states that the overview of the history of the Faculty of Medical Sciences of the University of the West Indies in Barbados from the 1960's to the 1990's. The author, a faculty member discusses such topics as academic progress expansion, administration, community work, and outreach programmes (AU)

We asked them and they told us: victims' views of the first surgical clerkship - abstract

This study was undertaken to obtain the views of the students concerning the effectiveness of the first clerkship in surgery. A short anonymous questionnaire was handed to each student at the end of their ten-week clerkship immediately following the multiple choice examination. Completed forms were collected before the students left the examination room. Four hundred and sixty-three questionnaires were returned and analysed from the five graduating classes 1988 - 1992. Three hundred and forty of these responded to the section asking for comments or criticisms of the clerkship. These were broken down into five main areas - organisation, evaluation, course content, teaching and teachers. While the majority of the students felt that the clerkship was well organised, three main areas of discontent were evident. It was felt that teaching should be more patient-oriented, that teachers were too frequently unavailable and that the present curriculum clash with the pathology/microbiology programme adversely affected the rotation. In addition, almost a quarter felt that time spent in the operating theatre was a poor learning experience. Based on the results presented to the lecturers in the department, the clerkship has been modified and a new questionnaire designed and administered. The new data are being stored in a computer database and being made available to the organisers of the clerkship on an on-going basis (AU)

A survey of patients' attitudes towards inpatient psychiatric ward rounds

Attitudes towards the multidisciplinary ward round were assessed in fifty psychiatric inpatients, from two wards, using a semi-structures interview. About three quarters of them had at least a moderately favourable impression of the ward round but more than half would still prefer not to be interviewed in this way. Levels of anxiety and perceived helpfulness were positively correlated. Afro-Caribbeans found the interview significantly less helpful, less understandable and less memorable. Men found it less helpful than women and there were differences found between the two wards. Possible explanations for these findings are discussed. (AU)

Knowledge and understanding of AIDS among health-care workers in Jamaica

Six hundred and fifty questionnaires were sent to Health-care Workers (HCW) in four hospitals to assess the knowledge and understanding on HIV transmission and isolation precautions to be instituted for control and also to ascertain whether any differences in knowledge existed between HCW of teaching and non-teaching hospitals. Five hundred and nine questionaires were returned, a response rate of 79 percent . Questions on HIV transmission via blood transfusion and sexual intercourse and proper disposal of sharp instruments received the highest scores (85-100), embracing all groups of teaching and non-teaching hospitals. The greatest area of misconception and misunderstanding was reflected in responses obtained on isolation precautions (<30) for both teaching and non-teaching hospitals. Our study emphasizes an urgent need for comprehensive, continuous education of HCW on prevention and control of HIV infections in Jamaica (AU)

Anaesthetics and intensive care 1948-1988 - abstract

This paper will review the development of the Department of Anaesthetics and Intensive Care at the U.H.W.I. and the growth of the specialty of anaesthesia between 1948 and 1988 (AU)

An analysis of caesarean sections in a Teaching Hospital

An audit of 9,202 consecutive deliveries at the Mt. Hope Maternity Hospital revealed a Caesarean section rate of 6.6 per cent, representing an increase in temporal local trend. In search of an explanation of this increased frequency of Caesarean sections, we found that foeto-pelvic disproportion, prolonged labour and severe pre-eclampsia accounted for most of the difference. There was a slight rise in the section rate for intrapartum foetal distress and this is believed to be due in part to more accurate diagnosis by foetal monitoring but the difference was not statistically significant (AU)

Infection in a multidisciplinary intensive care unit at the University Hospital of the West Indies

The records of 1,252 patients were reviewed to determine the incidence of infection, mortality and associated risk factors in our multi-disciplinary intensive care unit (MD-ICU) during the period 1977 to 1982. The infection rate and the mortality rate were 24 percent and 22 percent respectively. The mortality rate in the infected group was 25 percent. The infection rate was higher in the intra-abdominal and trauma group as compared to the cardio-thoracic group (P<0.05). The incidence of ICU-acquired respiratory tract infection (41 percent), wound infection (17 percent) and urinary tract infection (15 percent) was significantly different from non-ICU acquired infections (P<0.05). The commonest site of infection was the respiratory tract (37 percent). The incidence of infection was directly related to the duration of medical devices left in situ and the length of stay in the unit (more than seven days) (AU)