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1.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
Não convencional em Inglês | MedCarib | ID: biblio-1021986

RESUMO

Objective: Chest pain is a common Emergency Department (ED) presentation, but most patients will not have an Acute Coronary Syndrome (ACS). Decision tools have been developed to limit admissions to those at high risk of ACS, whilst allowing safe discharge of those at low risk. We aimed to evaluate the performance of three international decision tools (HEART, EDACS and VCPR) in the local setting. Design and Methodology: A prospective, observational cohort study was conducted to include ED patients presenting with low/intermediate risk chest pain. Participants were followed up at 6 weeks for Major Adverse Cardiac Events (MACE). Performance of clinical gestalt and the 3 scores were estimated. Results: 537 patients were enrolled, with 12 lost to followup, leaving 525 for analysis. Six patients developed MACE (1.14%). HEART had sensitivity, 16.67% (95% CI; 0.42% - 64.12%); specificity, 96.15% (95% CI; 94.11% - 97.63%); negative likelihood ratio (NLR), 0.87 (95% CI; 0.61 ­ 1.24). EDACS had sensitivity, 16.67% (95% CI; 0.42% - 64.12%); specificity, 95.38% (95% CI; 93.2% - 97.02%); NLR, 0.87 (95% CI; 0.61 ­ 1.25). VCPR had sensitivity 83.33% (95% CI; 35.88% - 99.58%); specificity, 67.05% (95% CI; 62.82% - 71.09%); NLR, 0.25 (95% CI; 0.04 ­ 1.49). Clinician gestalt had sensitivity 16.67% (95% CI; 0.42% - 64.12%); specificity, 97.5% (95% CI; 95.75% - 98.66%); NLR, 0.85 (95% CI; 0.6 ­ 1.22). Conclusion: In local patients with chest pain, the VCPR performed best for identifying patients for safe discharge, as well as with the lowest risk of MACE. The HEART, EDACS and clinical gestalt appear to be poorer decision tools.


Assuntos
Humanos , Masculino , Feminino , Doenças Cardiovasculares , Trinidad e Tobago , Serviço Hospitalar de Emergência , Síndrome Coronariana Aguda
2.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
Não convencional em Inglês | MedCarib | ID: biblio-1025220

RESUMO

Objective: This study aims to assess the quantity and quality of antibiotic prescribing in the emergency department at Wendy Fitzwilliam Pediatric Hospital (WFPH), per World Health Organization (WHO) and National Antimicrobial Prescribing Survey (NAPS) indicators. Design and Methodology: A clinical notes review of patients (aged one month to 13 years) seen in the WFPH emergency department was conducted between March and May 2018. The study population was 12,293 patients, convenience sampling was used and eligible patient notes were reviewed. For each encounter, patient demographics, prescription and indication were recorded. The analysis of the data, conducted using Microsoft Excel 2016, was based on WHO prescribing indicators (generic name and model formulary percentage) and NAPS compliance with guidelines indicators. Results: The study included 119 patients with a mean age of 5 years (s=3.55 years) and 52% (n=62) were male. 13.5% of the prescribed antibiotics included the drug's generic name while 95.7% were found on the WHO model formulary. Of all the prescribed antibiotics, 58% was compliant. Of the 141 antibiotics prescribed, 83% (n=117) were broad-spectrum, with amoxicillin/ clavulanic acid (48%) and amoxicillin (17%) being the most common. The most common indications were respiratory tract infections (42%) and skin, and soft tissue infections (40%). Conclusions: The WFPH emergency department had good adherence to an essential formulary and mostly complied with guidelines. However, the high number of broad-spectrum antibiotics prescribed for common infections indicate a need for further research, toward implementing a rational antibiotic prescribing policy in Trinidad and Tobago.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Serviço Hospitalar de Emergência , Hospitais Pediátricos , Trinidad e Tobago , Região do Caribe/etnologia , Prescrições
3.
In. Faculty of Medical Sciences. Faculty Research Day, Book of Abstracts. St. Augustine, The University of the West Indies, November 9, 2017. .
Não convencional em Inglês | MedCarib | ID: biblio-1007353

RESUMO

Background: Hospital crowding, ED waiting times and high demand for unscheduled care all place significant burdens on secondary care services. This impacts on patient care, staff morale and overall functioning of the whole healthcare system. Patient referrals from other healthcare providers often is a result of limited access to resources, specialists or because of acuity. However, some referrals may be more suitable for lower acuity settings, with the benefit of better overall patient experience. In addition, duplication of contacts with a healthcare professional may not result in additional benefit to patients, but may necessarily add to the patient journey and contribute to crowding. Objectives: We aimed to determine the originator of referrals to the ED. We also aimed to determine the proportion of referred patients who received any meaningful intervention at the ED. Finally, we aimed to estimate the proportion of patients referred who may have been suitable for direct inpatient referral or management in a lower acuity setting. Methods: We conducted a prospective evaluation of all referrals to the ED of a large urban hospital over 7 days. Routine anonymised demographic, diagnosis and intervention data were collected and simple descriptive analysis was undertaken using Microsoft Excel®. A validated algorithm was applied to determine suitability for lower acuity settings, and contextual secondary analysis was applied to determine choice of altResults: There were 168 formal referrals during the period evaluated (mean 24/day), of which data was available for 151. Most referrals were on Monday and Thursday. 39.7% were referred from the four regional District Health Facilities (DHF). 12 % were referred by specialists. There were significantly higher referrals from Local Health Centres located more than 5km of the hospital compared with those closer, although this could have been due to greater numbers outside the 5 km radius. 5.5% were thought suitable for primary care management and 31% could have been referred directly to an inpatient team if this were available. The majority (51.3%) of referred patients received no significant intervention in the ED, with almost 1 in 7 suitable for outpatient management. Conclusions: A significant number of patients referred to the ED may have been more appropriately directed. Direct special admission, access to outpatient referral slots or telephone advice from senior ED or specialty clinicians may prevent up to a half of referrals being seen by an ED clinician. This may reduce unnecessary transport, improve time and resource utilization and decongest the ED and hospital. Further large scale evaluation is warranted to investigate the predictors of referral, control for seniority, and make more robust recommendations for improving the patient journey ernate pathways.


Assuntos
Humanos , Masculino , Feminino , Trinidad e Tobago , Serviço Hospitalar de Emergência , Encaminhamento e Consulta
4.
In. Caribbean Public Health Agency. Caribbean Public Health Agency: 60th Annual Scientific Meeting. Kingston, The University of the West Indies. Faculty of Medical Sciences, 2015. p.[1-75]. (West Indian Medical Journal Supplement).
Monografia em Inglês | MedCarib | ID: med-17923

RESUMO

OBJECTIVE: To explore the perceptions and impact of violence experienced by Emergengy Department (ED) staff of the Princess Margaret Hospital in The Commonwealth of The Bahamas in order to inform administrative managers’ awareness and ED staff behavioural changes. DESIGN AND METHODS: A qualitative research design and interpretative epistemological view point was adopted. Purposive sampling method was utilized and 12 participants were recruited for the study. Data collected from semi-structured interviews were transcribed and thematically analysed to identify common themes. RESULTS: Five major themes were common to all interviews. Firstly, the overwhelming perception of violence was seen as an innate and inevitable ED occurrence. Secondly, facilitating elements were viewed multifactorially with verbal abuse perceived as the most common form experienced. Thirdly, personal and professional impact of ED violence was seen as having the potential to negatively affect patient care. Fourthly, support and coping measures viewed as post-incident essentials were considered lacking. Finally, suggested measures to decrease ED violence related to areas of patient, staff and ED improvements. However doubt was voiced as to the efficacy of such measures being adequately implemented. CONCLUSION: The study provided a useful insight into the perceptions and impacts of violence experienced by staff in the ED. The negative impact on staff personally was seen as having consequential negative effect on professional performance in the ED, with patient quality care ultimately being compromised. In sharing the results of this and the highlighted public health concern, awareness and behavioural changes were encouraged, along with the need for further research into this emotive issue.


Assuntos
Violência , Serviço Hospitalar de Emergência , Corpo Clínico Hospitalar , Bahamas
5.
In. Caribbean Public Health Agency. Caribbean Public Health Agency: 60th Annual Scientific Meeting. Kingston, The University of the West Indies. Faculty of Medical Sciences, 2015. p.[1-75]. (West Indian Medical Journal Supplement).
Monografia em Inglês | MedCarib | ID: med-18068

RESUMO

OBJECTIVE: To review basic, critical elements of emergency preparedness and response capacity in the healthcare system of Trinidad and Tobago. DESIGN AND METHODS: A descriptive study involving one major hospital and one randomly selected health centre in each Regional Health Authority (RHA). Responders were chosen by purposive sampling and structured face-to-face interviews were carried out. Data collection was undertaken using modified versions of two previously validated data collection tools. RESULTS: All 5 hospitals in each RHA and 4 of 5 health centres participated. Emergency response plans existed in all healthcare facilities reviewed; however plans were not regularly tested. An investigation team can be assembled in 24 hours and a patient referral system was in place in all hospitals. There appeared to be access to stockpiles in all facilities. There was a gap in ongoing infection control measures including the absence of regular personal protective equipment (PPE) training for staff. CONCLUSIONS: There was an urgent need for systematic rather than ad hoc measures for testing existing plans and staff training in their roles and responsibilities during an acute public health event should one occur. For infectious diseases with high case fatality rates such as avian influenza and Ebola, it is critical for front line staff to be aware of infection control measures including how to properly use PPE. Governments should take the opportunity of the Ebola outbreak in West Africa to utilize public health capacity to catalyse the systematic strengthening of core capacities for alert and response to meet their International Health Regulations (IHR) 2005 obligations.


Assuntos
Preparação em Desastres , Setor de Assistência à Saúde , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Avaliação da Capacidade de Trabalho , Trinidad e Tobago
6.
In. Maharajh, Hari D. ; Merrick, Joav. Social and cultural psychiatry experience from the Caribbean Region. New York, Nova Science Publishers Inc, 2010. p.193-200, tab. (Health and human development).
Monografia em Inglês | MedCarib | ID: med-17521

RESUMO

Self-poisoning by pesticides is a major public health problem, especially in agricultural communities. The purpose of this study is to investigate the pattern of poisoning of all patients admitted to an emergency care at a general hospital in Trinidad for the period 2003-2004. In a two-year retrospective study, data on self-poisoning from hospital archives were analyzed for demographic and other patterns. A total of 765 cases of self poisoning were identified. The most common source of poisoning was ingestion of pesticides (n=275, 35.9% of all cases). Differences in age and gender were found; patients with pesticide ingestion were younger (mean age 25.8 years) and more frequently female. The majority of patients with pesticide poisoning were admitted to wards and one death reported. Poisoning by pesticides is prevalent in South Trinidad. The high incidence indicates an urgent need for implementing public health strategies for prevention in keeping with the recommendations of the World Health Organization.


Assuntos
Humanos , Intoxicação , Exposição a Praguicidas , Serviço Hospitalar de Emergência , Trinidad e Tobago , Região do Caribe
7.
Emergency medicine journal ; 22: 391-392, 2005.
Artigo em Inglês | MedCarib | ID: med-17655

RESUMO

In summary, the problems of all Emergency Rooms are similar, but vary in detail. Achieving better waiting times in the Emergency Room may be at the expense of the quality of care in the entire system, if managed in isolation.


Assuntos
Humanos , Ocupação de Leitos , Serviço Hospitalar de Emergência/organização & administração , Corpo Clínico Hospitalar/organização & administração , Trinidad e Tobago
8.
West Indian med. j ; 49(Suppl. 2): 55, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-912

RESUMO

OBJECTIVE: This study documents the morbidity pattern of diseases in patients presenting to the Accident and Emergency (A&E) Unit at the University Hospital of the West Indies in Jamaica. DESIGN and METHODS: Data were retrieved from a log book kept by the nursing staff in the A&E Unit at the UHWI. This SPSS software package was used to select 100 random days in 1997. All cases treated in the A&E Unit on those days were included in the study. Data collected included demographic data, discharge diagnosis and disposal. Diagnosis were coded and classified using the International Classification of Diseases - 9th edition coding system. RESULTS: In 1997, 16,798 patients were treated in the A&E Unit during the 100 random days selected, 4611 of these were seen. Twelve cases were excluded, as the diagnoses were unknown. Some patient had more than one diagnosis and therefore, 4762 diagnoses were made in 4599 patients. The mean age was 34ñ 24 (SD) years. The male to female ratio was 1.8:1. Injuries and poisoning accounted for 31 per cent of cases. Respiratory diseases were the next most prevalent (16.2 percent). Cardiovascular and digestive diseases accounted for 5.8 and 10.5 per cent of cases, respectively. Infectious diseases accounted for only 1.75 per cent of cases; 71.7 per cent of patients were discharged home, 23.5 per cent admitted and 4.2 per cent transferred to another institution. The mortality rate was 0.6 per cent. CONCLUSIONS: The pattern of diseases seen in this study demonstrates epidemiologic transition where injuries, cardiovascular and other chronic diseases are evolving as the most prevalent conditions seen. This is now seen frequently in the Caribbean and other developing countries. (Au)


Assuntos
Feminino , Humanos , Masculino , Inquéritos de Morbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Coleta de Dados , Fatores Epidemiológicos , Jamaica , Doença Crônica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Ferimentos e Lesões/epidemiologia
9.
West Indian med. j ; 49(Suppl 2): 46, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-933

RESUMO

OBJECTIVES: To describe trends in asthma visits to Accident and Emergency (A&E) facilities during 1997 and to examine their associations with climatic conditions. DESIGN AND METHODS: A census of patients with asthma, defined as those who required brochodilator nebulization, was taken at five A&E facilities in Trinidad. Data on patients' age, gender and date of visit were obtained from the A&E records and, climate variables, including rainfall, temperature, relative humidity, and wind speed, were obtained from the Meteorological Office. RESULTS: There was a total of 27,848 asthma visits to the five facilities during 1997, of which the paediatric population(<16 years) accounted for 43 percent. There were steady increases in adult and elderly visits from January to December. A sharp increase in paediatric visits was observed in September, which coincided with the start of the school year. The results of multiple regression analysis indicated that paediatric visits to the A&E were positively associated with temperature and wind speed, while adults' visits were positively associated with temperature and relative humidity. None of the climatic variables predicted asthma visits in the elderly. CONCLUSION: There is a need for further research to explain the increase in paediatric visits at the start of the school year as well as to elucidate the mechanism for the observed associations between climate and asthma visits. (Au)


Assuntos
Adulto , Criança , Pessoa de Meia-Idade , Idoso , Humanos , Asma/epidemiologia , Serviço Hospitalar de Emergência/tendências , Coleta de Dados , Trinidad e Tobago , Efeitos do Clima , Umidade/efeitos adversos
10.
West Indian med. j ; 47(Suppl. 4): 20-1, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1304

RESUMO

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak - particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.(Au)


Assuntos
Idoso , Humanos , Atenção à Saúde , Erupções Vulcânicas , Serviços de Saúde Comunitária/organização & administração , Continuidade da Assistência ao Paciente , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Contaminação de Alimentos , Educação em Saúde , Serviços de Saúde para Idosos/organização & administração , Vigilância da População , Administração em Saúde Pública , Saneamento/classificação , Índias Ocidentais , Salas Cirúrgicas/organização & administração , Ambulatório Hospitalar/organização & administração
11.
West Indian med. j ; 47(suppl. 2): 22, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1914

RESUMO

We studied attendance for acute asthma at an Accident and Emergency department over a three-month period. Clinical details were recorded for 1248 subjects with an estimated ascertainment rate of 54 percent. Of 1213 subjects with known age, there were 453 (37 percent) aged 0-11 years, 141 (12 percent) aged 12-17 years, and 619 (51 percent) aged 18 years or older. There were 846 (70 percent) Afro-Trinidadian; 751 (62 percent) had previous attacks; and 667 (55 percent) had previous hospital admissions. Indicators of the severity of the attack were recorded as follows; heart rate, 968 (80 percent). respiratory rate, 985 (81 percent), peak flow rate, 495 (41 percent). The patient's usual maintenance treatment included inhaled salbutamol in 767 (63 percent) and inhaled corticosteroid in 286 (24 percent). Inhaled corticosteroids were more often used by patients aged > 18 years or who had previous hospital admissions for asthma. The acute attack was treated with nebulized salbutamol in 1031 (85 percent), nebulized atrovent in 769 (63 percent), intravenous corticosteroids in 268 (22 percent) or oral corticosteroids in 370 (31 percent). Overall corticosteroids were given in the acute attack to 623 (51 percent), corticosteroids were more often given to those > 18 years and those with higher respiratory rates (OR 1.41, 95 percent CI 1.02 yo 1.96). Only 247 (20 percent) had planned follow up arrangements recorded. We conclude that asthma attacks are common and often recurrent. Prophylactic treatment with inhaled corticosteroids may be under-utilized. Acute attacks are mostly treated with bronchodilators. Planned follow-up is not usual. It is possible that morbidity might be reduced through greater use of prophylactic treatment in those with recurrent symptoms.(AU)


Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Asma/epidemiologia , Trinidad e Tobago/epidemiologia , Serviço Hospitalar de Emergência , Asma/tratamento farmacológico
12.
WEST INDIAN MED. J ; 46(suppl. 2): 45, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2441

RESUMO

The records of 653 adult HIV-positive patients, covering the period July 1984 to June 1995, were reviewed to determine patient contact with surgical services at the Queen Elizabeth Hospital (QEH). The relationship of the Accident & Emergency (A&E) attendance prior to admission and survival was also assessed for first respiratory admissions. The balance of care between the HIV clinic at the QEH and the A&E department was also assessed. Surgical outpatient contact chiefly comprised consultations for ano-genital warts and follow appointment after admissions. There were 50 admissions (5 deaths) on the surgical wards out of a total of 1059 admissions. Ischiorectal abcesses were the cause of eight admissions and five patients were admitted after a fight; other admissions were for a wide range of reasons. Eight patients had a lymph node biopsy (4 whilst on medical wards) reflecting the conservative approach to lymphadenopathy in Barbados. Admission from the A&E was the most frequent route of admission associated with a worse outcome. There was no trend to decrease involvement in ambulatory care by A&E over time. In conclusion, the audit has shown that the A&E Department must be a focus for improving care. (AU)


Assuntos
Humanos , Síndrome de Imunodeficiência Adquirida , Serviço Hospitalar de Emergência , Barbados
13.
Kingston; s.n; 1997. 46 p.
Tese em Inglês | MedCarib | ID: med-1931

RESUMO

Orthopaedic injuries continue to be a major public health problem as they contribute to increased morbidity and mortality. This retrospective study was done among adolescents and young adults presenting during the period 30th November 1995 to 1st January 1996 and examined orthopaedic presentations and outcomes in adolescents and young adults at the Accident and Emergency Unit of the University Hospital of the West Indies (UHWI). Data was collected using a data collection sheet; 108 cases were collected during the period. Males accounted for 67 percent of the orthopaedic injuries, and females, 32.5 percent of injuries. Bone injuries were the commonest, accounting for 55.2 percent of injuries, liagments/soft tissue 22.8 percent, blood vessels 13.8 percent, muscle 4.0 percent, tendons 1.6 percent, nerves 1.6 percent, joints 0.8 percent. Falls and slips were the major contributor to injuries, with 52.7 percent followed by violence with 24 percent, motor vehicular accidents with 20.3 percent and sporting injures with 2.7 percent. Most patients were treated as out patients. Of this category, 91.6 percent received outpatient care and 8.3 percent impatient care, while 97.2 percent received closed reduction and 2.7 percent open reduction. Many patients received drug therapy, 69.3 percent (75 patients). The outcome varied with 64.8 percent being able to function partially and 32.4 percent fully functional on discharge in comparison to the 25 percent follow up, in which 20 percent was partially ambulant, unlike 80 percent who were fully functional within 3 months of follow up. A small number, 20 percent were affected for a longer period. The majority of injuries were outside of school time and therefore did not affect attendance. (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Ortopedia , Serviço Hospitalar de Emergência , Ferimentos e Lesões/epidemiologia , Jamaica , Acidentes
14.
Pediatr Emerg Care ; 12(6): 411-5, Dec. 1996.
Artigo em Inglês | MedCarib | ID: med-2105

RESUMO

PURPOSE: To describe the causes and outcomes of pediatric injuries using the emergency departments (ED) as a surveillance site. METHOD: Prospective, 14-days surveys of all injuries were conducted in the EDs of the two national trauma referral hospitals of Trinidad and Tobago. Data on patient demographics, type, cause, and outcome of injuries were collected. The chi 2 test for significance was was used for categorical variables. RESULTS: Pediatric patients (< 20 years) accounted for 41.5 percent (714/1722) of injury visits. Of these, 62.6 percent were male and 17.4 percent were < four years old, 26.2 percent four to nine years, 31.1 percent 10 to 14 years, and 25.4 percent were 15 to 19 years old. Three patients (0.4 percent) died, 68.6 percent were discharged, and 31.0 percent admitted. Intentional injuries accounted for 13.9 percent of injuries. Of the intentional injuries, the assailant was significantly more likely to be known than not (P < 0.01). The most common causes of all injuries were: falls, 44.4 percent; blunt objects, 12.3 percent sharp objects, 11.8 percent; motor vehicle (including pedestrians), 7.4 percent; poison, 3.6 percent and burns 1.7 percent. Injuries occurring in the home accounted for 46.2 percent in school, 25.5 percent; sports/recreation, 11.1 percent and at work, 4.5 percent. The contusion/abrasions, 26.7 percent fractures, 18.8 percent; and sprains/dislocations, 9.4 percent. CONCLUSION: Pediatric injuries are significant cause of morbidity and mortality in this country, accounting for almost one third of injured patients. Because of the low frequency of pediatric injury deaths, ED surveillance may be a more effective means of identifying high risk groups and activities for injuries. Data from the EDs may be useful in other developing countries to develop injury prevention programs.(AU)


Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Ferimentos e Lesões/epidemiologia , Estudos Prospectivos , Pediatria , Serviço Hospitalar de Emergência/estatística & dados numéricos , Países em Desenvolvimento , Distribuição por Idade , Centros de Traumatologia/estatística & dados numéricos , Trinidad e Tobago/epidemiologia , Violência , Ferimentos e Lesões/classificação , Ferimentos e Lesões/etiologia
15.
Kingston; s.n; 1996. vi,64 p. tab, graphs.
Tese em Inglês | MedCarib | ID: med-2932

RESUMO

Trauma in children continues to be a major public health problem and contributes significantly to mortality and morbidity rates. This cross-sectional study was aimed at describing children 0-10 years who presented at the University Hospital of the West Indies (UHWI) with trauma over two months and examined the aetiological agents and the impact of injury on each child. The socio economic status of children was also investigated. This study allowed for comparison with that of Bean (1995). Data was collected through an administered questionaire from 57 respondents. The findings revealed that 22 percent of the total number of children seen were trauma cases. There was a higher percentage of trauma among males (65 percent) as compared to females (35 percent). The 5-10 years age group was the one most affected. Limb injury ranked highest followed by head injury, and deep wound and bruising accounted for the highest percentage of injuries sustained. One child perished from choking while eating. A relative including mother or father supervised the child on 67 percent of times. The need of constant supervision of the child must be stressed. Health education and health promotion programmes using an intersectoral approach, with full community participation is important. Special target groups and the population at large should be involved. Alliances should be made with the electronic and print media to promote injury prevention messages all year round. (AU)


Assuntos
Humanos , Criança , Feminino , Masculino , Lactente , Pré-Escolar , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/epidemiologia , Acidentes , Jamaica , Serviço Hospitalar de Emergência
16.
Kingston; s.n; 1996. vi,51 p.
Tese em Inglês | MedCarib | ID: med-2940

RESUMO

The health care services in Jamaica are provided free or at a nominal charge to all citizens. Services range form a broad primary health care network to sophisticated tertiary care, and most Jamaicans have relatively easy access to all levels of health care service. A survey was conducted by means of a questionaire on a sample of 130 clients selected from the primary (Department of Social Preventive Medicine) and tertiary health care facilities (A/E UHWI) during February and March, 1996. Factors influencing client's choice were analyzed to determine reasons for bypassing the primary care facility resulting in the inefficient use of more specialized resources at the tertiary level. The results revealed that clients visiting the primary care facility (DSPM) resided within an estimated mean distance of 1.7 miles from the clinic and 4.3 miles from the tertiary care facility (A/E - UHWI). With respect to the distance travelled, transportation costs and time, the tertiary care facility (A/E -UHWI) was less accessible. The majority (94 percent) of clients visiting the primary facility, were able to commute within less than half an hour to access care at this facility. Also, those commuting paid less in transportation cost than those who visited the tertiary facility. Females were significantly (p<0.01) more likely to visit both health facilities than males. However in the 5 pm - 8 am and weekend time frames at the tertiary level, males out numbered the females 60 to 40 per cent. The majority of clients visiting both health facilities were in the under 20 and 20 - 39 age group. In terms of the clients' health seeking behaviour, 71 and 51 per cent utilized the primary and tertiary health care facilities respectively, as a first option for health care. Self referrals accounted for the highest percentage (60 percent) of all sources to the tertiary facility (A/E - UHWI). Of this total, 68 per cent was during the 5 pm - 8 am and weekend time frames. It was the finding also that the estimated waiting time for a doctors' consult was 55 minutes on average at the primary facility (DSPM) than the tertiary (A/E - UHWI). There were no significant differences in the level of satisfaction of the services received by clients visiting facilities. However 62 per cent were dissatisfied with the opening hours of the primary care facility. (AU)


Assuntos
Humanos , Adulto , Feminino , Masculino , Adolescente , Idoso , Lactente , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde , Serviços de Saúde/estatística & dados numéricos , Jamaica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde
18.
J Trauma ; 36(3): 391-4, Mar. 1994.
Artigo em Inglês | MedCarib | ID: med-8332

RESUMO

Over a 9-year period (July 1981-December 1985--pre-ATLS period; January 1986-June 1990-post-ATLS period), the hospital charts of 813 trauma patients with ISS > or = 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The freqeuncy of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access(i.V.), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies ( percent) were 83.5 vs. 65.3 for ET, 97.3 vs 98.0 for i.v., 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emergency room these frequencies ( percent) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for i.v., 11.0 vs. 97.1 for Foley 3.2 vs. 95.9 for NG, and 3.9 vs for CT. The differences in the application of these life saving procedures between the pre-ATLS and the post ATLS periods were statistically significant (p < 0.05) except i.v. access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patientys with severe chest injuries (AIS > or = 3) 87.7 percent and chest tubes post ATLS (94.4 percent in ER) compared with 48>1 percent pre ATLS (3.2 percent in ER). These differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS (AU Truncated at 250 words)


Assuntos
Humanos , Cuidados para Prolongar a Vida , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Cateterismo Periférico/estatística & dados numéricos , Tubos Torácicos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Intubação Gastrointestinal/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Trinidad e Tobago/epidemiologia , Cateterismo Urinário/estatística & dados numéricos
19.
West Indian med. j ; 42(2): 53-6, June 1993.
Artigo em Inglês | MedCarib | ID: med-9603

RESUMO

A random prospective study of 640 victims (76.6 percent) in the 15-39-year-old age group) of interpersonal violence (IPV) at the Kingston Public Hospital was conducted over three months. About 87.5 percent of the aggression on males and 74.5 percent on females was committed by males. However, there was more female/female than female/male violence. Weapons used ranged from guns to a variety of cooking wares, though knives were used most frequently (34.8 percent) for stabbing 48 percent of the victims. Head, neck and upper limb were the main sites of injury; only 13.4 percent of all the injured had complications, and 63 percent of these required hospitalization. Family members and acquaintances contributed to about 84 percent of the violence. Instinctive spontaneous aggression aimed at maiming the victim characterizes IPV in Jamaica. The Jamaican taxpayer bears 90-94 percent of the cost of managing trauma injuries. These costs should be recovered from the assailants, even in the form of blood donations and community service. (AU)


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Serviços de Saúde/economia , Violência , Ferimentos e Lesões/economia , Serviço Hospitalar de Emergência/economia , Distribuição por Idade , Distribuição por Sexo , Jamaica , Família , Relações Interpessoais , Armas de Fogo , Atenção à Saúde/economia
20.
West Indian med. j ; 42(Suppl. 1): 26, Apr. 1993.
Artigo em Inglês | MedCarib | ID: med-5151

RESUMO

The registers of the Casualty Department at the Marigot District Hospital, a 26-bed primary care facility, were analyzed for morbidity and utilization patterns, using the International Classification of Primary Care. From 1st October, 1991 to 30th September, 1992, a total of 9,504 encounters was recorded with a daily average attendance of 26 patients. A random 1 in 4 sample of records was analysed. Most patients came from Marigot village. The bulk of encounters (40.3 per cent) was for skin conditions. Of these, a third required only routine wound care. Other major reasons for encounter (REF) were abdominal pain, daily insulin treatment, musculoskeletal complaints, fever, cough and common cold and gastroenteritis. Circulatory, gynaecological and obstetrical conditions were relatively rare, the latter being attributed to the effective linkage of midwives with the obstetrical wards of the central referral hospital. Twenty to 25 per cent of all encounters were for strictly primary care activities such as routine wound care and administering of medication. A significant proportion of (19 per cent) was made up of children aged 0 - 4 years, mainly for cough and the common cold, gastroenteritis and skin conditions. A quarter of the patients seen were referred to the medical officer or family nurse practitioner, 4.3 per cent were admitted to the district hospital and 2.1 per cent referred to the central referral hospital (AU)


Assuntos
Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dominica , Serviços de Saúde/estatística & dados numéricos
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