Treatment of acute schizophrenia in open general medical wards in Jamaica

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of thier illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More that half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and s everity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients, superior to the outcome of treatment in conventional psychiatric facilities.(Au)

Methicillin resistant Staphylococcus aureus

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6 percent of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.(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)

Neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital, Barbados, 1987-1996

This paper reports on neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital (QEH) for the period November 1987 to November 1996, and is a follow up to an earlier report for the period January 1984 to November 1987. It outlines the pattern of referral, diagnoses, referral centres and costs based on examination of the files of all QEH patients transferred overseas under a government aided scheme. There were 203 transfers of 191 patients (69 males, 122 females) including 10 patients who were transferred twice and one patient who was transferred three times. Patients ages ranged from 1 to 80 years (mean 37 years). Twenty overseas centres were used during the period but most patients were transferred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center, New York, between 1989 and 1994, and Hospital de Clinicas Caracas, Venezuela (1992 to 1996). 65 percent of the referrals were for neurosurgery and 25 percent were for magnetic resonance imaging scans for diagnosis. The largest diagnostic categories were central nervous system tumors (40 percent) and subarachnoid haemorrhage (25 percent). Estimated costs reached almost BDS$11 million, but the mean actual cost was BDS$63,916 based on information from 123 patient transfers. Thus, the actual total government expenditure was probably closer to BDS$13 million. This study demonstrates the urgent need to establish a neurosurgical service at the QEH and the cost effectiveness of doing so.(AU)

Progressive statistical report: 1993

This booklet documents the performance of all clinic and ward operations within the Institution, including Auxillary Services such as, Pharmacy, Social Work, Physiotherapy and Nutrition and Dietetics. Pertinent information is illustrated in Statistical Format accompanied by supporting statements on the overall performances/progress of each area. Comparisons are also given and are illustrated through graphs for greater clarity. (AU)

Pre-admission treatment in childhood diarrhoeal diseases, Port-of-Spain General Hospital

The case records of 1295 children admitted to the Gastroenteritis Unit, Port-of-Spain General Hospital were reviewed. Data on age, mode of referral, pre-admission treatment, in hospital management and outcome were analysed. Of the 192 cases referred, 169 were referred by general practitioners, 18 by health centres and 3 by paediatricians. The bulk of admissions (1165) were however, self-referrals. 82 (46 percent) of the cases referred by general practitioners had documented evidence of pre-admission treatment. Only 7 (8.5 percent) received the recommended treatment with rehydration salts. The rest (91.5 percent) were treated with antidiarrheals, antibiotics or antiemetics. Lack of effectiveness of drug therapy, use of ORF (oral rehydration fluid) and health education are emphasized. (AU)

Deaths within 24 hours of surgical procedures at the Port-of-Spain General Hospital (January, 1976 to December, 1987)

Mortality, possibly related to anaesthesia, was reviewed prospectively over a 12-year period. There were 186 deaths in 129,107 anaesthetics. Mortality was predominantly confined to the 15 - 44, and 45 - 64 -year age groups. The overall mortality rate was 1:694. Sixteen deaths were directly related to regional and local anaesthesia and three were directly related to general anaesthetic management. In 66 deaths, general anaesthesia was considered to be contributory, and 101 deaths were considered to be unassociated with anaesthesia (AU)