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1.
Adv Med Educ Pract ; 7: 605-610, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27822131

RESUMO

In the late 20th century, the volume and complexity of laparoscopic operations being performed have increased worldwide. However, surgical practice lagged behind in the Caribbean region. This article reports a tailored approach to initiate advanced laparoscopy in Guyana, which can be used as a model to initiate laparoscopic services in other developing nations. This can be achieved in four stages: 1) relying on regional proctors to teach laparoscopic techniques adapted to resource-poor environments, 2) focusing on developing skill sets such as laparoscopic suturing in order to rely less on expensive consumables, 3) creating partnerships that include all stakeholders, and 4) collaborating with regional experts as a valuable resource for continued medical education, multidisciplinary support, and sharing learning experiences.

2.
J Infect Dev Ctries ; 10(10): 1088-1092, 2016 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-27801371

RESUMO

INTRODUCTION: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. METHODOLOGY: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. RESULTS: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). CONCLUSION: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.


Assuntos
Fidelidade a Diretrizes , Higiene das Mãos/métodos , Pessoal de Saúde , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Hospitais Universitários , Humanos , Jamaica , Estudos Prospectivos
3.
J Multidiscip Healthc ; 7: 227-30, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24920917

RESUMO

INTRODUCTION: By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes. METHODS: This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles. CONCLUSION: Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

4.
Trop Doct ; 44(3): 166-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24595216

RESUMO

BACKGROUND: Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated. METHODS: Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010. RESULTS: There were 26 cases of tetanus (annual incidence of 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases. CONCLUSIONS: Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.


Assuntos
Tétano/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
5.
Perm J ; 17(3): e114-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24355900

RESUMO

CONTEXT: Infection control interventions are important for containing surgery-related infections. For this reason, the modern operating room (OR) should have well-developed infection control policies. The efficacy of these policies depends on how well the OR staff adhere to them. There is a lack of available data documenting adherence to infection control policies. OBJECTIVE: To evaluate OR staff adherence to existing infection control policies in Jamaica. METHODS: We administered a questionnaire to all OR staff to assess their training, knowledge of local infection control protocols, and practice with regard to 8 randomly selected guidelines. Adherence to each guideline was rated with fixed-choice items on a 4-point Likert scale. The sum of points determined the adherence score. Two respondent groups were defined: adherent (score > 26) and nonadherent (score ≤ 26). We evaluated the relationship between respondent group and age, sex, occupational rank, and time since completion of basic medical training. We used χ(2) and Fisher exact tests to assess associations and t tests to compare means between variables of interest. RESULTS: The sample comprised 132 participants (90 physicians and 42 nurses) with a mean age of 36 (standard deviation ± 9.5) years. Overall, 40.1% were adherent to existing protocols. There was no significant association between the distribution of adherence scores and sex (p = 0.319), time since completion of basic training (p = 0.595), occupational rank (p = 0.461), or age (p = 0.949).Overall, 19% felt their knowledge of infection control practices was inadequate. Those with working knowledge of infection control practices attained it mostly through informal communication (80.4%) and self-directed research (62.6%). CONCLUSION: New approaches to the problem of nonadherence to infection control guidelines are needed in the Caribbean. Several unique cultural, financial, and environmental factors influence adherence in this region, in contrast to conditions in developed countries.


Assuntos
Competência Clínica , Protocolos Clínicos , Países em Desenvolvimento , Fidelidade a Diretrizes , Política de Saúde , Controle de Infecções/normas , Salas Cirúrgicas/normas , Adulto , Infecção Hospitalar , Feminino , Humanos , Controle de Infecções/métodos , Comportamento de Busca de Informação , Jamaica , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
6.
Perm J ; 17(3): e121-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24355903

RESUMO

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.


Assuntos
Atenção à Saúde , Países em Desenvolvimento , Recursos em Saúde , Hospitais Públicos , Liderança , Salas Cirúrgicas , Setor Público , Cirurgia Geral , Objetivos , Humanos , Jamaica
7.
Perm J ; 17(4): 22-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24361016

RESUMO

OBJECTIVE: This study was performed to evaluate the presurgical informed consent process at a training hospital in Jamaica. METHODS: A postoperative survey was administered to all consecutive able and willing adult patients who underwent the presurgical informed consent process with surgical residents during a 5-week period. Information was collected on patient demographics and patients' perception and satisfaction with the informed consent process. RESULTS: There were 210 surveys completed. Patients were unaware of the training status of the physician involved with their presurgical informed consent process in 48% of cases. Nineteen (9%) patients were instructed to sign a consent document without any discussion. An attempt was made to secure a signature after some discussion with the remaining 191 patients. Patients reported that details of the operation were discussed 74% of the time; potential benefits of the surgery, 72% of the time; potential morbidity, 84% of the time; potential mortality, 19% of the time; predicted postoperative course, 49% of the time; projected recovery, 26% of the time; and other treatment options, 33% of the time. Forty-five patients believed that they were instructed to sign the consent document with minimal discussion. At termination of the consent process, only 70% of the 210 patients reported that they signed the consent form voluntarily. Overall, 67% of patients thought the current informed consent process was unsatisfactory. CONCLUSION: The current informed consent process in use in the surgical training program at the University Hospital of the West Indies requires improvement to meet expected ethical and legal standards.


Assuntos
Comunicação , Educação Médica/normas , Cirurgia Geral/educação , Hospitais Universitários , Consentimento Livre e Esclarecido/normas , Satisfação do Paciente , Melhoria de Qualidade , Adolescente , Adulto , Idoso , Conscientização , Termos de Consentimento , Revelação , Ética Médica , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários/normas , Humanos , Consentimento Livre e Esclarecido/ética , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Índias Ocidentais , Adulto Jovem
8.
Prehosp Disaster Med ; 27(3): 299-302, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22853919

RESUMO

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol. While multiple errors can occur during a mass-casualty event, these can be reduced by frequent simulation exercises during which various personnel practice and learn designated roles. Efficient triage, proper communication, and knowledge of the roles are important in ensuring the best possible outcome. While the triage system and response of the EMS personnel were effective for this magnitude of catastrophe, more work is needed in order to meet predetermined standards. Ways in which this can be overcome include: (1) hosting more disaster simulation exercises; (2) encouraging more involvement with first responders; and (3) strengthening the links in the local EMS system. Vigorous public education must be instituted and maintained.


Assuntos
Acidentes Aeronáuticos , Serviços Médicos de Emergência/organização & administração , Incidentes com Feridos em Massa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Masculino , Pessoa de Meia-Idade , Triagem
9.
J Inj Violence Res ; 2(1): 55-60, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21483199

RESUMO

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical services in Jamaica. We explore the existing strategies and legislative policies that may prevent or reduce the severity of these injuries in Jamaica. This is an important aspect of health care as it may minimize the impact of these preventable injuries on the limited resources of the health services.


Assuntos
Acidentes de Trânsito/legislação & jurisprudência , Serviços Médicos de Emergência/legislação & jurisprudência , Motocicletas/legislação & jurisprudência , Prevenção Primária/legislação & jurisprudência , Segurança/legislação & jurisprudência , Acidentes de Trânsito/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Dispositivos de Proteção da Cabeça , Comportamentos Relacionados com a Saúde , Humanos , Jamaica , Motocicletas/estatística & dados numéricos
10.
BMC Res Notes ; 2: 252, 2009 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-20003471

RESUMO

BACKGROUND: Medical students at the University of the West Indies receive clinical training by passing through a series of hospital rotations at the University Hospital of the West Indies (UHWI). Many of these patients are unaware that medical students may be involved in their care. We performed this study to determine patient awareness and their willingness to participate in research and teaching activities. FINDINGS: All consecutive patients admitted to the UHWI between May 1, 2006 and May 29, 2006 who required elective or emergency surgical procedures were prospectively identified These patients were interviewed using a standardised pre-tested questionnaire about their knowledge and willingness to have medical students participate in the delivery of their hospital care. Data was analyzed using SPSS Version 12.0. There were 83 (39.5%) males and 127 (60.5%) females interviewed. The patients were unaware of the grade of the medical professional performing their interview/examination at admission in 157 (74.8%) cases or the grade of medical professional performing their operations in 101 (48.1%) cases. Only 14 (6.7%) patients were specifically asked to allow medical students to be present during their clinical evaluation and care. When specifically asked, 1 patient declined. Had they been asked, 196 (93.3%) patients would have voluntarily allowed medical student involvement. Only 90 (42.9%) patients were made aware that they were admitted to an academic centre with research interests. Only 6 (6.7%) patients declined. Had they been asked, 84 (93.3%) patients would be willing to participate in teaching or research projects. CONCLUSIONS: As medical educators, we are responsible to adhere to ethical and legal guidelines when we interact with patients. It is apparent that there is urgent need for policy development at the UWI to guide clinicians and students on their interactions with patients.

11.
BMC Res Notes ; 2: 172, 2009 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-19715612

RESUMO

BACKGROUND: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica. METHODS: A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12. RESULTS: Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries. CONCLUSION: Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.

12.
Stroke ; 40(5): 1892-3, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19246696

RESUMO

BACKGROUND AND PURPOSE: The purpose of this study was to determine the prevalence of carotid stenosis among patients presenting to the University Hospital of West Indies (UHWI) Accident and Emergency Department (A&E) with an ischemic stroke or transient ischemic attack (TIA). METHODS: Beginning in August 2006, all patients presenting to the UHWI A&E with an acute stroke or TIA were screened for enrollment. Patients were excluded if they had a hemorrhagic stroke or if informed consent could not be obtained. Demographic and clinical information were collected by chart review and interviewer-administered questionnaires. All participants had noncontrast head computed tomography (CT) and bilateral carotid duplex ultrasounds. RESULTS: 133 patients were enrolled in the study. 90% presented with a stroke and 10% with a TIA. Mean age was 64 years, 52% were male, 96% self-identified as black. 78% had diabetes mellitus or hypertension or both, 27% were current or past smokers. 65.1% had a normal carotid ultrasound, 28.5% had <50% stenosis, 1.6% had 50% to 69% stenosis, 0.8% had >or=70% stenosis to near occlusion, 1.6% had near occlusion and 1.6% total occlusion. CONCLUSIONS: The prevalence of moderate or high-grade carotid stenosis in this high-risk black Caribbean population presenting with an ischemic stroke or a TIA is 5.6%. This is lower than that described in other populations. Further studies are needed to determine the cost-effectiveness of routine screening for carotid stenosis in this population.


Assuntos
Estenose das Carótidas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , População Negra , Pressão Sanguínea/fisiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/economia , Análise Custo-Benefício , Diabetes Mellitus/epidemiologia , Endarterectomia das Carótidas , Feminino , Humanos , Hipertensão/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Risco , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Índias Ocidentais/epidemiologia , Adulto Jovem
13.
BMC Emerg Med ; 8: 11, 2008 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-18847504

RESUMO

BACKGROUND: Emergency Department (ED) medical officers are often the first medical responders to emergencies in Jamaica because pre-hospital emergency response services are not universally available. Over the past decade, several new ED training opportunities have been introduced locally. Their precise impact on the health care system in Jamaica has not yet been evaluated. We sought to determine the level of training, qualifications and experience of medical officers employed in public hospital EDs across the nation. METHODS: A database of all medical officers employed in public hospital EDs was created from records maintained by the Ministry of Health in Jamaica. A specially designed questionnaire was administered to all medical officers in this database. Data was analyzed using SPSS Version 10.0. RESULTS: There were 160 ED medical officers across Jamaica, of which 47.5% were males and the mean age was 32.3 years (SD +/- 7.1; Range 23-57). These physicians were employed in the EDs for a mean of 2.2 years (SD +/- 2.5; Range 0-15; Median 2.5) and were recent graduates of medical schools (Mean 5.1; SD +/- 5.9; Median 3 years).Only 5.5% of the medical officers had specialist qualifications (grade III/IV), 12.8% were grade II medical officers and 80.5% were grade I house officers or interns. The majority of medical officers had no additional training qualifications: 20.9% were exposed to post-graduate training, 27.9% had current ACLS certification and 10.3% had current ATLS certification. CONCLUSION: The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population.


Assuntos
Competência Clínica , Medicina de Emergência/educação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Países em Desenvolvimento , Educação de Pós-Graduação em Medicina , Tratamento de Emergência/normas , Tratamento de Emergência/tendências , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Papel do Médico , Qualidade da Assistência à Saúde , Sistema de Registros , Fatores de Risco , Recursos Humanos
14.
J Neurosurg ; 109(3): 433-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18759573

RESUMO

OBJECT: We evaluated management and outcome of traumatic brain injury (TBI) in a developed country (US) and a developing country (Jamaica). METHODS: Data were collected prospectively at Grady Memorial Hospital (GMH) in the US and at University Hospital of the West Indies (UHWI) and Kingston Public Hospital (KPH) in Jamaica between September 1, 2003, and September 30, 2004. RESULTS: Complete data were available for 1607 patients. Grady Memorial Hospital had a higher proportion of females (p = 0.003), and patients were older at GMH (p = 0.0009) compared with patients at KPH and UHWI. The most common mode of injury was a motor vehicle accident at KPH and GMH (42 and 66%, respectively) and assaults at UHWI (37%). Grady Memorial Hospital admitted more patients with severe head injuries (25.5%) than KPH (18.5%) and UHWI (14.4%). More CT scans were performed (p < 0.0001) and a higher proportion of patients were admitted to the intensive care unit (p < 0.0001) at GMH. There were no statistically significant differences in median days in the intensive care unit among the 3 hospitals. Patients experienced statistically significant differences in days undergoing ventilation between GMH, KPH, and UHWI (p = 0.004). Intracranial pressure monitoring was performed in 1 patient at KPH, in 6 at UHWI, and in 91 at GMH. There were 174 total deaths, but no statistically significant differences in mortality rates between the 3 sites (p = 0.3). Hospital location and TBI severity were associated with a decreased risk of mortality; patients with severe TBI at GMH had a 53% decrease in the risk of mortality (odds ratio = 0.47, p = 0.04). Patients at GMH had lower mean Glasgow Outcome Scale scores (p < 0.0001) and lower Functional Independence Measure self-feed (p = 0.0003), locomotion (p = 0.04), and verbal scores (p < 0.0001). CONCLUSIONS: Despite the availability of advanced technology and more aggressive neurological support at GMH, the overall mortality rate for TBI was similar at all locations. Patients identified with severe TBI had a significantly decreased risk of mortality if they were treated at GMH compared with those patients treated at hospitals in the developing world.


Assuntos
Lesões Encefálicas/terapia , Protocolos Clínicos , Países Desenvolvidos , Países em Desenvolvimento , Recursos em Saúde/estatística & dados numéricos , Padrões de Prática Médica , Adulto , Lesões Encefálicas/mortalidade , Estudos de Coortes , Feminino , Humanos , Jamaica , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Estados Unidos
15.
Int J Surg ; 6(5): 387-91, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18789880

RESUMO

UNLABELLED: There is no standardised protocol for the transfer of injured patients in Jamaica, a process that is well known to be potentially hazardous. We undertook this study to evaluate the inter-hospital transfer process of injured patients in this developing country. MATERIALS AND METHODS: A prospective descriptive analytical study of all consecutive patients transferred to the University Hospital of the West Indies from other hospitals was conducted over six months. Data were collected on specially designed proformas and analysed using SPSS version 10.0. RESULTS: Of 122 patients studied, 79.5% were male and the mean age was 27.8+/-20.7 years. Most injuries resulted from road traffic accidents (40.2%), falls (27.1%) and assaults (26.2%). Several problems with the transfer process were identified. There was poor documentation of clinical parameters at referring institutions, with records of pulse rates in 13.1% (16/122), blood pressure in 9.8% (12/122), respiratory rate in 9.8% (12/122), Glasgow Coma Score in 10.6% (13/122) and pupillary reaction in 4.9% (6/122) of cases. Transfer arrangements were made by junior medical officers in 93.4% (114/122) of cases while consultants requested only 3.3% (4/122) of transfers. Public hospital ambulances transported 91.8% (112/122) of patients and 7.4% (9/122) were transported by helicopter. These vehicles were equipped with facilities for oxygen administration in 99.2% (121/122) of cases and sphygmomanometers in 91% (111/122) of cases, but functional capacity for suction was only present in 50% of vehicles. These critically ill patients were accompanied by physicians in only 11.5% (14/122) of cases, while 68.9% (84/122) were accompanied only by nurses. CONCLUSIONS: The transfer of injured patients is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardised protocol for the transfer of such patients in Jamaica.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Transferência de Pacientes/tendências , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Ambulâncias/estatística & dados numéricos , Criança , Estudos de Coortes , Países em Desenvolvimento , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/tendências , Feminino , Escala de Coma de Glasgow , Hospitais Universitários , Humanos , Escala de Gravidade do Ferimento , Jamaica , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Avaliação de Resultados em Cuidados de Saúde , Transferência de Pacientes/normas , Estudos Prospectivos , Medição de Risco , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Adulto Jovem
16.
West Indian med. j ; 49(3): 212-5, Sept. 2000. tab, graf
Artigo em Inglês | LILACS | ID: lil-291975

RESUMO

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess of subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60 percent had fever. Subdural empyema was more common than a localised intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20 percent, and 21 percent of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimise morbidity and mortality.


Assuntos
Humanos , Masculino , Empiema Subdural/mortalidade , Abscesso Encefálico/mortalidade , Infecções do Sistema Nervoso Central/cirurgia , Sinusite Frontal , Cardiopatias Congênitas , Jamaica
17.
West Indian med. j ; 49(3): 216-9, Sept. 2000. tab
Artigo em Inglês | LILACS | ID: lil-291976

RESUMO

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85 percent of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernisation of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilisation and transport, prompt resuscitation, the standardisation of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalisation of a well-coordinated and rehearsed Spine team.


Assuntos
Humanos , Masculino , Traumatismos da Coluna Vertebral/prevenção & controle , Escala de Gravidade do Ferimento , Protocolos Clínicos , Assistência ao Paciente/métodos , Ressuscitação/educação , Imobilização , Jamaica
18.
West Indian med. j ; 49(1): 66-9, Mar. 2000. ilus
Artigo em Inglês | LILACS | ID: lil-291893

RESUMO

One per cent of all brain tumours and twenty per cent of meningiomas eventually develop an extracranial extension. The least common site is the neck. We report a case of malignant meningioma with extension into the neck of a 39-year-old male.


Assuntos
Adulto , Humanos , Masculino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias Meníngeas/tratamento farmacológico , Meningioma/tratamento farmacológico , Prognóstico , Encéfalo/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Neoplasias de Cabeça e Pescoço/terapia , Jamaica , Meningioma/terapia
19.
West Indian med. j ; 45(1): 31-3, Mar. 1996.
Artigo em Inglês | LILACS | ID: lil-165477

RESUMO

An observational cross-sectional survey showed that 21.1 percent of private motor vehicle drivers and 13.5 percent of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. Of all motor vehicles examined 10.1 percent were not equipped with seat belts. The oldest group of vehicles were mostly not fitted with seat belts. Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented


Assuntos
Humanos , Feminino , Cintos de Segurança , Automóveis , Acidentes de Trânsito/estatística & dados numéricos , Fatores Sexuais , Estudos Transversais , Jamaica/epidemiologia
20.
West Indian med. j ; 44(4): 143-5, Dec. 1995.
Artigo em Inglês | LILACS | ID: lil-165467

RESUMO

A malignant triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation, and is a very rare occurrence. We describe the case of a 33-year-old man with neurofibromatosis type 1 who presented with paraplegia. Pathological examination of an intradural, extramedullary tumour excised at lumbar laminectomy demonstrated a malignant schwannoma with rhabdomyoblastic differentiation. We believe this is the first documented case of a malignant triton tumour of the spine


Assuntos
Adulto , Humanos , Masculino , Neoplasias da Medula Espinal/patologia , Neurofibromatose 1/complicações , Neurilemoma/patologia , Neoplasias da Medula Espinal/cirurgia , Evolução Fatal , Laminectomia , Neurilemoma/cirurgia
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