The simulated Trauma Patient Teaching Module--does it improve student performance?

BACKGROUND: Student feedback from the old TEAM (Trauma Evaluation and Management) program prompted introduction of simulated trauma patient models in the new program. Performance after the new and old programs was compared to assess the impact of the simulated patient models. METHODS: Final year medical students randomly assigned to control and experimental groups completed a 20-item trauma multiple choice questionnaire examination (MCQE). The experimental groups attended the old or new TEAM program before completing a second MCQE and the control groups completed the same post-test without the TEAM programs. We used paired t tests for within and unpaired t tests for between group comparisons of the control and experimental groups' performances on the MCQ pre- and post-tests. On a 1 to 5 scale, students graded if objectives were met; trauma knowledge improved; trauma skills improved; overall satisfaction; and if TEAM should be mandatory. RESULTS: Post-test scores increased significantly after both the old and new programs but the increase was statistically significantly greater after the new program. In the old TEAM, 51.6% rated improvement in trauma skills at 4 or greater compared with 97.3% in the new program. A large percentage of students in the old program requested more hands-on teaching. Of students, 85% scored honors pass mark after completion of the new TEAM format, and no honors pass marks were achieved after completion of the old TEAM format. CONCLUSION: Simulated trauma patient models were rated highly and improved both trauma skills and knowledge. Wider application of these teaching models is suggested.

Surgically treated cerebral aneurysms in south Trinidad: twenty years experience 1986-2005.

INTRODUCTION: For many years the treatment of cerebral aneurysms was surgical - clipping or wrapping. In recent years however, interventional radiology is available with techniques of coiling and stenting. The current treatment of any aneurysm is based on a combination of interventional and surgical techniques and in many cases the final treatment is interventional. It may be useful to document surgically treated aneurysms at San Fernando General Hospital serving a population area of half million in south Trinidad in the twenty years 1986-2005 before the advent of interventional radiology in Trinidad which became available in late 2005

Clinical neurophysiology in Trinidad and Tobago - abstract

The clinical neurophysiological techniques available in Trinidad and Tobago are electroencephalography (EEG) nerve conduction studies (NCS) and electromyography (EMG). Two hundred consecutive EEGs and 100 consecutive NCS and 27 EMGs were retrospectively evaluated to determine the usefulness of these studies. EMGs were done on a Grass model 8/10 D, 8 channel recorder. The commonest symptoms investigated were seizures (78), headaches (42), post concussion syndrome (41), cerebral contusion (19), blackouts (17), dizziness (7) and stroke syndrome (7). Seizure were confirmed in 27:18, generalised; 7, focal, and 2, focal spreading to generalised. One showed the petit mal pattern of 3 per second spike and wave and another hypsarrhythmia. Eight out of 16 with febrile convulsions had paroxysmal activity. Of patients with headaches, 8 were abnormal, showinf focal slowing (6) and diffuse slowing (2). All patients with blackouts had normal tracings. Slow activity eas seen in 2 cases of dizziness and in 5 of stroke syndrome. In post concussion, 5 showed slowing and 1 sharp activity. NCS and EMG were done on a TECA model B6 machine. NCS were most commonly done on median nerve (75), ulnar (48), radial (15), and peroneal (20). EMG most frequently tested the biceps and deltoid. NCS confirmed compression of the median nerve (carpal tunnel syndrome) in 23, ulnar in 1, peroneal in 2 and medial plantar (tarsal tunnel syndrome) in 1. NCS also confirmed injury in the median nerve (6), ulnar (1), radial (4), multiple upper extremity nerves (2), brachial plexus 1, sciatic (1) and peroneal (1). Four cases of peripheral neuropathy indicated Guillan-Barre in 2 and motor neurone disease was suggested in another 4. EMG confirmed nerve injury and various stages of recovery in 9, motor neurone disease in 5 and myasthenia gravis in 1. EEG was useful in selecting patients for further studies. NCS identified specific nerve compression or injury and further evaluated cases of generalised neuropathy. EMG served to clarify and determine prognosis in nerve injury and compression and was valuable in the evaluation of generalised nerve and primary muscle disease (AU)

Cranial computerized axial tomography (CAT scanning) in Trinidad - abstract

Cranial computerized axial tomography (CAT Scanning) in Trinidad was studied retrospectively to determine the impact of computerized tomography (CT) in neurodiagnosis and patient care. Using a EMI 5005 modified scanner, 213 scans were done - 206 from Trinidad, 2 from Tobago and 5 from other West Indian territories. One hundred and thirty-six scans were normal and 77 were abnormal. The commonest CT diagnoses were cerebral infarctions (21), cerebral atrophy (12), hydrocephalus (8) and 17 primary and 5 metastatic brain tumours. Also seen were cerebral abscesses (2), subdural haematomata (2), arteriovenous malformations (2), cerebral oedema (1) and empty sella turcica (1). The commonest symptoms investigated were headaches, seizures and hemiparesis. Headache scans yielded only 6 abnormal scans out of 58, but the yield was high in seizures (12 of 41) and hemiparesis (11 of 21). Sixty-four doctors comprising 4 neurosurgeons, 2 physicians doing predominantly neurology, 31 specialists and 25 general practitioners referred patients. Montly referral rates gradually increased, and 5 new doctors used the scan each month. Neurosurgeons and physicians doing neurology had 45 abnormal scans out of 110 ordered, while specialist physicians had 27 out of 70 and general practitioners 5 out of 33. When compared to the previous six months (without CT), there was a dramatic reduction in invasive neuroradiological procedures - angiograms from 64 to 22, pneumoencephalograms from 52 to 24 ventriculograms from 12 to 3, indicating reduction by 66 percent, 54 percent and 75 percent respectively (AU)

True benign intracranial hypertension: a preliminary study - abstract

Benign intracranial hypertension (BIH) is a syndrome of raised intracranial pressure of uncertain cause, causing headaches, papilloedema and visual impairment. It requires diuretics, corticosteroids and sometimes cerebrospinal fluid drainage. The cases encountered in Trinidad and Tobago, however, seemed to represent a truly benign form of the condition and were further studied because of this observation. Twenty-three cases seen at Port-of-Spain General Hospital in the 5-year period July, 1980 to June, 1985 were studied retrospectively. All were female, mainly housewives, almost always of plump morphology, usually in the 20 to 30-year age froup and predominantly of African extraction. The most frequently symptoms were headaches (21), diminished vision (6) and diplopia (4). Five were pregnant. All had papilloedema and seven had 6th nerve palsy. Visual examination was normal in 18 cases, slightly impaired in 4, moderately impaired in 1; in 1 there was contracted visual fields. Skull X-ray showed deep or globular sella turcica in 8 cases (35 percent). Carotid angiogram in 13 and computerised axial tomogram in 7 were normal. Cerebrospinal fluid pressure was elevated to 400-190 mm of CSF in the 6 cases tested. Endocrine studies showed 3 elevated Prolactin level (35, 37 and 46 ng/ml). One was on oral contraceptives, 1 had sickle-cell disease and 1 had a sibling with reported BIH. Treatment was with Diamox and corticosteroids in 6 cases, steroids only in 5, Diamox only in 7, and 2 cases had Diamox and repeated spinal taps, 1 twice, the other 4 times; 3 cases needed no treatment. All improved, usually with complete resolution of symptoms. In no cases were there severe complications. True benign intracranial hypertension (TBIH) seems to describe these cases better than the BIH eponym. It is a distinct entity and possibly related to genetic and environmental factors. Its exclusive occurrence in females, the large sella and the endocrine chages are characteristics (AU)

Arteriomesenteric duodenal compression following head injury

A patient who lost 15 kg in weight while recovering from severe brain injury stated vomiting after 7 weeks. Barium meal confirmed vascular compression of the duodenum as the cause of his vomiting. Vomiting persisted in spite of high calorie liquid feeds and hyperalimentation. Duodenojejunostomy, performed 4 weeks later, cured his vomiting occurs in the severely brain-injured patient with weight loss, and indeed in any patient with prolonged recumbency and weight loss (AU)

Spinal injury in South Trinidad - rationale for a spinal unit - Pster abstract

OBJECTIVE: To determine the quantum and patterns of serious spinal injury in a population of half a million persons in South Trinidad and to determine if there is a need for a spinal unit. DESIGN and METHOD: Charts of all cases of serious spinal injury from January 1991 to December 1995 were reviewed and data collected on demographic and injury details, neurologic deficit, admitting and managing units, management, complications, duration of stay and outcome. RESULTS: There were 160 cases mainly in the third to fifth decades, male:female 3:1. Labourers outnumbered sedentary workers 2:1 and more than 1/3 fell from heights. Injuries were in the lumbo-sacral spine (50 percent), cervical (33 percent) and thoracic (25 percent) areas. Neurologic deficit was present in 38 cases and 16 other had potentially disabling injuries. The majority (112) were admitted to orthopaedics; 26 to general surgery and 37 cases were referred to neurosurgery and 32 cases were managed jointly by orthopaedics and neurosurgery. Management was by cervical collars, calipers 5, Minerva jackets 10, plaster jackets 88 and surgical treatment 17. Complication were mainly pressure sores and urinary tract infections. Mortality was 5, all quadriplegic. Hospital stay averaged 21.5 days. CONCLUSIONS: In South Trinadad from 1991-1995 a total of 54 cases of spinal injury had neurological deficit or potentially disabling injury and might have benefited from a spinal unit with joints management by specialists in several disciplines including nurses, technicians and social workers. A unit of 4-6 beds may be appropriate. (Au)

Heredofamilial neurological syndromes in Trinidad and Tobago - abstract

The only report in the literature of heredofamilial neurological syndromes (HNS) in Trinidad and Tobago was Beaubrun's study of Huntington's chorea (Beaubrun, 1965). This study of HNS in Trinidad and Tobago comprised all patients seen at the Port-of-Spain General Hospital (1980 - mid 1985), the San Fernando General Hospital (mid 1985 - 1989), together with those seen in private practice. The diagnosis and genealogy were verified. A wide variety of HNS was encountered and included amyotrophic lateral sclerosis [4 cases in 2 generations] olivopontocerebellar degeneration [9 in 3 generations], multiple sclerosis [2 in 2 generations], neurofibromatosis [3 in 3 generations], Crouzon's syndrome [2 in 3 generations], biparietal foramina [17 in 3 generations], a neurological syndrome referred to as "ptosis plus syndrome" [9 in 3 generations] and familial tremor [4 in 2 generations]. In addition there were 2 siblings each with cerebral gliomas and intracranial meningioma with familial occurrence of seizures, many cases of carpal tunnel syndrome in 1 family, and familial cases of Huntington's chorea. Mode of genetic transmission seemed to be autosomal dominant in all pedigrees, sometimes with incomplete penetrance or expressivity (AU)

Computerised axial tomography and magnetic resonance imaging bridging the gap - abstract

Since 1983, computerised axial tomography (CAT) has been the mainstay of neurological imaging in Trinidad and Tobago. In 1988, magnetic resonance imaging (MRI) became available in nearby South America. This study was done to examine the capabilities, limitations and pitfalls of CAT scanning and to provide guidelines for patients referral for MRI. The most recent 2,000 head and 68 body CAT scans performed from 1984 to 1988 were reviewed. Abnormalities were seen in 759 (38 percent) of head scans: tumours 262 (34.5 percent), cerebral atrophy 128 (17 percent), ischaemic infarcts 121 (16 percent), intracranial haemorrhage 105 (14 percent), hydrocephalus 42 (5.5 percent), traumatic cerebral contusions 40 (5 percent), infection 36 (5 percent) and vascular malformations 14 (2 percent). Abnormalities were seen in 45 (66 percent) body scans: spinal lesions 20 (44 percent), and lesions of the pancreas 8, liver 8, kidneys 4, adrenals 2, and 1 each in the lung, oesophagus and spleen. CAT scanning, however, was sometimes unable to resolve diagnostic dilemmas, and in 1988, 32 patients were referred for 22 head and 10 spine MRI studies. MRI head abnormalities were tumours 4, absceses 3 (1 in the brain stem), and 1 each of subdural haematoma, demyelinating disease and hydrocephalus. There were 12 normal head MRI studies. MRI spine abnormalities (7) were lumbar disc herination, cervical spondylosis 2, and syringomyelia 1, and 3 studies were normal. CAT scan limitations were most apparent with bone artefacts in the posterior and temporal fossae and the pituitary region, isodense subdural collections, differentiating enhancing infarcts from tumour and in demyelinating disease. MRI did not have these limitations and had the advantage of direct multiplanar (coronal and sagittal) imaging, superior tissue type differentiation, no ionizing radiation or allergenic contrast media. MRI is especially useful in imaging pituitary, parasellar and brain stem lesions, the spine and spinal cord, the heart, abdominal viscera, and joints. Its realtive disadvantages include slower scan times, danger to patients with indwelling ferromagnetic material, claustrophobia and higher equipment cost (AU)

Paediatric head injury - abstract

All paediactric head injury cases admitted to the Port-of-Spain General Hospital, Trinidad in the 12 months from August 1981- July 1982 were studied. There were 306 cases of which 187 (61 percent) were males and 119 (39 percent) females. Causes of injury were falls 221 (72 percent), road traffic accidents 71 (23 percent) other accidents 12(3 percent) and child abuse (2 cases). The commonest clinical features were loss of consciousness 124 (40 percent), nausea and vomiting 114 (37 percent), scalp haematomas 102 (33 percent), scalp lacerations 57 (19 percent), headaches 39 (13 percent), bleeding from ear or nose 19 (6 percent), seizures 18 (6 percent), focal deficits 6 (2 percent). Skull fractures were present in 29 (9 percent). Surgical interventions was necessary in 9 cases. Elevation of compound depressed fractures 3, craniotomy for evacuation of acute subdural haematomas 1 and multiple exploratory burr holes 5 showing cerebral contusions 3, and cerebral oedema 2 cases. Mortality was only 3, all with brain stem injuries. Regarding mobidity, 2 patients had hemiparesis 1 abnormal mental state and 5 continued treatment for seizures. These figures compare well with studies done in UK the United States and Canada regarding sex incidence, causes of injury and symptomatology; however, they differ considerably from the adult head injury in Trinidad where males account for 90 percent, road traffic accidents 59 percent, fights 27 percent, and other causes only 14 percent. These figures also indicate that paediatric head injury demands vigorous treatment despite the initial findings, as the result may be much better than initially predicted (AU)

Fat embolism in Trinidad and Tobago - abstract

The fat embolism syndrome is under-diagnosed because of low suspicion and this study was done to increase physician awareness and improve management. In the 6 years, 1984-1989 at San Fernando General Hospital, Trinidad, there were 10 cases - 1,2,2,1,1 and 3 in the years, respectively. Six were in the 3rd decade and all male, motor vehicle accidents accounted for 9 and a fall for one. There was poor attention to on-site immobilisation and sometimes delay in patients' transfer to hospital. Diagnosis was usually made on the 2nd or 3rd day. Eight patients had femoral fractures, one a bilateral, one a tibial and one a radial fracture. Soft tissue injury was common. Symptoms were alteration in level of consciousness in 9 with progression to coma in 3. Four had respiratory distress, 8 had conjunctival petechial haemorrhages, 3 respiratory crepitations and rhonchi and 2 tachycardia. Six had elevated temperature profile and gm/100ml haemoglobin was less than 10 and haematocrit less than 30 ml/100 ml in 4. Platelet count was normal in 6 tested. Treatment was with oxygen, antibiotics and steroids (Decadron or hydrocortisone), plaster immobilisation of the tibia and radius, skeletal traction in the 6 with femoral fractures and internal Kuntschner (K-nail) fixation was done in 5 at 12-19 days post injury. One had early K-nail at 12 hours post surgery. Nine showed complete recovery; however, complications of respiratory distress, siezures and renal failure resulted in one mortality. Sufficient facilities for arterial blood gasses and other parameters were not available for diagnosis and monitoring treatment. Treatment outcome was good because of aggressive management of oxygen, antibiotics and steriods. Long bone fractures need to be fixed early to reduce the incidence of fat embolism (AU)

Paediatric neurosurgery in Trinidad and Tobago - abstract

Neurosurgery in childhood is a distinct branch of neurosurgery. All cases admitted to the paediatric section of the neurosurgical unit in the 5 years from July 1980 to June 1985 were studied retrospectively, to determine the disease pattern and outcome. There were 260 cases with even annual and sex distribution, 40 percent in their first year, 20 percent total newborn, and the rest below the age of 12 years. Eighteen were from other Caribbean territories. There were 214 cranial diagnosis, distributed as congenital, 72; head injury, 76 infection, 12; vascular, 4; tumours, 20, and other, 30. Significant were hydrocephalus, 51; encephalocele, 8; craniosynostosis, 6; depressed skull fracture, 25 acute subdural haematoma, 3; brain stem injury, 8, and cerebral abscess, 3. The tumours were brain stem astrocytoma, 6; cerebral astrocytoma, 5 medulloblastoma, 4; craniopharyngioma, 2, and one each of cerebellar astrocytoma, pineal tumour and ependymoma. There were 63 spinal diagnosis - congenital, 52; injury, 4; tumours, 3 and other, 4. Significant were mylomeningocele, 40, and, in tumours, one each of cervical meningioma, chondrosarcoma and neurofibroma. There were 160 surgical procedures - congenital, 92: trauma, 37:infection, 8: vascular, 2: tumours, 19, and others, 2. The most frequent procedures were ventriculo-atrial shunt, 27: ventriculo-peritoneal shunt, 25; shunt revisions, 36; encephalocele repairs, 8; craniosynostosis, 5; release, 3 craniotomies for acute subdural haematoma, 21 fracture elevations, 10 exploratory burr holes, 3 cerebral abscess evacuation, and for tumours, 4 craniotomies, 4 posterior fossa explorations and 7 shunts. In the spinal group, there were 33 myelomeningocele repairs and a cervical meningioma, chondrosarcoma and neurofibroma were removed. Ther were 33 deaths; 21 of these had had surgical procedures. In the total group, 10 were related to congenital defects, 12 were severe head injury, 2 meningitis, 2 ruptured intra-cranial bascular lesions and 6 tumours. The following pertinent factors emerged: neural tube defects were noted in the East-Indian in the East-West corridor and Changuanas and in the Afro-Trinidadian in the Belmont-Laventille area. The ventriculoatrial shunt seemed preferable to ventriculo-peritoneal, and the use of 2 separate shunt systems in recurrently malfunctioning shunts was a successful new approach. Head injuries were common and the survival rate unexpectedly good. Spinal fractures were uncommon. Infection had a good prognosis but paediatric brain tumours presented the same dismal picture as it does worldwide (AU)

Transsphenoidal pituitary tumour surgery in Trinidad and Tobago - Poster abstract

OBJECTIVE: To determine whether the transsphenoidal approach for pituitary tumours is advantageous over the traditional transcranial approach. DESIGN andMETHODS: Retrospective analysis of consecutive patients who underwent transsphenoidal (TS) and transcranial (TC) procedures for pituitary tumor during January 1998 to September 1999. Age, gender, presenting symptoms, preoperative findings, endocrine and imaging studies, operative procedure, complications,outcome, hospital stay, cost and patient satisfaction were recorded and analyzed. RESULTS: There was atotal of 15 cases (8 TS and 7 TC). The male to female ratio was 1:2, with an age range 10 to 71 years.All presented with visual impairment, 10 with headaches and 5 with hyperprolactinaemia. Average operative time for TS procedure was 2 hr 55 min and for TC, 2 hr 12 min. Average hospital stay for TS cases was 5.3 days whereas TC patients stayed for 5.7 days. Average cost of hospitalization (excluding fees for the surgeons and anaesthetists) for TS patients was significantly lower than for the TC patients (p<0.001). Patient satisfaction mean index for TS cases was 4.125 while it was 3.71 for TC cases. Three TS patients had excellent satisfaction. There were no mortalities. CONCLUSION: The TS approach has certain advantages compared to the TC approach in the management of pituitary tumors. TS approach is recommended in selected cases in our setting in Trinadad and Tobago. (Au)

A neurosurgical profile - abstract

Neurosurgical disease patterns, trends and workload in a hospital with 30 years' neurosurgical experience, serving a population of 1/3 milion were studied to assess, provide guidelines for more cost-effective patient care and to provide data for the development of neurosurgical facilities in developing areas. At the San Fernando General hospital, Trinidad, 1979-1988, there was a general increase in total hospital admissions (approximately 48,000/yr), neurosurgical admissions (73 to 161/yr), transfers to the neurosurgical unit (39 to 76/yr), new clinic patients (170 to 269/yr), consultations (181 to 351/yr), neuro-radiological procedures (44 to 105/yr), and surgical procedures (32 to 140 yr). There was an increase in bed occupancy rate (68 percent to 87 percent) and a reduction in the length of stay per patient (16 to 11 days), and in deaths (from a peak of 20 to 13/yr). There was a decrease in invasive studies with the advent of computerized axial tomographic scanning and magnetic resonance imaging, and myelograms showed a sharp rise due in part to newer water soluble contrast media. Surgical procedures showed a trend to more definite cranial surgery with a sharp rise in spinal surgery - laminectomy. There was and increase in the relative value score and factor which take case complesity into consideration. The commonest condition was head trauma followed by cervical spondylosis, brain tumours, seizures, spinal fractures, herniated lumbar disc, hydrocephalus and congenital anomalies and spinal tumours (AU)

Neural tube defects in Trinidad - abstract

All cases of neural tube defects (NTD) at the Port-of-Spain General and Mount Hope Hospital for Women from June 1980 to July 1983 were studied retrospectively with respect to sex distribution, ethnic group, social class of parents, area of residence, birth weight, birth order, maternal age, associated congenital abnormalities, family history, annual incidence and other factors. There were 71 NTD with no sex predominance. Twenty-six were of African descent and 38 of East Indian descent and 7 of mixed ethnic origin. The incidence in Trinidad of NTD per thousand total births 1.52 overall, 1.40 in the African and 2.05 in the East Indian, was much lower than in countries of similar ethnic groups - 2.74 Pretoria, South Africa in the Bantu and 3.75 in Bombay, India. In Trinidad, the incidence of anencephalus was particularly low in the African. The incidence of hydrocephalus, hydrocephalus with spina bifida, occiptal meningocele and other neural tube defects was about the same in both ethnic groups, while spina bifida incidence was relatively higher in the East Indian. Those of African descent were clustered in the Belmont-Laventille-Morvant area, while those of East Indian descent were clustered in the Chaguanas and in the San Juan to Tunapuna area, and the occurence in these areas was disproportionately high and not totally explained by population distribution. Other positive findings were low birth weight and being first-born with anencephalus, and social classes 4 and 5 in parents of patients with NTD. This study shows a low Trinidad incidence of NTD, differing ethnic incidence and distribution, and suggests a multifcatorial aetiology (AU)

The role of water-soluble contrast myelography implications for the Caribbean - abstract

Since 1985, water-soluble contrast medium has been used for myelography in Trinidad; it has distinct advantages over the traditional oily medium. It is rapidly excreted in the urine so that it does not need removal. A smaller (20-22 gauge) spinal needle is used; less trauma causes less CSF leakage and hence less post-spinal headache. The needle is removed after contrast injection, allowing easier patient manipulation. The low viscosity contrast also gives a better view of the thecal sac, spinal cord and nerve roots; further, it can traverse a lesion enabling both cephalad and caudal margin delineation. Fluoroscopy is not absolutely necessary as the 5-30 degree head up postero-anterior and obliques show a lumber lesion. Further, it can be used as an outpatient procedure and allows for enhanced CT scanning. There were 57 cases in the 3 years from 1985 to 1987 (7, 15, 35): 30 at San Fernando, 12 at Port-of-Spain and 15 in private clinics. The 36 males and 21 females were aged 23 to 62 years; 54 had low-back syndrome, 2 suspected thoracic and the other suspected cervical lesions. Metrizamide (Amipaque) was used in 44 cases and Iohexo (Omnipaque) in 13. Visualization was good to excellent in all cases. Complications were headaches in 3, vomiting in 1 and seizures in another. In the latter patient, the contrast passed intracranially during the Trendelenburg tilting for thoracic visualisation. Twice some contrast was injected epidurally without complication. However, this comprised visualisation. Extreme care was taken in proper patient hydration, gentle motion in the procedure and the 15-30 degree head up position for 24 hours post-myelogram. There is advantageous ease of performance, rarity of complications, outpatient performance and lack of necessity for fluoroscopy in areas where this is not available. It is advised for use in developing territories where the common problem of back pain and suspected lower spinal lesions can be more easily investigates (AU)

Primary neoplasms of the central nervous system in Trinidad

The incidence of primary neoplasms of the central nervous system in Trinidad is less than 1 case per 100,000 population per year. There is no significant difference in the sex and age distribution of the cases, but a definite racial difference is seen in the frequency of different CNS neoplasms (AU)

Improving trauma care in Trinidad and Tobago

Indentification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago. (AU)

Advanced trauma life support program increases emergency room application of trauma resuscitative procedures in a developing country

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)

Preliminary report on hyperprolactinaemia in Trinidadian women: prevalence, clinical and endocrine features - abstract

Since the development of a reliable method of assay for prolactin, it has become widely accepted that disorders of prolactin secretion constitute the most common disorder of hypothalamic/pituitary function. Ninety female patients with serm prolactin concentrations above 40ng/ml (normal 0 - 14 ng/ml) over a one-year period were reviewed. The mean age of presentation was 31 years (range 16 -54). Of the 90 patients, 60 percent were Negro, 36 percent East Indian and 4 percent mixed. The commonest presenting complaints were (86 percent), galactorrhoea (68 percent) and hirsutism (57 percent). Fourteen patients had radiological evidence of tumour; all these had prolactin levels greater than 100ng/ml (range 121 - 895ng/ml) and 60 percent had LH/FSH ratios of less than 1.00. Over the last three years, requests for prolactin assays have increased markedly. During the period June 1984 to July 1985, 1,030 assays were done of which 20 percent were above 40ng/ml. This trend reflects an increased awareness of the importance of this condition (AU)