A comparison of the objective structured clinical examination results across campuses of the University of the West Indies (2001 and 2002).

OBJECTIVE: To compare the performance of medical students in the Objective Structured Clinical Examination (OSCE) of thefinal MBBS Examination across the four campuses of The University of the West Indies, over a two-year period DESIGN AND METHODS: All final examination results of the Medicine and Therapeutics OSCE were collectedfrom the Faculty of Medical Science at the four campuses of The University of the West Indies and analyzed using both parametric (t-tests and ANOVAs) and non-parametric tests (chi-squared tests). RESULTS: Results indicated that students achieved significantly higher mean scores in the 2002 examination than in 2001 (t = 3.85, df = 415, p = 0.000). There were no significant differences between campuses with regards to the mean corrected score in 2001. Also in 2001, in adult stations, all campuses achieved significantly higher scores than Jamaica. However, in Jamaica, mean child health station scores were significantly higher than all other campuses and, the mean score in Trinidad and Tobago was higher than the Bahamas and Barbados. In 2002, all other campuses achieved significantly higher scores than Trinidad and Tobago and females performed significantly better than males with regards to overall mean scores (t = 2.814, df = 189, p = 0.005). Also in 2002, Barbados achieved significantly higher mean corrected scores than Trinidad and Tobago (F = 4.649, df = 3191; p = 0.004) and Barbados and Trinidad and Tobago both obtained significantly higher mean child health station scores than Jamaica. CONCLUSIONS: The important conclusion from this study is that the OSCE scores in Medicine and Therapeutics are generally uniform across the four campuses of the University, thereby confirming the consistency of the approach to teaching and helping to validate the efficacy and veracity of the medical graduate being produced by The University of the West Indies.

A comparison of the objective structured clinical examination results across campuses of the University of the West Indies (2001 and 2002) / Una Comparación del Examen Clínico Objetivo Estructurado Resultados en los Campus de la Universidad de West Indies (2001 y 2002)

OBJECTIVE: To compare the performance of medical students in the Objective Structured Clinical Examination (OSCE) of thefinal MBBS Examination across the four campuses of The University of the West Indies, over a two-year period DESIGN AND METHODS: All final examination results of the Medicine and Therapeutics OSCE were collectedfrom the Faculty of Medical Science at the four campuses of The University of the West Indies and analyzed using both parametric (t-tests and ANOVAs) and non-parametric tests (chi-squared tests). RESULTS: Results indicated that students achieved significantly higher mean scores in the 2002 examination than in 2001 (t = 3.85, df = 415, p = 0.000). There were no significant differences between campuses with regards to the mean corrected score in 2001. Also in 2001, in adult stations, all campuses achieved significantly higher scores than Jamaica. However, in Jamaica, mean child health station scores were significantly higher than all other campuses and, the mean score in Trinidad and Tobago was higher than the Bahamas and Barbados. In 2002, all other campuses achieved significantly higher scores than Trinidad and Tobago and females performed significantly better than males with regards to overall mean scores (t = 2.814, df = 189, p = 0.005). Also in 2002, Barbados achieved significantly higher mean corrected scores than Trinidad and Tobago (F = 4.649, df = 3191; p = 0.004) and Barbados and Trinidad and Tobago both obtained significantly higher mean child health station scores than Jamaica. CONCLUSIONS: The important conclusion from this study is that the OSCE scores in Medicine and Therapeutics are generally uniform across the four campuses of the University, thereby confirming the consistency of the approach to teaching and helping to validate the efficacy and veracity of the medical graduate being produced by The University of the West Indies

Objetivo: Comparar el rendimiento académico de los estudiantes de medicina en el examen clínico objetivo estructurado del examen final de MBBS, en los cuatro campus de La Universidad de West Indies, en un período de dos años. Diseño y métodos: Se recopilaron todos los resultados del examen final de ECOE de Medicina y Terapéutica de la Facultad de Ciencias Médicas, en los cuatro campus de la Universidad de West Indies. Los datos fueron analizados usando tanto tests paramétricos (tests t y ANOVAs) como tests no paramétricos (tests de chi-quadrado). Resultados: Los resultados indicaron que los estudiantes alcanzaron puntuaciones significativamente más altas en el examen del 2001 que en el del 2002 (t = 3.85, df = 415, p = .000). No hubo diferencias significativas entre los distintos campus con respecto a los resultados corregidos promedios 2001. También en 2001, en las unidades asistenciales de adultos, todos los campus lograron resultados significativamente más altos que Jamaica. Sin embargo, en Jamaica, los resultados promedios de las unidades pediátricas fueron significativamente más altos que en todos los otros campus, y el resultado promedio en Trinidad y Tobago fue más alto que en Bahamas y Barbados. En 2002, todos los otros campus lograron resultados significativamente más altos que Trinidad y Tobago, y las mujeres obtuvieron rendimientos significativamente mejores que los de los hombres, con respecto a los resultados promedios generales (t = 2.814, df = 189, p = .005). También en 2002, Barbados alcanzó resultados corregidos promedios significativamente más altos que Trinidad y Tobago (F = 4.649, df = 3,191; p = .004), mientras que Barbados así como Trinidad y Tobago, obtuvieron resultados significativamente más altos en la unidades pediátricas, en comparación con Jamaica. Conclusiones: La conclusión principal de este estudio es que los resultados del OSCE en Medicina y Terapéutica son generalmente uniformes en los cuatro campus de la Universidad, confirmando de ese modo la solidez del enfoque de la enseñanza, y contribuyendo a validar la eficacia y calidad del graduado de medicina egresado de la Universidad de West Indies.

A history of cardiology in Jamaica.

The history of cardiology in Jamaica is conveniently considered in decades beginning in the 1950s. The decade of the 1950s was characterized by early descriptions of the pattern of cardiac disease in adults and children in Jamaica, the establishment of a cardiac clinic at the University Hospital of the West Indies and early cardiac surgical landmarks. Extensive preparatory experimental work in the canine laboratory with respect to cardiopulmonary bypass in the early to mid-1960s culminated in the successful completion of the first open heart surgical procedure in April, 1968. Cardiac catheterization was also increasingly developed in the decade of the 1960s. A highlight of the decade of the 1970s was the establishment of the Heart Foundation of Jamaica which began contributing greatly to preventive cardiology in Jamaica by providing a variety of programmes of prevention. In the decade of the 1980s, non-invasive cardiac diagnostic facilities in Jamaica were considerably enhanced by the introduction and development of echocardiography, treadmill exercise testing and ambulatory electrocardiography. In addition, the very important National Rheumatic Fever prevention programme was established. The cardiac catheterization laboratory was re-opened in the 1990s, thus allowing the performance of coronary arteriography in Jamaica for the first time, and interventional cardiology procedures soon followed. The Jamaica Foundation for Cardiac disease was also established in this decade. The vision for the new millennium of "A heart healthy Jamaica in the 21st century" is achievable, but will require appropriate emphasis on expanded preventive and curative cardiology programmes.

A history of cardiology in Jamaica

The history of cardiology in Jamaica is conveniently considered in decades beginning in the 1950s. The decade of the 1950s was characterized by early descriptions of the pattern of cardiac disease in adults and children in Jamaica, the establishment of a cardiac clinic at the University Hospital of the West Indies and early cardiac surgical landmarks. Extensive preparatory experimental work in the canine laboratory with respect to cardiopulmonary bypass in the early to mid-1960s culminated in the successful completion of the first open heart surgical procedure in April, 1968. Cardiac catheterization was also increasingly developed in the decade of the 1960s. A highlight of the decade of the 1970s was the establishment of the Heart Foundation of Jamaica which began contributing greatly to preventive cardiology in Jamaica by providing a variety of programmes of prevention. In the decade of the 1980s, non-invasive cardiac diagnostic facilities in Jamaica were considerably enhanced by the introduction and development of echocardiography, treadmill exercise testing and ambulatory electrocardiography. In addition, the very important National Rheumatic Fever prevention programme was established. The cardiac catheterization laboratory was re-opened in the 1990s, thus allowing the performance of coronary arteriography in Jamaica for the first time, and interventional cardiology procedures soon followed. The Jamaica Foundation for Cardiac disease was also established in this decade. The vision for the new millennium of [quot ]A heart healthy Jamaica in the 21st century[quot ] is achievable, but will require appropriate emphasis on expanded preventive and curative cardiology programmes

A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica.

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0% (0/129); HBV, 37% (48/129); HTLV-1, 5% (6/129) and syphilis, 20% (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50% versus 17/80, 21%; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32% versus 6/53, 11%; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections.

A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0 (0/129); HBV, 37 (48/129); HTLV-1, 5 (6/129) and syphilis, 20 (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50 versus 17/80, 21; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32 versus 6/53, 11; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections

Fifty years of clinical examinations at the University of the West Indies

The University of the West Indies was founded at Mona, Jamaica, in 1948. After fifty-two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper.

Intracoronary stent implantation in Jamaica. The initial experience.

Intracoronary stent implantation resulted in the complete or near complete dilatation of high grade occlusions of the left anterior descending coronary arteries in the four patients in whom it was undertaken. Intracoronary stent implantation is a useful adjunct to Percutaneous Transluminal Angioplasty (PTCA) and is applicable in selected patients with symptomatic ischaemic heart disease in a developing country with limited health resources like Jamaica. This is so since financial data presented here document the significant savings this technique (when appropriately utilised) could realise compared to the use of balloon angioplasty alone.

Intracoronary stent implantation in Jamaica. The initial experience

Intracoronary stent implantation resulted in the complete or near complete dilatation of high grade occlusions of the left anterior descending coronary arteries in the four patients in whom it was undertaken. Intracoronary stent implantation is a useful adjunct to Percutaneous Transluminal Angioplasty (PTCA) and is applicable in selected patients with symptomatic ischaemic heart disease in a developing country with limited health resources like Jamaica. This is so since financial data presented here document the significant savings this technique (when appropriately utilised) could realise compared to the use of balloon angioplasty alone.

Fifty years of clinical examinations at the University of the West Indies.

The University of the West Indies was founded at Mona, Jamaica, in 1948. After fifty-two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper.

Beta-adrenergic blockade in the treatment of congestive heart failure.

Although chronic sympathetic activation provides inotropic and chronotropic support to the failing heart, such activation may also have deleterious effects, including the direct cardiotoxic effects of catecholamines, activation of the renin-angiotensin-aldosterone system and an increase in myocardial oxygen demand. These observations indicate that beta-blockade might be beneficial in the treatment of heart failure. This suggestion is receiving growing support from clinical trials, which show that beta blockade improves the clinical and functional status of patients with heart failure resulting from dilated cardiomyopathy or ischaemic heart disease. These trials have also indicated beta blocking agents are much safer in patients with heart failure than was previously thought, provided that they are introduced at a low dose and titrated carefully. Newer beta blocking agents have ancillary properties that may be important in the treatment of heart failure. Bucindolol and carvedilol have vasodilating effects that may unload the failing heart, and carvedilol also has antiproliferative and antioxidant properties not shared by other beta blocking agents. Carvedilol is the only beta blocking agent that has reduced overall mortality in patients with heart failure in controlled clinical trials, and it also reduces hospitalization and improves the global assessment of patients. A large comparative trial against other beta blocking agents to confirm that these benefits are unique to carvedilol is about to be launched. Further clinical experience is required to determine the optimum use of carvedilol in the treatment of heart failure. The results obtained so far with carvedilol suggest that the management of heart failure is about to undergo a significant change.

The prophylaxis of acute rheumatic fever in a pair of monozygotic twins. The public health implications.

Recurrent acute rheumatic fever and rheumatic heart disease can be prevented by antibiotic intervention. We report the case of genetically identical twins, one of whom had overt rheumatic fever, received penicillin prophylaxis and did not have rheumatic heart disease. The other must have had inapparent rheumatic fever, received no chemotherapy prophylaxis and proceeded to develop rheumatic heart disease. A greater clinical and laboratory vigilance is required for the diagnosis of acute rheumatic fever in the asymptomatic identical twin of a patient with rheumatic fever. This case provides further evidence of a genetic predisposition to rheumatic fever and demonstrates the continued value of penicillin in the prophylaxis of acute rheumatic fever. It emphasises the need to maintain the integrity of preventive programmes against rheumatic fever worldwide. Studies which explore the HLA and other genetic linkages with rheumatic fever should be encouraged.

Percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis in Jamaica: the initial experience.

Although percutaneous balloon mitral valvuloplasty has been performed in the Caribbean before, there has not been any detailed description in the English-speaking West Indian Medical literature hitherto. This report provides a description of the first four cases of percutaneous balloon mitral valvuloplasty performed in Jamaica.

Percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis in Jamaica: the initial experience

Although percutaneous balloon mitral valvuloplasty has been performed in the Caribbean before, there has not been any detailed description in the English-speaking West Indian Medical literature hitherto. This report provides a description of the first four cases of percutaneous balloon mitral valvuloplasty performed in Jamaica.

Percutaneous transluminal coronary angioplasty (PTCA) in Jamaica. Preliminary results

This is the first detailed report from the Anglophone Caribbean of percutaneous transluminal coronary angioplasty (PTCA). The procedure resulted in complete dilatation of the occluded vessels in the five patients in whom it was undertaken, with significant improvement in exercise duration in the Bruce protocol (p < 0.001; 95CI 2.5 to 4.1 minutes) in the four patients who were studied. PTCA can be undertaken in developing countries with limited resources, and should be offered to selected patients with symptomatic coronary artery disease who need a revascularisation procedure.

Percutaneous transluminal coronary angioplasty (PTCA) in Jamaica. Preliminary results.

This is the first detailed report from the Anglophone Caribbean of percutaneous transluminal coronary angioplasty (PTCA). The procedure resulted in complete dilatation of the occluded vessels in the five patients in whom it was undertaken, with significant improvement in exercise duration in the Bruce protocol (p < 0.001; 95% CI 2.5 to 4.1 minutes) in the four patients who were studied. PTCA can be undertaken in developing countries with limited resources, and should be offered to selected patients with symptomatic coronary artery disease who need a revascularisation procedure.

Pulmonary artery pressure and the acute chest syndrome in homozygous sickle cell disease.

OBJECTIVE: To investigate whether attacks of acute chest syndrome affected pulmonary artery pressure in patients homozygous for sickle cell disease. MAIN OUTCOME MEASURES: Pulmonary artery pressure, assessed by non-invasive echocardiographic techniques. PATIENTS: 20 patients with homozygous sickle cell disease with a history of at least six episodes of acute chest syndrome and in 20 age, sex, and height matched controls with homozygous sickle cell disease without a history of acute chest syndrome. RESULTS: There was no difference in any of the echocardiographic or Doppler indices between these two groups. CONCLUSIONS: Repeated attacks of acute chest syndrome by the mean age of 12 (range eight to 16) years have not had a discernible effect upon pulmonary artery pressure.

Clinically significant hemorrhage due to warfarin-carbamazepine interaction.

A 61-year-old woman receiving warfarin for postoperative atrial fibrillation and carbamazepine for a peripheral neuropathy had extreme elevation of prothrombin time associated with clinically significant hemorrhage when the carbamazepine therapy was discontinued. The mechanism of this significant drug interaction involves the withdrawal of carbamazepine-induced enhancement of hepatic warfarin breakdown with resultant delay of warfarin excretion and excessive hypoprothrombinemia. The clinically significant hemorrhage associated with warfarin-carbamazepine interaction is an indication for caution when these two agents are prescribed concomitantly.

Torsade de pointes. An unusual form of ventricular tachycardia.

A 65-year-old man with hypertension and glaucoma developed diuretic-induced hypokalaemia complicated by torsade de pointes ventricular tachycardia. This arrhythmia requires accurate recognition so that appropriate therapy may be administered. When torsade de pointes is diagnosed, a careful search for underlying causes should be conducted as reversal of these may prove curative, as in this case.

Torsade de pointes: an unusual form of ventricular tachycardia

A 65-year-old man with hypertension and glaucoma developed diuretic-induced hypokalaemia complicated by torsade de pointes ventricular tachycardia. This arrhythimia requires accurate recognition so that appropriate therapy may be administered. When torsade de pointes is diagnosed, a careful search for underlying causes should be conducted as revesal of these may prove curative, as in this case