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1.
Soc Work Public Health ; 36(5): 558-576, 2021 07 04.
Artículo en Inglés | MEDLINE | ID: mdl-34182897

RESUMEN

The Novel Coronavirus Disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Trinidad and Tobago reported its first infection on March 12th 2020. This study assessed knowledge, attitudes and practices toward COVID-19 among Trinidadians during the post-lockdown period. A validated questionnaire was used to conduct a cross-sectional survey from May 25th to June 6th 2020.Most respondents (512, 96.6%) knew that COVID-19 is highly infectious. Many (523, 98.7%) identified vulnerable groups as persons 65 years and older and those with preexisting co-morbidities (480, 90.6%). Respondents identified COVID-19 symptoms as fever (498, 94.0%), dry cough (495, 93.4%), myalgia (403, 76.0%) and sore throat (441, 83.2%). Most 504 (95.1%) acknowledged that COVID-19 threatened the country's economy. Dominant practices included regular hand washing (97.2%) and social distancing (512, 96.6%).Health authorities should continue public education efforts to increase knowledge and the adoption of recommended practices.


Asunto(s)
COVID-19 , Conocimientos, Actitudes y Práctica en Salud , COVID-19/epidemiología , COVID-19/prevención & control , Estudios Transversales , Humanos , Cuarentena , Encuestas y Cuestionarios , Trinidad y Tobago/epidemiología
3.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33619923

RESUMEN

PURPOSE: A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective. DESIGN/METHODOLOGY/APPROACH: A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process. FINDINGS: Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process. RESEARCH LIMITATIONS/IMPLICATIONS: The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender. PRACTICAL IMPLICATIONS: The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings. ORIGINALITY/VALUE: Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.

4.
BMJ Open ; 10(12): e041422, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310804

RESUMEN

OBJECTIVES: Emergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This study aimed to explore the patient flow process in an ED in Trinidad and Tobago, identifying organisational factors influencing patient flow. METHODS: Multiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyse the data. SETTING: The study was conducted at a major tertiary level ED in Trinidad and Tobago. PARTICIPANTS: Patient and staff journeys in the ED were directly observed. RESULTS: Six broad categories were identified: (1) ED organisational work processes, (2) ED design and layout, (3) material resources, (4) nursing staff levels, roles, skill mix and use, (5) non-clinical ED staff and (6) external clinical and non-clinical departments. Within each category there were individual factors that appeared to either facilitate or hinder patient flow. Organisational processes such as streaming, front loading of investigations and the transfer process were pre-existing strategies in the ED while staff actions to compensate for limitations with flow were more intuitive. A conceptual framework of factors influencing ED patient flow is also presented. CONCLUSION: The knowledge gained may be used to strengthen the emergency care system in the local context. However, the study findings should be validated in other settings.


Asunto(s)
Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Región del Caribe , Comunicación , Eficiencia Organizacional , Humanos , Trinidad y Tobago
5.
Cureus ; 12(10): e10980, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33209536

RESUMEN

Objectives To investigate the epidemiology, management, and predictors of mortality in severe sepsis and septic shock in the intensive care units (ICUs) of Trinidad, Trinidad & Tobago. Methods A prospective observational study in four ICUs over a one-year period (August 2017-August 2018) was conducted. Physiologic variables, treatment data, and outcomes were collected on admission to ICU and daily until 28 days. The 28-day mortality and ICU mortality were recorded. Subgroup analysis was performed based on survival, and predictors of mortality were determined through logistic regression. Results Outcome data were available for 163 patients. The 28-day mortality rates for sepsis and septic shock were 42% and 47%, respectively. ICU mortality rate for sepsis was 34%. The most common suspected source of infection was pneumonia (33%). Acute kidney injury (AKI) was common and present in 71% of patients, with renal replacement therapy only being used in 30% of cases. Mechanical ventilation was required in 84% of cases. Moderate-to-severe acute respiratory distress syndrome (ARDS) (OR: 4; 95% CI: 1.9-8.8; p < 0.001) and the development of AKI (all stages) (OR: 10; 95% CI: 3.9-30.2; p < 0.001) were found to be predictive of mortality. Incidence of mechanical ventilation, moderate-to-severe ARDS, stage 3 AKI, septic shock, and failure to achieve a mean arterial pressure of > 60 mmHg within the first 24 hours of admission were higher in patients who did not survive (p < 0.05). Conclusions Sepsis and septic shock are associated with a high 28-day mortality. Organ dysfunction with renal and pulmonary involvement was an important factor in predicting a higher mortality.

6.
Ophthalmic Epidemiol ; 27(2): 132-140, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31818167

RESUMEN

Purpose: To study the impact of sociodemographic and socioeconomic factors on the cataract burden in Caribbean small island developing states (SIDS) using disability-adjusted life-years (DALYs).Methods: National and regional age and sex specific cataract DALY numbers and rates from 1990 to 2016 for Caribbean SIDS, were extracted from the Global Burden of Disease Study 2016. The human development index (HDI), healthcare access and quality (HAQ) index, and the World Bank's classification of economies were used as socioeconomic status indicators. The Gini coefficient, Atkinson, Theil and concentration indices were used to measure health inequality. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the sociodemographic and socioeconomic factors associated with differences in cataract burden.Results: Men had higher age-standardized DALY rates than women (P < .001) with median rates of 90.72 (Interquartile range [IQR], 87.8-94.2) and 83.94(IQR, 80.9-86.5), respectively. The burden of cataract increased with age. Upper-middle income countries had higher age-standardized DALY rates than high income countries (P < .001), with median rates of 90.1 (IQR, 86.8-93.4) and 79.8 (IQR, 77.5-81.8), respectively. Age-standardized DALY rates were inversely correlated with HDI (r = - 0.61, ß = - 51.56 [P < .05]) and HAQ (r = - 0.68, ß = - 0.46 [P < .01). Between-country inequality was negligible, and the burden of cataract is greater among the poor.Conclusion: Global trends of socioeconomic factors were confirmed. Significantly, men had higher age-standardized DALY rates than women. This is an area for further research.


Asunto(s)
Catarata/economía , Carga Global de Enfermedades/economía , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Ceguera/epidemiología , Ceguera/etiología , Región del Caribe/epidemiología , Catarata/complicaciones , Catarata/epidemiología , Grupos Étnicos , Femenino , Carga Global de Enfermedades/estadística & datos numéricos , Carga Global de Enfermedades/tendencias , Desarrollo Humano , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud/tendencias , Años de Vida Ajustados por Calidad de Vida , Distribución por Sexo , Factores Socioeconómicos
7.
Rev. bras. anestesiol ; 69(3): 233-241, May-June 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1013421

RESUMEN

Abstract Background and objectives: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. Design & methods: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). Results: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p = 0.04), emergency surgery (p = 0.04), African ethnicity (p = 0.01), longer duration of surgery (p = 0.007) and number of intubation attempts (p = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. Conclusions: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.


Resumo Justificativa e objetivos: O delirium do despertar após a anestesia geral com sevoflurano não tem sido relatado com frequência em adultos como nas crianças. Este estudo teve como objetivo determinar a incidência de delirium do despertar em pacientes adultos submetidos à anestesia com sevoflurano como agente volátil e os prováveis fatores de risco associados à sua ocorrência. Desenho e métodos: Um estudo observacional prospectivo foi conduzido com pacientes adultos sem distúrbios neurológicos ou psiquiátricos submetidos à anestesia geral para procedimentos não neurológicos. Dados demográficos como idade, sexo, etnia e dados clínicos, inclusive estado físico ASA, estado cirúrgico, tentativas de intubação, tempo de cirurgia, hipotensão intraoperatória, drogas usadas, dor pós-operatória, analgesia de resgate e presença de cateteres, foram registrados. A intensidade do delirium do despertar foi medida com a Escala de Triagem de Delirium em Enfermagem (Nursing Delirium Scale - NuDESC). Resultados: A incidência de delirium do despertar foi de 11,8%. Os fatores significativamente associados ao delirium do despertar incluíram idade avançada (> 65) (p = 0,04), cirurgia de emergência (p = 0,04), descendência africana (p = 0,01), tempo maior de cirurgia (p = 0,007) e número de tentativas de intubação (p = 0,001). Fatores como sexo, uso de álcool e drogas ilícitas e especialidade cirúrgica não influenciaram a ocorrência de delirium do despertar. Conclusões: A incidência de delirium do despertar em adultos após a anestesia geral com sevoflurano é significativa e não tem sido relatada adequadamente. Fatores de risco modificáveis precisam ser abordados para reduzir ainda mais sua incidência.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Anestésicos por Inhalación/administración & dosificación , Delirio del Despertar/epidemiología , Sevoflurano/administración & dosificación , Anestesia General/métodos , Incidencia , Estudios Prospectivos , Factores de Riesgo , Anestésicos por Inhalación/efectos adversos , Tempo Operativo , Sevoflurano/efectos adversos , Anestesia General/efectos adversos , Persona de Mediana Edad
8.
Braz J Anesthesiol ; 69(3): 233-241, 2019.
Artículo en Portugués | MEDLINE | ID: mdl-31076155

RESUMEN

BACKGROUND AND OBJECTIVES: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. DESIGN AND METHODS: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). RESULTS: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p=0.04), emergency surgery (p=0.04), African ethnicity (p=0.01), longer duration of surgery (p=0.007) and number of intubation attempts (p=0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. CONCLUSIONS: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.


Asunto(s)
Anestesia General/métodos , Anestésicos por Inhalación/administración & dosificación , Delirio del Despertar/epidemiología , Sevoflurano/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia General/efectos adversos , Anestésicos por Inhalación/efectos adversos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos , Factores de Riesgo , Sevoflurano/efectos adversos , Adulto Joven
9.
Turk J Anaesthesiol Reanim ; 47(2): 128-133, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31080954

RESUMEN

Objective: The Surgical Apgar Score (SAS) is a simple 10-point scoring system that has been shown to be predictive of major postoperative complications and death after surgery. We evaluated the predictive ability of this score in a cohort of patients undergoing emergency abdominal surgery in a Caribbean tertiary hospital. Methods: The SAS was calculated retrospectively from the anaesthesia records of all patients undergoing emergency abdominal surgery during a 12-month period. The postoperative surgical records of these patients were then examined for the presence of major complications and death. The association between the SAS and outcomes was tested using binary logistic regression, and the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis. Results: Of the 220 patients studied, 72 (33%) suffered an in-hospital major complication or death. The highest complication rate occurred in the low-scoring groups, with 68% of those scoring <4 being affected. Low-scoring patients (<4) had four times the risk of major complications when compared to higher-scoring groups (relative risk [RR], 4.21; 95% confidence interval [CI], 2.5-7.3; p<0.001). The odds ratio (OR) for major complications or death per unit increase in the SAS was 0.58 (95% CI, 0.47-0.72; p<0.001). The c-statistic of the SAS for predicting major complications or death was 0.71 (95% CI, 0.68-0.73; p<0.0001). Conclusion: The SAS is a simple 10-point score that can be used in patients undergoing emergency surgery in a Caribbean setting to help identify those that are at a higher risk of postoperative complications. Due to its ease in calculation, it can be added to other commonly used criteria to help triage the postoperative patient.

10.
Emerg Med J ; 35(10): 626-637, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30093379

RESUMEN

OBJECTIVES: Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs. METHODS: An umbrella review of systematic reviews published between 2000 and 2017 was undertaken. Included studies were systematic reviews and meta-analyses of quantitative primary studies assessing an intervention that aimed to improve ED throughput. RESULTS: The search strategy yielded 623 articles of which 13 were included in the umbrella review. The publication dates of the systematic reviews ranged from 2006 to 2016. The 13 systematic reviews evaluated 26 interventions: full capacity protocols, computerised provider order entry, scribes, streaming, fast track and triage. Interventions with similar characteristics were grouped together to produce the following categories: diagnostic services, assessment/short stay units, nurse-directed interventions, physician-directed interventions, administrative/organisational and miscellaneous. The statistical evidence from 14 primary randomised controlled trials (RCTs) was evaluated to determine if correlation or clustering of observations was considered. Only the fast track intervention had moderate evidence to support its use but the RCTs that assessed the intervention did not use statistical tests that considered correlation. CONCLUSIONS: Overall, the evidence supporting the interventions to improve patient flow is weak. Only the fast track intervention had moderate evidence to support its use but correlation/clustering was not taken into consideration in the RCTs examining the intervention. Failure to consider the correlation of the data in the primary studies could result in erroneous conclusions of effectiveness.


Asunto(s)
Medicina de Emergencia/tendencias , Mejoramiento de la Calidad , Factores de Tiempo , Aglomeración , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Revisiones Sistemáticas como Asunto
11.
J Perianesth Nurs ; 33(1): 37-44, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29362045

RESUMEN

PURPOSE: Postoperative shivering has been anecdotally observed to be frequent and severe in Cannabis smokers following general anesthesia in the Caribbean. The aim of this study was to compare the frequency and intensity of postoperative shivering in Cannabis users versus non-users. DESIGN: A prospective, cross-sectional, observational design was used. METHODS: Demographic data were obtained. Patients were grouped into Cannabis users and non-users. All patients received standardized general anesthesia and were administered warmed fluids intraoperatively. Ambient room temperatures and clinical data were recorded. Patients' core body temperature was recorded at 10-minute intervals both in the operating room and the post-anesthesia care unit (PACU). Postoperatively an independent observer assessed the patients who had shivering using a scoring system ranging from 0 to 3. Treatment for shivering and post-treatment shivering scores were also recorded. FINDINGS: Fifty-five patients were studied, of which 71% were male. There were 25 (45%) Cannabis users, of which 50% smoked < 5 joints per week, and 35% smoked >10 joints per week; 30 (55%) patients were non-users. The overall incidence of postoperative shivering was 36%; 16% had a shivering score of '3', 13% had '2' and 7% had a score of '1'. The incidence of postoperative shivering among Cannabis users was 40% while it was 33.3% in non-users. Also, 90% of Cannabis users had shivering scores of 2 and 3, compared to 70% of non-users. CONCLUSIONS: There was a higher incidence and intensity of shivering in Cannabis smokers, although the study could not establish a statistically significant difference in the frequency and severity of shivering between Cannabis users and non-users.


Asunto(s)
Cannabis , Fumar Marihuana/efectos adversos , Tiritona , Adulto , Anestesia General/efectos adversos , Estudios de Casos y Controles , Femenino , Hospitales Públicos/organización & administración , Humanos , Incidencia , Masculino , Trinidad y Tobago
13.
J Intensive Care Med ; 32(8): 480-486, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26768423

RESUMEN

OBJECTIVES: The prognosticating ability of one-time recorded Acute Physiology and Chronic Health Evaluation (APACHE) IV score was compared with serially recorded Mortality Prediction Model (MPM) II scores. DESIGN AND METHODS: A prospective observational study was conducted for a period of 6 months. Acute Physiology and Chronic Health Evaluation IV score was recorded during the first day on intensive care unit (ICU) admission. Mortality Prediction Model II was recorded on admission, 24, 48, and 72 hours. Predicted mortality was compared with observed mortality. The systems were calibrated and tested for discriminant functions. RESULTS: One hundred and fifty patients were studied. The observed mortality was 21.3%. The mean predicted hospital mortality by APACHE IV was 20.6%. The mean predicted hospital mortality rate by serial MPM II measurements was 27.7%, 24.3%, 25.5%, and 25.8%. The area under the receiver-operating characteristic curve was 0.87 for APACHE IV and 0.82, 0.84, 0.85, and 0.89 for MPM II series. Both systems calibrated well with similar degree of goodness of fit. CONCLUSION: Acute Physiology and Chronic Health Evaluation IV on admission predicted hospital mortality better than serially recorded MPM, which overestimated mortality. Also, APACHE IV had a slightly better discrimination compared to MPM II on admission. One-time recording of APACHE IV on admission may be sufficient for prognostication of ICU patients rather than serial MPM scores.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Mortalidad Hospitalaria , Índice de Severidad de la Enfermedad , APACHE , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Adulto Joven
14.
Risk Manag Healthc Policy ; 9: 253-260, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27895521

RESUMEN

INTRODUCTION: The Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice. MATERIALS AND METHODS: In this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes. On August 1, 2013, a UWI team was introduced with a mandate to optimize teaching and promote laparoscopic surgery. The UWI team had a similar staff complement to the existing service-oriented teams. There was no immediate investment in equipment, hospital beds, ICU beds, or operating room space. Therefore, the new team was introduced with limited change in existing conditions, resources, and equipment. RESULTS: There were 252 laparoscopic operations performed over the study period. After introduction of the UWI team, there was an increase in the mean number of unselected laparoscopic operations (3.17 vs 10.83 cases per month; P<0.001; 95% confidence interval [95% CI] -8.5 to -6.84; standard error of the difference [SED] 0.408), the mean number of basic laparoscopic operations (3.17 vs 6.94 cases per month; P<0.0001; 95% CI -4.096 to -3.444; SED 0.165), the mean number of advanced laparoscopic operations (0 vs 3.89; P<0.0001), the number of teams undertaking unselected laparoscopic operations (2 vs 5), and the number of teams independently performing advanced laparoscopic operations (0 vs 4). CONCLUSION: At this facility, we have demonstrated a significant increase in laparoscopic case volume and complexity when partnerships were formed between the UWI and this service-oriented hospital. Continued cross-fertilization and distribution of skill sets across the surgical community can reasonably be expected. We also identified maneuvers that can be used as a template to build laparoscopic services in other service-oriented hospitals in developing nations.

16.
Br J Pain ; 10(2): 108-15, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27551421

RESUMEN

OBJECTIVES: Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. DESIGN AND METHODS: A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. RESULTS: A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. CONCLUSION: The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.

17.
J Anaesthesiol Clin Pharmacol ; 32(1): 18-24, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27006535

RESUMEN

BACKGROUND AND AIMS: This study aimed to determine whether a separate written consent form improved the efficacy of the informed consent process for anesthesia in adult patients undergoing elective surgery at a tertiary care teaching hospital. MATERIAL AND METHODS: We randomized patients into two groups prospectively. The first group (Group A) signed the hospital's standard Consent for Operation form only while the second group (Group B) signed a separate Consent for Anesthesia form additionally. Patients were interviewed postoperatively with an eight-item questionnaire with responses in a 5-point Likert scale. A composite adequacy of consent index was generated from the responses and analyzed. RESULTS: Two hundred patients (100 in each group) were studied. All patients indicated that the anesthesiologist(s) had their permission to proceed with their anesthesia care. The mean adequacy of consent index score in Group B was higher than that of Group A (30.6 ± 4.6 [standard deviation (SD)] vs. 27.9 ± 5.2 [SD]) (P < 0.001). The separate written consent had a positive impact on the patients' understanding of the nature and purpose of the intended anesthesia procedures (P = 0.04), satisfaction with the adequacy of information provided about common side effects (P < 0.001) and rare but serious complications (P = 0.008). CONCLUSIONS: A separate written consent for anesthesia improved the efficacy of the informed consent process with respect to better information about the nature and purpose of anesthesia, common side effects, and rare but serious complications.

18.
Perm J ; 19(4): e128-32, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26828072

RESUMEN

CONTEXT: A top-down evaluation of the costs of operating rooms (ORs) is not commonly done because it is relevant mostly in a publicly funded system. OBJECTIVE: This study was conducted to determine the costs and utilization of ORs in a public hospital in Trinidad, West Indies, for two one-year periods using a top-down model. DESIGN: Quantitative observational study.Main Outcome Measures: A "cost-block" model suggested for evaluation of intensive care unit costs was adapted to suit ORs. Data were obtained from personal interviews, records, and surveys from the appropriate hospital departments. Adjusted OR utilization times also were recorded for both years. RESULTS: The total annual costs of 4 ORs for the years 2006 and 2009 were approximately US $2.2 and $3.2 million, respectively. Capital expenditure contributed to 70% of the costs, followed by consumables (15%) and medical staff salary (8%). The daily cost of running the ORs was US $6242 in 2006, which rose to $8873 in 2009. The cost of unutilized OR time was approximately US $298,342 in 2006 and was reduced to $198,315 during 2009. CONCLUSION: The adapted cost-block model was useful to evaluate the costs of ORs in a public hospital in Trinidad and can be used from the government's expenditure perspective. Because the cost of running the ORs was high, efficiency must be improved to minimize waste.


Asunto(s)
Costos de Hospital/estadística & datos numéricos , Hospitales Públicos/economía , Hospitales de Enseñanza/economía , Quirófanos/economía , Quirófanos/estadística & datos numéricos , Humanos , Trinidad y Tobago
19.
Perm J ; 18(1): e101-4, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24626079

RESUMEN

CONTEXT: Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. OBJECTIVE: To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. METHODS: We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. RESULTS: There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. CONCLUSIONS: Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.


Asunto(s)
Pie Diabético/economía , Enfermedades del Pie/economía , Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/sangre , Pie Diabético/terapia , Femenino , Enfermedades del Pie/terapia , Hemoglobina A Glucada/análisis , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trinidad y Tobago , Adulto Joven
20.
J Natl Med Assoc ; 106(1): 69-72, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-26744116

RESUMEN

Sportman's hernia: (Athletic pubalgia) is an uncommon and poorly understood condition afflicting athletic individuals. Sufferers complain of chronic groin pain and often present diagnostic dilemmas to physicians and physiotherapists. We present a series of cases illustrating the varying presentations of sportman's hernia and diagnostic approaches that can be utilized to exclude common differentials. We also describe laparoscopic mesh repair as an effective treatment option for this condition.

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