Tracking Medical Graduates in Jamaica and The Bahamas / Tras los graduados de medicina en Jamaica y las Bahamas

ABSTRACT Objective: To determine the availability of employment and retention for the increased number of medical graduates in Jamaica and The Bahamas. Methods: The availability of internships and junior medical posts for graduates of The University of the West Indies in Jamaica and The Bahamas over the five-year period of 2012 to 2016 was reviewed. Results: There were 947 medical graduates between 2012 and 2016 in Jamaica; 69.4% of them were female. The number of graduates increased annually. The majority of graduates were Jamaicans; non-Jamaicans comprised 18.2%. All Jamaican graduates obtained internship posts in the public hospitals and at the University Hospital of the West Indies, Jamaica, with a phased increase of approximately 20% in the posts available over the period. The public hospitals employed 75% of the graduates. There were 172 non-Jamaican graduates, the majority of whom were from Trinidad and Tobago, who did not seek employment in Jamaica. In The Bahamas, there were 132 graduates, all of whom obtained internship posts in public hospitals. Of the 2259 applicants, 664 were accepted to postgraduate programmes in Jamaica and The Bahamas between 2012 and 2016. Seventy per cent of all graduates were working in the English-speaking Caribbean, with the majority in Jamaica. Conclusion: The number of medical graduates trained increased, with a predominance of females. All graduates obtained employment in Jamaica and The Bahamas, mainly in public institutions. Although there was 70% retention of graduates, there is an urgent need to increase the number of postgraduate posts and accredited training institutions in the Caribbean.

RESUMEN Objetivo: Determinar la disponibilidad de empleo y la retención para el número creciente de graduados de medicina en Jamaica y las Bahamas. Métodos: Se revisó la disponibilidad de pasantías y puestos médicos para recién graduados de la Universidad de West Indies en Jamaica y las Bahamas durante el período de cinco años de 2012 a 2016. Resultados: Hubo 947 graduados de medicina entre 2012 y 2016 en Jamaica, de los cuales el 69.4% eran mujeres. El número de graduados aumentó anualmente. La mayoría de los graduados eran jamaicanos; los no jamaicanos comprendían el 18.2%. Todos los graduados jamaicanos obtuvieron puestos de pasantía en los hospitales públicos y en el Hospital Universitario de UWI, Jamaica, con un aumento gradual de aproximadamente 20% de los puestos disponibles durante el período. Los hospitales públicos emplearon el 75% de los graduados. Hubo 172 graduados no jamaicanos, la mayoría de los cuales eran de Trinidad y Tobago, y no buscaban empleo en Jamaica. En las Bahamas, hubo 132 graduados, todos los cuales obtuvieron puestos de pasantía en hospitales públicos. De los 2259 solicitantes, 664 fueron aceptados en los programas de postgrado en Jamaica y las Bahamas entre 2012 y 2016. El setenta por ciento de todos los graduados trabajaban en el Caribe de habla inglesa, mayormente en Jamaica. Conclusión: El número de graduados médicos entrenados aumentó, con predominio de las mujeres. Todos los graduados obtuvieron empleo en Jamaica y las Bahamas, principalmente en instituciones públicas. Aunque hubo 70% de retención de graduados, hay una necesidad urgente de aumentar el número de puestos de posgrado y formación acreditada en las instituciones del Caribe.

Patterns of violence related injuries presenting to the Cornwall Regional Hospital

OBJECTIVES: Determine the factors associated with violence related injuries (VRI) presenting the Cornwall Regional Hospital (CRH). DESIGN AND METHODS: Data were collected from the Jamaica Injury Surveillance System (JISS) on all patients presenting to the CRH during April and May 2014. This information was collected at hospital registration from all patients with VRIs after triage in the hospital emergency room. RESULTS: A total of 438 patients presented to the Cornwall Regional Hospital during April and May 2014. Complete data were located for 407 of these patients (93%). Of these 58% (237) were males and 42% (170) were female. The most common age group presented in the data was 18-29 years (37%) and blunt trauma was the most common method of injury (34%). The most common circumstance surrounding VRIs was a fight (77%) and 43% of persons were injured by an acquaintance. Gang and drug related VRIs accounted for less than 1% of injuries. CONCLUSIONS: The JISS represents an excellent source of data on VRIs in Montego Bay and Jamaica. It allows the creation of a profile of those injured during violence and the surrounding circumstances. Violence might be a common part of interaction between friends and family.

The Jamaica Injury Surveillance System: a profile of the intentional and unintentional injuries in Jamaican hospitals.

BACKGROUND: Injuries in Jamaica are a major public health problem as demonstrated by a hospital based computerized injury surveillance system established in 1999 that provides a risk profile for injuries. SUBJECTS AND METHOD: Injury data from 2004 were selected to provide an annual profile, as comprehensive injury data were available from nine public hospitals. These nine public hospitals provide care for 70% of the Jamaicans admitted to hospitals annually. RESULTS: Data are presented on unintentional injuries where falls caused 44%, lacerations 27% and accidental blunt injuries were 17% of these. For motor vehicle related injuries, 55% were sustained while commuting by motorcars, 17% while riding motorbikes/bicycles and 16% of those injured were pedestrians. Most violence related injuries were due to fights (76%) with acquaintances (47%) who used sharp objects (40%) to inflict the injury. CONCLUSION: The Jamaica Injury Surveillance System (JISS) data, augmented by data collected on injuries from the health centres and the sentinel surveillance system, give a measure of the magnitude of the impact of injuries on the health services. The JISS provides data on the profile of injuries seen and treated at health facilities in Jamaica. In collaboration with police data and community-based surveys, it can be used to complete the risk profiles for different types of injuries. The data generated at the parish, regional and national levels form the basis for the design and monitoring of prevention programmes, as well as serve to support and evaluate policy, legislative control measures and measures that impact on interventions.

Jaundice post laparoscopic cholecystectomy.

In just over 20 years, laparoscopic cholecystectomy has emerged as the standard therapy for cholelithiasis and is now being performed with increased safety. However an uncommon complication of this technique has been jaundice even in patients without iatrogenic bile duct injury. We report on two cases where this complication occurred and review the literature on this topic.

The Jamaica Injury Surveillance System a profile of the intentional and unintentional injuries in Jamaican Hospitals / El Sistema de Vigilancia de Lesiones en Jamaica (SVLJ) u n perfil de las lesiones intencionales y no intencionales en hospitales de Jamaica

BACKGROUND: Injuries in Jamaica are a major public health problem as demonstrated by a hospital based computerized injury surveillance system established in 1999 that provides a risk profile for injuries. SUBJECTS AND METHOD: Injury data from 2004 were selected to provide an annual profile, as comprehensive injury data were available from nine public hospitals. These nine public hospitals provide care for 70% of the Jamaicans admitted to hospitals annually. RESULTS: Data are presented on unintentional injuries where falls caused 44%, lacerations 27% and accidental blunt injuries were 17% of these. For motor vehicle related injuries, 55% were sustained while commuting by motorcars, 17% while riding motorbikes/bicycles and 16% of those injured were pedestrians. Most violence related injuries were due to fights (76%) with acquaintances (47%) who used sharp objects (40%) to inflict the injury. CONCLUSION: The Jamaica Injury Surveillance System (JISS) data, augmented by data collected on injuries from the health centres and the sentinel surveillance system, give a measure of the magnitude of the impact of injuries on the health services. The JISS provides data on the profile of injuries seen and treated at health facilities in Jamaica. In collaboration with police data and community-based surveys, it can be used to complete the risk profiles for different types of injuries. The data generated at the parish, regional and national levels form the basis for the design and monitoring of prevention programmes, as well as serve to support and evaluate policy, legislative control measures and measures that impact on interventions.

ANTECEDENTES: Las lesiones constituyen un problema importante de la salud pública en Jamaica, como lo demuestra el sistema de vigilancia computarizada de las lesiones, establecido en 1999, el cual proporciona un perfil de riesgo de las lesiones. SUJETOS Y MÉTODO: Datos de lesiones ocurridas en el 2004 fueron seleccionados a fin de ofrecer un perfil anual, ya que se disponía de un conjunto amplio de datos de nueve de los hospitales públicos. Estos nueve hospitales públicos dan atención al 70% de los jamaicanos ingresados a los hospitales cada año. RESULTADOS: Se presentan datos sobre lesiones no intencionales, según los cuales las caídas representaron el 44%, las laceraciones el 27% y las contusiones accidentales el 17%. En cuanto a las lesiones relacionadas con automóviles, el 55% fueron producidas durante la transportación diaria en vehículos automotores a centros de trabajo o estudio; el 17% se produjo en viajes en motos o bicicletas; y el 16% de los heridos fueron peatones. La mayoría de las lesiones relacionadas con la violencia se debieron a peleas (76%) con conocidos (47%) que usaron objetos perforocortantes (40%) para infligir las heridas. CONCLUSIÓN: Los datos del SVLJ, aumentados con los datos sobre lesiones recopilados en los centros de salud y el sistema de vigilancia centinela, dan una medida de la magnitud del impacto de las lesiones en los servicios de salud. El SVLJ proporciona datos sobre el perfil de las lesiones vistas y tratadas en los centros de salud de Jamaica. En colaboración con datos de la policía y encuestas a nivel de la comunidad, el sistema puede ser usado para completar los perfiles de riesgo en relación con diferentes tipos de lesiones. Los datos generados a nivel provincial, regional y nacional constituyen la base para el diseño y monitoreo de los programas de prevención. Asimismo, sirven para apoyar y evaluar políticas, legislaciones, medidas de control así como medidas relativas al impacto de las intervenciones.

Jaundice post laparoscopic cholecystectomy / Ictericia post colecistectomía laparoscópica

In just over 20 years, laparoscopic cholecystectomy has emerged as the standard therapy for cholelithiasis and is now being performed with increased safety. However, an uncommon complication of this technique has been jaundice even in patients without iatrogenic bile duct injury. We report on two cases where this complication occurred and review the literature on this topic.

En sólo poco más de 20 años, la colecistectomía laparoscópica se ha convertido en la forma de terapia estándar de la colelitiasis, y se la está utilizando en la actualidad con mayor seguridad. No obstante, una complicación poco común de esta técnica ha sido la ictericia, incluso en pacientes sin lesión iatrogénica de la vía biliar. Reportamos dos casos en lo que ocurrió esta complicación, y examinamos la literatura sobre este asunto.

Results of an exercise to estimate the costs of interpersonal violence in Jamaica / Resultados de un ejercicio para estimar el costo de la violencia interpersonal en Jamaica

This report describes the application of a draft version of the World Health Organization (WHO)/ United States Centers for Disease Control and Prevention (CDC) Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence to measure costs of injuries from interpersonal violence. METHODS: Fatal incidence data was obtained from the Jamaica Constabulary Force. The incidence of nonfatal violence-related injuries that required hospitalization was estimated using data obtained from patients treated at and/or admitted to three Type A government hospitals in 2006. RESULTS: During 2006, direct medical cost (J$2.1 billion) of injuries due to interpersonal violence accounted for about 12% of Jamaica's total health budget while productivity losses due to violence-related injuries accounted for approximately J$27.5 billion or 160% of Jamaica's total health expenditure and 4% of Jamaica's Gross Domestic Product. CONCLUSIONS: The availability of accurate and reliable data of the highest quality from health-related information systems is critical for providing useful data on the burden of violence and injury to decision-makers. As Ministries of Health take a leading role in violence and injury prevention, data collection and information systems must have a central role. This study describes the results of one approach to examining the economic burden of interpersonal violence in developing countries where the burden of violence is heaviest. The WHO-CDC manual also tested in Thailand and Brazil is a first step towards generating a reference point for resource allocation, priority setting and prevention advocacy.

Este reporte describe la aplicación de una versión preliminar del Manual de Centros de Estados Unidos para el control y prevención de enfermedades (CDC)/Organización Mundial de la Salud (OMS), para estimar el costo económico de las heridas debidas a la violencia interpersonal y la violencia auto-dirigida, con el fin de evaluar los costos de las heridas por violencia interpersonal. MÉTODOS: Datos sobre las incidencias fatales fueron obtenidos de las Oficinas de la Policía de Jamaica. La incidencia de las heridas no fatales relacionadas con la violencia, pero que no obstante requirieron hospitalización, se calculó a partir de pacientes tratados o ingresados en hospitales gubernamentales del tipo A, en el año 2006. RESULTADOS: Durante el 2006, el costo médico directo (2.1 billones JMD) por heridas a causa de violencia interpersonal, representó alrededor del 12% del total del presupuesto para la salud en Jamaica, mientras que las pérdidas de productividad debido a heridas relacionadas con la violencia, representaron aproximadamente 37.5 billones JMD, o 160% del total de gastos de salud y el 4% del producto interno bruto de Jamaica. CONCLUSIONES: Disponer de datos confiables y exactos de la más alta calidad provenientes de los sistemas de información relacionados con la salud, resulta crucial a las hora de suministrar datos útiles sobre la carga de la violencia y las heridas para quienes tienen a su cargo las tomas de decisiones. Como que los Ministros de Salud desempeñan un papel dirigente en la prevención de las heridas y la violencia, la recogida de datos y los sistemas de información tienen que jugar un papel central. Este estudio describe los resultados de un enfoque para examinar la carga económica de la violencia interpersonal en los países en vías de desarrollo, en los cuales la carga de la violencia es más pesada. El manual CDC-OMS también probado en Tailandia y Brasil, es un primer paso hacia la generación de un punto de referencia para asignar recursos, establecer prioridades y defender la prevención.

Results of an exercise to estimate the costs of interpersonal violence in Jamaica.

UNLABELLED: This report describes the application of a draft version of the World Health Organization (WHO)/ United States Centers for Disease Control and Prevention (CDC) Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence to measure costs of injuries from interpersonal violence. METHODS: Fatal incidence data was obtained from the Jamaica Constabulary Force. The incidence of nonfatal violence-related injuries that required hospitalization was estimated using data obtained from patients treated at and/or admitted to three Type A government hospitals in 2006. RESULTS: During 2006, direct medical cost (J$2.1 billion) of injuries due to interpersonal violence accounted for about 12% of Jamaica's total health budget while productivity losses due to violence-related injuries accounted for approximately J$27.5 billion or 160% of Jamaica's total health expenditure and 4% of Jamaica's Gross Domestic Product. CONCLUSIONS: The availability of accurate and reliable data of the highest quality from health-related information systems is critical for providing useful data on the burden of violence and injury to decision-makers. As Ministries of Health take a leading role in violence and injury prevention, data collection and information systems must have a central role. This study describes the results of one approach to examining the economic burden of interpersonal violence in developing countries where the burden of violence is heaviest. The WHO-CDC manual also tested in Thailand and Brazil is a first step towards generating a reference point for resource allocation, priority setting and prevention advocacy.

Selective operative cholangiography in the performance of laparoscopic cholecystectomy.

The objective of this prospective study was to evaluate the role of intraoperative cholangiography (IOC) for patients undergoing laparoscopic cholecystectomy (LC) to determine whether it could be safely omitted for all patients who fit standard criteria, namely normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD) diameter less than 10 mm or previous history of jaundice. Data were collected prospectively from 194 consecutive patients who had LC for symptomatic gall bladder disease. IOC was not performed in any patient. The conversion rate was 6.1% and one CBD injury occurred. Our experience demonstrates that LC performed without routine IOC does not result in an increased incidence of retained stones in selected patients who have no history of pancreatitis, normal liver function tests and CBD less than 10 mm diameter.

Wound healing and care in the infected diabetic foot

The care of the infected diabetic foot remains an area for continued research as we try to reduce the morbidity and mortality of this most prevalent disease process. None of the new and advanced products can take the place of proper assessment, timely, and adequate surgical intervention and control of the blood sugar; they are only adjunctive. The use of non-invasive investigative techniques such as magnetic resonance imaging and nuclear bone scan can help to confirm the presence of osteomyelitis which must be eradicated to accelerate the healing process. The gold standard for diagnosing vascular disease is angiography. Defective blood flow to the lower extremity must be corrected to ensure aequate blood supply and nutrients to the wound. In addition, good glucose control, adequate nutrition and strong psychological support will make a difference in healing these difficult wounds.

Wound healing and care in the infected diabetic foot.

The care of the infected diabetic foot remains an area for continued research as we try to reduce the morbidity and mortality of this most prevalent disease process. None of the new and advanced products can take the place of proper assessment, timely, and adequate surgical intervention and control of the blood sugar; they are only adjunctive. The use of non-invasive investigative techniques such as magnetic resonance imaging and nuclear bone scan can help to confirm the presence of osteomyelitis which must be eradicated to accelerate the healing process. The gold standard for diagnosing vascular disease is angiography. Defective blood flow to the lower extremity must be corrected to ensure aequate blood supply and nutrients to the wound. In addition, good glucose control, adequate nutrition and strong psychological support will make a difference in healing these difficult wounds.

Laparoscopic cholecystectomy in Jamaica. The initial experience. UHWI/KPH Laparoscopic Surgery Group.

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.