The prevalence of seat belt use in Kingston, Jamaica: a follow-up observational study five years after the introduction of legislation / Prevalencia del uso del cinturón de seguridad en Kingston, Jamaica: un estudio observacional de seguimiento, cinco años después de introducida la legislación

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0. 001) and as front seat passengers (79.9% vs 66.3%; p < 0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p < 0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized

Un estudio transversal observacional llevado a cabo en Kingston en el año 2004 mostró que los cinturones de seguridad eran usados por el 81.2% de los conductores de vehículos motorizados privados, y el 74.0% de los pasajeros del asiento delantero. Esto representa una mejoría significativa en comparación con el 21.1% y el 13.6% respectivamente en 1996 antes de que se introdujera la legislación en 1999 (p < 0.001). Las tendencia de las mujeres a usar cinturones de seguridad fue significativamente mayor que la de los hombres, tanto al conducir (92.5% vs 77.3%; p < 0.001) como al viajar como pasajeras en el asiento delantero (79.9% vs 66.3%; p < 0.001). De los 2289 vehículos motorizados examinados, todos – excepto uno – estaban equipados con cinturones de seguridad. No se examinó la utilización de los cinturones de seguridad por parte de los pasajeros en los asientos traseros. Los conductores de vehículos nuevos mostraron una tendencia mayor que los otros conductores a usar cinturones de seguridad (p < 0.001). Los conductores varones, los conductores de vehículos más viejos, y todos los pasajeros puede que requieran ser objeto específico de una campaña destinada a educarlos o a hacer cumplir la ley si se desea maximizar los beneficios del uso del cinturón de seguridad.

Surgery in the elderly: is age a risk factor? / La Cirugía en los Pacientes Mayores de Edad ¿Es la Edad un Factor de Riesgo?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources

Este estudio observacional prospectivo de un año analizó 623 pacientes de 60 años de edad o más, de una cohorte de 2375 pacientes que fueron admitidos consecutivamente a las salas de cirugía general del Hospital Universitario de West Indies. Aunque sólo 9.7% de la población jamaicana tiene 60 años de edad o más, este grupo etario representó el 26.2% del total de ingresos. La comparación de pacientes mayores con no mayores no mostró ninguna diferencia en cuanto a género, pero los pacientes menos mayores fueron ingresos de emergencia (52% vs 64%, p < 0.001), más necesitaron cirugía (68% vs 60%, p <0.001), su período medio de estancia en el hospital fue más largo (11.5 vs 8.0 días, p <0.001) y su tasa de mortalidad fue más alta (8.8% vs 1.9%, p < 0.001). Los ingresos de emergencia (52%) excedieron a los ingresos electivos dentro del grupo de los pacientes mayores de edad. Cuarenta y cuatro (80%) de las 55 muertes en el grupo de mayores de edad fueron pacientes ingresados como emergencias en comparación con los ingresos electivos (p < 0.001). Se produjeron 11 fallecimientos entre las 296 admisiones electivas (3.7%) pero 44 muertes entre las 327 admisiones de emergencia (13.5%), una diferencia significativa en la tasa de mortalidad (p < 0.001). Por regla general, la tasa de mortalidad entre los hombres fue más alta. El cáncer fue el diagnóstico más común (21%) entre los ingresos y la causa más frecuente de las mortalidades. Los pasos para mejorar las oportunidades de ingreso temprano y optimizar la atención a pacientes quirúrgicos ancianos, no sólo redundaría en beneficio de estos últimos, sino que representaría también un paso importante hacia un uso más eficaz de recursos que están escasos.

Student self-assessment in a paediatric objective structured clinical examination / Autoevaluación del Estudiante en un Examen Clínico Objetivo Estructurado de Pediatría

OBJECTIVE: The objective structured clinical examination (OSCE) has been recognized not only as a useful assessment tool but also as a valuable method of promoting student learning. Student self-assessment is also seen as a means of helping students recognize their strengths and weaknesses, understand the relevance of core learning objectives and to take more responsibility for each stage of their work The authors sought to evaluate the accuracy of medical student self-assessment of their performance in the paediatric clerkship OSCE and thus obtain preliminary data for use in programme strengthening. DESIGN AND METHODS: A self-administered questionnaire was completed by successive groups of students immediately after the OSCE at the end of each clerkship rotation. Students assessed their performance at each station, using a performance rating scale. Performance data were summarized using descriptive and non-parametric tests. Basic statistical analysis of the Likert items was conducted by calculatingfrequencies, means and standard deviations. Regression analysis was used to correlate self-reported rating and actual performance in each station. A p value of < 0.05 was considered significant. Eighty-one students (92) completed the questionnaire. RESULTS: Fifty-eight (72) of the students achieved greater than minimum competence in their overall scores. Significant positive correlation (p < 0.05) between student self-rating and actual score was noted- among the following stations: technical skills, cardiovascular examination, assessment of dysmorphism, dermatology, communication and photographic interpretation stations. Students overestimated their performance in the gastrointestinal examination, radiological and arterial blood gas interpretation. Students underestimated their performance in the following: respiratory system, examination of the head, developmental and nutritional assessment. CONCLUSIONS: The findings highlight the perceived strengths and weaknesses in clinical competence and self-assessment skills and provide direction for programme training needs

Objetivo: El examen clínico objetivo estructurado (ECOE) ha sido reconocido no sólo como una herramienta de evaluación útil, sino también como un valioso método para promover el aprendizaje del estudiante. La auto-evaluación estudiantil es vista también como un medio de ayudar a que los estudiantes reconozcan sus fortalezas y debilidades, entiendan la relevancia de los objetivos de aprendizaje comunes, y tomen más responsabilidad en cada etapa de su trabajo. Los autores buscaron evaluar la exactitud de la auto-evaluación del rendimiento del estudiante de medicina en la estación pediátrica del ECOE, obteniendo de eso modo datos preliminares a ser usados en el fortalecimiento del programa. Diseño y métodos: Una autoencuesta fue completada por grupos sucesivos de estudiantes inmediatamente después del ECOE al final de cada rotación de las estaciones. Los estudiantes evaluaron su rendimiento en cada estación, usando una escala de evaluación del rendimiento. Los datos del rendimiento fueron resumidos utilizando tests descriptivos y no paramétricos. El análisis estadístico básico de los ítems tipo Likert se llevó a cabo calculando las frecuencias, medias y desviaciones estándar. El análisis de regresión fue usado para correlacionar la calificación autoreportada con el desempeño real en cada estación. Un valor de p < 0.05 fue considerado significativo. Ochenta y un estudiantes (92%) respondieron la encuesta. Resultados: Cincuenta y ocho (72%) de los estudiantes lograron un rendimiento por encima del mínimo en sus resultados (puntuaciones) generales. Se observó una correlación positiva significativa (p < 0.05) entre la autocalificación del estudiante y el resultado real en las estaciones siguientes: habilidades técnicas, examen cardiovascular, evaluación del dismorfismo, dermatología, y las estaciones de comunicación e interpretación fotográficas. Los estudiantes encima de-estimaron su actuación en el examen gastrointestinal, la interpretación de gas de sangre radiológica y arterial. Los estudiantes subvaloraron su competencia en las siguientes estaciones: sistema respiratorio, examen de la cabeza, evaluación del desarrollo y la nutrición. Conclusiones: Los hallazgos resaltan las fortalezas y las debilidades percibidas en la competencia clínica y la autoevaluación de las habilidades, a la par que proveen dirección a las necesidades de entrenamiento en los programas.

Motivation for and concerns about entering a medical programme

The motivation for and concerns about studying medicine and future career plans of students at the Faculty of Medical Sciences, The University of the West Indies (UWI), were studied using a cross-sectional survey that included Year 1 medical students at both the Mona (Jamaica) and St Augustine (Trinidad and Tobago) medical schools of the UWI. The data were collected using a self-administered questionnaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences. A total of 193 students took part in the study, 103 from Mona and 90 from St Augustine (88 response rate). Seventy per cent of the students were between 18 to 22 years of age with 59 being females. The highest rated motives for studying medicine were the 'opportunity for working with people' and an 'interest in human biology'. Female students scored significantly higher for the motive of an 'opportunity for working with people', while males rated the 'social prestige/status' significantly higher. The greatest concerns of the students were 'fear of failure' and 'contracting diseases'. The female students had a greater concern for dealing with the long hours involved in medical training than their male counterparts. Surgical specialties (43), family medicine (38) and paediatrics (34) were the top choices of the students for future specialty and more women than men chose obstetrics. Although the motives that students have reported are varied, there was a reasonable spread of desirable motives. This study provides a baseline for observing possible changes as students advance through medical training. A programme of study that strives to maintain these well-placed motives while providing opportunities for dealing with the concerns of the students will assist in creating caring, empathetic physicians for the Caribbean

Penetrating wounds of the heart

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low blood pressure levels was in 33 per cent of the patients with cardiactamponade. Pulsus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was not helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with mediansternotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate

Visceral complications of electrical burn injury: a report of two cases and review o the literature

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforations. The rarity of this complications is examined in light of the pathophysiology of electrical injury, and its management is discussed wiht reference to previously published reports on this conditions

Benign biliary strictures

Benign biliary strictures are rare. Their management represents a challenge to the practising surgeon. Six cases seen at the University Hospital of the West Indies are reviewed. Early recognition and management by an experienced surgeon will improve prognosis

Massive hepatic haemangioma

Small haemangiomas of the liver are not uncommon, but very large tumors constitute a very rare clinical entity. We describe a case of massive, diffuse, cavernous haemangioma of both lobes of the liver in which therapeutic angiographic embolization was successfully used to control persistent haemorrhage following biopsy. The current literature is also reviewed with particular reference to diagnosis and treatment

Temporary tube gastrostomy: a clinical evaluation

A prospective analysis of 150 temporay tube gastrostomies performed over two 12-mounth periods is presented. All were carried out at the time of another abdominal surgical procedure and were intende for post surgical procedure and to any tube-related complications. Gastrostomu was found to be a safe, comfortable and effective method of achieving prolonged gastric decompression, an its use is recommended in selected patients