ABSTRACT
OBJECTIVES: The purpose of this study is to assess the knowledge, attitudes and practices among medical students in relation to medical ethics and law. The results of the study will be a useful guide to tutors of medical students and curricula designers. METHODS: A thirty-item self-administered questionnaire about knowledge of law and ethics, and the role of an ethics committee in the healthcare system was devised, tested and distributed to all levels of students and staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) in 2003. The data from the completed questionnaires were entered into an SPSS database and analyzed using frequency and multiple cross-tabulation tables. RESULTS: Completed responses were obtained from 55 (96) of the medical students. Medical students generally attested to the importance of ethical knowledge but felt that they knew little of the law. Students varied widely as regards the frequency with which they saw ethical or legal problems, with a quarter seeing them infrequently, but another quarter seeing them every day. They received their knowledge from multiple sources and particularly from lectures/seminars, and found case conferences the most helpful. Only a few students felt that text books had been helpful. Students were generally knowledgeable about most ethical issues, but many had uncertainties on how to deal with religious differences in treating patients, on the information to be given to relatives, and how violent patients should be treated. CONCLUSIONS: The results of the study highlight that medical students felt an inadequacy of knowledge of law as it pertains to their chosen career Since most of their knowledge of law was obtained from lectures, these should be reviewed and other avenues of tuition explored. The study also highlights the need to identify the minority of students who have problems with their ethical knowledge and to devise means whereby any deficiencies can be discussed and...
OBJETIVOS: El propósito de este estudio es evaluar los conocimientos, las actitudes y la práctica entre los estudiantes de medicina en relación con la ética y las leyes en el campo de la medicina. Los resultados del estudio serán una guía útil para los tutores de los estudiantes de medicina y los diseñadores de currículos de estudios. MÉTODOS: Una encuesta auto-administrada de treinta puntos sobre los conocimientos de leyes y ética, y el papel de un comité de ética en el sistema de atención a la salud, fue diseñada, probada y distribuida a todos los niveles entre los estudiantes y el personal del Hospital Queen Elizabeth en Barbados (un hospital docente de atención terciaria) en 2003. Los datos de las encuestas completadas fueron introducidos en una base de datos de SPSS, y analizados usando tablas de frecuencia y tablas múltiples de tabulación cruzada. RESULTADOS: Se obtuvieron cuestionarios respondidos por parte de 55 (96%) de los estudiantes de medicina. Los estudiantes de medicina por lo general atestiguaron la importancia de los conocimientos éticos, pero sentían que sabían poco de las leyes. Hubo grandes diferencias entre los estudiantes con respecto a la frecuencia con que veían problemas éticos o legales una cuarta parte de ellos señalando que no los veía frecuentemente, y otra cuarta parte indicando que los veía todos los días. Ellos recibieron sus conocimiento de múltiples fuentes especialmente de conferencias y seminarios y encontraron que las conferencias sobres casos, fueron las más útiles en tal sentido. Sólo unos pocos estudiantes fueron del parecer de que los libros de texto habían sido útiles. Por lo general, los estudiantes se mostraron conocedores de la mayoría de los problemas éticos, pero muchos manifestaron incertidumbre en cuanto a cómo abordar las diferencias religiosas al tratar con los pacientes, qué información dar a los familiares, y cómo debían ser tratados los pacientes violentos...
Subject(s)
Humans , Male , Female , Adult , Health Knowledge, Attitudes, Practice , Education, Medical, Undergraduate , Students, Medical/psychology , Legislation, Medical , Ethics, Medical/education , Barbados , Data Collection , Ethics Committees, Clinical , Hospitals, Teaching , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate the clinical characteristics and costs incurred for patients who stayed for a prolonged period in a surgical intensive care unit (ICU). DESIGN AND METHODS: Data of all patients admitted to a surgical ICU in Barbados during the period of two years from July 1999 to June 2001 were prospectively collected. Demographic data, diagnoses on admission and Acute Physiology and Chronic Health Evaluation (APACHE II) score were recorded. Costs for treatment were calculated from using a cost block model. The characteristics of patients who had a prolonged stay (> 14 days) were compared with a concurrent cohort of patients who stayed less than 14 days. RESULTS: Of 438 admissions, 58 (13.2) stayed in the ICU for more than two weeks. The overall age, hospital outcome, APACHE II scores in the prolonged stay group were significantly higher than that of the patients who stayed less than two weeks. Cost analysis showed about six times more expenditure in the long stay patients (dollar US 3800 vs dollar US 24000). Of the prolonged stay ICU patients, 29.2would have required only a step-down unit due to less severity of illness as evidenced by their low mean APACHE II scores [7.3 +/- 2.6 (SD)] compared to overall mean APACHE II score 10.7 +/- 7.5 (SD). CONCLUSION: The study highlighted the need for a step-down unit and a protocol to transfer eligible patients to such a unit.
OBJETIVO: Evaluar las características clínicas y costos en que incurren los pacientes que permanecen un periodo prolongado de tiempo en una unidad quirúrgica de cuidados intensivos (UCI). DISEÑO Y MÉTODOS: Los datos de todos los pacientes ingresados en una UCI en Barbados durante el período de dos años de julio de 1999 a junio de 2001 de junio, fueron recopilados de manera prospectiva. Se registraron los datos demográficos, los diagnósticos al momento del ingreso, y la puntuación APACHE II. Se calcularon los costos del tratamiento mediante un modelo de bloques del costo. Las características de los pacientes que tuvieron una estancia prolongada (> 14 días) fueron comparadas con una cohorte concurrente de pacientes que permanecieron menos de 14 días. RESULTADOS: De 438 admisiones, 58 (13.2%) permaneció en la UCI por más de dos semanas. La edad general, el resultado hospitalario y la puntuación APACHE II fueron significativamente más altos en el grupo de estancia prolongada que en el de los pacientes que permanecieron menos de dos semanas. El análisis del costo mostró aproximadamente seis veces más gastos en relación con los pacientes de estancia prolongada ($3800 usd vs. 2 4000 usd). El 29.2% de los pacientes que tuvieron una estancia prolongada en la UCI, habrían requerido sólo un área de recuperación de fase II con una labor menos intensiva (step-down) debido al carácter menos severo de la enfermedad, tal cual lo pone de manifiesto la media baja de sus puntuaciones APACHE II [7.3 ± 2.6 (SD)] en comparación con la media general de la puntuación APACHE II (0.7 ± 7.5 (SD). CONCLUSIÓN: El estudio puso de relieve la necesidad de una unidad de recuperación de fase II (step-down) y un protocolo para transferir a los pacientes elegibles para esa unidad.
Subject(s)
Humans , Male , Female , Middle Aged , Postoperative Care/methods , Critical Illness , Utilization Review , Length of Stay/statistics & numerical data , Intensive Care Units , APACHE , Barbados/epidemiology , Postoperative Care/economics , Prospective Studies , Time Factors , Hospital Mortality , Length of Stay/economics , Intensive Care Units/economicsABSTRACT
Propofol, a new intravenous anaesthetic induction agent, was evaluated on female patients undergoing short surgical procedures. The incidence of pain on injection, apnonea following injection, and the fall of systolic and diastolic blood pressure levels, was similar to yhat previously reported. There was no significant fall in pulse rate. The quality of anaeshesia during induction was good in all patients who reported they would be happy to receive the drug agaim
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Female , Apnea/chemically induced , Anesthesia, Intravenous , Phenols/administration & dosage , Phenols/adverse effects , Hypotension/chemically inducedABSTRACT
In order to assess the immune status to Hepatitis B in a general hospital population in the Caribbean, we studied the antibody level to Hepatitis B surface antigen (anti HBs) and to core antigen (anti HBc) in 90 health-care workers aat the Queen Elizabeth Hospital in Berbados, West Indies. There was one asymptomatic carrier with Hepatitis B antigen (HBsAg). Therteen (14.6%) of the remaining 89 possessed anti ABs; 10 of these (11.2%) were considered to be immune, and three non-immune. The 10 immune sujects were also positive for anti HBc wereas the other three "non-immune" positives were not. One person in the studey had strong anti HBc immunity but was negative for anti HBs. There appeared to be no relationship between immunity and age, sex, profession or duration of work years. From the study, 76 individuals (84%) were easily identified as being susceptible to Hepatitis B and were candidates for HBV vaccine