Pancreas Alone Grafts from Cardiac Death Donors; is Procurement Damage an Issue?.

Aims: In order to minimize damage to DCD (deceased cardiac donors) pancreatic grafts the donor surgery has to proceed as quickly as possible. Because of this previous studies have suggested that organs procured (liver and kidney) from DCD donors have higher discard rates. The aim of this study was to establish whether DCD pancreatic grafts were more likely to be damaged and discarded when compared to conventional DBD (deceased brainstem) pancreatic grafts. Methods: Data was collected retrospectively from pancreatic alone organ offers to our single centre over a 12 month period and analyzed, Simultaneous kidney pancreas (SPK) grafts were excluded. Results: Of 33 pancreas alone offers 15 were DCD’s and 18 were DBD’s. There was no difference in leading cause of death between DCD or DBD donations of which intracranial hemorrhage was the most frequent and Hypoxic brain injury [joint with cardiovascular accidents (CVA) for DBD donations] the next most frequent cause. There was also no difference in BMI between the two groups. For DCD’s the mean donor age was 45.5 years compared with 42.6 years for DBD organs. 6% of all organs were discarded (n=2) because of procurement damage and all were from DBD donors. Of the remaining 31 organs only 6 were transplanted (DBD n=5 to DCD n=1). The leading cause of decline for the remaining 27 organs was donor history for both groups followed by prolonged cold ischemia for DBD’s and other logistical reasons for DCD’s. Procurement damage was the third most common cause of decline for DBD pancreas alone grafts. Conclusions: Although there did not appear to be a higher incidence of pancreatic graft damage when the organ was retrieved from a DCD donor in comparison to DBD donors, there are still organs being discarded because of procurement damage. Enhanced training techniques/supervision during the retrieval process still need to be optimised to reduce organ discard rates even further so no organs are ever wasted because of procurement damage.

Assessment of community health aides

A research project funded by the Commonwealth Caribbean Medical Research Council (CCMRC) began in February 1987, to study aspects of the situation in connection with 508 Community Health Aides (CHAs) employed in Government Service of Jamaica. There were in the service 1,328 CHAs in 1978, reducedto 1,183 in 1982 and to 1,168 in 1984. By 1985/86 the numbers were further reduced,reaching the low figure of 508. This report deals specifically with the responses of 615 members of the community who were interviewed, and questionaires were returned from all parishes in the four Administrative Health areas in Jamaica. The responses from community members are very important in the assessment ofcommunity health aides as members of the community health team. A number of useful and practical suggestions were reflected in their responses regarding service from community health aides

Survey of community health aides in Jamaica (1987-1988)

The Community Health Aide (CHA) was initiated in 1967, and, by the early 1980s, 1,328 CHAs had been trained and over 1,100 remained in the service. The aim of the programme was to train CHAs to assist in the deliveryof basic health care. During the restructuring of the health services in 1985-1986, many CHAs were made redundant. As part of a large study aimed at assessing the current status of the CHA programme, this paper reports results of interviews with 415 CHAs still in service in 1987-1988 and 134 CHAs no longer employed in the programme at that time. The survey of CHAs still employed as such showed that they continued to perform duties in the community and health centres with emphasis on the maternal and child health services and the management of the diabetics and hypertensives. The survey of CHAs no longer as such showed that the majority remained unemployed though many continued to use their skills on a voluntary basis. These CHAs felt that home visiting had been reduced and environmental health was being neglected since they left, and that problems were not being regularly reported to the professionals at the health centres. It was recommended that all CHAs be offered training in the taking of blood pressure levels and in the giving of insulin injections to diabetics. Recommendations included improved methods of selection, longer training, greater community outreach, esprecially to the elderly, post-training evaluation, regular assessment of the CHAs' performance, and improved upward mobility opportunities and job security

Patient-flow and waiting times in General Medical and Dental Clinics in Jamaica's primary health care services

Jamaica has implemented primary health care services closely in accordance with the philosophy of the Declaration of Alma Ata. However, resources are scarce and need to be well managed. Ideal patient-flow in health centres (HCs) would achieve both high efficiency in use of staff time and minimum waiting times for patients. this study of 465 patients in 44 general medical clinics served by 34 doctors and 25 nurse practitioners, and 167 patients served by dentists in each of 15 clinics, showed that mean contact time of patients with doctors was 7 minutes, with nurse practitioners 11 minutes, and dentists 4 minutes. Medical patients waited an average of 3 hours 53 minutes, whilst dental patients waited an average of 2 hours 23 minutes. Doctor's, nurse practitioners' and dentists' median times for starting to see patients were 10.00 a.m., 9.35 and 9.48 a.m. respectively. They were able to work without experiencing any delays in patient-flow since many patients were waiting at the HC by 8 a.m., and preliminary processing was short. It is suggested that if they started seeing patients earlier, patients' waiting times would be shorter. The shortage of pharmacists to dispense drugs after medical consultations added to patients' waiting time. The results were a natural outcome of the low supply of personnel and high demand for services situation being experienced in the medical and dental services

The use of Community Health Aides as perceived by their supervisors in Jamaica, West Indies 1987/88

A research project funded by the Commowealth Caribbean Medical Research Council (CCMRC) began in February 1987, to study aspects of the situation in connection with the 508 Community health Aides employed in the Government Service of Jamaica. This report deals specifically with the role of Supervisors (Public health Nurses and Midwives) in relation to Community Health Aides (CHAs) employed in the Government Primary Health Care Service, Jamaica. There were 77 Supervisors interviewd, and questionaires were returned from all four Administrative health areas in Jamaica. The Supervisors reported that they could supervise more CHAs in the community setting than in the clinic setting alone. In-service training was an integral part of the CHA programme, and there was regular evaluation of the CHAs, with at least an annual evaluation in keeping with the policy of the agency. Resource from other sectors assist in continuing education programmes for the CHAs. The study outlines the main weaknesses and the strengthes of the community health aide programme, and highlights the fact that the CHA is a valuable member of the health team and does contribute significvantly to Primary Health Care