Is preventive medicine a component of the primary care service for diabetes in Barbados? - abstract

Diabetes mellitus is a chronic illness that requires continued medical care and education to prevent acute complications and to reduce the risk of long-term complications. Diabetics should receive care and treatment from a health team with interest and expertise in the management of diabetes. This study aimed to evaluate the quality of care offered to diabetics in three different clinic settings in Barbados. The case notes of 690 diabetic patients attending private practitioner offices, polyclinic general clinics and polyclinic diabetic clinics, were identified during a six-week index period, and a questionnaire was completed for each patient. Although the average number of visits annually was similar in each of the three settings (5-6 visits/year), private practitioners had the lowest percentage of patients (30.7 percent) with poor glycaemic control (defined here as a fasting blood sugar >/=8 mmol/l, or any other blood sugar >/=10 mmol/l. Overall, the glycaemic control was poor in 44.9 percent of patients. Screening for potential long-term complications such as cardiovascular complications, foot problems, eye problems and kidney problems was recorded as being done in a minority of patients, while the concomitant menace of poorly controlled hypertension, which is known to accelerate the progression of diabetic complications, was present in a significant number of patients. While recognising the limitations of the technique of case note review, these results indicate a need for clear concise guidelines for diabetic primary care, with emphasis on prevention and early detection (AU)

Sports injuries

Inadequate treatment of sports injuries may result in complications and disability. Sports injuries can be prevented through thorough physical conditioning, building up of muscle bulk, adequate warm up, appropriate clothing and equipment, a well balanced diet and nutrition and pre-season physical examination. In sport, most injuries involve muscles and tendons, joint and ligament damage including displacement and/or rupture and soft tissue injuries. Early therapy is referred to as the RICE therapy; rest, ice, compression and elevation

Attitudes to after-hour calls in Barbadian family practice - abstract

A 6-month prospective study was carried out at the General Practice Unit in Wildey and at two privately run group practices. An after-hour call was defined as any request for care outside regular office hours. Information recorded by the doctor included estimation of the necessity of the call and his or her reaction to it. Wherever possible, patients were contacted at a later date by an interveiwer who recorded the type of management, the patient's perception of his or her main reason for calling and the satisfaction with the service received. A total of 557 calls were made, representing 3.0 percent of the total workload (office visits and AH visits). Of the 339 patients interviewed the majority gave discomfort and anxiety as their main reason for calling. Two hundred and twenty-nine of all patients (41.1 percent) were managed on the telephone. One hundred and thirty-six of these were among the group of patients interviewed. Only 6(4.4 percent) were dissatisfied with the service received. Three hundred and seventy of all calls (65.4 percent) were judged by the doctor as being necessary. Only 68 (12.0 percent) were judged to be totally unnecessary. The majority of calls (61.4 percent) engendered interest and satisfaction with only 99 (18.2 percent) evoking anger and frustration. Surprisingly, only 4.0 percent of 52 patients interviewed, who belonged to the latter group, were dissatisfied with the service received. This study has shown that a great deal of satisfaction can be derived from doing after-hour work. Areas of educational importance have also been identified, such as the need for teaching the skills of "telephone medicine", dealing with anger and frustration and the "very unnecessary" call (AU)