Management of symptomatic gallstone disease: Equity between two healthcare delivery systems in Trinidad & Tobago

Objective: Patients with symptomatic gallstones require laparoscopic cholecystectomy (LC) to remove the gallbladder to avoid complications. LC should be performed with as little delay as possible. We sought to determine whether the health care delivery systems in Trinidad & Tobago were adhering to best practices. Design and Methodology: At a public and a private institution, the general surgical operating theatre registers were reviewed for the period Jan 2016 to Aug 2018 to identify all patients having undergone LC. Hospital records were then retrieved and retrospectively reviewed. The following data were extracted: patient demographics, index diagnosis, date of index diagnosis, interval between index diagnosis and LC, complications between index diagnosis and LC, duration of LC, complications after LC. Results: 98 patients were studied from both centers with a mean age of 44.8 years ± 12.4(SD) and 92.8% were female. The most common indication for cholecystectomy overall was biliary colic (31.6%). For patients with biliary colic, the mean waiting time for LC was 289.3 days ± 521.5 (SD) days at the public institution compared to 9 days ± 6 (SD). Acute cholecystitis accounted for 30% of diagnoses at both centers. The mean waiting times for patients who presented with acute cholecystitis was 392.9 ± 876.2 days (mean ± SD) in the public healthcare system vs 26.1 ±27.3 days (mean ± SD) in the private healthcare system. Conclusions: There is some disparity in management of symptomatic gallstones between the private and public healthcare systems in Trinidad & Tobago. Specifically, a statistically significant difference in waiting times to complete LC exists between the systems.

Utility of the Tono-Pen in Measuring Intraocular Pressure in Trinidad: A Cross-sectional Study.

AIM: To determine the sensitivity and specificity of the Reichert™ Tono-Pen AVIA® when used by novice medical students in an ethnically diverse population in Trinidad. SUBJECTS AND METHOD: Participants were residents of Trinidad between the ages of 20 and 90 years attending the Ophthalmology Clinic at the Eric Williams Medical Sciences Complex (EWMSC). Intraocular pressure (IOP) was measured using the Goldmann applanation tonometer (the gold standard) for ophthalmology clinic patients as part of their routine care. Intraocular pressure measurements were then taken using the Tono-Pen. RESULTS: One hundred persons participated, consisting of Indo-Trinidadians (55%), Afro-Trinidadians (36%), Mixed (8%) and 1% of Caucasian descent. Fourteen per cent reported a diagnosis of glaucoma, with 70.6% of these being of African descent. One hundred and ninety-eight readings of IOP were taken. At a cut-off point of 21 mmHg, there were nine true positives, four false positives, seven false negatives and 178 true negatives. The sensitivity and specificity were found to be 56.3% (95% CI 33.2, 76.9) and 97.8% (95% CI 94.5, 99.1), respectively. The positive predictive value was calculated as 69.2% (95% CI 42.4, 87.3) while the negative predictive value was 96.2% (95% CI 92.4, 98.2). The prevalence of elevated IOP in this population was 8.1% (95% CI 4.8, 13.0). The likelihood ratio of a positive result was calculated to be 25.6 (95% CI 8.6, 73.9). CONCLUSION: The high specificity and negative predictive value suggests that the Tono-Pen can be used with minimal training, and can prove beneficial at the primary care level in the exclusion of increased IOP in an ethnically diverse high-risk Caribbean population.

Investigation of dengue related knowledge, attitudes and practices among form three secondary school students in the seven counties of Trinidad

OBJECTIVE: To investigate dengue related knowledge, attitudes and practices among secondary school students in Trinidad. DESIGN AND METHODS: A cross-sectional study was undertaken. All counties were included; one school from each county was randomly selected. Form Three students of the 7 schools were invited to participate. Data collection was conducted using a questionnaire. RESULTS: Almost three-quarters of respondents (73.1%) demonstrated sufficient knowledge about dengue. There appeared to be a link with preventative practices among households and adequate knowledge. Moreover, students associated with persons who had been previously diagnosed with dengue demonstrated a greater level of knowledge than those without. In fact, the school with highest knowledge levels also had the greatest proportion who reported a relative with a past diagnosis of dengue. Furthermore, 53.3% agreed that dengue was a community concern, while 59.6% believed that control and eradication of the dengue vector was primarily the responsibility of Health Authorities. CONCLUSION: It appears that students with greater knowledge engaged in preventative measures and vice versa. Knowledge, attitudes and practices may be influenced by several rather than a single factor. With a greater proportion stating that vector control was the responsibility of the health authorities, the findings, though encouraging in parts, highlighted a need for further targeted health education measures.

Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the patients.