The development of postgraduate anaesthesia and intensive care training at the University of the West Indies.

The one-year Diploma in Anaesthetics (DA) was the first postgraduate programme offered by the then Faculty of Medicine of The University of the West Indies (UWI). It was instituted in 1966, when the need for trained physician anaesthetists became paramount. Over 200 physicians have been awarded the DA which was discontinued in 1994. The four-year Doctor of Medicine in Anaesthetics [DM (Anaesthetics)] was commenced in 1974 and continues to train most of the region's physician anaesthetists. The majority of the 119 graduates (as of December 2011) are providing invaluable services to the people of the Caribbean. The time has come for the establishment of a regional certifying body, the Caribbean College of Anaesthetists. This college would determine the standards for the training and clinical practice of anaesthetists as perioperative physicians including: the conduct of anaesthesia, critical care, acute and chronic pain management. It would also facilitate continuing medical education and recertification of all practising anaesthetists within the region.

The development of anaesthetic services in Jamaica.

The development of anaesthetic services in Jamaica arose out of the recognition that dedicated physicians offered a better morbidity/mortality profile to patients. From untrained personnel offering anaesthesia at the turn of the 20th century, much progress has been made, such that specialized anaesthetists have been trained for the various surgical subspecialties.

Thirty-five years of cardiac surgery in Jamaica.

A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months. The common surgical procedures were valve surgery--replacement and repair (37.65), correction of patent ductus arteriosus (25.2%) and repair of congenital heart disease (24.2%). Coronary arterial bypass grafting procedures constituted a small percentage (4.1%) of the cardiac surgical operations. A considerable number of patients have undergone CS in Jamaica, but much more needs to be done as the patient load exists. The future of the cardiac surgical service therefore depends on improvement in the facilities at both institutions and the cadre of the intensive care nursing staff The building of the Cardiothoracic-Neurosurgical Unit (commenced in March, 2003) is an essential step towards this.

Thirty-five years of cardiac surgery in Jamaica

A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months. The common surgical procedures were valve surgery--replacement and repair (37.65), correction of patent ductus arteriosus (25.2) and repair of congenital heart disease (24.2). Coronary arterial bypass grafting procedures constituted a small percentage (4.1) of the cardiac surgical operations. A considerable number of patients have undergone CS in Jamaica, but much more needs to be done as the patient load exists. The future of the cardiac surgical service therefore depends on improvement in the facilities at both institutions and the cadre of the intensive care nursing staff The building of the Cardiothoracic-Neurosurgical Unit (commenced in March, 2003) is an essential step towards this

Enhanced accuracy of defect detection by myocardial single-photon emission computed tomography with attenuation correction with gadolinium 153 line sources: evaluation with a cardiac phantom.

BACKGROUND: Photon attenuation is a major cause of artifacts on single-photon emission tomographic imaging. METHODS AND RESULTS: To study a new method to perform photon attenuation correction (AC), we used a cardiac phantom filled with (99m)Tc and imaged it (1) without extrinsic attenuation or defects, (2) with extrinsic attenuation but without defects, (3) without extrinsic attenuation but with defects involving 10% of the myocardial volume and activity ranging from 0% to 75% of maximum, and (4) with both extrinsic attenuation and defects. Transmission and emission images acquired with a dual-head single-photon emission computed tomographic system with 153Gd line sources were processed by iterative maximum-likelihood-expectation-maximization and were evaluated both qualitatively and quantitatively. The small defects were readily identified both before and after AC. Mean count activity (percent of maximal activity) of the segments with overlying extrinsic attenuation but without defects was only 56% +/- 4% without AC but increased to 86% +/- 4% with AC (p < 0.0001). Without AC, the count activities in the defects with overlying extrinsic attenuation were lower than the actual defect activities, but AC resulted in better approximation of actual defect activities in all but the most severe (0% tracer activity) defects. CONCLUSION: This new AC method provided an improved estimation of actual myocardial count activity. Even small defects with mild reduction in tracer activity were still identifiable after AC.

Nasal non-invasive positive pressure ventilation. A new method of ventilatory support for patients with chronic respiratory failure.

This case report is presented to illustrate the advantages of Nasal Non-invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercapnic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exist.

Nasal non-invasive positive pressure ventilation

This case report is presented to illustrate the advantages of Nasal Non-Invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercanic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exists