An exploratory analysis of the epidemiology and surgical management of perforated diverticular disease over a two-year period at a referral centre in the Caribbean.

OBJECTIVE: We present an exploratory analysis of data collected on perforated diverticular disease (PDD) in Barbados and suggest possible areas for further study. SUBJECTS AND METHODS: All cases of perforated diverticular disease treated at the Queen Elizabeth Hospital (QEH) Barbados, between January 1, 2005 and December 31, 2006 were reviewed. The patient's age, gender location of disease, Hinchey stage, operative procedure, rate of colostomy reversal, length of hospitalization, incidence of peri-operative morbidity and postoperative mortality were analysed using principal components analysis (PCA). RESULTS: Fourteen cases of PDD were treated at the QEH during this period. Six (43%) of the patients had perforated right-sided diverticulitis (PRSD). In the PCA, Dimensions 1 and 2 were the two dimensions examined, as they both had Eigenvalues over 1. Dimension 1 can be taken as an indicator of the intensity of the disease. On dimension 2, length of hospitalization had the highest component loading (0.875). The mean hospital stay was 10.6 days in PRSD, 9.5 in left-sided perforations with primary anastomosis, and 16.2 days for those with a Hartmann's procedure. The overall peri-operative morbidity was 28% and there was no mortality in the series. CONCLUSION: This preliminary study seems to show a relatively high incidence of PRSD in a predominantly Afro-Caribbean population. More research is needed to determine the exact aetiology of this disease. In our experience, primary anastomosis in carefully selected patients with either PRSD or perforated left-sided diverticulitis (PLSD) may result in shorter hospitalization.

Knowledge, attitudes and practice of medical students at the Cave Hill Campus in relation to ethics and law in healthcare.

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 modified.

Knowledge, attitudes and practice of medical students at the Cave Hill Campus in relation to ethics and law in healthcare / Conocimientos, actitudes y prácticas de los estudiantes de medicina en el campus cave Hill en relación con la ética y las Leyes en el Campo de la Atención a la Salud

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...

Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country.

Data on all patients scheduled to have elective and emergency surgeries during the period of 6 weeks from September 1999 to October 1999 were prospectively collected to determine scheduled starting times, actual starting times, completion times, causes for delays and cancellations. Of 840 procedures scheduled during the study period, 594 (71%) were available for analysis. Eighty-nine per cent of cancellations occurred in patients undergoing elective surgery. The common causes of cancellations were non-availability of beds in recovery room (RR) (15%), patients not showing up (9%), improper pre-operative patient preparation (13%), unavailability of nurses (11%) and anaesthetists (8%). Twenty-three per cent of the cancellations were day cases. Public patients were cancelled more frequently than private patients. Surgical procedures started on time in only 7% of patients. The most common cause of delay was due to delayed transport of patients to the operating theatre (17%). Optimal utilisation of operating theatres in our situation may be effected by increasing the bed-strength of ICUs to free the RR, proper pre-operative work up, adequate counselling of day-care surgery patients and efficient floor management of the operating theatre.

Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country

Data on all patients scheduled to have elective and emergency surgeries during the period of 6 weeks from September 1999 to October 1999 were prospectively collected to determine scheduled starting times, actual starting times, completion times, causes for delays and cancellations. Of 840 procedures scheduled during the study period, 594 (71 per cent) were available for analysis. Eighty-nine per cent of cancellations occurred in patients undergoing elective surgery. The common causes of cancellations were non-availability of beds in recovery room (RR) (15 per cent), patients not showing up (9 per cent), improper pre-operative patient preparation (13 per cent), unavailability of nurses (11 per cent) and anaesthetists (8 per cent). Twenty-three per cent of the cancellations were day cases. Public patients were cancelled more frequently than private patients. Surgical procedures started on time in only 7 per cent of patients. The most common cause of delay was due to delayed transport of patients to the operating theatre (17 per cent). Optimal utilisation of operating theatres in our situation may be effected by increasing the bed-strength of ICUs to free the RR, proper pre-operative work up, adequate counselling of day-care surgery patients and efficient floor management of the operating theatre.

Health in Barbados in the 20th century

At the beginning of the 20th century, Barbados was described as the most unhealthy place in the British Empire; at the end of the century, it is considered amongst the healthiest of developing countries. At the start of the century the statistics were harsh; for example, there was an infant mortality rate of 400 per 1000 live births. It is now between 10 and 15 per 1000 live births. In the last two-thirds of the century, there was a series of ongoing revolutions in Education, Public Health and Hospital Services that affected the health status favourably. The revolution in education was enhanced by the provision of University education starting with Medicine at Mona, Jamaica. Training of doctors expanded to Barbados in 1967 and has been an essential ingredient in the medical care revolution of the last third of the century. In 1953, the first Public Health Centre was opened and Barbados can now boast the most modern public health and primary care facilities. However, modern lifestyles are associated with an epidemic of obesity, diabetes mellitus and hypertension. HIV/AIDS has emerged as a major problem. Health in the 21st century will need to look at lifestyles--the effects of the internal combustion engine, the availability of tools of violence, the lure of 'illegal drugs', personal relationships and gender as well as the driving forces behind the associated lifestyles.(AU)

Health in Barbados in the 20th century

At the beginning of the 20th century, Barbados was described as the most unhealthy place in the British Empire; at the end of the century, it is considered amongst the healthiest of developing countries. At the start of the century the statistics were harsh; for example, there was an infant mortality rate of 400 per 1000 live births. It is now between 10 and 15 per 1000 live births. In the last two-thirds of the century, there was a series of ongoing revolutions in Education, Public Health and Hospital Services that affected the health status favourably. The revolution in education was enhanced by the provision of University education starting with Medicine at Mona, Jamaica. Training of doctors expanded to Barbados in 1967 and has been an essential ingredient in the medical care revolution of the last third of the century. In 1953, the first Public Health Centre was opened and Barbados can now boast the most modern public health and primary care facilities. However, modern lifestyles are associated with an epidemic of obesity, diabetes mellitus and hypertension. HIV/AIDS has emerged as a major problem. Health in the 21st century will need to look at lifestyles--the effects of the internal combustion engine, the availability of tools of violence, the lure of 'illegal drugs', personal relationships and gender as well as the driving forces behind the associated lifestyles.

Current status of regulation of ethics in health care in the English-speaking Caribbean.

Clinical ethics committees are poorly developed in the English-speaking Caribbean. There is no lack of recognition that there is a problem in the conduct of some health professionals; however, there is a lack of administrative will to deal with the problems. Why there is such a lack of will can be speculated upon and may involve the feeling of a loss of control, and in small communities, the fact that Caesar may be asked to stand in judgement on Caesar. However, the public is increasingly impatient with the stalemate of misconduct and the lack of regulation and is seeking legal remedies or indulging in vilification of the profession to obtain some satisfaction of their grievances. For their own professional health, professionals should demand from administrators that ethical expertise and guidance be made available or they should bypass the administrators and seek to find the necessary expertise and guidance to ensure that this area is no longer ignored and does not remain a convenient and readily available weapon against them.

Current status of regulation of ethics in health care in the English-speaking Caribbean

Clinical ethics committees are poorly developed in the English-speaking Caribbean. There is no lack of recognition that there is a problem in the conduct of some health professionals; however, there is a lack of administrative will to deal with the problems. Why there is such a lack of will can be speculated upon and may involve the feeling of a loss of control, and in small communities, the fact that Caesar may be asked to stand in judgement on Caesar. However, the public is increasingly impatient with the stalemate of misconduct and the lack of regulation and is seeking legal remedies or indulging in vilification of the profession to obtain some satisfaction of their grievances. For their own professional health, professionals should demand from administrators that ethical expertise and guidance be made available or they should bypass the administrators and seek to find the necessary expertise and guidance to ensure that this area is no longer ignored and does not remain a convenient and readily available weapon against them.

The Caribbean experience with the diabetic foot management of the diabetic foot

The foot complications of diabetic patients are one of the commonest and most devastating of medical problems that occurs in the Caribbean. The scale of the problem is reflected in the fact that, on average, 75of the beds in the general surgical wards of the Queen Elizabeth Hospital in Barbados are occupied by patients with this problem. Of the patients admitted, a third lose a limb by amputation and another third of the patients lose toes or part of their feet and remain in hospital an average of two months as doctors struggle to prevent them losing their limbs. Half of the patients are in their 70s when they are admitted to hospital but 4 per cent are as young as thirty to forty years. It is clear to the surgeons who struggle to save the limbs of these patients that preventive care and early and aggressive intervention, when problems occur, are the best way to avoid prolonged hospitalization and loss of limb. The events that precipitate the problems often appear trivial to most people. a little nick cutting a nail or a callus, a crack under the toe, an ingrowing nail, stepping on a rock in the yard or, even more devastating, on a dirty or rusty nail. The diabetic's foot is more susceptible to injury, sepsis and gangrene because of an altered inflammatory response and an increased incidence of occlusive vascular disease and neuropathy. Injuries normally considered minor can threaten the limb in diabetics by rapid progression of necrosis along tissue planes. Prevention is of primary importance and patients need to be educated and to remind themselves over and over again to clean their feet daily, paying particular attention to the interdigital areas: looking at them to make sure that there is no swelling or cuts or change in colour. Looking is important since diabetics, especially those with neuropathy, cannot rely-on pain as a symptom of injury. Patients have to be trained to recognise and respond to the signs of injury and infection without relying on the signal of pain that they and the health care workers usually rely upon to assess the seriousness of most conditions. Diabetics should wear something on their feet at all times, in and out of the house. What is worn should have a good firm sole to prevent penetration. If a sandal is worn, it should be strapped on so that it does not slip off easily. If something goes wrong, or is noticed to be wrong with the feet, professional help should be sought the same day. Treatment and observation are neede.

The Caribbean experience with the diabetic foot management of the diabetic foot.

The foot complications of diabetic patients are one of the commonest and most devastating of medical problems that occurs in the Caribbean. The scale of the problem is reflected in the fact that, on average, 75% of the beds in the general surgical wards of the Queen Elizabeth Hospital in Barbados are occupied by patients with this problem. Of the patients admitted, a third lose a limb by amputation and another third of the patients lose toes or part of their feet and remain in hospital an average of two months as doctors struggle to prevent them losing their limbs. Half of the patients are in their 70s when they are admitted to hospital but 4 per cent are as young as thirty to forty years. It is clear to the surgeons who struggle to save the limbs of these patients that preventive care and early and aggressive intervention, when problems occur, are the best way to avoid prolonged hospitalization and loss of limb. The events that precipitate the problems often appear trivial to most people. a little nick cutting a nail or a callus, a crack under the toe, an ingrowing nail, stepping on a rock in the yard or, even more devastating, on a dirty or rusty nail. The diabetic's foot is more susceptible to injury, sepsis and gangrene because of an altered inflammatory response and an increased incidence of occlusive vascular disease and neuropathy. Injuries normally considered minor can threaten the limb in diabetics by rapid progression of necrosis along tissue planes. Prevention is of primary importance and patients need to be educated and to remind themselves over and over again to clean their feet daily, paying particular attention to the interdigital areas: looking at them to make sure that there is no swelling or cuts or change in colour. Looking is important since diabetics, especially those with neuropathy, cannot rely-on pain as a symptom of injury. Patients have to be trained to recognise and respond to the signs of injury and infection without relying on the signal of pain that they and the health care workers usually rely upon to assess the seriousness of most conditions. Diabetics should wear something on their feet at all times, in and out of the house. What is worn should have a good firm sole to prevent penetration. If a sandal is worn, it should be strapped on so that it does not slip off easily. If something goes wrong, or is noticed to be wrong with the feet, professional help should be sought the same day. Treatment and observation are needed on a daily basis. In order to try and save a limb, patients may need to have a series of minor operations and for those who are seen by surgeons early enough, four out of every five persons will have their limbs preserved. However, after the limb is saved, it is in greater danger for further problems and patients may require special shoes to prevent recurrence. The area of rehabilitation and prevention needs a great deal of improvement in the Caribbean for specialist orthotic advice and skills are scarce. Team work is essential for, by working together, patients, doctors, nurses, chiropodists and orthotic technicians can improve outcomes for the diabetic patient.

Health in Barbados in the 20th century.

At the beginning of the 20th century, Barbados was described as the most unhealthy place in the British Empire; at the end of the century, it is considered amongst the healthiest of developing countries. At the start of the century the statistics were harsh; for example, there was an infant mortality rate of 400 per 1000 live births. It is now between 10 and 15 per 1000 live births. In the last two-thirds of the century, there was a series of ongoing revolutions in Education, Public Health and Hospital Services that affected the health status favourably. The revolution in education was enhanced by the provision of University education starting with Medicine at Mona, Jamaica. Training of doctors expanded to Barbados in 1967 and has been an essential ingredient in the medical care revolution of the last third of the century. In 1953, the first Public Health Centre was opened and Barbados can now boast the most modern public health and primary care facilities. However, modern lifestyles are associated with an epidemic of obesity, diabetes mellitus and hypertension. HIV/AIDS has emerged as a major problem. Health in the 21st century will need to look at lifestyles--the effects of the internal combustion engine, the availability of tools of violence, the lure of 'illegal drugs', personal relationships and gender as well as the driving forces behind the associated lifestyles.

Quality of care of patients with diabetic foot problems in Barbados.

In Barbados diabetics with foot problems account for 80% of the patients in the female and 50% of those in the male general surgery wards, and many patients have major amputations for preventable problems. A six month prospective study was undertaken of all cases admitted with foot problems to the general surgical wards of the Queen Elizabeth Hospital (QEH) in order to determine the quality of foot care, particularly among diabetics. 67.5% of the 195 patients (55% female) admitted to the study were diabetic, most of whom were diagnosed 10 to 19 years previously. Most of the patients were 70 to 80 years old, but significantly more diabetics than non-diabetics were 40 to 70 years old. Foot problems in diabetics were precipitated by events that are considered trivial in non-diabetic patients. 87 (58%) of 150 responding patients had their feet inspected by health personnel in the previous year. 47 (63.5%) of the 74 who responded about the care of their nails said that they took care of their nails themselves. Nearly 40% of diabetic and non-diabetic patients had no reported source of care before their admission. 14 patients (10 diabetic) sought care the same day and 11 (nine diabetics) the day after noticing foot problems. Most patients presented with infection as part of their problem; recognition of the early signs of infection should be an integral part of the education of the diabetic patient. Educational efforts for patients must be continually reinforced because many patients said they had had no education about the care of their feet in the previous year.

Quality of care of patients with diabetic foot problems in Barbados

In Barbados diabetics with foot problems account for 80of the patients in the female and 50of those in the male general surgery wards, and many patients have major amputations for preventable problems. A six month prospective study was undertaken of all cases admitted with foot problems to the general surgical wards of the Queen Elizabeth Hospital (QEH) in order to determine the quality of foot care, particularly among diabetics. 67.5of the 195 patients (55female) admitted to the study were diabetic, most of whom were diagnosed 10 to 19 years previously. Most of the patients were 70 to 80 years old, but significantly more diabetics than non-diabetics were 40 to 70 years old. Foot problems in diabetics were precipitated by events that are considered trivial in non-diabetic patients. 87 (58) of 150 responding patients had their feet inspected by health personnel in the previous year. 47 (63.5) of the 74 who responded about the care of their nails said that they took care of their nails themselves. Nearly 40of diabetic and non-diabetic patients had no reported source of care before their admission. 14 patients (10 diabetic) sought care the same day and 11 (nine diabetics) the day after noticing foot problems. Most patients presented with infection as part of their problem; recognition of the early signs of infection should be an integral part of the education of the diabetic patient. Educational efforts for patients must be continually reinforced because many patients said they had had no education about the care of their feet in the previous year.

Anaesthesia in Barbados.

PURPOSE: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the government-owned Queen Elizabeth Hospital (QEH): and to describe the Department's approaches to optimise safety and cost-effectiveness of anaesthesia at QEH. SOURCE OF INFORMATION: Authors (KBS, HSLM, RAH), who collectively provided more than 50 yr of anaesthesia at QEH; the Dean (ERW) of the University of West Indies Medical School (Barbados campus); archives of Barbados; and records of QEH. PRINCIPAL FINDINGS: The government of Barbados provides modern health care services to all of its citizens, primarily at QEH. Barbados, however, has tight financial constraints, infrastructural limitations, and a bureaucratic administration that predispose QEH's Anaesthesia Department to unexpected depletions of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain equipment: purchasing an oxygen concentrator to reduce oxygen costs: decreasing nitrous oxide use (expensive in Barbados): and initiating its own quality and safety standards. CONCLUSION: Continuous delivery of high quality, cost-effective anaesthesia care requires thoughtful planning by administrators and judicious resource allocations. Health care administrators and clinical departments need to work together closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial resources are best allocated to meet the departmental priorities.

Congenital solitary non-parasitic cyst of the liver.

Although non-parasitic cysts of the liver have often been described in adults, solitary non-parasitic cysts are rare in infants. We report a 17-month-old child with a large hepatic cyst.