COVID-19 and its effects upon orthopaedic surgery: The Trinidad and Tobago experience.

The World Health Organisation (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. COVID-19 is not the first infectious disease to affect Trinidad and Tobago. The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively. The viral pandemic is predicted to have a significant impact upon all countries, but the healthcare services in a developing country are especially vulnerable. The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19. Strick 'lockdown' orders, office closures, social distancing and face mask usage recommendation were implemented following advice from the WHO. This approach has seen Trinidad and Tobago emerge from the second wave of infections, with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country. The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences. Constrained by shortages in personal protective equipment and inadequate testing facilities, the public system moved into emergency mode prioritizing the care of urgent and critical cases. Private healthcare driven more by economic considerations, quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted. Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents. The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues. The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods. Many of these changes will remain long after the pandemic is over, permanently transforming the practice of orthopaedics.

Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective: To report the results of a survey of all percutaneous injuries that occurred between 2009 ­ 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods: Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results: A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as "high." After injury, 41% of the respondents followed the school's protocol for sharps injuries. Conclusion: The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Total laparoscopic hysterectomy versus vaginal hysterectomy at the University Hospital of the West Indies: a 5-year retrospective study

OBJECTIVE: To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a wellestablished procedure, in a university teaching hospital. SUBJECTS AND METHODS: A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired ttest was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. RESULTS: Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. CONCLUSION: Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH. However, TLH was associated with a significantly longer operative time.

Attitudes of medical students toward the acquired immune deficiency syndrome (AIDS).

Several studies have reported negative attitudes toward AIDS patients, homosexuals and drug abusers among physicians, nurses, and health workers in training. To examine attitudes towards AIDS of a group who in the near future would be practising physicians in the Caribbean, medical students at the Cave Hill Campus of the University of the West Indies were surveyed regarding their attitudes toward AIDS. This paper analyses responses to 21 Attitude Items with reference to five primary areas related to AIDS: Testing for HIV, Homosexuality, Fear of Contagion, Comfort in Interacting with AIDS Patients, and Intention to care for Persons with AIDS. The analysis indicates that these students were all not comfortable with issues related to homosexuality, and there was wide variation and some inconsistency in opinions regarding controversial and contentious issues. Most of these students, regardless of their choice of specialty after graduating, will eventually come into contact with an HIV-positive individual or an AIDS patient. There is a distinct possibility that biases and misperceptions held during the period of training are at risk of being carried over into clinical practice, resulting in unwillingness, or even refusal, to treat certain types of patients. What has also become evident is that emphasis should be placed on ethical and attitudinal training within the Faculty of Medical Sciences. Our future doctors have to be trained to effectively manage the many psycho-social, ethical, and legal problems that will be generated by the AIDS epidemic. What is urgently needed, therefore, is relevant curriculum design and development in the area of AIDS Education directed at the region's future physicians.

Ethics and law in the medical curriculum--a university of the West Indies perspective.

The Faculty of Medical Sciences (FMS), University of the West Indies, recognizes that ethics and law are not currently given adequate importance in the training of health professionals. FMS also recognizes the rapid advancement of technology, such as transplants, artificial organs, in vitro fertilization, life-sustaining equipment and euthanasia, as well as the ever-increasing prevalence of malpractice. Thus, two conferences were held to consider the implementation of ethics and law in the medical curriculum. The conferences recommended an increased input into the curriculum of ethics and law, and that this programme be taught and examined in all the medical years. The article discusses implementation strategies.