Advancement of laparoscopic surgery in Guyana: a working model for developing countries.

In the late 20th century, the volume and complexity of laparoscopic operations being performed have increased worldwide. However, surgical practice lagged behind in the Caribbean region. This article reports a tailored approach to initiate advanced laparoscopy in Guyana, which can be used as a model to initiate laparoscopic services in other developing nations.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

Introduction: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica.

Methodology: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period.

Profile of a Malignant Brain Tumour in Jamaica: An Eight-year Review, 2005 to 2012.

Objective: Glioblastoma multiforme (GBM) is the most malignant and most common primary brain tumour worldwide. This study was undertaken to investigate the demographics of this tumour in Jamaica as there is to date no such published data. Data from the recently started Intracranial Tumour Registry (ITR) at the University Hospital of the West Indies was used.

Overcoming obstacles to establish a multidisciplinary team approach to hepatobiliary diseases: a working model in a Caribbean setting.

Introduction: By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes.

Methods: This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles.

Conclusion: Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations.

Epidemiology of tetanus in Jamaica, 1993-2010.

Background: Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated.

Methods: Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010.

Results: There were 26 cases of tetanus (annual incidence of 0.

From the patient's perspective: is there a need to improve the quality of informed consent for surgery in training hospitals?

Objective: This study was performed to evaluate the presurgical informed consent process at a training hospital in Jamaica.

Methods: A postoperative survey was administered to all consecutive able and willing adult patients who underwent the presurgical informed consent process with surgical residents during a 5-week period. Information was collected on patient demographics and patients' perception and satisfaction with the informed consent process.

Leadership in surgery for public sector hospitals in Jamaica: strategies for the operating room.

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.

Infection control practice in the operating room: staff adherence to existing policies in a developing country.

Context: Infection control interventions are important for containing surgery-related infections. For this reason, the modern operating room (OR) should have well-developed infection control policies. The efficacy of these policies depends on how well the OR staff adhere to them.

EMS response to an airliner crash.

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol.

Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica.

There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema.

Delays in presentations of stroke patients at the University Hospital of the West Indies.

Thrombolytic therapy has been proven to be beneficial in selected patients with ischaemic strokes. Early diagnosis is paramount because there is a narrow therapeutic window for these patients to derive benefit from thrombolytics. We sought to evaluate the timing of stroke presentations at the University Hospital of the West Indies (UHWI) in order to assess the potential eligibility for definitive therapy A retrospective audit of all consecutive patients who had emergent computed tomographic (CT) scans for suspected ischaemic stroke at the UHWI was performed over a six-month period between February 2006 and July 2006.

Revisiting current strategies for primary prevention of motorcycle collisions in Jamaica.

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical services in Jamaica. We explore the existing strategies and legislative policies that may prevent or reduce the severity of these injuries in Jamaica. This is an important aspect of health care as it may minimize the impact of these preventable injuries on the limited resources of the health services.

Informed consent from patients participating in medical education: a survey from a university hospital in Jamaica.

Background: Medical students at the University of the West Indies receive clinical training by passing through a series of hospital rotations at the University Hospital of the West Indies (UHWI). Many of these patients are unaware that medical students may be involved in their care. We performed this study to determine patient awareness and their willingness to participate in research and teaching activities.

Motorcycle accident injury profiles in Jamaica: an audit from the University Hospital of the West Indies.

There is little data available on the prevalence of motorcycle accidents, their resultant injuries and the demand on the health care services in Jamaica. We performed a descriptive, analytical study to evaluate the extent of this problem and the need for preventative national policy measures. Between 1 January 2000 and 1 January 2007, demographic and clinical data on all motorcycle accident victims admitted to the University Hospital of the West Indies were collected in a prospective database.

The impact of helmets on motorcycle head trauma at a tertiary hospital in Jamaica.

Background: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries.

Prevalence of carotid stenosis in a high-risk Caribbean population.

Background And Purpose: The purpose of this study was to determine the prevalence of carotid stenosis among patients presenting to the University Hospital of West Indies (UHWI) Accident and Emergency Department (A&E) with an ischemic stroke or transient ischemic attack (TIA).

Methods: Beginning in August 2006, all patients presenting to the UHWI A&E with an acute stroke or TIA were screened for enrollment. Patients were excluded if they had a hemorrhagic stroke or if informed consent could not be obtained.

Emergency department physician training in Jamaica: a national public hospital survey.

Background: Emergency Department (ED) medical officers are often the first medical responders to emergencies in Jamaica because pre-hospital emergency response services are not universally available. Over the past decade, several new ED training opportunities have been introduced locally. Their precise impact on the health care system in Jamaica has not yet been evaluated.

Inter-hospital transfer of trauma patients in a developing country: a prospective descriptive study.

Unlabelled: There is no standardised protocol for the transfer of injured patients in Jamaica, a process that is well known to be potentially hazardous. We undertook this study to evaluate the inter-hospital transfer process of injured patients in this developing country.

Materials And Methods: A prospective descriptive analytical study of all consecutive patients transferred to the University Hospital of the West Indies from other hospitals was conducted over six months.

Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome.

Object: We evaluated management and outcome of traumatic brain injury (TBI) in a developed country (US) and a developing country (Jamaica).

Methods: Data were collected prospectively at Grady Memorial Hospital (GMH) in the US and at University Hospital of the West Indies (UHWI) and Kingston Public Hospital (KPH) in Jamaica between September 1, 2003, and September 30, 2004.

Results: Complete data were available for 1607 patients.

Maternal hydrocephalus in pregnancy and delivery: a report of two cases.

We present two cases of maternal hydrocephalus in pregnancy. In one case, the patient had no medical problems and had a spontaneous vaginal delivery of a normal neonate at term. In the second case, the patient had an uneventful pregnancy until 36 weeks when she presented to the labour ward with drowsiness and decreasing consciousness.

A case report of chronic subdural haematomas in two elderly patients.

The authors present two elderly patients with chronic subdural haematomas following minor trauma. The difficulty associated with making the diagnosis is discussed. A high index of suspicion and routine follow-up of such patients is recommended in order to promote early diagnosis and prompt treatment of this reversible cause of dementia.

An assessment of the process of informed consent at the University Hospital of the West Indies.

Objective: To assess the adequacy of the process of informed consent for surgical patients at the University Hospital of the West Indies.

Method: The study is a prospective, cross-sectional, descriptive study. 210 patients at the University Hospital of the West Indies were interviewed using a standardised investigator-administered questionnaire, developed by the authors, after obtaining witnessed, informed consent for participation in the study.

Surgical and intensive care needs of head-injured patients transferred to the University Hospital of the West Indies.

A cross-sectional, descriptive study utilizing data collected in the 'Trauma Registry' of the Department of Surgery, Radiology, Anaesthesia and Intensive Care at the University Hospital of the West Indies (UHWI) was undertaken to document injury severity, surgical requirements and intensive care needs of head-injured patients transferred to the UHWI over a three-year period Of 144 patients studied, the majority (71%) were young males. Overall, injury tended to be mild Twenty-three patients (16.0%) had severe head injury and 27 patients (18.

Unnecessary admissions of head-injured patients at the University Hospital of the West Indies.

The prospectively collected data in the Jamaica National Trauma Registry operated by the Section of Surgery identified 88 patients who were admitted with head injury to the University Hospital of the West Indies over a one-year period. There were 67 males (76.1%), the mean (SD) age of the entire group being 35.

The aetiology of head injury in admitted patients in Jamaica.

This cross-sectional, descriptive study identified 857 head-injured patients who were admitted to the University Hospital of the West Indies (UHWI) over a four-year period. Their median age (IQR) was 28 (16, 45) years and 629 (73.5%) were males.