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 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases.CONCLUSIONS:Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.

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. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

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. There is a lack of available data documenting adherence to infection control policies. OBJECTIVE To evaluate OR staff adherence to existing infection control policies in Jamaica. METHODS We administered a questionnaire to all OR staff to assess their training, knowledge of local infection control protocols, and practice with regard to 8 randomly selected guidelines. Adherence to each guideline was rated with fixed-choice items on a 4-point Likert scale. The sum of points determined the adherence score. Two respondent groups were defined: adherent (score > 26) and nonadherent (score ≤ 26). We evaluated the relationship between respondent group and age, sex, occupational rank, and time since completion of basic medical training. We used χ(2) and Fisher exact tests to assess associations and t tests to compare means between variables of interest. RESULTS The sample comprised 132 participants (90 physicians and 42 nurses) with a mean age of 36 (standard deviation ± 9.5) years. Overall, 40.1% were adherent to existing protocols. There was no significant association between the distribution of adherence scores and sex (p = 0.319), time since completion of basic training (p = 0.595), occupational rank (p = 0.461), or age (p = 0.949).Overall, 19% felt their knowledge of infection control practices was inadequate. Those with working knowledge of infection control practices attained it mostly through informal communication (80.4%) and self-directed research (62.6%). CONCLUSION New approaches to the problem of nonadherence to infection control guidelines are needed in the Caribbean. Several unique cultural, financial, and environmental factors influence adherence in this region, in contrast to conditions in developed countries.

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.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.

Background: Anecdotal reports suggest that cannabis users require increased postoperative analgesia but there is insufficient supporting data.Methods: A prospective randomized study was carried out in 73 patients undergoing elective operations. Postoperatively, all patients were assessed by a blinded investigator, who recorded pain intensity, sedation levels, mood, and hourly analgesia requirements. We calculated the mean pain intensity difference at the first postoperative hour (MPID1) and the sum of pain intensity differences (SPID1). The following end points were compared between cannabis users and non-users using SPSS 16: MPID1; SPID; patient mood; supplemental analgesia requirements and global assessment scores.Results: There were 42 cannabis users and 31 non-users. Cannabis users had significantly higher supplemental pethidine requirements (82.7 mg, SD = 3.4 vs. 51.6 mg, SD = 42.7, p = 0.003) and significantly greater MPID1 scores (1.88, SD = 1.09 vs. 1.35, SD = 1.12, p = 0.001) compared to non-users. Female cannabis users required significantly more analgesia than males (93.3 mg, SD = 45.8 vs. 78.3 mg, SD = 44.3, p = 0.025).Conclusion: Cannabis users require significantly more opioid rescue analgesia in the immediate postoperative period. Further research is needed to elucidate the precise mechanism by which this occurs.

Surgical operations provide opportunities for the transmission of infection between patients and healthcare workers (HCWs) and between patients. This risk may be increased in under-developed and developing countries by low compliance with infection control (IC) policies and precautions. This study investigated the attitude and compliance of HCWs in the operating department (OD) of a Jamaican teaching hospital, with the objective of obtaining data to design evidence-based interventions. A single-center, cross-sectional, descriptive study, using a self-administered questionnaire, was conducted between March-May, 2009. Ninety doctors and forty-two nurses, representing 73% and 75%, respectively, of their total OD population participated in the study. Reported compliance was low: only 17% of all participants were compliant with all of the seven infection control policies inquired into. The results also showed that HCWs were selective in what practices they adhered to: reported rates of compliance were high for hand-washing (100%), use of gloves (98%), use of gowns (83%) and facemasks (87%); but low for use of eye protection mask (56%), not re-sheathing needles (46%) and changing clothes when exiting and re-entering the OD (55%). Discrepancies were observed between attitude and compliance rates in such cases as ‘use of facemasks’- low favorable-attitude (68%) but high compliance; ‘use of eye protection masks’- high favorable-attitude (100%) but low compliance; and ‘not re-sheathing needles’- high favorable attitude (86%) but low compliance. Overall, nurses had higher favorable attitude (p<0.001) and compliance rates (p=0.008).than physicians. To improve HCWs adherence to guidelines, interventions must take account of those factors which determine human behaviour.

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. ‎

OBJECTIVE:It has been suggested that vascular access operations should only be performed in high-volume centres to ensure good outcomes. Vascular access operations have been routinely performed in the Cayman Islands since 2005. However, with an estimated population of 45,000 persons, only a small number of patients require vascular access in any given interval. A cost-benefit analysis of this practice was performed.METHODS:All patients who had vascular access operations over four years were retrospectively identified. Two groups were defined - the local group, who had operations performed by surgeons in the Cayman Islands, and the offshore group, who were transferred off the island and had operations overseas. Cumulative cost, morbidity, patency and failure rates were compared. Significance was considered present with a two-tailed P≤0.05.RESULTS:There were 14 patients in the local group and 22 in the offshore group. The mean cost of access creation was 6.9 times greater in the offshore group (US$26,883.36 versus US$3,913.33; P<0.001). The likelihood of the use of arteriovenous grafts was significantly greater in the offshore group (P=0.04). When therapeutic outcomes were compared, there were no differences in primary or secondary failure, primary or secondary patency, or overall access-specific morbidity.CONCLUSIONS:In the present setting, vascular access creation exceeded all the goals set by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative and the Fistula First Breakthrough Initiative. Compared with overseas centres, this is being achieved at a significantly lower cost, with a greater likelihood of native fistula use and similar therapeutic outcomes.

Motorcycle Collisions place a heavy burden on health care delivery systems in Jamaica. Preventive strategies are important public health issues that may minimize the impact of these injuries on limited health resources. Secondary prevention aims to limit the severity of injury once a collision has occurred. We explore the existing strategies for secondary prevention of motorcycle collision injuries in Jamaica

Objectives: There is little data available on the prevalence of extremity injuries from motorcycle accidents in Jamaica. We performed a descriptive, analytical study to evaluate the injury profiles from motorcycle accidents in a tertiary referral hospital in Jamaica. Methods: Between January 1, 2000 and January 1, 2007, demographic and clinical data on all motorcycle accident victims admitted to the University Hospital of the West Indies with extremity injuries were collected in a prospective database. The data were analyzed using the SPSS version 12.0. Results: Of 270 motorcycle accident victims, there were 257 (95.2%) males and 13 (4.8%) females. The commoner extremity injuries were: soft tissue trauma 270 (100%); limb fractures 198 (73.4%); vascular 9 (3.3%); nerve (0); muscle 65 (24.1%). Associated injuries involved the head 143 (53.0%), abdomen 38 (14.1%) and thoracic viscera 71 (26.3%). The mean injury severity score was 9.0 (SD 9.4; Median 8; Mode 4). There were 195 patients needing surgical intervention in the form of orthopaedic operations (94), neurosurgical operations (43), abdominal operations (49), and vascular operations (14). The mean duration of hospitalization was 10 days (SD 11.2; Range 0-115; Median 6; Mode 3). There were 12 (4.4%) deaths, 9 (75%) due to traumatic brain injuries. Fatal injuries were commoner in males (11) and un-helmeted patients (10). Conclusions: Motorcycle accident victims place an additional burden on emergency surgical services. Educational intervention strategies and legislative policies are needed to minimize the impact of these preventable injuries on the limited resources of the health services.

Aim: Despite the implementation of mandatory helmet laws in Jamaica in 1999, compliance remains poor. We carried out a descriptive study of non-compliant motorcycle accident victims in order to define a high-risk population to target for educational campaigns.Methods: Demographic and clinical data were collected from all motorcycle accident victims treated at tertiary referral hospital in Jamaica between January 1, 1999 and January 1, 2007. Pedestrians and automobile passengers involved in collisions with motorcycles were excluded. The demographics of the sub-population of non-compliant patients were analyzed using SPSS version 12.Results: There were 270 motorcycle accident victims, of which 136 (50.4%) were un-helmeted. The majority of non-compliant patients were in the third and fourth decades of life. There were 11 non-compliant females at a mean age of 27 years (SD 8.4; Range 16-42; Median 26; Mode 26) and 125 non-compliant males at a mean age of 32.2 years (SD 109; Range 7-63; Median 30; Mode 27). There were trends toward decreased compliance in females (11/13 females vs 125/257 males) and pillion passengers (23/26 pillion passengers vs 112/244 drivers). Since 1999, there has been a downward trend in the prevalence of non-compliance with helmet laws. Conclusion: The compliance with mandatory helmet use on Jamaica’s motorways is low. Educational campaigns targeting high-risk groups may be an effective strategy to improve compliance. Young women in the second and third decades who are pillion passengers on motorcycles comprise a high-risk group that deserves special attention in public health campaigns. It is time for legislators to revise the legislation with special attention to appropriate penalties for non-compliance and motorcycle license issuance protocols.

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. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica.METHODS:A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12.RESULTS:Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries.CONCLUSION:Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.

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.

This report describes the presentation of an inflammatory fibroid polyp as a lead point for small bowel intussusception. The condition itself is uncommon. However, the case highlights the most common of its presentations.

Abstract 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. We sought to determine the level of training, qualifications and experience of medical officers employed in public hospital EDs across the nation. Methods A database of all medical officers employed in public hospital EDs was created from records maintained by the Ministry of Health in Jamaica. A specially designed questionnaire was administered to all medical officers in this database. Data was analyzed using SPSS Version 10.0. Results There were 160 ED medical officers across Jamaica, of which 47.5% were males and the mean age was 32.3 years (SD +/- 7.1; Range 23–57). These physicians were employed in the EDs for a mean of 2.2 years (SD +/- 2.5; Range 0–15; Median 2.5) and were recent graduates of medical schools (Mean 5.1; SD +/- 5.9; Median 3 years). Only 5.5% of the medical officers had specialist qualifications (grade III/IV), 12.8% were grade II medical officers and 80.5% were grade I house officers or interns. The majority of medical officers had no additional training qualifications: 20.9% were exposed to post-graduate training, 27.9% had current ACLS certification and 10.3% had current ATLS certification. Conclusion The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population.

During the first 36 months after its introduction to Jamaica, ERCP was performed with relatively high overall morbidity and poor therapeutic success. We sought to evaluate outcomes after eight years of experience with ERCP at a tertiary level hospital in Jamaica. All consecutive patients who had ERCP performed between March 1999 and March 2007 were identified from an operative log. Their hospital records were retrospectively analyzed. There were 369 procedures performed over the study period, but the final analysis was performed on 301 patients who met the inclusion criteria. There were 79 males and 222 females, with a mean age of 45.0 years (SD +/-18.6; range 14-94). There has been a reduction in the incidence of post-ERCP pancreatitis (5.3% vs. 10%) and overall morbidity (24/301; 7.97% vs. 12.5%). The commoner complications included pancreatitis (16/301; 5.32%), ascending cholangitis (8/301; 2.66%), perforation (0) and hemorrhage (0). There were 4/301 (1.33%) deaths directly resulting from an ERCP complication (ascending cholangitis in 3; multiple organ failure from severe pancreatitis in 1). There has also been improvement in the success of stone clearance from the common bile ducts (55/72; 76.39%) and biliary stenting (32/36; 88.89%). Currently, local endoscopists are performing ERCP with acceptable morbidity and mortality compared to international standards.