Hospital In Jamaica Research Articles

Comparative Analysis of Healthcare Quality Between the University Hospital of the West Indies and Public Hospitals in Jamaica

Comparative Analysis of Healthcare Quality Between the University Hospital of the West Indies and Public Hospitals in Jamaica

Complications among assisted reproductive technique (ART) twin gestations versus spontaneously conceived twin gestations (SC): A retrospective outcome analysis among an Afro-Caribbean population at a university-based hospital in Jamaica

Aim: The aim of the study is to compare the frequency of maternal and neonatal complications among pregnant women with twin pregnancies conceived spontaneously versus conceived by assisted reproductive technique (ART). Methods: Univariate and bivariate analyses of maternal characteristics and neonatal outcomes were performed in this retrospective cohort study at a university-based hospital between 2006 and 2016 in Jamaica, a middle-income Caribbean country. Neonatal data were the primary outcomes: APGAR scores, gestational age, birth weight, admission to the neonatal intensive care unit (NICU), and the level of ventilatory support required. Maternal characteristics, comorbidities, and pregnancy complications were other outcomes studied. Results: There were 157 SC and 27 ART twin gestations. Women conceiving via ART were more likely to be advanced maternal age (p greater 0.001), have uterine fibroids (p greater 0.001), previous myomectomy (p=0.001), and incompetent cervix (p=0.003), delivery by cesarean section (p=0.007), and experience hemorrhage (p=0.017) than SC. There were no statistically significant differences in rates of preterm births, birth weight, APGAR scores, or NICU admissions. Assisted reproductive technique twins were more likely to require continuous positive airway pressure (CPAP) (p=0.025), with no differences observed between the two groups for neonatal respiratory distress. Conclusion: In our predominantly Afro-Caribbean population, ART mothers were observed to have more poor maternal outcomes than mothers who conceived spontaneously. Assisted reproductive technique and SC twins had similar neonatal outcomes; however, ART twins were more likely to require CPAP.

Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica.

The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City.

Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.

Improving Compliance to Follow-Up Care After Primary Emergency Department Ophthalmic Consultation

To identify factors that affect the likelihood of follow-up after emergency department (ED) visit for ophthalmic complaints and to evaluate a protocol to improve compliance. Prospective interventional study with historical controls. This study was conducted at Jamaica Hospital Medical Center in Jamaica, New York. The study population included 962 patients who presented to the ED and who required ophthalmology consultation. Participants in the control group were given only verbal follow-up instructions. Participants in the intervention group were given verbal instructions, written instructions, telephone calls, and, if not responding to calls, a mailed letter. The primary outcome was the overall follow-up rate. Secondary outcomes were follow-up rate by demographic subgroup. Patients in the intervention group were significantly more likely to follow up (68.8% vs 42.9%, P < .001). Nearly all subgroups exhibited significantly improved follow-up with the intervention, with the exception of patients 18 to 29 years of age, patients with diagnosis severity class III, patients with no insurance, patients with hospital financial aid, patients paying with workers' compensation, and patients with an unknown employment status. Before the intervention, most patients receiving ophthalmology consultation in the ED did not return for follow-up care. These patients tended to be young, unemployed, uninsured or use hospital financial aid, were in the control group, had good visual acuity, reported no change in vision, and had a condition that was not vision-threatening. Follow-up rates were improved in nearly all subgroups by providing written instructions, telephone calls, and mailed letters. Such instructions should be considered in similar populations.

Profile and outcomes of supraventricular tachycardia presenting to accident and emergency

Abstract Objective To describe the profile and outcomes of patients presenting to the Accident and Emergency (A&amp;E) department of a large tertiary hospital in Jamaica with Supraventricular Tachycardia (SVT) over a 28- month period. Methods A cross-sectional study was done involving 130 patients presenting to the A&amp;E department with an electrocardiogram (ECG) - confirmed diagnosis of SVT requiring medical therapy, over a 28- month period. Data relating to sociodemographic characteristics, presenting complaint, comorbidity and patient outcomes were obtained. Logistic and linear regressions were used to identify independent predictors of cardioversion in A&amp;E, death on the ward, and length of hospital stay. Results Most (69.2%) patients were female. Number of chronic illnesses ranged from zero to three (median =1). The most common presenting complaint was palpitation (82.3%), and the majority (73.6%) of patients were treated with Adenosine. Approximately 89% of patients cardioverted in the A&amp;E. Almost all patients were admitted to the ward; Length of hospital stay ranged from 1-20 days (median = 3 days). ‘Palpitation’ was the only variable that independently predicted length of hospital stay (B= - 3.351, p=&lt;0.001); those presenting with palpitation, spending less days in hospital. Compared to those who presented to the emergency room unresponsive, patients who presented to the emergency room responsive were almost 98% less likely to die on the ward (OR=0.022, 95% CI: 0.001-0.661, p= 0.028). Conclusion Established protocols, a multidisciplinary approach, advanced training and adequate resources are key in the management of SVT patients in order to improve outcome. Key words: Supraventricular tachycardia; cardioverted; emergency room; Jamaica

Severity and Outcomes of Dengue in Hospitalized Jamaican Children in 2018-2019 During an Epidemic Surge in the Americas.

ObjectiveIn 2019, dengue was among the “top-ten threats to global health,” with 3.1 million cases reported from the Americas, the highest ever. Simultaneously, Jamaica reported its largest dengue outbreak in 40 years, following Chikungunya and Zika virus epidemics, in 2014 and 2016–2017, respectively. We describe dengue in children admitted to five hospitals in Jamaica during August 2018 through September 2019.MethodsHospitalized children and adolescents aged 0 to 15 years with dengue were managed using PAHO/WHO criteria. Data were extracted from questionnaires, entered into a dataset on Microsoft Excel version 2016, exported to SPSS version 20 and analyzed. Groups were compared using Student's t-test for normally distributed parametric data. Chi-square analysis, or Fisher's exact test was used for categorical variables. A p-value < 0.05 was considered statistically significant.ResultsThere were 339 children, 245 (72.3%) aged 1–10 years, males:females 1:1. Classification was “dengue without warning signs” 53 (15.3%), “dengue with warning signs” 218 (64.3%) and “severe dengue” 68 (20%). Co-morbidities were reported in 88 (26%). Hemoglobin SC disease was associated with severe dengue with hemorrhage (p = 0.005). Organ-system involvement occurred in 334 (98.5%) including gastrointestinal 317 (93.5%), hematologic 311 (91.7%) and musculoskeletal 180 (53.1%). Thirty-nine (11.5%) had 5–7 organ-systems involved. Metabolomics emphasized increased hepatic transaminases 245 (72.3%), lactate dehydrogenase 164 (48.4%) and creatine phosphokinase 84 (24.8%) approaching the high thousands (121,560 u/L), both were markers for severe disease (p < 0.002). Thirteen (3.8%) received intensive care. Dengue was laboratory-confirmed in 220 (78.9%): NS1 antigen-positive (218); RT-PCR-positive (23), with an overlap of NS1 antigen and RT-PCR positive (21); DENV-3 serotype (20). Seventeen (5%) died, 16 (94.1%) had severe dengue and 11 (64.7%) succumbed within 24 to 48 h of admission despite resuscitation and transfusion of blood products.ConclusionSevere dengue with increased attributable mortality occurred in hospitalized children after Jamaica's maiden Zika epidemic.

#38 The Impact of the COVID-19 Pandemic on Acute Appendicitis Presentation in Two Urban Multiethnic Community Hospitals

BackgroundAcute appendicitis (AA) is the most common abdominal surgical emergency in pediatrics. There was a precipitous drop in pediatric visits to hospitals, including the emergency department, since the United States declared COVID-19 a national emergency. Managing AA during the pandemic remains a challenge as fear of COVID exposure can lead to delays in presentation and surgery, as well as a shift to conservative management. Alvarado score (AS) is a ten-point clinical scoring system to identify AA and the American Association for the Surgery of Trauma (AAST) grading system (I-V) is a validated tool for AA diagnosis and severity. There are no studies on prevalence and severity of AA during the COVID-19 pandemic in an urban multiethnic community.MethodThis is a retrospective chart review of patients admitted to Flushing Hospital Medical Center and Jamaica Hospital Medical Center with the diagnosis of AA from March 2018 to March 2021. Charts were reviewed for demographics, clinical, imaging and surgical data to determine AS and AAST. AS grouped from 1-6 (less likely to require surgery) and 7-10 (more likely to require surgery). AAST scoring was based on most severe criteria if grading discrepancies were found between pathology, surgical and computed tomography findings. Leukocytosis was defined as white blood cell count >10. G1 identified AA cases March 2018 - February 2020 and G2 March 2020 – March 2021. Data was analyzed using SPSS software, p<0.05 was considered significant.ResultsOf 239 patients with AA over 3 years, G1 totaled 184 (77%) in 2 years pre-pandemic and G2 had 55 (23%) during first year pandemic. Mean age, gender and ethnicity were similar for G1 and G2. AS and AAST were compared for G1 and G2, Table 1. G2 had significantly greater overall AS of >7 (p=0.038) and higher AAST (p=0.016). Only three patients tested positive for SARS-CoV-2 and 9 (16%) of G2 were transferred to a tertiary care center.ConclusionAlthough there was a decline in number of AA evaluated in our emergency department, the severity of AA was heightened during the pandemic. Healthcare providers need to have a high index of suspicion of increased severity with AA complications.

#29 Skin and Soft Tissue Infections and Associated Complications in Children Aged 0-3 Years in Two Urban Multiethnic Community Hospitals

Abstract Background Skin and soft tissue infections (SSTI) include cellulitis and abscess. Cellulitis is an infection of the deep dermis and an abscess is a collection of pus within the dermis and subcutaneous space. Complications of SSTI include bacteremia, lymphadenitis, endocarditis, septic arthritis or osteomyelitis, metastatic infection, sepsis, and toxic shock syndrome. There are no studies evaluating SSTI and complications and outcomes in children aged 0-3 years. Method This is a retrospective chart review of SSTI in children aged 0-3 years in Flushing Hospital Medical Center and Jamaica Hospital Medical Center between Jan 2015 and Oct 2021. Data extracted from EHR include demographics (age, gender, ethnicity), clinical presentation, laboratory studies, imaging studies, antibiotic used, treatment course, complications and length of stay (LOS). Data were analyzed using percentages. Results Of 206 patients admitted for SSTI, about a half (48%) were abscesses, less than half (44%) cellulitis, few impetigo (6%) and staphylococcal scalded skin syndrome (2%). Most were male (52%), Hispanic (70%) and Asian (26%). A fifth (18%) had previous SSTI and a tenth (8%) had a positive family history. Of a third (36%) who had imaging studies, three quarters (76%) had an ultrasound, less than a half (44%) confirmed an abscess and less than a third (29%) soft tissue infection. Almost all (94%) had a blood culture and most a wound culture (59%). Of the positive blood cultures (4%), majority (78%) were contaminants or normal skin flora and remainder (22%) Staphylococcus aureus. Of the positive wound cultures, most (86%) were Staphylococcus aureus. Methicillin-sensitive S. aureus (MSSA) was equal to methicillin-resistant S. aureus (MRSA) (44% vs 43%). Of the 11% having complications, the most common was lymphadenitis (6%). Clindamycin was the antibiotic of choice in most (70%) and 14% required a change in antibiotic due to susceptibility pattern. The median LOS was 3 days. Conclusion The most common SSTI in children aged 0-3 years is abscess and cellulitis. The yield of blood cultures is low. The prevalence of MRSA was equal to MSSA. Knowing the low prevalence of complications in children with SSTI, healthcare providers can provide appropriate antibiotic coverage and disposition for SSTI in our community.

Young Women's Health Initiative.

A reflective conversation amongst the Jamaica Hospital Medical Center obstetrics and gynecology team regarding the misinformation we believed as young women resulted in a program focused on young women. The program was designed to provide young women with accurate information on their health and well-being. Equipped with this information, we believe that young women would be poised to make better decisions for their future. We discussed community engagement and outreach to target schools in the surrounding Jamaica Hospital Medical Center community. In the midst of the pandemic, when educational systems moved toward virtual and electronic platforms, the Jamaica Hospital Medical Center obstetrics and gynecology team established a virtual program to promote the health and wellness of young women in middle and high schools. To accomplish these objectives, the Jamaica Hospital Medical Center obstetrics and gynecology team created seven modules that cover the following topics: Module 1-an informational session that addresses female hygiene and other health-related topics for young women and girls. This session allowed the team to assess the knowledge of our cohort. Module 2-a tutorial on the anatomy of the female body to empower young women and girls to understand how their bodies work. Modules 3 and 4-two sessions focused on puberty and the associated changes young women and girls should expect. Module 5-a session focused on sexually transmitted infections and their long-term effects, both physically and emotionally. Module 6-a session focused on physical and mental health wellness (including topics that resonate with our cohort such as body image and eating disorders). Module 7-a session focused on breast health, specifically gauged to the needs of our cohort.Each module required a commitment of at least 60 minutes, and, in some instances, a module had to be split into two sessions to ensure that the subject matter of that module was sufficiently covered. These modules were collaboratively developed from feedback provided by obstetricians in the community and educators at our target schools. The modules included interactive elements such as Poll Everywhere, videos, and diagrams that facilitated thoughtful and academic discussions. We successfully implemented this pilot program in two classes (one middle school class and one high school class), with the curriculum adjusted to cater to its audience. We received overwhelmingly positive feedback from both the students and their educator liaisons. We recognize that this program is an important engagement tool to be shared with other communities to inform a wider audience of young women and girls.

Validation of a Palliative Care Consultation Trigger Tool for Trauma Patients at Jamaica Hospital Utilizing a Machine Learning Approach (S506)

Validation of a Palliative Care Consultation Trigger Tool for Trauma Patients at Jamaica Hospital Utilizing a Machine Learning Approach (S506)

Cryptococcaemia in a Jamaican Cohort

Abstract Background The study objective was to describe the clinical features associated with cryptococcaemia in a Jamaican cohort and determine associated risk factors and outcomes. Methods All blood samples collected at the Microbiology Laboratory at a Tertiary Care Hospital in Jamaica between April 2015 and March 2017 were analysed. De-duplicated patients with cryptococcaemia were selected and their clinical information retrospectively analysed. Results Six patients (three males, three females) ages 22-55 years, were diagnosed with cryptococcaemia. One patient had diabetes and the remaining five were infected with HIV. Over 70% of these patients were non-compliant with anti-retroviral medication and 40% had an associated viral load of &gt;10,000 RNA copies/ml with low CD4 counts. Fifty percent of these patients were diagnosed with sepsis with 33.3% having had meningitis. At least two patients had a lower respiratory tract infection but none were formally diagnosed with pulmonary cryptococcosis. No information was available on environmental sources. All were treated with antifungals but only one had completed the full course of therapy with amphotericin B and fluconazole and was the only patient to survive. Conclusion HIV remains a major risk factor for cryptococcaemia. These research findings suggest that there may be a need to have a high index of suspicion for cryptococcosis in these patients as &gt;50% did not show signs of typical underlying cryptococcal infections. The mortality rate was high in these patients, which would suggest that further studies may be needed in order to determine whether the presence of cryptococcaemia is a possible predictor for a poor outcome. Keywords: cryptococcaemia, fungi, HIV, AIDS, cryptococcus

Motorcycle Injuries: Socio-demographic, Temporal and Injury Patterns at a Regional Hospital in Jamaica

ABSTRACT Objective To describe the demographic profile, temporal and injury patterns of persons treated at the St. Ann’s Bay Regional Hospital, Jamaica for injuries sustained following a motorcycle crash. Methods A cross-sectional study was conducted over 28 months. Patients involved in motorcycle crashes who were managed in the emergency room, admitted directly to the surgical ward, or referred to the Orthopaedic Clinic, were included in the study. Patients were interviewed within 24 hours of presenting to the Orthopaedic service. Socio-demographic and injury-related data were collected. Results Of the 155 patients, 98.7% were males. Ages ranged from 14 to 64 years (median 28 years, IQR = 16.5); 47.1% were 20-29 years old and 20.3% were between 30-39 years old. Higher injury rates were observed for ‘holidays’ and ‘weekend days’ compared to ‘weekdays’: 53.8, 24.5, and 14.2 per 100-day type respectively. The most popularly reported contributory mechanism for injury were collision (47.4%, n=101), loss of control (38.0%, n= 81) and errant overtaking (14.6%, n=31). The commonest injured areas were the leg (18%), ankle (12%), forearm (12%) and thigh (11%). Conclusion Males less than 40 years accounted for most motorcycle injuries in the study. Motorcycle crashes occur substantially more during holidays and weekends, and affect mainly the legs. Mechanisms of injury suggest critical roles for preventative strategies in efforts to reduce morbidity and health system burdens from motorcycle crashes. Keywords: Motorcycle, Injury, St. Ann, Jamaica

800. Needle Stick And Sharps Injuries Among Health Care Workers – The Experience of a Tertiary Hospital in Jamaica

BackgroundDespite advances in occupational safety protocols in healthcare facilities, needle stick and sharps injuries (NSSIs) continue to be a concerning occurrence among healthcare workers (HCWs). Such exposures lead to the risk of blood borne infections as well as emotional and financial consequences which may be difficult to measure. Few studies on NSSIs among Jamaican HCWs have been published in the last decade. We evaluated adherence to established NSSIs management protocols and investigated the demographic and work-related characteristics of HCWs sustaining NSSIs. The proportion of HCWs affected and frequency and direct costs associated with these injuries were estimated.MethodsThis retrospective case-series reviewed HCWs employed or contracted to an urban tertiary teaching hospital in Jamaica, who reported NSSIs in the emergency room during the period January 1, 2015 and December 31, 2018. Archived incident reporting forms for these HCWs were reviewed. Data were analyzed using STATA 14 statistical software.Results57 cases of NSSIs were reported at an average rate of 1 per month and an annual incidence of 0.14 per 100 beds and 4.75 per 100 workers. 49 (86%) HCWs were female and 18 (14%) were male. 55% of HCWs were between the ages of 24-29 years old. Nurses (53%) and physicians (19%) made up most of the sample. 28 (58%) HCWs reported not wearing gloves during the incident. Improperly handling used sharps and re-capping needles were reported by 26 (46.5%) and 17 (30%) of HCWs respectively. HIV and viral Hepatitis screening of source patients were performed 85% and 55% of the time respectively. Only 25% of HCWs were prescribed HIV post exposure prophylaxis. Post-injury counselling occurred with 52 (91%) HCWs and follow up care arranged for 36% of cases. The mean direct cost associated with the initial management of the HCW was US &163.22 per NSSI.ConclusionThe frequency of reported NSSIs by HCWs is low but the burden of direct costs is high. There is inadequate adherence to NSSIs management protocols and accurate monitoring systems are lacking. We recommend the need for safer needle disposal methods and devices, routine auditing of sharps practices and training in occupational hazard prevention and management. This may improve occupational risk perception among HCWs and workplace safety. Disclosures All Authors: No reported disclosures

Vertical Transmission of COVID-19 to the Neonate.

Objective To estimate the incidence rate of vertical transmission of coronavirus disease 2019 (COVID-19) to the neonate during the third trimester. Study Design. We conducted a retrospective observational study of pregnant women diagnosed with COVID-19 during the third trimester, who delivered at Flushing Hospital Medical Centre (FHMC) or Jamaica Hospital Medical Centre (JHMC) between March 20, 2020, and April 30, 2020. The study participants were symptomatic pregnant women diagnosed with COVID-19 via positive SARS-CoV-2 RNA, real-time reverse transcription-polymerase chain reaction (SARS-CoV-2 rRT-PCR) test. Evidence of vertical transmission was assessed in the neonate via a SARS-CoV-2 rRT-PCR test, with nasopharyngeal swab samples collected on the neonates after 24 hours of birth. The exclusion criteria for this study were maternal or neonate records without SARS-CoV-2 rRT-PCR test results, neonates not delivered at FHMC or JHMC, and foetuses with suspected foetal anomalies or incomplete medical records. Results We identified 19 symptomatic pregnant women diagnosed with COVID-19, including two women with twin pregnancies. Seven patients (36.8%) were delivered via cesarean. 12 patients (63.1%) presented in spontaneous labour, and 8 (38.1%) had preterm delivery. No maternal intensive care unit admission, maternal sepsis, or maternal mortality was observed. Twenty-one neonates were evaluated for COVID-19 after birth. SARS-CoV-2 rRT-PCR test results were negative in 100% of the neonates. Thirteen neonates (61.9%) were admitted to the neonatal intensive care unit. Prematurity was the most common cause of NICU admission 6 (46.1%), with a length of stay of 5.5 ± 6.4 days. No invasive mechanical ventilation, neonatal sepsis, or neonatal mortality was observed. Conclusion In our cohort, symptomatic COVID-19 during the third trimester of pregnancy was not associated with vertical transmission to the neonate.

Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model

Facility Spotlight| November 2020 Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model Jolynn Tumolo Jolynn Tumolo Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor November 2020, Vol. 84, 44. https://doi.org/10.1097/01.ASM.0000722196.92474.39 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Jolynn Tumolo; Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model. ASA Monitor 2020; 84:44 doi: https://doi.org/10.1097/01.ASM.0000722196.92474.39 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search The patient didn't know about the ASA's Perioperative Surgical Home (PSH) model or Jamaica Hospital Medical Center's yearslong commitment to it; but he did know that his PSH team was there to support him during a particularly trying time. “He had extreme anxiety over his impending surgery and recovery,” said Stephanie Smith, RN, BSN, Director of Care Management at not-for-profit Jamaica Hospital Medical Center, Jamaica, N.Y., part of the Medisys Health Network. “One of our community care assistants was in touch with him throughout the experience, and they developed a strong therapeutic relationship. She knew when his anxiety was escalating, and he calmed down because he knew that he could pick up the phone at any time and discuss whatever questions he had.” The community care assistant walked this patient through the experience and his care pathway. Putting the patient at the center of the surgical care experience is a... You do not currently have access to this content.

COVID-19 Response in the Global Epicenter: Converting a New York City Level 1 Orthopedic Trauma Service into a Hybrid Orthopedic and Medicine COVID-19 Management Team.

The SARS-COV-2 (COVID-19) pandemic has placed unprecedented challenges on the health care system in the United States with New York City at its epicenter. By the end of the 8 week (4/23/2020) since the virus's emergence in New York City, there have been 142,432 confirmed COVID-19 cases and 10,977 deaths attributed to complications from COVID-19-related illnesses. Secondary to policies enacted by the New York State government to limit spread of the virus, Orthopedic Surgery departments at hospitals around the area have witnessed an abrupt change in clinical demands. At a local level one trauma hospital in Queens, New York, Orthopedic Surgery elective cases have been cancelled, trauma consult volume has experienced a sharp decline, and both residents and attendings have been repurposed to meet the new clinical demands of this medical crisis. Our own orthopedic surgery service has adopted care for patients normally admitted to an internal medicine service in a novel Ortho-Medical COVID-19 management team. We prepared this primer to make our experience with caring for COVID-19 patents available as a reference for other surgical subspecialty services preparing to adjust the clinical focus of their hospital teams during this or future pandemics. LEVEL OF EVIDENCE:: Level V.

Prevalence, co-infection and antibiotic resistance of Escherichia Coli from blood and urine samples at a hospital in Jamaica.

Escherichia coli (E. coli) is a very common uro-pathogen and pathogen of bloodstream infections (BSI) in Jamaica. The aim of this study was to examine this organism's prevalence, determine co-infection rates and assess antibiotic resistance patterns. In the absence of automated systems, data on all E. coli isolates identified at the University Hospital of the West Indies in Kingston, Jamaica during the first six months of 2008 and 2012 was collected and sorted. Data were analyzed using IBM SPSS Statistics version 20 for Windows. A total of 1188 isolates (1072 from urine and 116 from blood) was analyzed. Patients with E. coli BSI were older than those with E. coli urinary tract infections (UTI) (55.3 years vs 42.4 years, p < 0.05) and both had a female predominance. Sensitivity profiles in 2012 for E. coli in blood and urine were highest for the carbapenems, Amikacin and Nitrofurantoin and lowest for the fluoroquinolones and Trimethoprim-sulfamethoxazole. Based on antimicrobial susceptibility patterns, Nitrofurantoin was identified as an appropriate choice for empiric therapy for UTI. Ten antibiotics were noted in this study to have developed statistically significant antibiotic resistance. Patients with E. coli BSI had a co-infection E. coli UTI rate of 39%. Resistance patterns change drastically in a few years making frequent antimicrobial susceptibility profiling necessary. Further studies would be beneficial in guiding management of these patients.

Nursing student and faculty perceptions of reciprocity during international clinical learning experiences: A qualitative descriptive study

BackgroundExposure of nursing students to global health care systems and cultures that are vastly different from which they are accustomed allow them to gain a unique perspective of our global village. A plethora of research has studied the lived experiences of visiting students during international clinical placements. Many studies have noted a multitude of benefits for visiting students. However, very little research examined the perspectives of host participants. ObjectivesThis study explores both visiting and host students and faculty's perceptions of reciprocity during international learning experiences. DesignA qualitative descriptive design was utilised. SettingIntercultural collaboration between visiting and host participants occurred over a two week clinical learning experience in a regional hospital in Jamaica. ParticipantsTen third year undergraduate Bachelor of Nursing students and two faculty from Canada engaged in clinical learning experiences with twelve fourth year host nursing students and three faculty from Jamaica. MethodVisiting students submitted reflective papers, participated in interviews, and a focus group two months later. Two separate focus groups were held to gather data from the hosting students and faculty. All data was analysed using thematic analysis for recurring themes. ResultsThe findings of this study show that both host and visiting students and faculty mutually gain benefits from intercultural exchange and collaboration. Reciprocity was noted in experiential knowledge acquisition, cultural awareness from educational and professional perspectives, and personal and professional transformative learning. Although notable differences from contrasting health care worlds were identified, the recognition of similarities and opportunities for transformative learning greatly outweighed the differences. ConclusionThere are reciprocal benefits to be gained in nursing education for visiting and host participants through the development of collaborative international partnerships. More research is required to further explore mutuality for students and faculty from different countries.

Predictors of hospitalization and surgical intervention among patients with motorcycle injuries

BackgroundTo describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica.MethodsA cross-sectional study...