19 research outputs found
Health services in Trinidad: throughput, throughput challenges, and the impact of a throughput intervention on overcrowding in a public health institution
No full textAbstract Background Throughput might be partially responsible for sub-optimum organisational and medical outcomes. The present study examined throughput and the challenges to ensuring optimum throughput in hospitals, and determined the effectiveness of a throughput intervention in reducing overcrowding in a public healthcare institution in Trinidad and Tobago. Methods First, a literature review of throughput and its processes in relation to improving hospital care was conducted. Second, the challenges to throughput in healthcare were reviewed. Data were also collected from print media, hospital records, and the central statistical office in Trinidad and Tobago to discuss throughput and describe the throughput status in hospitals. Finally, the effect of a throughput intervention on overcrowding was determined. The intervention was implemented over six months, from October 2010 to March 2011, and comprised three stages of a five-stage throughput process: transferring patients to a specific medical ward, bedside electrocardiograms (ECG), and promptly obtaining patient investigative reports and patient files. Results Problems with the throughput process led to prolonged delays or failures in obtaining lab reports, radiology services, ECGs, and pharmaceutical supplies, as well as inadequate social work services and other specialised services. During the throughput intervention, there was a reduction in overcrowding/overflow to 5–10 patients per day with a daily admission rate of 58. However, at post-intervention, there was increased overcrowding/overflow to 20–30 per day but fewer admissions (52 per day) i.e. similar to pre-intervention period. Additionally, there was an increase in bed complement in the department of medicine from 209 (2011) to 227 (2012). Overcrowding continued into 2016 and beyond: medical admissions in 2016 were 46.4 per day and the medical bed capacity was 327 (indicating a 44% increase in capacity from 2012). Conclusion Hospital throughput processes are currently suboptimum. Improving specific throughput processes or targeting the greatest primary constraints might help decrease overcrowding
Use of complementary and alternative medicine by patients with end-stage renal disease on haemodialysis in Trinidad: A descriptive study
No full textPrevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago
No full textAbstract Background Psychosocial issues are major determinants as well as consequences of cardiovascular disease (CVD). This study sought to assess the prevalence and identify factors associated with depression among patients with cardiac disease in a public health institute in Trinidad and Tobago. Methods A cross-sectional study was conducted with a convenience sample of 388 hospitalised, stable, adult patients with cardiac disease admitted in the only tertiary public health institute in South Trinidad. Patients were identified and interviewed 3 to 5 days after admission using a questionnaire comprising questions on demographic, medical, and lifestyle issues and the 9-item Patient Health Questionnaire (PHQ-9). Results The prevalence of clinically significant depression (PHQ-9 > 9) among hospitalised patients with cardiac disease was 40.0%. However, the prevalence of non-minimal depression (PHQ-9 ≥ 5) in this study was 78.4%. It was greater among women (83.1%) than among men (72.9%). Non-minimal depression was associated with sex (p = 0.015), employment status (p = 0.007), hypertension (p = 0.017), stressful life (p ≤ 0.001), feelings of depression (p ≤ 0.001), regular exercise (p ≤ 0.001), and living alone (p = 0.006). Age, ethnicity, education level, income, or religious affiliations were not associated (p > 0.05) with depression. Participants diagnosed with depression commonly reported feeling tired (81.2%), having trouble sleeping (74.7%), and moving/speaking slowly (73.5%). Patients with self-claimed depression (past or current) were four times more likely to have depression and those with self-reported stress and loneliness were twice as likely to have depression. Employed patients and those who exercised regularly were approximately 50% less likely to have depression. Conclusions Clinical depression prevalence among hospitalised patients with cardiac disease was 40.0%. Approximately twice as many (78.4%) had non-minimal depression, with higher prevalence among women. Employment, sex, hypertension, stressful life, feelings of depression, regular exercise, and living alone were associated with non-minimal depression. Patients with self-claimed depression, stress, and those living alone had a much higher likelihood of having depression, while those who were employed and exercised regularly were approximately half as likely to have depression
Early Post-Acute Myocardial Infarction: Psychosocial and Financial Concerns
No full textPurpose: Acute myocardial infarction (AMI) is a major cardiovascular event that has significant psycho-social-physical and lifestyle consequences. This study assessed the feelings of patients within days following an AMI in a public health institute in Trinidad and Tobago. Results: Of the 150 AMI patients, 134 (89.3%), were included in the study. Sixteen (10.7%) patients were not included due to inadequate information. Among the post-AMI patients, common negative feelings experienced include fear of another heart attack (n = 74, 55.2%), fear of death (n = 40, 29.9%), and fear of the future (n = 29, 21.6%). However, the positive thoughts of the AMI patients predominated: intentions to improve eating habits (n = 97, 73.5%), and increased spirituality (n = 82, 62.1%). Changes in feelings from pre to post AMI were most pronounced for positive feelings such as improved eating habits, regular exercise, and improved goals. In general, among the post-AMI patients, there were no significant associations between age and sex. However, significant associations were found between selected lifestyles variables (exercise, alcohol, eating habits, employment status, hypertension, and obesity) and psychological issues such as fear of another heart attack, improved relationships, or turning to God. Conclusions: Post-AMI patients experienced major psychosocial issues in the early post-AMI period. Though negative feelings were common, most of the patients resolved to make positive lifestyle changes
An evaluation of the effectiveness of the decentralized health system in Trinidad and Tobago
No full textSchool systems in Trinidad and Tobago: A cause of deviant behaviours/violent crimes and the XYZ model of school violence
No full textThe aetiology of violence is manifold (genetic, personal, environmental, and situational) and of major concern to Trinidad and Tobago. The school system itself (the main conduit for overall child development) might be a major contributor to poor performance, deviance, and violent behaviour. Primary and secondary school education is a strategic instrument for promoting or hindering children’s growth and development. This study aims to show the possible relationship between the school system and school performance and the potential for deviant and violent behaviour. Data were collected on the school system, school performance, and national crime levels. A literature search was also conducted on school systems, performance, and violence. Results indicate that primary school training focused on academic performance and did not cater to universal accessibility or ‘legitimate structural accessibility’ for all children, and focused on obtaining places in prestigious institutions for higher education. Since 2018, approximately 40% of the students have failed the secondary entrance assessment exam, with approximately 11% scoring less than 30%. With universal secondary school enrolment, students may be deprived further of accessibility. This may become compounded by the mixing of students of varying tendencies, behaviours, and otherwise. This continued reliance on academics satisfied the students at prestigious schools. The secondary school system brings added challenges such as the mixing of students (academics, non-academics, students with violent or deviant tendencies, etc.) of varied backgrounds and continued lack of ‘legitimate structural accessibility’. A large section of the non-academically inclined (half passing fewer than five subjects) may find themselves doing inappropriate things, eventually leading to deviance or even violent behaviour. This is further complicated by contributions from the public health system. In the public school system, students, especially those who are not academically inclined, endure further stress, anger, frustration, and eventually ending in deviant/violent behaviour. A school system with an academic focus effectively decreases ‘legitimate structural accessibility’ and opportunities. This subsequently leads to ‘non-performing students’ affecting their psyche and confidence and disturbing other students, eventually leading to deviance and criminal activity. Such a dysfunctional school system must be corrected to allow student education to be holistic. Additionally, a need exists to develop a system to screen and identify students who are at risk or display deviance, and implement corrective measures
Prevalence, patterns, and perceived value of complementary and alternative medicine among cancer patients: a cross-sectional, descriptive study
No full textPrevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study
No full textDepression: A Major Psychosocial-Lifestyle Sequela of Cardiac Disease Diagnosis
No full textEven the suspicion of cardiac disease diagnosis tends to have significant psychological, physical, and social repercussions for patients. The present study explored the psychosocial and physical lifestyle changes in stable, ambulant patients with suspected or newly diagnosed cardiac disease. This cross-sectional study of cardiac clinic attendees at a public health institution was conducted between July and August 2015. Face-to-face interviews were conducted with eligible patients (aged at least 18 years, not confused, and able to undergo a 20-minute interview) following patient consent. Collected data were analysed using descriptive and analytic methods (chi-squared test and multiple linear regression) using a 5% error and 95% confidence interval. The prevalence of depression increased from 1.7% pre-diagnosis to 36.6% following suspected or confirmed diagnosis. Among demographic variables, only gender was associated with depression, with females being more affected. Diabetes, stress, and eating seafood and sugary foods were associated with increased depression, while exercising at least three times per week was associated with diminished depression. Functional activities (social, communicative, and physical) worsened, with significant differences between pre- and post-diagnosis. Depression was relatively common in the sample, particularly among females. There is a need for increased focus on the development of interventions addressing depression, especially those encouraging physical exercise for optimum management of patients diagnosed with cardiac disease
Use of complementary and alternative medicine by patients with end-stage renal disease on haemodialysis in Trinidad: A descriptive study
No full textAbstract Background Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of illness, holistic care, and counteracting the adverse effects of conventional medicine (CM). This study investigates the use of CAM by patients with end-stage renal disease (ESRD) on haemodialysis. Methods This quantitative study was conducted from November 1, 2014 to December 31, 2014 in the haemodialysis unit at San Fernando General Hospital (San Fernando, Trinidad). Face-to-face questionnaire-based interviews were held with101of 125 eligible patients (response rate, 80.5%) at the chairside during haemodialysis. The completed questionnaires were entered into a secure computer database. Data analysis included descriptive analysis, χ2 tests, and binary logistic regression analysis. Results A minority of the patients were CAM users (n = 19; 18.8%). All 19 CAM users took medicinal herbs, 78.9% (n = 15) used spiritual therapy, and 10.5% (n = 2) used alternative systems. Medicinal tea (n = 15; 78.9%), garlic (Allium sativum) (n = 17; 73.7%), and ginger (Zingiber officinale roscoe) (n = 13; 68.4%) were the most commonly used medicinal herbs. Seven (36.8%) patients used Chinese herbal medicines and 3 (15.8%) patients used Aloe vera. All CAM users were willing to use CAM without supervision or monitoring by their doctors while receiving CM. The use of CAM could not be predicted by age, sex, ethnicity, education, religion, marital status, or employment. Nearly all (98%) patients were satisfied with CAM. More than one-third (36.8%) of patients did not disclose their use of CAM to their doctors, who were generally indifferent to such therapy. Conclusions The use of CAM by patients with ESRD was relatively infrequent. All patients used medicinal herbs, most patients used spiritual therapy, and a minority of patients used alternative systems. Complementary and alternative medicine was primarily used for spiritual reasons and the likelihood of its use was influenced by family, friends, and other patients. Patients continued using CM with one or more CAM therapies without informing their healthcare providers, which is a major health risk
