Open Access Conference Abstract

Promoting Safer and More Efficient Medication Administration within the Accident and Emergency Department at Georgetown Public Hospital Corporation

Jessica Van Meter, Sally Dye, Amanda Clarke, Marcia Heylinger, Arlene Thomas

Journal of Advances in Medicine and Medical Research, Page 1-2
DOI: 10.9734/jammr/2019/v30i1230252

Objective: The Emergency Department is a complex environment in which healthcare providers are confronted with uncontrolled and unpredictable critical patient workload. This necessitates multitasking, organization, critical thinking and clear communication. Safe practices during dispensing and administration of medications vastly reduces the potential for patient harm and decreases medication errors (Institute for Healthcare Improvement, 2008).  

Design/Methods: An eight-question survey was developed to determine nurses’ perceptions of the current medication storage system. Participants were asked to identify ways in which this system could be improved and medications organized in a safer, more systematic way. Following initial data collection, all medications were rearranged to improve medication organization and retrieval. The participants were then surveyed following the intervention to ascertain feedback.

Results: 68% of participants noted that they perceived the current system to be chaotic. When asked if organizational changes might improve patient care delivery and safety, 96% responded in the affirmative. Labeling medication with both generic/ brand names and organizing them by class and alphabetically thereafter were all identified as potential options for reorganization. Following the intervention, a post-survey demonstrated that 100% of respondents remained enthusiastic about the new system approximately 9 months after implementation.

Conclusions: The previous medication storage system was fractured and chaotic. Systematic organization of medications by name/class improved nurses’ perceptions of medication safety and delivery while inadvertently reducing the waste of expired medications. Greater measures are needed to truly minimize the risk for a medication administration errors including targeted continuing education and implementation of an electronic medication administration system.

Open Access Conference Abstract

Assessing the Incidence of Depression among Patients Attending the Chronic Disease Clinic at the Campbellville Health Centre

Sahodra Rambharose, Ruth Durkenne, Tamica Daniels-Williamson

Journal of Advances in Medicine and Medical Research, Page 3-4
DOI: 10.9734/jammr/2019/v30i1230253

Objective: To determine the incidence of depression among the chronic disease patients attending the Campbellville chronic disease clinic.

Methods: Data were collected at the Campbellville Health Centre, during the chronic disease clinic hours from the 8th–18th April, 2019. Information was collected using PHQ9 questionnaires and a demographic data collection sheet.

Results: Of the 98 patients analyzed, nine (9) patients scored 10 or more points on the PHQ9 questionnaire which translated to an incidence of depression of 9.1%. Of the patients with a positive screen for depression; 6 (66.7%) were females and 3(33.3%) males, 5 (55.5%) Afro Guyanese, 4 (44.4%) were East Indians, 5 (55.5%) patients were between 50-69yrs and 4 (44.4%) were more than 70 years old. Of these patients, there were 8 (88.8%) Christians and 1(11.1%) Hindu, 5 (55.5%) were married, 2 (22.2%) single and 2 (22.2%) were widowed, while 7 (77.7%) were unemployed, 2 (22.2%) were employed and 6 (66.6%) patients were diagnosed with at least 2 chronic diseases.

Conclusion: Depression is a mental health disorder that affects persons with chronic disease. The incidence of depression at Campbellville Health Centre was found to be 9.1%.  The PHQ9 is a validated, free and easy to use tool for screening and follow up of these patients.

Recommendations: A national screening guideline along with adequate materials to diagnose and manage depression should be made available, including access to councilors and medications within the primary care setting.

Open Access Conference Abstract

Emergency Readiness in Primary Health Care – A Case Study of Seven Health Centers with Family Medicine Residents in Guyana

Tariq Azar Jagnarine

Journal of Advances in Medicine and Medical Research, Page 5-6
DOI: 10.9734/jammr/2019/v30i1230254

Objectives: To understand emergency response in primary health care, to investigate the frequency and status of emergency preparedness at seven healthcare centres in Guyana with Family Residents.

To enquire if the seven centres are equipped with human and other resources to respond to emergencies and to suggest measures to improve emergency responses at the seven centres.

Design and Method: This study was based on a case-study research. The sample population consisted of 39 Family Residents and other Doctors whose experience with emergency preparedness at the facilities were analysed. Nurses, non-medical personnel and other staff at the Centres under study were excluded. The period of study was for one fiscal year- January-December 2018. Questionnaires were utilized as the primary research instrument and data was analyzed using SPPSS 23.

Results: Emergency cases were very frequent 69,4 % of the respondents indicated that emergency cases were frequent with 1-3 cases per week. The most common emergencies were asthmatic attacks, chest pain and severe trauma and lacerations. Most of the respondents have 3-5 years of medical experience while 72% been fully registered. The study shows 88.9% of the respondents indicating that there are no existing emergency protocols at the centres and 5.6% conducted case simulations.

Conclusion: There exist a need to better integrate and mainstream optimally emergency medical response at the seven centres. The centres are not prepared with the necessary drugs and equipment to respond to emergencies.

Recommendation: The study recommends making the necessary equipment and drugs, support facilities and training readily available at the Centres to respond to emergencies. Further studies are necessary.

Open Access Conference Abstract

From Best Evidence to Best Practice – Implementation of a Hand Washing Campaign in the Accident and Emergency Department of the Georgetown Public Hospital Corporation

Jessica Van Meter, Sally Dye, Natansa Amsterdam, Gangapattie Dani, Le-Ann Hamilton, Bhumika Sookdeo

Journal of Advances in Medicine and Medical Research, Page 7-8
DOI: 10.9734/jammr/2019/v30i1230255

Objective: Hand washing compliance amongst emergency healthcare providers is complicated by limited supplies, patient volume, mal-positioning of hygiene materials, and lack of education on the importance of hand hygiene.

Design and Methods: A survey was distributed to A&E healthcare staff to determine baseline knowledge about the importance of hand hygiene. Participants were asked to identify departmental obstacles to the practice of proper hand hygiene. Using World Health Organization teaching materials, a hand hygiene clinical observation tool was implemented to determine compliance prior to delivery of tailored education. Education was done utilizing posters, flyers, and powerpoint presentation. Hand sanitizer stations were installed to improve compliance. Finally, the clinical observation tool was implemented following the education initiative to determine impact on provider compliance. A post-implementation survey was distributed to determine if increased education and supplies impacted baseline knowledge and compliance.

Results: Only 88% of surveyed providers recognized that the A&E has a current hand hygiene policy with 64% noting GPHC does not stress hand hygiene enough. Providers reported they utilize hand hygiene 75% yet all participants acknowledged that proper hand washing greatly reduces the spread of infection. 53% of providers surveyed felt comfortable encouraging their peers to wash their hands.

Conclusions: Initial provider hand hygiene within the A&E was abysmal. Though identified as a predominant barrier, supplies were readily available throughout the observation window. Educational materials placed throughout the department improved both the perception and compliance of hand hygiene. The importance of provider hand hygiene must be continually stressed in order to maintain optimal compliance.

Open Access Conference Abstract

Determination of MICs of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus Isolated from a Tertiary-care Hospital in Guyana

Drovashti Seepersaud, Tereasia Ramlochan, Paul Cheddie

Journal of Advances in Medicine and Medical Research, Page 9-10
DOI: 10.9734/jammr/2019/v30i1230256

Objective: Previous studies done in the hospital setting in Guyana have shown that the frequency of isolation of methicillin-resistant Staphylococcus aureus isolates far exceeds the worldwide estimate of 50%. These past studies have been based on the use of the Kirby-Bauer disk diffusion methodology. The present study was conducted to determine the minimum inhibitory concentration of clinical isolates of methicillin-susceptible and methicillin-resistant S. aureus using the broth microdilution method.

Design and Methods: A total of 101 consecutive, non-repetitive S. aureus isolates obtained from the GPHC medical lab during a six-week period were included in the study. These isolates were identified as MRSA and MSSA by laboratory personnel using the cefoxitin disk diffusion method. The oxacillin MICs for all isolates obtained were determined using prepared oxacillin broth microdilution trays with concentrations ranging from 4 μg/ml to 256 μg/ml. All results were interpreted according to CLSI guidelines.

Results: The prevalence of MRSA at GPHC was found to be 65.35% with a majority of the isolates being high level oxacillin resistant strains with MICs > 256 μg/ml (84.85%). In our study, most resistant isolates were collected from patients admitted to the FSW (16.67%), Paediatric Wards (13.65%), MSW (13.64%), and FMW (12.12%). Additionally, 35 (79.55%) MSSA were suspected oxacillin susceptible with MIC < 4 μg/ml. The relationship between the cefoxitin disc diffusion and oxacillin broth microdilution results was found to be statistically significant with a p < 0.001.

Conclusion: Methicillin-resistance continues to be a major problem in the hospital setting, and this study has should that commonly used conventional techniques are unlikely to identify all of the potentially resistant isolates.

Recommendation: The high prevalence and high oxacillin MIC of MRSA at GPHC suggests that more emphasis should be placed on infection control and surveillance programs within the hospital setting.

Open Access Conference Abstract

What is the Prevalence of Use of Herbal Medicine When Compared to Prescribed Medications in Diabetic Patients at Enmore Polyclinic?

Aneisha Moore, Tamica Daniels-Williamson

Journal of Advances in Medicine and Medical Research, Page 11-12
DOI: 10.9734/jammr/2019/v30i1230257

Objective: To investigative the prevalence of herbal products used among Diabetic patients of Enmore Polyclinic and correlate with socio - demographic data and to find out the various types of herbal medicines used.

Methods: A cross sectional study conducted at Enmore Polyclinic from April to June, 2019. Data were collected using a preset data collection sheet and analyzed using Microsoft Excel.

Results: From a sample size of three hundred and eleven (311) participants, two hundred and thirty (230) - 74.2% used herbal medicine to control Diabetes; which was used predominantly by females. East Indians used more herbal products. The 51 – 60 years age group recorded the highest use of herbal medicine, with corilla being the most widely used herbal product was corilla.

Conclusion: The Use of Herbal Medicine in the control of Diabetic patients at Enmore Polyclinic is similar to that of the United States and Dubai, but slightly higher than that of tropical Sub-Saharan Africa and Trinidad.

Recommendation: Similar studies should be carried out in other areas of Guyana so as to ascertain the country’s prevalence of the use of Herbal Medicine in the control of Diabetes. Additionally, the adherence to prescribed medication should be enforced: while the effects of these herbal products should be investigated.

Open Access Conference Abstract

Improving the Quality of Care for Acute Pain Management in Recovery Room at the Georgetown Public Hospital Corporation

Dorette Husbands-Anderson, Jennifer Szerb, Alexandra Harvey

Journal of Advances in Medicine and Medical Research, Page 13-14
DOI: 10.9734/jammr/2019/v30i1230258

Objectives: To observe the method of pain assessment and pain management intervention performed by nurses in the PACU.

Methods and Design: A QI prospective observational study was conducted to observe nurse’s pain assessment and management of thirty (30) patients from the time of PACU admission to discharge. The sample size was determined using the sealed envelope power calculator.

Data Collection Included: patients demographics, the method and frequency of pain assessments as well as modalities of the pain intervention and the type and average dose of pain medications administered by PACU nurses.

Data analysis was done using Microsoft excel.

Results: No validated pain assessment tool was used in the PACU.  The majority of patients 67%, n=20) had no pain assessments or pain interventions. When performed, the frequency of pain assessments recorded were low, 70% of patients had 1-2 assessments. The principal pain management intervention was pharmacological with the use of opioids, accounting for 96%.

Conclusion: Post-operative pain management in the PACU at GPHC does not meet accepted standards of care. More frequent nursing pain assessment using a validated pain assessment tool is required. Monotherapy with the opioid was the main pain intervention for pain management.

Recommendations: Effective pain management begins with the appropriate pain assessment; therefore pain management education programs for health care professionals are essential. Also, the implementation of a standardized pain assessment tool, a standardized post anesthetic order sheet with a multimodal approach to pain management and restructuring the post-anesthetic record to allow for documentation of pain assessment will greatly improve pain management in the PACU.

Open Access Conference Abstract

Outcomes of Breast Cancer Receptor Testing at the Georgetown Public Hospital Corporation from December 2016 to December 2018

Sandy Solomon, Ravi Motilall

Journal of Advances in Medicine and Medical Research, Page 15-16
DOI: 10.9734/jammr/2019/v30i1230259

Objectives: To review the outcomes of oestrogen receptor (ER), progesterone receptor (PR) and Human epidermal growth factor receptor 2 (HER2) in breast cancer patients at GPHC over a 2 year period from December 2016-December 2018.

Hypothesis: There is a higher incidence triple negative(ER (-), PR (-), HER2 (-)) breast cancer among patients in Guyana when compared to the Caribbean.

Secondary Objectives: To identify the patients who had hormone receptor testing done at the Georgetown Public Hospital Corporation (GPHC).

To specify the current trends of ER, PR and HER2 in patients at GPHC from December 2016- December 2018.

To enumerate the percentage of BC diagnosed in the patients under 40 years.

Design and Methods: Retrospective cohort study of 90 BC patients with known receptor status from December 2016-Dcember 2018.

Results: In this study of 90 patients 46% of the patients are triple negative BC, while 38% are hormone receptor positive. Of least frequency are the triple positive BC representing 3%.

The persons 40years and under represent 16% of the population.

Conclusion: There in a high percentage of breast cancer in patients under 40 years representing 16% of the study population.

There is a higher percentage of triple negative or non-hormonal receptive breast cancer at GPHC of approximately 46% which supersedes 20% when compared to the Caribbean population.

Recommendations: Further study is needed, with screening and development of protocols. Breast receptor testing in all patients need to routinely done and a formal cancer registry and Digital database established.

Open Access Conference Abstract

The Incidence and Short-term Outcome of Perforated Peptic Ulcers

Gabrielle DeNobrega, Ravi Motilall, Bibi Hussain

Journal of Advances in Medicine and Medical Research, Page 17-18
DOI: 10.9734/jammr/2019/v30i1230260

Objective: To determine the incidence of non-traumatic perforated gastro-duodenal ulcers in the surgical population at GPHC.

To identify/ discuss mortality associated with perforated hallow viscus at GPHC and its related outcomes.

Study Design and Methods: This study involves a retrospective analysis of all inpatients in the female and male adult surgical wards at GPHC. All charts coded for ‘acute abdomen’, ‘perforated hollow viscus’ and pneumoperitoneum were collected from 2016 to 2018 Data from this selective population were collected using the data collection tool. All data was coded for and entered into spreadsheet of which double data entry was done.  Data was then analyzed using SPS.

Results: Initially a total of 109 charts were collected but was reduced to sample size of 31 patients after review of charts. Majority of patients were males with an average age of presentation of 45.8years. Although many comorbidities are associated with perforations only 1 patient in this studyhad chronic hypertension. Time of presentation from onset of symptoms greatly influences theoutcomes for affected patients. However, 80% of patients presented after 24 hrs, none in a state of shock and no early mortality was found. Smoking affects the mucosal barrier of stomach and increases risk of peptic ulcer disease. In this study 67.7% of patients admitted to being frequent marijuana smokers and 74.2% cigarette smokers and although a small population size, a high association between smoking and resultant disease was shown with a P value of 0.0028. Graham’s patch was done by residents on all patients with an average operative time of 68.4 minutes. Intraoperatively the most common site of perforation was the antrum (60%) compared to the duodenum (6.7%), pylorus (6%) and body of stomach (3.3%). Post- op there was a 40% morbidity rate.

Conclusions: Primary repair is a safe surgical approach with a low mortality.

Open Access Conference Abstract

Laparoscopic Rectopexy – A New Management for Rectal Prolapse at the Georgetown Public Hospital Corporation

Joshua Bhudial, Hemraj Ramcharran, Navin Rambarran, Zoilo Leon

Journal of Advances in Medicine and Medical Research, Page 19-20
DOI: 10.9734/jammr/2019/v30i1230261

Introduction: Rectal prolapse is a debilitating and unpleasant condition adversely affecting the quality of life. It is a distal displacement of the rectum through the pelvic diaphragm that produces pressure symptoms on other pelvic organs causing fecal incontinence, obstructive defecation, or even strangulation. Different perineal and abdominal approaches have been described for surgical correction of rectal prolapse. Laparoscopic Rectopexy has been proven to be an effective treatment for rectal prolapse.

Objective: LPR has recently been practiced as a method of treatment for rectal prolapse at GPHC. This study aims to assess the clinical and functional outcomes of the patients who underwent Laparoscopic Rectopexy in the effort to highlight this practice in Guyana and the Caribbean.

Design /Method: The study design includes a retrospective review and prospective follow-up of a series of 4 patients who underwent LPR at GPHC for rectal prolapse. Pre-operative, intra-operative and post-operative factors surrounding the procedure were recorded and analyzed.

Results: All patients were males of 29-52 years of age. One (1) Patient was a smoker and One (1) used alcohol. Two (2) patients had a previous perineal approach for rectal prolapse that recurred. No comorbidities were recorded. All patients had complete rectal procidentia. Laparoscopic Ventral Mesh Rectopexy was done for each patient. None of the cases were converted. All patients were fully ambulant by postoperative day one and all were discharged by postoperative day three. No short-term recurrence was recorded for three patients; the fourth patient did not complete the six months postoperative period.

Conclusion: Laparoscopic Rectopexy was successfully pioneered at GPHC as a method of management for rectal prolapse with good outcomes.

Open Access Conference Abstract

Impact of Educational Weaning Knowledge and Practices of Parents and Guardians of Children under Two Years Old at the David Rose Health Centre

Padmini Bissessar, Kenesha Adams, Gina Chin, Sheena Chin, Paul Garraway, Bibi Alladin

Journal of Advances in Medicine and Medical Research, Page 21-22
DOI: 10.9734/jammr/2019/v30i1230262

Objectives: To assess the knowledge of weaning, of parents and guardians, of children under two-years-old, attending David Rose Health Centre.

To assess whether there is an association between selected demographic variables, and the weaning knowledge.

To educate the parents and guardians on the World Health Organisation recommended weaning practices.

To assess the change in knowledge of weaning after the delivery of an educational intervention.

Design and Methods: A prospective longitudinal study with repeated measures design obtained 120 participants using a convenient, non-probability sampling method. Data was collected using a pre-intervention and post-intervention questionnaire. The data was processed using the SPSS Version 24 Software Program and analysed with a scoring system developed by the researchers using the PAHO/WHO “Guiding Principles for Complementary Feeding of the Breastfed Child”.

Results: Both educational interventions increased the participants knowledge from good to almost 100%.

Conclusions: Most parents and guardians had good baseline knowledge. However, there were certain aspects where they lacked or had inaccurate knowledge. Overall, their knowledge improved regardless of the type of educational intervention they were exposed to.

Recommendations: Future studies should be held in classroom settings, with more time allowed to assess change of knowledge.

Open Access Conference Abstract

Non-operative Management of High-grade Renal Injuries in Children: A Review of Two Cases Seen at the Georgetown Public Hospital Corporation

Andrea Kissoon, Marisa Seepersaud, Pradeep Ramkoomar

Journal of Advances in Medicine and Medical Research, Page 23-24
DOI: 10.9734/jammr/2019/v30i1230263

Purpose:  Blunt abdominal trauma in children results in renal injury in approximately 10 to 20% of cases. In about 20% of these patients, significant complications may arise; for example urinoma (1%) and post trauma extravasation (2-18%). Urinomas and persistent hematuria were traditionally managed surgically by partial or total nephrectomy. Today, nonoperative management is well accepted for the majority of high grade renal injuries, as organ preservation is highly desirable due to patients’ projected lifespan. We present a retrospective review of two cases of high renal injuries seen at GPHC’s Paediatric Surgical Department.

Methods: In February and April 2019, two patients met the criteria for grade four renal injury. All medical records were reviewed. Cause of injury, complications, interventions and hospital stay were analyzed. These patients were followed up post discharge, clinically and radiologically.

Results: Two males, ages 11 and 10 years, sustained blunt abdominal trauma and presented to GPHC with hematuria and abdominal tenderness. On initial assessment, they were hemodynamically stable and were diagnosed with grade four renal injuries by computed tomography. Complications developed after one week of hospitalization. One patient had persistent hematuria lasting over a week, requiring blood transfusions in excess of 4 units, and the other developed a urinoma, urinary tract infection and deep vein thrombosis. Both patients had paralytic ileus and acute hypertension. These complications were all managed non operatively. The very large urinoma was successfully treated with percutaneous drainage after 25 days. Average hospital stay was 35 days and both patients had complete resolution of their renal injuries within 90 days post trauma.

Conclusion: Non operative management of high-grade renal injury is highly successful and safe in children. Even in the presence of significant complications, preservation of renal tissue should be considered.

Open Access Conference Abstract

Mortality in Paediatric Medical Services over a Two-Year Period at the Georgetown Public Hospital Corporation

Rashma Sanichar, Bibi Alladin

Journal of Advances in Medicine and Medical Research, Page 25-26
DOI: 10.9734/jammr/2019/v30i1230264

Objectives: To identify common causes and patterns of mortality and associated modifiable factors in Paediatric medical services, GPHC for 2016 and 2017.

Design and Methods: Descriptive, Cross-sectional retrospective study of all Paediatrics deaths for 2016 and 2017 from the Paediatrics Medical Ward and ICU at GPHC. Data were analysed using IBM SPSS version 23 for descriptive statistics.

Results: The Paediatrics Medical Ward saw 2419 admissions in 2016 and 2168 in 2017. There were 86 deaths recorded in the death registry during the two years, of which 57 deceased patient charts were reviewed, 29 charts (33.7%) were missing.

Of the 57 charts reviewed, 42.1% were males and 57.9% were females. The most common final diagnosis was bronchopneumonia/pneumonia (n=1 (22.8%), followed by sepsis (n= 12 (21.0%). This pattern was seen in both the general sample population and the patients ≤ 5 years. Some of the modifiable factors which showed clinical significance when compared with length of hospitalization were; lack of routine reviews on the ward (p value 0.016), poor documentation of consultation information on referral notes (p value 0.032) and poor or no pre-hospital treatment before transfer (p value 0.017).

Conclusions: Factors associated with mortality are mainly hospital-related and should, therefore, be given urgent attention for resolution which may reduce childhood mortality. In addition, the common causes of death are preventable and treatable respiratory and infectious diseases.

Recommendations: Develop referral, transfer and management protocols for critical patients. Sensitization of staff on modifiable factors to effect positive behavioural change.

Open Access Conference Abstract

Rates and Indication of Primary Caesarean Section at the Georgetown Public Hospital Corporation

Rohini Rupan

Journal of Advances in Medicine and Medical Research, Page 27
DOI: 10.9734/jammr/2019/v30i1230265

Objective: To determine the rate and indication of primary caesarean deliveries at Georgetown public hospital and ascertaining changing trends after implementation of Obstetrics and gynaecology residency program.

Methods: A four-year retrospective chart review of patients who underwent primary caesarean sections for the years 2014-2017.

Results: A total of 5055 caesarean sections were performed in the years 2014-2017, these include both primary and secondary c-sections. In this total 2298 were primary caesarean sections representing a 45% of total c-sections. For the years 2014, 2015, 2016 and 2017 the individual primary caesarean section rate was 7.06%, 7.42%, 11.23% and 11.53% respectively.

Conclusion: This study suggest that as the years advance the total number of deliveries increase and hence primary caesarean section rates. Also, the major indication for same is non reassuring fetal heart tracing as the years progressed.

Open Access Conference Abstract

Evaluation of Outcomes after Implementation of Induction of Labour Protocol at the Georgetown Public Hospital Corporation

Ravindra Hardyal, Ademola Biala, Ruth Derkenne

Journal of Advances in Medicine and Medical Research, Page 28-29
DOI: 10.9734/jammr/2019/v30i1230266

Objective: To evaluate the incidence of failed induction of labour (FIOL), and determined whether this resulted from non-adherence to the induction of labour protocol.

Design and Methods: This study was a retrospective cohort analysis of all term patients who underwent induction of labour from 1st January to 30th June 2018. 

Materials: GPHC IOL protocol, inpatient charts, nurses and theatre log books, electronic handing over records, Microsoft Excel, Word and

Results: They were 388 patients induced that met the eligibility criteria outlined, 298 were included in the study while 90 were excluded because of failure to locate the patient records.

77,5% of the term patients induced achieved spontaneous vaginal delivery and 21,8% delivered by cesarean section, the nulliparous patients had a higher incidence of cesarean delivery at 33,1% (P=0,0514), compared with the multiparous patients 10,6% (P=0,0158). The rate of FIOL was 10,4% (31 patients). 48,4% of these diagnosis were not in accordance with the labour induction protocol (P=<0,0001).

Conclusions: The incidence of FIOL was 10,4%, of which 48,4% was not in accordance to the protocol.

Standardization of management and adherence to the labour induction protocol decreases the time to delivery and cesarean section rate.

Recommendations: The diagnosis of FIOL should be made in accordance with the international guidelines adapted by GPHC’s induction protocol.

Open Access Conference Abstract

Endocrine Disorders in a Specialized Hospital in Guyana

Yaquelin Gonzalez Ricardo, Yaritza Lopez Diaz, Ravendra Johnaton Dudnauth, Maritza Oliva Perez

Journal of Advances in Medicine and Medical Research, Page 30-31
DOI: 10.9734/jammr/2019/v30i1230267

Background: Endocrine diseases are characterized by hormonal alterations (excess or defect). Due to the low prevalence (less than five case 5 / 10 000 inhabitants), a large number of them, qualify to be classified as rare diseases such as those of organs like: hypophysis, adrenal glands, gonads as well as some congenital thyroid diseases. Others like Diabetes are considering almost epidemic.

Objective: To define the types of diseases observed in the only Endocrinology Clinic in Guyana.

Methods: The diagnoses of all patients who attended the endocrinology clinic of the Georgetown Public Hospital Corporation from June 1, 2016 to May 31, 2017, were analyzed.

Results: During the one year of this study, approximately 639 patients attended the endocrinology clinic. Of this, 178 patients had thyroid-related diseases with 80 of these having thyrotoxicosis, 49 having hypothyroidism followed by 110 patients with diabetes mellitus. Pituitary tumors were also diagnosed with 2 of acromegaly and 6 of prolactinomas. Cases of hypoadrenalism (n = 5), hypogonadism (n = 4), and pheochromocytoma (n = 6) were not rare; gonadal disease were also found in 17 patients.

Thyroid disease was the most frequent diagnosis followed by diabetes mellitus. New emerging endocrine disorders such as hyperlipidemia (n = 1) were rare. Some persons attending the clinic were also noted to be overweight /obese however this was not the primary reason for joining the clinic. Traditional diseases such as Sheehan Syndrome have become rare due to improvements in Obstetric care. 

Open Access Conference Abstract

The Relationship between Job Satisfaction and Absenteeism at the Georgetown Public Hospital Corporation

Marisa Seepersaud, Marissa Singh, Chrisanne Rodrigues, Keith Alonzo

Journal of Advances in Medicine and Medical Research, Page 32-33
DOI: 10.9734/jammr/2019/v30i1230268

Objective: Job satisfaction is a major determinant of performance in the workplace. Studies have shown that job dissatisfaction can intensify emotional exhaustion, and this can influence nurses to perceive their work as tiresome and repetitive, leading to frustration and discouragement. The purpose of this study was to investigate the relationship between job satisfaction and absenteeism at Georgetown Public Hospital Corporation (GPHC), and to explore the parameters that may impact on job satisfaction among nurses in 3 different units (Paediatric High Dependency Unit (PHDU), ICU, Paediatric Medicine ward), at GPHC.

Methods: The study was a retrospective audit of the nurses’ timesheets of 3 departments at GPHC to determine the level of absenteeism among the various levels of nursing staff (RNS, NAs). The nurses of each unit were then given an anonymous Lickert job satisfaction survey to complete to ascertain the potential impact of various parameters on their level of satisfaction. The data was analysed to determine if there was any correlation between the level of job satisfaction and the level of absenteeism.

Results: The absent days of the PHDU was 48 (31 official sick leave) for 11 staff members (360 shifts).

The absent days on the ICU was 193 (51 official sick leave) for 27 staff members (540 shifts).

The absent days on the Paediatric Medicine ward was 323 (136) for 22 staff members (540 shifts).

The level of job satisfaction across most parameters related to supervision, support and teamwork was significantly better in the PHDU than the other two units. General parameters related to promotion and administrative support remained low among all 3 units.

Conclusions: The level of absenteeism was markedly lower in the PHDU when compared to the other two units. The majority of respondents were unsatisfied with conditions related to their jobs. The respondents from the PHDU displayed higher satisfaction than their counterparts in the ICU and Paeds med units.

Open Access Conference Abstract

Degree of Adherence to Contact Precautions by Healthcare Workers in the Medical Laboratory

Chandanie Panday, Karishma Raghubir, Davon Van-Veen

Journal of Advances in Medicine and Medical Research, Page 34-35
DOI: 10.9734/jammr/2019/v30i1230269

Objective: To determine adherence to contact precautions, and trends in knowledge, attitudes, and adherence by healthcare workers in a selected medical laboratory.

Methods: The study design was quantitative, cross-sectional, and observational. Medical technologists and laboratory aides of one laboratory operating by the GYS 170 Standard were studied for twenty-four days. Firstly, compliance and supply availability were discretely observed and recorded on standardized tally charts. Secondly, thirty questionnaires were randomly distributed to determine knowledge of, attitudes to, and self-perceived compliance with contact precautions; twenty-four were returned. Data was analyzed in Microsoft Excel 2007 via percentages for observational results and averages for questionnaire results. Actual and perceived adherences were compared. Pearson’s χ2 test was used to determine association between variables.

Results: Of 2,564 events, compliance (72.4%) was greater than non-compliance (27.4%). Medical technologists were more non-compliant (74.1%) than laboratory aides (37.7%). Staff were more likely to practice hand hygiene upon leaving (84.1%) than entering (39.9%). Laboratory coats were most used (86.2%) and gloves the least (69.9%). Also, gloving was associated with hand hygiene and with laboratory coat usage. The questionnaires revealed low knowledge, positive attitudes and low perceived compliance among workers. Finally, perceived adherence was larger than actual adherence. A p-value of less than 0.05 was determined to be statistically significant.

Conclusion: Although supplies and guidelines exist and are positively received by workers, implementation is a challenge. Low knowledge and actual compliance, especially among medical technologists, is risky. Therefore, stricter initiatives and educational training are necessary.

Open Access Conference Abstract

Update on Laparoscopic Surgery at the Georgetown Public Hospital Corporation

Joshua Bhudial, Hemraj Ramcharran, Navindranauth Rambarran, Delon Ramnarine

Journal of Advances in Medicine and Medical Research, Page 36-37
DOI: 10.9734/jammr/2019/v30i1230270

Background: Laparoscopic surgery is a pioneering technique that has metamorphosed the field of surgery in the past and is now considered the recommended surgical approach for many procedures. 1 The last published data showed an average of eight cases per month. 5 The purpose of this study was to assess an increase or decrease in the number of Laparoscopic surgeries at GPHC and if there were more advanced cases as compared to the last published data.

Methods: Data of the laparoscopic surgeries done at GPHC for the year 2018 was obtained from the records in the Main Operating theatre. Data collected will focus on the number and type of Laparoscopic surgeries.

Results: An audit of GPHC operating register shows a total of 180 cases for 2018 representing an average of 15 cases per month. There was a significant difference in the first six months of 2018 (5 cases per month) versus the last six months of 2018 (25 cases per month). A total of 19 cases were converted. Most of the advanced cases were done in latter half of 2018 and included 27 diagnostic laparoscopy, 9 inguinal hernias, 2 AP resections, 2 Graham’s patch, 2 ventral hernias, 2 rectopexy and 1 Heller’s myotomy.

Conclusion: The number of laparoscopic surgeries at GPHC has increased significantly especially in the latter half of 2018. This number has risen to three times the number in the last published data. While the majority of cases continued to be cholecystectomy and appendectomies, a greater variety of advanced cases were done in 2018 as compared to the last published data.