Browsing by Author "Bahall, Mandreker"

Now showing 1 - 7 of 7
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    Health services in Trinidad: throughput, throughput challenges, and the impact of a throughput intervention on overcrowding in a public health institution
    (2018-02-20) Bahall, Mandreker
    Abstract 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.
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    Medical care of acute myocardial infarction patients in a resource limiting country, Trinidad: a cross-sectional retrospective study
    (2019-07-18) Bahall, Mandreker; Seemungal, Terrence; Khan, Katija; Legall, George
    Abstract Background Cardiovascular disease remains the most common cause of death. However, effective and timely secondary care contributes to improved quality of life, decreased morbidity and mortality. This study analyzed the medical care of patients in a resource limiting country with a first presentation of acute myocardial infarction (AMI). Methods A cross-sectional retrospective study was conducted on first time AMI patients admitted between March 1st 2011 and March 31st 2015 to the only tertiary public hospital in a resource limiting country, Trinidad. Relevant data were obtained from all confirmed AMI patients. Results Data were obtained from 1106 AMI patients who were predominantly male and of Indo Trinidadian descent. Emergency treatment included aspirin (97.2%), clopidogrel (97.2%), heparin (81.3%) and thrombolysis (70.5% of 505 patients with ST elevation MI), but none of the patients had primary angioplasty. Thrombolysis was higher among younger patients and in men. There were no differences in age, sex, and ethnicity in all other treatments. Of the 360 patients with recorded times, 41.1% arrived at the hospital within 4 h. The proportion of patients receiving thrombolysis (door to needle time) within 30 min was 57.5%. In-patient treatment medication included: aspirin (87.1%), clopidogrel (87.2%), beta blockers (76.5%), ACEI (72.9%), heparin (80.6%), and simvastatin (82.5%). Documentation of risk stratification, use of angiogram and surgical intervention, initiation of cardiac rehabilitation (CR), and information on behavioral changes were rare. Electrocardiogram (ECG) and cardiac enzyme tests were universally performed, while echocardiogram was performed in 57.1% of patients and exercise stress test was performed occasionally. Discharge treatment was limited to medication and referrals for investigations. Few patients were given lifestyle and activity advice and referred for CR. The in-hospital death rate was 6.5%. There was a significantly higher relative risk of in-hospital death for non-use of aspirin, clopidogrel, simvastatin, beta blockers, and heparin, but not ACE inhibitors and nitrates. Conclusions Medication usage was high among AMI patients. However, there was very minimal use of non-pharmacological measures. No differences were found in prescribed medication by age, sex, or ethnicity, with the exception of thrombolysis.
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    Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago
    (2019-01-07) Bahall, Mandreker
    Abstract 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.
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    Quality of life of patients with first-time AMI: a descriptive study
    (2018-02-13) Bahall, Mandreker; Khan, Katija
    Abstract Background Outcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL). This study explores health-related QOL of first-time patients following AMI. Methods This cross-sectional study used a sample of patients with first-time AMI experienced between April 2011 and March 2015 at a tertiary health institution. Recruited patients belonged to different post-AMI periods: 2–10 weeks, 5–22 months, and > 22 months to 4 years post AMI. Inclusion criteria were not confused and communicating freely. Exclusion criteria were non-contactable, refusing to participate, and deceased. One-on-one interviews were conducted using the validated and pre-tested Quality of Life after Myocardial Infarction (QLMI) questionnaire. QOL of patients after AMI was evaluated at each period. Descriptive, Mann–Whitney U, Kruskal–Wallis, and regression analyses were conducted using SPSS version 24. Results A total of 534 participant interviews (overall response rate 65.4%) were conducted. Interviewees were predominantly male (67%), aged 51–65 years (45%), Indo-Trinidadian (81.2%), NSTEMI (64.4%), and hypertensive (72.4%). Overall QOL improved over time and in all domains: Emotional, Physical, and Social. Lower QOL was found among women, patients with NSTEMI, and diabetics in all domains; in patients with hypertension and renal disease in the Physical and Social domains only; and in patients with ischaemic heart disease (IHD) in the Physical domain only. Self-reported stress and lack of exercise were associated with lower QOL while drinking alcohol and eating out were related to better QOL. Hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Declining QOL in the Physical domain with age was also found. The leading components of QOL were self-confidence and social exclusion (early post AMI), lack of self-confidence (intermediate post AMI), and tearfulness (late post AMI). Conclusions QOL in AMI survivors improves over time. Female gender, NSTEMI, diabetes, hypertension, renal disease, stress, and lack of exercise were associated with lower QOL while hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Cardiac rehabilitation and psychological support may enhance earlier increased QOL among survivors, particularly among vulnerable groups.
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    School systems in Trinidad and Tobago: A cause of deviant behaviours/violent crimes and the XYZ model of school violence
    (Science Publishing Group, 2024) Bahall, Mandreker
    The 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.