Developing appropriate community-based postgraduate training in a developing country

The School of Medical Sciences, KNUST, established in 1975, indicated its educational orientation to a community-based and community-oriented system using the problem-based learning approach. Falling victim to the phenomenon of brain-drain, the School developed a postgraduate medical curriculum which takes into account the needs and demands of national governments and communities for quality specialist care and equitable distribution of existing health facilities. There is an innovative community-based fourth year for obstetrics and gynaecology, ophthalmology, otorhinolaryngology, paediatrics, surgery and medicine. After attainment of the Part I Examination, residents are sent to Ulm, Maastricht, Britain and the United States for clinical attachments for a period of 3 to 6 months before returning to sit for their Final Part II for the Fellowship of the West African College of Surgeons or Physicians (FWACS, FWACP). By ensuring that the Final Examinations take place after the elective attachment, none of the new breed of specialists so far produced has been lost to the Western world. The strengths and weaknesses of the programme are discussed.     

Pattern of poisoning in a developing agricultural country

Four hundred and seventy-two cases of poisoning were seen over a two-year period in Kandy, Ceylon. The overall mortality was 23·7%. The pattern of poisoning was different from that in western countries in that 49·8% of the cases were due to insecticide poisoning and only 10·7% were due to drugs, including barbiturates. Insecticides accounted for 73·2% and drugs for only 4·5% of the 112 fatal cases. Of the fatal cases 51·7% were between the ages of 20 and 40 years and only 6·2% were over 50 years. The wastage of economically useful lives indicates the need for a poison centre.     

Needlestick injuries during medical training

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.     

Economic burden of ventilator-associated pneumonia in a developing country

Ventilator-associated pneumonia (VAP) developed in 96 (60%) of 159 patients with 37.2 cases per 1000 ventilation-days in a medical intensive care unit (MICU). Median time for VAP development was 5.5 days (range: 2-25). The most significant risk factors for VAP were stay in hospital before MICU and length of stay in MICU. The mean length of stay in MICU for VAP patients was 23.8 ± 19.8 days, which was four-fold higher than for non-VAP patients. The daily cost for VAP patients was half that for non-VAP patients. The total costs for VAP patients were about three-fold higher than for non-VAP patients.     

Patients' awareness of their rights in a developing country

AIM: To determine the awareness of a regulation on patients' rights passed in 1998 in Turkey. METHODS: All hospitalized patients in the internal medicine and general surgery wards in three large hospitals during the study period were eligible for the study, which was performed in 2001 in the Denizli province, Turkey. The study group consisted of 166 patients. Data were collected during face-to-face interviews using a questionnaire. RESULTS: Only 9% of patients were aware of the regulation about patients' rights. Most patients were given equal access to health care (91%), benefitted from the capabilities of their selected healthcare institutions (86.7%), and their privacy was protected (86.1%). Those patients who stated that they had not received care in accordance with their rights identified the shortcomings as not receiving written (95.2%) or verbal (53%) information from healthcare professionals, and the failure of healthcare personnel to introduce themselves (75.3%). On most occasions, the patients stated that they were not able to request services as stated in the PRR from healthcare professionals. CONCLUSION: Few patients knew about the regulation on patients' rights, indicating a need for extensive education of patients and healthcare professionals.     

Rational use of cytotoxic drugs in a developing country

Malignant disease poses a major problem in Africa. To managepatients with cancer satisfactorily, sophisticated facilitiesand trained personnel are needed, and the cost of treatmentis high. The concept of essential drug lists with guidelinesfor treatment is of undoubted value and such programmes havebecome increasingly widespread. In Zimbabwe a committee hasbeen formed to formulate both a list of appropriate cy-totoxicdrugs and a national policy for the management of patients withmalignant conditions. To date a drug list has been drawn upand a number of policy principles agreed. There will be twomain centres for oncology treatment in the country, and drugutilization will be carefully monitored so as to keep withinthe separate oncology drug budget. Limited resources permitonly a limited number of patients to be treated, and to facilitateselection of patients who will derive maximum benefit, the malignantdiseases have been divided into three categories. The majorityof cytotoxic agents will be utilized in category 1 which listsconditions in which remission rates are high or in which long-termeffective palliation is possible. Protocols outlining investigationsand management in various conditions are being designed. Thistype of unified standardized approach will lead to the mostefficient use of available resources and provide an acceptablelevel of care for the patient with cancer. It is proposed thata pocket-sized manual of drug list, policy, protocols and variousother aspects of cancer care will be published.     

高等医学专科学校医学美容专业开设健康教育课的意义与建议

医学美容是一门以人体形式美理论为指导,采取手术或非手术的医学手段,来直接维护、修复和再塑人体美,以增进人的生命活力美感和提高生命质量为目的的新兴医学交叉学科[1].随着社会经济发展和科学技术进步及人们生活水平的逐渐提高,越来越多的人开始关注自身体态及容貌变化,因此,促进了医学美容的发展.医学美容正在成为人们改善体形、保持容貌美、维护青春、延缓衰老的重要手段.