BackgroundThe unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area.MethodsA cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests.ResultsOf 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ± 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 ± 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction.ConclusionThe use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

HighlightsPhyllodes tumors are rare biphasic fibroepithelial neoplasms of breast and are classified as benign, borderline and malignant.Resection of the tumor is the preferred treatment, whereas the role of radiation therapy, and adjuvant chemotherapy are undefined.Wide excision or mastectomy should be performed with the goal of histological clear margins.Axillary nodal dissection is not required.

HighlightsMalignant melanoma of the heel is a rare melanoma subtype globally.This is the first reported case study of malignant melanoma of the heel in the Caribbean.Our case highlights the need for the development of strategies to increase patient adherence in developing countries.The literature search shows that this is the first reported case of malignant melanoma of the heel among non-fair skin individuals in 40 years.Increasing rates of malignant melanoma of the heel suggest the need for increased public awareness, early diagnosis and shared clinical decision making.

HighlightsThis case series provides details on one surgeon’s experience performing pelvic exenterations (PEs) in a developing country.We provide a detailed surgical approach as well as complications based on the Clavien-Dindo classification.We offer suggestions for surgeons in developing countries planning to undertake PEs.