Overcoming obstacles to establish a multidisciplinary team approach to hepatobiliary diseases: a working model in a Caribbean setting

Cawich, Shamir O; Johnson, Peter; Shah, S.; Roberts, Patrick; Arthurs, Milton; Murphy, Trevor; Bonadie, Kimon O; Crandon, Ivor W; Harding, H. E.; Hilal, Mohammed Abu; Pearce, Neil

doi:10.2147/jmdh.s60604

Cited by 21 publications

(24 citation statements)

References 18 publications

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“…There has been no prior report on PHA from the Anglophone Caribbean, a region consisting of 17 English-speaking Caribbean countries with a cumulative population of 6.5 million (9). We commenced a hepatobiliary registry to record all primary and metastatic liver tumours encountered in the three main referral centres for the Anglophone Caribbean in January, 2011 (9). This was the first case encountered in the registry, allowing us to estimate the annual incidence as 0.05 per million population in the Anglophone Caribbean, which is comparable to the incidence in Western countries (7,8).…”

Section: Discussionmentioning

confidence: 99%

Herald bleeding from a ruptured primary hepatic angiosarcoma: A case report

Cawich

Ramjit

2015

Molecular and Clinical Oncology

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Abstract. Primary hepatic angiosarcomas (PHAs) are rare tumours with an estimated annual incidence of 0.05 per million in the Caribbean, which is similar to that reported in Western countries. Although a number of cases are detected post-mortem, the most common clinical presentation is with tumour rupture and herald bleeding. This is the case report of a 60-year old female patient who presented with vague upper abdominal pain, found via imaging examinations to be due to a ruptured hepatic tumour in segment III of the liver. The tumour was removed via laparoscopic left lateral sectionectomy, with clear resection margins. The histopathological and immunohistochemical examination established the diagnosis of PHA. Therefore, an index of suspicion should be maintained in selected patients and, when detected ante-mortem, PHAs should be treated aggressively with complete surgical resection to achieve microscopically clear margins, as the response of these tumours to other forms of adjuvant therapy may be unpredictable.

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Section: Discussionmentioning

confidence: 99%

Herald bleeding from a ruptured primary hepatic angiosarcoma: A case report

Cawich

Ramjit

2015

Molecular and Clinical Oncology

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“…Primary hepatic malignancies account for 0.5–2% of all the solid tumors in childhood . Hepatoblastoma (HB) is the most common pediatric liver tumor accounting for almost two‐thirds of the primary malignant liver tumors, with an overall incidence of 1.5 cases per million, followed by hepatocellular carcinoma .…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of hepatoblastoma in children: Experience from a developing country

Shanmugam¹,

Scott²,

Kumar³

et al. 2016

Pediatric Blood & Cancer

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“…There were also many “self-imposed obstacles” such as deficiencies in surgical leadership,5 lack of prioritization by policy makers,2,5 and the “sole practitioner culture”6 that prevailed in the Caribbean. This led to high rates of emigration of skilled health care workers,7 compounding the deficiencies.…”

Section: Introductionmentioning

confidence: 99%

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Cawich¹,

Pooran²,

Amow³

et al. 2016

RMHP

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IntroductionThe Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice.Materials and methodsIn this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes. On August 1, 2013, a UWI team was introduced with a mandate to optimize teaching and promote laparoscopic surgery. The UWI team had a similar staff complement to the existing service-oriented teams. There was no immediate investment in equipment, hospital beds, ICU beds, or operating room space. Therefore, the new team was introduced with limited change in existing conditions, resources, and equipment.ResultsThere were 252 laparoscopic operations performed over the study period. After introduction of the UWI team, there was an increase in the mean number of unselected laparoscopic operations (3.17 vs 10.83 cases per month; P<0.001; 95% confidence interval [95% CI] −8.5 to −6.84; standard error of the difference [SED] 0.408), the mean number of basic laparoscopic operations (3.17 vs 6.94 cases per month; P<0.0001; 95% CI −4.096 to −3.444; SED 0.165), the mean number of advanced laparoscopic operations (0 vs 3.89; P<0.0001), the number of teams undertaking unselected laparoscopic operations (2 vs 5), and the number of teams independently performing advanced laparoscopic operations (0 vs 4).ConclusionAt this facility, we have demonstrated a significant increase in laparoscopic case volume and complexity when partnerships were formed between the UWI and this service-oriented hospital. Continued cross-fertilization and distribution of skill sets across the surgical community can reasonably be expected. We also identified maneuvers that can be used as a template to build laparoscopic services in other service-oriented hospitals in developing nations.

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Overcoming obstacles to establish a multidisciplinary team approach to hepatobiliary diseases: a working model in a Caribbean setting

Cited by 21 publications

References 18 publications

Herald bleeding from a ruptured primary hepatic angiosarcoma: A case report

Herald bleeding from a ruptured primary hepatic angiosarcoma: A case report

Multidisciplinary management of hepatoblastoma in children: Experience from a developing country

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

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