Search

Au Burkina Faso, le taux de mortalité infanto-juvénile demeure élevé. La barrière financière est souvent indexée comme étant la cause de non-utilisation des services de santé accentuant le risque de décès dans cette frange de la population. Des politiques d’allègement des charges financières sont formulées et mises en oeuvre. C’est dans cette optique que la politique d’exemption de paiement direct des soins au profit des enfants de moins de 5 ans et des femmes enceintes est mise en oeuvre depuis avril 2016. Elle vise la réduction de la mortalité infanto-juvénile. L’application de cette politique de gratuité a entraîné la surconsommation des services de santé (augmentation du nombre de contacts par an et par enfant de 77 % entre 2015 et 2018). La disponibilité des médicaments, condition incontournable pour l’atteinte de l’objectif de la gratuité a conduit à la réalisation de cette recherche dans trois structures de soins de premier niveau de la direction régionale de la santé du Centre (Ouagadougou). Nous avons opté pour une démarche mixte quantitative-qualitative. Une enquête par distanciation sociale a permis de collecter les données au cours de 137 observations directes. De plus, 33 entretiens individuels et un focus group ont été également réalisés respectivement auprès des usagers et des soignants. La collecte des données a duré six mois. Les principaux résultats montrent une disponibilité insuffisante en médicaments. Le ministère de la Santé n’a pas tiré les leçons y relatives issues de la mise en oeuvre de la subvention des accouchements. Il n’a pas prévu de mesures d’atténuation de ces ruptures en médicaments malgré son importance pour le succès de la gratuité mainte fois réaffirmée dans les documents officiels. Les bénéficiaires de la gratuité ont alors recours à d’autres stratégies de financement des coûts supplémentaires pour compenser le manque de médicaments. Lesquelles stratégies induisent des conséquences sociales et économiques désastreuses pour les ménages. [ABSTRACT FROM AUTHOR]

Copyright of Vie et Sciences de l'Entreprise is the property of ANDESE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: L'allaitement maternel (AM) est un événement de vie qui peut survenir au cours de la formation des futures professionnelles de médecine générale. Cet article explore comment les internes de médecine générale mettent en place et vivent l'allaitement maternel au cours du Diplôme d'Études Spécialisées, et quel impact cela peut-il avoir sur leur pratique ? La confrontation au système de soins, pour ces internes au cours de l'AM, peut être génératrice d'angoisse ou de conflit. Du fait de leurs connaissances médicales, elles évincent assez rapidement les conseils déstabilisants. Il se crée ainsi une expertise profane nouvelle sur l'AM. Cette expérience d'AM influence leur formation médicale, et réciproquement les contraintes liées à la formation ont un impact sur leur projet d'AM. A la suite de cette expérience, l'expertise profane se positionne au service de l'expertise médicale dans une approche respectant les principes de l' Evidence Based Medicine et centrée sur le patient. Breastfeeding (BF) is a life event that can occur during the training of future general medical professionals. This article explores how residents initiate and experience BF during the Specialist Diploma, and what impact this may have on their practice. Confrontation with the health care system for these residents during BF can be a source of anxiety or conflict. Because of their medical knowledge, they are able to oust destabilising advice fairly quickly. This creates new lay expertise on BF. This BF experience influences their medical training, and conversely the constraints of training have an impact on their BF project. As a result of this experience, lay expertise is positioned at the service of medical expertise in an approach that respects the principles of Evidence Based Medicine and focuses on the patient. [ABSTRACT FROM AUTHOR]

Résumé: Il n'existe pas de liste du matériel obligatoire à posséder par le médecin généraliste et, entre tous les équipements médicaux disponibles, il peut être difficile pour un praticien de faire un choix. Les objectifs étaient de dresser un état des lieux du matériel possédé par le médecin généraliste dans la Loire et la Haute-Loire en 2018 et d'étudier la fréquence d'utilisation de ce matériel. There is no list of the equipment to be possessed by the general practitioner and, among all the available medical equipment, it can be difficult for a general practitioner to choose his equipment. The objectives were to draw up an inventory of the equipment owned by the general practitioner in the Loire and Haute-Loire in 2018 and to study the frequency of use of this equipment. [ABSTRACT FROM AUTHOR]

Abstract: Where tuberculosis is concerned, early diagnosis, especially for active pulmonary cases, allows to quickly start therapy. We evaluated the Patho-TB kit (Anda Biologicals, France) as an alternative for the fastidious search for acid-fast bacilli by the Ziehl-Neelsen method. Three hundred and ten samples from 189 patients were collected between July 2005 and March 2006, these were divide between 301 pulmonary and 9 extrapulmonary samples. The Patho-TB tests consists of a filtration step on a cassette followed by an immuno-chromatographic revelation. Samples were decontaminated by the Kubica method; after neutralization, an aliquot of the centrifuged pellet was saparated for evaluation of the Patho-TB test. The rest was used for direct microscopic examination and cultures on solid and liquid medium. Positive results with auramine were always confirmed by the ZN staining. Analysis of the results per sample gave the follows results: 91.1% sensitivity and 85.5% specificity compared to 91.8% and 100% respectively or microscopy. Sensitivity of the Patho-TB test rose to 93.7% when only the MTB complex was considered. Per patient, the Patho-TB was found to be 96.4% sensitive and 86% specific. By comparison the sensitivity of microscopy was 94.5% and its specificity 100%. Positive and negative values were respectively 90.6% and 94.4% for the Patho-TB while they were 100% and 92.9% for microscopy. It is concluded that the Patho-TB test gives good performances; it is easy to use and very easy to determine the results. For direct observation, we recommend this test to laboratories that do not perform microscopy with auramine, which is the case in tuberculosis endemic areas. [Copyright &y& Elsevier]

Copyright of Recherches Sociographiques is the property of Recherches Sociographiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Fibroscan® is a new medical device that measures liver stiffness noninvasively. The method is based on one-dimensional transient elastography. Ultrasound signals (3,5 MHz) are used to follow the propagation of a low-frequency shear elastic wave (50 Hz) that propagates at a velocity that depends on liver stiffness. Measurement is performed on the right lobe of the liver using a probe that is placed on the skin surface. Result is obtained at the end of examination that takes about 5 minutes. Pilot and multicentre studies have shown that liver stiffness is strongly correlated to fibrosis stage obtained from liver biopsy on patients with chronic hepatitis C. Fibroscan® could be used to improve the evaluation of patients with liver chronic diseases by reducing the number of liver biopsies and by allowing the following of treatments. [Copyright &y& Elsevier]

Abstract: The authors refer 2 cases of iatrogenic lesions of the ulnar nerve at the arm level after insertion of contraceptive hormonal implants. The presence of a small under-skinned pannicula of fat on the internal side of the arm of slim women exposes the ulnar nerve during the insertion of the implant or its withdrawal. Therefore we advise the insertion of such implants on medial side of thigh in slim women. We equally recommend that withdrawal of non-tangible devices implanted on the medial side of the arm or in case of neurologic trouble, even transitory, be done by a trained microsurgeon. [Copyright &y& Elsevier]

Abstract: Mechanical cardiac support represents a large spectrum of devices, differing by the duration of assistance, the support or replacement of the heart, the mono or bi ventricular assistance, the paracorporal or implantable positioning, the pulsed or continuous flow, the pneumatic or electric power source. We can distinguish: 1) the ECMO/ECLS systems (extracorporeal membrane oxygenation–extracorporeal life support) systems of peripheral extracorporeal circulation, accessible at patient bedside, that benefited from technological developments allowing longer assistance and therefore more indications; 2) the ventricular assist devices (VADs) that comprise pneumatic ventricles (mono- or biventricular, extra- or paracorporal), implantable left-VAD (pulsed-flow electromechanical ventricles and continuous-flow axial pumps), total artificial hearts (partially or totally implantable) and percutaneous left-VAD (available in the catheterization laboratory, still in the development stage). Partial or total mechanical cardiac support, although used in routine for 20 years, remains a technology seldom used outside the operating room. This slow diffusion is due to the small number of indications (end-stage heart failure and different heart failures considered as reversible), but also to its extreme complexity and to the alternative offered by heart transplantation. However, this situation is changing with the decreasing availability of organs and with the improvements of devices. [Copyright &y& Elsevier]

Abstract: The increasing evolution of biomedical equipments associated to single use supplies extends to all the sectors of biomedical services'' activity. The industrial offer quickly adapted to the lawful constraints which makes single use a preferential medium of fight against the nosocomial infections (Circular of March 14, 2001). This evolution currently leads the biomedical services to reconsider the organization of their activity of purchase with the various services responsible for the single use supplies. The lack of effectiveness and coherence of the purchases, when equipments are disconnected from their consumable supplies, justifies the well-founded of a collaboration. These purchases, called mixed, must be the result of a common will, shared by the Directorate. In this context, the Directorate of the Investments and Logistics, the Pharmacy and the Department of the Biomedical Equipment of the University Hospital Complex of Angers carried out a reflexion on the mixed purchases. This study led to the mounting of a specific organization which gives to this transverse activity a better legibility. Its setting between the Pharmacy and the Service of the Biomedical Equipment is facilitated by tools : two standardized specifications and a charter of working between these two services. [Copyright &y& Elsevier]

Two devices for continuous cardiac output (CO) monitoring at patient bedside were evaluated. Vigilance™ monitor (Baxter Lab.) provides CO measurements by intermittent bolus (TDCO Vig) and continuous thermodilution (CCO Vig) methods, curves are both collected using a pulmonary artery catheter ; PICCO™ monitor (Pulsion Lab.) also provides continuous CO by pulse contour analysis (CCO Pic) and intermittent trans-thoracic thermodilution CO measurements (TDCO Pic), which is used to calculate a calibration factor for further beat-to-beat estimations of CCO Pic. Both systemic arterial pressure and thermodilution curves are collected using a femoral arterial catheter. The objectives of the study were : 1) to compare both methods, 2) to identify the situations possibly responsible for a poor reliability of the pulse contour method. CO measurements (n=301) were recorded simultaneously with both devices in 10 ICU patients : 44 conflicting data pairs, measured after vaso-active drugs initiation or following a calibration procedure performed during cardiac arythmia, were excluded. 257 data pairs for continuous CO measurements were compared using linear regressions and Bland-Altman plots method. Mean values for CCO Vig and CCO Pic were 7,3±2,63 and 7,8±3,04 l.min−1 respectively, and the correlation was significant (r=0,94, p<10−4). The average difference (bias) was 0,5± 1,06 l.min−1, i.e 7 % overestimation of CO by CCO Pic, and the 95 % confidence interval was large. For 9 among 10 patients the correlation between CCO Vig and CCO Pic was good (Spearman test). For CO values less than 8 l.min−1, the bias and 95 % confidence interval were smaller (0,2±0,66 l.min−1, n=180). Moreover, 108 data pairs for intermittent CO measurements were collected. The correlation between TDCO Vig (7,4±2,7 l.min−1) and TDCO Pic (8,1±1,06 l.min−1) was significant (r=0,97, p<10−4). The bias was 0,76±0,86 l.min−1 and could be related to a thermal loss between pulmonary and femoral arterial collection. On the whole, the agrement between both continuous CO measurments is acceptable. Since TDCO Pic is used for CCO Pic calibration, the difference between the two CO continuous methods could be partly explained by an overestimation of TDCO Pic. Consequently, the software calibration process should be refined. Moreover, we identified two situations that are responsible for erroneous values of CCO Pic and require a new calibration : cardiac arythmia during PICCO™ calibration, vaso-active drugs initiation. [Copyright &y& Elsevier]

The Vanguad™ endoprotheses were implanted transluminally through the femoral route and deployed at the site of surgically created aneurysms in the thoracic or abdominal aortas of dogs for prescheduled periods of implantation of 1 week, 1, 2 and 3 months. The in vivo dimensional stability of the endoprothesis was confirmed by angiography after insertion and before the sacrifice and by macroscopic observations after retrieval. Histological and scanning electron microscopic (SEM) studies were performed to assess the healing sequence of the device. Microscopic studies of the textile components and surface chemical analysis of the Nitinol wires by electron spectroscopy for chemical analysis (ESCA) were undertaken, after specimen cleaning to remove adherent tissue, to detect structural modifications to the textile structure and to evaluate the bioresilience of the Nitinol. Analysis of the angiograms after implantation and before the sacrifice revealed that morphological changes such as sliding and compression of the metal structure occurred initially after deployment and during implantation. Thrombogenicity of the luminal surface of the endoprotheses was low but the healing was still incomplete after 90 days of implantation. The lack of stability of the metal structure may explain the migration distally and the poor healing of the device. ESCA analysis showed that a physiosorbed passivation layer covered the surface of the Nitinol wires masking the nickel (Ni) component of the alloy. Ion bombardments of the surface of the wires confirmed the presence of a contaminated layer composed of carbon and other elements followed by a highly oxidized titanium (Ti) layer, and then, by the Ti/Ni alloy. Although innovative, the minimally-invasive endovascular technique for the treatment of aortic aneurysms is still in its infancy. Significant improvements are required in terms of ease of handling, effectiveness, innocuousness, biostability and healing. [Copyright &y& Elsevier]

The introduction of new array detector technology for multislice CT improves CT-scan capabilities. This technique offers significant advantages : improved temporal and spatial resolutions, retrospective determination of slice thickness, shorter acquisition time and contrast media saving. The most recent improvements lead to high quality cardiac and vascular examinations. The main principles of this technique are exposed and its diagnostic as well as its economic impacts are discussed. [Copyright &y& Elsevier]

Abstract: Cardio-pulmonary assistance is now possible outside a cardiac surgery unit, thanks to the last device generation. Four cases of assistance are reported, two for ARDS and two for intoxication with membrane stabilizer anti arrhythmic. In all cases, the evolution was good. [Copyright &y& Elsevier]