L'environnement sonore des nourrissons placés en incubateur dans les hôpitaux

The knowledge of the neonate's saund environment in incubators has the aim to better define the ways to protect neonates of nose effects and to improve their acoustic comfort The present study, realized in 9 hospitals, constitutes a sound database at 216 hows of recording made and outside of neonate's compartments, allowing valid statistical analysis end characterisation. The statistical index analysis of sound data shows that continuous noises are generally higher inside of incubators (50 ± 3 dBA) than outside (42 ± 8 dB A) Thar origins are mainly the incubator itself and the external medical devices sometimes used Or the contrary impulsive noises are far more frequent. and intense outside ot the incubator than inside Most of these noises come from the hospital activity for 88% of the time and are essentially produced by medical staff and nurses Furthermore. 25 incubators witnout neonate are evaluated with respect to the NF EN 60601-2-19 standard. Among these incubators, one is out of standard tor the internal level, an other is also out of standard for the internal alam sound, white all tested incubators are out of standard for alarm sound perceived outside. The protection of neonates and the improvement at their acoustic comfort can be achieved by instrumental, human and architectural proposals .     

Recours aux SMS pour convoquer les mères aux séances de vaccination à Bobo-Dioulasso

Even though the expanded programme for immunization (EPI) coverage at national level is high in Burkina (95% of fully vaccinated children), mothers of children following EPI in Health Centres (HC) would benefit from being reminded of EPI sessions by sending SMS (short message service) to their own mobile phone, or through mobile phone of a family member living in the same compound. SMS could be sent through Computerized Immunization Registers (CIR), hosted by HC computers. 210 mothers of children aged 0 to 5 years were chosen at random and questioned if they owned a mobile phone, if they could read a SMS, or, if not, what language they would understand if a voice SMS was sent. They were also asked if a family member could receive, read and transmit the message, if mothers did not own a mobile phone. They were also asked if they are willing to give their telephone number to HC. 94% of mothers could be reached through written or voice SMS, sent to their own or family member's mobile phone. 100% of mothers would be willing to give their telephone number to their HC to improve their ability to come at the right time for vaccination sessions. SMS reminders, delivered through CIR, should improve EPI attendance and management of sessions in HC, especially in epidemic context.     

Surveillance thérapeutique des traitements anticancéreux

Drug monitoring of anticancer chemotherapies. Drug doses used in anticancer treatments are mostly calculated by the use of clinical criteria, sometimes by using nomograms providing a posology based on the body surface area (BSA) but rarely by taking into account classical pharmacokinetic parameters, as usually for optimizing the treatment with other pharmaceutical classes of drugs (antibiotics, antiepileptics,…). Because the narrow therapeutic index and important intra- and interindividual variations of the pharmacokinetic parameters, anticancer drugs could constitute a pharmacological class for which the posology could be defined by a classical therapeutic drug monitoring.Of course, the determination of the plasmatic level of anticancer drug does not always permit to predict their pharmacological efficacy and toxicity. To reach it, it is necessary to calculate the area under the curve obtained on base of several blood concentrations.     

Diagnostic des hépatopathies et de leur sévérité

Diagnosis and prognosis of liver diseases are considered here in the context of surgery. When a chronic liver disease is suspected by clinical signs or abnormal liver function tests, the degree of liver fibrosis has to be evaluated. The most accurate markers to assess clinically significant fibrosis in clinical practice are now prothrombin index and serum hyaluronate. The diagnostic accuracy for cirrhosis approaches 90% using non invasive means. The most accurate signs are in clinics: firm liver, in laboratory tests: thrombopenia, decreased prothrombin index and increased hyaluronate, with ultrasonography-Doppler: increased portal diameter and decreased portal velocity and with endoscopy: esophageal varices (but this not a true non-invasive tool). Improvement by blood fibrosis markers and ultrasonography-Doppler are awaited. Child-Pugh score is the most used prognostic score in clinical practice and trials. This is due to its simplicity but some limitations are known. Therefore, other scores are used: APACHE III ou MELD in surgery or resuscitation, Maddrey's score in alcoholic hepatitis and Mayo Clinic's scores in cholestatic diseases.     

Représentations de l’échec thérapeutique des traitements ARV chez les patients et les professionnels de santé à Dakar

The aim of this qualitative study was to describe and analyze representations of therapeutic failure and the medical and social responses proposed by health care professionals and patients receiving follow-up in the ANRS cohort 1215 in Senegal from 1999 to 2010. Patients’ medical histories show that therapeutic failures are related to complex multifactorial situations, resulting from factors attributable to patients (adherence failure related to various psychosocial problems) but also to health care structures (organization of the health system, training for health care professionals and availability of biological exams and appropriate drugs). Both patients and health care staff recognize these causes. The incidence of the onset of therapeutic failures should be regarded as an indicator of the quality of care provided. Further thought should be given to how well health care systems function when changes occur in these rates.