Les besoins non couverts des personnes âgées en incapacités fonctionnelles à Bobo-Dioulasso (Burkina Faso)

BackgroundIn sub-Sahara Africa, the strong involvement of the family in multidimensional cares/supports of elderly is often presented like the family ensures almost everything to these people. Thus, few studies have focused on unmet needs of the elderly in their family or above. This study was conducted in Bobo-Dioulasso to identify those needs.MethodsThis is a longitudinal study including 58 people or 15 elderly and 43 caregivers from 15 families in Bobo-Dioulasso. In addition to regular observations of these families during 1 year, we conducted in-depth individual interview with each participant at the beginning and at the end of the study. The data were analyzed using QSR NVivo 8 software.ResultsA priori, respondents let believe that there is no unmet functional needs of the elderly in their family. However, the food, the first and main functional need of the elderly is not qualitatively satisfied by their family as well as other equipments or health needs. The quality of social cares/supports, biomedical cares and community supports are insufficient when these cares/supports are provided. The family demands many free or subsidized services to public or community structures then they are not currently available.DiscussionIn a context of widespread poverty, it is difficult for each actor of the social system of maintaining elderly in functional autonomy to provide services/supports of optimal quality. A synergy of action will reduce the unmet needs of the elderly in Bobo-Dioulasso.     

Strategies for Distance Education

Abstract

Advances in and access to technology have loosened academia's ties to the traditional classroom. In this paper we present our experiences in developing, implementing, and evaluating three approaches to distance education. The first program was delivered by interactive videoconferencing and provided multiple gerontological lessons for Extension agents gathered at two different sites in Virginia. The second program was a graduate-level course taught simultaneously at multiple sites also using interactive videoconferencing. The third program was a full-fledged Internet course whose target audience included students enrolled in a gerontology certificate program. The overall strengths of the programs included enhancing the instructors' ability to reach students in a variety of locations without leaving campus and expanding the flexibility and availability of course offerings. The weaknesses and constraints of the various approaches centered on the amount of instructor time necessary to develop and implement the instructional units, technological problems, and student involvement and motivation.     

War is bad for health

While actively working to promote the abolition of all nuclear weapons from the world since the end of the cold war, Japan's disarmament policies are not without problems. Promoting the elimination of nuclear weapons as Japan remains under the US nuclear umbrella creates a major credibility problem for Tokyo, since this decision maintains a Japanese deterrence policy at the same time that officials push for disarmament. Tokyo also advocates a gradual approach to the abolition of nuclear weapons, a decision that has had no effect on those countries that have been conducting sub‐critical nuclear testing, nor stopped India and Pakistan from carrying out nuclear tests. Consistent with Article 9 of the Constitution, the Japanese war‐renouncing constitutional clause, Tokyo toughened Japan's sizeable Official Development Assistance (ODA) programme in the early 1990s. Because of the anti‐military guidelines included in Japan's ODA programme, Tokyo stopped new grant and loan aid to India and Pakistan in 1998 after these countries conducted nuclear tests. However, because of the criticism Japan faced from its failure to participate in the 1991 Gulf War, Tokyo has been seeking a new Japanese role in international security during the post‐cold war period. Deepening its commitment to the security alliance with the US, Tokyo has become increasingly influenced by Washington's global polices, including the American war on terrorism. After Washington decided that Pakistan would be a key player in the US war on terrorism, Tokyo restored grant and loan aid to both Islamabad and New Delhi, despite the unequivocal restrictions of Japan's ODA programme.     

severe disease complicated by osteoporosis

In this illustrative case, rheumatoid disease changed an active, self-supporting woman into a disabled, dependent and depressed person. When disease activity is continuous, early efforts to prevent severe deformity take on great urgency. It is also important to alleviate the psychosocial impact of the disease, which may well be more than even a highly motivated patient can handle alone.     

A Global Vision of Prehospital Care

Abstract

Background. Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure. Methods. Data were collected on 300 consecutive patients, 6 years of age or older, weighing at least 20 kg, who were intubated using TL. They were compared with data on 315 patients who were intubated using VL. All intubations were confirmed by visualization where possible, auscultation, misting, and capnography. In addition, all were continuously monitored by capnography. Results. The average time to intubate in the VL group was 21 seconds (range 8–43 seconds) versus 42 seconds (range 28–90 seconds) in the TL group. The average number of attempts was 1.2 (range 1–3) in the VL group versus 2.3 (range 1–4) in the TL group. Successful intubation was 97%% in the VL group versus 95%% in the TL group. There were no unrecognized misplaced tubes in either group. For failed intubations, an alternative airway was successful in 99%% of the VL group and 99%% of the TL group. Maximum nonventilated time during any one intubation attempt was 37 seconds in the VL group and 55 seconds in the TL group. Conclusions. The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.     

Pulseless Electrical Activity:

Abstract

Objectives. The primary aims of this study were to compare paramedic success rates and complications of two different video laryngoscopes in a prehospital clinical study. Methods. This study was a multi-agency, prospective, non-randomized, cross over clinical trial involving paramedics from four different EMS agencies. Following completion of training sessions, six Storz CMAC? video laryngoscopes and six King Vision? (KV) video laryngoscopes were divided between agencies and placed into service for 6 months. Paramedics were instructed to use the video laryngoscope for all patients estimated to be ≥ 18 years old who required advanced airway management per standard operating procedure. After 6 months, the devices were crossed over for the final 6 months of the study period. Data collection was completed using a telephone data collection system with a member of the research team (available 24/7). First attempt success, overall success, and success by attempt, were compared between treatment groups using exact logistic regression adjusted for call type and user experience. Results. Over a 12-month period, 107 patients (66 CMAC, 41 KV) were treated with a study device. The CMAC had a significantly higher likelihood of first attempt success (OR = 1.85; 95% CI 0.74, 4.62; p = 0.188), overall success (OR = 7.37; 95% CI 1.73, 11.1; p = 0.002), and success by attempt (OR = 3.38; 95% CI 1.67, 6.8; p = 0.007) compared to KV. Providers reverted to direct laryngoscopy in 80% (27/34) of the video laryngoscope failure cases, with the remaining patients having their airways successfully managed with a supraglottic airway in 3 cases and bag-valve mask in 4 cases. The provider-reported complications were similar and none were statistically different between treatment groups. Complication rates were not statistically different between devices. Conclusion. The CMAC had a higher likelihood of successful intubation compared to the King Vision. Complication rates were not statistically different between groups. Video laryngoscope placement success rates were not higher than our historical direct laryngoscopy success rates.     

《伤寒论》太阳篇辩证思维内涵探讨

本文结合思维方法学对《伤寒论》太阳篇进行分析,认为太阳证是一个太阳证的抽象与具体概念及其对应治法组成的综合体系.“太阳篇”首先据太阳证的基本病机选择提纲证,形成其抽象概念,然后以此为逻辑起点,依据太阳证自身及其与伤寒病其他五证、类似病证、患者机体、宿疾、误治的内在联系,以太阳证的演变过程为逻辑顺序,从不同角度阐述太阳证的本质及其表现形式、治法方法、转归预后等,展现出一个具体的太阳证概念.太阳证概念体系中蕴含着从抽象上升到具体的辩证思维方法,把握这一特点并加以运用,有助于掌握仲景伤寒、杂病辩治体系.     

烧伤病房实施循证护理的对比分析

目的：探讨循证护理应用于大面积烧伤病人的实施效果。方法：选取我院烧伤病房2005年-2006年开展循证护理前后收治的大面积烧伤患者344例，分别实施烧伤常规护理和循证护理，将两组护理效果进行对比。结果：284例实施循证护理患者的治疗护理配合程度和病人满意率明显提高（P〈0．05），差异有统计学意义；实施循证护理组病人并发症发生率降低，平均住院日减少（P〈0．05）．差异有统计学意义。结论：对大面积烧伤病人实施循证护理，提高了烧伤护理质量和服务水平。     

不同营养支持方式对肠外瘘患者人体组成改善作用之比较

目的观察不同营养支持方式对肠外瘘患者人体组成的改善作用。方法30例肠外瘘患者分成两组各15例,分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN),观察10d前后患者人体组成及血清胰岛素样生长因子-1(IGF-1)的变化。结果10d后所有患者的体重指数(BMI)与体细胞群(BCM)显著改善,而TEN组患者10d前后BCM增加幅度更明显,分别为(27.5±0.8)kg和(29.0±0.6)kg,Day10与Day0相比,P<0.01。两组患者总体水(TBW)与细胞内水(ICW)均增加,尤其ICW,Day10与Day0相比,TEN组P<0.01;TPN组P<0.05。血清IGF-1在两组患者治疗后均有显著上升,TEN组增加幅度更明显,Day0为(175.0±32.9)ng/ml,Day10为(255.5±34.1)ng/ml,与Day0比较,P<0.01;与TPN组比较,P<0.05。IGF-1的变化与BCM的改善显著正相关(r2=0.16,P<0.05)。结论营养支持治疗能显著改善肠外瘘患者的体细胞群,纠正细胞内、外水的异常分布,而EN作用更明显。