'What vision?': experiences of Team members in a community service for adults with intellectual disabilities.

BACKGROUND: In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. METHODS: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. RESULTS: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. DISCUSSION: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.

[Percutaneous tracheotomy in developing countries: experience in the intensive care unit of the Principal Hospital in Dakar, Senegal]. / La tracheotomie percutanée en milieu tropical: expérience du service de réanimation de l'hôpital principal de Dakar.

The first use of percutaneous tracheotomy in intensive care was by Sheldon in 1957. Because this technique saves time, costs less, and reduces staff requirements, it is well suited to conditions in underdeveloped countries where resources are often lacking. The purpose of this prospective study conducted in intensive care unit of the Principal Military Teaching Hospital in Dakar, Senegal was to evaluate percutaneous tracheotomy in terms of effectiveness, time and resource management, and perioperative problems while trying to adapt it to resources available in a tropical intensive care setting. A total of 2958 patients were admitted during the study period including 100 who underwent percutaneous tracheotomy. Most cases involved traumatic injury. The mean implementation period was 10 days with a mean procedure time of 6 minutes. Two failures occurred requiring conversion to a surgical approach. Two patients had presented esotracheal fistula including one who died after inhalation when feeding was attempted. One patient developed stenosis. Operator experience and training were identified as good prognostic factors.

Evaluation of the use of Home Emergency in a Sub-Sahara African hospital: Example of the Hospital Principal in Dakar.

Overloaded emergency departments are common around the world. This prospective, descriptive, and analytical study evaluates the reasons for emergency room use and describes the severity of the patients' conditions and how they reach the emergency department. It took place at the emergency department of the principal hospital of Dakar (the Armed Forces Teaching Hospital) over a one-week period (from August 23 to August 30, 2016) and included a sample of 219 patients of both sexes aged 15 years and older. Data were collected about social and demographic characteristics, reasons for choosing the emergency department rather than other care, time of day, day of the week, accessibility, means of transport, diagnosis, and severity. More than half of patients (55 %) were men, with a mean age of 42 +/- 18. Only 10 % of patients lived within 5 km of the hospital. Most (84.5 %) came from the Dakar region and lived between 5 and 35 km from the hospital. Most patients reached the hospital by their own means (83 %). Only 2 % were transported by the public emergency ambulance service. The reasons for choosing the emergency unit were the opportunity for additional tests in 41.1 % of cases ; the desire to be hospitalized in 26.9 % ; fear of death in 26.5 %, no waiting list in 14.2 %, and lack of money in 11 % of cases. Patients in truly serious condition accounted for only 5 % of cases. Most (88 %) returned home after stabilization, 12 % were hospitalized, and 0.5 % died. Good practices, good organization, and improved complementarity between public, private, and emergency services are needed to reduce the use of the latter.

[Profile of patients admitted for myocardial infarction at the emergency reception facility of Principal Hospital in Dakar, Senegal]. / Profil des patients admis pour infarctus du myocarde au service d'accueil des urgences de l'Hopital Principal de Dakar.

This retrospective study was carried out from January 2005 to December 2006 to ascertain the profile of patients admitted for treatment of myocardial infarction (MI) in a modern emergency reception facility (ERF) in Sub-Saharan Africa. Diagnosis of MI was based on clinical presentation, electrocardiography (persistent ST-segment depression), and laboratory findings (measurement of troponine T and CPK MB). Study data included epidemiological parameters (including risk factors and interval between onset of symptoms and admission), clinical and paraclinical findings, therapeutic modalities (including any prehospital management), complications at the time of admission, and mortality within the first five days. Men accounted for 77% of the 52 consecutive patients hospitalized for MI during the study period. Mean age was 59 years. Risk factors included hypertension in 46% of cases, tobacco use in 40%, and diabetes in 21%. The mean interval for management was approximately 29 hours with only 5 patients receiving care within the first 6 hours. Chest pain was the main reason for coming to the ERF (86%). The location of pain was anterior in 58% of cases and inferior in 37%. Diagnosis was confirmed by laboratory findings in 96% of patients. Ten patients benefited from transportation by ambulance and four patients underwent thrombolysis before hospitalization. Complications at the time of admissions included cardiovascular collapse (n=3), acute pulmonary edema (n=13), and arrhythmia (n=6). Eleven patients (21%) died within the first five days. These findings confirm the need to educate the population in an effort to reduce the interval for management, to develop prehospital medical care, and to increase the availability of coronary artery revascularization modalities to improve the prognosis of MI in the acute phase.

[Post surgical pain: pathophysiological and therapeutic approaches]. / La douleur post operatoire: approches physiopathologiques et therapeutiques.

Post surgical pain is a histonic reality. At the beginning of eighteen century (18th), morphine was used for the first time in analgesic aim. Post surgical pain is a reality for which takes care of it. The impact of pain pain post surgical in Europe is between 31 to 75% as for pain softened instinct, any type of mergened surgery. In Africa, the taking care of post surgical pain is not still well codified. To take care of it better, is needed a valvation of its intensity, analgesic means and a goad strategy.

Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE: To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN: Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING: Health district in South East Thames region. SUBJECTS: 1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES: Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS: 35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS: The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

[Epidemiology and prognostic value of organ failure during severe malaria in the Principal Military Teaching Hospital of Dakar, Senegal]. / Épidémiologie et valeurs pronostiques des défaillances viscérales au cours du paludisme grave à l'hôpital d'instruction des armées principal de Dakar, Sénégal

We report the results of a retrospective study in the medical intensive care unit of the Principal Military Teaching Hospital of Dakar. The objectives were to determine the epidemiological and clinical aspects of severe malaria and to evaluate the prognostic values of the failure of different organs. Eighty-seven patients were admitted for severe malaria. Their average age was 35 ± 18.53 with a sex-ratio of 1.71 for men. Mortality was 33.3% and concerned mainly young adults. Neurological failure was the most frequent (79.3%). Hemodynamic failure was the most relevant prognostic factor for mortality, followed by hypoglycemia, respiratory and renal failure. The Simplified Acute Physiology Score II (SAPS II) was reliable in predicting mortality. The mean SAPS II was 44.85, with an expected mortality of 32.6%.

[Outcome of elderly patients in an intensive care unit in Dakar, Senegal]. / Devenir des sujets âgés en réanimation à Dakar (Sénégal).

OBJECTIVES: To determine the frequency of admission and its reasons, severity and outcome among elderly patients in our intensive care unit (ICU) and compare them with those for younger subjects. METHODOLOGY: Retrospective study covering a 5-year period (January 1, 2005, through December 31, 2009) in the ICU of the principal hospital in Dakar. We included as elderly patients all those aged at least 65 years and compared them with the young patients, that is, those younger than 65 years. RESULTS: During the study period, 2196 patients were admitted to the ICU, 374 of them elderly. The ratio of men to women was 1.43. The mean age among the elderly was 74.4 ± 6.5 years, and their mean duration of ICU stay was 5.6 ± 4.67 days. Nearly 80% had a serious medical history or preexisting condition, most often, myocardial infarction, stroke, or lung disease. The older patients were more seriously ill than the younger ones (p<0.01), but their care was less complex. Mortality was higher among the older, compared with the younger, subjects (42.80% vs. 28.4%). The only mortality-related factor that appeared to vary with age was cardiogenic pulmonary edema. CONCLUSION: The management of elderly subjects remains a problem in intensive care. High mortality is generally not directly related to their age but rather to their overall condition.

Problematique de la prise en charge de l'infarctus du myocarde a L'Hopital Desegou (Mali)

INTRODUCTION: Myocardial infarction is a major emergency involving life-threatening in the absence of appropriate treatment. The aim of this study was to analyze the problem of management of myocardial infarction in a second reference hospital in Mali. PATIENTS AND METHODS : This was a prospective descriptive study over a period of six months from January to June 2010. It concerned all patients admitted for myocardial infarction in intensive care.The diagnosis was suspected in chest pain or the occurrence of complications (PAO, cardiogenic shock) and electrocardiogram signs on at least two precordial leads. The parameters studied were: age,reason for admission, risk factors, hemodynamic parameters, the deadline for completion of the ECG, the topography of lesions and electrical changes within 15 days. RESULTS: A male was found with a mean age of 54.62 years. Chest pain was the main reason for admission (6 cases) followed by cardiogenic shock (1 case) and acute pulmonary edema (1 case). The electrocardiogram was performed in 7 patients more than 24 hours after admission. The anterior territory was the most affected. On admission three patients had a systolic pressure below 90 mmHg.The evolution was marked by occurred heart failure (3 cases) and death (2 cases). CONCLUSION: The lack of diagnostic and therapeutic method in our heath facility helps to increase morbidity and mortality associated with myocardial infarction.

[Problems with the management of myocardial infarction at the Desegou Hospital]. / Problematique de la prise en charge de l'infarctus du myocarde a L'Hopital Desegou (Mali)

INTRODUCTION: Myocardial infarction is a major emergency involving life-threatening in the absence of appropriate treatment. The aim of this study was to analyze the problem of management of myocardial infarction in a second reference hospital in Mali. PATIENTS AND METHODS: This was a prospective descriptive study over a period of six months from January to June 2010. It concerned all patients admitted for myocardial infarction in intensive care.The diagnosis was suspected in chest pain or the occurrence of complications (PAO, cardiogenic shock) and electrocardiogram signs on at least two precordial leads. The parameters studied were: age,reason for admission, risk factors, hemodynamic parameters, the deadline for completion of the ECG, the topography of lesions and electrical changes within 15 days. RESULTS: A male was found with a mean age of 54.62 years. Chest pain was the main reason for admission (6 cases) followed by cardiogenic shock (1 case) and acute pulmonary edema (1 case). The electrocardiogram was performed in 7 patients more than 24 hours after admission. The anterior territory was the most affected. On admission three patients had a systolic pressure below 90 mmHg.The evolution was marked by occurred heart failure (3 cases) and death (2 cases). CONCLUSION: The lack of diagnostic and therapeutic method in our heath facility helps to increase morbidity and mortality associated with myocardial infarction.