Gestion de la qualité des soins au service d'acceuil des urgences (SAU) de l'hôpital du Mali: enjeux et perspectives / Management of the quality of care at the emergency reception service (SAU) of the hospital of Mali : challenges et perspectives

Introduction : La Neurochirurgie au Mali reste une discipline relativement jeune par rapport aux autres spécialités chirurgicales. Le but de ce travail est de décrire le parcours des urgences neurochirurgicales admises au SAU de l'hôpital du Mali.Patient et méthodes : C'est une étude prospective transversale analytique qui s'est déroulée au SAU de l'hôpital du Mali sur une durée de 02 mois. Sont inclus dans cette étude, tous les patients admis au SAU et dont on a eu recours à un avis neurochirurgical. Nous avons recensé et analysé les données épidémiologiques, cliniques, paracliniques et thérapeutiques chez 82 patients. Résultats : Sur un total de 152 patients admis au SAU, il y'avait 82 cas pour lesquels un avis neurochirurgical a été demandé soit 53, 95 % des admissions. Parmi ces 82 patients, il y avait 50 cas de traumatismes crâniens, 20 cas de traumatismes du rachis, 08 cas d'accident vasculaire cérébral hémorragique (AVCH), 03 cas de suppurations intracrâniennes et 01 cas de tumeur cérébrale. Nous avons opéré 41 patients (50%) et mis en observation 32 patients (39,02%). Malgré nos efforts, 09 patients sont sortis contre avis médical ou par faute de moyens. Nous avons noté 03 cas de décès. Conclusion : La qualité des soins et l'accès aux soins sont très souvent considérés par les patients comme les éléments essentiels de la performance d'un système de santé. En tant que Etablissement Public Hospitalier (EPH) de niveau 3, il doit bénéficier d'un plateau technique adéquat et d'un personnel médical et paramédical suffisant afin d'assurer une prise en charge correcte des patients

Introduction : Neurosurgery in Mali remains a relatively young discipline compared to other surgical specialties.The aim of this study is to describe the course of neurosurgical emergencies in "Hôpital du Mali". Patients and methods: This is a prospective cross-sectional analytical study that took place at the emergency department of "hôpital du Mali" over a period of 02 months. Are included in this study, all the patients admitted in emergency for whom neurosurgical advice was sought. We identified and analyzed epidemiological, clinical, paraclinical and therapeutic data in 82 patients.Results: Out of a total of 152 patients admitted to our emergency unit, there were 82 cases for which a neurosurgical opinion was requested, ie 53.95% of admissions. Among these 82 patients, there were 50 cases of head trauma, 20 cases of spinal trauma, 08 cases of brain stroke, 03 cases of intracranial suppurations and 01 case of brain tumor. We operated on 41 patients (50%) and observed 32 patients (39.02%). Despite our efforts, 09 patients were released against medical advice or for lack of funds. We noted 03 cases of death. Conclusion: The quality of care and access to care are very often seen by patients as essential elements of the performance of a health system. As a level 3 public hospital, it must have an adequate technical platform and sufficient medical and paramedical staff to ensure correct patient care

Patient Identification and Hospital Information Management Systems in Sub-Saharan Africa: a Prospective Study in Rwanda and Burundi

For many sub-Saharan health facilities; accurate patient identification remains a challenge. Poor national person identification systems; inefficient identification procedures; the use of weak search criteria and sometimes fraudulent practice consist some of the underlying causes. In this study; patient identification effectiveness has been compared between 27 sub-Saharan hospitals using paper based procedures and 6 health facilities in the same region that had implemented a hospital information management system. Based on a simple metric; results show a significant (p0.001) improvement reducing identification errors from 64.6 before to 2.3 after information system implementation in a sample of 1 private and 5 public hospitals in Rwanda and Burundi

Drug Therapy; Lifestyle Modification and Blood Pressure Control in a Primary Care Facility; South of Johannesburg; South Africa: An Audit of Hypertension Management

Background: Hypertension management is suboptimal in many settings. We assessed blood pressure (BP) control according to target; the appropriateness of antihypertensive therapy and the extent of implementing lifestyle modification among hypertensive patients.Method: This study was an audit involving a retrospective review of medical records of hypertensive patients who were 18 years of age and older (n = 300); attended to by doctors or primary health care nurses at a large community health centre; south of Johannesburg; South Africa. Demographic; anthropometric; clinical and management data were extracted from the files of hypertensive patients who met the inclusion criteria. Data analysis included the use of descriptive statistics; the chi-square test and Fisher's exact test. The main outcome measures were the proportions of patients with controlled BP; who used appropriate antihypertensive drugs and who had documented lifestyle modifications.Results: Most patients were black (75.7) and female (68.3). The mean age was 60 years. The majority of the patients (55.7) were either overweight or obese. Fifty-seven per cent of the patients (n = 171) had BP control meeting the target. Appropriate choice of antihypertensive drugs was documented in 81.3 of patients (n = 244); while 56.3 had lifestyle modification documented in their records. Significantly more women had their BP controlled to target compared to men (P = 0.0028). Factors significantly associated with good BP control were white race (P = 0.0001) and documentation of adherence to therapy (P = 0.000).Conclusion: BP control was achieved in the majority of patients and the vast majority was on appropriate drug therapy. White race; female sex and adherence to treatment documented in the medical record were significantly associated with BP controlled to target

Pre-Hospital and In-Hospital Management of Non-Fatal Road Traffic Injuries in Khartoum State: A Case Study

Abstract:Road traffic injuries are a major global public health concern. Millions of disabilities and death occur every year around the whole world. Low and middle income countries suffer more from road traffic injuries;subsequent complications and deaths. Studies have shown that these deaths could be prevented and injured persons would receive proper pre-hospital management and prompt ambulance services. This case study was conducted in three main hospitals in Khartoum State. The aim of the study was to explore pre-hospital and early hospital management provided to road traffic victims. One hundred seventy sixinjured persons were explored in this study. The study revealed that 53 (30) of the respondents had received first aid at the scene of the accident. Most victims arrived to hospitals with private cars in less than five hours. In hospitals; they were seen by doctors who were in charge. They received medical care such as sedation procedures to stop bleeding. Poor; delayed and incomplete pre-hospital or in-hospital management were the main findings of this study

Probiotics; with Special Emphasis on their Role in the Management of Irritable Bowel Syndrome

Probiotics are live microorganisms; and when administered in adequate amounts; bestow beneficial effects on the host. The therapeutic and preventative application of probiotics in several disorders is receiving increasing attention; and this is especially true when gastrointestinal microbiota is thought to be involved in their pathogenesis; as in irritable bowel syndrome (IBS). Given the increasingly widespread use of probiotics; a thorough understanding of their risks and benefits is important. The purpose of this review is to update healthcare professionals on current probiotic information; and provide an overview of probiotic treatment approaches; with special emphasis on IBS

Audit of Paediatric Cardiac Services in South Africa

objective: to evaluate paediatric cardiac services in south Africa with respect to referral base; services provided and human resources. study design: A descriptive study design was used. An audit of the referral base; personnel and activity of paediatric cardiac units throughout south Africa was conducted by means of a questionnaire. A specialist from each centre was asked to provide the relevant data. Where accurate data was not available; estimates were provided by practitioners within each centre. results: All identified units participated in the audit. three were private sector units while the other five were primarily public sector units. twenty four paediatric cardiologists; equally distributed between public and private sector units; were practicing in the country as at end 2008; with a further eight paediatricians undergoing training in paediatric cardiology. this is significantly less than the 88 paediatric cardiologists required for the population of south Africa. Eight paediatric cardiac surgeons were operating predominantly on children in public hospitals and five in private institutions. An estimated 1370 operations for congenital heart disease were performed over a one year period; with 800 of these in the public sector. Extrapolating from accepted estimates of congenital heart disease incidence; this represents conservatively; less that 40of operations required for the population. Additionally; only 26of the estimated 114 simple transposition of great arteries born annually were operated on; indicating serious deficiencies in the ability to adequately detect and intervene in serious congenital heart disease presenting in the neonatal period. conclusion: the infrastructure and resources to detect and manage heart disease in children in south Africa; particularly within the public sector; are grossly inadequate

Optimal Paediatric Cardiac Services in South Africa - What do we Need? Statement of the Paediatric Cardiac Society of South Africa

Most children with congenital heart disease have a good outcome if treated appropriately; however the majority of children with heart disease in south Africa do not receive appropriate care. this is related to serious deficiencies in as a major shortage of skilled personnel to care for these children at all levels .Most public sector hospitals are unable to cope with the number of patients requiring surgery; mainly due to inadequate theatre time allocation and intensive care facilities. Key interventions to address these deficiencies include: 1. strategies to improve both the training and the retention of all professionals involved in the care of congenital heart disease. 2. Programmes to increase awareness of both congenital and acquired heart disease in children among health care personnel. 3. Ensuring appropriate infrastructure and equipment designed for children with congenital heart disease are available. 4. Development of congenital heart surgery as an independent subspecialty with dedicated resources and personnel. 5. Dedicated intensive care facilities for paediatric heart surgery. In addition; development of appropriate patterns of referral; timulation of research and positive private-public partnerships are all necessary to ensure that appropriate care is delivered

Evaluation des activites de bacteriologie medicale dans les laboratoires d'analyses medicales de la commune de Yopougon

Cette etude est une enquete par sondage realisee du 18 juillet 2005 au li Janvier 2006 aupres de 15 laboratoires de biologie medicale dans la commune de Yopougon; a Abidjan. L'objectif general de l'etude etait d'evaluer les activites de bacteriologie dans les laboratoires de biologie medicale de la commune de Yopougon. Les objectifs specifiques etaient de : -Lister les analyses de bacteriologie effectuees dans les laboratoires de ville de la commune de Yopougon ; -Identifier les insuffisances des procedures de la pratique de la bacteriologie dans les divers laboratoires ; -Collecter des informations sur la structuration et l'organisation des laboratoires de Bacteriologie. Au terme de l'enquete; il ressort que : *Dans la commune de Yopougon; tous les laboratoires d'analyses medicales sont integres a des centres de sante. *40 pour cent des laboratoires enquetes effectuent des etapes de diagnostic direct de bacteriologie sur des prelevements de patients adresses pour analyse bacteriologique. *Les urines sont les prelevements les plus souvent analyses par les laboratoires. *Seul un laboratoire; en occurrence celui du CHU; realisait l'identification des bacteries apres culture bacterienne. *Aucun des laboratoires enquetes ne realisait d'antibiogramme ; *Seuls 3 laboratoires sur les 15 etaient diriges des Medecins biologistes ou des Pharmaciens biologistes ; *Tous les laboratoires realisaient des activites de serologie bacterienne; principalement par des tests rapides dont les resultats sont habituellement suffisants en routine ; *Seul le laboratoire du CHU avait des locaux et des equipements adaptes a des activites de diagnostic direct de bacteriologie

Evaluation de la tenue du dossier medical en pneumologie : audit clinique de 511 dossiers medicaux colliges au PPH de cocody

Notre etude s'est deroulee du 1er janvier au 31 decembre 1999. Il s'agissait d'une etude retrospective portant sur 511 dossiers medicaux archives au PPH de Cocody. L'objectif general etait d'apprecier la qualite de la tenue du dossier medical en pneumologie. Au terme de cette etude; les principaux resultats sont : 1) Au plan de l'etat des dossiers : 4;7 pour cent des dossiers n'ont pas ete retrouves. 2) Au plan des elements de structure du dossier : -Dans 99;8 pour cent des cas; le service et le numero de service sont precises; -La qualite du redacteur; precisee dans 34;6 pour cent; -Les elements d'identification du patient sont precises dans plus de 90 pour cent; -Les donnees d'admission sont precisees dans plus de 98 pour cent; -les antecedents pulmonaires sont precises dans plus de 71;4 pour cent et la notion alcoolo-tabagique a pres de 81 pour cent; -Les elements de l'examen general sont precises dans plus de 53 pour cent; la taille precisee dans 2;3 pour cent; -Les elements de l'examen pleuro-pulmonaire sont precises dans 80 pour cent des cas; -Le syndrome est precise 49;5 pour cent des cas; -Dans 87;3 pour cent; le resume de l'observation medicale est precis; -Les hypotheses diagnostiques sont precisees dans 39;7 pour cent des cas; -La radiographie pulmonaire est demandee dans 86;1 pour cent des cas contre l'IDR dans 8;4 pour cent; -Dans 80 pour cent des cas; les resultats des examens demandes sont parvenus; sauf la lecture de I'IDR qui est fait dans 23;3 pour cent des cas; -Le diagnostic de sortie est precise dans 90;8 pour cent des cas; -Les elements ayant contribue a poser le diagnostic sont precises dans 81;6 pour cent; -Les elements du traitement medical sont precises dans plus de 87 pour cent; -Le debut traitement precise dans 86;5 pour cent; -Les effets secondaires precises dans 0;8 pour cent; -Les elements de surveillance clinique et la fiche de temperature sont retrouves dans plus de 86 pour cent et l'evolution dans 82;4 pour cent; -Le traitement de sortie est precise dans 57;9 pour cent et le mode de sortie est precise dans 52;3 pour cent; -Dans 100 pour cent des cas; les elements para cliniques sont identifies au nom du patient; -Dans 57;8 pour cent des cas; les elements contenus dans le dossier sont bien agrafes; -Le plan d'observation est respecte dans 37;8 pour cent des cas. 3) Au plan des conditions d'archivages des dossiers : -Salle des archives bien tenue; sous la responsabilite d'un archiviste; -Les dossiers; ranges par annee et par numero d'ordre. De notre etude se degage l'interet de la realisation d'autres audits cliniques etendus aux autres services du CHU en vue d'en apprecier la qualite de la tenue du dossier medical. Aussi; l'interet de la vulgarisation de l'outil d'audit medical