Démarche diagnostique face à une fièvre aiguë isolée de l'enfant de 3 à 36 mois en médecine générale PDF Download

Author: Mayalen Sorel
Publisher:
ISBN:
Category :
Languages : fr
Pages : 0

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Introduction : avant l'introduction de la vaccination contre Haemophilus en 1992 et le Streptococcus pneumoniae en 2000, les bactériémies occultes représentaient la deuxième cause de fièvre aiguë isolée. Il semblait alors justifié d'adopter une attitude diagnostique et thérapeutique maximale devant ce symptôme. Actuellement, le risque de bactériémie occulte est inférieur à 1% chez un enfant présentant une fièvre aiguë isolée bien tolérée, ce qui a incité les médecins à changer leur attitude. Cependant, il n'existe pas de recommandation française actualisée depuis la généralisation de la vaccination à tous les enfants. Objectifs : analyser la pratique des médecins généralistes face à ce motif de consultation, entre l'attitude maximaliste des recommandations américaines comprenant une analyse d'urine et une NFS dépistant les bactériémies et l'attitude minimaliste des britanniques, qui se concentre sur l'analyse d'urine. L'objectif secondaire est de mettre en avant les déterminants de la prescription d'examens complémentaires qu'ils soient objectifs ou subjectifs. Matériel et méthodes : étude descriptive de la prise en charge des fièvres aiguës isolées par des médecins généralistes installés et remplaçants en Gironde, via un questionnaire portant sur le dernier cas vu au cabinet envoyé à 1543 généralistes installés et 782 remplaçants. Résultats : le taux de participation a été de 6,2% pour les médecins installés et 16% pour les remplaçants. Soit un total de 220 questionnaires reçus. Notre enquête a montré que les médecins généralistes adoptent une attitude ambulatoire, avec observation de l'enfant (80%) sans réalisation d'examen complémentaire. L'intensité et la durée de la fièvre sont des déterminants de la prescription d'examen complémentaire. Au contraire les médecins ont déclaré ne pas prendre en compte l'âge de l'enfant ou son statut vaccinal. Chez le nourrisson à risque (fièvre >39°C évoluant depuis plus de 24 heures) seuls 21% des enfants ont bénéficié d'une analyse d'urine, 45% des médecins déclarent attendre 72 heures avant de réaliser des examens complémentaires, et passé ce délai 67% réalisent une NFS et 98% une analyse d'urine. Cette étude laisse suggérer que l'analyse d'urine n'est pas prescrite assez rapidement, alors que le bila! n sanguin semble sur-prescrit. Les critères subjectifs étudiés (peur d'une bactériémie occulte, incertitude diagnostic, compréhension des parents, connaissance de l'enfant) n'entraînent pas plus de prescriptions d'examen complémentaire mais un suivi plus rapproché de l'enfant. Conclusion : la démarche diagnostique devant une fièvre aiguë isolée au cabinet de médecine générale est controversée. Le médecin généraliste tient cependant une place primordiale dans le diagnostic des rares infections bactériennes potentiellement sévères. Cette prise en charge passe en premier lieu par la réalisation d'une analyse d'urine compte tenu de l'épidémiologie actuelle des bactériémies occultes dans l'ère post vaccination prevenar. Il serait donc intéressant qu'une recommandation française actualisée soit publiée.

Author: Tifanie Benacin
Publisher:
ISBN:
Category :
Languages : fr
Pages : 190

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Introduction : la fièvre est le motif le plus fréquent de consultation en pédiatrie. Dans 20% des cas, aucune cause n'est retrouvée. Les pratiques des médecins généralistes varient en fonction des caractéristiques de l'enfant, de la fièvre, mais également de l'expérience et du ressenti personnel du praticien. Leur enjeu est d'exclure, de façon la plus fiable possible, une infection bactérienne sévère (IBS). Nous proposons donc ici, d'analyser les pratiques déclarées des médecins généralistes face à une fièvre isolée, évoluant depuis plus de 48 heures chez un enfant âgé de 3 à 36 mois sans antécédent particulier, afin d'affiner l'arbre décisionnel. Méthodes : Nous avons réalisé une étude quantitative descriptive transversale incluant 210 médecins généralistes d'Ile-de-France, qui ont répondu à un questionnaire sur leur prise en charge théorique et sur un cas réel de fièvre isolée évoluant depuis plus de 48h chez un enfant âgé de 3 à 36 mois. Résultats : les trois prises en charge les plus pratiquées sont : le retour à domicile avec surveillance parentale (66,7%), la réévaluation de l'enfant au cabinet (64,8%) et la prescription d'examens complémentaires (43,8%). Seulement trois médecins généralistes réalisent une bandelette urinaire. Les examens complémentaires sont surtout prescrits en fonction de l'impression personnelle du médecin (69,5%) et les caractéristiques de la fièvre (66,6%). Lorsqu'un examen complémentaire est prescrit, l'examen cytobactériologique des urines (ECBU) est prescrit dans 96,1% des cas, une biologie dans 61,9% des cas et une radiographie du thorax dans 30,2% des cas. 70% des médecins généralistes peuvent être amenés à prescrire une antibiothérapie probabiliste et 82,9% d'entre elles sont prescrites en fonction des résultats de la biologie. Il apparaît, de manière significative, que les médecins mieux formés en pédiatrie, en prescrivent moins (p

Author: Mariane Rochon
Publisher:
ISBN:
Category :
Languages : fr
Pages : 188

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Le but de notre travail était l'évaluation, en médecine générale, des protocoles pour fièvre aiguë de l'enfant du guide de la Société Française de Pédiatrie "Pédiatrie par téléphone - Aide à l'orientation". Notre étude, prospective, a été réalisée au sein de Régulation 63, organisme pour la régulation de la permanence des soins dans le Puy-de-Dôme. Nous avons inclus 141 cas, dont 59 pour le protocole "fièvre aiguë du nourrisson" et 82 pour le protocole "fièvre aiguë de l'enfant de plus de 2 ans", sur une période allant du 06/11/2006 au 08/04/2007. Pour les médecins, le protocole concernant la fièvre aiguë de l'enfant de plus de 2 ans, était adapté à la situation dans 83% des cas et celui concernant la fièvre aiguë du nourrisson l'était dans 80% des cas. Le protocole pour les enfants de plus de 2 ans avait aidé le médecin dans sa gestion de l'appel téléphonique dans 68% des cas et celui pour les nourrissons dans 69% des cas. Notre étude a conclu, pour les 2 protocoles, à une mauvaise concordance entre les orientations théoriques (définies a posteriori au regard des diagnostics), et les orientations découlant des protocoles : coefficient de Kappa à 0,09 pour les enfants de plus de 2 ans et à 0,08 pour les nourrissons. Cette étude s'inscrit dans le cadre d'une prise de conscience de la nécessité de mettre en place des méthodologies de travail et d'évaluation dans le domaine de la médecine par téléphone. Ces protocoles sont actuellement les premiers à exister sur le sujet. Notre étude n'a pas permis de vérifier leur supériorité de manière statistique par rapport à la pratique sans ces protocoles. Cependant, ils participent à une démarche de qualité qui reste encore à développer dans ce domaine particulier, mais croissant, de la réponse médicale aux appels téléphoniques. Les objectifs des améliorations futures devraient être une approche plus scientifique et moins subjective de cette pratique, par la généralisation de la diffusion de ces protocoles et l'amélioration, sous contrôle d'évaluations régulières, de leur qualité.

Author: World Health Organization
Publisher: World Health Organization
ISBN: 9241549602
Category : Medical
Languages : en
Pages : 203

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First published in March 2014 under the title "Clinical management of patients with viral haemorrhagic fever: a pocket guide for front-line health workers: interim emergency guidance for West Africa".

Author: Neil L. Schechter
Publisher: Lippincott Williams & Wilkins
ISBN: 9780781726443
Category : Medical
Languages : en
Pages : 924

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This Second Edition is a significant revision of the leading text and clinical reference on pediatric pain. Written by an international group of experts from all relevant disciplines, this new edition is a vital reference for all pain practitioners, and for nurses, psychologists, PTs, anesthesiologists, and pediatricians dealing with acute and chronic pediatric pain. This edition includes new and expanded information on NSAIDs, opioids, and regional anesthesia. New chapters cover sedation, pain in the ICU, multidisciplinary pain services, palliative care, and the long-term consequences of pain. User-friendly new features include many more illustrations of techniques.

Author: Andrea Maloney Schara
Publisher:
ISBN: 9780615928791
Category : Families
Languages : en
Pages : 318

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"Your Mindful Compass" takes us behind the emotional curtain to see the mechanisms regulating individuals in social systems. There is great comfort and wisdom in knowing we can increase our awareness to manage the swift and ancient mechanisms of social control. We can gain greater flexibility by seeing how social controls work in systems from ants to humans. To be less controlled by others, we learn how emotional systems influence our relationship-oriented brain. People want to know what goes on in families that give rise to amazing leaders and/or terrorists. For the first time in history we can understand the systems in which we live. The social sciences have been accumulating knowledge since the early fifties as to how we are regulated by others. S. Milgram, S. Ashe, P. Zimbardo and J. Calhoun, detail the vulnerability to being duped and deceived and the difficulty of cooperating when values differ. Murray Bowen, M.D., the first researcher to observe several live-in families, for up to three years, at the National Institute of Mental Health. Describing how family members overly influence one another and distribute stress unevenly, Bowen described both how symptoms and family leaders emerge in highly stressed families. Our brain is not organized to automatically perceive that each family has an emotional system, fine-tuned by evolution and "valuing" its survival as a whole, as much as the survival of any individual. It is easier to see this emotional system function in ants or mice but not in humans. The emotional system is organized to snooker us humans: encouraging us to take sides, run away from others, to pressure others, to get sick, to blame others, and to have great difficulty in seeing our part in problems. It is hard to see that we become anxious, stressed out and even that we are difficult to deal with. But "thinking systems" can open the doors of perception, allowing us to experience the world in a different way. This book offers both coaching ideas and stories from leaders as to strategies to break out from social control by de-triangling, using paradoxes, reversals and other types of interruptions of highly linked emotional processes. Time is needed to think clearly about the automatic nature of the two against one triangle. Time and experience is required as we learn strategies to put two people together and get self outside the control of the system. In addition, it takes time to clarify and define one's principles, to know what "I" will or will not do and to be able to take a stand with others with whom we are very involved. The good news is that systems' thinking is possible for anyone. It is always possible for an individual to understand feelings and to integrate them with their more rational brains. In so doing, an individual increases his or her ability to communicate despite misunderstandings or even rejection from important others. The effort involved in creating your Mindful Compass enables us to perceive the relationship system without experiencing it's threats. The four points on the Mindful Compass are: 1) Action for Self, 2) Resistance to Forward Progress, 3) Knowledge of Social Systems and the 4) The Ability to Stand Alone. Each gives us a view of the process one enters when making an effort to define a self and build an emotional backbone. It is not easy to find our way through the social jungle. The ability to know emotional systems well enough to take a position for self and to become more differentiated is part of the natural way humans cope with pressure. Now people can use available knowledge to build an emotional backbone, by thoughtfully altering their part in the relationship system. No one knows how far one can go by making an effort to be more of a self-defined individual in relationships to others. Through increasing emotional maturity, we can find greater individual freedom at the same time that we increase our ability to cooperate and to be close to others.

Author: Konrad Bork
Publisher: W.B. Saunders Company
ISBN:
Category : Medical
Languages : en
Pages : 448

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Author: Octave Mirbeau
Publisher: Library of Alexandria
ISBN: 1465606947
Category : Fiction
Languages : en
Pages : 219

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One evening some friends were gathered at the home of one of our most celebrated writers. Having dined sumptuously, they were discussing murder—apropos of what, I no longer remember probably apropos of nothing. Only men were present: moralists, poets, philosophers and doctors—thus everyone could speak freely, according to his whim, his hobby or his idiosyncrasies, without fear of suddenly seeing that expression of horror and fear which the least startling idea traces upon the horrified face of a notary. I—say notary, much as I might have said lawyer or porter, not disdainfully, of course, but in order to define the average French mind. With a calmness of spirit as perfect as though he were expressing an opinion upon the merits of the cigar he was smoking, a member of the Academy of Moral and Political Sciences said: “Really—I honestly believe that murder is the greatest human preoccupation, and that all our acts stem from it... “ We awaited the pronouncement of an involved theory, but he remained silent. “Absolutely!” said a Darwinian scientist, “and, my friend, you are voicing one of those eternal truths such as the legendary Monsieur de La Palisse discovered every day: since murder is the very bedrock of our social institutions, and consequently the most imperious necessity of civilized life. If it no longer existed, there would be no governments of any kind, by virtue of the admirable fact that crime in general and murder in particular are not only their excuse, but their only reason for being. We should then live in complete anarchy, which is inconceivable. So, instead of seeking to eliminate murder, it is imperative that it be cultivated with intelligence and perseverance. I know no better culture medium than law.” Someone protested. “Here, here!” asked the savant, “aren't we alone, and speaking frankly?” “Please!” said the host, “let us profit thoroughly by the only occasion when we are free to express our personal ideas, for both I, in my books, and you in your turn, may present only lies to the public.” The scientist settled himself once more among the cushions of his armchair, stretched his legs, which were numb from being crossed too long and, his head thrown back, his arms hanging and his stomach soothed by good digestion, puffed smoke−rings at the ceiling: “Besides,” he continued, “murder is largely self−propagating. Actually, it is not the result of this or that passion, nor is it a pathological form of degeneracy. It is a vital instinct which is in us all—which is in all organized beings and dominates them, just as the genetic instinct. And most of the time it is especially true that these two instincts fuse so well, and are so totally interchangeable, that in some way or other they form a single and identical instinct, so that we no longer may tell which of the two urges us to give life, and which to take it—which is murder, and which love. I have been the confidant of an honorable assassin who killed women, not to rob them, but to ravish them. His trick was to manage things so that his sexual climax coincided exactly with the death−spasm of the woman: 'At those moments,' he told me, 'I imagined I was a God, creating a world!”

Author: Linda Strande
Publisher: IWA Publishing
ISBN: 1780404735
Category : Technology & Engineering
Languages : en
Pages : 428

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It is estimated that literally billions of residents in urban and peri-urban areas of Africa, Asia, and Latin America are served by onsite sanitation systems (e.g. various types of latrines and septic tanks). Until recently, the management of faecal sludge from these onsite systems has been grossly neglected, partially as a result of them being considered temporary solutions until sewer-based systems could be implemented. However, the perception of onsite or decentralized sanitation technologies for urban areas is gradually changing, and is increasingly being considered as long-term, sustainable options in urban areas, especially in low- and middle-income countries that lack sewer infrastructures. This is the first book dedicated to faecal sludge management. It compiles the current state of knowledge of the rapidly evolving field of faecal sludge management, and presents an integrated approach that includes technology, management, and planning based on Sandecs 20 years of experience in the field. Faecal Sludge Management: Systems Approach for Implementation and Operation addresses the organization of the entire faecal sludge management service chain, from the collection and transport of sludge, and the current state of knowledge of treatment options, to the final end use or disposal of treated sludge. The book also presents important factors to consider when evaluating and upscaling new treatment technology options. The book is designed for undergraduate and graduate students, and engineers and practitioners in the field who have some basic knowledge of environmental and/or wastewater engineering.

Author: World Health Organization
Publisher: World Health Organization
ISBN: 9241547006
Category : Health & Fitness
Languages : en
Pages : 284

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Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.