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Emergency medecine

Catrin Schulte-Hillen, Nelly Staderini, Jean-François Saint-Sauveur
MSF responds to needs for the termination of pregnancy, including on request (TPR); it is part of the organization's work aimed at reducing maternal mortality and suffering; and preventing unsafe abortions in the countries where we work. Following the publication of "Why don't humanitarian organizations provide safe abortion care?" we offer an insight into MSF's experience over the past few years. The article looks at the legal concerns and proposes that the importance of addressing maternal mortality should replace them and the operational set-up and action organized in a way that mitigates risks...
2016: Conflict and Health
Bachir Tazkarji, Robert Lam, Shawn Lee, Soumia Meiyappan
OBJECTIF: Guider les médecins de famille dans l'élaboration de plans de dépistage et de traitements préventifs à l'intention de leurs patients âgés. SOURCES DE L'INFORMATION: Une recension a été effectuée dans la base de données MEDLINE pour trouver des lignes directrices canadiennes sur les soins de santé primaires et les personnes âgées; des lignes directrices, des méta-analyses, des guides de pratique clinique ou des révisions systématiques portant sur le dépistage de masse chez les 80 ans et plus et les aînés fragiles, se limitant à ceux publiés entre 2006 et juillet 2016; et des articles sur les services de santé préventifs à l'intention des aînés et présentant un intérêt pour la pratique familiale ou les médecins de famille, limités à ceux publiés en anglais entre 2012 et juillet 2016...
September 2016: Canadian Family Physician Médecin de Famille Canadien
Ana Cecilia Andrade de Moraes Weintraub, Mariana Gaspar Garcia, Elisa Birri, Nathalie Severy, Marie-Christine Ferir, Engy Ali, Katie Tayler-Smith, Dinah Palmera Nadera, Mark Van Ommeren
BACKGROUND: Severe mental disorders are often neglected following a disaster. Based on Médecins Sans Frontières' (MSF) experience of providing mental health (MH) care after the 2013 typhoon in the Philippines, we describe the monthly volume of MH activities and beneficiaries; characteristics of people seeking MH care; profile and outcomes of people with severe mental disorders; prescription of psychotropic medication; and factors facilitating the identification and management of individuals with severe mental disorders...
September 2016: International Health
Fati Sidikou, Maman Zaneidou, Ibrahim Alkassoum, Stephanie Schwartz, Bassira Issaka, Ricardo Obama, Clement Lingani, Ashley Tate, Flavien Ake, Souleymane Sakande, Sani Ousmane, Jibir Zanguina, Issaka Seidou, Innocent Nzeyimana, Didier Mounkoro, Oubote Abodji, Xin Wang, Muhamed-Kheir Taha, Jean Paul Moulia-Pelat, Assimawe Pana, Goumbi Kadade, Olivier Ronveaux, Ryan Novak, Odile Ouwe Missi Oukem-Boyer, Sarah Meyer
BACKGROUND: To combat Neisseria meningitidis serogroup A epidemics in the meningitis belt of sub-Saharan Africa, a meningococcal serogroup A conjugate vaccine (MACV) has been progressively rolled out since 2010. We report the first meningitis epidemic in Niger since the nationwide introduction of MACV. METHODS: We compiled and analysed nationwide case-based meningitis surveillance data in Niger. Cases were confirmed by culture or direct real-time PCR, or both, of cerebrospinal fluid specimens, and whole-genome sequencing was used to characterise isolates...
August 23, 2016: Lancet Infectious Diseases
Anna Kuehne, Emily Lynch, Esaie Marshall, Amanda Tiffany, Ian Alley, Luke Bawo, Moses Massaquoi, Claudia Lodesani, Philippe Le Vaillant, Klaudia Porten, Etienne Gignoux
Between March 2014 and July 2015 at least 10,500 Ebola cases including more than 4,800 deaths occurred in Liberia, the majority in Monrovia. However, official numbers may have underestimated the size of the outbreak. Closure of health facilities and mistrust in existing structures may have additionally impacted on all-cause morbidity and mortality. To quantify mortality and morbidity and describe health-seeking behaviour in Monrovia, Médecins sans Frontières (MSF) conducted a mobile phone survey from December 2014 to March 2015...
August 2016: PLoS Neglected Tropical Diseases
Shona Horter, Beverley Stringer, Jane Greig, Akhmet Amangeldiev, Mirzagaleb N Tillashaikhov, Nargiza Parpieva, Zinaida Tigay, Philipp du Cros
BACKGROUND: Treatment for multi-drug resistant tuberculosis (MDR-TB) is lengthy, has severe side effects, and raises adherence challenges. In the Médecins Sans Frontières (MSF) and Ministry of Health (MoH) programme in Karakalpakstan, Uzbekistan, a region with a high burden of MDR-TB, patient loss from treatment (LFT) remains high despite adherence support strategies. While certain factors associated with LFT have been identified, there is limited understanding of why some patients are able to adhere to treatment while others are not...
2016: BMC Infectious Diseases
G Benedetti, M Mossoko, J P Nyakio Kakusu, J Nyembo, J P Mangion, D Van Laeken, R Van den Bergh, W Van den Boogaard, M Manzi, W K Kibango, V Hermans, J Beijnsberger, V Lambert, E Kitenge
SETTING: The Democratic Republic of Congo suffers from an amalgam of disease outbreaks and other medical emergencies. An efficient response to these relies strongly on the national surveillance system. The Pool d'Urgence Congo (PUC, Congo Emergency Team) of Médecins Sans Frontières is a project that responds to emergencies in highly remote areas through short-term vertical interventions, during which it uses the opportunity of its presence to reinforce the local surveillance system...
June 21, 2016: Public Health Action
Morten Rostrup, Jeffrey K Edwards, Mohamed Abukalish, Masoud Ezzabi, David Some, Helga Ritter, Tom Menge, Ahmed Abdelrahman, Rebecca Rootwelt, Bart Janssens, Kyrre Lind, Raido Paasma, Knut Erik Hovda
BACKGROUND: Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise...
2016: PloS One
Dhruvin H Hirpara, Michelle C Cleghorn, Sanjeev Sockalingam, Fayez A Quereshy
BACKGROUND: Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery...
June 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Agnès Oude Engberink, François Carbonnel, Béatrice Lognos, Elodie Million, Marion Vallart, Suzanne Gagnon, Gérard Bourrel
OBJECTIVE: To understand parents' representations based on their own lived experiences and their influence on the decision to vaccinate their children. METHODS: This was a qualitative, in-depth, phenomenological study using semi-structured interviews with 14 volunteer parents who have children age-eligible for vaccination. The participants were recruited through family doctors in the Montpellier region (France). The methodology is modeled on grounded theory. The data, collected by audio recording, were analyzed using a semio-pragmatic method that brought forth conceptual categories giving meaning to the phenomenon being studied...
November 2015: Canadian Journal of Public Health. Revue Canadienne de Santé Publique
Claire Reading
Midwifery practice in rural central Africa is full of joys (an abundance of twins, births by candlelight and resilience and stoicism that would leave even the very experienced birth practitioner speechless), but also a lot of challenges (every obstetric emergency in your wildest nightmares and worse) that are compounded by a lack of access to a skilled birth attendant. Women here have a strong culture of traditional practices and remedies, and hospital is often not the first port of call. Caring for women who cannot, themselves, consent to emergency life-saving caesarean sections, is a cultural aspect that we accept and respect as medical professionals working in the Democratic Republic of Congo (DRC)...
January 2016: Practising Midwife
Gerlant van Berlaer, Tom Staes, Dirk Danschutter, Ronald Ackermans, Stefano Zannini, Gabriele Rossi, Ronald Buyl, Geert Gijs, Michel Debacker, Ives Hubloue
OBJECTIVES: Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. METHODS: Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years...
March 10, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Jessica F Davies, Annick Lenglet, Marten van Wijhe, Cono Ariti
BACKGROUND: The African continent has the greatest burden of surgical disability-adjusted life years, yet the least is known about operative care here. This analysis describes the surgical patients admitted to 7 hospitals supported by the Médécins Sans Frontières (MSF) over 3 years in 3 conflict-affected countries-Eastern Democratic Republic of Congo, Central African Republic, and South Sudan. METHODS: A standardized operative data collection tool was used for routine collection of operative inpatient data between 2011 and 2013 at 7 MSF surgical facilities...
May 2016: Surgery
Promise Ariyo, Miguel Trelles, Rahmatullah Helmand, Yama Amir, Ghulam Haidar Hassani, Julien Mftavyanka, Zenon Nzeyimana, Clemence Akemani, Innocent Bagura Ntawukiruwabo, Adelin Charles, Yanang Yana, Kalla Moussa, Mustafa Kamal, Mohamed Lamin Suma, Mowlid Ahmed, Mohamed Abdullahi, Evan G Wong, Adam Kushner, Asad Latif
BACKGROUND: Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. METHODS: The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome...
March 2016: Anesthesiology
H Guiga, G Sarlon Bartoli, F Silhol, W Radix, B Vaïsse
OBJECTIFS: Étudier la prévalence et la gravité des urgences et des poussées hypertensives dans un Service d'Urgence Hospitalière de CHU, et effectuer un suivi à 3 mois des patients hospitalisés. MéTHODES: Cette étude prospective a été réalisée dans le Service des Urgences entre le 1(er)(a)vril et le 31 juin 2015 : tous les patients avec une PA > 180 et/ou 110mmHg ont été comptabilisés et classés en urgences vraies (présence d'une souffrance viscérale) et en poussées hypertensives isolées...
December 2015: Annales de Cardiologie et D'angéiologie
Sheila Isanaka, Céline Langendorf, Fatou Berthé, Smaila Gnegne, Nan Li, Nassirou Ousmane, Souley Harouna, Hamidine Hassane, Myrto Schaefer, Eric Adehossi, Rebecca F Grais
BACKGROUND: High-quality evidence supporting a community-based treatment protocol for children with severe acute malnutrition, including routine antibiotic use at admission to a nutritional treatment program, remains limited. In view of the costs and consequences of emerging resistance associated with routine antibiotic use, more evidence is required to support this practice. METHODS: In a double-blind, placebo-controlled trial in Niger, we randomly assigned children who were 6 to 59 months of age and had uncomplicated severe acute malnutrition to receive amoxicillin or placebo for 7 days...
February 4, 2016: New England Journal of Medicine
Matthieu Mengin, Arachk De Gorski, Christophe E Iselin
Although the issue is specifically urologic, scrotal pain and/or enlargement is not an exception at the general practitioner's outpatient clinic. Besides testicular torsion, usually managed in an emergency division setting, there are four frequent diagnoses: testicular tumor, orchi-epididimytis, hydrocele or spermatocele, so as varicocele. The purpose of this article is to provide an update and allow to easily identify serious or frequent scrotal pathologies in primary care medecine.
December 2, 2015: Revue Médicale Suisse
Marc Leroy Guifo, Agnes Essiene, Marie Ngo Nsoga, Ibrahima Farikou, Eone Daniel Handy, Ernest NjihTabah
BACKGROUND: Chronic wounds, especially Buruli ulcers (BU) are emerging public health threat in West and Central Africa. Akonolinga in Cameroon is one of the four health districts affected by BU. Since 2002, Médécins Sans Frontières has established a specialized wound carecenter to actively diagnose and provide treatment of chronic wounds that is accessible and affordable for all patients. Our objectives were to report the surgical activities in Akonolinga, to provide description of the types of chronic wounds and elements of anticipation of treatment needs in a public health perspective...
May 2016: World Journal of Surgery
Miguel Trelles, Lynette Dominguez, Katie Tayler-Smith, Katrin Kisswani, Alberto Zerboni, Thierry Vandenborre, Silvia Dallatomasina, Alaa Rahmoun, Marie-Christine Ferir
BACKGROUND: Since 2011, civil war has crippled Syria leaving much of the population without access to healthcare. Various field hospitals have been clandestinely set up to provide basic healthcare but few have been able to provide quality surgical care. In 2012, Medecins Sans Frontieres (MSF) began providing surgical care in the Jabal al-Akrad region of north-western Syria. Based on the MSF experience, we describe, for the period 5th September 2012 to 1st January 2014: a) the volume and profile of surgical cases, b) the volume and type of anaesthetic and surgical procedures performed, and c) the intraoperative mortality rate...
2015: Conflict and Health
Deborah Wilson
In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency...
December 2015: American Journal of Nursing
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