Médecine tropicale : revue du Corps de santé colonial
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Sensitivity, specificity, and predictive value are the standard parameters used to evaluate the efficacy of diagnostic tests. However all three parameters assume the existence of a gold standard test. ⋯ The solution involves assessment of agreement between two raters. This article based on an example drawn from an African setting describes the value and computation of the most widely used tool for assessing agreement and reproducibility of measures, i.e., the kappa coefficient.
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The implementation of essential drugs policies and widespread use of generic products in humanitarian programs has ensured access to medication for poverty-stricken populations. However rigorous drug selection according to origin is necessary to guarantee quality. ⋯ An obvious danger for drugs such as antibiotics is that use of poor quality products producing insufficient bioavailability will promote development of microbial resistance. This could become a worldwide public health problem with particularly dramatic consequences for the treatment of tuberculosis and retroviruses.
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The purpose of this retrospective study was to determine the profile of medical emergencies and their management in a university hospital center in a tropical area. Between July 1 and December 31, 2001, all patients examined in a medical and surgical emergency room were included. Obstetrical emergencies, pediatric emergencies, emergencies admitted directly to the cardiology, ORL emergencies and urologic emergencies were not included. ⋯ Gastrointestinal events accounted for 20.23% of cases, cardiovascular events for 9.12%, respiratory events of 8.56%, metabolic events for 1.78%, trauma for 48.20% and infectious disease for 12.09%. Surgical mortality was 2.41%. Most problems facing the intensivist treating medical emergencies in a tropical setting involved resuscitation.
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Governmental humanitarian action is an old concept in France, that is a topic of current interest. To conduct humanitarian action, the French government has deployed various facilities. The military biological risk team was established to control epidemics, provide expertise during epidemiological emergencies, and conduct mass vaccination programs. The author describe the missions carried out by the biological risk team during the 1990s as an illustration of governmental humanitarian action.
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The main goal of emergency medicine training is to teach the wide range of sciences and skills necessary to recognize and stabilize emergency situations. Emergency medicine training has proven highly effective in developed countries especially with regard to organization of survival medicine. This type of training is especially important in sub-Saharan Africa where there is a severe shortage of intensive care specialists and an almost total lack of other personnel qualified to manage life-threatening trauma and disease. ⋯ Students undergo regular assessment of their scientific knowledge and practical competencies after each module. As additional prerequisites for the diploma, they must be certified in first aid and rescue and present a research paper. Despite the lack of faculty and teaching materials, this program is expected to increase the number of emergency medical care providers and improve access to high-quality emergency care services.