RESUMEN
The care management of patients treated for cases of sexual or blood exposure requires stringent clinical and biological follow-up procedures. Despite the provision of information about the importance of regular follow-up, the number of patients dropping out of screening consultations at the Hospital Lariboisière-Fernand Widal (Assistance Publique-Hôpitaux de Paris) has increased. The main purpose of this study is to improve follow-up for patients treated with anti-retroviral prophylaxis following a known sexual or blood exposure. An investigation based on 5 markers of a targeted clinical audit form ("drop-outs" or lost to follow-up, conduct of HIV serology tests, traceability of clinical, biological and compliance monitoring) was carried out. A review of practices was conducted on the basis of an analysis of patient cases over a six-month period, followed by the implementation and evaluation of corrective measures over a two-year period. A significant decline in the number of patients lost to follow-up was observed. The study shows a significant improvement in other markers: serological follow-up, compliance traceability, and clinical and biological monitoring. These results were observed between 2005 and 2007. Two distinctive effects were identified: improvement in patient care management and the quality of care, and the empowerment of actors, thereby ensuring a certain continuity of action. The decline in the rate of lost to follow-up patients and improved monitoring of compliance and iatrogenic risks confirm these effects. The overall approach is incorporated into an evaluation of professional practices.
Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/prevención & control , Garantía de la Calidad de Atención de Salud , Auditoría Clínica , Estudios de Seguimiento , Francia , Humanos , Cumplimiento de la Medicación , Pacientes Desistentes del TratamientoRESUMEN
The Trench Foot was described during the Napoleon's wars but its clinical picture dates from 1915. As a result of soldiers' life in trenches, it was recognized as a neurological, circulatory and infectious disease which struck thousands of fighters (chiefly French and English). At the beginning it was considered as a simple "frostbite" and troublesome for the military physicians who did know know how to cure this supposedly dermatological disease. More than 200 papers were published about the Trench Foot and the numerous individual inventions to protect the soldier's foot from mud, rain, cold and compression. As this issue is found in most testimonies of the fighters that proves it was a real and further suffering in the trenches.
Asunto(s)
Enfermedad/etiología , Pie de Inmersión/historia , Medicina Militar/historia , Primera Guerra Mundial , Francia , Alemania , Historia del Siglo XX , Humanos , Reino UnidoRESUMEN
Rotten corpses were occasionally used as weapons in the Antiquity. So wells and springs were usually contaminated. In 1915-1916, just after the use of poison gas on the battlefield, bacteriological suspensions were prepared to destroy men and cattle in Europe, Russia and the United of America but the attempts of using bacteriological weapons remained inefficient. Moreover the evidences of this use during the Great War are very fragile. After the war there was a consensus about inhumanity of this weapon which yet might be used if the enemy did it. Between 1925 and 1933 the debates in the Society of Nations proved that bacteriological war was possible in spite of a compromise solution between some nations. Then English journalist Wickdam Steed disclosed the German tries of bacteriological weapons in the Paris metro and the London tube in 1933 (Was this article a manipulation?).