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More specific examinations are d efined in relatio n to the p ro gram m e.
A labo rato ry can be used in three co m p lem entary w ays:
– Clinically: exam inatio ns are requested fo r ind ivid uals d ep end ing o n th e clinical
p icture. T he aim is to o rient a d iagno sis (e.g. leuco cyto sis in a full blo o d co unt) o r to
d eterm ine o r elim inate an aetio lo gy (e.g. sto o l exam inatio n fo r p arasites, blo o d
sm ear,
rap id test).
– Epidemiologically: the o bjective is to facilitate d iagno sis and treatm ent. B y stud ying a
sam p le o f p atients p resenting w ith sim ilar clinical p ro files an aetio lo gy can be
sp ecified . T he valid ity ( sensitivity and sp ecificity) o f th e p articular sym p to m s o r
synd ro m e can also be stud ied . T hro ugh these m eans ap p ro p riate treatm ent p ro to co ls
can be intro d uced fo r all p atients p resenting w ith the sam e sym p to m s o r synd ro m e.
F o r exam p le: is the synd ro m e no n- febrile blo o d y d iarrh o ea p red ictive o f am o ebic
d ysentery? A n investigatio n o f ap p ro xim ately 1 0 0 p atients w ill answ er this questio n.
If a significant p ro p o rtio n o f the sam p les are p o sitive, an ap p ro p riate treatm ent can
be given to all p atients p resenting w ith this synd ro m e. T his ap p ro ach, w hile p ractical
d uring so m e ep id em ics, sho uld no t sto p the p ractitio ner fro m co nsid ering d ifferential
d iagno sis as the sensitivity o f a synd ro m e is rarely 1 0 0 %
– Operational research: labo rato ry exam inatio ns are also used d uring resistance stud ies
(m alaria) and fo r o ther o p eratio nal research.
T h e co m binatio n o f clinical examination and complementary examinations sh o uld
result in an aetio lo gical d iagno sis if p o ssible, if no t, a sym p to m atic o r synd ro m ic
d iagno sis.
Treatment
P rescribe a treatm ent:
– aetio lo gical (treat the cause)
– sym p to m atic
– give relevant ad vice, w hether o r no t the p atient w as treated
o r refer.
Recording data and the individual patient record
R eco rd the essential info rm atio n in a register and o n an ind ivid ual p atient reco rd (see
th e exam p le o f a h ealth card , annex 3 ) , an exam inatio n card o r in a fam ily h ealth
bo o k let. Info rm atio n sho uld includ e:
– d iagno sis is im p o rtant p o sitive and negative signs (e.g. blo o d y d iarrho ea w itho ut fever)
– labo rato ry exam inatio ns requested and the results
– d rugs p rescribed (in IN N ), d o sage, d uratio n
Training
T raining and retraining o f staff sho uld be carried o ut acco rd ing to their technical level
(this sho uld be evaluated ) and is therefo re co ntext d ep end ent. T his m anual and o ther
d o cum ents m ay be useful to o ls in d efining and m eeting training o bjectives.
12
More specific examinations are d efined in relatio n to the p ro gram m e.
A labo rato ry can be used in three co m p lem entary w ays:
– Clinically: exam inatio ns are requested fo r ind ivid uals d ep end ing o n th e clinical
p icture. T he aim is to o rient a d iagno sis (e.g. leuco cyto sis in a full blo o d co unt) o r to
d eterm ine o r elim inate an aetio lo gy (e.g. sto o l exam inatio n fo r p arasites, blo o d
sm ear,
rap id test).
– Epidemiologically: the o bjective is to facilitate d iagno sis and treatm ent. B y stud ying a
sam p le o f p atients p resenting w ith sim ilar clinical p ro files an aetio lo gy can be
sp ecified . T he valid ity ( sensitivity and sp ecificity) o f th e p articular sym p to m s o r
synd ro m e can also be stud ied . T hro ugh these m eans ap p ro p riate treatm ent p ro to co ls
can be intro d uced fo r all p atients p resenting w ith the sam e sym p to m s o r synd ro m e.
F o r exam p le: is the synd ro m e no n- febrile blo o d y d iarrh o ea p red ictive o f am o ebic
d ysentery? A n investigatio n o f ap p ro xim ately 1 0 0 p atients w ill answ er this questio n.
If a significant p ro p o rtio n o f the sam p les are p o sitive, an ap p ro p riate treatm ent can
be given to all p atients p resenting w ith this synd ro m e. T his ap p ro ach, w hile p ractical
d uring so m e ep id em ics, sho uld no t sto p the p ractitio ner fro m co nsid ering d ifferential
d iagno sis as the sensitivity o f a synd ro m e is rarely 1 0 0 %
– Operational research: labo rato ry exam inatio ns are also used d uring resistance stud ies
(m alaria) and fo r o ther o p eratio nal research.
T h e co m binatio n o f clinical examination and complementary examinations sh o uld
result in an aetio lo gical d iagno sis if p o ssible, if no t, a sym p to m atic o r synd ro m ic
d iagno sis.
Treatment
P rescribe a treatm ent:
– aetio lo gical (treat the cause)
– sym p to m atic
– give relevant ad vice, w hether o r no t the p atient w as treated
o r refer.
Recording data and the individual patient record
R eco rd the essential info rm atio n in a register and o n an ind ivid ual p atient reco rd (see
th e exam p le o f a h ealth card , annex 3 ) , an exam inatio n card o r in a fam ily h ealth
bo o k let. Info rm atio n sho uld includ e:
– d iagno sis is im p o rtant p o sitive and negative signs (e.g. blo o d y d iarrho ea w itho ut fever)
– labo rato ry exam inatio ns requested and the results
– d rugs p rescribed (in IN N ), d o sage, d uratio n
Training
T raining and retraining o f staff sho uld be carried o ut acco rd ing to their technical level
(this sho uld be evaluated ) and is therefo re co ntext d ep end ent. T his m anual and o ther
d o cum ents m ay be useful to o ls in d efining and m eeting training o bjectives.
12
