[Implementation of the safe surgery checklist of the World Health Organization at the University hospital of Monastir [Tunisia]]

To evaluate the impact of introduction of the WHO safe surgery checklist in the university hospital of Monastir over a period of five months. We conducted a longitudinal study [before - after] with evaluation of five result indicators which were: percentage of surgical site infections, not prescribed antibioprophylaxis, unplanned return to the operating room, postoperative length of stay and postoperatively death. We identified 185 patients during the period and 323 patients after the introduction of the WHO checklist. The proportion of surgical site infection decreased significantly from 13.5% in the reference period to 1.3% after the introduction of the checklist [p < 0.001]. The proportion of unplanned return to the operative room was 10.3% before the introduction of the checklist and deceased significantly to 1.3% at the intervention period [p = 0.003]. The proportion of not prescribed antibioprophylaxis and median post-operative length of stay deceased also significantly during the study period [p < 0.001]. The surgical checklist control contributes to the development of a safety culture in the operating room. Maintaining its use should be supported by incentives such as certification and accreditation

[Epidemiological, clinical features therapeutic results and evolution of gastrointestinal stromal tumour: about 25 cases]

Gastrointestinal stromal tumors [GIST] are mesenchymal tumors occuring in the majority of cases in the stomach and small intestine, rarely in rectum, colon, esophagus or mesentery. They are derived from cells of cajal or their precursor, and are typically CD117/KIT + [95%], CD34 + [70%]. aims: is to study the epidemiological, clinical, therapeutic and evolution of astrointestinal stromal tumors. Retrospective study including all patientswith the diagnosis of GIST supported in the department of gastroenterology and surgery in universital hospital of Monastir. 25 patients were included, 12 men and 13 women with an average age of 60.5 years. Digestive symptomatology was dominated by gastrointestinal bleeding [n = 12] and abdominal pain [n = 12]. The tumor was discovered incidentally in two patients. The small intestine was the most common site of the tumor [n = 10], followed by the stomach in 9 patients, rectum in two patients, the colon [n = 1], the bulb of water [n = 1], duodenum [n = 1] and liver in a patient. The tumor size ranged from 0.8 to 24 cm. GIST was localized in 16 patients, in whom therapeutic care based mainly on surgery and optimal broad. It was metastatic in 9 patients, in whom treatment using imatinib as first-line in 4 of them with a good response in 3 patients and the possibility of R0 surgery in one patient, initial stabilization and then a secondary exhaust in a patient. The first surgery was necessary in 5 patients in complicated situation or if diagnostic doubt. The best characterization of GIST thanks to advances in cancer research has led to improved treatment of these tumors. Surgery is the standard treatment in localized forms. Imatinib is the standard treatment in metastatic GIST first line as well as adjuvant after surgery

Tracking medication pathway as per better securing drugs' use in three clinical departments at the university hospital of monastir [Tunisia]

In Tunisia, few studies have an interest to the assessment of medication errors and the implementation of preventive measures. The aim of this study was to evaluate the barriers existing in hospital pharmacies in order to prevent medication errors and to help institutions to make improvement actions. First step: a clinical audit was conducted by observation against a set of standards that are representing a guideline. Second step: interview with health professionals to identify their perceptions about medication safety. Third step: in this step we develop adverse events scenarios according to results of the clinical audit in order to be investigated by the field practice. Fourth step: organizing a multi-professional feedback meeting to raise health professional's awareness and to make them more conscientious about adverse drug events negative consequences and invite them to contribute in the establishment and implementation of corrective solutions. In the participating departments medical prescription did not include patient information's [age, weight medical background]. Nurses do not verify systematically duration of prescription and administration route. Health professionals interview revealed that physician's have lack of awareness about prescription rules. Lack of communication was the main nurse's problem that requires improvement. This project has led to a first overview of the situation of medication use in Tunisia. Results will be used to create a dynamic process to improve the medication system safety