[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

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

Trends in hospital morbidity among adults in the region of Monastir [Tunisia] between 1996 and 2007

To study trends of hospital morbidity among adults in the region of Monastir during a period of 12 years [1996 - 2007]. We analyzed data from the morbidity database of the university hospital of Monastir [Tunisia] between 01/01/1996 and 31/12/2007. Data were drawn from the register of hospital morbidity implemented in the Department of Preventive Medicine and Epidemiology since 1995. The International Classification of Diseases [tenth revision] was used to identify and classify morbid conditions. During the study period, we collected 150749 admissions with male tendency [sex-ratio = 1.27]. Among these admissions 24.4% were over than 64 years. Morbid conditions were dominated by Ischemic Heart diseases [4.24%] followed by cancers and diabetes mellitus [3.3% and 2.52% respectively]. Chronological trends, using Spearman correlation rank test, showed that overall rate of chronic conditions increased significantly from 4.4% in 1996 to 9.1% in 2007 [r'= |0.88|, p-value < 0.001]. In contrast, the rate of infectious and parasitic diseases decreased from 4.3% to 2.9% [r'= |0.98|, p-value < 0.001]. Morbidity trends reflect the epidemiological transition of our country and call to a backing of the ambulatory system and the development of specific services able to decrease the needs of hospitalizations

[Epidemiological and chronological profile of the parturientes in the extreme ages in the Monastir region between 1994 and 2003]

Pregnancy outside 19-34 years interval is risk factors of the maternal and fetal morbidity and mortality. Tunisia, witch known an epidemiological transition, implanted the national program of perinatality since 1990 and one of its objectives is the surveillance of the high risk pregnancies. The aim of this study is to draw up the epidemiological profile of the parturient in extreme ages in the region of Monastir and to study the chronological tendencies of the associated factors during a decade [1994 -2003]. In all, the study interest 13225 extreme ages parturient, representing 22.5% of all women admitted for delivery in the public maternities of the district. The mean age was 18.6% +/- 0.6 years for the parturient less than 20 years and 37 +/- 2 years for the older than 35 years and more, among them 40% were older primipara. The prenatal care was inadequate for 35.4% of younger women and 47.6% of aged women. During the decade, we notice a significant decrease of the frequency of pregnancy for teenager parturient [from 3 in 1994 to 1.99% to 17.7% in 2003] [p<0.001]. Adequate prenatal care increased and the frequency of parturient without any follow-up decreased [from 17.2 to 2%] [p<0.001]. Given to this demographic and social transition, our healthcare system is called for greater vigilance and a more rigorous application of the recommendations of the national program of perinatality

[Epidemiological profile and chronological tendencies of the multiparity in the sanitary district of Monastir [Tunisia] between 1994 and 2003]

Multiparity, risk factor of maternal and foetal morbidity and mortality, is a worldwide public health problem. In Tunisia, in spite of the activities of the national program of maternal and infantile health implanted since 1966, the multiparity is yet observed in some regions of our country. Is to draw up the epidemiological profile of the multipara woman [parity<6] and the grand multipara [parity >/= 6] in the sanitary district of Monastir and to study the chronological tendencies of the factors associated during a decade [from 1994 to 2003]. In all, 16649 multipara were studied, representing 24% of the total women admitted for childbirth in the public motherhoods of the district. The global means age was 33.3 +/- 4.5 years with a statistical significance between multipara and grand multipara [32.7 and 35.6 respectively]. The prenatal follow up was absent or inadequate for 50.2% of multipara and 62.8% of the grand multipara [p <0.001]. In the decade, the main chronological tendencies are similar in the two multipara groups. Their frequency decreased from 28, 5 to 19% [p<0.001], yet the age and the adequate follow up increased from 32, 6 to 34 years and from 37, 4 to 57, 9% respectively [p<0.001]. Although the multiparity is decreasing and its associated factors seem to improve, the vigilance is asked again in order to avoid the inherent risks

[Validation of a school children addictive behaviors questionnaire]

The aim was to develop and validate an addictive behaviors screening tool in school children

Methodology: A cross sectional study including a self administrated 223 item questionnaire developed in Arabic language. The questionnaire included identification of the student and seven life domains: school, family, addiction, relationships with peers, leisure and well being. risky behaviors and personality traits. N = 854 high school children. of Monastir City

Results: the questionnaire Alpha Cronbach's Coefficient ranged between 0.3 and 0.8. Only items with a coefficient higher than 0.6 were maintained in the final version. The time reliability by using the Bland and Altman method 15 days after the first measure showed a Pearson's coefficient of 0.81. Validity evaluated by principal components analysis led to 3 independent factors consisting respectively in 20, 4 and 3 well correlated items: family, school and risky behaviors

Conclusion: validated version of the questionnaire consisted in 102 items, easy to, read and understand. This version doesn't require much time to be filled in and takes into consideration cultural particularities of the school children of Monastir. It could be considered as an interesting tool for both the assessment and the prevention of addictive behaviors in school

urgences infectieuses dans un service d'urgences medicales

The aim of this study is to evaluate the frequency of infectious urgencies and the quality of their management in an emergency medical service. During the period of study, 21737 consultants are recorded, from which 2011 for an infectious urgency [9.25%], pharyngitis with rhinitis excluded. 692 patients are hospitalized and 1074 receive ambulatory antibiotics. Therapeutic urgencies are the most frequent infectious urgencies [48.4%], followed by protection urgencies [46.3%], urgencies due to antibiotics [5.2%] and prevention urgencies [0.1%]. The conduct is considered correct for 1379 cases [68.5%] and incorrect for 500 cases [25%]. Main incorrect conducts are the absence of follow-up [81.6%] and the maladjusted antibiotherapy [11.8%]. These results incite, mainly, to the improvement of the professional training of emergency physicians and their communication with their colleagues of the other sanitary structures

[Hospital morbidity in an urban district in Tunisia]

In the health region of Monastir, Tunisia, there is a register of admissions to all public hospitals. Those relating to patients resident in Ksar Hellal District during the year 1995 were identified [N = 1983 admissions to hospital]. This made it possible to establish the population-based pattern of hospital morbidities. The annual hospitalization rate is 6.1%; the rate for patients aged ' 65 years is estimated at 13.1%. Chronic diseases are responsible for 31.5% of admissions to hospital and are predominantly diabetes and asthma. The morbidity pattern reflects a phenomenon of epidemiological transition and calls for the strengthening of ambulatory care and development of specific services likely to reduce the need for hospitalization