Physical activity and quality of life among breast cancer survivors.

INTRODUCTION AND AIM: To assess physical activity (PA) and its determinants in breast cancer survivors (BCS), attending a Tunisian hospital, as well as to assess their quality of life (QOL) and examine the relationship between PA and BCS'QOL. METHODS: We conducted a cross-sectional study among BCS attending the outpatient oncology, gynecology and radiotherapy clinics at a Tunisian hospital in April 2022 using a self-administered questionnaire. The valid Arabic version of the International Physical Activity. Questionnaire short version was used to assess PA and sitting time. QOL was assessed using the valid Arabic version of the 12-item Short-Form health survey. RESULTS: A total of 95 BCS were recruited. BCS reported overall moderate PA levels with a median MET of 1440 (IQR 680- 2400) minutes/week and a mean total sitting time of 281.79±134.36 minutes/day. Overall, patients aged 50 years and above had significantly lower levels of sitting time (231.43±129.32vs 332.14±121.63, p= 0.04). Similarly, subjects aged 50 years and above, and of rural origin had higher levels of PA (1908.5 (IQR 939.7-3268.5) vs. 1266 (IQR 471-2946), p= 0.114 and 1788.5 (IQR 1072.5-3252) vs. 1440 (IQR 537-3057), p= 0.259 respectively). Regarding BCS'QOL, they showed moderate disability in the physical component (39.3 ±7.08) , and mild disability in the mental component (43.94 ±9.23). BCS' QOL was significantly correlated to PA (r=0,258, p=0,012). CONCLUSION: Adherence to regular PA is effective in improving BC patients' survival rate. Therefore, to enhance survivors' QOL, a healthy lifestyle including regular PA is well recommended.

Safety and efficiency of COVID-19 vaccine in North Africa.

Background In the absence of a specific treatment for COVID-19, preventive measures have been implemented to control this pandemic and vaccination is one of them. However, it is crucial to verify the safety and efficiency of every vaccine. The aim was to determinate the predictive factors of side effects and reinfection after COVID-19 vaccine. Methods A cross-sectional study was conducted in February 2022 among Tunisians infected with COVID-19 between March 2020 and February 2022, using an online self-administered questionnaire. We conducted univariate and multivariate analyses using binary stepwise logistic regression. Results A total of 1541 was selected from 1911 individuals. Comorbidities affected a quarter of the population (22.3%). Before the initial infection, 39.3% had received full vaccination, and 8.7% had received partial vaccination. By February 2022, the majority (82.9%) had received at least two vaccine doses. The reinfection rate was 30.6%. All vaccines prior to the first infection was identified as a protective factor against reinfection. Inactivated virus vaccinations were less likely to induce adverse effects. Conclusion ach vaccine has its own set of advantages and disadvantages: mRNA-based vaccines had a higher incidence of side effects but all vaccines provided better protection against reinfection.

Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers.

PURPOSE: Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients. METHODS: We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators. RESULTS: The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients. CONCLUSION: The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.

Symptoms and risk factors for long COVID in Tunisian population.

BACKGROUND: The COVID-19 pandemic has presented various challenges, one of which is the discovery that after the acute episode, around 30% of patients experience persistent symptoms or develop new ones, now known as long COVID. This new disease has significant social and financial impacts. The objective is to determine the prevalence of long COVID in the Tunisian population and identify its predictive factors. METHODS: This was a cross-sectional study conducted among Tunisians who were infected with COVID-19 between March 2020 and February 2022. An online self-administered questionnaire was distributed through social media, radio, and television channels over the course of one month (February 2022). Long COVID was defined as the persistence of existing symptoms or the development of new symptoms within three months after onset, lasting for at least two months, and with no differential diagnosis. We performed univariate and multivariate analyses using binary stepwise logistic regression with a significance level set at 5%. RESULTS: A total of 1911 patients participated in our study, and the prevalence of long COVID was 46.5%. The two most frequent categories were general and neurological post-COVID syndrome, with a prevalence of 36.7% each. The most commonly observed symptoms were fatigue (63.7%) and memory problems (49.1%). In the multivariate analysis, the predictive factors for long COVID were female gender and age of 60 years or older, while complete anti-COVID vaccination was found to be a protective factor. CONCLUSIONS: Our study found that complete vaccination was a protective factor against long COVID, while female gender and age of 60 years or older were identified as the main risk factors. These findings are consistent with studies conducted on other ethnic groups. However, many aspects of long COVID remain unclear, including its underlying mechanisms, the identification of which could guide the development of potential effective treatments.

Medical students' resilience level and its associated factors: A Tunisian study.

INTRODUCTION: Resilience is one's ability to adapt to internal and external stressors and cope with challenges encountered throughout life. AIM: Our work aimed to determine resilience levels at the Medical University of Ibn El Jazzar-Sousse (Faculty of Medicine of Sousse) Tunisia and to identify the key factors influencing resilience in order to help students improve their college experience, as well as their future career and eventually their quality of life. METHODS: It's a cross-sectional study conducted during October and November 2021 at the FMS including all undergraduate medical students using a questionnaire elaborated in French language and composed of 02 major parts Socio-demographic and general health data and The Connor-Davidson Resilience Scale (CD-RISC). Data were collected using Google Forms platform via social networks (Facebook students' groups). RESULTS: A total of 225 participants filled the questionnaire; the mean age was 21±5 years. Among them 75.1% were females (sex ratio=0.33). The total resilience mean score was 56.36±12.43. Comparison of resilience scores according to different covariates showed that resilience was positively associated with male gender, extracurricular activities, relationships with both colleagues and teachers and physical exercise, but negatively associated with imposed course of study and perception of both study difficulties and personal academic results. No correlation was found between resilience score and age. CONCLUSIONS: This work encourages university administrators to devote more resources to promote resilience, and it emphasizes the importance of implementing new educational and entertaining interventions to improve students' ability to deal with academic challenges.

Patient safety culture in Tunisian maternity care: Analytic study.

INTRODUCTION: Given the potential risks involved in childbirth, patient safety is of utmost importance in maternity care. AIM: To compare the level of patient safety culture between physicians and paramedics in public maternity care structures in Sousse, Tunisia. METHODS: An observational descriptive and cross-sectional study was conducted among health professionals working in all public health maternities of Sousse, Tunisia. A valid Hospital Survey On Patient Safety Culture (HSOPSC) questionnaire was used to gather data, and a score was calculated for each dimension by taking the average of the positive response proportions per item. RESULTS: The global response rate was 86.4%. Paramedics had a higher response rate compared to physicians (90.6% versus 62.1%). The overall scores for the ten dimensions of patient safety culture showed significantly higher scores for physicians compared to paramedics for the dimensions of "Expectations and actions of superiors regarding care safety" and "healthcare professional-patient relationship and safety culture" (88.43% versus 63.73%; p=0.027 and 75.38% versus 65.73%; p=0.041 respectively). Conversely, a significant difference was found in favor of paramedics compared to physicians regarding the dimension of "Management support for care safety" (37.3% versus 13%; p=0.019). CONCLUSION: Significant differences in patient safety culture scores among healthcare professionals. It suggest that efforts should be made to improve management support for care safety for physicians, while paramedics could benefit from increased attention to expectations and actions of superiors regarding care safety and healthcare professional-patient relationship.

Compassion fatigue among frontline healthcare workers during the covid-19 pandemic in Tunisia.

BACKGROUND: Healthcare workers (HCWs) are highly vulnerable to compassion fatigue (CF), which not only leads to decreased mental and physical health, but also to deterioration in the safety of care delivered. Our study aims to measure compassion satisfaction (CS), CF levels and their predictors among Tunisian HCWs. METHODS: We conducted a cross-sectional study among HCWs caring for confirmed and suspected Covid-19 patients, staff at two university hospitals in Sousse, Tunisia during the 4thwave of coronavirus through a self-administrated Questionnaire, using the French version of the Professional Quality of Life scale ProQol, version 5. RESULTS: A total of 274 professionals were recruited with a mean age of 32.87±8.35 years. HCWs tend to have an overall moderate levels of compassion satisfaction, secondary traumatic stress and burnout with mean scores 35.09±7.08, 29.72±7.62, 28.54±5.44 respectively. Self-reported resilience (ß = 0.14, p = 10-3), work engagement (ß = 0.39, p = 10-3) and burnout (ß = -0.32, p = 10-3) were the predictors of compassion satisfaction in the linear regression analysis (adjusted r2 = 0.45). Similarly, limited work experience, compassion satisfaction and secondary traumatic sub-scores were the determinants of burnout (ß = -0.1, p = 0.04; ß = -0.54, p = 10-3; ß = 0.35, p = 10-3 respectively); (adjusted r2 = 0.48). Regarding STS, female professionals (ß = 0.20, p = 10-3), being married (ß = 0.19, p = 10-3), the fear of transmitting the infection (ß = 0.11, p = 0.03) and burnout (ß = 0.39, p = 10-3) were the predictors for the occurrence of secondary traumatic stress (adjusted r2 = 0.48). CONCLUSION: More resilience promoting interventions and more coping skills programs must be implemented to fulfill HCWs' psychological well-being needs.

Patient safety in medical education: Tunisian students' attitudes.

Health care delivery continues to be unsafe despite major patient safety (PS) improvement efforts over the past decade. Medical school education plays an important role in promoting this culture during initial training. To determine undergraduate medical students' attitudes toward PS at a Tunisian medical school. We carried out a cross-sectional study among undergraduate medical students at Ibn Al Jazzar Medical School in Sousse, Tunisia, using a self-administered questionnaire inspired from the valid tool: Attitudes to Patient Safety Questionnaire (APSQ III). A total of 178 medical students responded to the questionnaire. Medical students tend to have an overall positive perceptions of PS culture with a global mean score 5.33 ± 0.5. Among the individual domains 'Working hours as a cause of error' earned the highest score (6.38 ± 1.0) followed in order by 'Team functioning' (6.24 ± 0.8), 'Error inevitability' (5.91 ± 1.0) and 'Patient involvement in reducing error' (5.50 ± 1.0). The lowest score was for 'Professional incompetence as a cause of error' (4.01 ± 1.0). A PS domain's mean scores comparison based on socio-demographic variables: gender, age, academic year and on PS training revealed a statistically significant difference (p < 0.05) for five PS key dimensions: ' Error reporting confidence ', ' Working hours as a cause of error ', ' Professional incompetence as a cause of error ', ' Team functioning ' and 'PS training received'. Tunisian medical students showed positive attitude towards PS. Nevermore, intensive in terms of frequency and duration sessions, based on various teaching methods may be needed to fulfill students' educational needs.

Hesitation of the Tunisian population to COVID-19 vaccination, and its associated factors.

BACKGROUND: Many people are reluctant to be vaccinated against COVID-19. AIM: To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians. METHODS: We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression. RESULTS: In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR: 3.257, 95% CI : 1.204 - 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 - 0.433) were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 - 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it. CONCLUSION: The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.

[Strength of academic motivation among medical students in the Faculty of Medicine of Sousse (Tunisia)].

INTRODUCTION: Motivation is an important component of learning. It remains a complex phenomenon to explore, largely influenced by multiple external and internal factors. It is important to measure the strength of student motivation in a long training course such as medical studies and its influencing factors. AIM: to measure strength of motivation among medical students the Faculty of Medicine of Sousse (FMS). METHODS: It was a cross-sectional study conducted among medical students enrolled at the FMS during the 2021/2022 academic year for 3 months using a questionnaire based on a validated scale: Strength of Motivation for Medical School-Revised (SMMS-R). RESULTS: A total of 185 students participated in the study. The mean age was 20.97 ± 1.8 years. The sex ratio was 0.34. The SMMS-R score was 55[47-63]. This score was higher international students (p=0.029), students who chose medical studies before passing the baccalaureate (p<10-3) and students satisfied with their choice of medical studies (p<10-3). CONCLUSION: Our results revealed a strong association between students' satisfaction and motivation. Thus, the learning environment, governed mainly by institutional rules, educational activities and evaluative practices, greatly influences satisfaction and therefore motivation of medical students.

Good hygiene practice application in the private sector, Tunisia.

BACKGROUND: Healthcare-associated infections (HCAIs) occurring outside of health facilities are underestimated because there are a lack of structured preventive organization and absence of epidemiological surveillance. HCAI prevalence is likely to grow with the increase in patient care outside of health institutions. AIMS: To set up a situational analysis of good hygiene practices among private general practitioners (GPs) to better organize HCAI prevention in this sector. METHODS: A descriptive cross-sectional study was conducted between November 2017 and March 2018, using a self-administered questionnaire among all GPs in Sousse City, Tunisia. RESULTS: Participation rate was 93.1%. There was a predominance of male GPs (63%), with a sex ratio of 1.7:1. Up-to-date vaccination status was reported by 82 (75.9%) of GPs. Fifty-six (51.3%) GPs used hydroalcoholic solutions, 13 (12.1%) adopted autoclaving, and 106 (98.1%) wore gloves during invasive care. Blood exposure accidents (BEAs) were reported by 38 (35.2%; declared in 26.3% of cases) and were more prevalent in the group aged > 50 years who used significantly more reusable equipment. BEAs were primarily due to needle-stick injuries (86.8%). CONCLUSION: We identified the priority axes to be considered in organizing HCAI prevention in the private sector, which allows guidance of GPs, avoiding their isolation and compensating for their lack of training and information. This requires willingness and a culture of improving the quality and safety of care in this sector. Committed involvement of several stakeholders at different levels of decision-making in health care is needed.

Burden of Healthcare-associated infections in a Tunisian University Hospital in 2019.

BACKGROUND: Healthcare-associated infections (HAI) represent a real threat to patient safety and their prevention should be a priority for any Health system. Prevalence surveys constitute one of the most common methods of HAI epidemiological surveillance to determine the burden of this problem. AIM: The aim of this study is to determine the prevalence of HAI and its associated risk factors. METHODS: It is a cross-sectional survey, carried out at Farhat Hached University Hospital in 2019, over a period of nine days including all patients who had been hospitalized for at least 48 hours, in 21 clinical departments of our hospital. A single passage has been carried out by department. RESULTS: Of 373 patients included, a total of 66 patients experienced HAI, with a mean prevalence of 17.7%. In addition, four patients suffered from two types of HAIs. The overall prevalence of HAI in Farhat Hached University Hospital was 19%. Peripheral venous catheter associated infection (41.5%) was the most common type of infections recorded in this survey. Patients admitted to a surgical ward were 4.6 times more likely to acquire HAIs. Patients admitted for more than 7 days were 4.57 times more at risk of developing HAIs. Exposure to peripheral venous catheter, to central venous catheter and to mechanical ventilation were among significant risk factors responsible for HAI with adjusted OR of 4.90, 10.65 and11.99, respectively. CONCLUSION: Prevalence of HAI is high at our center. National strategy to address HAI should be implemented for better control of HAIs.

Learning of medical English and academic curricular reform in medicine.

BACKGROUND: English is indispensable in the field of science and especially in medicine: it is the predominant language of publications and medical bibliographic databases. In addition, the training of competent physicians and the foundation of a socially responsible faculty of medicine and in order to comply with the international standards stipulated by the accreditation and certification of faculties of medicine, the Faculty of Medicine of Sousse- Tunisia initiated a curriculum revision leading to the setting up of a working group to reform the "Medical English" system. AIM: To identify the deficiencies of the academic learning of medical English following a rigorous analysis of the specificities of the teaching, to make the diagnosis of the current situation and to propose the required recommendations. METHODS: The analysis of the so far medical English teaching process at the Faculty of Medicine of Sousse was approached by coupling the two methods related to the cause and effect: the SWOT (Strength-Weaknesses / Opportunities-Threats) methodology and the diagram of Ichikawa. RESULTS: Our analysis revealed a lack of effectiveness for various reasons related to the lack of identification of learning needs by levels in a clear and precise manner, a quantitative and qualitative insufficiencyof hourly volume with an inadequate distribution compared to the other disciplines and content not updated. Thus,a shortfall ininnovative human and material resources. CONCLUSION: The learning of medical English must be upgraded in order to improve skills and promote the quality of health care.

Promoting safety culture through health-care professional-patient relationship's improvement.

BACKGROUND: promoting patient safety culture is a strategic priority and converges towards improving quality of health care. The healthcare professionals-patient relationship is an essential concept of patient safety culture. However, the increase of patient safety awareness is still delayed in Tunisia. OBJECTIVE: to assess and analyze the healthcare professional-patient relationship level among all healthcare professionals' categories in university hospital centre (UHC)FarhatHached, Sousse¬ Tunisia in order to further direct our strategies. METHODS: We carried out a descriptive cross-sectional study among healthcare professionals at our UHC. The French version of the "Hospital Survey On Patient Safety Culture" was adopted, and self-administered to 319 care providers, including 116 physicians and 203 paramedical personals. RESULTS: Response rate was 90.5% (289/319). The overall mean score for positive perception of the explored domain was 58.4%. However, physicians reported significant higher percentage of positive responses than paramedical staff (69.7% versus 53.4%; p=0.01). Positive perception was notified by 83.5% of all healthcare professional regarding to item relative to "adverse events may affect the relationship of trust between physician-patient", it was significantly higher among  physicians compared to paramedics (97.7% versus 77.4% ; p<10-4). CONCLUSION:   Dimension concerning healthcare professional-patient relationship was poorly developed among health care professionals in our hospital. Thus, it is crucial to improve this situation and to create a well-balanced healthcare professional-patient relationship based on partnership and taking into account individual factors.

Maternal mortality in Maghreb: problems and challenges of public health.

The epidemiology of Maternal Mortality (MM) associated with practical field specificities led, inter alia, to adopt consensus approaches developed by international community in order to control the situation (MM in 2015 of  303000 with 830 daily deaths by perinatal complications). Application degree of these approaches, while based on scientific evidence, remains country-dependent, with emerging problems within large geographical entities. This is the case of the Maghreb countries* that are facing concrete realities requiring better state commitment, allocation of resources and time, and improved accessibility to the continuum of care. Public health remains the leading discipline in maternal health offering expertise in analysis and intervention that will not be enough to implement effective programs, because it is essential to consider practical realities, often poorly known or ignored. The required efficiency needs a large, egalitarian and multi-disciplinary partnership with socio-anthropology, health economics, political science and political and community mobilization specialists. Strategies adopted by Maghreb countries* must be updated and adapted to national and then regional specificities by involving stakeholders in concerned sectors. In addition, to implant mechanisms ensuring best governance and actor's accountability, it is a priority to support quality assurance projects, institutionalize partnerships between different care levels and opt to accreditation of maternal health care structures and services. A depth reflection seam necessary for implementation of mobile health support schemes that provide maternal care with enhanced proximity and better adaptation to real needs of communities. * The article concerns exclusively the following 3 countries: Tunisia, Algeria and Morocco.

[Incidence of adverse events associated with the peripheral venous catheter in a Tunisian university hospital]. / Incidence des événements indésirables associés au cathéter veineux périphérique dans un service de cardiologie, Tunisie.

OBJECTIVE: To determine the incidence of peripheral venous catheters-related adverse events (PVCAEs). METHODS: We conducted a prospective observational study in the cardiology department over a period of 3 months. All inserted PVCs were monitored (every 12 hours) from insertion to up to 48 hours after removal. RESULTS: Data were analyzed for 148 patients with a mean age of 63.37±12.26 years and male predominance (n=76, 51.4%). The most common medical history was high blood pressure (56.1%) followed by obesity (39.2%). Intake of antibiotics was noted in 16.2% of cases where amoxicillin-clavulanic acid was the most prescribed molecule (4.1%). A total of 210 PVCs was studied (794 PVC-days). The mean maintenance time was 5.36±3.95 days. 38 PVCs resulted in 70 AEs with an incidence of 33.33 % (8.81 per 1000 PVC-days). The most common complication was pain (n=35, 50%), followed by mechanical PVCAEs (n=22, 31.42%). CONCLUSION: The incidence of PVCAEs remains high. The analysis of the main risk factors for these AEs would make better the identification of the preventive actions that should be undertaken.

[Perceptions of a healthcare-associated infections reporting system in a Tunisian university hospital]. / Perceptions d'un système de signalement des infections associées aux soins dans un hôpital universitaire tunisien.

Objective: The implementation of a healthcare-associated infections reporting system is a principal component of infection control and quality improvement policies in healthcare institutions. This study was designed to determine the perceptions of health professionals concerning implementation of a healthcare-associated infections reporting system and to analyse factors influencing these perceptions.Methods: A descriptive cross-sectional study conducted in 2012 using a predefined, pre-tested and self-administered questionnaire in 380 health professionals working in 16 different departments of Farhat Hached University Hospital, Tunisia.Results: The majority of respondents (71.8%) reported that no healthcare-associated infections surveillance procedure had been implemented in their departments. However, most respondents (93%) recognised the value of implementation of a healthcare-associated infections reporting system in order to provide them with corrective actions (77%), to support the investigation of epidemic and emerging phenomena (49%) and to share experiences about the prevalence of healthcare-associated infections and their risk factors (44%).Conclusion: Staff training and development of a regulatory framework are essential to implementation and correct functioning of a healthcare-associated infections reporting system.

Device-vigilance and environment of the medical practice.

INTRODUCTION: The Device-vigilance (DV) manages incidents or risk of incidents related to the use of medical devices (MD). In Tunisia, absence of a regulatory framework organizing DV is the major obstacle to caregivers' involvement in this system. OBJECTIVE: 1/Compare knowledge, attitudes and practices of our UHC's physicians regarding the establishment of DV system (medical versus surgical) and 2/Detect effect of healthcare's environment on risk's perception linked to the use of MD. METHODS: It is a descriptive cross-sectional and comparative study type knowledge, attitudes and practices; among all physicians of our UHC who are users of MD during their practice. A self-administered pre-established pre-tested questionnaire has been established. Data seizure and analyzing was performed using SPSS software20.0. Test adopted was the X2 (Pearson)(p<0.05) with correction using Yates or exact test Fischer. RESULTS: A statistically significant difference in favor of physicians exercising in medical services is reported for the knowledge of standardized reporting form's existence(p=0.04). Physicians practicing in surgical services report incidences and risk of incidences regarding MD use significantly more than their colleague of medical services. For attitudes, surgical physicians perceive the responsible of the reporting as any caregiver (p=0.007).As for the practices, they are for the presence of MD's organized management in the service of exercise(P<10-4). CONCLUSION: At any healthcare environment, lack of knowledge, inadequacy of the attitudes and readjustment of practices among our physicians must be filled. The promulgation of regulatory texts is necessary in order to promote DV's sector of and to ensure the safety of both patients and caregivers.

[Legal redress in relation to physical injury due to post-traumatic anterior pituitary insufficiency]. / Réparation juridique en dommage corporel de l'insuffisance antéhypophysaire post-traumatique.

Post-traumatic anterior pituitary insufficiency (PTAPI) is a rare but established disease caused by ischemic lesions after severe cranial trauma. This case study aims to highlight the criteria for imputability of PTAPI to a cranial trauma as well as the specific principles of legal redress in relation to this disease. We conducted a forensic study of a patient with diagnosed PTAPI followed up in the Division of Endocrinology and Legal Medicine at the University Hospital, Sousse (Tunisia). The patient included in the study was a 45-year old woman with no particular past medical history. (6 gynaecological procedures, 4 parities and 2 abortions) having regular menstrual cycles, without a history of hemorrhagic childbirth, who had been involved in a road accident (pedestrian got hit by a car) causing occipital trauma without initial knowledge loss. She developed hypothyroidism three years after the accident. The hormonal assessment showed the involvement of all the other axes. Neuroradiological examination objectified pituitary gland and pituitary stalk integrity. The definitive diagnosis of PTAPI was made. Medical examination (performed 4 years after the accident) concluded that PTAPI was imputable to the accident. Permanent partial disability rate according to ordinary law has been assessed at 25%. PTAPI diagnosis is made by elimination. The evaluation of physical injury should be based on residual symptoms, on therapeutic constraints and on its impact on daily and professional activity. Patient's evolution under hormone replacement therapy is often favorable, however, complications may occur, hence the necessity to establish these complications in order to preserve the right of the patient to underwent new treatments.

[Patient safety culture based on a non-punitive response to error and freedom of expression of healthcare professionals]. / Culture sécurité des patients par la réponse non-punitive à l’erreur et la liberté d’expression des soignants.

This study provided an overview of healthcare professionals’ perception of patient safety based on analysis of the concept of freedom of expression and non-punitive response in order to identify and correct errors in our health system. This concept is a cornerstone of the patient safety culture among healthcare professionals and plays a central role in the quality improvement strategy..