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This paper investigates organizational reform in healthcare organizations and particularly in Emergency Departments (EDs). As EDs play a fundamental role in ensuring both the continuity and permanence of high-quality health care, their organization is still the subject of increasing attention from both researchers as well as professionals and remains a crucial field requiring continuous improvement. In this study, we are interested in a particular real case study focusing on the ED of a Tunisian public teaching hospital. Given the Tunisian context for health care system, the goal was first to explore the considered ED in-depth to examine carefully the actual organization and detect several problems on this issue. In this context, effective job descriptions were established to identify the strategic responsibilities and distinguish competencies of health care staff. Based on this organizational analysis, we were focused on the elaboration of an optimal organizational structure that is more appropriate to the investigated ED. Considering these successful initiatives in designing the overall organization structure, health care specialists would be able to create momentum for new progress in health care performance such as making much more effective schedules for their operational processes.

Despite the tremendous clinical advances, breast cancer remains one of the deadliest cancers for women around the world. This has led to a wide variety of awareness and screening programs in several countries, with often questioned real impacts. In this perspective, this multidisciplinary study was conducted to evaluate the effectiveness of the Tunisian national breast cancer screening campaign in 2019. The Data Envelopment Analysis (DEA) approach was used to measure the relative effectiveness of the governorates with respect to this campaign. Preliminary numerical experimentation reveals promising results and highlights venues for future studies.

The healthcare sector aims providing patients with the best quality of care. However, healthcare supply chain management is costly. In this paper, we focus on inventory drugs management. The main major problems regarding inventory management practice in healthcare system are: drugs shortage, overstock, unfunded forecasting technique due to the lack of drugs consumption information and absence of IT support as Decision Support System. In order to address this concern, this paper presents a real case study of a drug inventory management problem within the emergency service of a Tunisian Hospital: Charles Nicolle Teaching Hospital. The indicated service aims to optimize the drug stock management and procurement while reducing drug shortage and stock management costs. Precisely, we have investigated a set of the real hospital dataset and, in particular, the emergency service's pharmacy. This analysis phase has yield to develop a drugs classification and to establish adequate inventory policy for each drug family. The implementation of the developed policies reduces significantly the stock management costs. Then, a Decision Support System (DSS) was implemented to assists users to improve the drugs inventory management as well as to make reliable decisions by taking the adequate action at the right moment.

Introduction: The Hajj pilgrimage in Mecca is an annual mass gathering event with high risk of infectious diseases.Method: In this short communication we try to check clinical evidence comforting pneumococcal vaccination to prevent pneumonia in elderly pilgrims to Mecca.Results and Discussion: Current medical researches focused on microorganism portage and pathogens responsible of epidemic infectious diseases. In this context, and since the epidemic meningitides declared among Mecca pilgrims in 1987, vaccination procedures were developed. However recommendations for prevention of respiratory tract infection, mostly faired when Influenza H1N1 or Middle East Coronavirus are suspected, are still under health professional expectations.Conclusion: Since many countries published clinical expert reports, we recommend an international clinical survey to provide evidence based practice of pneumococcal vaccination for elderly pilgrims to Mecca.

Resume Objectif Le prelevement d’organes humains en Tunisie reste en deca des besoins. Ceci est en partie du au refus des familles a ce que l’on preleve les organes de leurs proches en mort encephalique. Nous avons realise une enquete sur un echantillon representatif de la population de la capitale tunisienne (2,8 millions habitants) avec comme objectif de preciser, parmi les personnes refusant cette notion du don cadaverique, les determinants du refus pour individualiser des pistes d’action. Methodes Ce sondage d’opinion a ete effectue dans la region de Tunis entre le mois de mars 2006 et le mois de fevrier 2007. Les 16 questions de l’enquete repondaient a quatre themes principaux a savoir l’evaluation des connaissances, l’opinion et l’attitude du citoyen, la justification explicite du refus et les declarations avancees en cas de refus du don d’organes. Resultats 80,7 % des 902 individus sondes connaissaient la greffe d’organes en Tunisie. Une personne sur deux acceptait de donner ses organes apres la mort. Parmi le groupe d’enquetes refusant le don de leurs organes apres la mort, l’absence d’un plaidoyer clair a ete observee dans 55,3 % des cas. L’atteinte a l’integrite du corps apres la mort ainsi que l’obstruction religieuse etaient en tete de liste des determinants du refus avec respectivement une prevalence de 79,9 % et 63,1 %. Conclusion La quete dans la relation corps et spiritualite et l’individualisme comportemental sont les deux explications de l’ampleur de ce phenomene de refus du don d’organes a Tunis.

Background The mild head injury is a mild traumatic pathology in most cases and the role of emergencies often comes down to an early lesion assessment, analgesic treatment and practice of a brain scan. The follow up is assured by the neurology departments and no feedback is communicated to emergencies and thus no relationship between the original picture and the prognosis can be established. The aim of our study is to evaluate the prognosis of mild head injury after one month based on initial data. Methods Descriptive prospective study of the clinical and evolutionary characteristics of mTBI isolated over a three months period (October-December 2009). Results We collected 200 cases of mTBI. The average age of patients was 38.9 years with a sex ratio of 1.78. The initial loss of consciousness was reported in 95 patients (47.5%) and was predictive of the presence of intracranial lesions (p = 0.02). Follow up has been done in 84.5% of cases. CT scan was performed in 50.5% and allowed to reveal traumatic defects in 16.8% of cases. The existence of an epistaxis, agitation or periorbital hematoma was correlated with the existence of traumatic injuries to the scanner (p Conclusions The initial loss of consciousness, the initial GCS, evaluating the severity of the accident and the patient’s condition are predictors of the existence of intracranial lesions indicating brain scan. These factors with brain damage, Masters Score and ISS are prognostic factors which are correlated with the appearance of post concussion syndrome. Early psychological treatment is necessary.