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Gaddas AM, Ben Dhiab M, Ben Saad H. Physician autonomy in crisis: examining the right to refuse commitment. Libyan J Med 2024; 19:2337475. [PMID: 38569155 DOI: 10.1080/19932820.2024.2337475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Auteurs Meriem Gaddas
- Faculty of Medicine 'Ibn el Jazzar' of Sousse, University of Sousse, Sousse, Tunisia
- Department of Physiology and Functional Explorations, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Faculty of Medicine 'Ibn el Jazzar' of Sousse, University of Sousse, Sousse, Tunisia
- Forensic Medicine Service, Farhat Hached EPS of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Faculty of Medicine 'Ibn el Jazzar' of Sousse, University of Sousse, Sousse, Tunisia
- Department of Physiology and Functional Explorations, Farhat Hached University Hospital, Sousse, Tunisia
- Research Laboratory LR12SP09 'Heart Failure, University of Sousse, Farhat Hached University Hospital, Sousse, Tunisia
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Farhat H, Alinier G, Helou M, Galatis I, Bajow N, Jose D, Jouini S, Sezigen S, Hafi S, Mccabe S, Somrani N, Aifa KE, Chebbi H, Amor AB, Kerkeni Y, Al-Wathinani AM, Abdulla NM, Jairoun AA, Morris B, Castle N, Al-Sheikh L, Abougalala W, Dhiab MB, Laughton J. Perspectives on Preparedness for Chemical, Biological, Radiological, and Nuclear Threats in the Middle East and North Africa Region: Application of Artificial Intelligence Techniques. Health Secur 2024. [PMID: 38335443 DOI: 10.1089/hs.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Over the past 3 decades, the diversity of ethnic, religious, and political backgrounds worldwide, particularly in countries of the Middle East and North Africa (MENA), has led to an increase in the number of intercountry conflicts and terrorist attacks, sometimes involving chemical and biological agents. This warrants moving toward a collaborative approach to strengthening preparedness in the region. In disaster medicine, artificial intelligence techniques have been increasingly utilized to allow a thorough analysis by revealing unseen patterns. In this study, the authors used text mining and machine learning techniques to analyze open-ended feedback from multidisciplinary experts in disaster medicine regarding the MENA region's preparedness for chemical, biological, radiological, and nuclear (CBRN) risks. Open-ended feedback from 29 international experts in disaster medicine, selected based on their organizational roles and contributions to the academic field, was collected using a modified interview method between October and December 2022. Machine learning clustering algorithms, natural language processing, and sentiment analysis were used to analyze the data gathered using R language accessed through the RStudio environment. Findings revealed negative and fearful sentiments about a lack of accessibility to preparedness information, as well as positive sentiments toward CBRN preparedness concepts raised by the modified interview method. The artificial intelligence analysis techniques revealed a common consensus among experts about the importance of having accessible and effective plans and improved health sector preparedness in MENA, especially for potential chemical and biological incidents. Findings from this study can inform policymakers in the region to converge their efforts to build collaborative initiatives to strengthen CBRN preparedness capabilities in the healthcare sector.
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Affiliation(s)
- Hassan Farhat
- Hassan Farhat, MRes, MSc, is a Quality Improvement Mentor, Quality Patient Safety and Risk Management, Ambulance Service Group, Hamad Medical Corporation, Doha, Qatar; PhD Candidate, Faculty of Medicine "Ibn El Jazzar," University of Sousse, Sousse, Tunisia; and PhD Candidate, Faculty of Sciences, University of Sfax, Sfax, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Guillaume Alinier
- Guillaume Alinier, PhD, MPhys (Hons), PGCert, SFHEA, NTF, is Director of Research, Ambulance Service, Hamad Medical Corporation, Doha, Qatar; Visiting Professor, School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Adjunct Professor, Weill Cornell Medicine-Qatar, Doha, Qatar; and Visiting Professor, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Mariana Helou
- Mariana Helou, MD, MSc DM, is a Clinical Assistant Professor and Clerkship Director of Emergency Room, Division Head of Emergency Medicine, Internal Medicine Department - Emergency, Medicine Gilbert and Rose-Marie Chagoury School of Medicine, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Ionnais Galatis
- Ionnais Galatis, Brigadier General (ret.), MD, MSc, MC, is an MD Consultant in Allergy & Clinical Immunology, Medical/Hospital/Ops CBRNE Planner/Instructor, Senior Asymmetric Threats Analyst, and Research Associate, Center for Security Studies (KEMEA), Athens, Greece; Manager, CBRN Knowledge Center, International CBRNE Institute, Brussels, Belgium; and Senior Advisor, Research Institute for European and American Studies, Alimos, Greece, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Nidaa Bajow
- Nidaa Bajow, MD, PhD, is Disaster Medicine Coordinator and Disaster Medicine Training Supervisor, Disaster Medicine Unit, Emergency Department Security Force Hospital Riyadh, Saudi Arabia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Denis Jose
- Denis Jose, Pharm D, PhD, is Colonel, Head, Pharmaceutical Services, and Technical Adviser on Toxicological and CBRNE Risk Management, Alpes-Maritimes Fire and Rescue Services, Paris, France, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sarra Jouini
- Sarra Jouini, MD, is Emergency Coordinator, Emergency Department, Charles Nicolle Hospital, and an Associate Professor, EL Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sermet Sezigen
- Sermet Sezigen, MD, PhD, is an Associate Professor, Department of Medical CBRN Defense, University of Health Sciences, Ankara, Turkey, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Samia Hafi
- Samia Hafi, MD, is Head of SAMU(EMS), Hospital of Gabes, Gabes, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sheena Mccabe
- Sheena Mccabe, MSc, is a Consultant Lecture for BSc in Crisis and Emergency Management, Ras Laffan Emergency and Safety College, Ras Laffan, Qatar, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Naoufel Somrani
- Naoufel Somrani, MD, is General Director of Public Health Facilities, Ministry of Health, Tunis, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Kawther El Aifa
- Kawther El Aifa, MSc, is a Quality Management/Improvement Reviewer, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Henda Chebbi
- Henda Chebbi, MD, is Assistant Director of Emergency Medicine Unit, Strategic Health Operations Center (SHOCR Room), Emergency Medicine Directorate, Ministry of Health, Tunis, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Asma Ben Amor
- Asma Ben Amor, MRes, is a Paramedicine Professor, Higher School of Health Sciences and Technologies of Sousse, and a PhD Candidate, Faculty of Medicine "Ibn El Jazzar," University of Sousse, Sousse, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Yosra Kerkeni
- Yosra Kerkeni, MD, is Emergency Coordinator, Emergency Medicine, Ministry of Health, Tunis, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Al-Wathinani
- Ahmed M. Al-Wathinani, MHA, PhD, is Vice Dean of Academic Affairs, College of Applied, Business Administration; Chairman of the Emergency Medical Services Department; Associate Professor of Emergency and Disaster Management, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, at King Saud University, Riyadh, Saudi Arabia
| | - Nassem Mohammed Abdulla
- Nassem Mohammed Abdulla, PhD, is Head of Department, Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates, in Doha, Qatar
| | - Ammar Abdulrahman Jairoun
- Ammar Abdulrahman Jairoun, PhD, is Senior Consumables Material Inspection Officer, Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates; and Head of Department, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia, in Doha, Qatar
| | - Brendon Morris
- Brendon Morris, MRes, MTec, is Executive Director, Major Incident Planning and Resilience, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Nicholas Castle
- Nicholas Castle, PhD FIMC, is Interim Executive Director, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Loua Al-Sheikh
- Loua Al-Sheikh, MBChB, BSc(Hons), FRCA, is Medical Director, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Walid Abougalala
- Walid Abougalala, MBBS, EMDM, JMC(EM), MSc, MAo, MEdu, is a Consultant Emergency Preparedness and Response Department, Ministry of Public Health; Chairman, Corporate Facility Management and Safety Committee; and Consultant Emergency and Disaster Medicine, Hamad Medical Corporation, in Doha, Qatar
| | - Mohamed Ben Dhiab
- Mohamed Ben Dhiab, MD, is Vice Dean, Academic Affairs, Faculty of Medicine "Ibn El Jazzar," University of Sousse, and Professor of Forensic and Legal Medicine, Farhat Hached Academic Hospital, Sousse, Tunisia
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Kouada R, Annabi K, Mosbahi A, Masmoudi T, Ben Dhiab M. L’accès aux soins des migrants en Tunisie en 2023-2024: Situation actuelle et enjeux éthiques. Tunis Med 2024; 102:65-69. [PMID: 38567469 DOI: 10.62438/tunismed.v102i2.4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.
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Affiliation(s)
- Rihem Kouada
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Khaled Annabi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Amal Mosbahi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Tasnim Masmoudi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
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Ben Abderrahim S, Chérif K, Nfikha Z, Gharsallaoui S, El Aini I, Jedidi M, Mokni M, Ben Dhiab M. Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature. J Forensic Sci 2023. [PMID: 37144741 DOI: 10.1111/1556-4029.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Hepatic adenomatosis is a rare disease consisting of multiple adenomas in otherwise-normal liver parenchyma. Though the discovery of this entity goes back several years, its diagnosis is still challenging in terms of its definition and pathophysiology. Clinically, patients may be completely asymptomatic and the diagnosis is only made incidentally through imaging tests. The discovery could be made when complications occur such as intraperitoneal hemorrhage with hypovolemic shock due to the rupture of an adenoma. We report a fatal case of a ruptured adenoma in a case of hepatic adenomatosis discovered at autopsy. In order to achieve a better view of this disease, we conducted a literature review on this subject describing the pathogenesis, manifestations, and autopsy contribution to addressing this entity.
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Affiliation(s)
- Sarra Ben Abderrahim
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Khouloud Chérif
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Zeineb Nfikha
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sarra Gharsallaoui
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen El Aini
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Maher Jedidi
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Moncef Mokni
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
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Ben Daly A, Gharsallaoui S, Jedidi M, Gammoudi B, Zemni M, Souguir MK, Ben Dhiab M. Fatal blast injuries in tyre blowouts: two autopsy case reports. Egypt J Forensic Sci 2022. [DOI: 10.1186/s41935-022-00317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Fatal blast injuries are generally reported as a consequence of explosions, mainly in terrorist events, work-related detonations, or domestic settings. Although quite rare, blast injuries of high kinetic energy can be seen in tyre blowouts and are very dangerous and potentially lethal because of their unpredictability. This phenomenon is rarely reported in the existing forensic literature.
The aim of this study was to report two cases of fatal truck tyre bursts and to discuss the mechanisms leading to the burst and the pattern of injuries.
Case presentations
Case 1 was of a 58-year-old truck driver man who was standing nearby a detached tyre that was being inflated in a repair shop when the burst occurred. The tyre struck him in the face and threw him. The medicolegal autopsy showed a right periorbital haematoma, a large wound of the left parietal scalp, a diffuse subarachnoid haemorrhage, an atlanto-occipital dislocation, a fracture of the hyoid bone, multiple rib fractures, and lacerations of the ascending aorta and the pulmonary arteries. Case 2 involved a young man of 24-year-old, a worker in a tyre repair shop, who was inflating a truck’s tyre when it burst violently. The injuries sustained included bleeding from the right ear, fractures of the facial bones, a left hemispheric subdural haematoma associated with the fracture of the skull base, a rib fracture, and diffuse areas of contusions to the lungs. Toxicological analyses were negative in both cases.
Conclusion
Fatalities related to tyre blowout accidents are uncommon. The mechanisms leading to a blowout can be mechanical or chemical in origin, and the main danger of a burst often occurs when air enters the tyre during inflation. Internal damage caused by the pressure waves of the blast often exceeds what would be expected based on external signs alone.
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Ben Abderrahim S, Jedidi M, Ben Daly A, Nfikha Z, Ben Dhiab M, Zemni M, Mokni M, Souguir MK. Death by late presenting of diaphragmatic hernia in an infant: case report and review of the literature. Egypt J Forensic Sci 2022; 12:39. [PMID: 36158167 PMCID: PMC9489477 DOI: 10.1186/s41935-022-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. If not properly diagnosed before or at birth, CDH represents a life-threatening pathology in infants and a major cause of death. We present a fatal case of congenital diaphragmatic hernia corresponding to Bochdalek hernia, discovered incidentally during a sudden death’s autopsy of an infant. To achieve a better view of the range of these anomalies, we also conducted a literature review on this subject describing the pathogenesis, manifestations, diagnosis, and autopsy contribution to addressing these CDH. Case presentation The case involved a 4-month-old female infant who presented sudden respiratory difficulties after breastfeeding. External examination found marked cyanosis with no evidence of trauma. Upon opening the chest cavity, the stomach, markedly distended, was occupying much of the left pleural cavity. The left lung was compressed and displaced superiorly, and the heart was also compressed and deviated to the right. This mediastinal deviation was due to an ascension of the stomach into the chest cavity through a 2 × 1.5 cm defect in the posterior left hemidiaphragm. Further examination remarked an ecchymotic appearance of the stomach portion entrapped in the hernia defect suggesting recent strangulation of the stomach. The lungs showed atelectasis with signs of pulmonary infection in the histology study. Conclusions CDH might be considered uncommon and not always mentioned in the list of sudden death in infant causes. Forensic pathologists should know of this malformation in order to apply the best autopsy techniques and thus allow positive feedback to pediatricians considering the possible legal implications.
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Gaddas M, Ben Dhiab M, Ben Saad H. Medical experimentation on prisoners (part 2): role of doctors in research abuses. Tunis Med 2022; 100:497-502. [PMID: 36571737 PMCID: PMC9703464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The involvement of physicians as an executive tool in the excesses of medical experimentation in prisons continues to raise questions and incomprehension. From the depths of the extermination camps under the Nazi regime to the iterative exploitation scandals after the Second World War, the ability of certain physicians to overstep the foundations of the Hippocratic Oath of «do no harm» and associate themselves with so many atrocities will always surprise. The answers to this question seem ambiguous because the excesses of medical experimentation in prisons should be reconsidered in their associated historical-political context. This history note, the second in a series on medical experimentation in prisons, aims to relieve the excesses attributed to physicians during medical experimentation on prisoners.
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Affiliation(s)
- Meriem Gaddas
- 1. Service de Physiologie et des Explorations Fonctionnelles, EPS.Farhat Hached de Sousse, Tunisie /Université de Sousse, Faculté de Médecine «Ibn el Jazzar»
| | - Mohamed Ben Dhiab
- 2. Service de Médecine Légale, Sousse, EPS.Farhat Hached de Sousse, Tunisie. / Université de Sousse, Faculté de Médecine «Ibn el Jazzar» de Sousse
| | - Helmi Ben Saad
- 1. Service de Physiologie et des Explorations Fonctionnelles, EPS.Farhat Hached de Sousse, Tunisie /Université de Sousse, Faculté de Médecine «Ibn el Jazzar»,3. Laboratoire de recherche (LR12SP09) «Insuffisance cardiaque», EPS Farhat HACHED de Sousse, Tunisie.
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Tlili MA, Aouicha W, Tarchoune S, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Ajmi T, Ben Rejeb M, Mallouli M. Predictors of evidence-based practice competency among Tunisian nursing students. BMC Med Educ 2022; 22:421. [PMID: 35655300 PMCID: PMC9161527 DOI: 10.1186/s12909-022-03487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based practice (EBP) is an important competency of undergraduate nursing students which should be cultivated before graduation by increasing future healthcare providers' knowledge, skills and attitudes towards EBP. This study aimed to describe nursing students' competencies (attitudes, knowledge, skills) in Evidence-based practice (EBP) and to determine factors predicting EBP competency. METHODS A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among 365 nursing students. Data were collected using the validated Evidence Based Practice Competencies Questionnaire (EBP-COQ). Multiple linear regression was performed to determine factors predicting EBP competencies. RESULTS The overall score of EBP-COQ questionnaire was 3.26 ± 0.53 out of 5. The attitude, skills and knowledge subscales received 4.04 ± 0.41; 3.05 ± 0.77 and 2.70 ± 0.74 as mean scores respectively. Multiple linear regression analysis (table 4) revealed that significant related factors were academic level (β = 0.271, p = 0.001), English-language reading skills (β = 0.435, p < 0.001), facing staff resistance in implementing a new evidence-based procedure (β = - 0.081, p = 0.035) difficulties in obtaining full-text papers (β = - 0.127, p < 0.001) and training in methodology (β = 0.232, p < 0.001) and also in statistics (β = 0.205, p < 0.001). CONCLUSIONS These results help to understand students' attitudes, knowledge and skills in EBP and can be therefore a starting point to develop effective strategies for EBP curricula.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, 4054, Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, 4054, Sousse, Tunisia
| | - Syrine Tarchoune
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, 4054, Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, 4054, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia
- Sahloul University Hospital, Department of Prevention and Care Safety, 4054, Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
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Ben Abderrahim S, Gharsallaoui S, Ben Daly A, Mosbahi A, Chaieb S, Nfikha Z, Ismaïl S, Makni C, Mokni M, Fathallah-Mili A, Jedidi M, Ben Dhiab M. Imported malaria in adults: about a case of cerebral malaria. Egypt J Forensic Sci 2022; 12:19. [PMID: 35382261 PMCID: PMC8972756 DOI: 10.1186/s41935-022-00279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Malaria is the first parasitic infection endemic in the world caused by parasites species of Plasmodium. Cerebral malaria (CM) is a rapidly progressive and severe form of Plasmodium falciparum infection, characterized by a greater accumulation of red blood cells parasitized by Plasmodium falciparum in the brain. The diagnosis of malaria is usually made in living patients from a blood sample taken in the course of a fever on return from an endemic country, whereas CM, often associated with fatal outcomes even in treated subjects, is usually diagnosed at autopsy.
Case presentation
We present the case of a 36-year-old man who died a few days after returning from a business trip to the Ivory Coast. As a result of an unclear cause of death, a medicolegal autopsy was ordered. Autopsy findings revealed massive congestion and edema of the brain with no other macroscopic abnormalities at organ gross examination. Histology and laboratory tests were conducted revealing a Plasmodium falciparum infection, with numerous parasitized erythrocytes containing dots of hemozoin pigment (malaria pigment) in all examined brain sections and all other organs. Death was attributed to cerebral malaria with multiple organ failure.
Conclusions
This report summarizes several features for the diagnosis of malaria and how postmortem investigations, as well as histology and laboratory diagnosis, may lead to a retrospective diagnosis of a fatal complicated form with cerebral involvement.
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Gaddas M, Ben Dhiab M, Jedidi M, Zribi M, Ben Khelil M, Ben Saad H. [Medical experimentation on prisoners (part 5): ethical considerations]. Tunis Med 2022; 100:736-743. [PMID: 37551514 PMCID: PMC10226411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Medical experimentation on prisoners is one of the most difficult ethical issues because it brings many principles into conflict with the reality of the practice. These ethical principles, which are universal and timeless, are accepted as elementary rights for every human being. However, in a detention setting, these principles are easily lost. Moreover, the scope of this problem goes far beyond the walls of the penitentiary to touch on conflicting issues of scientific publication, social discrimination, and even political decisions sometimes. The present history note, the fifth in a series on medical experimentation on prisoners, intended to discuss the main ethical considerations regarding prisoners, and to highlight the difficulty of their implementation.
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Zairi I, Ben Dhiab M, Mzoughi K, Ben Mrad I, Kraiem S. Assessing medical student satisfaction and interest with serious game. Tunis Med 2021; 99:1030-1035. [PMID: 35288906 PMCID: PMC9390128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Serious games are interactive and entertaining digital software with an educational purpose, and they are increasingly being used in undergraduate medical education. Effective serious games attempt to form positive mood in order to encourage players to continue the play, leading to increased interest in gameplay and satisfaction as well as better academic performances. AIM To determine the medical students' satisfaction, situational and individual interest during a serious game. METHODS This was a prospective study performed during a 2-year period (2018-2019 and 2019-2020). A total of 108 third-year medical students participated in this study. Students were asked to play a serious game on a computer for 20 minutes. A set of questionnaires containing evaluation grids to measure the satisfaction and interest was given to students. The effectiveness of the game was assessed using pre and post-tests. RESULTS Following the exclusion criteria of students due to missing data, complete data were available for 97 students. Satisfaction and interest experienced by the students were high. The median of the game performance of students was 418, 04 points. There was a positive relationship between ease of use and game performance. There was a negative correlation between the three scales of interest and game performance. There was a significant difference between the mean scores of pre-tests and post-tests (p<0.01). CONCLUSION The results of this study suggest the potentials of serious game on medical student's satisfaction, interest and learning achievement.
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Affiliation(s)
- Ihsen Zairi
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université de Tunis El Manar
| | - Mohamed Ben Dhiab
- 2- Service de médecine légal, Hôpital Farhat Hached, Faculté de Médecine de Sousse, Université de Sousse.
| | - Khadija Mzoughi
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université de Tunis El Manar
| | - Imtinen Ben Mrad
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université de Tunis El Manar
| | - Sondos Kraiem
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université de Tunis El Manar
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Zairi I, Dhiab MB, Mzoughi K, Mrad IB, Abdessalem IB, Kraiem S. Serious Game Design with medical students as a Learning Activity for Developing the 4Cs Skills: Communication, Collaboration, Creativity and Critical Thinking: A qualitative research. Tunis Med 2021; 99:714-720. [PMID: 35261002 PMCID: PMC8796679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The impact of technology in education has led to various changes in the way that different stakeholders, like students and teachers work and interact with each other. The use of the serious game design in educational contexts has been related to the development of the 21st century skills such as communication, collaboration, creativity and critical thinking. AIM To analyze a serious game design process by third -year medical students, from the perspective of the 21st century competencies engaged in the game design process. Those outlined key competencies are communication, collaboration, creativity and critical thinking. METHODS This is a qualitative, descriptive, and inductive study that follows a phenomenological approach. Twelve volunteer third-year medical students participated in an activity of designing of serious games. This study, carried out during summer internship in the cardiology department of Habib Thameur Hospital. The course of the designing of serious games with students spread over 4 weeks with 10 hours face-to-face and 10 hours of remote work. RESULTS The participants in our study were twelves third-year medical students. Of these 12 students, 10 were female. The duration of each interview depends on each participant's ability. The analysis of the data, based on the phenomenological method of Giorgi brought out four central themes: theme 1: Critical thinking skills and problems solving skills, theme 2: Communication, theme 3: Creativity, theme 4: Collaboration. The overall essence of the phenomenon is these third medical students who experienced the serious game design outlined key competencies. CONCLUSION Using serious game development-based learning as a learning method to impart multidimensional skills and knowledge suggests a promising approach for developing clinical reasoning, creativity, communication, and collaboration in students.
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Affiliation(s)
- Ihsen Zairi
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de médecine de Tunis
| | | | - Khadija Mzoughi
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de médecine de Tunis
| | - Imtinen Ben Mrad
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de médecine de Tunis
| | - Imen Ben Abdessalem
- 3- Service de cardiologie, Hôpital Farhat Hached, Faculté de médecine de Sousse
| | - Sondos Kraiem
- 1- Service de cardiologie, Hôpital Habib Thameur, Faculté de médecine de Tunis
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Nihel H, Latifa M, Anissa A, Raja G, Souheil M, Wael M, Maher J, Slah S, Ben Dhiab M. Characteristics of violence against women in Kairouan, Tunisia, in 2017. Libyan J Med 2021; 16:1921900. [PMID: 33970830 PMCID: PMC8118423 DOI: 10.1080/19932820.2021.1921900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia. This survey was designed as a cross-sectional study. It concerned women victims of violence over 18 years old, consulting the emergency department of the University Hospital of Kairouan during 3 months in 2017. We defined violence against women according to the Tunisian protection of gender discrimination law. This survey included 100 Tunisian victims of violence; their median age was 35 (ranging from 18 to 59 years old). This study showed that 58% of victims, CI95% [48.3%, 67.6%], were illiterate or had only a primary level education and that 90%, CI95% [84.1%, 95.8%], had a low or middle socioeconomic level. The Intimate Partner Violence was about 70% among all cases, CI 95% [61.0%, 78.9%]. Most aggressive partners were young (aged between 39 and 51 years old). The most affected part of the body was the face (76%, CI 95% [67.6%, 84.3%]). Alcohol consumption was the primary risk factor of violence in 29.6% of cases, CI95% [20.0%, 37.9%]. Other risk factors were the occupational instability, conflicts with the family in-laws and infidelity. Violence against women remains widespread. Even strict legislations in Tunisia didn’t protect women sufficiently from different types of violence. It mostly happens within intimate relationships. Therefore, surveillance and early intervention controlling risk factors are extremely important.
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Affiliation(s)
- Haddad Nihel
- Department of Epidemiology and Hospital Hygiene, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Merzougui Latifa
- Department of Epidemiology and Hospital Hygiene, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ajina Anissa
- Department of Anesthesiology, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Guezel Raja
- Department of Emergency, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mlayeh Souheil
- Department of Forensic Medicine, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Majdoub Wael
- Department of Forensic Medicine, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Jedidi Maher
- Department of Forensic Medicine, University Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Soui Slah
- Department of Anesthesiology, University Hospital Ibn El Jazzar of Kairouan, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Department of Forensic Medicine, University Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Aouicha W, Tlili MA, Sahli J, Dhiab MB, Chelbi S, Mtiraoui A, Latiri HS, Ajmi T, Zedini C, Ben Rejeb M, Mallouli M. Exploring patient safety culture in emergency departments: A Tunisian perspective. Int Emerg Nurs 2020; 54:100941. [PMID: 33341462 DOI: 10.1016/j.ienj.2020.100941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors. METHODS A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire. RESULTS In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions. CONCLUSION This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.
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Affiliation(s)
- Wiem Aouicha
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Mohamed Ayoub Tlili
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Dhiab
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
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Tlili MA, Aouicha W, Dhiab MB, Mallouli M. Assessment of nurses’ patient safety culture in 30 primary health-care centres in Tunisia. East Mediterr Health J 2020; 26:1347-1354. [DOI: 10.26719/emhj.20.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
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Tlili MA, Aouicha W, Sahli J, Zedini C, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Latiri H, Ajmi T, Ben Rejeb M, Mallouli M. A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals. Aust Crit Care 2020; 34:363-369. [PMID: 33121872 DOI: 10.1016/j.aucc.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings. OBJECTIVES This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors. METHODS This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items. RESULTS A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10-3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018). CONCLUSION This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia) - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
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Aouicha W, Tlili MA, Limam M, Snéne M, Ben Dhiab M, Chelbi S, Mtiraoui A, Ajmi T, Ben Rejeb M, Mallouli M. Evaluation of the Impact of Intraoperative Distractions on Teamwork, Stress, and Workload. J Surg Res 2020; 259:465-472. [PMID: 33616077 DOI: 10.1016/j.jss.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Within the operating rooms (ORs), distractions occur on a regular basis, which affect the surgical workflow and results in the interruption of urgent tasks. This study aimed to observe the occurrence of intraoperative distractions in Tunisian ORs and evaluate associations among distractions, teamwork, workload, and stress. METHODS This observational cross-sectional study was conducted in four different ORs (orthopedic, urology, emergency, and digestive surgery) of Sahloul University Hospital for a period of 3 mo in 2018. Distractions and teamwork were recorded and rated in real time during the intraoperative phase of each case using validated observation sheets. Besides, at the end of each operation, stress and workload of team members were measured. RESULTS Altogether, 50 cases were observed and 160 participants were included. Distractions happened in 100% of the included operations. Overall, we recorded 933 distractions that occurred once every 3 min, with a mean frequency of M = 18.66 (standard deviation [SD] = 8.24) per case. It is particularly noticeable that procedural distractions occurred significantly higher during teaching cases compared with nonteaching cases (M = 3.85, M = 0.60, respectively, P < 0.001). The mean global teamwork score was M = 3.85 (SD = 0.67), the mean workload score was M = 58.60 (SD = 24.27), and the mean stress score was M = 15.29 (SD = 4.00). Furthermore, a higher stress level among surgeons was associated with distractions related to equipment failures and people entering or exiting the OR (r = 0.206, P < 0.01 and r = 0.137, P < 0.01, respectively). Similarly, nurses reported a higher workload in the presence of distractions related to the work environment in the OR (r = 0.313, P < 0.05). CONCLUSIONS This study highlighted a serious problem, which often team members seem to ignore or underestimate. Taking our findings into consideration, we recommend the implementation of the Surgical Checklist and preoperative briefings to reduce the number of surgical distractions. Also, a continuous teamwork training should be adopted to ensure that OR staff can avoid or handle distractions when they happen.
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Affiliation(s)
- Wiem Aouicha
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia.
| | - Mohamed Ayoub Tlili
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia
| | - Manel Limam
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia
| | - Maha Snéne
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia
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Turki E, Mosbahi A, Annabi K, Majdoub W, Ben Dhiab M. Patient information in radiology: medico-legal considerations. Tunis Med 2020; 98:705-709. [PMID: 33479941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Information constitutes a basic right of the patient and a legal obligation of the physicians. Radiological daily practice has evolved mainly by introducing the care rule of radiologists. This active rule is leading to add new medico-legal challenges. Patient Information is considered as a cornerstone of the valid consent to radiological investigations. A lack of information constitutes a fault against medical humanism being able to engage civil or administrative medical liability. Therefore, radiologists must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information.
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Tlili MA, Aouicha W, Sahli J, Testouri A, Hamoudi M, Mtiraoui A, Ben Dhiab M, Chelbi S, Ajmi T, Ben Rejeb M, Mallouli M. Prevalence of burnout among health sciences students and determination of its associated factors. PSYCHOL HEALTH MED 2020; 26:212-220. [PMID: 32835517 DOI: 10.1080/13548506.2020.1802050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Burnout is a major issue among healthcare students and a public health issue in general. Indeed, the consequences of student burnout are as complex as other mental distress factors, such as those concerned with smoking and alcohol consumption, or an unhealthy lifestyle. This study aimed to determine the prevalence of burnout among health sciences students and to determine its associated factors. This is a cross-sectional descriptive study conducted among 368 students of a Tunisian institution using the French validated version of the MBI-SS. The prevalence of burnout was 64.4%. The presence of a diagnosed health problem, a diagnosed mental disorder or sleep problems were associated with burnout. Students who live alone are significantly the most emotionally exhausted (p=0.010) and the most cynical (p=0.033). Students who had a low socio-economic level are significantly more cynical than those who had a medium or high socio-economic level (p=0.032). Performing leisure activities and practicing physical activities were associated with emotional exhaustion (p=0.007, p= 0.008, respectively).In our study, burnout is prevalent among Tunisian health sciences students. Many factors were found to be associated with this syndrome. These findings reinforce the need to establish early preventive strategies to encounter this problem and its consequent risks.
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Affiliation(s)
- Mohamed Ayoub Tlili
- Faculty of Medicine of Sousse, Laboratory of Research LR12ES03 «Qualité des soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia
| | - Wiem Aouicha
- Faculty of Medicine of Sousse, Laboratory of Research LR12ES03 «Qualité des soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia
| | - Jihene Sahli
- Faculty of Medicine of Sousse, Department of Community Health, Laboratory of Research LR12ES03 «Qualité des Soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia
| | - Ameni Testouri
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia
| | - Marwa Hamoudi
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia
| | - Ali Mtiraoui
- Faculty of Medicine of Sousse, Department of Community Health, Laboratory of Research LR12ES03 «Qualité des Soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Souad Chelbi
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia.,Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thouraya Ajmi
- Faculty of Medicine of Sousse, Department of Community Health, Laboratory of Research LR12ES03 «Qualité des Soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - Manel Mallouli
- Faculty of Medicine of Sousse, Department of Community Health, Laboratory of Research LR12ES03 «Qualité des Soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia
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Mlayeh S, Annabi K, Daly AB, Jedidi M, Dhiab MB. Pesticide poisoning deaths: a 19-year retrospective study of medicolegal autopsies in center Tunisia. Egypt J Forensic Sci 2020. [DOI: 10.1186/s41935-020-00201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pesticide poisoning is recognized as an important public health problem worldwide, especially in the developing countries, such as Tunisia, where these products are massively used in agriculture. The objective of our study was to document the forensic deaths caused by pesticides reported from a forensic center located in the coastal region of Tunisia.
Methods
This is a 19-year retrospective descriptive study of lethal pesticide poisoning victims autopsied in the Department of Forensic Medicine at Farhat Hached University Hospital in Sousse, Tunisia, from 1991 to 2009.
Results
One hundred thirty deaths were collected. The majority of the victims were female (62% vs 38%). The mean age was 27.46 years with the highest frequency of poisoning deaths occurring in the 21-30 years age group (34%). Eleven percent of the victims were found in a state of coma and 4.6% suffered from respiratory distress. Signs observed during the external examination of the bodies were as follows: bluish discoloration of the lips and the limbs (n = 130, 100%), leakage of urine (n = 13, 10%), foaming at the mouth or the nose (n = 66, 50.8%). The most frequent signs found during autopsies were pulmonary edema in 88.4% of the cases and multiorgan congestion in 86.9%. Toxicological screening of the stomach content was positive for pesticides in 126 cases. Intoxication was mainly caused by cholinesterase inhibitor insecticides: carbamates (50%) and organophosphorus compounds (31.5%). In 92% of cases, death was in a context of suicide.
Conclusions
This study shows that a large proportion of pesticide poisoning deaths are preventable. Prevention is, on the one side, by restricting the availability of pesticides and on the other side by promulgating more vigorous legislation concerning the manufacturing, the marketing, and the use of these products.
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Tlili MA, Aouicha W, Ben Rejeb M, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Laatiri H, Ajmi T, Zedini C, Mallouli M. Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study. J Crit Care 2020; 56:208-214. [PMID: 31952015 DOI: 10.1016/j.jcrc.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it. MATERIALS AND METHODS This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study. The measuring instrument used is the French validated version of the "Hospital Survey on Patient Safety Culture" questionnaire. RESULTS A total of 402 professionals, from 18 ICUs and 10 hospitals, participated in the study with a participation rate of 82.37%. All dimensions were to be improved. The most developed dimension was teamwork within the unit (47.87%) and the least developed dimension was the non-punitive response to error (18.6%). Seven dimensions were significantly more developed in private institutions than in public ones. Results also show that when workload is reduced, the PSC was significantly increased. CONCLUSION This study has shown that the PSC in ICUs needs improvement and provided a baseline results to get a clearer vision of the aspects of security that require special attention.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Houyem Said Laatiri
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
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Mzoughi K, Zairi I, Kedous MA, El Mhamdi S, Ben Dhiab M, Mghaieth F, Kraiem S. Script concordance test as a sanctionnal evaluation in cardiology. Tunis Med 2018; 96:330-334. [PMID: 30430468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Sanctioning evaluation in cardiology is carried out using multiple choice questions, short-answer questions, clinical cases and editorial questions. However, these methods do not assess clinical reasoning in a context of uncertainty in contrast with script concordance tests (SCT). AIM To compare the scores obtained by the students in the 3rd year of medicine with the SCT versus the sanctioning test of cardiology and to study the correlation between these two evaluation methods. METHODS This is a prospective study including 31 3rd year students who completed their cardiology clerckship in the Cardiology Department of the HabibThameur Hospital during the first half of 2016. We compared the scores obtained in the 13 SCT test (39 items) with those of the cardiology normative test. RESULTS Students 'mean score at SCT was significantly lower than that of experts (66.6 ± 10.2 vs 86 ± 6.7%, p <0.0001). The mean score obtained by students at the SCT was significantly higher than that of the cardiology sanctioning test (p <0.001). Cronbach alpha coefficient was 0.71. There was no correlation between the two tests (r = 0.329; p= 0.07). CONCLUSION The evaluation of our students by the SCT showed mean score statistically higher than the questions of a classic test, without correlation between them. This should encourage us to incorporate SCT into our assessment methods to promote clinical reasoning.
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Affiliation(s)
- Manel Mallouli
- Department of Community and Family Medicine, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Maha Dardouri
- Higher School of Sciences and Techniques of Health, University of Sousse, Sousse, Tunisia
| | - Maher Maoua
- Department of Occupational Medicine, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Chekib Zedini
- Department of Community and Family Medicine, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Ali Mtiraoui
- Department of Community and Family Medicine, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Higher School of Sciences and Techniques of Health, University of Sousse, Sousse, Tunisia
| | - Thouray Ajmi
- Department of Community and Family Medicine, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
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Braham MY, Jedidi M, Hmila I, Masmoudi T, Souguir MK, Ben Dhiab M. Epidemiological aspects of child abuse and neglect in Sousse, Tunisia: A 10-year retrospective study. J Forensic Leg Med 2018; 54:121-126. [PMID: 29413953 DOI: 10.1016/j.jflm.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/18/2017] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
Abstract
The aim of our study was to examine epidemiological aspects of child abuse and neglect in Tunisia. We conducted a retrospective and descriptive study over a period of 10 years (January 2006-December 2015), based on the files handled by the Child Protective Services (CPS) agency in the city of Sousse, Tunisia. During the study period, 3736 referrals were received by the CPS agency of Sousse. Of the total, 2212 (59.2%) were screened in and investigated. Of the investigated cases, 317 (14,3%) were substantiated as abuse or neglect. The reports of maltreatment came mostly from parents (37.8%). Neglect was the major type of maltreatment (51.4%) and an association of 2 types of maltreatment was found in 76 cases (24%). Parents were the perpetrators in 221 cases (69.7%). The average age of the victims was 10 years and boys accounted for 56%. In the 257 cases where the marital status of the parents was noted in the files, the parents were divorced in 62 cases (24.1%) and the child lived with a single mother in 35 cases (13.6%). Alcohol addiction was found in 21 parents (6.6%) and one of the parents was incarcerated in 39 cases (12.3%). As for the socio-economic status, it was evaluated in 188 families and was low in 123 cases (65.4%). In the absence of studies related to this scourge in Tunisia, we hope to raise awareness of the abuse and alert those who come into contact with the child on the importance of detecting and reporting early maltreatment and thus to introduce more appropriate care. A comprehensive prevention strategy needs to be established by addressing risk factors, cultural norms conducive to abuse and unwanted pregnancies.
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Affiliation(s)
- Mohamed Yassine Braham
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia.
| | - Maher Jedidi
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia
| | - Imene Hmila
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia
| | - Tasnim Masmoudi
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia
| | - Mohamed Kamel Souguir
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Department of Legal Medicine, Farhat Hached University Hospital, Avenue Ibn El Jazzar, 4000 Sousse, Tunisia
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Jedidi M, El khal MC, Mlayeh S, Mahjoub M, Mezgar Z, Masmoudi T, Dhiab MB, Zemni M, Souguir MK. Death in detention in Sousse, Tunisia: a 10-year autopsy study. Egypt J Forensic Sci 2018. [DOI: 10.1186/s41935-018-0044-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tlili MA, Belgacem A, Sridi H, Akouri M, Aouicha W, Soussi S, Dabbebi F, Ben Dhiab M. Evaluation of surgical glove integrity and factors associated with glove defect. Am J Infect Control 2018; 46:30-33. [PMID: 28893444 DOI: 10.1016/j.ajic.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. MATERIAL AND METHODS This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ2 test was used with a significance threshold of 5%. RESULTS A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015). CONCLUSIONS This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.
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Affiliation(s)
- Mohamed Ayoub Tlili
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia.
| | - Amina Belgacem
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Haifa Sridi
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Maha Akouri
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Wiem Aouicha
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Sonia Soussi
- Health Sciences Research, Higher School of Health Sciences and Techniques of Tunis, University of Tunis El Manar, Tunisia
| | - Faten Dabbebi
- Department of Occupational Medicine, University Hospital Center of Sahloul, Tunisia
| | - Mohamed Ben Dhiab
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
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Abbes I, Abdelhak S, Abdelhedi C, Abid K, Abidi R, Acacha E, Achour S, Achour A, Adouni O, Afrit M, Ahlem A, Akik I, Akremi M, Aloui R, Aloulou S, Ammar N, Arem S, Athimni S, Attia L, Attia M, Ayadi M, Ayadi A, Ayadi K, Ayadi H, Ayadi L, Ayadi I, Ayari J, Azzouz H, Bacha D, Bahloul R, Bahri I, Bahri M, Bakir D, Balti M, Bargaoui H, Batti R, Bayar R, Bdioui Thabet A, Beji M, Bel Hadj Hassen S, Bel Haj Ali A, Belaid I, Belaid A, Beldjiilali Y, Belkacem O, Bellamlih O, Ben Abdallah W, Ben Abdallah M, Ben Abdellah H, Ben Abderrahmen S, Ben Ahmed S, Ben Ahmed K, Ben Ayache M, Ben Ayoub W, Ben Azaiz M, Ben Azouz M, Ben Daly A, Ben Dhia S, Ben Dhiab M, Ben Dhiab T, Ben Fatma L, Ben Ghachem D, Ben Hammadi S, Ben Hassen M, Ben Hassena R, Ben Hassouna J, Ben Kridis W, Ben Leila F, Ben Mahfoudh KH, Ben Mustapha N, Ben Nasr S, Ben Othman F, Ben Rejeb M, Ben Rekaya M, Ben Rhouma S, Ben Safta Z, Ben Safta I, Ben Said A, Ben Salah M, Ben Salah H, Ben Slama S, Ben Temime R, Ben Youssef Y, Ben Zid K, Benabdella H, Benasr S, Bengueddach A, Benna M, Benna F, Bergaoui H, Berrazaga Y, Besbes M, Bhiri H, Bibi M, Blel A, Bohli M, Bouali S, Bouaouina N, Bouassida K, Bouaziz H, Boubaker J, Boudaouara T, Boudaouara Z, Boudaouara O, Boughanmi F, Boughattas W, Boughizane S, Bouguila H, Bouhani M, Bouhlel B, Boujelbane N, Boujemaa M, Boulma R, Bouraoui S, Bouriga R, Bourmech M, Bousrih C, Boussen H, Boussen N, Bouzaien F, Bouzayene F, Brahem I, Briki R, Chaabene K, Chaabouni M, Chaari H, Chabchoub I, Chachia S, Chaker K, Chamlali M, Charfi L, Charfi M, Charfi S, Charradi H, Cheffai I, Chelly B, Chelly I, Chenguel A, Cherif A, Cherif O, Chiboub A, Chouchene A, Chraiet N, Daghfous A, Daldoul A, Daoud N, Daoud J, Daoud R, Daoud E, Debaibi M, Dhaouadi S, Dhief R, Dhouib F, Dimassi S, Djebbi A, Doghri R, Doghri Y, Doudech B, Dridi M, El Amine O, El Benna H, El Khal MC, Eladeb M, Elloumi M, Elmeddeb K, Enaceur F, Ennouri S, Essoussi M, Ezzairi F, Ezzine A, Faleh R, Fallah S, Faouzi N, Fathallah K, Fehri R, Feki J, Fekih M, Fendri S, Fessi Z, Fourati N, Fourati M, Frikha I, Frikha M, Gabsi A, Gadria S, Gamoudi A, Gargoura A, Gargouri W, Ghariani N, Ghazouani E, Ghorbal A, Ghorbel L, Ghorbel S, Ghozzi A, Glili A, Gmadh K, Goucha A, Gouiaa N, Gritli S, Guazzah K, Guebsi A, Guermazi Z, Guermazi F, Gueryani N, Guezguez M, Hacheni F, Hachicha M, Haddad A, Haddaoui A, Hadoussa M, Haj Mansour M, Hajjaji A, Hajji A, Hamdi A, Hamdi Y, Hammemi R, Haouet S, Hdiji A, Hechiche M, Hedfi M, Helali AJ, Henchiri H, Heni S, Hentati A, Herbegue K, Hidar S, Hlaf M, Hmida W, Hmida I, Hmida L, Hmila Ben Salem I, Hochlef M, Hsairi M, Jaffel H, Jaidane M, Jarraya H, Jebsi M, Jedidi M, Jlassi A, Jlassi H, Jmal H, Jmour O, Jouini M, Kabtni W, Kacem M, Kacem S, Kacem I, Kaid M, Kairi H, Kallel M, Kallel R, Kallel F, Kammoun H, Kamoun S, Kanoun Belajouza S, Karray W, Karrit S, Karrou M, Kchir N, Kdous S, Kehili H, Keskes H, Khairi H, Khalfallah MT, Khalifa MB, Khanfir A, Khanfir F, Khechine W, Khemiri S, Khiari H, Khlif A, Khouni H, Khrouf S, Kochbati L, Korbi I, Korbi A, Krir MW, Ksaier I, Ksantini R, Ksantini M, Ksantini F, Ktari K, Laabidi S, Laamouri B, Labidi A, Lahmar A, Lahouar R, Lamine O, Letaief F, Limaiem F, Limayem I, Limem S, Limem F, Loghmari A, M'ghirbi F, Maamouri F, Magherbi H, Mahjoub N, Mahjoub M, Mahjoubi K, Majdoub S, Makhlouf T, Makni A, Makni S, Mallat N, Manai MH, Mansouri H, Maoua M, Marghli I, Masmoudi T, Mathlouthi N, Meddeb K, Medini B, Mejri N, Merdessi A, Mesali C, Mezlini E, Mezlini A, Mezni E, Mghirbi F, Mhiri N, Mighri N, Mlika M, Mnejja W, Mnif H, Mokni M, Mokrani A, Mosbah F, Moujahed R, Mousli A, Moussa A, Mrad Dali K, Mrizak N, Msakni I, Mzabi S, Mzali R, Mzoughi Z, Naimi Z, Najjar S, Nakkouri R, Nasr C, Nasrallah D, Nasri M, Njim L, Noubigh GEF, Nouira Y, Nouri O, Omrani S, Osmane W, Ouanes Y, Ouanna N, Oubich F, Oumelreit Belamlih G, Rachdi H, Rafraf F, Rahal K, Raies H, Rammeh S, Rebaii N, Rekik W, Rekik H, Rhim MS, Rhim S, Rihab D, Rjiba R, Rziga T, Saad H, Saad A, Saadi M, Said N, Salah R, Sallemi N, Sassi A, Sassi K, Sassi Mahfoudh A, Sbika W, Sellami A, Serghini M, Sghaier S, Sh Zidi Y, Siala W, Slimane M, Slimani O, Soltani S, Souguir MK, Sridi A, Tabet Zatla A, Tajina D, Talbi G, Tbessi S, Tebra Mrad S, Temessek H, Tlili G, Toumi N, Toumi O, Toumia N, Tounsi H, Trigui E, Triki M, Triki A, Turki M, Werda I, Yahyaoui S, Yahyaoui Y, Yaich A, Yamouni M, Yazid D, Yousfi A, Zaghouani H, Zaied S, Zairi F, Zaraa S, Zehani A, Zenzri Y, Zidi A, Znaidi N, Zouari K, Zouari S, Zoukar O, Zribi A. Summaries of the papers of the 4th National Congress of the Tunisian Society of Medical Oncology attached to the 4th Maghreb Congress of Oncology. Tunis Med 2017; 95:859-964. [PMID: 29873056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Jedidi M, Tilouche S, Masmoudi T, Sahnoun M, Chkirbène Y, Mestiri S, Boughamoura L, Ben Dhiab M, Souguir MK. Infant acute myocarditis mimicking acute myocardial infarction. Autops Case Rep 2017; 6:15-19. [PMID: 28210569 PMCID: PMC5304557 DOI: 10.4322/acr.2016.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022] Open
Abstract
Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosis.
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Affiliation(s)
- Maher Jedidi
- Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia
| | - Samia Tilouche
- Department of Pediatrics - Farhat Hached University Hospital, Sousse - Tunisia
| | - Tasnim Masmoudi
- Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia
| | - Maha Sahnoun
- Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia
| | - Youssef Chkirbène
- Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia
| | - Sarra Mestiri
- Department of Pathology - Farhat Hached University Hospital, Sousse - Tunisia
| | - Lamia Boughamoura
- Department of Pediatrics - Farhat Hached University Hospital, Sousse - Tunisia
| | - Mohamed Ben Dhiab
- Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia
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Tlili MA, Mallouli M, Aouicha W, Guedhami F, Ben Dhiab M. The check-list in operating rooms, as perceived by tunisians caregivers. Tunis Med 2017; 95:115-119. [PMID: 29424870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The operating room is a high-risk environment for the patient and the healthcare professional and therefore their safety remains a priority in this unit. The checklist "patient safety in the operating room" showed, through the years, its effectiveness in promoting the quality of care and the patient safety. AIM To explore the perception of operating theaters professionals on the use of the checklist. METHODS This is a descriptive cross-sectional study among operating theaters professionals of the university hospitals in Sousse, Tunisia, and this during the period from 15 July 2015 until 15 September 2015. The measuring instrument used is derived from the validated questionnaire and proposed by the National Health Authority "individual questionnaire of opinion on the use of the checklist". RESULTS 98.1% expressed agreement that the checklist improves safety culture and 97.2% say that it is an opportunity to avoid mistakes. 88.1% think that the checklist is an additional administrative burden. The whole study population (100%) confirms the usefulness of the checklist in improving patient safety in the operating room. CONCLUSION Professionals operating theaters have expressed a positive attitude towards the checklist, however, its implementation raises some difficulties.
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Mallouli M, Tlili MA, Aouicha W, Ben Rejeb M, Zedini C, Salwa A, Mtiraoui A, Ben Dhiab M, Ajmi T. Assessing patient safety culture in Tunisian operating rooms: A multicenter study. Int J Qual Health Care 2017; 29:176-182. [DOI: 10.1093/intqhc/mzw157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/24/2016] [Indexed: 12/25/2022] Open
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Braham MY, Jedidi M, Chkirbene Y, Hmila I, ElKhal MC, Souguir MK, Ben Dhiab M. Caregiver-Fabricated Illness in a Child: A Case Report of Three Siblings. J Forensic Nurs 2017; 13:39-42. [PMID: 28212199 DOI: 10.1097/jfn.0000000000000141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver inducing a child's illness, leading to unnecessary and potentially harmful medical procedures and treatments. This condition can result in significant morbidity and mortality. We present the case of three siblings in Tunisia who were poisoned with chloralose by their own mother. The symptoms that the children presented with led to misdiagnoses, which resulted in the death of two of the children. Characteristics of the clinical presentation are articulated, followed by a discussion of the legal measures that apply to the offender and the role of physicians, nurses, and medicolegal experts involved in such a complex medical situation.
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Zairi I, Mzoughi K, Ben Dhiab M, Soussi S, Kraiem S. Evaluation of clinical reasoning teaching for third year medical students. Tunis Med 2017; 95:1-5. [PMID: 29327761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Clinical reasoning teaching is an educational method based on learning and contextualized education.The aim of this study was to determine the value of clinical reasoning teaching sessions, from the perspective of third year medical students using a self-administered questionnaire. METHOD Two successive groups of nine students (a total of 18 students) participated in this study.They had anexternship in the cardiology department of HabibThameur hospital during amonth.An anonymous evaluation self-administered questionnaire was submitted to the two groups at the end of the traineeshipperiod. RESULTS The average scores given by students for the items "quality of education", "workload", "atmosphere", "interest in teaching sessions"and "acquisition of new clinical knowledge" were greater than 8/10. Exposed health problem to be solved has attracted the interest and the motivation of 16 students and prompted 15 others to do further research.Fourteen students opted for clinical reasoning teaching as the preferred teaching method for optimal memorization.Thirteen students have found a real contribution ofreasoning teaching in the management of relationship with the patient.All students assumed that clinical reasoning meetings session should be more frequently usedduring the internship period. CONCLUSION Clinical reasoning teaching session appears to be widely desired by medical students.
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Ksiaa F, Ziadi S, Gacem RB, Dhiab MB, Trimeche M. Correlation between DNA methyltransferases expression and Epstein-Barr virus, JC polyomavirus and Helicobacter pylori infections in gastric carcinomas. Neoplasma 2014; 61:710-7. [PMID: 25341997 DOI: 10.4149/neo_2014_086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It' is accepted that aberrant expression of DNA methyltransferases (DNMTs) is responsible for hypermethylation in genes. However, there are limited data related to factors inducing aberrant expression of DNMTs. A total of 43 surgically resected gastrc carcinomas (GC) samples were analysed. Using immunohistochemistry assay we have determined expression level of DNMT1 and 3b. The presence of H.pylori was evaluated by histology, whereas JC polyomavirus (JCV) and Epstein-Barr virus (EBV) detection were carried out by PCR and in situ hybridization techniques, respectively. High expression of DNMT1 and 3b were detected in 46.5% and 53.5% of GC cases, respectively. Co-expression of DNMT1 and 3b were found in 37.2% of cases. Using different techniques, H. pylori, JCV and EBV were detected in 55.8%, 32.6% and 9%, respectively. Moreover, in 37% of cases, we noted the presence of JCV and/or EBV infections. H.pylori co-infection was found in 64.3% (9/14) of JCV positive cases and in 50% of EBV positive GC, without a reliable significant relationship. Correlation analyses have showed a marked increase in DNMT1 expression in EBV associated GC (P= 0.02). Also, co-expression of DNMT1 and 3b was significantly associated with EBV infection in GC (P=0.05). Similarly, JCV associated GC mostly displayed DNMT1 positive status, but the difference did not reach the significant threshold. Nevertheless, infection with JCV and/or EBV was significantly correlated with increased expression of DNMT1 in GC (P= 0.05). Our study suggests that EBV and JCV infections in GC correlated with deregulation of DNA methyltransferases.
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Jedidi M, Ben Dhiab M, Mlayeh S, Majdoub W, Zemni M, Duguet AM. [Organ and tissue harvesting in children: comparison of the legal framework in Tunisia and France]. Tunis Med 2011; 89:659-662. [PMID: 21948665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In Tunisia as in France, the legislator recognized the organ harvesting as of public health priority. To promote it, cells of coordination are created, and controlled by regulatory texts. There are differences in the strategy of organ harvesting in minor but whether he is alive or dead, he is well protected by law. Organ harvesting in alive child is prohibited in both Tunisia and France but the haematopoietic cells one is authorized. In the minor deceased organ harvesting obeys common principles, appearing in the bioethical law (France) and the law n°91-22 of March 25, 1991 (Tunisia) with a difference in the procedure of the assent of the legal guardian.
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Affiliation(s)
- Maher Jedidi
- Service de medicine legale, Chu Farhaat Hached, Tunisie
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Tomas C, Sanchez JJ, Barbaro A, Brandt-Casadevall C, Hernandez A, Ben Dhiab M, Ramon M, Morling N. X-chromosome SNP analyses in 11 human Mediterranean populations show a high overall genetic homogeneity except in North-west Africans (Moroccans). BMC Evol Biol 2008; 8:75. [PMID: 18312628 PMCID: PMC2315647 DOI: 10.1186/1471-2148-8-75] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 02/29/2008] [Indexed: 11/20/2022] Open
Abstract
Background Due to its history, with a high number of migration events, the Mediterranean basin represents a challenging area for population genetic studies. A large number of genetic studies have been carried out in the Mediterranean area using different markers but no consensus has been reached on the genetic landscape of the Mediterranean populations. In order to further investigate the genetics of the human Mediterranean populations, we typed 894 individuals from 11 Mediterranean populations with 25 single-nucleotide polymorphisms (SNPs) located on the X-chromosome. Results A high overall homogeneity was found among the Mediterranean populations except for the population from Morocco, which seemed to differ genetically from the rest of the populations in the Mediterranean area. A very low genetic distance was found between populations in the Middle East and most of the western part of the Mediterranean Sea. A higher migration rate in females versus males was observed by comparing data from X-chromosome, mt-DNA and Y-chromosome SNPs both in the Mediterranean and a wider geographic area. Multilocus association was observed among the 25 SNPs on the X-chromosome in the populations from Ibiza and Cosenza. Conclusion Our results support both the hypothesis of (1) a reduced impact of the Neolithic Wave and more recent migration movements in NW-Africa, and (2) the importance of the Strait of Gibraltar as a geographic barrier. In contrast, the high genetic homogeneity observed in the Mediterranean area could be interpreted as the result of the Neolithic wave caused by a large demic diffusion and/or more recent migration events. A differentiated contribution of males and females to the genetic landscape of the Mediterranean area was observed with a higher migration rate in females than in males. A certain level of background linkage disequilibrium in populations in Ibiza and Cosenza could be attributed to their demographic background.
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Affiliation(s)
- Carmen Tomas
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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