Introductionintensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few data regarding both outcomes of admitted patients to intensive care unit (ICU) in comparison with outcomes of not admitted patients. The aim of this study was to assess reasons and factors associated to refusal of admission to ICU as well as the impact on mortality at 28 days and patients' outcomes.MethodsSingle-center, cross-sectional descriptive study conducted in 8-bed Medical ICU at a Tunisian University hospital. All consecutive adult patients referred for admission to ICU during 6 months were included. We collected demographic data, ICU admission/refusal reasons, co-morbidity and diagnosis at time of admission, mortality probability model (MPMII0) score, day and time of admission, request for admission and mortality at 28 days.Results327 patients were evaluated for ICU admission and 260 were refused to ICU (79.5%). Patients refused because of unavailability of beds represented 50% and patients considered “too sick to benefit” represented 22%. Multivariate analysis showed that the presence of acute respiratory failure and request by direct contact in the unit were independently associated to admission to ICU (OR: 0.15; 95% CI: 0.07-0.31 and OR: 0.16; 95% CI: 0.08-0.31, respectively). Higher mortality rates were shown in patients “too sick to benefit” (80.7%) and unavailable beds (26.56%).ConclusionRefusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. ICU clinicians should evaluate their triage decisions and, if possible, routinely solicit patient preferences during medical emergencies, taking steps to ensure that ICU admission decisions are in line with the goals of the patient. Ultimately, these efforts will help ensure that scarce ICU resources are used most effectively and efficiently.
Background Illicit substance use among college students represents one of the most complicated social problems. Studying its predictors could help deal with this problem more efficiently. Aims To determine the prevalence of life time illicit substance use and its predictors among Tunisian college students. Methods A cross-sectional study was conducted in five colleges in the region of Sousse, Tunisia in the 2012-2013 school year. A sample of 556 college students responded to an anonymous self-administrated questionnaire. Collected data concerned socio-demographic characteristics and substances use. Results The mean age of students was 21.8 ± 2.2 years. Females represented 51.8% of participants. Among respondents: 31 (5.6%) had used illicit substance at least once. Cannabis was the main substance used by 26 (4.7%) students. The average age of the illicit substance use initiation was 19 (±2.5) years while it was almost 17 (±3) years for both tobacco and alcohol use initiations. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, tobacco use and low socioeconomic level. Conclusion This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.
Background Bullying is a serious public health concern affecting the emotional well-being of pupils. We conducted this study to examine the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior. Methods This is a cross-sectional study conducted in 2015 among a representative sample of pupils enrolled in 14 colleges in Sousse using the revised Olweus Bully/Victim Questionnaire. Results We included 1584 students aged between 11 and 15 years. The prevalence of bullying and victimization was 16.0% [95% CI: 14.2%, 17.8%] and 11.3% [95% CI: 9.7%, 12.9%] respectively. Four groups of students were identified, 11.7% were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy (38.3%, p < 10-3) and liking school (30.0%, p < 10-3). They were more likely to be aggressive (56.2%, p < 10-3) and disintegrated in the class (30.6%, p = 0.002). Among the victims, 11.1% reported that their parents contacted the school several times to stop their victimization. The majority of the middle school students perceived that their classmates (54.1%) and teachers (39.5%) did nothing to counteract the bullying behavior. Conclusions The school institution is expected to be for pupils a highly meaningful space for social, emotional and academic development. Parents, teachers and students should learn effective ways to handle the bullying problem since it has been emphasized that the most effective programs are comprehensive targeting students, schools, families, and the community. Key messages This is the first study conducted in Tunisia to highlight the extent of school bullying. Our findings can help to raise awareness of parents, school staff and policy makers about bullying.
IntroductionLa mortalité maternelle est un problème majeur de santé mondiale. Une grande proportion de ces décès serait évitable par des soins adéquats, une aide à l'accouchement, la disponibilité des soins d'urgence et l'utilisation des outils d'aide à la décision tels que le partogramme. L'objectif était d’évaluer l’écart entre ce qui est censé être fait et ce qui est fait réellement pour les différents paramètres situés dans le partogramme au sein d'une maternité de 3ème niveau et élaborer des recommandations pour la mise en place d'un plan d'action.MéthodesIl s'agit d'une étude descriptive rétrospective par audit clinique, effectuée sur un échantillon de 400 dossiers obstétricaux des parturientes ayant accouchées dans la maternité du CHU Farhat Hached durant l'année 2011. Le référentiel utilisé est celui réalisé par l'Agence Nationale d'Accréditation et d'Evaluation en Santé en l'an 2000, concernant la qualité de la tenue du partogramme.RésultatsLa majorité des critères d’évaluation portant sur la présentation du partogramme était conforme. Deux critères concernant la variété de la présentation et le rythme cardiaque fœtal étaient non conformes parmi ceux portant sur la surveillance du fœtus. Plusieurs critères en rapport avec la surveillance de la mère étaient non conformes. Aucun des critères portant sur les traitements administrés et les marqueurs d’évènements n'est conforme. Les critères portant sur la naissance et la surveillance immédiate qui étaient non conformes sont: le début des efforts expulsifs, le mode d'accouchement, l’état du périnée, la délivrance et la révision utérine.ConclusionLa véritable démarche de l'audit clinique se doit d'aller au-delà du recueil et de l'analyse des données, le but final étant l'amélioration des pratiques.
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