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[en] Many experiences were carried out through international cooperation projects in Tunisia. The exploitation of Tunisia aquifers depends more on development economic choices then on the characteristics of water tables. (N. H.)
[en] Cancer is a worldwide problem. According to the World Health Organization (WHO), 12.4 million of new cancer cases and 7.6 million of deaths have been registered worldwide, during 2012-2013. The trend is still rising. The International Agency for Research on Cancer (IARC), report that by 2030 there will be between 20 and 25 million cases of cancer, and 13 to 16 million of annual deaths due to cancer. Cancer remains the second cause of deaths in developed countries after cardiovascular diseases. This situation is beginning to be observed in emerging countries. Three main factors are advanced to explain the development of cancer: The population aging, the adoption of western lifestyle (bad eating habits, physical inactivity, obesity ...) and tobacco. In our country, the number of new cases of cancers per year is estimated to be 10300 (5900 for males and 4400 for females). The crude incidence rate for all localities is about 117.9 / 100 000, for male and 87.6 / 100,000, for females. We list the main achievements registered until now: The first program planed for the cancer was performed in the city of Jerba, in August 1995. The second cancer plan was done in 1995-1998, in Carthage. In December 1996, a cancer plan was established for the period between 2006 and 2010. About the cancer registration: three population-based cancer registries were set up (in the North, Sfax and Sousse). Regarding infrastructure, we count in the public sector: The Salah Azaiez Instiute of cancer (SAI), in Tunis, the two cancer centers (in Sousse and Sfax), the four units of oncological medicine (Jendouba, Gafsa, Gabes, Kairouan). Projects concerning radio and chemotherapy units are currently in progress, in Ariana, and two units of oncological medicine, in Beja and Monastir. In the private sector, three clinics are mentioned: 02 clinics are already active, the third is under construction and 04 clinics for radiotherapy (02 in Tunis and 02 in Sfax). There is a clear reduction in the time of appointment for radiotherapy in the public sector, especially when patients became taken in charge by the CNAM. We mention that the establishment of references (although not yet validated) and the law of 28 days for the prescription of morphine drugs, are useful to take in charge patients having certain cancers Major failures are observed in the taking in charge of patients for a good palliative care at the hospital and at home. It has been estimated that 66 beds are needed (20 in SAI, 10 in Ariana, 15 in Sousse, 15 in Sfax 15, 2 in each of the regional centers), four physicians (ISA, Sfax, Sousse and Ariana), 48 paramedics (15 to SAI, 6 to Ariana, 9 to Sfax, 9 to Sousse, 3 to Gafsa, 3 to Gabes 3, 3 to Jendouba), 10 physiotherapists (2 to SAI, 2 to Sfax, 2 to Sousse, 1 to Ariana, 1 in each regional unit). The main guidelines of the strategy against the cancer proposed for 2010-2014 are: consolidation of achievements and remediation of insufficiency. In the state plan it was proposed to enhance the program of prevention, early detection and treatment of cancers. We can be inspired by Paris chart against cancer to organize especially: the rights of patients, the help of their families and the fight against the stigma, the reduction of inequalities between patients and the development of research on cancer. It was proposed to develop the fight against cancer on several levels and that to reduce cancer mortality and exposure to major risk factors and improve the quality of life of patients and preserve their rights. Topics subject of development are: support of patients by health insurance, palliative care, assistance to patients and their families and the reduction of inequalities in access to care, early detection of the disease (which is the subject of these journeys), prevention, training, research and monitoring. (Author)
[en] In Tunisia the centralized organization of the medicine sector has a strategic and economic importance. It presents particular characteristics concerning the importation and the control of drugs. Tcp has a monopoly on the importation of drugs for the country, which enters in the state policy for the control of drug purchasing costs, their availability in different region of the country and their guarantee and quality. The Tcp has a crucial role in the availability of drugs and in the holding safety stock and strategic reserve of the imported pharmaceutical products, either for the public or private sector. The Tcp has to stock up medicaments, chemical and pharmaceutical products, objects of bandages, instruments, accessory tools and other supplies necessary for the human and veterinary medicine. The Tcp packages any specialized or not medicament and all other products or supplies. The Tcp provides medicaments and products entering within the framework of its task to different health groups and hospitals. The Tcp provides distributors, laboratories and pharmacies over the country. In Tunisia the import of radioisotopes used in the medical domain is attributed to the Tcp. The objective is to centralize purchases and to guarantee: the security, the availability as well as the traceability. The Tcp supply radiopharmaceutical products for diagnostic and therapy purposes according to an authorization delivered annually by the National Center of Radiation Protection (NCRP). An authorization of removal used at the customs allows the clearance of products at the level of the air freights by the transit service of the Tcp. Regarding the evolution of purchases of radio-pharmaceutical products, their importation remained stable during the last three years. Indeed, it is approximately around 1MDT annually (954 121 DT in 2010, 939 956 in 2011 and 1047 967 in 2012). Sources of supply are divided between 4 suppliers: International IBA-CISBIO (49.9 pour cent), COVIDIEN EX (TYCO HEALTHCARE GROUP AG) (28 pour cent), GE HEALTHCARE LIMITED (15.3 pour cent) and BEBIG (6.8 pour cent). Analysis of radioactive products showed that: 24 products on 155 imported products (15,48 pour cent), represent 80 pour cent of the global value of the imported products. Regarding the consumption of the 4 main customers, the analysis shows that SALAH AZAIZ institute used (47.2 pour cent), HABIB BOURGUIBA Sfax hospital (21.4 pour cent), SAHLOUL hospital, Sousse (9.9 pour cent), and the military hospital of Tunis (7.9 pour cent). These four institutions correspond to 80 pour cent of the sales. The distribution of the sales by category of customer (public - private) is rather stable for the last three years and is around 88 pour cent for public and of 12 pour cent for the private. Among problems encountered by the Tcp associated with the provision of radiopharmaceuticals products we can mention: a direct agreement between the customer and the supplier, a withdrawal of the customer for certain scheduled deliveries and so times totally or partially received products, a reception of radiopharmaceuticals products having a low activity with respect to that required, recorded delays in the receipt of purchase orders from customers, PCT clears radiopharmaceuticals products urgently on the basis of a proforma invoice. Any delays in the submission of final invoices from the supplier involve penalties. To conclude, the Tcp plays an intermediate role between the supplier of radioisotopes and the users. Therefore it needs an accredited laboratory of quality control to accomplish its mission which requires the recruitment of at least a radio pharmacist. It is important to draw attention to the necessity of providing training in radio-protection to the staff involved in the handling, storage, and transport of radioisotopes. (Author)
[en] Objectives: Risk management is an important issue in the activity of a radiation oncology department. CREX (in French: comité de retour d’expérience) were inspired from the French experience in civil aviation to ensure quality and security of treatment delivery. We aimed to report our experience in the feedback committee. Methods: In the department of radiation oncology (Habib BOURGUIBA hospital, Sfax- TUNISIA), CREX staffs were started since December 2014. We planned monthly meetings with the participation of all the team: doctors, medical physicians, manipulators. Its aim is to collect and expose errors or misses in the medical care. The different points and difficulties are declared. It enables each active member in the department to listen to every event, to select the event that will be selected for analysis (ORION method) and choose the most important correcting actions. A report is written after each meeting. Results: In our experience of about 2 years, we detected 3 major events (dose prescription, fields) which were analyzed. Correcting actions were discussed and chosen. We verified the application of those actions. The minor events were also noticed and attention was required. Conclusion: Risk management is an important issue requiring the involvement of all the staff, a clear communication, structured steps and the verification of applying correcting actions. Such experience should be generalized in all radiotherapy departments. (author)
[en] Nefza region, specifically Oued Belif, has a unique geological diversity in Tunisia. That's why it was chosen to be a study of natural radioactivity. The results were encouraging and have allowed us to draw conclusions about the origin of the high natural radioactivity found in certain rocks.