Background and Aim:Customer Relationship Management (CRM) with its various components has been considered as a tool causing customers’ loyalty. The present study aims to investigate the relationship between the various components of customer relationship management and patients’ loyalty to the place of their treatment.Methods:This cross sectional and descriptive-analytical study was conducted among nurses and hospitalized patients in inpatient wards in selected hospitals in 2014. Using the stratified random sampling method, 224 valid and reliable researcher-drafted questionnaires were completed for CRM by nurses and 359 questionnaires were completed by patients for patients’ loyalty in the studied wards. Data were analyzed using the SPSS20 software.Results:There was no statistically significant relationship between the level of patients’ loyalty and organizational indicators, information technology and knowledge management (P Value>0.05). However, there was a statistically significant relationship between loyalty and the dimensions of the service process (P Value=0.04), human resources (P Value=0.002) and CRM (P Value=0.038). The strength of these relationships were 34, 40 and 36 percent, respectively all of which were positive.Conclusion:Customer Relationship Management is a tool for improving influencing factors on patients’ satisfaction and loyalty. Therefore, attempts to implement customer relationship management as a process for improving hospitals performance and improving communication between service providers in hospitals and customers leading to enhance patients’ loyalty should be taken into account by managers and policy makers in the health sectors.

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Context: Good governance has been discussed as a new concept for poverty alleviation and economic development by global organizations, but this concept has been neglected in the health system. Therefore, this study was conducted with the goal of analyzing good governance in the health system. Evidence Acquisition: This was a descriptive study with systematic review method conducted at the medical bases of Medline,

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

The questionnaire was created by the researcher and, having determined its reliability and validity, was distributed among the employees and collected. Since the variables were normal, the T Test and Analysis of Variance were used to investigate the significance of the differences of role clarity and efficiency variables and also to investigate the relationship between the role clarity and factors of efficiency. Most of the employees in this study were female (63.9%), holders of Master's degrees (40.6%). The most average of the surveyed variables belonged to role clarity (2.47) and the least average accounted for educational aspect (1.66) among the employees. There was a significant statistical relationship between role clarity and general efficiency of the employees (p-value=0.000), and between the role clarity and each aspects of efficiency of employees including alignment with organizational goals, work pace, proper use of the equipment and facilities, selfassessment, trainings, being committed to the workplace regulations. There is a significant and direct relationship between the role clarity and the efficiency of the employees. Therefore, the managers of Ministry of Health and Medical Education are suggested to aim their efforts to increase the role clarity to create a more proper ground for the efficiency of the works.