La Tunisie médicale
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Authors expose in the first part of this article practical modes to implement the health insurance reform under the angle of the mastery of care expenses, at the micro and the macroeconomic levels. Thus they pass in review the different possibilities to master expenses, at the supply and the demand sides, by identifying advantages and risks of each of they and by specifying orientations of the health insurance reform in this area: the moderating ticket, contractual payment methods of hospitals and health professionals, the path of care, the refund of care expenses, the rationalization of consumption of medicines and complementary examinations and the harmonious development of care supply by a better public and private mix. A particular accent is put on preliminaries and implementation conditions of the prospective payment of providers and organizational conditions of care provision, from general practitioner that would become the main entry of the care system. ⋯ On the basis of decentralization and a three levels organization (local, regional and central), social security bodies will put in place the most appropriate organization to insure a steady efficient implementation of the health insurance reform, in dialogue with stakeholders. Consultative committees at regional and central levels, regrouping all the intervening in the health insurance, will be instituted. The sought-after objective through this organization is to administer the health insurance, at the strategic, decisional and operational levels, with suppleness, as a changing and dynamic project, in function of flexibility imperatives necessary for the reform implementation.
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We report in this work a case of anterior pur dislocation of elbow in a patient of 45 years, with antecedent of elbow trauma in childhood, occurred after a direct trauma on bent elbow. The diagnosis is obvious and represented by a pseudarthrosis of the epitrochlea. The treatment consisted of a reduction practiced immediately of the dislocation and contention by a posterior plaster for two weeks. The consequences are good without recidivism with a latenesis over one and half year.
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La Tunisie médicale · Nov 2000
[Study of the incidence and cost of nosocomial infections in general surgery].
Nosocomial infection incidence and its cost were study. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9.4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent (60%), operative site infection (9.1%), inferior respiratory ways infections (2.2%). ⋯ Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and no-infected one is 9.3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode.
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La Tunisie médicale · Oct 2000
[Ultrasonographic diagnosis of ectopic pregnancies. A report of 109 cases].
To assess the accuracy of ultrasonographic diagnosis of ectopic pregnancies. ⋯ Transvaginal sonography is the method of choice for the evaluation of women with a suspected ectopic pregnancy. However, serum B HCG levels are useful for diagnosis in 11% of cases.