[Patients' opinions about day cataract surgery in a general hospital]. / Opinion des patients sur l'hôpital de jour pour la chirurgie de la cataracte au sein d'un hôpital général.

OBJECTIVE: To evaluate the patient satisfaction as a performance indicator of quality of health care delivery in outpatient cataract surgery. PATIENTS AND METHODS: We performed a prospective study using a questionnaire containing 14 items (preoperative work-up, administrative formalities, local anesthesia..) evaluating all the phases of ambulatory surgery for cataract. RESULTS: We collect 75 responding patients and we observed 2/3 of relative satisfaction about outpatient cataract surgery. Negative opinion was in relation with the prolonged time required for preoperative work-up which is done outside the outpatient surgery structure. CONCLUSION: Advances in techniques of locoregional anesthesia and surgery permit today the frequent use of ambulatory treatment in cataract surgery. This method seems to be well accepted by patients. However the prolonged time used to do the preoperative work-up require in the future a centralisation for this procedure.

Rural-urban migration and self-selection in Tunisia.

PIP: This article presents a model of returns to rural-urban migration accounting for self-selection of migrants using survey data from Tunisia. Of particular interest in this research is the sign and significance of the selectivity terms in the mover and the stayer group. The model focuses on the importance of human capital investment incentives and personal characteristics. This article is organized as follows. Section 2 presents the Tunisian context. Section 3 describes a simple model of migrant behavior in which the decision to migrate, viewed in the context of investment in human capital, results as the solution to an optimal control problem. Section 4 provides details of a simultaneous equation model, which incorporates the decision to migrate, returns to migration, and self-selection. The results of the research lead to the conclusion that by purely statistical assessment the expected monetary gain effect is significantly different from zero. Although by economic considerations, it is small. This low effect is a result of the omission of other relevant variables from the analysis of rural-urban migration in Tunisia. In the migration-earning equations the selectivity variable is not significant, whereas there is a strong evidence of positive self-selection in the earnings of nonmigrants.^ieng

Closed versus open mitral commissurotomy in pure noncalcific mitral stenosis: hemodynamic studies before and after operation.

Controversy persists regarding whether the efficacy of closed instrumental mitral commissurotomy compares well enough with that of open commissurotomy to warrant its continued use. The purpose of this study was to compare the results of operation as determined by catheterization studies in 63 patients with pure, severe, and noncalcified mitral stenosis. The patients were randomly assigned to one of two groups: thirty-two patients were operated on by the closed technique (group I) and 31 by the open technique (group II). All patients underwent left-sided and right-sided catheterization before and 4 months after operation. Preoperatively the two groups were statistically similar with regard to major clinical data and hemodynamic findings. There were no deaths at operation or systemic embolism in the two groups. The prevalence of surgically induced mitral regurgitation was similar in the two groups (12.4% versus 12.9%). Pulmonary arterial pressure and arteriolar and total pulmonary vascular resistance decreased significantly in the two groups. Pulmonary capillary wedge pressure decreased from 23.3 +/- 8.5 to 15.8 +/- 7 mm Hg in group I (p less than 0.001) and from 23.7 +/- 6 to 14 +/- 5.8 mm Hg in group II (p less than 0.001). Cardiac index increased from 2.86 +/- 0.84 to 3.14 +/- 0.78 L/min/m2 in group I, but this increase did not reach statistical significance. In group II cardiac index increased from 2.89 +/- 0.6 to 3.6 +/- 0.6 L/min/m2 (p less than 0.005). The mean and end-diastolic transmitral pressure gradients decreased significantly in the two groups, but the decrease was statistically greater in the open mitral commissurotomy group (p less than 0.001). Mitral valve area increased from 0.82 +/- 0.18 to 1.4 +/- 0.40 cm2 in group I (p less than 0.01) and from 0.84 +/- 0.15 to 2.14 +/- 0.53 cm2 in group II (p less than 0.001). The mean increase in mitral valve area was 0.61 cm2 in group I and 1.34 cm2 in group II (p less than 0.001). At exercise, in patients with resting pulmonary capillary wedge pressures of 18 mm Hg or less, cardiac index increased by 36% in group I (23 patients) and 48% in group II (24 patients), because of a smaller mitral valve area in group I (1.61 +/- 0.39 cm2) than in group II (2.45 +/- 0.65 cm2). Thus open commissurotomy improved hemodynamic values to a greater extent than closed commissurotomy at both rest and exercise.(ABSTRACT TRUNCATED AT 400 WORDS)