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Biomedical subjects

A Israeli

Publications and source records attributed to A Israeli.

At least 55 records · Page 3Linked to original sources
PubMed1991

Alternative methods of hospital remuneration in Israel.

The current method of remunerating hospitals by an average per diem fee tends to over-reimburse hospitals that have a concentration of departments whose true costs are less than the average price received. Hospitals with a high concentration of expensive high-technology service departments whose true costs are more than the average price received will be under-reimbursed and are obliged to cover their running deficits by other means, e.g., donations. Reimbursements on a per diem basis provide a 'perverse incentive' for all hospitals to maximize the length of patient stays in order to maximize their income. This paper briefly examines alternative methods to the deficient per diem method of reimbursing hospitals, such as fee for service, historical budgeting, capitation, gatekeeper's fees and diagnosis-related groups (DRGs). Fee for service or historical budgeting shows little or no advantage over the present system. However, a combination of capitation and/or DRG linked with some form of payment via physician gatekeepers appears to provide a favorable option for correcting the distortions of the per diem system. Department-specific DRG weights for each hospital's department admission mix are used to estimate the magnitude of the current distortion in resources allocated to hospitals. The calculation is based on the changes in hospital income were a DRG mechanism introduced instead of a per diem method. Such changes would increase the hospitalization income of hospitals with low lengths of stay and high bed turnover rates up to 39%. Regional hospital centers with high lengths of stays and low bed turnover rates would receive as much as 17% lower income in some cases. Only if DRG weights were available for each individual hospital would it be possible to ascertain whether differences in lengths of stay reflect differing severities of case loads or differing hospital efficiency levels.

Capitation Fee↗
PubMed1990

Which X-ray views are required in juvenile ankle trauma?

Although ankle sprains are probably the most common injury in adolescent sports people, epiphyseal injuries are missed on the presumption of a ligamentous tear. The risk of damaged ligaments has been overemphasized while the potentially dangerous epiphyseolysis has been understressed. An oblique X-ray of the ankle joint is indicated prior to "stress" pictures.

Ankle Injuries↗
PubMed1990

Effects of lovastatin therapy on LDL receptor activity in circulating monocytes and on structure and composition of plasma lipoproteins.

The effect of lovastatin therapy on LDL-receptor activity in fresh monocytes and on the structure and composition of lipoproteins was determined in 9 patients with familial hypercholesterolemia (FH) and 8 patients with non-familial hypercholesterolemia (NFH). Lovastatin reduced LDL-cholesterol levels by 34.8 and 47.5%, respectively, in the 2 groups of patients, and plasma apo B levels by 33.3 and 42.5%. LDL receptor activity in fresh monocytes increased by 53% and 86% respectively. HDL-cholesterol and plasma apo A-I levels increased only in the NFH group, by 10.2 and 7.1%. Lipoproteins were separated by centrifugation on a zonal rotor. Except for the intermediate density lipoprotein (IDL) fraction, no changes were observed in the structure and composition of the various lipoproteins. The investigations thus demonstrated that lovastatin therapy is associated with a measurable and significant increase of LDL-receptor activity in circulating monocytes that may contribute to the lipid lowering action of the drug.

Apolipoproteins↗
PubMed1990

Israel's expenditure on health services.

In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations. However, Israel devoted fewer dollars per citizen on health care than any of the eight other nations. We investigate the role of three factors that contributed to this relatively low expenditure level: a) health personnel and bed supply levels, b) operations and procedure rates, and c) relative wage costs of health personnel. If Israel had the same level of per capita GNP as the USA, its annual health service per capita expenditure would increase from $472 to $1,328. If, in addition, its health personnel received the same wage differentials (in relation to the average wage levels) as those received by health personnel in the USA, it is estimated that Israel would spend around $1,842 annually per capita on health care (representing 10.7% of its GNP). This figure is only $98 less than what the USA spends, and creates a vastly different impression concerning the efficiency of the health system than does the original unadjusted expenditure of only $472 per head, which is $1,468 less than that spent by the USA. The Israeli health system can be said to be characterized by adequate manpower inputs, high bed occupancy rates, low surgery rates relative to the USA (not necessarily a negative phenomenon), and low relative wage inputs. The relatively limited available output indicators lead us to believe that productivity per person employed in the health services could be raised. The low absolute levels of health expenditures in Israel are mainly due to a combination of a low GNP per head and relatively low wage differentials between health service staff and other income earners.

Bed Occupancy↗
PubMed1989

Diagnosis deferred--the clinical spectrum of diagnostic uncertainty.

This study attempts to define the term "Diagnosis Deferred" (DD) and determine its natural history and outcome. It is suggested that such a "non-diagnosis" should be used when the clinical and laboratory picture cannot be explained by any known disease entity after a minimum of 5 days hospitalization. During a 9 year period (1972-1980) 250 patients (1.8%) were identified as warranting the term DD from a total of 14,098 admissions to a department of Internal Medicine. Their average stay in hospital was 11.5 days. There was no sex difference between the patients, whose average age was 42.8 +/- 17.6 years (mean +/- SD; range 14-93). Three complaints predominated: joint pains (21.6%), abdominal pain (20.4%) and chest pain (16.8%). In 103 of the patients, there was follow-up information until the diagnosis was made or for at least 24 months (average 53.0 +/- 40.0 months, range 2-186). These patients were representative of the original cohort in both age, sex and classification of symptoms. Forty-three patients (42%) were subsequently diagnosed. 58% of these patients were diagnosed as a result of a change in or appearance of a clinical symptom during the follow-up period. "The survival of diagnostic uncertainty" in 50% of the patients was 84.5 months (7 years) with a range of 2-13 years. This time was significantly shorter for chest pain than for abdominal pain (33 months vs 87 months) (p = 0.003). In patients with "Diagnosis Deferred", a diagnosis was reached in 42%; in 22% the symptoms disappeared leaving 36% undiagnosed, and a continuing clinical challenge.

Abdomen, Acute↗
PubMed1989

Right ventricular outflow tract obstruction due to extracardiac tumors. A report of three cases diagnosed and followed up by echocardiographic studies.

Echocardiography has become a valuable diagnostic tool in various clinical conditions. Its use for the detection of extracardiac tumors has seldom been reported. The majority of these descriptions are of single case reports. We have recently encountered three patients (two with lymphomas and one with seminoma) who presented with signs and symptoms suggestive of right ventricular outflow tract obstruction. Two-dimensional echocardiography enabled the prompt diagnosis of extracardiac tumors compressing the heart. Moreover, echocardiography proved to be an excellent noninvasive tool for assessing the success of therapy for mediastinal tumors.

Adult↗
PubMed1988

Glibenclamide causing thrombocytopenia and bleeding tendency: case reports and a review of the literature.

We described two patients with severe thrombocytopenia and bleeding tendency related to treatment with glibenclamide (short-acting sulfonylurea). To the best of our knowledge, thrombocytopenic purpura associated with this medication has been reported only twice previously. We suggest that platelet count should be carried out early after initiating glibenclamide treatment and every 3 months thereafter.

Diabetes Mellitus, Type 2↗
PubMed1988

Influence of moderate exercise on glucose homeostasis and serum testosterone in young men with low HDL-cholesterol level.

Fifty-five healthy sedentary non smoking and non obese 24-26-year-old men with a low serum concentration of HDL-cholesterol were selected for a study of the effect of nine weeks of exercise on glucose homeostasis, and blood testosterone. The participants were randomized into two groups. Twenty-eight subjects were assigned to a nine-week program of submaximal aerobic exercise three times weekly, while 27 were assigned to a non exercising control group. The improvement in physical fitness was assessed by change in estimated oxygen consumption (EVO2 max) that was increased by 15% in the exercise group (p less than 0.001), but remained unchanged in the control group. During the study the body weight of both groups remained essentially unchanged. There was a significant reduction of mean plasma fructosamine in the exercise group, and non significant reduction in serum insulin. Serum testosterone, glycohemoglobin and HDL-cholesterol were not influenced by exercise, while serum triglycerides were significantly reduced.

Adult↗
PubMed1987

Preferential binding of [3H]cholesteryl linoleyl ether-HDL3 by bovine adrenal membranes.

Membranes isolated from bovine adrenal cortex, incubated with human high-density lipoproteins (HDL3), labeled with 125I and [3H]cholesteryl linoleyl ether, showed preferential binding of [3H]cholesteryl linoleyl ether. The preferential binding was Ca2+ independent, temperature sensitive and was slightly increased after phospholipase C or pronase treatment. Reduction of membrane phosphatidylcholine by phospholipase A2 resulted in a marked increase in the binding of the entire HDL3 particle and a relative decrease in preferential binding of [3H]cholesteryl linoleyl ether. These findings suggest that the presence of intact phospholipid in the membrane plays an important role in the magnitude of the preferential binding.

Adrenal Cortex↗