Biomedical subjects
J Shemer
Publications and source records attributed to J Shemer.
Primary trauma care experience of army reserve combat medics: is a new approach needed?
Combat medics play a significant role in any fighting unit. In recent years, during times of peace and low-intensity military conflicts, as well as in operations other than war, reserve combat medics have been challenged to treat major casualties in the field. Although this work requires important manual skills, the medics perform basic treatment maneuvers that are not necessarily for saving of lives. A sample survey of reserve combat medics revealed that most (70%) were engaged in medical care for trauma victims during their regular and reserve service. Many (32.5%) were involved in incidents with multiple casualties. These incidents included seriously injured victims, with 39.2% of the medics being involved with air evacuation and 44.4% with fatalities. Not all medics are exposed to major trauma, but for those who are, the numbers of patients per medic is not large. Therefore, the need to educate the medics in cognitive, and more importantly, in manual skills, is obvious. Suggestions for the means to do so are provided.
[Changes in structure and process components of trauma care in emergency departments in Israel--Part I].
In recent years there have been tremendous efforts to improve primary trauma care. The Ministry of Health and other authorities have invested in new trauma facilities in various hospitals. A nationwide survey with regard to structure and function of emergency departments was carried out. Compared to a similar survey conducted in 1992, significant progress in quality and quantity of equipment at various emergency departments was demonstrated. However, there are still differences between various hospitals. A drive to standardize trauma care will undoubtedly contribute to improvement in care of the injured.
[Israel's ATLS program: summary and outlook].
In recent years a vigorous effort has been made to improve quality of primary trauma care in Israel. Advanced trauma life support courses (ATLS) were given to physicians throughout the country, regardless of their specialties. In 7 years 4229 physicians participated in 202 courses with an average success rate of 76%. In the future, issues such as mandatory vs. voluntary training, language barriers, and continuous decline of knowledge should be addressed if momentum is to be maintained.
[Recurrent aphthous stomatitis].
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Structure and process components of trauma care services in Israeli acute-care hospitals.
In recent years a vigorous effort has been made to improve primary trauma care in Israel. The Ministry of Health and other authorities have invested in new facilities in various hospitals which are engaged in trauma care. A survey was conducted in order to identify deficiencies in organization, personnel and equipment required to provide optimal trauma care. A cross-country survey was conducted by using a questionnaire that dealt with structure and process components of trauma care. The questionnaire was submitted to medical directors of emergency departments in all 24 acute-care hospitals in Israel. Additional information was obtained by a telephone poll when required. Inter-hospital variation concerning structure of trauma services, protocols and qualification of manpower responsible for primary care of the injured was found. The conclusions are that an increase in homogeneity in the field of trauma care is still needed. A continuous effort should be made in order to structurally and functionally further develop independent trauma units in all hospitals in Israel. Methods should be found to encourage young physicians to enter the field of trauma care. The establishment of a nationwide trauma registry system will undoubtedly contribute to future improvement in the initial care of the injured in Israel.
Major adverse reactions to yeast-derived hepatitis B vaccines--a review.
Yeast-derived recombinant DNA hepatitis B vaccines usage became widely accepted since the early 1990s. Severe adverse events have been reported infrequently in adults and rarely in infants and children given hepatitis B vaccine in the ten years which have passed since the introduction of the vaccine. Some of the data were summarized in previous review articles. Our review of the literature revealed reports of serious adverse reactions which included immediate reactions (anaphylaxis and urticaria) as well as delayed reactions, including skin, rheumatic, vasculitic (including Systemic Lupus Erythematosus and glumerulonephritis), hematologic, ophthalmologic and neurologic reactions. These cases were summarized and a pathogenetic mechanism is offered.
Cost-utility analysis of total hip arthroplasties. Technology assessment of surgical procedures by mailed questionnaires.
A retrospective study comparing 700 consecutive total hip arthroplasties, utilizing four types of implants, was performed. Questionnaires based on hip scores were sent to 593 living patients. Useful responses were received from 363 (61%) patients. Hip scores and quality-adjusted life-years were calculated. Multiple regression analysis, controlling for all possible biases, demonstrated one cementless implant as superior to all others. We believe that the use of mailed questionnaires is a simple and convenient system of follow-up, saving patients the need for outpatient clinic visits. The validity of such replies, however, has yet to be established.
Hepatitis A antibody prevalence among young adults in Israel--the decline continues.
This study sought to determine whether the decline in prevalence of hepatitis A virus (HAV) antibodies detected in Israel in 1977, 1984, and 1987 has continued. The anti-HAV antibody prevalence of a systematic sample of 578 male and female recruits inducted into the Israel Defence Force in 1996 was 38.4%. The reduction in antibody prevalence from 1977 (64%) was highly significant (P < 0.001). There was a smaller decrease rate in recruits of European, North American, Australian and South African origin than from elsewhere. A 'strategy' that uses active immunization against hepatitis A (inactivated vaccine, instead of gamma globulin) should be considered, particularly in high risk groups such as field units during military service.
Macrosomia does not predict overweight in late adolescence in infants of diabetic mothers.
OBJECTIVE: To determine the predictive value of macrosomia for overweight later in adult life in infants of diabetic mothers. DESIGN: Data from the computerized records of the Jerusalem Perinatal Study were matched to measurements made at age 17 obtained from the military draft medical examination records. PARTICIPANTS: 10,891 infants born in Jerusalem between November 1974 and February 1976. MAIN OUTCOME MEASURES: Macrosomia based on 90th percentile birth weight for gestational age and overweight defined as the 90th percentile for body mass index at age 17. RESULTS: Diabetes was diagnosed in 87 (0.8%) of the mothers. Thirty-one (35.6%) of the infants of the diabetic mothers were macrosomic compared to 1012 (9.4%) of the siblings of nondiabetic mothers (p < 0.001). At 17 years of age 10.3% vs. 9.4% of the siblings of diabetic vs. nondiabetic mothers were overweight (p > 0.05). The rate of adolescent overweight in macrosomic vs. nonmacrosomic subjects was 12.3% vs. 9.7% (p < 0.01) in siblings of nondiabetic mothers, and 16.1% vs. 7.1% (p > 0.05) for diabetic mothers. The sensitivity and specificity, in diabetic mothers, of macrosomia for overweight at age 17 was 44.4% and 66.7%, respectively. The positive and negative predictive value of macrosomia for overweight at age 17 was 16.1% and 92.9%, respectively. CONCLUSIONS: The risk of adolescent overweight was significantly increased among macrosomic infants, although this trend did not reach statistical significance in the smaller group of infants born to diabetic mothers. Macrosomia among infants of diabetic mothers had little predictive value for overweight in late adolescence.
Meningococcal polysaccharide vaccination of military recruits in Israel: preliminary assessment of vaccine effect.
Meningococcal disease in the Israel Defense Force is caused mainly by serogroups C and Y. Immunization of recruits with quadrivalent polysaccharide vaccine was introduced in November 1994. The person-time incidence rate dropped from 1.33 cases per 100,000 person-years for the preceding decade to 0 for the 32 months following immunization (p = 0.025).
Influenza vaccine efficacy in young, healthy adults.
Findings concerning influenza vaccine efficacy in young, healthy adults are inconsistent. A high incidence of influenza in the winter of 1995 provided an opportunity to study the efficacy of influenza vaccine among young, healthy military personnel. Influenza activity was confirmed by isolation of influenza A and B viruses from nasopharyngeal swab specimens from hospitalized soldiers. Self-administered questionnaires concerning vaccination status and disease symptoms were used in two study groups: recruits and veteran soldiers serving in different camps. Six hundred eighty-four individuals had received influenza vaccine and 652 had not. Vaccine efficacy was found to be 38.1% (P = .002) for preventing febrile illness with or without symptoms and slightly higher (41.6%; P < .001) for preventing fever together with upper respiratory tract symptoms. The current influenza vaccine significantly reduced febrile illness among healthy military personnel.
Cognitive knowledge decline after Advanced Trauma Life Support courses.
OBJECTIVE: To assess the cognitive knowledge decline among graduates of the Advanced Trauma Life Support (ATLS) program in Israel, to compare the rate of decline between surgeons and nonsurgeons, and to recommend appropriate timing for refresher courses. METHODS: A prospective study based on multiple-choice question test results of 220 ATLS course graduates was conducted 3 to 60 months after course completion. These results were then compared with the examination results immediately after the course. A statistical model based on survival analysis was used to evaluate the decline pattern and extent and to compare the study groups. RESULTS: A significant decline of cognitive knowledge over time among ATLS graduates was demonstrated. This decline was significantly greater in the nonsurgical group. A critical point of 20% cognitive knowledge loss among 50% of the examined physicians was observed around the 180th week after completion of the course. CONCLUSION: Physicians taking the ATLS course lose a significant part of their acquired cognitive knowledge after 3.5 years. Surgeons retain their cognitive knowledge for longer periods of time. Based on the study results, the optimal timing for a refresher course is between 3 and 4 years after the initial ATLS course.
Response to nitrous-oxide and oxygen among dental phobic patients.
The present study evaluated the records of 27 patients (20 men, 7 women) who were treated under nitrous-oxide (N2O) and oxygen sedation due to extremely high dental anxiety. Corah's DAS and Kleinknecht's dental fear survey were completed by the patients. Patients who responded positively to the gas were categorised as N2O+ patients, whereas those who responded negatively were categorised as N2O- patients. A mean DAS score of 19.3 +/- 1.6 was observed for the entire population. No significant difference was found between N2O+ patients and N2O- patients in any DAS item, nor in the total scores (19.4 +/- 1.35 and 18.67 +/- 2.24 respectively). Only in answer to the question, 'Has fear of dental work ever caused you to cancel or not appear for an appointment?' were the scores of N2O- patients significantly higher than of N2O+ patients. No differences were found between patients who reported pain as the source for their dental anxiety and those who did not; between patients with gag reflex and those without, between patients who had never had any dental treatment and those who had, and between patients who required two or three appointments before administration of the gas with respect to successful treatment under N2O and oxygen sedation. Among the N2O- group, significantly more patients did not attend for two appointments or more. The results suggest that lack of keeping previous dental appointments may indicate patients' possible negative response to nitrous-oxide and oxygen sedation.
[Viagra--utility and risk].
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[Professional assessment of senior physicians who immigrated to Israel up to 1996].
Israel has absorbed many immigrant physicians and has utilized their skills without compromising local professional standards. In accordance with this policy a special law for the assessment of the licensing of senior immigrant physicians, mainly from the former Soviet Union, who had practiced medicine for at least 14 years was implemented in 1994. Considering their considerable medical experience on the one hand and their lack of experience in speaking Hebrew or undergoing testing techniques, they were exempted from the written national licensing examination. Instead they were obliged to undergo a 6-month clinical observation period in a local hospital or clinic. At the end of this period a letter of confirmation was issued which was followed by an oral assessment of their clinical ability. In the assessment session, each candidate was presented with written presentations of 4 typical clinical cases which practitioners encounter on a daily basis, in family medicine, emergency medicine, surgery, and pediatrics or gerontology. Of 114 cases prepared, 4 were selected for each candidate by the committee of 13 trained, experienced Israeli physicians. 3 members of the committee assessed each candidate using specified criteria. The assessment, which lasted about an hour, focused on the candidates' professional knowledge involved in differential diagnosis and case management. Of 497 candidates examined between 1994 and 1996, approximately 80% passed in their first attempt. However, about 30% of the invited candidates did not appear for the exam. Characteristics of successful candidates were being young and being among the seniors with the least clinical experience. Most had specialized in internal medicine and had completed their observation period in a non-academic hospital. There they had received somewhat more attention than those who had been in academic hospitals. Significantly, the successful candidates were more proficient in Hebrew than the unsuccessful candidates, and reported no special problems during the observation period.