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Biomedical subjects

L Levi

Publications and source records attributed to L Levi.

At least 127 records · Page 7Linked to original sources
PubMed1966

Pangamic acid (vitamin B 15, pangametin, sopangamine): Its composition and determination in pharmaceutical dosage forms.

Pangamic acid is shown to be a mixture of variable composition. Criteria of identity and methods of analysis are described for five pharmaceutical dosage forms. Experimental results indicate that the products are not uniform in composition and that composition does not conform to label claims. No satisfactory preclinical drug application for any such preparation has so far been submitted to the Food and Drug Directorate.

Dosage Forms↗
PubMedDate not supplied

Severe head injury in children--analyzing the better outcome over a decade and the role of major improvements in intensive care.

We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January 1984 to June 1988 we saw 117 children (ages 0-14) with postresuscitation GCS (Glasgow Come Scale) scores of 3-8. The more recent cohort of children seen in 1994-1996 was made up of 152 patients. Apart from standard statistics we used a segmentation method called CHAID (SSPS software). Previously known predictors of outcome are found still to apply in our series. Although in the recent period there was a lower proportion of patients with GCS 3-4 (11% versus 32%), a higher percentage had suffered multiple trauma (56% versus 33%). The rates of craniotomy and of ICP monitoring were similar (66% and 61%). Comparison of the two cohorts for outcome at discharge and through 1 year shows that mortality fell from 33% to 10% and the proportion achieving improvement of neurological status increased from 24% to 56%. CHAID analysis showed that the mortality rates of patients within specific groups declined significantly over the two periods: (1) a significant reduction in mortality was seen in patients with GCS 5-7, especially those with diffuse axonal injury (DAI) (17.3% to 0%); (2) no child admitted in shock survived in the earlier period, whereas 7 with GCS 4-6 survived during the recent period. The best model for mortality prediction includes GCS, and in the GCS 4-7 subgroup, the presence of subdural hematoma. It seems that the trend toward better immediate outcome is continuous, and this is the more striking when the severity of injury is taken into consideration. Our belief is that the modern medical and surgical techniques, although incurring higher costs and necessitating ongoing intensity, are well worth the effort.

Adolescent↗
PubMedDate not supplied

Glaucoma screening in the health care setting.

Glaucoma surveys are an important means of detecting early cases of glaucoma. Traditionally, most such surveys have been conducted in the community, while the health care setting has been underutilized as a screening location. We reviewed studies on surveys conducted in community and health care settings, using tonometry and ophthalmoscopy, and presented data from a study we carried out in the outpatient department of a hospital. Results of our review indicate that over 11 times as many people were screened in the community studies as in the health care studies, but the latter had the higher percentage of referrals. Data from the literature review, as well as from our own study, suggest that the high number of referrals is related to the characteristics of the population available for screening in a health care facility. In such a population there is a higher percentage of individuals at risk for development of glaucoma. Risk factors for the disease include age, sex (males more at risk than females), race, (blacks more at risk than whites), family history of glaucoma, and presence of diabetes and vascular diseases. It was also found that ophthalmoscopy is an effective, but underutilized, method of screening. We recommend an increase in use of health care facilities as sites of glaucoma screening surveys. We also suggest that physicians employ ophthalmoscopy to screen for glaucoma as part of the routine funduscopic examination.

Adult↗
PubMedDate not supplied

Immune function in unemployed women.

Immunologic effects of unemployment were prospectively studied in women over a period of 8 months. Subjects were classified into three groups depending on their employment history, and were studied concomitantly. Group A consisted of unemployed women who were recipients of traditional support from the Swedish welfare state. Group B was composed of unemployed women who were given the opportunity to participate in a psychosocial program, in addition to receiving the traditional unemployment benefits received by group A. Group C, the control, consisted of securely employed women. Phytohemagglutinin (PHA) reactivity of lymphocytes decreased significantly in both groups of unemployed women after 9 months of unemployment. The psychosocial program did not counteract this decrease. Reactivity to purified protein derivative (PPD) of tuberculin also decreased significantly in the unemployed subjects. No changes were observed in the securely employed women. There were no significant differences among the groups in T cell subpopulations, B cells, and serum cortisol. The data suggest that some aspects of the immune system may be altered at a specific time period following the loss of work. Further studies are needed to see if this effect is only temporary or more long lasting.

Adult↗
PubMedDate not supplied

Does number of beds reflect the surgical capability of hospitals in wartime and disaster? The use of a simulation technique at a national level.

INTRODUCTION: The raw number of hospital trauma beds and occupancy has been used to assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations. METHODS: Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of "standard wartime casualties." Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A "what-if" module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of "standard casualties." Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load. RESULTS: Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected. The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital. RECOMMENDATIONS: The use of simulation techniques might be useful method to assess the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.

Computer Simulation↗
PubMedDate not supplied

Hospital disaster management simulation system.

INTRODUCTION: Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals. METHODS: The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casualty incident (MCI) were developed in the pilot phase. It contains detailed descriptions of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committee decided the crucial model issues and established the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required. The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD). RESULTS: During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms. CONCLUSIONS: Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.

Computer Simulation↗