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Biomedical subjects

P Shvartzman

Publications and source records attributed to P Shvartzman.

At least 19 recordsLinked to original sources

Hypodermoclysis: an alternative infusion technique.

Hypodermoclysis, the subcutaneous infusion of fluids, is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. The method is considered safe and does not pose any serious complications. The most frequent adverse effect is mild subcutaneous edema that can be treated by local massage or systemic diuretics. Approximately 3 L can be given in a 24-hour period at two separate sites. Common infusion sites are the chest, abdomen, thighs and upper arms. The preferred solution is normal saline, but other solutions, such as half-normal saline, glucose with saline or 5 percent glucose, can also be used. Potassium chloride can be added to the solution bag if needed. Hyaluronidase can also be added to enhance fluid absorption. Hypodermoclysis can be administered at home by family members or a nurse; the technique should be familiar to every family physician.

Aged↗

Factors associated with daily smoking among Israeli adolescents: a prospective cohort study with a 3-year follow-up.

BACKGROUND: A prospective, 3-year cohort study of smoking habits was conducted among 9th grade pupils in Israel. METHODS: A self-administered questionnaire was answered by pupils in the 9th grade and again in the 11th and 12th grades. RESULTS: The baseline questionnaire was answered by 748 9th graders. In the 11th grade 448 (60%) completed the questionnaire for the second time, and in the 12th grade 388 (52%) completed the questionnaire. In all, 312 pupils (42% of the original cohort) completed all three questionnaires. There were no significant sociodemographic differences between these 312 and the original 748. Eight 9th graders (2.6%) were active smokers (at least one cigarette daily for the last month) compared with 64 (20.5%) in the 11th grade (P < 0.0001 vs 9th grade) and 70 (22.4%) in the 12th grade (P = 0.34 vs 11th grade). Most pupils knew the health hazards of smoking. Variables associated with smoking in the 11th grade included religiosity (religion was associated with lower smoking rates, P = 0.07), past experimentation with smoking (P < 0.0001), smoking among family members (P < 0.01), perceived future smoking status (P < 0.001), self-image (P < 0.001), influence of a teacher (P = 0.07) or celebrity (P < 0.05), and effect of peer pressure (P < 0.01). These results were similar for the 12th grade students except for active or previous smoking by gender (a significantly greater proportion of females than males, P = 0.04). CONCLUSIONS: The study design reduces the potential bias of follow-up attrition on assessment of predictors for smoking initiation. Gender, social modeling and peer pressure, past experimentation with smoking, smoking among family members, role models, and self-image were associated with smoking. These factors should be emphasized in intervention programs.

Adolescent↗

Effects of a fundholding discontinuation. An Israeli health maintenance organization natural experiment.

OBJECTIVE: To evaluate the effects of fundholding on cost containment and after termination of the project. DESIGN AND SETTING: Primary care practices participating in the project were allocated an itemized budget. Practices assumed authority for hospitalization, drugs, ambulatory medical diagnostic, consultant services and acquisition of minor equipment. Financial incentives were offered, but no penalties were imposed on practices where expenditure exceeded budget. SUBJECTS: Nine primary care practices in southern Israel. MAIN OUTCOME MEASURE: Total expenditure and a breakdown of expenditure per capita. RESULTS: Fundholding practice expenditure was compared with expenditure in the district as a whole. During the study period, total expenditure in fundholding practices rose by 12%, whereas that of the district rose by 37%. With discontinuation of the project, expenditure of the designated practices returned to the original levels, equivalent to those of the district. CONCLUSION: Fundholding is an efficient method of cost-containment. The effect will be long lasting only if motivation is maintained.

Budgets↗

Second-hand prostatism: effects of prostatic symptoms on spouses' quality of life, daily routines and family relationships.

OBJECTIVES: The aim of this study was to explore the impact of male prostatic symptoms on their partners' quality of life, daily routines and family relationships. METHODS: A structured telephone interview study was carried out on a random sample of 215 of the wives and partners of men aged 50 years or older drawn from those registered at four family medicine centres in Israel. They were asked about sleep disturbances, number of night-time wakings, and the effect on sexual relations, travel, entertainment, family and social relationships. RESULTS: The vast majority of women (86%) were affected by their partners' prostatism, with multiple consequences for their daily routines, quality of life and relationships. Sleep was the area of greatest concern, with 46% of women regularly waking due to their partners' urination disorder. The women reported other limitations: 37% noted problems with sexual functioning; 17% were unable to take long trips with partners; 10% could not visit places without toilets; while 8% were unable to go to the cinema or theatre. Women felt that their partners' prostatic symptoms were also to be blamed for upsetting family relationships (10%) and relationships with friends (16%). There was near total correspondence between women and their male partners regarding the effects of prostatic symptoms. CONCLUSIONS: Prostatism has an impact on men and women; strategies that consider the whole couple should be developed and utilized when considering treatment options.

Comorbidity↗

Breast cancer screening in two multicultural family practice teaching clinics.

BACKGROUND: Breast cancer is one of the most prevalent malignancies in women, yet one of the most treatable. Early detection is essential to obtain the desired remission and longevity. Numerous studies have shown that periodic screening for breast cancer can reduce mortality by 20-30%. OBJECTIVE: To assess the rates, compliance, characteristics as well as barriers in women regarding mammography screening. METHODS: The study group comprised a random sample of 702 women aged 50 or older from 5,914 eligible women in two teaching clinics in southern Israel. Phone interviews using structured questionnaire were conducted. RESULTS: The mean age of the study population was 61 years. The vast majority of the women were not born in Israel. Sixty-three percent of the women had undergone a mammography screening, 48% in the past 2 years. Monthly self-breast examinations were performed by 12% of the women in the last 2 years. Significant factors associated with undergoing mammography were: more than 7 years since immigration, married, a higher education level, adequate knowledge about breast cancer and mammography, presence of past or current cancer, and cancer in relatives. The main reasons for not being screened was no referral (54%) and a lack of knowledge about breast cancer and mammography (19%)--conditions easily remedied by physician counseling. CONCLUSION: The study suggests that promotional efforts should be concentrated on new immigrants and on less educated and unmarried women.

Aged↗

Aetiology of respiratory tract infections: clinical assessment versus serological tests.

Two hundred and fifty ambulatory patients with febrile respiratory tract infections were included in a prospective study, aimed at determining the reliability of physicians judgements relating to the aetiology of the infection. Compared with advanced serological testing, physicians' judgements for a bacterial/atypical, rather than viral, aetiology had a negative predictive value of 60% and a positive predictive value of only 50%. We conclude that physicians' ability to assess whether the infectious aetiology of RTI is viral or bacterial/atypical is low and no more reliable than tossing a coin.

Adult↗

Lower urinary tract symptoms in primary care--a multicenter community-based study in Israel.

BACKGROUND: Lower urinary tract symptoms are highly prevalent in older men, have been shown to affect men's quality of life, and may be associated with more serious outcomes. OBJECTIVES: To determine the prevalence of LUTS among men aged 50 years or older registered at family practice centers in Israel and to assess the effect of these complaints on different aspects of their life. METHODS: In a random sample cohort of men aged 50 years and older, fluent in Hebrew, drawn from those registered in four family clinics in Israel, patients identified with LUTS were interviewed by phone using a structured questionnaire. RESULTS: The prevalence of LUTS in our study was 21%. Less than a third of these patients had low severity LUTS (28%), 59% were rated moderate, and 13% had severe symptoms. Age had a positive correlation with the severity of LUTS, and increasing severity of symptoms had a negative effect on the daily function and quality of life of patients. CONCLUSIONS: Our community-based study shows that LUTS is a common finding among men above the age of 50 (21%) and has a significant negative effect on their quality of life and daily function. Knowledge of these data should make primary care physicians more aware of this common problem and thus improve the treatment and quality of life of these patients by better identification and prompt treatment.

Age Factors↗

Variations in referrals to consultants: a study of general practitioners' characteristics in southern Israel.

The rate at which primary physicians refer patients to consultants varies considerably, not only within different regions, but also among practices within defined areas. Differences also have been identified between doctors within the same practice. This variation in referral rates is a source of concern because of the costs generated and implications for quality and quantity of care. Many studies that tried to identify the sources for this variation explained only part of it; however, these studies were based on small numbers.

Age Distribution↗

Patients' smoking status: the family practice physician's view.

BACKGROUND: Smoking rates have decreased in western countries as well as in Israel during the past 20 years. OBJECTIVES: To estimate current rates of smoking and smoking cessation, and to assess factors associated with smoking and smoking cessation in family practice. METHODS: Prospective face-to-face interviews were conducted with 1,094 subjects, aged 16 years or older, registered in a family practice. RESULTS: Of all subjects studied, 746 (68.2%) were nonsmokers, 237 (21.7%) were current smokers, and 111 (10.1%) had stopped smoking. Overall, 31.8% of the males and 13.8% of the females were current smokers, and 20.1% males and 2.4% females had stopped smoking. Current smoking and smoking cessation rates were significantly and inversely associated with age among males and females. Smoking rates were higher among males and females who were married, had 10-12 years of education, and among males of North African origin and females of Israeli origin. The number of cigarettes smoked per day was associated with smoking and smoking cessation in males, but not in females. The highest rate of quitting occurred among males who smoked > or = 25 cigarettes per day. In a multiple regression analysis, gender and the number of cigarettes smoked per day were the most significant factors that predicted smoking cessation. The most common reason for stopping was the appearance of new signs of illness or the development of a new chronic disease, followed by a physician's recommendation to quit smoking. CONCLUSIONS: Female smokers and male smokers who smoke less than 25 cigarettes per day are the least likely to quit smoking. Future programs should be designed for and targeted at these groups of patients.

Adolescent↗

Interruptions to the physician-patient encounter: an intervention program.

BACKGROUND: Israeli physicians are very familiar with the problem of interruptions during encounters with patients. However, a thorough search of the medical literature revealed only one report of this problem from Israel, and none from other countries. OBJECTIVES: To characterize the phenomenon of interruptions to the patient-physician encounter in a clinic in Dimona and to assess the effect of an intervention program designed to reduce the magnitude of this problem. METHODS: During an 8 day work period in March 1997 all patient-physician encounters were recorded and characterized. An intervention program was then designed and implemented to reduce the number of interruptions. Data were again collected a year after the initial data collection. RESULTS: During the 8 day study period prior to the intervention program there were 528 interruptions to 379 encounters (mean of 1.39 per encounter). The main causes of interruptions were entrance of uninvited patients to the examination room (31%) and telephone calls (27%). Most of the interruptions occurred during the morning hours between 8 and 10 a.m. (45%) and at the beginning of the week (Sunday 30%). After the intervention program there were 402 interruptions to 355 encounters (mean of 1.13 per appointment, P = 0.21). CONCLUSIONS: There was no statistically significant improvement in the number of interruptions following the intervention program. This finding is either the result of a local cultural phenomenon, or it indicates a national primary care health system problem that may require a long-term educational program to resolve it. Further research is needed on the magnitude, causes and consequences of interruptions in family practice and, if warranted, methods will have to devised to cope with this serious problem.

Humans↗

Pharmacological treatment of cancer pain.

Pharmacological control of cancer pain is simple and can be achieved by using the simple principles of--by the ladder, by the clock, oral (if possible), and by the patient (adapted specifically). Consultation might be needed only for those patients who have difficult pain problems or refractory pain.

Analgesics, Non-Narcotic↗

Screening intention and practice among first-degree relatives of colorectal cancer patients in southern Israel.

BACKGROUND: First-degree relatives of colorectal cancer patients are the largest groups of individuals at increased risk for colorectal cancer. OBJECTIVE: To assess the knowledge, attitudes and behavior to disease prevention and colorectal cancer screening among first-degree relatives of colon cancer patients. METHODS: A descriptive, point-prevalence epidemiological study was conducted among 215 first-degree relatives of survivors of colorectal cancer in the southern (Negev) region of Israel. Variables included perceived health status, knowledge about cancer screening, compliance rates with colorectal cancer screening, and interest in participation in early detection programs in the future. RESULTS: The mean age of the respondents was 47.9 +/- 11.2 years, and 54% were males. Only 58 (27%) remembered having been encouraged to undergo an early detection test. In the previous year only 15% underwent fecal occult blood tests, while 9% had a barium enema and 14% an endoscopic examination of the colon by sigmoidoscopy or colonoscopy. A total of 49% of the asymptomatic respondents were unaware of recommendations for screening, and only 38.3% expressed any interest in participating in early detection programs in the future. Only 19% of respondents over the age of 50 and 8% of respondents over age 60 were interested in participating compared with 49% under the age of 50 (P < 0.0001). CONCLUSION: A minority of first-degree relatives of colorectal cancer patients reported having been counseled to undergo screening, although most had seen their family physician in the previous 3 years. Primary care physicians should be more active in informing at-risk patients and encouraging them to undergo periodic screening.

Adult↗

[Knowledge, attitudes and skills of family physicians in Israel with regard to chronic pain management in cancer].

Prolonged suffering from pain can affect quality of life to the point where patients lose desire to live. The attitude towards pain management in cancer patients has changed over the last two decades. The principles of treatment are based on prescribing analgetics while individually adapting medications and dosage according to the level of pain. Use of existing guidelines may relieve pain symptoms in 90% of patients. We evaluate knowledge, attitudes and skills of family physicians in Israel with regard to treatment of pain in cancer patients. The study included 123 family medicine residents and specialists from 3 different regions in Israel (Negev, Emek-Izrael, Jerusalem) who filled a self-reply, structured questionnaire. The response rate was 68%. The majority of physicians were residents in family medicine (55%) with work experience of 4-10 years, whose average age was 38.5 +/- 5.5 years. The majority of the study population: believe that treatment of pain in cancer patients is their responsibility (57%); do not believe that strong opioids cause addiction while it is thought that there is a moderate to high risk of addiction; feel comfortable prescribing opioids and are aware that opioids should be prescribed as needed without restriction. However, 25% will prescribe opioids "as needed" to a certain limit, and 30% will prescribe opioids only with a recommendation from the oncologist; most feel lack of knowledge in the areas of pain evaluation, opioid treatment, and managing side-effects of opioid treatment and feel a need for additional knowledge of opioid use. The treatment of cancer patients and their families is an important and serious challenge facing the family physician. The teaching of the proper tools will assist the future generation of family physicians in facing this challenge.

Adult↗

[Second degree atrioventricular block in Graves' disease].

Cardiac tachyarrhythmias are common in thyrotoxicosis. We report an uncommon case of a 53-year-old woman with Grave's disease who developed second degree A-V block while euthyroid on propylthiouracil. The most likely mechanism is an autoimmune response causing infiltration of the cardiac conduction pathways.

Antithyroid Agents↗