Biomedical subjects
P Shvartzman
Publications and source records attributed to P Shvartzman.
Responsibility taking and role definition in family practice: effect of training and practice setting.
There is evidence that family physicians (FPs) reduce health care costs by reducing patient referral to more expensive secondary and tertiary care facilities. Presumably, the effectiveness of FPs in meeting patients' needs is related to their role definition and willingness to assume responsibility. The purpose of this study was to determine the influence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-administered questionnaire was completed by 153 certified FPs and FP residents from five departments of family practice in Israel. The main independent variables were previous training and practice setting. The main outcome measures were self-reported data on responsibility taking, role boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define broader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple regression analysis shows that professional development is associated with an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performance. Practice setting alters the tendency to perform a wider range of interventions, but does not affect physicians' attitudes.
Acute bronchial asthma associated with the administration of ophthalmic indomethacin.
A life-threatening episode of bronchial asthma may follow treatment by ophthalmic indomethacin. This case report describes an elderly man who experienced a serious attack of bronchial asthma after receiving ophthalmic indomethacin solution for aphakic cystoid macular edema, following extracapsular cataract extraction.
[Benign meningioma following scalp irradiation in north African immigrants].
Many Jewish immigrants from North Africa in the late 1950s were treated with low-dose irradiation of the scalp for tinea capitis. In 2 such patients, a 47-year-old man and a 43-year-old woman, both with long histories of headaches and dizziness, meningiomas were found. There is a well-known correlation between low-dose irradiation of the scalp and development of meningioma. Therefore, in immigrants from North Africa with prolonged headaches and dizziness, there should be a careful history with regard to irradiation of the scalp and investigation to exclude meningioma.
Nocturnal penile tumescence and rigidity monitor--use in a family practice.
We describe our experience using the nocturnal penile tumescence and rigidity monitor (NPTR) in 181 impotent patients referred to the specialized evaluation service in our Family Medicine Center, and review the literature. The 181 patients were referred to the center during 18 months. Their mean age was 53.5 +/- 9.45 years (range 26-76) and 92% were married; about a quarter (26.8%) suffered from impotence for 4-10 years. They were referred by urologists (54.7%), psychiatrists (24.3%), and general practitioners (13.8%). About a third had a normal rigidity, more than half had a normal base tumescence, but only a quarter had normal tip tumescence. Abnormal rigidity and tumescence was significantly associated with diabetes but not with hypertension. We conclude that family physicians have to be actively involved in and responsible for the diagnosis and treatment of impotent patients. Reading and interpreting NPTR is a simple as reading an electrocardiogram and can easily be performed in a primary care setting.
A novel method for isolating and quantifying urine pathogens collected from gel-based diapers.
BACKGROUND: Given that children often present to physicians with a wet gel-based diaper, a method for using this diaper for a urine specimen was studied. METHODS: A blinded clinical laboratory trial was conducted in the microbiology laboratory. The sampling technique involved the use of oval gynecologic forceps as a template and sterile scissors to cut out samples of diapers. Each diaper sample was then vortexed in 20 mL of sterile saline and the supernatant quantitatively cultured. Diaper sample supernatant cultures with simulated infected urines (suspensions of Escherichia coli) were used. RESULTS: Weight measurements of the diaper samples soaked with 20 mL or more of saline yielded reproducible results (0.703 g; 95% confidence interval [CI], 0.52 to 0.88 g). Culture results (colony-forming units per liter [CFU/L] of supernatant) from diapers soaked with 25 mL of various concentrations of E coli (10(6), 10(7), 10(8), 10(9) CFU/L) showed excellent correlation with the inoculum used, and no effect of a 2-hour delay in culturing the wet diapers. CONCLUSIONS: Our technique provides accurate and reliable estimates of bacterial concentrations in the usual range for infected urine from gel-based diapers soaked with solutions of E coli. Further evaluation of clinical implementation is needed.
[Hypothermia in the elderly in the Negev].
Hypothermia in the elderly is a medical emergency with mortality varying from 32-80%. Its most frequent predisposing factors, as reported in the current literature, are extremes of age, cold environment and alcoholism. In the Negev (southern region of Israel, mostly desert area) the mean temperature range during November-March is 9.6 to 15.2 degrees C and during April-October, 16-25.9 degrees C. The records of all patients with hypothermia, aged 65 and above admitted over a 5-year period (1984-1988) were reviewed (44 admissions of 39 patients of whom 23 were females). 34 were admitted during the winter months and 10 during the rest of the year. Important associated or predisposing conditions included infections in 54.5%, renal failure in 29.5% and diabetes mellitus in 29.5%. Alcoholism (13.6%) was relatively infrequent. Those of Asian or African origin appeared to be at greater risk, constituting 73% of admissions, but only 47% of the elderly population of the Negev. The annual incidence of up to 4/1000 of elderly patients admitted to our medical wards, which serve a population of 350000, indicates that hypothermia is not rare in this desert region.
[Shigellosis in a primary care practice].
The epidemiological and clinical characteristics of 47 patients infected with Shigella in 3436 patients at a primary care clinic during 30 months were reviewed. Most cases were seen during the winter. The prominent clinical features were abdominal pain (91.5%), headaches (72.5%), bloody diarrhea (66%), mucoid stools (63.8%), fever (53.2%) and 75% had 4-10 stools per day. Most patients presented the first day of the illness (75%). S. sonnei has been found the most prevalent among 4 types of shigella. Resistance to ampicillin was complete and to Resprim 95%, but to nalidixic acid and to tetracycline, 4.9%. A third of the patients were treated with oral fluids and an appropriate diet and 2/3 received antibiotics. Children between 1-4 years of age who attend kindergartens are the main risk group for Shigellosis.
Are antibiotics appropriate for sore throats? Careful prescribing is beneficial.
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[Guidelines for diagnosis and management of pharyngitis].
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Simultaneous involvement of the skin and joints in a case of dermatitis herpetiformis affecting an adolescent boy.
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Variation in acceptance of common oral antibiotic suspensions.
Palatability of oral antibiotic suspensions is important and may be a substantial factor in determining compliance in young pediatric patients. Because no comparative systematic data are available, we undertook the present study to assess the acceptance of and compliance with oral antibiotic suspensions commonly used in Israel. During a 4-month period lists of children receiving oral antibiotic suspensions were obtained from 3 major pediatric clinics, and parents were contacted by telephone 10 to 14 days after initiation of therapy, at which time information on age, sex, main disease, prescribed drugs and duration of treatment was obtained. Information regarding acceptance, side effects and compliance was obtained from 11 questions with graded scores. In the study 546 children received one of the following drugs: amoxicillin (n = 222); cefaclor (n - 142); cefuroxime axetil (n = 107); trimethoprim/sulfamethoxazole (n = 75). No major differences in background data were noted; more than 50% of each group had acute otitis media. Seventy-three percent of the cefaclor group reported acceptance of the drug with "pleasure" or "without problems" vs. 60, 55 and 20% for amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, whereas "resentment" or "refusal" was reported in 11, 16, 26 and 56%, respectively (P < 0.0001). Mothers reported to be generally "satisfied" or "extremely satisfied" with the drug in 89, 81, 74 and 67% with cefaclor, amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, and 85, 77, 73 and 67% of the children, respectively, received the drug for the entire prescribed course (P < 0.001). Our data demonstrate that marked variations exist in acceptance and compliance of oral antibiotic suspensions with children.(ABSTRACT TRUNCATED AT 250 WORDS)
Urban family physicians and the care of cancer patients.
Members in the Department of Family Medicine of a university teaching hospital were surveyed to find out their involvement in caring for cancer patients. Respondents indicated that many cancer patients were followed, but few cancer support services in the hospital and the community were used. The desire to take on new cancer patients was lacking, yet an interest in continuing medical education existed. Feedback from the department will help guide our Education Committee to develop continuing medical education programs for family physicians caring for cancer patients.
Past and present contraceptive behavior of new Soviet immigrant women in Israel.
This exploratory research investigated past and current use of contraceptives among a purposive sample of 117 new immigrant women from the Commonwealth of Independent States (former Soviet Union). The findings confirm the widespread use of induced abortion (IA) as a method of birth control before immigration. Fifty-eight percent of the sample had had at least one IA, and the average was 2.7 IA. The most commonly used types of contraception before immigration were the pill, safe days, withdrawal, and the IUD. Currently used types of contraception were the IUD, safe days, withdrawal, and condoms; however only 45% of the sample were currently using any type of contraception. Of particular interest were the relatively high reported use of the pill before immigration and low current use, and the former low level of condom use and its increase in popularity in Israel. Despite the availability of more effective methods of birth control, safe days and withdrawal remain commonly used. The high cost of the pill was mentioned as a deterrent to its current use. Despite the high prior level of IA, the majority of women in this sample (84%) preferred today to use other birth control methods, and would like the opportunity to receive professional advice. These findings support the need for educational efforts directed toward new immigrant women from CIS.
A mobile intensive care ambulance--use by community primary care teams.
OBJECTIVE: This study investigates the use of a mobile intensive care ambulance (MICA) by primary care teams in a large, semi-rural health district in northern Israel. METHOD: We reviewed the MICA records covering three years for all calls from a doctor or a nurse working in a community primary care clinic. RESULTS: Over the period studied, there were 649 such calls. Two-thirds of the patients were male, 70.5% were aged 60+ and only 2% were children under the age of one year. Of the total, 358 (55.2%) calls originated from kibbutzim (communal settlements), although only 7.5% of the district's population lives on such settlements. There were 12 calls (1.9%) from Arab villages, where 27.5% of the district population resides. The MICA personnel were more intervention prone than was the primary care team. The service was utilized mainly for cardiovascular emergencies and, in this study, children and residents of Arab villages appear to have been underserved. There was a disproportionately high representation of elderly kibbutz members. CONCLUSIONS: There is a need for further research to assess standards for emergency equipment in primary care clinics, and continuous training of the primary care team. Introduction of a high service technology such as the MICA might be a problem in certain populations.
Recurrent dermatitis from jellyfish envenomation.
Jellyfish envenomation can cause an immediate local skin reaction, which is usually a painful linear vesiculourticarial eruption. Persistent, delayed, or recurrent dermatitis is less common. Because jellyfish sting reactions and their management are unfamiliar to family physicians, we describe a case of recurrent local dermatitis after jellyfish envenomation and suggest appropriate treatment.
Giant ovarian cyst mimicking ascites.
A 60-year-old female patient presented to our clinic with complaints of abdominal distention. The rapid accumulation of fluid was originally thought to be ascites, based on ultrasonographic examination. The cause, however, was ultimately determined to be a borderline malignant giant ovarian cyst. Several processes can mimick ascites: bladder distention or diverticulum, hydronephrosis, pancreatic pseudocysts, and large uterine or ovarian tumors. For this reason, clinicians must consider processes other than ascites in the differential diagnosis of large abdominal fluid accumulation.
Local skin irritation in the course of subcutaneous morphine infusion: a challenge.
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