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Biomedical subjects

P Shvartzman

Publications and source records attributed to P Shvartzman.

At least 73 records · Page 4Linked to original sources
PubMed1994

The role of nocturnal penile tumescence and rigidity monitoring in the evaluation of impotence.

The inability to achieve or maintain an erection of sufficient rigidity to perform sexual intercourse is a problem that affects between 10% and 20% of men at some time during their lives. Historically, the evaluation of impotence has been limited to history and psychological assessment. Nocturnal penile tumescence (NPT) monitoring is a procedure that can be used in the evaluation of impotence. Performed with appropriate measurement techniques and knowledge of the recording conditions and combined with a complete and accurate sexual history, NPT monitoring is the most effective noninvasive method of determining whether the underlying cause is organic or psychogenic.

Erectile Dysfunction↗
PubMed1993

Treatment of streptococcal pharyngitis with amoxycillin once a day.

OBJECTIVE: To evaluate treatment of group A beta haemolytic streptococcal pharyngitis with amoxycillin once daily compared with phenoxymethylpenicillin three or four times a day. DESIGN: Randomised controlled study of consecutive patients presenting with symptoms suggestive of group A beta haemolytic streptococcal pharyngitis in whom culture of a throat swab yielded positive results. SETTING: Five family medicine practices. SUBJECTS: 157 patients aged over 3 years who required treatment with antibiotics. MAIN OUTCOME MEASURES: Clinical response, bacteriological response, days at work and school lost, and compliance. RESULTS: During the period of the study 393 patients presented with symptoms suggesting streptococcal pharyngitis; 157 of them had throat swabs that yielded positive results on culture. Eighty two were treated with phenoxymethylpenicillin and 75 with amoxycillin. No difference was observed in the clinical response, days at work and school lost (139 days for 64 patients taking phenoxymethylpenicillin v 100 days for 57 patients taking amoxycillin; p > 0.2), or residual positive cultures after two days (6 (7.3%) v 3 (4%); p > 0.5). A significant difference in the bacteriological response was found after 14 days (5 (6.1%) v 0; p < 0.04) with no positive cultures observed in the amoxycillin group. CONCLUSIONS: These findings support the hypothesis that amoxycillin once daily is as effective as phenoxymethylpenicillin in the treatment of group A beta haemolytic streptococcal pharyngitis.

Absenteeism↗
PubMed1993

[An autonomous primary care clinic within a health maintenance organization].

The health system in Israel, as elsewhere in the world, is facing crises of organization and economics. Israel's largest HMO, which insures some 70% of the population, is a highly centralized body that makes policy decisions without consulting the community-based primary care teams. We describe the process of extending autonomy to a primary care clinic with the object of lowering costs and allowing its staff to prioritize the problems of the patient population and the community they serve.

Ambulatory Care Facilities↗
PubMed1993

[Primary care consultation rates among the middle aged and elderly].

The consultation rate among family physicians has been widely discussed in the literature, but very few studies have been done in Israel. We analyzed the pattern of visits to the family physician of 1,860 patients aged 40 years and older in 3 urban clinics, 2 kibbutzim and 1 rural clinic with a total population of 6,700. The consultation rate rose steadily with age. It was 3.4 per year at age 40-49, and 5.6 at ages 70 and over, with a mean annual rate of 4.6. 77% of the screened population consulted the physician in 1 year and 91.4% in 3 years. Only 9.6% did not visit their physicians in the 3 years. About two-thirds visited the physician 1-4 times a year, and only 2% visited more than 15 times. In urban practices women attended more often than men but there was no significant sex difference in the rural practices. As a result of the greater visit rates of the elderly, they consumed a larger share of medical services. The mean consultation rate in this survey is similar to that in England and in other Western countries. However, it is relatively low in comparison to other studies in Israel. This may be due to the different practice setting and the use of a different sampling frame.

Adult↗
PubMed1993

Parkinson's disease camouflaging early signs of hypothyroidism.

Development of hypothyroidism in a patient with Parkinson's disease may be overlooked because the clinical manifestations of the two disorders are similar. In addition, drugs used to treat Parkinson's disease may mask the slight rise in thyrotropin level that is characteristic of the early stages of hypothyroidism. In this article, the authors discuss a case in which the diagnosis of hypothyroidism was delayed in a patient who had previously been diagnosed with signs and symptoms of Parkinson's disease.

Humans↗
PubMed1993

Stories from the sealed rooms: patient interviews during the Gulf war.

The mass deployment of gas masks to an entire population, which occurred in Israel prior to the Persian Gulf crisis and their use in early 1991, were phenomena without precedent. In addition to the historical significance, there were considerable health and psychological ramifications. This research examines the experiences of the Israeli public during the Gulf war using a qualitative methodological approach, narrative analysis. Interviews of a convenience sample of 60 patients attending primary care clinics were audio-recorded by three family physicians using an open-ended interview guide. Encounters took place at sites located in the north, south and centre of the country during the period of Iraqi missile attacks. Patients' stories were analysed using a multistep narrative analysis protocol. Seventy per cent of subjects reported deleterious health effects related to the missile attacks or civil defence measures, mainly psychological and neurological complaints, sleep disorders, gastrointestinal and respiratory symptoms. Recurrent themes and metaphors in the narratives most often focused on the difference of this war to others, the central involvement of the family, concern for children and identification and connection to the nation. The Scud missile attacks combined with the civil defence measures had significant impact on the population, as manifested in subjects' stories, symptoms, symbols and behaviour. Narrative analysis provided an efficient method to capture the rich texture of patients' experiences.

Adolescent↗
PubMed1992

[Quality control in primary care: an instrument for constructing a database].

An instrument for constructing a database and defining standards for quality control in primary care medicine is presented. A questionnaire adapted from a U.S. Department of Health and Human Services form will be used randomly at least twice a year for screening all patient-staff contacts in most Kupat Holim clinics in the Negev Region (small rural clinics excepted). Analysis of the responses will enable definition of standards for measuring the quality of primary care. The tool is simple, inexpensive, not too time-consuming, and can provide the required data. A pilot study to test the tool was carried out in 3 primary care clinics serving an insured population of 17,763. The study surveyed 474 patient visits to the clinics, of which 57% were consultations with a physician. The younger patients usually saw the physician, while the older tended to visit the nurse. The most common reason for clinic visits was an acute condition, and only 4% of visits were for administrative reasons. 28% of the patients were not prescribed any medication and 27% were prescribed only 1 drug. The majority of problems were dealt with at the clinic level and only a few were referred to specialists or to external diagnostic services.

Adolescent↗
PubMed1992

[Characteristics and perceptions of physician managers in Israel].

In a survey of 120 physician managers (PM) of the Israel Ministry of Health and the General Sick Fund (Kupat Holim), demographic and managerial characteristics and perceptions of what is important for effective performance were studied. Medical directors of hospitals, districts and Kupat Holim clinics were included. The majority of the respondents had some training in medical management. 33% are family physicians, 15% are internists, 33% have degrees in public health, 17% are board certified in medical management, and 8% are pediatricians. None of the district and hospital medical directors of the General Sick Fund is a woman, but 40% of medical directors in Ministry of Health districts are women. More than 50% of PMs are not satisfied with the dualistic management that exists mainly in the General Sick Fund. 42% of the respondents stated that 8 or more years after residency is the most appropriate time to assume managerial roles. The average score of those who chose medical management from the point of view of job satisfaction was 7.4 +/- 2.3, but the rated satisfaction from performance as a PM in the health care system today is 4.2 +/- 2.6 (on a 1-10 scale). The most important managerial characteristics perceived by the respondents were credibility, ability to communicate and delegate, and leadership.

Female↗
PubMed1992

The interrupted consultation.

This paper focuses attention, in a modest empirical way, on a hitherto unexplored phenomenon. Widespread in Israel, the interrupted patient-physician consultation may or may not be found extensively elsewhere. It is assumed that interruptions coming from the social environment affect communication and hence diagnosis and therapy, as well as satisfaction of both doctor and patient. Observations were conducted in a random sample of 100 consultations, averaging 9.4 minutes, of four physicians in a neighbourhood health centre in Israel. Interruptions were recorded in 94 cases, with an average of 1.36 interruptions per consultation. Contrary to Israeli myth, most interruptions were not by other patients but by clinic staff. The phenomenon is considered in terms of cultural practice and the consequences of group practice, nurse autonomy and medical student teaching. Further research is proposed to study the extent, sources and consequences of interruptions in family practice and, if warranted, methods of coping.

Communication Barriers↗
PubMed1991

Outbreak of pertussis in a closed population with a high vaccination rate.

An outbreak of pertussis encompassing 78 cases in a population of 964 persons living on kibbutz is described. The attack rate was 36.1% among children aged 4 to 11 years, although all had been fully vaccinated. Female predominance and seasonal incidence conformed with what has been reported in the literature. The age distribution, however, was markedly different from that usually observed, indicating that local factors may influence the epidemiology of whooping cough. Despite the seeming paradox of the disease breaking out in a population with a high immunization rate, our results suggest that the vaccine had a protective effect in all age-groups. The incidence of pertussis in Israel in 1987 was considerably higher than that in the United States for the same year, and raises the question of changing the recommendations for vaccination here.

Adolescent↗
PubMed1989

Unsuspected source of vitamin K in patients treated with anticoagulants: a case report.

The administration of warfarin requires careful attention. The concurrent intake of drugs can either enhance or compete with its anticoagulant effect. Less frequently encountered are the effects from vitamin K added to food, intake of foods with naturally occurring high levels of vitamin K and diets deficient in vitamin K. We report a case in which loss of anticoagulant control was caused by a dietary supplement taken during a weight reducing diet by a patient who was receiving warfarin following a pulmonary embolus. A review of the literature reveals several similar cases. Amounts of vitamin K in food supplements and in foods with large amounts of naturally occurring vitamin K are tabulated along with suggestions for surveillance of patients taking anticoagulants.

Adult↗
PubMed1988

Complications of chiropractic treatment for back pain.

Back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. Rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. Physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.

Back Pain↗
PubMed1988

Voluntary dislocation of shoulder.

Voluntary dislocation of the shoulder is rarely seen by primary care physicians, but they must be able to recognize it and treat it correctly. Patients often use this ability to attract attention to themselves. Since the dislocations are painless and are performed at will, surgical intervention is not required. Proper treatment involves preventing repetition of the dislocations and providing emotional support for the patient.

Child↗