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S Noy

Publications and source records attributed to S Noy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Sexual dysfunction in relapsing-remitting multiple sclerosis: magnetic resonance imaging, clinical, and psychological correlates.

The purpose of this study was to examine the sexual complaints and severity of sexual dysfunction in relapsing-remitting multiple sclerosis patients and to correlate them with psychological, neurological, and radiological variables. Frequency and characteristics of sexual disturbances were reported by 41 multiple sclerosis patients (32 females, 9 males; mean age 35.4 +/- 10.2 y). Clinical neurologic variables tested were disease duration, exacerbation rate, and disability; psychological variables tested were anxiety and depression. All patients underwent a brain magnetic resonance imaging (MRI) scan at the time of this study. The sexual dysfunction questionnaire included items based on the 3 phases of human sexual response: loss of libido, excitement (arousal difficulties, impotence, premature ejaculation), and anorgasmia. Five males (55.5%) and 16 females (50.0%) reported at least 1 sexual disturbance. The most frequent dysfunctions were loss of libido (26.8%) and arousal difficulties (19.5%). Females rated their difficulties as more severe. Sexual dysfunctions correlated with depression, (r = 0.68, P = 0.001). No correlation between MRI score and depression was found. Anorgasmia correlated with brain stem and pyramidal abnormalities (r = 0.56, P = 0.011; r = 0.56, P = 0.012, respectively). The total area of lesions (plaques) on the brain MRI scan also correlated with anorgasmia (r = 0.41, P = 0.02). Sexual dysfunctions in multiple sclerosis patients are frequent, are mild to moderate in severity, correlate with depression and in some cases central nervous system (CNS) demyelinating process, and thus may be related either to the psychological impact of this disease or to specific organic lesions in the brain.

Adult↗
PubMed1996

Allocation of emergency ward patients to medicine departments: increasing physicians' incentive to shorten length of stay.

BACKGROUND: Duration of hospital stay is one of the major determinants of hospital cost. In addition, high bed occupancy, especially in internal medicine departments, can delay the admission of patients from the emergency ward. OBJECTIVE: To shorten average hospital stay and hasten admission of patients from the emergency room to the medicine department. DESIGN: Patients from the emergency ward were assigned to internal medicine departments according to a quota system that insured that each department received a similar share of these admissions. Outcome measures for the year following this administrative change were compared to the two prior years in the same hospital and to a similar public hospital during the study period. SETTING: A major public hospital. MAIN OUTCOME MEASURES: Length of hospital stay (LOS), occupancy rate, number of admissions, number of readmissions, and mortality. RESULTS: The average length of stay in the internal medicine departments was shortened from 8 +/- 8 days in 1987 and 1988 to 6.3 +/- 6.8 days in 1989 (p = 0.0001). Occupancy rate was also reduced from 94% in 1987 and 1988 to 88% in 1989 (p = 0.002). The number of admissions increased by 19.2%, with a higher rate of readmissions within 30 days of discharge from the index hospitalization (12.5% and 13.4%, respectively in 1987 and 1988, versus 16.4% in 1989, p = 0.0001). In-hospital as well as 6-month mortality were unchanged. Case mix was similar during the study period to that in the previous two years. Length of stay, occupancy rate, and number of admissions were unchanged during the same period at a similar hospital without a corresponding patient allocation system. CONCLUSION: A relatively simple administrative intervention influenced physician incentive and significantly decreased hospital length of stay.

Emergency Service, Hospital↗
PubMed1996

The economic burden of Alzheimer's disease in Israel.

Owing to expected increases in the number of persons at risk for developing Alzheimer's disease and the expected decrease in the number of potential caregivers, the economic burden on society and families is expected to rise. Given changes in demographics and labor force participation, it is likely that the burden will be transferred from informal to formal paid services. Understanding the burden and cost of caring for this large population of patients is essential in order to make rational decisions with regard to allocating resources and providing quality care.

Alzheimer Disease↗
PubMed1994

T-cell subsets in acute psychotic schizophrenic patients.

Two-color flow cytometric analysis was performed on peripheral blood lymphocytes of 16 untreated schizophrenic patients during an acute psychotic attack and 16 healthy control subjects to evaluate differences in T-cell subpopulations. In schizophrenic patients, we observed decrease in CD4+ 2H4+ (suppressor-inducer) and CD8+ 2H4+ (suppressor-effector) T-cell subsets. The selective loss of 2H4+ cell markers both on helper and suppressor T cells was not correlated to the severity of the acute psychosis. Our results may indicate a mechanism of an immune disequilibrium in schizophrenic patients during an acute psychotic attack.

Acute Disease↗
PubMed1994

Israeli ED experience during the Gulf War.

The experience in an emergency department (ED) during the Gulf War in treating casualties referred to the ED soon after each missile attack is reported. Data were gathered within an 8-hour period of each nationwide alert on all patients who presented to the ED with injuries or complaints directly related to the missile attacks of the Tel Aviv area. One hundred three patients presented with symptoms directly related to the missile attacks. Of 103, 70 suffered from acute psychological reaction, 19 from false autoinjection of atropine, and nine from physical injuries from the explosion. Of the remainder, four had mild symptoms of smoke inhalation, and one had intercurrent myocardial infarction. The missile attacks resulted in a relatively small number of serious injuries. Most of the patients who presented to the ED soon after the missile attacks suffered from either anxiety reaction or false atropin injection.

Adult↗
PubMed1994

Intravenous gammaglobulin treatment in multiple sclerosis and experimental autoimmune encephalomyelitis: delineation of usage and mode of action.

Multiple sclerosis (MS) is a central nervous system demyelinating disease of implicated autoimmune aetiology. The effect was evaluated of intravenous gammaglobulin (IVIg), a successful therapy in various autoimmune diseases, in relapsing-remitting MS patients treated for three years. IVIg treatment significantly reduced the number and severity of acute exacerbations and resulted in a lesser neurological disability. There were no significant short or long-term adverse effects to IVIg treatment. To clarify the putative therapeutic effects of IVIg, this treatment was examined in the animal model of experimental autoimmune encephalomyelitis (EAE) in the rat. IVIg suppressed active EAE in relation to disease severity and duration, despite the presence of T-cell reactivity to specific antigens, while the treatment had no effect on passive EAE induced by adoptive transfer of myelin basic protein specific CD4 + T-cells. It is concluded that IVIg treatment may be a promising treatment in relapsing-remitting MS as it can alter the natural course of the disease.

Adult↗
PubMed1994

Schizophrenia and autoimmunity--a possible etiological mechanism?

Schizophrenia is a chronic disease which begins during early adulthood and persists throughout life. It may appear in two main clinical patterns: chronic progressive and relapsing-remitting. The diagnosis is based entirely on clinical data, as no auxiliary laboratory tests are available. Schizophrenia has a heterogeneous clinical expression which may reflect different etiological factors, such as genetic susceptibility, dysfunction of different neurotransmitter systems or environmental, stressogenic and interfamilial influences. Recently, an autoimmune hypothesis has gained acceptance, which proposes that schizophrenia is one of a spectrum of neuropsychiatric diseases in which an autoimmune attack on the brain occurs. It is also possible, however, that the immunological changes seen in schizophrenic patients are secondary to the disease itself. The main evidence supporting an autoimmune hypothesis is the presence of immunological alterations in schizophrenia that also occur in other autoimmune diseases, e.g. an elevation in serum immunoglobulin levels, a decrease in mitogen responses, morphologically abnormal lymphocytes, an increase in antibrain antibodies, an increase in antibodies to nuclear factor, and a decrease in CD4+ T cells. An autoimmune etiology, if proven correct in the pathogenesis of schizophrenia, would have potential implications for the direction of future psychopharmacological therapies.

Autoimmune Diseases↗
PubMed1994

Myotonic dystrophy gene analysis in affected Israeli families.

Myotonic dystrophy (DM) is an autosomal dominant disease with an estimated incidence of 1:7,500 individuals. The clinical manifestations are variable and include muscle wasting and weakness, myotonia, intellectual impairment, cardiac abnormalities, cataracts, and testicular atrophy. Despite its phenotypic variability, the disease is genetically homogeneous, and a specific molecular defect has been located to chromosome 19q13.3 and found to be associated with the expansion and instability of trinucleotide (CTG) repeats. Whereas normal individuals have 5-36 CTG repeats, affected individuals have 50 to several thousands. Therefore, DM can now be diagnosed accurately using molecular biology techniques that allow detailed analysis and determination of the size of DNA in the unstable DM gene region. In this way even mildly affected patients can be identified. We used this method to study the DM gene in 11 affected Israeli families (39 individuals). In most of the families, the unstable DNA sequence increased in size when transmitted to offspring. In one of the families we found contraction of the CTG repeat in a DM offspring of an affected male; and in another family a CTG repeat contraction occurred in three offspring of an affected female while in the fourth offspring there was CTG expansion. Southern blot analysis using BglI restriction provided the most accurate technical results. There was an obvious phenotype/genotype correlation between the size of the CTG repeat and severity of disease.

Adolescent↗
PubMed1993

Physician-hospital conflict among salaried physicians.

Physicians who were full-time salaried employees in nonprofit hospitals experienced conflict between their medical-clinical considerations and the administrative constraints imposed by the hospital. The level of experienced conflict was mostly related to the physicians' commitment to the hospital, the realization in the hospital of their work expectations, and external political influences exerted on the hospital. The implications of the findings for the physicians under a highly controlled work setting are discussed.

Conflict of Interest↗
PubMed1992

Open controlled therapeutic trial of intravenous immune globulin in relapsing-remitting multiple sclerosis.

Ten patients with relapsing-remitting multiple sclerosis were treated with intravenous immune globulin, 0.4 g/kg per day for 5 consecutive days, and then with additional booster doses of immune globulin of 0.4 g/kg, once every 2 months, for the next 12 months. Ten untreated patients with relapsing-remitting multiple sclerosis who were matched with the study patients for age, disease duration, and number of attacks per year served as controls. Immune globulin treatment was well tolerated, with no side effects. The exacerbation rate decreased from 3.7 +/- 1.2 exacerbations per year before treatment to 1.0 +/- 0.7 exacerbations per year during the treatment in the immune globulin-treated patients, while it remained unaltered in the controls. The posttreatment Kurtzke Expanded Disability Status Scale score decreased from a mean of 4.45 to 4.15, whereas in controls it increased from 3.55 to 3.75. The results suggest that immune globulin suppresses the ongoing pathologic process in multiple sclerosis and may be a promising treatment to prevent disease exacerbations.

Adult↗
PubMed1992

Public knowledge about characteristics of moles and melanomas.

In a study aiming to determine public knowledge about moles and melanomas 590 residents of Victoria aged 14 and over were interviewed in a face-to-face household survey. The majority believed that moles were primarily raised lesions. Recognition of the term melanoma was high (91 per cent), but many held misconceptions about key characteristics. Many thought an early melanoma was raised (20 per cent) or could be raised (42 per cent), compared with only 10 per cent who thought it was flat. Fifty per cent of respondents thought being ugly was a common characteristic. In response to photographs of skin lesions, a late melanoma, seborrhoeic keratosis and a squamous cell carcinoma were most likely to be identified as needing to be seen by a doctor, while a normal raised mole and two early melanomas were least likely. The data suggest that a large proportion of the community have misconceptions about the early signs of melanoma. Education programs are needed to inform the public that most early melanomas are flat. Strategies which might confuse this message, such as likening melanoma to moles, should be avoided.

Adolescent↗
PubMed1991

[Professional and personal characteristics of Israeli public hospital physicians].

The profile of the Israeli public hospital physician was evaluated in a survey of 703 physicians. Background variables (age, sex, marital status), working habits (time devoted to various activities, management position) professional characteristics (specialty, seniority, tenure, etc.) and hospital characteristics (size, ownership) were recorded. The profile that emerged was that of physicians in their early 40's, the majority men, 2/3 senior physicians, and half with tenure. They work 50 to 60 hours a week, mostly in clinical work, with less than 10% of their time in research. Physician mobility between hospitals is low: in any 5-year period very few positions become available, and then usually only when physicians retire. For these openings there is severe competition by a large number of residents. It is clear that research in hospitals should be encouraged in order to maintain hospital standards.

Adult↗
PubMed1990

[Changing economic environment of hospitals: management challenges of the 1990s].

The modern hospital is an organization which is influenced by the external environment in which it functions. A major relevant area is the economic environment. In recent years the western world has been facing the challenge of rising costs of health care and an increase in their proportion to the gross national product of most countries. Consequently, hospitals as major providers of health care are under pressure from governments and health insurance companies to cut costs and to "produce" more efficiently. Since hospitals worldwide are finding it hard and painful to function in the new environment in which attitudes to hospitals are changing, a potential managerial-economic crisis may be the next phase. How can the hospital adapt to these changes? First, by adopting managerial attitudes and the tools of the business sector. These include: the strategic planning process, hospital operative autonomy, creating medical-economic responsibility centers as departments, cost-accounting for medical procedures, and case-mix budgeting. Management information systems are necessary during the transition. The hospital information system should include functions at the operative level, such as outpatient visits, and admissions and discharges of patients; and also clinical, diagnostic and laboratory procedures related to the patient case-mix. The second level is a management information system which includes salaries of personnel, case-mix budgeting with variance analysis, prices of procedures and epidemiological data. The authors believe that only the managerial approach combining medical and economic disciplines can meet the challenges of the changing modern economic environment.

Economics↗
PubMed1990

[Strategic planning in the hospital today--a mandatory process].

Since the beginning of this decade strategic planning has become a common analytical method in nonprofit organizations, as well as in the business sector. In the nonprofit sector it has been implemented mainly in hospitals and universities. From experience, it is clear that strategic planning has contributed to the hospital's survival, improved performance, implementation and control. However, such good results have only followed correct planning and implementation, with emphasis on the business elements of an economic firm, such as marketing and budgetary planning, a control system and funding with increasing integration of "mathematical business" models. Recent studies have proved that strategic planning is a necessary condition for the survival of nonprofit organizations in a competitive environment. Experience demonstrates that modification of the business model of strategic planning in the nonprofit sector has significant advantages for both public and private sectors. We describe the way strategic planning is performed in hospitals, as well as relevant modification and limitation of the process. Our message to Israeli hospitals is that those which do not prepare themselves systematically for change, may find survival impossible.

Hospital Administration↗