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        תוצאת חיפוש

        אוגוסט 1998

        עמירם שראל, ג'ף בורקן, רפאל ל' קרסו, יהודית ברנשטיין ואורי רוזובסקי
        עמ'

        Attitudes of Family Physicians to Alternative Medicine

         

        Amiram Sarel, Jef Borkan, Ralph L. Carasso, Judith Bernstein, Uri Rozovsky

         

        Brull-Tel Aviv Community Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba; and Dept. of Neurology, Hillel Yaffe Medical Center, Hadera

         

        80 Israeli family physicians (51.25% men and 48.75% women) participated in a telephone survey concerning attitudes, practices and experience with alternative medicine. 23.75% reported practicing 1 or more alternative techniques, most commonly acupuncture28%) and hypnotherapy (24%). 55% had referred at least 1 patient to an alternative practitioner during the preceding month. Physicians who studied in Israel or Western countries referred more patients than graduates of medical schools of Eastern Europe. Specialists referred patients more often than residents. The most common reason for referral was back pain.

        ס' זלבסקי, ש' וינקר, ע' פיאדה, ד' ליבון וא' קיטאי
        עמ'

        Background Music in the Family Physician's Surgery: Patient Reactions

         

        S. Zalewsky, S. Vinker, I. Fiada, D. Livon, E. Kitai

         

        Family Medicine Clinics and Dept. of Family Medicine, Sackler School of Medicine, Tel Aviv University

         

        Music is a universal language, and its effects on pain relief and stress reduction are well known. We evaluated patients' opinions of the effects of background music in their family doctors' surgery. Low volume, background, classical music was played in the doctors' surgery on 5 consecutive clinic days. All patients were asked to fill a short anonymous questionnaire on leaving. Among the 135 consecutive patients offered the questionnaire, there was 87.4% compliance. Among the 118 who completed the questionnaire, 95% said that the background music did not disturb them, 89% thought it made them feel better and 80% thought that it aided the doctor's performance. We conclude that low volume, background music in the doctors's surgery may contribute to better doctor-patient interaction, although larger studies are needed to confirm our findings.

        שלמה וינקר, ששון נקר, זהבה אלון, חאמד אבו-עמר, גד סדובסקי ואיתן חי-עם
        עמ'

        Urgent, Unscheduled Self-Referrals by Ambulatory Patients

         

        S. Vinker, S. Nakar, Z. Alon, H. Abu-Amar, G. Sadovsky, E. Hyam

         

        General Sick Fund, Central District and Dept. of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University

         

        Direct self-referral to a consultant is common in the Israeli health system. Yet patients' reasons for their urgent, unscheduled self-referrals for ambulatory consultations (UUSR) have not been explored. We studied such consultations in an urban multi-disciplinary consultation center serving a population of approximately 100,000. Over a 3-month period such consultations in ophthalmology, ear-nose-and-throat and dermatology clinics were treated by a duty family physician (FP). The FP was instructed to focus on the urgent complaint and either to give definitive treatment and schedule a consultation when needed, or refer the patient for immediate specialist consultation. Patients treated by the FP were asked to fill an anonymous questionnaire, which 347/645 (55.4%) did.

         

        Among the reasons for UUSR were that the patient thought that his/her complaints should be treated by a consultant (29%), the patient was sent by the FP without a consultation note (13.9%), the FP was not available (10.4%), or the patient wished to see the consultant for a second opinion (8.2%). In only 7.8% had the patient noted that his complaint needed urgent consultation. Duration of complaints, but not prior efforts to schedule a consultation, were associated with different reasons for asking for an UUSR. For various reasons patients preferred an UUSR rather than seeing their own FP. Patients' opinions regarding self-referrals are important in planning primary care facilities and FP training.

        יוני 1998

        אנדרה מטלון
        עמ'

        Pains and Pleasures of a Family Physician: 10 Years of Caring for a Family

         

        Andre Matalon

         

        Family Medicine Dept., Tel Aviv University and Kupat Cholim Klalit, Machoz Dan, Petah Tikva

         

        One of the major characteristics of family medicine is the duration of the doctor-patient relationship over a continuum of time. Physician and family contribute to establishing a relationship that is both therapeutic and gratifying. This mutual bond and involvement was called by Balint "a mutual investment company," in which understanding and trust grow over the years. This paper deals with these contributions and investments, and the positive and negative emotions evoked in the family physician by the patient and family. After 20 years of caring for the family presented, it was possible to address more specifically the analysis of the pains and pleasures of this continuity of care, and the sources of the complex bonding between the family and the family physician.

        נחום רוזנברג ושלום שטהל
        עמ'

        Osteoid Osteoma of the Hand: a Rare Location

         

        Nahum Rosenberg, Shalom Stahl

         

        Dept. of Orthopedics A, and Hand Surgery Unit, Rambam Medical Center, Haifa

         

        Osteoid osteoma is a benign bone tumor. It is rare in the hand where it may cause local swelling and pain. Marginal resection is almost always curative, without residual functional disability. Because it is rare in this location, osteoid osteoma is not usually considered in the differential diagnosis of painful lesions of the hand, which may delay treatment. Osteoid osteoma in the hand has characteristic clinical, roentgenologic and scintigraphic features. Early diagnosis of this lesion may be improved by recognition of these features. An algorithm for decision-making that may help is proposed. We describe our experience in 3 cases involving, respectively, the capitate bone, a proximal, and a distal phalanx, in which cases marginal resection was curative.

        דורון חרמוני, מיכאל קאפמן ואליעזר קיטאי
        עמ'

        Alternative Medicine in a Kibbutz Community

         

        D. Hermoni, M. Kafman, E. Kitai

         

        Dept. of Family Medicine, Rappaport Faculty of Medicine, The Technion, Haifa and Family Medicine Dept., Sackler Faculty of Medicine, Tel Aviv University

         

        Interest in, and use of alternative medicine has increased in the past few years in Israel. Still, little is known about the extent to which it is utilized, the more common treatments, patterns of use, and its influence on the conventional primary care system. We surveyed a kibbutz community to determine prevalence and patterns of use of alternative medicine and satisfaction with the outcome. The entire kibbutz population was asked to fill out a questionnaire (parents answered for their children). They were questioned as to their use of alternative medicine in the previous 5 years, types and dates of treatment, duration of treatment, and whether it had helped.


        Of 1044 subjects, 830 responded (79.5%). 16.4% had used alternative medicine at least once in the previous 5 years. Of these, more than a 1/4 were treated by 2 or more types of alternative therapy. About 2/3 of those responding were women. Most had muscle-skeletal (36%), upper respiratory and/or atopic problems (19.3%). The most common treatments were homeopathy (31%) and acupuncture (20%). In approximately 2/3, the treatment was considered helpful, and either solved the problems or gave long-lasting improvement. 70% of those who used alternative medicine were treated within the previous 15 months and about 40% within the previous 3 months. The use of alternative medicine is increasing and it is now includein standard medical services. Most of those who used alternative therapy felt is hadhelped.
         

        אלדד זילברשטיין, טלי זילברשטיין, גד שקד, מרים כץ, משה מזור ויצחק לוי
        עמ'

        Acute Appendicitis during Pregnancy

         

        Eldad Silberstein, Tali Silberstein, Gad Shaked, Miriam Katz, Moshe Mazor, Itzhac Levi

         

        Dept. of Surgery C, Divisions of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        Acute appendicitis is the most common surgical problem in pregnancy, when it is difficult to diagnose early because of the physiological changes of pregnancy. We studied the problem in the Negev population and present the main issues in diagnosis and management. Between 1988-96, 26 women were operated on for acute appendicitis during pregnancy (1/3297 deliveries), 3 by laparoscopy. In 13 there was a histopathological confirmation of the diagnosis. Clinical diagnosis was more accurate in the first trimester of pregnancy than in the second or third (p=0.073). Premature delivery rate was higher in both confirmed and unconfirmed acute appendicitis than in other pregnancies (p<0.00001), but without significant differences between the 2 groups with appendicitis. Other indexes of maternal and perinatal morbidity did not differ either.

        ר' אברהמי, מ' חדד, ס' וטמברג, א' שטלמן, א' קורן, ג' דהן וא' זליקובסקי
        עמ'

        Popliteal Vascular Trauma

         

        R. Avrahami, M. Haddad, B. Watemberg, E. Stelman, A. Koren, J. Dahn, A. Zelikovski

         

        Dept. of Vascular Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva

         

        6 cases of popliteal vascular trauma are presented, 3 due to posterior dislocation of the knee and 3 due to crush injury. The patients were referred from another hospital and some had undergone unnecessary angiography when ischemia was present, leading to delay in surgery. All patients presented with distal ischemia and underwent reconstructive surgery; 2 subsequently underwent below-knee amputation because of irreversible ischemia and sepsis.

         

        Urgent operation for popliteal vascular trauma is necessary whenever there is ischemia and intraoperative angiography may be necessary. There should be reconstruction of the artery and vein when there is concomitant venous damage, and fasciotomy and debridement are important. The harmful potential of occult popliteal vascular injuries and their ostensible mild presentation present a challengfor the emergency room surgeon.

        מאי 1998

        רותי מרגלית-סטשפסקי, אברהם לורבר ואיל מרגלית
        עמ'

        Familial Occurrence of Ebstein Anomaly

         

        Ruti Margalit-Stashefski, Avraham Lorber, Eyal Margalit

         

        Family Practice Unit, Kupat Holim Klalit, Haifa, Pediatric Cardiology Unit, Rambam Hospital, Haifa and Ophthalmology Dept., Hadassah--University Hospital, Jerusalem

         

        Ebstein anomaly is a rare congenital disease which affects location, structure and mobility of the tricuspid valve, and right atrium and ventricle. Although most cases are sporadic, familial occurrence has been reported. We report 2 brothers born with Ebstein anomaly. The parents were first degree cousins and there were 8 other children. 2 daughters were born with other congenital heart anomalies, 1 with ventricular septal defect and the other with severe pulmonary artery stenosis. We suggest that in some families, Ebstein anomaly is an autosomal dominant disease with different expression in the sexes.

        מ' קליגמן ומ' רופמן
        עמ'

        Conversion Total Hip Replaceafter Failed Internal Fixation of Intertrochantric Fracture

         

        M. Kligman, M. Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

        אפריל 1998

        פסח שורצמן, רויטל גרוס, חווה טבנקין, דני יובל, מרים גרינשטיין ובורמה ויאנקה
        עמ'

        Primary Care Physicians in Israel Compared with European Countries

         

        P. Shvartzman, R. Gross, H. Tabenkin, D. Yuval, M. Grinshtein, B. Wienka

         

        Dept. of Family Medicine, Ben-Gurion University of the Negev, Beer Sheba;

        Brookdale Institute, Jerusalem; and Nivel Institute, Maastricht, the Netherlands

         

        This study compares Israeli primary care physicians with those of European countries. In Israel a larger proportion of those in primary care are women. The Israeli physicians see many patients a day, but almost never make home visits. They also report for work the fewest hours a day, but spend 21 hours a month in continuous medical education. (more than Europeans?) The Israeli primary care physician scores high in screening for breast cancer and blood cholesterol level, but very low in the fields of minor surgery and alcohol and smoking prevention, contraception, nutrition counseling and normal pregnancy follow-up. Residency training and education may be inadequate, and more emphasis has to be put on the health system and recognizing environmental influences.

        מרץ 1998

        א' כרמל, ה' עמיטל, י' שמר וא' שחר
        עמ'

        Clinical Characteristics of those who Leave the Emergency Room Against Advice

         

        A. Carmel, H. Amital, Y. Shemer, A. Sahar

         

        Emergency Dept. and Dept. of Medicine B, Gertner Institute for Medical Service Research, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        The object of this study was to characterize those who leave the emergency department agmedical advice and to examine the short-term consequences. The study was conducted retrospectively 1992 and prospectively during May-August 1993 by telephone interviews. About 0.5% of all the patients who applied to the emergency department left against medical advice. Their main characteristic was that they were mostly young, single men. A wide range of complaints had brought them to the emergency department, very similar to that of the control group, but with a higher tendency to abuse drugs and alcohol. Most of those who left against medical advice had less severe disease than the controls. However 10% of them had to be hospitalized within the subsequent 2 weeks, in comparison with 4% of the controls. This study suggests that improving the efficiency of the emergency department will decrease the number leaving against advice.

        דרור פוקס, חיים צינמן ודינה לוינזון
        עמ'

        Aseptic Loosening of Joint Implants

         

        Dror Fuchs, Chaim Zinman, Dina Lewinson

         

        Orthopedic and Traumatology Dept. B, Rambam Medical Center; and Div. of Morphology Sciences, Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        The purpose of orthopedic joint implants is to improve joint movement. Within the past 30 years, biomechanical improvements affecting the life-span of the implants has brought a new type of problem: the biological response to debris from the implant material contributes greatly to aseptic loosening of the prosthesis. The process is mediated by osteotropic factors, cytokines released from mononuclear cells, and osteoblasts and osteoclasts in the bone-cement interface or bone-implant interface.

        אנבל אהרון-מאור, יאיר לוי ויהודה שינפלד
        עמ'

        Fibrosarcoma after Silicone Breast Augmentation: Associated?

         

        Anabel Aharon-Maor, Yair Levy, Yehuda Schoenfeld

         

        Medical Dept. B, Chaim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe a 42-year-old woman in whom bilateral fibrosarcoma of the breast was diagnosed 15 years after bilateral breast augmentation with silicone implants. 3 years prior to admission the implants were replaced and 2 years prior to admission mammography showed a nodule in the left breast which biopsy showed to be fibrosarcoma. The implants were removed from both breasts and she was given chemotherapy but later that year underwent bilateral mastectomy. Despite chemotherapy, as well as adjuvant radiotherapy, the disease progressed, with involvement of the lungs and the skin of the left hemithorax. She was admitted repeatedly for severe anemia caused by bleeding from the malignant skin lesions, and died less than 2 years after diagnosis of the disease.

        Not all reports in the literature find a significant connection between silicone implants and subsequent development of breast cancer, but there are reports that do connect them. Breast fibrosarcoma is not significantly more frequent after silicone augmentation, but still there is controversy as to whether there is a connection between silicone implants and breast malignancy. In the patient we present, the prolonged exposure to silicone may have been a predisposing factor for the development of bilateral fibrosarcoma, since other known risk factors for breast cancer were denied.

        פברואר 1998

        מ' קליגמן ומ' רופמן
        עמ'

        Intra-Osseous Ganglion of Scaphoid and Lunate Bones

         

        M. Kligman, M. Roffman

         

        Dept. of Surgery, Carmel Medical Center, Haifa

         

        We present a patient with intra-osseous ganglion of the left scaphoid and lunate bone. These were excised and a bone graft inserted. 1 year after operation the patient was free of pain, without limitation of wrist motion. Intra-osseous ganglion of the carpal bone is not common and lunate and scaphoid intra-osseous ganglion has rarely been reported. Awareness of this condition may lead to earlier diagnosis and treatment, with satisfactory outcome.

        הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303