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        תוצאת חיפוש

        מאי 2000

        סימה לבני, אריאל המרמן, שגב שני ויהושע שמר
        עמ'

        Israel Hospital Pharmaceutical Services: A National Survey 


        S. Livny, A. Hammerman, S. Shani, J. Shemer

         

        Hiliel Yaffe Medical Center, Hadera; Israel Center for Technology Assessment in Health Care; Gertner Institute, Tel HaShomer; Dept. of Internal Medicine, Sheba Medical Center, Tel HaShomer; and Sackler School of Medicine, Tel Aviv University

         

        Results of a 1996 survey of hospital pharmaceutical services in Israel are presented. A questionnaire was mailed to 46 pharmacy directors in Israel hospitals of which a total of 33 were returned (72%).

        The main services provided at hospital pharmacies are production of pharmaceuticals and inventory management. The pharmacy directors estimated that more then half of their pharmacists' time was spent on technical work that did not need their academic, professional knowledge. In Israel general hospitals there are on the average 1.23 full time pharmacist positions per 100 hospital beds and 1.09 positions for other pharmacy employees.

        A similar survey carried out in the United States showed an average of 7.4 pharmacists per 100 hospital beds. Pharmacists there have broad clinical roles which, in general Israeli pharmacists do not have.

        Computer systems are used in our pharmacies mainly for inventory management. About half of the directors did not think that the location, structure and furnishings of their pharmacy were appropriate for its role.

        Under current conditions, Israel hospital pharmacies are not organized to provide pharmaceutical services beyond inventory management and pharmaceutical production. Appropriate budgets and personnel are required to develop clinical pharmacy services at Israel hospitals. This would lead to improved quality of drug treatment and cost-containment and would allow pharmacists to exploit their knowledge, skills and training that under the current system, are only partially utilized.

        ספטמבר 1999

        מרדכי מרק, רחל מגנזי, אסנת לוקסנבורג, מרים זיבצינר ויהושע שמר
        עמ'

        Clozapine in the Treatment of Schizophrenia

         

        M. Mark, R. Magnezi, O. Luxenburg, M. Siebzehner, J. Shemer

         

        Israel Center for Technology Assessment in Health Care, Sackler Faculty of Medicine, Tel Aviv University

         

        Schizophrenia is associated with brain abnormalities and is typically evidenced by disorganized speech and behavior, delusions, and hallucinations; it usually requires extended hospitalization. Its incidence in the western world is estimated at 4-7 cases/10,000/year.

        A method of shortening hospitalization and improving level of functioning is the use of unique medication, including clozapine, which has been in use in Israel for the past 6 years.

        We report 327 patients who participated in a community rehabilitation program and were treated with clozapine. They were compared with 417 patients who corresponded to the guidelines of the Director of Mental Health Services for treatment with clozapine, but were not treated with it for reasons not defined in the guidelines.

        The study included those 25-44 and 45-64 years of age and according to the division of the population of patients hospitalized in both government and private hospitals. The project demonstrates the savings from use of clozapine as opposed to the alternative of hospitalizing these patients. It also shows the complexity and difficulty in assimilating new technologies, in relation to the influence of social considerations and supplier/insurer accounting on the patterns of technological assimilation.

        יולי 1999

        שגב שני ויהושע שמר
        עמ'

        The Israeli Pharmaceutical Market

         

        Segev Shani, Joshua Shemer

         

        Pharmaceutical Policy and Economics Unit, Israeli Center for Health Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        The pharmaceutical market in Israel has undergone many major changes over the past 2 years. We detail measures taken with regard to drug prices and utilization, from 1992 until 1995, when the National Health Insurance Law was implemented. This provides an information base for marketing and dispensing of drugs, economic planning in the public health system, and for physicians and pharmacists in clinical practice.

        The national expenditure on pharmaceuticals in 1994 was 9.4% of the annual national health expenditure. From this fact, and the number of registered drugs and the number of clinical trials conducted, it appears that our pharmaceutical market is quite diversified and well developed compared to other markets in the western world. This size advantage enables our sick funds to purchase drugs at much lower prices than the private sector.

        אוקטובר 1998

        יורם זולברג, אורית נחתומי-שיק, יהושע שמר ומנחם אלקלעי
        עמ'

        Terror in Japan: Mass-Intoxication with the Nerve-Agent Sarin

         

        Yoram Solberg, Orit Nachtomi-Shick, Yehoshua Shemer, Menachem Alcalay

         

        Medical Corps, Israel Defense Forces and Sheba Medical Center, Tel Hashomer

         

        During 1994/5 the Japanese civilian population suffered 2 terror attacks by the organophosphorus nerve-agent sarin. In these 2 episodes it is estimated that more than 6000 people were injured, of whom 19 died. The quick and efficient response of the civilian emergency systems to these unforseen, attacks has to be analyzed by local authorities to determine the best solutions in case of another attack. We summarize the events, and note the emergency system's response, the need for rapid and accurate chemical identification of the toxin, the necessity for decontaminating the casualties and for providing protective gear for rescue units in the contaminated area. We also describe the clinical status of the casualties and outline the mode of therapy applied.

        יולי 1998

        נטע נוצר, מרים זיבצנר, יהושע שמר ומרדכי רביד
        עמ'

        Professional Assessment of Senior Immigrant Physicians

         

        N. Notzer, M.I. Zibziner, J. Shemer, M. Ravid

         

        Sackler Faculty of Medicine, Tel Aviv University

         

        Israel has absorbed many immigrant physicians and has utilized their skills without compromising local professional standards. In accordance with this policy a special law for the assessment of the licensing of senior immigrant physicians, mainly from the former Soviet Union, who had practiced medicine for at least 14 years was implemented in 1994.

         

        Considering their considerable medical experience on the one hand and their lack of experience in speaking Hebrew or undergoing testing techniques, they were exempted from the written national licensing examination. Instead they were obliged to undergo a 6-month clinical observation period in a local hospital or clinic.

         

        At the end of this period a letter of confirmation was issued which was followed by an oral assessment of their clinical ability. In the assessment session, each candidate was presented with written presentations of 4 typical clinical cases which practitioners encounter on a daily basis, in family medicine, emergency medicine, surgery, and pediatrics or gerontology. Of 114 cases prepared, 4 were selected for each candidate by the committee of 13 trained, experienced Israeli physicians.

         

        3 members of the committee assessed each candidate using specified criteria. The assessment, which lasted about an hour, focused on the candidates' professional knowledge involved in differential diagnosis and case management.

         

        Of 497 candidates examined between 1994 and 1996, approximately 80% passed in their first attempt. However, about 30% of the invited candidates did not appear for the exam. Characteristics of successful candidates were being young and being among the seniors with the least clinical experience. Most had specialized in internal medicine and had completed their observation period in a non-academic hospital. There they had received somewhat more attention than those who had been in academic hospitals. Significantly, the successful candidates were more proficient in Hebrew than the unsuccessful candidates, and reported no special problems during the observation period.

        אפריל 1998

        רפאל יוסף חרותי, רון בן-אברהם, מיכאל שטיין, יניר אברמוביץ, יהושע שמר וברוך מרגנית
        עמ'

        Changes in Structure and Process Components of Trauma Care in Emergedepartments

         

        Rephael Joseph Heruti, Ron Ben-Abraham, Yanir Abramovitch, Michael Stein, Joshua Shemer, Baruch Marganit

         

        Trauma Control, Israeli Center for Disease Control (ICDC), Israel Ministry of Health and Sackler School of Medicine, Tel Aviv University

         

        In recent years there have been tremendous efforts to improve primary trauma care. The Ministry of Health and other authorities have invested in new trauma facilities in various hospitals. A nationwide survey with regard to structure and function of emergency departments was carried out. Compared to a similar survey conducted in 1992, significant progress in quality and quantity of equipment at various emergency departments was demonstrated. However, there are still differences between various hospitals. A drive to standardize trauma care will undoubtedly contribute to improvement in care of the injured.

        מרץ 1998

        רון בן אברהם, מיכאל שטיין, יורם קלוגר, גדעון פרת, אברהם ריבקינד ויהושע שמר
        עמ'

        Israel's ATLS Program: Summary and Outlook

         

        Ron Ben Abraham, Michael Stein, Yoram Kluger, Gideon Paret, Avraham Rivkind, Joshua Shemer

         

        Medical Dept., Israel Defense Forces and Israel Trauma Society

         

        In recent years a vigorous effort has been made to improve quality of primary trauma care in Israel. Advanced trauma life support courses (ATLS) were given to physicians throughout the country, regardless of their specialties. In 7 years 4229 physicians participated in 202 courses with an average success rate of 76%. In the future, issues such as mandatory vs. voluntary training, language barriers, and continuous decline of knowledge should be addressed if momentum is to be maintained.

        דצמבר 1997

        חן בן אברהם, מיכאל שטיין, יורם קלוגר, גדעון פרת, אברהם ריבקינד ויהושע שמר
        עמ'

        ATLS Course for Surgery Residents - Should it be Mandatory?

         

        Ron Ben-Abraham, Michael Stein, Yoram Kluger, Gideon Paret, Avraham Rivkind, Joshua Shemer

         

        Medical Corps, Israel Defense Forces; Sourasky Medical Center and Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University; and Hadassah Medical Center, Jerusalem

         

        Senior surgeons were asked about mandatory participation of general surgery residents in the advanced trauma life support (ATLS) course. Although trauma care in Israel is given by surgical residents, in the opinion of their senior mentors the course should continue to be mandatory for them.

        נובמבר 1997

        אורי גבעון, מרים א. זיבצנר, משה סלעי, אהרן צ'צ'יק, הנרי הורושובסקי ויהושע שמר
        עמ'

        Orthopedic Ward Policy in Introduction of New Types of Total Hip Implants

         

        U. Givon, M.I. Siebzhener, M. Salai, A. Chechick, H. Horoszowski, J. Shemer

         

        Orthopedic Staff, Medical Technology Unit, Medical Dept. F, and Gertner Institute for Study of Health Services, Chaim Sheba Medical Center, Tel Hashomer

         

        The use of different types of total hip implants in medical centers in Israel was surveyed. Questionnaires were sent to all orthopedic ward directors in Israel requesting information on the number of total hip arthroplasties performed between the years 1984-1993, the types of implants used, and whether attending physicians or residents perform the operations. 22 of 24 orthopedic wards responded but 1 ward was excluded because only the results for 1993 were reported. 5 wards reported more and 16 fewer than 50 operations a year. 15 different types of implants were in use in Israel in that period, and in 5 wards 5 or more types of implants were used. Only 1 of the wards performed more than 50 operations a year. We conclude that the indiscriminate use of multiple technologies in wards performing few operations can lead to the long "learning curves" previously associated with poor results. Orthopedic surgeons should resist the impulse to introduce new implants, thus improving results and lowering expenditure. The need for regulating the introduction of new implants is emphasized.

        אוקטובר 1997

        איתמר גרוטו, יוסי מנדל, יצחק אשכנזי ויהושע שמר
        עמ'

        Epidemiological Characteristics of Outbreaks of Diarrhea and Food Poisoning in the Israel Defense Forces

         

        I. Grotto, Y. Mandel, I. Ashkenazi, J. Shemer

         

        Army Health Branch, IDF Medical Corps and Sackler Faculty of Medicine, Tel Aviv University

         

        Acute infectious diseases of the gastrointestinal tract and food poisoning are problems of great importance in the Israel Defense Force (IDF). They involve individual and epidemic morbidity, with impairment of health of individual soldiers and in the activities of units. Outbreaks of gastrointestinal infectious diseases must be reported to the IDF army health branch, which conducts epidemiological investigation. This study is based on data from yearly epidemiological reports for 1978-1989, and from a computerized database for the years 1990-1995. The incidence of outbreaks is characterized by an unstable trend, It was highest at the end of the 80's (68.3 per 100,000 soldiers on active duty) and lowest for the last 2 years (1994-1995, 36.3 per 100,000). The incidence of soldiers involved in food-borne outbreaks has been more stable, constantly declining during the course of the years. There was marked seasonality with a peak in the summer months. Sporadic morbidity was constant in 1990-1995, with a yearly attack rate of 60% in soldiers on active duty. Shigella strains were the leading cause of outbreaks until 1993, while in 1994-1995 their proportion decreased, with an increase in the proportion of Salmonella strains. As to Staphylococcus aureus, its role in causing food poisoning has been characterized by marked changes. Shigella sonnei replaced Shigella flexneri as the leading strain. 73.3% of outbreaks were small, with fewer than 40 soldiers involved, while 5.4% of outbreaks affected more than 100 soldiers. Outbreaks in which a bacterial agent was identified or which occurred in new-recruit bases were larger than those in which a bacterial agent was not identified, or which occurred in active field unit bases. In conclusion, the rates of infectious disease of the gastrointestinal tract are still high, although there has been a marked decrease since 1994. The incidence of outbreaks has also decreased, as well as the role of Shigella as a leading causative agent.

        מאי 1997

        רון בן-אברהם, מיכאל שטיין, יורם קלוגר, אמיר בלומנפלד, אברהם ריבקינד ויהושע שמר
        עמ'

        ATLS Course in Emergency Medicine for Physicians?

         

        Ron Ben-Abraham, Michael Stein, Yoram Kluger, Amir Blumenfeld, Avraham Rivkind, Joshua Shemer

         

        Medical Corps, Israel Defense Forces; and Trauma Units of Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, and of Hadassah Hospital, Jerusalem

         

        Implementation of Advanced Trauma Life Support (ATLS) skills among practicing physicians and its perceived utility in their civilian practices, as well as in their potential army combat assignments, was evaluated. 177 physicians in various subspecialties, who were graduates of ATLS training courses, answered a specially designed telephone questionnaire. An unexpectedly high percentage of physicians (47%) had used their ATLS training when called to treat trauma victims. 67% of physicians stressed the contribution of the ATLS course to enhancing their skills. We believe that a properly designed ATLS course for general practitioners would be very beneficial for trauma victims.

        אפריל 1997

        יצחק אשכנזי ויהושע שמר
        עמ'

        Smoking Habits of Young Israeli Soldiers

         

        I. Askenazi, J. Shemer

         

        Medical Corps, Israel Defense Forces, and Sackler Faculty of Medicine, Tel Aviv University

         

        A random sample of 32,166 soldiers were interviewed (on their day of discharge from the Israeli Defence Forces, between 1980-1995) with regard to smoking habits. Among men, prevalence of current smoking was 46.8%, and among women 32.9%. Over the study period, prevalence in men decreased 27%. Among women, prevalence decreased from 1981 to 1991, but since then it has steadily increased. Among men, mean number of cigarettes smoked decreased from 21.6 in 1989 to 16.6 in 1995. Among women cigarettes smoked decreased from a mean of 14.3 in 1989 to 13.1 in 1995. 65.9% of the men and 49.3% of the women had started smoking by the age of 18. Among men the age distribution of smoking changed hardly at all over the years of the study. However, the proportion of women who began to smoke in the youngest age bracket (15 years of younger) doubled over the course of the study.

        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
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