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עמוד בית
Sun, 14.04.24

June 2018 (Issue 38)

Capt. Avishai Tsur, Lt. Yaara Binyamin, Lt. Col. Lena Koren-Feldman
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Introduction: In recent years, patient satisfaction takes a central role in the perception of service quality of medical centers within Israel and abroad. The aim of this study is to examine the factors effecting satisfaction from waiting times to see general practitioners among soldiers.

Methods: The study is based on a questionnaire built for the participants in the study- soldiers serving on a training base. Upon arrival to the clinic the soldiers were requested, by a nurse, to fill out the questionnaire stating the waiting times they experienced before seeing the medic and the doctor, versus there expectations.

Results: Satisfaction from the waiting time to see the medic was higher than satisfaction from the wait time to see the physician (87.65% vs. 73.28%, respectively). We found no significant difference in the distributions of expected waiting time to a medic and expected waiting time to the physician among satisfied vs. unsatisfied patients (p=0.15 and p=0.69, respectively). In a multivariate analysis, using a logistic regression it was found that the satisfaction from waiting times to see the physician was due to two parameters: satisfaction from waiting time to see the medic (OR=4.704, p<0.001), and whether the patients waited less or more than three days for the appointment (OR=8.432, p<0.001).

Discussion & Conclusions: Patient satisfaction from the waiting time for the medic and the physician was higher than expected. Waiting less than three days to see the physician was found significant to patient satisfaction. These findings suggest that methods to improve patient satisfaction include increasing the availability of medics, spreading physician schedules over the workweek, and developing an application that warns about long wait times.

Keywords: Patient satisfaction; Appointments and schedules; Waiting Lists; Primary health care.
Maj. Avi Shemesh, Binyamin Reinstein, Moshe Wojakowski, Capt. Idan Shavit
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Background: In dentistry, research has been carried out in many fields, including the field of military dentistry. The aim of this article is to review studies carried out to date in the field of military dentistry, and to recommend additional research directions.

Methods: A literary review was made of selected publications published by the Dental Department of the Medical Corps in the field of military dentistry. The publications were classified into several main subjects.

Results: Forty-two studies of military dentistry were reviewed. The studies in the field of dental and maxillofacial trauma examined the incidence, causes, and prevention methods of trauma and the practical knowledge of dentists, military doctors, paramedics and prevention and primary care patients. In the field of aviation and hyperbolic dentistry, the incidence of tooth aches arising during the change in atmospheric pressure, the reasons for its appearance and preventive methods developed following these studies were examined. In addition, studies and publications on the utilization of health services and health economics, knowledge and decision making in military dentistry and lifestyle among different population groups in the army are described.

Conclusions: The research in the field of military dentistry is extensive and encompasses a variety of topics related to this field. The authors recommend that the research on the prevention of dental trauma in IDF soldiers be deepened.

Keywords: IDF Dentistry; Military dentistry; Combat soldiers; Dental trauma; Lifestyle.
Maj. Gil Zlotnik, Maj. Tal Brosh-Nissimov, Lt. Col. Ilan Green
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Background: Herpes genitalis is one of the most common infections transmitted sexually, caused by Herpes Simplex Virus (HSV-1 or HSV-2).

Objectives: This article describes the management of an atypical presentation of herpes genitalis after receptive oral intercourse. The clinical presentation of urethritis due to bacterial infection may be very similar to herpes simplex virus, therefore, herpes genitalis must be taken into consideration in any patients who presents with dysuria and discharge from the urethra. The prevalence of HSV-1 is 55-60% and the prevalence of HSV-2 is 15-20%. Due to the high prevalence of herpes genitalis and the high incidence of viral shedding for long periods of time, it can be very difficult to diagnose an active infection of herpes genitalis by laboratory tests, therefore, the physical examination and careful diagnosis are very important. In the past, herpes genitalis was mainly caused by HSV-2, however in the past few decades the incidence of HSV-1 has been increasing, making the laboratory diagnosis more difficult. It is very important to evaluate those who were in contact with the patient, to explain the routes of transmission and to educate about safe sex. There is a treatment protocol for the acute phase, remission and prevention, as describes in the article

Keywords: Herpes genitalis; Urethritis; Sexually transmitted infections.
Capt. Itay Ketko, Lt. (res) Nathan Schiffmann, Maj. Chen Fleischmann, Capt. (res) Ofir Frenkel, Lt. (res) Savyon Mazgauker, Lt. Col. (res) Yuval Heled, Maj. Ran Yanovich
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Introduction: Extensive technological developments have been made in recent years in the fields of fabric production and clothing manufacturing techniques. These developments are aimed at improving the physical properties of the final product so that, on the one hand, sustained operational performance over prolonged working durations is achieved, even in harsh environments, and on the other hand, the resulting negative effect on sweat evaporation and heat transfer to the environment is minimal. Accordingly, the Clothing department in the MATMON of the Ground Arm Command approached the Warrior Health Research Institute in order to carry out a study that would evaluate the physiological impact of a new set of combat attire and compare it with the current working uniforms.

Objective: physiological evaluation of new moisture wicking combat clothes, which were under consideration for IDF soldiers, by assessing the stress induced during exposure to mild physical activity in a warm environment.

Methods: 13 healthy male subjects aged 18-30 were recruited to this study. Following a heat acclimation protocol, the subjects were randomly selected to wear the standard working uniforms or the new combat clothes, with or without a combat vest, and then asked to perform treadmill walking (5 kmh, 2% incline) under moderate heat load conditions (30 degrees C, 60% relative humidity). Core body temperature, skin temperature and heart rate were continuously monitored throughout the exposure. Sweat rate was calculated post-hoc. Additionally, the subjects were requested to rate their perceived exertion during the exercise, using the BORG scale.

Results: In light of the similarity of physiological and subjective exertion measures that were observed for the standard uniforms and the new combat clothes, we concluded that there is no physiological advantage in replacing the standard uniforms with the new suggested clothing ensemble.

Keywords: Core temperature; Exercise; Heat; Uniform.
Nili Greenberg Gabriel Chodick, Lary Skuratovsky Robert Meyer Manor Shpriz
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Introduction: Handling friable asbestos-fabric may release airborne asbestos fibers that could penetrate lung tissue and cause respiratory illnesses. Maintenance of armored personnel-carrier engines may result in exposure to asbestos since the engine exhaust-pipes are covered with friable asbestos insulation-fabric. The present study examines a field procedure that allows performing asbestos-related maintenance with a reduced health-risk in remote areas.

Objective: To evaluate a field-method for removing friable asbestos insulation from vehicle exhaust pipes that will minimize potential occupational and environmental risk.

Methods: The present study was conducted while removing asbestos-fabric insulation from exhaust pipes in an open area. The fabric was pre-treated by wetting with a detergent-water solution and wrapping with polyethylene sheets before removal of the vehicle exhaust-pipes. Afterwards, the fabric was removed from exhaust pipes in a portable closed tent under HEPA-conditions. Personal and environmental airborne asbestos measurements were made over the entire work period. The results were compared to occupational and environmental standards.

Results: Sixteen of the 18 personal short-term exposure measurements and the two long-term exposure measurements during exhaust pipe removal were below the analytical detection-limits. Two short-term exposures had low detectable results (0.046 fiber/cc and 0.06 fiber/cc). The personal sample results measured during fabric removal were negligible (one result below the analytical detection-limit, and the second was low (0.01 fiber/cc). Environmental airborne-asbestos samples were below the analytical detection-limit.

Conclusions: The findings of the study show that pre-treatment of the insulating fabric on exhaust pipes, and using a portable closed structure with HEPA system, can dramatically reduce personal and environmental exposure to asbestos while performing asbestos removal tasks.

Keywords: Asbestos; Exhaust pipes; Insulation material; Short exposure.
The New "Journal of Israeli Military Medicine" Editorial Board:
Capt. Haggai Sherman, Epstein Yoram, Maj. Ran Yanovich
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Background: A wide variety of intrinsic and extrinsic factors may underlie the inability to work or train in a hot environment. An objective estimate of an individual's tolerance to heat is required to support the return-to-duty (RTD) decision for soldiers who have experienced heat injury.

Goals: To elaborate on the theoretical basis of heat intolerance, and the rationale behind the design, application and interpretation of the Heat Tolerance Test (HTT).

Conclusion: This review presents the knowledge, accumulated in the Warrior Health Research Institute over 40 years of successful application of HTT. In addition, we discuss some open questions and directions for future research.

Keywords: Heat intolerance; Exertional heat stroke; Heat exhaustion; Heat tolerance test.
Ethics In Medicine
Lt. Col. DR. Adi Leiba Editor-in-Chief Journal of Military Medicine (JIMM) , Translated from Hebrew by Avi Kolel
IDF medical research is conducted with the instruction of the IDF’s Surgeon
General and guidance of the IDF Medical Corps’ academic branch, and
implemented according to the principles and guidance of the Helsinki
Commission of the IDF Medical Corps. The main policy document below
presents ethical principles and guidelines regarding scientific publication in
the Journal of Israeli Military Medicine (JIMM), established on the policies
of the IDF Medical Corps and thusly on the central position paper from
the Ethics Office of Israel Medical Association: “Ethical Rules of Scientific
Publication”, January 2006.
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