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עמוד בית
Mon, 17.06.24

March 2020: Corona (Issue 45)


Introduction
Lt. Col. Itamar Netzer
Reviews
Maya Simchoni, Itay Klopstock, Lt. Col. Ariel Furer
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At the end of 2019, a novel Corona virus was discovered in the city of Wuhan, China, which soon burst into other countries, causing the global pandemic we are currently facing. As most of the world's morbidity occurs among the middle aged and elderly, the existing literature mainly describes this age-group. In this review, we characterized the novel Corona virus morbidity among young adults, aged 18-45, who constitute the age strata of IDF soldiers. We used existing information from the scientific literature, new daily published studies and non-scientific sources of information describing past outbreaks in the world's armies. The findings of this review deal with the characteristics of morbidity among the young population, morbidity and mortality rates, unique complications and the issue of silent spreaders. The main goal is to learn from the knowledge gained so far, example cases that occurred in foreign armies and the existing guidelines for drawing conclusions thereby improving the IDF's coping with the new reality forced upon it.

Keywords: COVID-19; Young adults; Army; Morbidity; Mortality.
Gilad Sharabi, Osnat Levtzion-Korach, Dani Moran
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Today big data technology influences every field of our lives: industry, commerce and economy, society, education and medicine. Analysis of the data and identification of patterns enable the development of diverse innovative applications also in the field of medical treatment and diagnosis, prediction of the patient’s medical condition, research on diseases and transition to preventive medicine and personalized treatment. Establishment of management and control centers in hospitals in Israel, based on big data and artificial intelligence technologies, may change the management of health systems and afford a solution to the need for improving medical care, while reducing costs and affording better service to the patients. Adoption of these innovative technologies and transition to centralized data-based management using algorithms and models for predicting operation will lead to an improvement in the medical care and the service experience of the patient by reducing loads and shortening the waiting time for an appointment and the waiting time at clinics and surgeries. Concomitantly, application of the management and control center model will also enable increasing the operational efficiency and reducing costs. This will be achieved by optimally regulating logistic resources and manpower according to the predicted activity, optimization and increasing the hospitals’ activity capacity and incomes.

Keywords: Hospital Command Center; Big Data, Data analysis management; Improving medical care; Improving hospitals efficiency.
Articles
Lior Feldman, Eran Galili, Yuval Cohen, Michael Hartal, Nirit Yavnai, Itamar Netzer
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Background: Hand disinfection using chlorhexidine gluconate (CHG) is routinely used to prevent the spread of infection in hospitals as well as in the community. Studies examining the clinical efficacy of its use in military settings have been equivocal. The current study examines the correlation between CHG use and infectious morbidity on Israeli Navy ships.

Methods: A randomized, clustered controlled study that took place in the Haifa Navy Base. Israeli Navy surface vessels were randomly assigned to a study group (347 sailors) and main control group (350 sailors). Two additional non-intervention groups included in the study were sailors from a different unit on the base (n=360), and soldiers serving in headquarters (n=859). CHG dispensers were installed on all the ships assigned to the study group, in addition to water and liquid soap in unlimited quantities. Morbidity was analyzed based on the computerized medical record, subjective self-report questionnaires and bacterial cultures taken from sailors hands. Compliance with hand hygiene was analyzed using a self-reported questionnaire on two occasions: at the beginning of the trial and three months later. The study took place in the months of May to September.

Results: No significant differences were found between the groups in terms of sick-leave or reduced-activity days, or in the incidence of respiratory or gastrointestinal infectious morbidity. Palm cultures showed that continuous use of CHG did not contribute to decreasing colonization. No significant differences were found between the study group and control group in reported hygiene habits.

Conclusions: The use of CHG on navy ships was not found to be more efficacious than hand washing with soap and water

Keywords: Hand hygiene; Infection control; Naval medicine.
Capt. (res.) Ronli Hershkovitz Neiterman, Maj. Shai Hertzberger, Capt. Tom Caspi Maj. Akiva Esterson, Maj. Edward Koifman, Lt. Col. Itamar Netzer,
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Introduction: Radiomedico has been in existence for nearly a century – since 1921, when Captain Robert Huntington established the first service in New York. As embarked Israeli Navy ships do not always have a physician on board, a Medico service has been available for the past several decades.
Objective: An analysis and presentation of the findings, conclusions and recommendations of telemedical services in the Israeli Navy accumulated over a decade.

Methods: All Medico calls in the navy are debriefed after return to shore. We reviewed all debriefings from the years 2006-2016. Computerized patient records were consulted if the sailor's identity was known.

Results: We analyzed 216 cases. Of these, 111 were evacuated to shore, 68 were subsequently transferred to the emergency room. 7 were hospitalized, 1 was dead on arrival. The most common reason for using telemedical assistance was abdominal pain and vomiting (60 cases). The second most common was trauma (24 cases). Of the cases that were considered emergent – 83.3% were evacuated, and 20% were hospitalized. Of the patients who received physician order treatments, fewer were evacuated to shore compared to sailors who did not receive treatment (40% evacuated vs. 77.9%). We also found that patients who received oral anti pain medicine, antiemetic medication or oral antibiotics were less likely to be evacuated {Anti pain medicine: 28% evacuated. Statistically significant (P value = 0.00001), antiemetic medication: 22.2% evacuated. Statistically significant (P value = 0.009), Oral antibiotics: 23.1% evacuated. Statistically significant (Fisher test = 0.043). Patients who were given oxygen were evacuated in 100% of the cases. Another predictor for evacuation was abnormal measurements of body temperature, pulse or blood pressure (60.3% evacuated). Four cases of minor trauma were evacuated to shore but did not need to be taken to the emergency room. We suggest that had a picture been sent to the physician these evacuations would have prevented .

Discussion: Radio consultations in the Israeli Navy in medical cases that were beyond the scope of the ship caregiver's training prevented the need to evacuate approximately half of ill sailors. The merits of naval telemedicine are on the rise, as it is based on advanced technologies and the need remains relevant. The findings of this study regarding telemedicine’s potential to reduce evacuations may signify an age of conceptual transformation in this regard, as technological advancements afford new horizons for telemedicine in general, and maritime telemedicine in particular.

Keywords: Telemedicine; Naval medicine; Radiomedico.
Maj. Dror Ofir
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Introduction: For a number of years, evaluation of the respiratory safety of CBRN respirators has been conducted at the Israel Naval Medical Institute (INMI) as part of the general evaluation process for respirators by the Head of the IDF Medical Corps. Tests include mainly the measurement and calculation of inspired carbon dioxide (CO2), which is liable to increase due to the additional dead space present in any respirator, and inspired oxygen (O2) which is liable to decrease. The INMI recently began using a breathing simulator to evaluate respirators under development, or respirators which had failed to pass the regular evaluation procedure. Simulator testing allows us partially to predict the results which would be obtained using human subjects.

Objective: The purpose of the study was to compare the advantages and disadvantages of the breathing simulator compared to the human test.

Findings: The findings motivated us to investigate whether simulator testing may partially or completely replace the evaluation process for CBRN respirators conducted using human subjects. The main finding was that human evaluation methods better represent the physiological response to a CBRN respirator, however, these methods require a large sample size. By contrast, the breathing simulator mimics the work of breathing in humans inexpensively but fails to simulate human heterogeneity.

Conclusions: We conclude that simulator evaluation should be a prerequisite before any testing of CBRN respirators on humans. Further studies will be required before simulator evaluation can replace the use of human subjects.

Keywords: respiratory protection; breathing simulator; carbon dioxide.
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