Harefuah最新文献

Introduction: Medical errors pose a significant risk to public health. A mistake can often be prevented by timely access to the information that was unnoticed by the decision maker. Communication failure within the team is responsible for most errors that cause patient harm. This article reviews literature on challenges in reducing errors through a culture of listening within the team. A significant barrier to good team communication is fear of speaking up. According to surveys in the USA and Israel, nearly a third of the staff testified to fear reporting something that could endanger a patient. The difficulty of expressing oneself freely prevents the correction of failures and causes burnout at work. Improved communication is related to psychological safety in the organizational culture: the leader demonstrates humility, curiosity and gratitude towards the opinions of the team members and makes sure that no one gets hurt if they express an idea, question, concern or report a mistake. Training juniors and seniors by providing tools to improve communication within the team may be useful and can be facilitated through a simulation-based workshop. The challenge of listening to prevent disasters was learned in a tragic way at the National Aeronautics and Space Administration (NASA), and more recently, in Israel when repeated ominous warnings were ignored before the October 7th monstrous terror attack. Respectful listening is an essential key to cooperation and success in society in general and health organizations in particular.

Introduction: The importance of early detection of keratoconus lies in early treatment to prevent complications resulting from disease progression and in planning optimal follow-up or screening schedules for family members, considering the genetic component of the disease. In the past, with the absence of accessible, adequate imaging technology such as corneal topography to detect subtle manifestations of the disease, keratoconus was considered rare. This resulted in later detection when the disease had progressed to a more advanced, severe state, with many patients requiring corneal transplants. Currently, early detection can have significant consequences because of the possibility of early intervention, such as corneal cross-linking‏, which slows disease progression. Early detection of mild ectatic changes in the cornea is essential when screening candidates for refractive surgery to prevent postsurgical ectasia. In recent years, the detection of keratoconus has focused on the molecular level, such as identifying inflammatory biomarkers, and in corneal imaging. The progress in corneal imaging technology now provides detailed imaging of the epithelial and Bowman layers, which augment the ability to detect minimal changes, revealing disease development at a very early stage. Analyzing anterior corneal high-order aberrations also assists in identifying keratoconus. Corneal biomechanics evaluation likewise contributes to early keratoconus diagnosis. The latest frontier in keratoconus diagnosis is employing artificial intelligence, which has been combined in the past few years with corneal imaging devices. The following review will focus on the most current developments concerning keratoconus diagnosis, concentrating on the most novel tools and strategies.

Introduction: The characteristic of thoracolumbar junction syndrome (TLJS( described by Maigne are pain in the iliac crest and tenderness on palpation at the level of the junction between the lower dorsal and the upper lumbar vertebra. It is an often unrecognized and treatable cause of low back pain. TLJS is commonly associated with those who have low back pain, although it does not always present pain in this region. The source of the pain may be due to a disorder, which affects the nerves in the thoracolumbar junction of the spine, but presents usually in the lower abdomen, around the pelvic region, and in the groin. However, while the majority of the stress may be borne by the facet joints between T12 and L1, in reality, any spinal joints between T9 and L2 have the potential to develop lesions and nerve impingements, increasing the risk of referred pain. Lumbar vertebrae are not suited to rotation or twisting like the thoracic vertebrae, are making the site susceptible to problems. Patients with Maigne's syndrome generally respond well to manual techniques. In addition, therapeutic exercises for the spine, anti-inflammatory and analgesic drugs, and nerve block can improve functional outcome.

Introduction: The use of artificial intelligence (AI) in medicine is rising fast. We continually hear about novel AI-based technologies being deployed to aid clinical teams in areas like interpreting medical images, understanding pathology, determining diagnosis, predicting prognosis, and deciding on interventions. The field of surgery, however, has been slower to jump on the AI bandwagon. In this paper, we present Surgical Intelligence, an innovative and fast-developing field involving routine capture and AI-based analysis of endoscopic procedure videos. We discuss the need for documenting surgical video, the potential benefits for training and quality improvement, and the features that allow Surgical Intelligence platforms to provide accessible and effective solutions for medical teams.

Introduction: Books Review: A Family of Heroes, OUTLIVE, Literature and medicine in German literature between the two world wars.

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, which is mediated by Th2 cells that could start at any age, from early childhood to adulthood. The pathogenesis of the disease is not fully understood, but apparently it consists of a combined interaction between hereditary and environmental factors. Over the years, EoE has become an increasingly diagnosed disease in the context of esophageal symptoms. Nowadays, it is considered the second most common cause of chronic esophagitis and dysphagia (after GERD which is the leading cause on the list). The hallmark of the disease is the presence of eosinophils in the esophageal mucosa (> 15 eosinophil/HPF). Clinically, EoE is characterized by various esophageal symptoms, ranging from mild dysphagia to complications that eventually appear, including esophageal food impaction which usually requires urgent endoscopic removal. Long term complications occur as a result of a defective remodeling process of the inflamed esophagus, which includes histological changes of fibrosis, angiogenesis, and smooth muscle hypertrophy. Due to its progressive course, treatment of the disease requires a close and long-term managerial and therapeutic strategy. There are currently a variety of treatment options for the disease depending on its degree and severity, starting with dietary treatment, pharmacological therapy and ending with esophageal dilations if necessary.

Introduction: Letters to Editor: The risk for clinically significant copy number variants in pregnancies with two soft markers, Geriatriophobia - a new concept in the medical world in Israel.

Introduction: Coronary vasospasm is a well-known condition causing acute chest syndrome and can lead to myocardial infarction, ventricular arrhythmias, and even sudden cardiac death. While there are extensive case series showing the association of coronary vasospasm with drugs like cocaine, the association of marijuana with coronary vasospasm has not been reported frequently. When smoked, marijuana results in a rapid, dose-dependent tachycardia, an increase in blood pressure, and an increase in cardiac output. This in turn leads to increased oxygen demand, which is augmented by the vasoconstriction endothelial damage by smoking and activation of cannabinoid receptor 1 ( CB1) by marijuana. We presented a case of a 38-year-old young male who was admitted with chest pain, ST elevation in electrocardiogram (ECG) and normal coronary arteries at cardiac catheterization and a positive Acetylcholine Provocation test. With the legalization of marijuana and medical cannabis in certain states, marijuana-related hospitalizations and Emergency Room visits are likely to increase. It is therefore important for clinicians to know the various effects of marijuana, especially potentially fatal ones like coronary vasospasm. This case illustrates the importance of recognition of vasospasm in patients taking marijuana .Physicians should consider this in their differential diagnosis of patients presenting with chest pain and history of cannabis use.

Introduction: Massive pulmonary embolism (PE) is a life threatening condition with age-related escalation in prevalence. Acute PE is a common and sometimes fatal disease. The approach to the evaluation should be efficient while simultaneously avoiding the risks of unnecessary testing so that therapy can be promptly initiated and potential morbidity and mortality avoided. The imminent condition might lead to obstructive shock with acute right heart failure and eventually to rapid hemodynamic deterioration and death. At a younger age, massive PE causes death very rapidly in one third of the cases. During one year, follow-up of death in the presence of right heart failure is three times higher than those without it. About half of PE cases, are idiopathic and occur without acquired risk factors such as antecedent trauma, surgery, immobilization, or diagnosis of cancer. Unlike provoked PE (pPE) with acquired risk factors, idiopathic PE (iPE) is less likely to be predicted or prevented. Failure to accurately and promptly diagnose and treat deep vein thrombosis (DVT) and PE can result in excess morbidity and mortality due to post thrombotic syndrome, pulmonary hypertension, and recurrent thrombosis. Chest pain and shortness of breath are chief complaints frequently evaluated in the emergency department. Younger patients tend to have benign presentations, and often leave with diagnoses of self-limiting diseases or etiologies that are easily treated in the emergency department. The presenting clinical signs and symptoms should illuminate the primary physician to this life-threatening condition leading to fast diagnosis and prompt lifesaving treatment. At the end of the primary treatment, we need to assess and address each patient for the likelihood of thromboembolism recurrence, which will be highest among those patients with idiopathic events or those with cancer-associated thrombosis. We favor prolonged anticoagulation in these scenarios. In addition, we strongly advocate periodic scheduled follow-up of patients on long-term anticoagulation for secondary prophylaxis to re-evaluate their bleeding and recurrence risk. In practice, initial treatment of deep venous thrombosis and pulmonary embolism should be based on low molecular weight heparin (LMWH) in patients without renal failure. Thrombolytic agents may be useful in case of massive pulmonary embolism, but more evaluation is needed. Bleeding and heparin thrombocytopenia are the main adverse effects of these treatments.

Background: C-reactive protein (CRP) is increasingly being used as an inflammatory marker in sepsis. Its main use is for diagnosis, less for prognosis, while it is increasingly used for serial monitoring of response to treatment - with little evidence to support this practice.

Objectives: Assessment of the effectiveness of serial measurements of CRP in the management of patients with blood stream infection (BSI).

Methods: This was a retrospective study of two patient cohorts, one in 2015 (cohort A) and the other in 2018 (cohort B), each included 200 consecutively diagnosed patients with proven BSI. We assessed the following outcome markers: antibiotic management, duration of admission and in-hospital mortality.

Results: Baseline demographic and clinical data of the cohorts were similar. In cohort A, a single CRP test was obtained from 5% of the patients, while in cohort B, 95% of patients had CRP tests with a mean of 5.7 tests/person. Empiric, appropriate antibiotic treatment, increased from 72% in cohort A to 75% in cohort B (NS). Duration of antibiotic treatment did not change (10±8 days). The in-hospital mortality rate decreased from 38.5% in cohort A to 30.5% in cohort B (NS), as did mortality <7 days after diagnosis of BSI, from 17.5% to 14% respectively (NS).

Conclusions: We found statistically insignificant differences between the cohorts. In our view there is currently no solid evidence to support the serial use of CRP tests in the management of patients with BSI.