Harefuah最新文献

Introduction: This study introduces a group observation technique to enhance the diagnostic evaluation of Autism Spectrum Disorder (ASD) in children and adolescents. Conducted by a physician and a psychologist, the procedure involves six consecutive 50-minute sessions over six weeks, designed for individuals aged 6-18 years in a peer group setting. Three case studies illustrate the technique. By considering social context and peer interactions over time, this method helps resolve ambiguities and discrepancies in the ASD diagnostic process, uncovering alternative explanations for behaviors observed in single meetings between a psychologist and neurologist/psychiatrist with a patient. Detailed case descriptions demonstrate the value of this approach. The group observation provides unique insights into social communication and restricted behaviors, offering a valuable addition to current ASD diagnostic practices.

Introduction: ANCA-associated vasculitis is a rare inflammatory disease with a heterogeneous clinical presentation. The present case illustrates a late relapse after a prolonged remission, manifesting as a life-threatening pulmonary complication. This case highlights the importance of continuous clinical follow-up even during extended periods.

Introduction: There are currently 29 emergency departments (EDs) in Israel seeing more than 3 million patients per year. Many of these departments are still staffed by residents in internal medicine, surgery, orthopedics, and gynecology with emergency medicine (EM) being one of the youngest specialties in Israel. Training started as a 2.5-year fellowship after a primary residency and then a 4.5-year track was added. To "standardize care and raise the standard of care" a unique course - the National Israeli Course in Emergency Medicine (N.I.C.E.M.) was initiated in 2014. This is a national one-year course meeting with over 20 daily sessions, which is a requirement for all residents in the 4.5-year EM track. It is also unique in its emphasis on advanced pedagogic skills which include the flipped classroom, simulations, crisis resource management, case-based learning, and skill stations. The sessions cover the entire range of EM including resuscitation, critical care, trauma, orthopedics, and pediatrics. Point-of-care ultrasound is learned throughout the course. The integration of a mandatory nationwide Graduate Medical Education Course into the new specialty of Emergency Medicine in Israel has been challenging. New content and teaching methods are continually being introduced. The feedback from the participants has been overwhelmingly positive, and the course has likely made a significant impact on ED patient care throughout the country.

Introduction: In recent years, a long-acting Oxytocin analogue, Carbetocin, has been shown to offer clinical advantage over the commonly used Oxytocin.

Aims: To evaluate Carbetocin's clinical and financial benefits compared to Oxytocin in preventing postpartum hemorrhage (PPH) during cesarean delivery.

Methods: We analyzed perinatal outcomes comparing two periods, before (Group 1, Oxytocin era) and after (Group 2, Carbetocin era), when Carbetocin was implemented as a preventive method for PPH during cesarean delivery.

Results: Rates of PPH were significantly lower in Group 2 as compared with Group 1, as evidenced by lower requirements for blood transfusions (1% vs. 4.1%, p=0.003) and post-operative hemoglobin drop of ≥ 3g/dL (5.2% vs. 10.3%, p=0.008). The number of administered packed red blood cells (4 vs. 27 units, p=0.002), delta in hemoglobin level at discharge (1.3 ± 0.9 vs. 1.6 ± 1.2, p=0.002), and duration of hospitalization and re-admission rate were all significantly in favor of Carbetocin use. Financial benefit significantly favored using Carbetocin (ILS 112,237 vs. ILS 125,106.5, respectively, cost-difference of ILS 12,869.5).

Conclusions: Carbetocin has been shown to reduce rates of PPH and provide cost-effective benefits compared to the commonly used uterotonic Oxytocin.

Discussion: Carbetocin showed several advantages compared to Oxytocin in PPH prevention during cesarean section. The clinical and economic research evidence supports the routine implementation of Carbetocin administration to prevent PPH during cesarean delivery.

Introduction: Similar to major natural disasters and large-scale wars, the events of October 7th and the retaliatory Iron Swords war resulted in both direct and indirect exposure of a significant proportion of the population to traumatic events. A major challenge for healthcare systems in such scenarios is the early identification of populations that develop Post Traumatic Stress Disorder (PTSD). The medical literature was reviewed to assess whether language models could be integrated into a screening program for at-risk populations and which tools can be used to evaluate the quality of studies describing screening instruments based on language models. The concept of prompting a large language model to adopt a peer-reviewer persona was also explored to study whether it could be used to assess study quality.

Introduction: The vision of the Department of Pediatrics at the University of Toronto and The Hospital for Sick Children in Toronto, Canada, defines medical education as highly important and the strategic plans and policies of the hospital management for training residents in pediatrics have been adjusted accordingly. A section of Medical Education has been established, which is headed by a physician who is appointed as a Vice-Chair of the department. In this department there are several staff members including physicians and trained administrative staff who are all devoted to the medical education affairs. In each clinical division, there is a program director position dedicated to medical education. Furthermore, every resident is guided by a (faculty) senior mentor throughout the entire residency. In addition, a specific residency program committee plans the curriculum and all residents are routinely assessed, and provided with feedback on a regular basis. All staff physician teachers are provided with faculty development training in education and receive feedback regularly and excellence in teaching is considered a major factor in academic promotion. Ethical issues, equity, diversity and inclusion, as well as professionalism in interactions with residents are receiving special attention. The pediatric residency consists of 13 rounds of 4 weeks each in the second year of residency, which includes all subspecialties in pediatrics. The optimal way of considering the residency or fellowship is "working while learning". This contrasts with "learning while working" in other places which lack the resources to support such an impressive medical education program.

Introduction: The injured and disabled during war (and the survivors of the "Spanish Flu" and the poliomyelitis epidemics) received public and medical establishment attention mainly after the 20th century's World Wars, and in Israel during and after the War of Independence. Apparently, war and trauma were followed by significant advancement of technology, surgery, intensive care and rehabilitation medicine.

Introduction: Maternal mortality during pregnancy and childbirth is a key indicator of the quality of healthcare and is crucial for setting healthcare goals. In recent years, there has been a reported trend of decreasing maternal mortality rates worldwide.

Aims: The current study aims to examine obstetrical and non-obstetrical causes associated with maternal mortality in Israel.

Methods: This retrospective cohort study examines maternal mortality cases in Israel from 2015 to 2022, using records obtained from Ministry of Health data and Society of Maternal-Fetal Medicine publications. We compared these findings to data from developed countries as reported by the WHO.

Results: Between the years 2015 and 2022, a maternal mortality rate of 2.6 per 100,000 births was reported in Israel, with 27 women dying during pregnancy, labor and puerperium. The average age at the time of death was 33 years. Most deaths (88.2%) occurred <24 weeks of gestation, 66.7% around labor. Overall, 92% of deaths were among healthy women with no prior known risk factors.

Conclusions: Our analysis found that most maternal deaths in Israel occurred in women without underlying medical conditions, making it difficult to link medical history to the cause of death.

Discussion: Increasing awareness, regularly conducting extreme scenario drills, and discussing cases nationally may help reduce maternal mortality. The majority of cases of maternal death in our study occurred among healthy women, and most deaths occurred in the second trimester and through labor. No predictive factors were identified, highlighting the need to increase awareness and enhance healthcare team training to reduce mortality rates.

Introduction: We present a case that demonstrates the importance of imaging in the accurate diagnosis of inflammatory joint diseases. The judicious use of X-ray imaging enabled the identification of calcifications characteristic of a crystal deposition disease, leading to a change in both diagnosis and treatment.

Introduction: Gastrocnemius muscle ruptures are frequent in both recreational and competitive athletes. The superficial posterior compartment of the leg includes the gastrocnemius and soleus muscles, and a tear can occur in either one of them or both. Gastrocnemius injuries usually occur in young adult male athletes in their 40s. Moreover, they are common in sport involving eccentric lower extremity movements such as football, basketball, and tennis. Injuries are more common in athletes who have not warmed up adequately or are fatigued. The diagnosis is based on the patient's history and physical examination. Patients will complain of pain, swelling, difficulty to flex the ankle joint, Furthermore, patients will usually have difficulty bearing weight on the affected leg. Imaging is rarely needed for diagnosing a gastrocnemius muscle rupture, although ultrasound may be helpful to weigh the severity of the injury and to monitor recovery. Conservative treatment will include rest, anti-inflammatory drugs, lifestyle modifications, cooling regimens and physical therapy. Surgical treatment is rarely indicated and can be suggested for the treatment of the complete rupture, patients with prolonged (4-6 months) pain and large intramuscular hematomas that might impair clinical progress. An acute complication is a compartment syndrome which is an indication for urgent surgery.