Y. Barzilay, M. Liebergall, O. Safran, A. Khoury and R. Mosheiff
Background: Pelvic fracture is a severe and life-threatening injury that requires treatment by a dedicated team. One of the goals of a nationwide trauma system is to provide appropriate medical care for such injuries.
Objectives: To use pelvic fractures as a test case for the efficiency of the Israeli trauma system, as reflected in the experience of our medical center.
Methods: Data were obtained from the medical charts of all cases of pelvic fractures admitted to our medical center between 1987 and 1999. We obtained demographic data, information on the cause of injury, fracture classification, co-injuries and Injury Severity Score, treatment strategies, and mortality rate.
Results: Altogether, 808 patients with pelvic injuries were treated in our medical center. The most common cause of injury was motor vehicle accidents (51%). Pelvic fractures without acetabular involvement were diagnosed in 58% of patients and isolated acetabular fractures in 32%, while 10% sustained combined injuries to the pelvic ring and the acetabulum. The overall rate of operative stabilization was 34%. The majority of patients had associated injuries, mostly additional musculoskeletal injuries. Altogether, 13% were referred from Level II/III trauma centers. We observed an increase in the total number of local admissions, in the percentage of referred patients and in the percentage of operated patients during the study period. The observed mortality rate was 5%.
Conclusions: Our results show a more than twofold increase in the percentage of referred patients following the designation of a Level I trauma center. These referrals result not only from the designation as a Level I trauma center, but also from the presence of a dedicated team of pelvic fracture specialists, available 24 hours a day. In addition, a larger percentage of patients undergo surgery for internal fixation of pelvic fractures, in accordance with current worldwide trends.
A. Kesler, A. Mosek, N. Fithlicher and Y. Gidron
Background: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a relatively rare disorder of increased intracranial pressure >250 mm water, with a normal neuroimaging and normal cerebrospinal fluid content.
Objectives: To examine whether hostility, anxiety and autobiographical memory (a correlate of depression) are associated with IIH[1].
Methods: Using a case-control cross sectional design, 20 patients with IIH were compared with 9 healthy controls of similar age, weight and height, and 11 headache controls. Patients were assessed for hostility and anxiety. The Autobiographical Memory Test was used to assess episodic memories.
Results: The IIH group reported significantly more anxiety and more general episodic memories than the healthy controls, but not the headache control group. The headache control patients reported more general memories than did the healthy controls.
Conclusions: Patients with headaches, whether of general origin or related to IIH, have a poor psychosocial profile. While the study design does not permit any conclusions regarding causality, our results support the need to consider psychological factors in evaluating and treating IIH and headache patients.
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[1] IIH = idiopathic intracranial hypertension
E. Zimlichman, A. Lahad, A. Aron-Maor, A. Kanevsky and Y. Shoenfeld.
Background: As complementary and alternative medicine is gaining popularity among health consumers, diagnostic screening tools based on neuroreflexology are also being developed. These techniques, which are based on the rationale that measurement of electrical impedance of specific dermatomes reflects corresponding internal organ pathologies, have not yet been the subject of conventional scientific research.
Objectives: To determine the effectiveness of a neuroreflexology-based screening test, specifically the Medex device (Medex Screen Ltd.), for diagnosing patients undergoing conventional internal organ assessment, in a hospital setting.
Methods: Patients admitted to an internal medicine department, who met the inclusion criteria and agreed to participate, underwent conventional medical evaluation that included past medical history and physical examination. Another examination was conducted by a second physician using the Medex device to determine internal organ pathologies. A third researcher compared the actual “conventional” diagnosis with the Medex device output using standard statistical analysis.
Results: Overall, 150 patients participated in the study. Correlation was significant for all categories (P < 0.01) except for blood and lymphatic disease. A high sensitivity (>70%) was measured for cardiovascular, respiratory, gastrointestinal and genitourinary diseases. The highest measure of agreement, as represented by the Cohen-Kappa factor, was found for respiratory disease (0.57).
Conclusions: Although the exact mechanism is not entirely clear, measurement of electroskin impedance of dermal-visceral zones has the potential to serve as a screening tool for inner organ pathologies. Further research should be conducted to create more evidence to support or dispute the use of this technique as a reliable diagnostic tool.
S. Yust-Katz, M. Katz-Leurer, L. Katz, Y. Lerman, K. Slutzki and A. Ohry.
Background: Population structures are changing across the western world, with particularly rapid growth in the number of very old people. Life expectancy has been increasing gradually over years, resulting in a larger subpopulation of people aged 90 and over.
Objectives: To describe the sociodemographic, medical and functional characteristics of people aged 80–90 and 90+ who were admitted to a sub-acute geriatric hospital and to compare the hospitalization outcomes between these subgroups.
Methods: We compared the demographic and clinical data (extracted by means of chart review) of two groups of elderly who were admitted to the Reuth Medical Center during 2001–2002: those aged 90+ and those 80–89. Among survivors, the main outcome measures at discharge were mortality rate, functional ability, and place of residence.
Results: The study included 108 patients who were admitted to different divisions of Reuth: 55 patients aged 90+ and 53 aged 80–90. The mortality rate was significantly elevated in the older age group (49.1% vs. 28.1% in the younger age group) on multivariate analysis. The most important prognostic factors for mortality were incontinence (odds ratio 3.45) and being dependent before admission (OR[1] 4.76). Among survivors an association was found between being incontinent and dependent before hospitalization, and being dependent on discharge.
Conclusions: The main prognostic factors for mortality and functional outcome in patients admitted to a non-acute geriatric hospital are incontinence and functional state prior to admission, and not age per se.
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[1] OR = odds ratio
Y. Waisman, L. Amir, M. Mor and M. Mimouni.
Background: The Pediatric Advanced Life Support course of the American Heart Association /American Academy of Pediatrics was established in Israel in 1994 and has since been presented to over 3,108 medical and paramedical personnel.
Objectives: To assess the achievements of participants in the PALS[1] course, as a cohort and by professional group, and their evaluations of different aspects of the course; and to describe the educational modifications introduced to the course since its introduction in Israel on the basis of our teaching experience.
Methods: The study sample consisted of physicians, nurses and paramedics from all areas of Israel who registered for PALS between January 2001 and December 2003. Participants took a standardized test before and after the course; a score of 80 or higher was considered a pass. On completion of the course, participants were requested to complete a 24-item questionnaire evaluating the quality of the course as a whole, as well as the lectures, skill stations, and instructors’ performance. Items were rated on a 5-point scale. Results were analyzed using the BMPD statistical package.
Results: Altogether, 739 subjects participated in 28 courses: 13 attending (in-hospital) physicians (1.8%), 89 community pediatricians (12%), 124 residents (16.8%), 304 nurses (41.1%), and 209 paramedics (28.3%). About half (48.9%) were hospital-based, and about half (47.9%) had no experience in emergency medicine. A passing grade was achieved by 89.4% of the participants; the mean grade for the whole sample was 87.2%. The mean test score of the residents was significantly better than that of the nurses (P < 0.05) and pediatricians (P < 0.01). The median evaluation score for four of the five stations was 5, and the mean overall score for all items was 4.56 (range by item 3.93–4.78).
Conclusions: PALS was successfully delivered to a large number of healthcare providers in various professional groups with very good overall achievements and high participant satisfaction. It significantly increased participants’ knowledge of pediatric resuscitation. We therefore recommend the PALS course as an educational tool in Israel.
O. Nissim, M. Bakon, B. Ben Zeev, E. Goshen, N. Knoller, M. Hadani and Z. Feldman.
Moyamoya disease is a cerebral vasculopathy characterized mainly by progressive narrowing of the major intracranial vessels. While more common and having a familial predilection in the Far East, it can also develop in association with some common hereditary diseases and can be acquired after environmental exposure. In the young its manifestations are the result of cerebral ischemia. Adults usually suffer from repeated incidents of intracerebral hemorrhage. Surgical revascularization of ischemic cerebral territories plays a major role in their treatment. We review the literature and present our series of three adult and five pediatric patients; these patients were diagnosed at our institution and treated with indirect revascularization techniques.
X. Giakoumi, M. Tsironi, C. Floudas, E. Polymeropoylos, E. Papalambros and A. Aessopos
G. Almogy, O. Pappo, M. Gips, S. Lieberman. Y. Edden and A. Eid.
D. Hazzan, J. G. Eckstein, R. Steinhagen
E. Mezer, I. Krasnits, I. Beiran, B. Miller, R. Shreiber and D. Goldsher.