Shimon Izhakian MD, Walter G. Wasser MD, Baruch Vainshelboim PhD, Benjamin D. Fox BM BS and Mordechai R. Kramer MD FCCP
Background: Studies in lung transplantation demonstrate that the ancestry and gender dissimilarities of donor–recipients lead to a decrease in survival of the recipient.
Objectives: To evaluate the survival of lung transplant recipients in Israel based on whether the donors and recipients are of Jewish or Arab ancestry as well as survival based on gender match or mismatch.
Methods: We performed a retrospective observational cohort study of 345 lung transplant recipients at the Rabin Medical Center, Petah Tikva, Israel between January 1997 and January 2013. We compared the survival of lung transplant recipients in two ancestry categories: ancestry matched (Jewish donors to Jewish recipients or Arab donors to Arab recipients) and ancestry mismatched (Jewish donors to Arab recipients and vice versa). We also compared the survival among the four gender donor and recipient combinations (male to male, female to female, male to female, and female to male).
Results: Survival analysis revealed no significant differences between the two ancestry groups (P = 0.51) and among the four gender combinations (P = 0.58). On Cox multivariate analysis, younger donor age was the only significant parameter for longer survival (hazards ratio 1.025, 95% confidence interval 1.012–1.037).
Conclusions: Gender and ancestry mismatches in these two Israeli populations do not appear to alter the clinical outcomes following lung transplantation.
Shimon A. Goldberg MD, Diana Neykin MD, Ruth Henshke-Bar-Meir MD, Amos M. Yinnon MD and Gabriel Munter MD
Background: Medical history-taking is an essential component of medical care.
Objectives: To assess and improve history taking, physical examination and management plan for hospitalized patients.
Methods: The study consisted of two phases, pre- and post- intervention. During phase I, 10 histories were evaluated for each of 10 residents, a total of 100 histories. The assessment was done with a validated tool, evaluating history-taking (maximum 23 points), physical examination (23 points), assessment and plan (14 points) (total 60 points). Subsequently, half of these residents were informed that they were assessed; they received their scores and were advised regarding areas needing improvement. Phase II was identical to phase I. The primary endpoint was a statistically significant increase in score.
Results: In the study group (receiving feedback after phase I) the physical examination improved from 9.3 ± 2.4 in phase I to 10.8 ± 2.2 in phase II (P < 0.001), while in the control group there was no change (11.3 ± 1.9 to 11.5 ± 1.8 respectively, P = 0.59). The assessment and plan component improved in the study group from 6.4 ± 2.7 in phase I to 7.4 ± 2.6 in phase II (P = 0.05), while no change was observed in the control group (8.2 ± 2.7 and 7.8 ± 2.3, P = 0.43). Overall performance improved in the study group from 30.4 ± 5.1 in phase I to 32.9 ± 4.5 in phase II (P = 0.01), a 10% improvement, while no change was observed in the control group (35.5 ± 6.0 to 34.6 ± 4.1, P = 0.4).
Conclusions: A review of medical histories obtained by residents, assessed against a validated score and accompanied by structured feedback may lead to significant improvement.
Daniel Hardoff MD, Assaf Gefen MA, Doron Sagi MA and Amitai Ziv MD
Background: Human dignity has a pivotal role within the health care system. There is little experience using simulation-based medical education (SBME) programs that focus on human dignity issues in doctor-patient relationships.
Objectives: To describe and assess a SBME program aimed at improving physicians’ competence in a dignifying approach when encountering adolescents and their parents.
Methods: A total of 97 physicians participated in 8 one-day SMBE workshops that included 7 scenarios of typical adolescent health care dilemmas. These issues could be resolved if the physician used an appropriate dignifying approach toward the patient and the parents. Debriefing discussions were based on video recordings of the scenarios. The effect of the workshops on participants’ approach to adolescent health care was assessed by a feedback questionnaire and on 5-point Likert score questionnaires administered before the workshop and 3 months after.
Results: All participants completed both the pre-workshop and the feedback questionnaires and 41 (42%) completed the post-workshop questionnaire 3 months later. Practice and competence topics received significantly higher scores in post-workshop questionnaires (P < 0.001). A score of high to very high was given by 90% of physicians to the contribution of the workshop to participants understanding the dignifying approach, and by 70% to its influence on their communicative skills.
Conclusions: A one-day simulation-based workshop may improve physicians’ communication skills and sense of competence in addressing adolescents’ health care issues which require a dignifying approach toward both the adolescent patients and their parents. This dignity-focused methodology may be expanded to improve communication skills of physicians from various disciplines.
Haim Y. Knobler MD and Yoram Blachar MD
Francesca Riboni MD, Stefano Cosma MD PhD, Pino Gino Perini MD and Chiara Benedetto MD PhD
Galit Pomeranz MD, Avishalom Pomeranz MD, Alexandra Osadchy MD, Yigal Griton MD and Ze’ev Korzets MBBS
Bernardo Melamud MD, Shikma Keller MD, Mahmud Mahamid MD, Kalman Paz MD and Eran Goldin MD
Gabriel S. Breuer MD, Naama Bogot MD and Gideon Nesher MD
Marina Khvan MD and Sandro Vento MD