Biomedical subjects

Eliezer Kitai

Publications and source records attributed to Eliezer Kitai.

12 recordsLinked to original sources

PubMed2006

Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?

OBJECTIVES: Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists. METHODS: The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD. RESULTS: 7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02). CONCLUSION: Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.

Adrenergic beta-Antagonists↗

PubMed2006

[The effects of violence and terrorism on chronic physical illness].

Over the past few years more than a thousand Israeli civilians were murdered and thousands were wounded in recurrent terrorist attacks. Many others had been exposed to the terrorists' attacks, either directly or indirectly. However, the impact of the terror on physical illness had not yet been explored. Stress may cause diseases like hypertension or ischemic heart diseases and may exaggerate asthma, inflammatory bowel diseases and others; this is in addition to posttraumatic disorders, depression and anxiety. This article reviews the influence of stress, and especially conflicts, on chronic physical illness and aims to encourage further research on this subject in Israel.

Chronic Disease↗

PubMed2005

Teaching evidence-based medicine in a managed care setting: from didactic exercise to pharmacopolicy development tool.

OBJECTIVES: To implement a residency-based program for the teaching of evidence-based medicine in an Israeli HMO and to incorporate this effort into the HMO's routine drug policy formulation process. METHODS: Residents and preceptors participating in the family practice residency program in The Leumit Health Fund, 1 of the 4 HMOs operating in Israel, were invited to participate in a workshop for the formulation of guidelines for antibiotic treatment of the common infectious diseases encountered in primary care. The participants were allocated to teams consisting of a preceptor (an attending physician) and a resident physician, with each team choosing a different disease to analyze. Upon completion of the program, a questionnaire was sent to all residents and preceptors who participated in the workshop to evaluate attitudes concerning the outcomes of the program. RESULTS: Guidelines for the treatment of 14 infectious diseases commonly seen in the primary care setting were formulated. The program was accepted by the participants, who ultimately cooperated with the relevant HMO stakeholders in the formulation of official HMO policies for drug prescribing. CONCLUSION: The utilization of family practice residents is a feasible method of formulating in-house clinical practice guidelines for a managed care setting. The program was mutually beneficial for both the residents and for the stakeholders in the HMO.

Communicable Diseases↗

PubMed2005

Quality of diabetes care in the community: a cross-sectional study in central Israel.

BACKGROUND: Good care of the diabetic patient reduces the incidence of long-term complications. Treatment should be interdisciplinary; in the last decade a debate has raged over how to optimize treatment and how to use the various services efficiently. OBJECTIVES: To evaluate the quality of care of diabetic patients in primary care and diabetes clinics in the community in central Israel. METHODS: We conducted a retrospective cross-sectional study of a random sample of 209 diabetic patients in a district of the largest health management organization in Israel. Patients were divided into two groups - those treated only by their family physician and those who had attended diabetes clinics. Data included social demographics, medications, risk factors, quality of follow-up, laboratory tests, quality of diabetes and blood pressure control, and complications of diabetes. RESULTS: Of the 209 patients 38% were followed by a diabetes clinic and 62% by a family physician. Patients attending the specialist clinic tended to be younger (P= 0.01) and more educated (P= 0.017). The duration of their diabetes was longer (P < 0.01) and they had more diabetic microvascular complications (P= 0.001). The percentage of patients treated with insulin was higher among the diabetes clinic patients (75% vs. 14%, P= 0.0001). More patients with nephropathy received angiotensin-converting enzyme inhibitors in the diabetes clinic (94% vs. 68%, P= 0.02). Follow-up in the specialist clinic as compared to by the family physician was better in the areas of foot examination (P< 0.01), fundus examination (P= 0.0001), and hemoglobin A1c testing (P= 0.01). On a regression model only fundus examination, foot examination and documentation of smoking status were significantly better in the diabetes clinic (P< 0.05). CONCLUSION: There is still a large gap between clinical guidelines and clinical practice. Joint treatment of diabetic patients between the family physician and the diabetes specialist may be a proposed model to improve follow-up and diabetes control. This model of treatment should be checked in a prospective study.

Aged↗

PubMed2004

Primary care follow up of patients discharged from the emergency department: a retrospective study.

BACKGROUND: The visit to the emergency department (ED) constitutes a brief, yet an important point in the continuum of medical care. The aim of our study was to evaluate the continuity of care of adult ED visitors. METHODS: We retrospectively reviewed all ED discharge summaries for over a month 's period. The ED chart, referral letter and the patient's primary care file were reviewed. Data collected included: age, gender, date and hour of ED visit, documentation of ED referral and ED discharge letter in the primary care file. RESULTS: 359 visits were eligible for the study. 192 (53.5%) of the patients were women, average age 54.1 +/- 18.7 years (mean +/- SD). 214 (59.6%) of the visits were during working hours of primary care clinics ("working hours"), while the rest were "out of hours" visits. Only 196 (54.6%) of patients had a referral letter, usually from their family physician. A third (71/214) of "working hours" visits were self referrals, the rate rose to 63.5% (92/145) of "out of hours" visits (p < 0.0001). The ED discharge letter was found in 50% (179/359) of the primary care files. A follow-up visit was documented in only 31% (111/359). Neither follow up visit nor discharge letter were found in 43% of the files (153/359). CONCLUSIONS: We have found a high rate of ED self referrals throughout the day together with low documentation rates of ED visits in the primary care charts. Our findings point to a poor continuity of care of ED attendees.

Adult↗

PubMed2004

Methemoglobinemia caused by topical teething preparation: a case report.

Methemoglobinemia (MetHb) remains an uncommon, but potentially fatal disorder. Benzocaine (ethyl aminobenzoate), a topical anesthetic, has been reported to cause acquired MetHb when used during endoscopic or other ambulatory procedures. Reports of severe MetHb following benzocaine-containing preparations in the community, however, are very rare. We discuss this entity by describing an unusual case of severe MetHb in a 5-year-old child, caused by unattended self-use of a benzocaine-containing, pain-relief gel for teething. This case story illustrates the potential lethal risk of over-the-counter topical anesthetics for pediatric use. We review the risks of this potentially deadly disorder and the associated diagnostic challenges. Physicians not familiar with this rare complication may face diagnostic dilemmas, as its presentation is often nonspecific and rapid treatment is essential to prevent life-threatening complications.

Administration, Topical↗

PubMed2004

[Community care of diabetic patients--in the family practice, in specialized diabetic clinics or in cooperation?].

Type 2 diabetes is a common chronic illness with many complications, entailing enormous expenditures health services. In the Western world, diabetes is the most common cause of amputations of the lower limb, end stage renal failure and blindness amongst 18-65 year olds. The care of the diabetic patient is multi-faceted and the long term compliance of the patient is essential. In the last decade there is an ongoing heated debate regarding how treatment and care should be provided to diabetics and by whom. "Shared care" between the family physician and the specialist diabetes clinic is becoming more popular in an attempt to raise standards of care while reducing costs. The aim of the current review is to evaluate management modalities of the diabetic patient and its' applications to the Israeli health system.

Adult↗

PubMed2003

Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism.

BACKGROUND: The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. OBJECTIVES: The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. METHODS: During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. RESULTS: The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. CONCLUSION: This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

Anthrax↗

PubMed2003

Awareness of personal healthcare and menopause in menopausal women in Israel.

BACKGROUND: Menopause affects women's health and well-being, but their knowledge of proper care and maintenance is uncertain. OBJECTIVE: To assess the attitude and approach of the healthy, low risk, postmenopausal population in Israel to personal healthcare and menopause. METHODS: The study population comprised 500 menopausal women attending community outpatient primary care clinics. All women completed a 20-item questionnaire covering personal healthcare habits, lifestyle, knowledge about menopause, and attitude and approach to menopause and use of hormone replacement therapy. RESULTS: The patients' mean body mass index was 25.8 +/- 4.1 kg/m2; more than half the women were overweight, 28% engaged in regular sports activity, and 11.2% smoked; 74% had a positive attitude towards their age; 60% underwent yearly screening mammography; 74% had had Pap smear, and 86% had lipid profile measurements during the last year; self-examination of the breast was regularly performed by only 49%. HRT is currently being used by 27% and had been used in the past by another 16%. The primary reasons for stopping therapy were irregular bleeding in 38% and apparent ineffectiveness in 35%. There was a positive significant correlation between level of education and both undergoing regular medical screening and engaging in regular sports activity. HRT current utilization was negatively associated with age and being a housewife. CONCLUSIONS: A relatively high percentage of the study population safeguards its health and regularly uses HRT. We believe that stronger efforts are needed in Israel to promote good healthcare habits and positive attitudes toward menopause and HRT use.

Body Weight↗

PubMed2003

[Driver drowsiness--are physicians at a special risk?].

BACKGROUND: Sleepiness at the wheel is the main cause of approximately a fifth of road traffic accidents. The driver will often feel drowsy before the accident, therefore preventive measures can be taken in order to stay alert. AIM: To estimate sleepiness among sleep deprived drivers and to explore methods they use to stay alert. METHODS: We choose three professions at increased risk of sleepiness: physicians working night shifts, night shift nurses and hi-tech workers who work 12 hours or more a day at least twice a week. The subjects answered an anonymous questionnaire concerning past involvement in road accidents or "near misses", known risk factors for road accidents and methods used to fight sleepiness, as well as some demographic data. RESULTS: A total of 115 drivers (38 physicians, 37 nurses and 40 hi-tech workers) participated in this study. The average age was 36.0 + 7.9 years and 53% males. Thirteen percent had been involved in road accidents as drivers in the last year, 53% of them remember that the accident was due to sleepiness or fatigue. Thirty-seven percent remember at least one occasion of "near accident" due to sleepiness. Driving in the "dangerous" hours was positively associated with "near accidents" (69% vs. 29%, p < 0.001) and in accidents (17% vs. 11% P = NS). Physicians were involved in "near accidents" (p < 0.005) more often. The most frequent methods used to overcome sleepiness were: listening to the radio (86.1%), opening the window (65.2%) and turning on the air conditioning in the car (57.4%). CONCLUSION: Driving whilst sleepy is an important contributor to road accidents. It seems that sleep deprived workers and especially physicians working in shifts, are at an increased risk. This issue should receive a higher priority as part of preventive medicine among physicians themselves and their patients.

Accidents, Traffic↗

PubMed2002

Erectile dysfunction--the effect of sending a questionnaire to patients on consultations with their family doctor.

BACKGROUND: Erectile dysfunction (ED) is a common problem among male adults that generally has been ignored by family practitioners. OBJECTIVE: Our aim was to assess the effect of a mailed questionnaire about ED on the readiness of patients to raise the subject with their family doctor. METHODS: The study population included all men aged 40 years and over on the patient list of a family practitioner. A control group made up of males of similar ages was chosen in another family practice. The patient files were reviewed for ED. Anonymous questionnaires including questions about sexual dysfunction and satisfaction with sex life, as well as demographic and medical details, were sent to the study population. Patients who suffered from ED were invited to visit their family doctor. In the following 2 months, the study and control group populations' visits to the family practitioner were monitored for complaints of sexual dysfunction. RESULTS: In the 2 years prior to the study, 14/205 (6.8%) of the study population had complained to their family practitioner of ED in comparison with 6/205 (2.9%) in the control group (P = NS). In the 2 months following the sending of the questionnaire, 23 patients consulted their family practitioner with ED, 19 of whom had not discussed their problem with the family practitioner previously; only a further two patients went to discuss ED in the same period in the control group (P < 0.001). A total of 85/205 (41.5%) patients returned the questionnaire and 35/85 (42.5%) said they suffered from ED. Of 35 patients who reported ED, 15 had been for a consultation; only six of them consulted their family doctor. CONCLUSION: ED is reported infrequently to family doctors. Sending an anonymous questionnaire on the subject increases awareness of the problem and in turn increases the number of cases that can be treated.

Aged↗

PubMed2002

The role of family physicians in increasing annual fecal occult blood test screening coverage: a prospective intervention study.

BACKGROUND: Colorectal cancer is the second leading cause of cancer mortality in israel. Unfortunately, compliance with annual fecal occult blood testing is very low. OBJECTIVE: To assess the effectiveness of interventions to increase FOBT screening in primary care clinics in Israel. METHODS: A prospective, randomized study included all 50-75 year old enrollees of six family physicians in two primary care clinics. The register of two physicians, one from each clinic, was allocated to one of three groups. Two FOBT reminder strategies were tested: a physician reminder (753 patients), and a patient reminder that was either a phone call (312 patients) or a letter (337 patients). The control group (913 patients) of physicians continued administering their regular level of care. The main outcome measure was the percentage of patients undergoing FOBT screening in each study arm at the conclusion of the one year study period. RESULTS: In the intervention groups 14.3% (201/1,402) were screened using the FOBT over the course of the study year. Using an intent-to-screen analysis, the screening rate in the physician and patient reminder groups was significantly higher than in the control group (16.5 and 11.9%, vs. 1.2% respectively, P < 0.0001). Phone reminders were significantly more effective than letters (14.7 vs. 9.2%, P = 0.01). CONCLUSIONS: Various reminder systems for FOBT are beneficial, especially those centered around the family physician. Further research should focus on this area, in conjunction with other novel approaches.

Aged↗