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Biomedical subjects

G Sadovsky

Publications and source records attributed to G Sadovsky.

16 recordsLinked to original sources
PubMed1998

[Urgent, unscheduled self-referrals by ambulatory patients].

Direct self-referral to a consultant is common in the Israeli health system. Yet patients' reasons for their urgent, unscheduled self-referrals for ambulatory consultations (UUSR) have not been explored. We studied such consultations in an urban multi-disciplinary consultation center serving a population of approximately 100,000. Over a 3-month period such consultations in ophthalmology, ear-nose-and-throat and dermatology clinics were treated by a duty family physician (FP). The FP was instructed to focus on the urgent complaint and either to give definitive treatment and schedule a consultation when needed, or refer the patient for immediate specialist consultation. Patients treated by the FP were asked to fill an anonymous questionnaire, which 347/645 (55.4%) did. Among the reasons for UUSR were that the patient thought that his/her complaints should be treated by a consultant (29%), the patient was sent by the FP without a consultation note (13.9%), the FP was not available (10.4%), or the patient wished to see the consultant for a second opinion (8.2%). In only 7.8% had the patient noted that his complaint needed urgent consultation. Duration of complaints, but not prior efforts to schedule a consultation, were associated with different reasons for asking for an UUSR. For various reasons patients preferred an UUSR rather than seeing their own FP. Patients' opinions regarding self-referrals are important in planning primary care facilities and FP training.

Consultants↗
PubMed1997

Urgent self-referrals to ambulatory consultant--a prospective evaluation of triage by a qualified family physician.

Direct self-referrals to a consultant, especially on an urgent basis, has not been widely explored before. The health insurance system in Israel permits elective direct self-referrals to various specialists, but the range and reasons of urgent self-referrals has not yet been evaluated. Our aim was to evaluate urgent self-referrals to ambulatory consultants and to see to what extent a qualified family physician can triage and treat those patients. The setting was an urban ambulatory multi-disciplinary consultation center in the city of Ashdod in central Israel, serving a population of approximately 150,000. Over a three-month period, all patients who made urgent self-referrals for an ambulatory consultant in Ophthalmology, Ear, Nose and Throat (ENT) and Dermatology were triaged by an on-duty qualified family physician. The physician was instructed to take care of the patient in one of three ways: 1) immediate referral to a specialist; 2) begin treatment and schedule the patient for a specialist consultation; 3) administration of definitive treatment. Eight hundred and ninety-eight patients aged 46 +/- 22 years were treated by the triaging family physician. Forty-six percent had ophthalmological symptoms, 26% had dermatological symptoms and 20% had ENT-related symptoms. A symptom duration of less than 24 hours was reported by 36% of the patients. Eye problems were more commonly of short duration (p < 0.001). Sixty percent of the patients were given a definitive treatment, another 19% were given immediate treatment and scheduled for elective consultation with a specialist and 21% were referred for an immediate specialist consultation. Of the immediate consultations, 73% were ophthalmological and 27% came from a range of other complaints (p < 0.001). Our conclusion was that a family physician can treat most of the urgent self-referrals to ambulatory consultations in the three domains that were evaluated. A triage system is particularly suitable for urgent self-referrals to ENT as well as dermatological problems.

Adolescent↗
PubMed1993

Correlates of military tank simulator sickness.

A military tank driving simulator is currently widely used as a training aid for tank drivers. The purpose of this study was to investigate the relationship between possible correlates of simulator sickness and the occurrence of sickness and performance test results among simulator drivers. The average number of motion sickness-like symptoms reported after driving the simulator among subjects with a history of susceptibility to motion sickness was 3.4, significantly higher than the average of 1.6 reported among subjects who did not report previous susceptibility to motion sickness (p < 0.05). Subjects driving the simulator while screen image quality was disturbed had a longer reaction time (42.0 s) than when driving the simulator without screen interferences (18.4 s, p = 0.001). Subjects driving the simulator for a short period had the same number of symptoms as did those driving for a longer period, but had better digit symbol test results. There was no statistically significant association between the development of sickness and tank driving experience. Suggested countermeasures are expected to prevent simulator sickness among some of the simulator trainees and to make simulator training more effective.

Adolescent↗
PubMed1990

Antepartum heart rate patterns in small-for-gestational-age third-trimester fetuses: correlations with blood gas values obtained at cordocentesis.

Antepartum fetal heart rate records were made immediately before cordocentesis and blood gas analysis in 58 small- and 29 appropriate-for-gestational-age fetuses at 27 to 38 weeks' gestation. All appropriate-for-gestational-age fetuses had blood PO2 and pH values within the normal ranges for gestation, and in 27 of 29 cases the heart rate pattern was reactive; in two it was nonreactive. Abnormal heart rate patterns were present in 15 of the 19 small-for-gestational-age fetuses that were found to be hypoxemic, acidemic, or both. The abnormalities included decreased baseline variation, absence of accelerations, presence of decelerations, and increased baseline heart rate. A repetitive decelerative pattern best identified the hypoxemic fetuses. Fetal PO2 values in the lower normal range, present in many of the small-for-gestational-age fetuses, were in general associated with a reactive fetal heart rate pattern.

Blood Specimen Collection↗
PubMed1989

Heart rate patterns in normoxemic, hypoxemic, and anemic second-trimester fetuses.

Fetal heart rate monitoring was performed immediately before cordocentesis on 71 occasions on 49 patients at 20 to 26 weeks' gestation. In the normoxemic, nonanemic fetuses, the basal fetal heart rate was 120 to 160 beats/minute, the baseline variability was more than 5 beats/min, and there were no prolonged decelerations. Accelerations were present in 19 of the 25 recordings. In the tracings from the hypoxemic (n = 11) or anemic (n = 35) fetuses, there was tachycardia, baseline variability of less than 5 beats/min, and prolonged fetal heart rate decelerations. However, the sensitivity of these pathologic patterns in predicting moderate-to-severe hypoxemia or anemia was 45% and 33%, respectively. The data demonstrate a gestation-dependent maturation of both normal and pathologic fetal heart rate patterns.

Anemia↗
PubMed1989

Fetal heart rate patterns in red blood cell isoimmunized pregnancies.

Fetal heart rate was monitored in 33 red blood cell isoimmunized patients at 32 to 36 weeks' gestation immediately before cordocentesis. The fetal heart rate patterns were analyzed according to 25 different classifications, and the values were related to the fetal hemoglobin concentration, oxygen tension, and oxygen content. Nonreactive, suboptimal, or pathologic fetal heart rate patterns were encountered more commonly in fetuses that were hypoxemic and anemic than in those that were normoxemic and nonanemic. However, the positive predictive value of these abnormal fetal heart rate patterns with respect to fetal anemia was 50% to 100%; the negative predictive value was 18% to 40%.

Erythroblastosis, Fetal↗
PubMed1989

Reference ranges for fetal heart rate patterns in normoxaemic nonanaemic fetuses.

Reference ranges for the various components of fetal heart rate (FHR) patterns with gestation were established from the study of 119 fetuses at 20-39 weeks. These fetuses were proved by cordocentesis to be normoxaemic and nonanaemic. The mean baseline FHR decreased, while the baseline variability, both for amplitude and oscillation frequency, increased with gestation. The number and amplitude of accelerations increased, and the frequency and duration of decelerations decreased with gestation. These data indicate that in the interpretation of FHR patterns adjustments according to the gestational age of the fetus should be made.

Female↗
PubMed1988

Heart rate patterns in fetal anemia.

Fetal heart rate (FHR) was monitored immediately before cordocentesis on 105 occasions in 49 red cell-isoimmunized patients at 27-37 weeks of gestation. The fetal hemoglobin concentration, oxygen tension and oxygen content were measured and the values related to the FHR patterns, which were classified as reactive, non-reactive, decelerative (isolated or repetitive), terminal or sinusoidal. In 88% of non-anemic fetuses the FHR pattern was reactive. Extreme deficits in fetal hemoglobin concentration or oxygen content (greater than 9 standard deviations below the appropriate normal mean for gestation) were consistently associated with sinusoidal and repetitive decelerative patterns. However, with lesser degrees of fetal compromise the relationship between the various FHR patterns and fetal anemia or hypoxemia was less clearly defined.

Anemia↗
PubMed1988

Ovarian residual syndrome.

During the years 1979 to 1983, 329 patients underwent hysterectomy with preservation of one or both ovaries. Six patients were evaluated for postoperative chronic lower abdominal pain and dyspareunia. Findings at laparotomy confirmed the diagnosis of residual ovarian syndrome in all six. Relief of symptoms was observed after adnexectomy in four, oophorectomy in one patient and ovariopexy in one. The literature concerning this rare complication after hysterectomy is briefly reviewed.

Abdomen↗
PubMed1982

Improved fertility following ectopic pregnancy.

The reproductive performance subsequent to operative removal of ectopic pregnancy was examined in 154 women. They represent 64% of 242 women admitted for ectopic pregnancy between 1969 and 1979. The follow-up period averaged 4.2 years. The patients at risk had a conception rate of 81%, with a repeat ectopic pregnancy incidence of 7.8%, and 65% had at least one live birth. Postoperative infertility was significantly associated with (1) previous sterility, (2) coexistent periadnexal adhesions and/or tubual disease, (3) rupture of the ectopic pregnancy, and (4) older age. A statistically significant advantage of conservative over radical treatment, as regards future fertility, was demonstrated only in 53 patients with either history or findings suggestive of previously impaired fertility. Early, prerupture diagnosis and treatment, coupled with conservative and restorative measures, might account for the improved reproductive performance.

Adolescent↗
PubMed1982

Conservative surgery for tubal pregnancy.

Fifty-seven conservative surgical procedures for unruptured tubal pregnancy were performed on 54 patients. Salpingotomy was performed in 44 cases and fimbrial expression of the ectopic gestation was performed in 13 cases. In this patient group, 80% of the patients (39 of 49) experienced intrauterine pregnancy following surgery and 71% (35 of 49) had a live birth. The recurrence rate of tubal pregnancy was 12%. Ninety percent of the patients with a normal contralateral tube had an intrauterine pregnancy following surgery and a 7% recurrence rate of tubal pregnancy, a ratio of 1:15. It is suggested that the indications for the conservative surgical management in patients with unruptured tubal pregnancy should be broadened to all patients interested in future pregnancies and should also be considered in those cases with normal contralateral tube.

Fallopian Tubes↗
PubMed1981

Severe ovarian hemorrhage in congenital afibrinogenemia.

This is a case report of a patient with congenital afibrinogenemia and massive intra-abdominal bleeding from a ruptured corpus luteum cyst. None of the previously reported 100 cases mentioned obstetrical or gynecological complications associated with this rare entity.

Adult↗
PubMedDate not supplied

Motion sickness-like syndrome among tank simulator drivers.

A military tank driving simulator has recently been introduced as a training aid for tank drivers in the Israel Defense Forces. Reports of nausea and vomiting among the first users of the simulator launched our investigation of the possible existence of a motion sickness-like syndrome among simulator drivers. Although the 59 subjects drove the simulator without any report of vomiting, other motion sickness-like symptoms were frequently reported. A comparison of symptoms reported after simulator and real tank driving show that dizziness, nausea, disorientation and hypersalivation were more frequently reported by simulator drivers and were of greater intensity. However, sweating and drowsiness were more prevalent among real tank drivers. The objective effect of driving the simulator was evaluated by instability and performance tests that were conducted before, during and after driving the simulator. A greater decrement in test results was observed among subjects reporting higher frequency of motion sickness-like symptoms.

Adult↗