[The emergency room in a general hospital: a link in the health service system].
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Biomedical subjects
Publications and source records attributed to L M Epstein.
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Despite recent advances in the treatment of stage D carcinoma of the prostate many patients become refractory to all therapeutic modalities. Progressive and incapacitating pain is one of the most difficult symptoms to manage. Ten patients with severely symptomatic metastatic adenocarcinoma of the prostate have been treated with either single or sequential doses of half body radiation using 800 rad delivered by a Linac 10 mV linear accelerator. There were 15 courses of half body radiation delivered and a good to excellent response was noted in 11 instances. Results often were immediate and the duration of the response was variable. Treatment was well tolerated with no fatal complications. Half and total body radiation appears to offer significant palliation and its use with other forms of therapy warrants further investigation.
A longitudinal community health study was commenced in a neighborhood of western Jerusalem in 1969. Its main aims were the investigation of etiologic factors in selected common diseases and disabilities, the development and testing of epidemiologic tools for use in community diagnosis, the provision of a factual basis for decisions concerning community health care for the population studied, and the use of the findings in an evaluation of the effectiveness of community health care. In the first round, 90% of residents 25 or more years old were interviewed and 81% were examined. Among children under 15 years of age, the corresponding rates were 94 and 83%. Response was low among persons in the age range 15 to 24 years, especially males. People who were concerned about their health were readier to be examined. Response was not related to region of birth, education or other variables. The possible bias introduced by nonresponse appeared to be small except in the age group 15 to 24 years.
The health status of males aged 15 or more years was studied as part of a community health survey in a neighborhood of western Jerusalem. Most subjects (75%) reported that they felt well; clinical appraisals revealed a need for treatment in 33%. Hypertension was found in 14% and coronary heart disease in 6%. Other common disorders included hemorrhoids (16%), varicose veins (11%), overweight (18%), hypercholesterolemia (13%), inguinal hernia (13%), symptoms of prostatic hypertrophy (10%) and diabetes (5%). The prevalence of specific symptoms of emotional ill health ranged from 6 to 23%. A quarter reported serious current problems; 10% were dissatisfied with their present life situation; and 10% had concentration camp experience. Half were current cigarette smokers. The prevalence of most disorders rose in successive age groups. Mean diastolic blood pressure, serum cholesterol, relative weight and the prevalence of cigarette smoking were lower in the oldest age groups. With some exceptions, the age trends were similar to those found in other populations.
The epidemiology of inguinal hernia was investigated in a community survey in a neighbourhood of western Jerusalem in 1969-71. The current prevalence rate, excluding operated hernias, was 18 per 100 men aged 25 and over, and the lifetime prevalence, including operated hernias, was 24 per 100. Prevalence rose markedly with age; the lifetime prevalence rate reached 40 per 100 men at the ages of 65-74 and 47 per 100 at 75 and over. The prevalence of hernia was significantly higher in the presence of varicose veins, in men who reported symptoms of prostatic hypertrophy, and, among lean men only, in the presence of haemorrhoids. These associations may reflect the role of increased abdominal pressure. The prevalence of hernia was low in the presence of overweight or adiposity, suggesting that obesity is a protective factor. No significant age-independent associations were found with chronic cough, constipation, physical activity at work, or a number of other variables. Two-thirds of the hernias had not been operated upon. The prevalence of unrepaired hernias rose with age; 13% of all men aged 65-74 and 23% of those aged 75 and over had unoperated groin swellings. One in every five operated hernias showed evidence of recurrence. No significant age-independent associations were found between evidence of occurrence and other characteristics. A comparison of interview responses and examination findings showed that interview data on the presence of hernias were of low validity, mainly because of under-reporting.
A community-orientated programme for the control of hypertension, atherosclerotic disease, and diabetes has been developed in a family practice in a neighbourhood of Jerusalem. Intervention is directed mainly towards the control of risk factors associated with these diseases.The programme has specific objectives for diet, smoking, obesity, blood pressure, serum cholesterol, glucose intolerance, and diabetes mellitus, and the identification and treatment of patients with cardiovascular diseases. The survey seeks to identify the nature and extent of problems, intervention by medicinal and educational means, and continuing surveillance and evaluation.The programme aims to test and demonstrate the feasibility of carrying out multifactorial community health care within the framework of a family practice, thereby developing a joint practice of primary health care and community medicine.
Surveillance of hospital-associated infections at the Hadassah University Hospital has been carried out since 1970. Criteria for infection were defined and were monitored by trained nurse-epidemiologists, with the cooperation of the surgical staff. This report deals with the results of a prospective study of infections present on admission, and those acquired during hospitalization, in six surgical departments between January 1972 and June 1973. Of the 7,339 patients discharged, 7.5% acquired an infection in hospital, while 10.6% were admitted with an infection. Several important factors appeared to increase the risk of acquiring an infection in hospital. These include advanced age, certain surgical procedures, such as gallbladder and small and large bowel operations, and the presence of infection on admission. Most of the latter occurred at the site of the proposed operation, and thus increased the risk of development of postoperative wound infection.
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