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Lisa Amir

Publications and source records attributed to Lisa Amir.

12 recordsLinked to original sources
PubMed2006

Medical education and quality of care in the pediatric emergency department setting: a combined model.

OBJECTIVES: To describe a combined program for ongoing medical education and quality assurance in the pediatric emergency department. METHODS: Between January and June 2003, all residents and students working in the emergency department of a major tertiary pediatric center were required to participate in a structured 1-h morning session every weekday conducted by the attending physician. The charts of all children who had presented to the emergency department within the last 24 h were systematically reviewed for measures of management and pertinent clinical, academic, or administrative aspects. Radiology reports were reviewed for discrepancies between readings and culture results for appropriateness of treatment. All educational comments, X-ray discrepancies, culture findings that warranted a change in therapy, and unscheduled return visits to the emergency department within 24 h were recorded and statistically analyzed (BMDP software). RESULTS: The charts of 18,663 children aged 3 days to 18 years were reviewed. Educational comments numbered 1527 (8.2% of cases). Significant discrepancies were found in 216 X-ray films (6.1%) and nonsignificant discrepancies in 357 (10.2%). A change in therapy was indicated in 19 of 4005 blood cultures (0.5%), 59 of 1270 urine cultures (4.65%), and 227 other cultures (1.2%). One hundred eighty-three children (1.3%) returned for an unscheduled visit. Over time, there was an increase in nonsignificant X-ray discrepancies and a decrease in educational comments and significant X-rays discrepancies. CONCLUSIONS: A combined program of medical education/quality assurance-improvement in the emergency department is feasible and seems to contribute to improved medical services and patient care.

Adolescent↗
PubMed2006

Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial.

OBJECTIVE: Intramuscular dexamethasone is an effective, but painful, treatment for croup. The effectiveness of betamethasone, an oral, palatable, and equally potent glucocorticoid has not been studied. The purpose of this study was to compare the effectiveness of a single oral dose of betamethasone with intramuscular dexamethasone in the outpatient treatment of mild to moderate croup. METHODS: Children aged 6 months to 6 years presenting to a tertiary care pediatric emergency department (ED) with a modified Westley croup score of 0 to 11 were randomized to receive either 0.6 mg/kg IM dexamethasone or 0.4 mg/kg PO betamethasone. Croup score, heart rate, respiratory rate, pulse oximetry, and need for supplemental treatments were recorded at study entry and at 1, 2, and 4 hours after treatment. Follow-up data were collected by daily telephone follow-up on persistence of symptoms and the need for additional treatment or physician visits up to 7 days after the ED visit. RESULTS: Each study group contained 26 patients. Despite randomization, the mean baseline croup score was higher in the dexamethasone group (3.6 +/- 2.6 vs. 2.0 +/- 2.4, P = 0.03). Patients in both groups showed a significant reduction in the croup score after treatment, and there were no significant differences between croup scores at 4 hours (P = 0.18). Similarly, there were no differences between groups in the hospital admission rate, time to resolution of symptoms, need for additional treatments, or number of return ED visits. CONCLUSION: There is no difference between oral betamethasone and intramuscular dexamethasonein the management of mild to moderate viral croup. It is palatable and does not require a nurse for administration, making it a good alternative for ambulatory management.

Administration, Oral↗
PubMed2005

Role of diagnosis-specific information sheets in parents' understanding of emergency department discharge instructions.

OBJECTIVES: To investigate the contribution of diagnosis-specific information sheets at discharge from the emergency department on parental understanding of the discharge instructions. METHODS: The study group consisted of a convenience sample of parents of children discharged home from the emergency department of an urban tertiary care pediatric facility (n=95). At discharge by the physician, all were given a disease-specific information sheet to accompany the physician's discharge instructions. Thereafter, the parents were asked to complete the same 13-item questionnaire used in our previous study, covering demographics, level of anxiety, and quality of physician's explanation, in addition to a description, in their own words, of their child's diagnosis and treatment instruction and an indication of their preferred auxiliary method of delivery of information. The findings were compared with the study group in the first phase study (n=287) who did not receive the disease-specific information sheet. The BMDP statistical package was used for the analysis. RESULTS: No statistically significant differences between the two groups in age, sex, and education, level of anxiety before or after the emergency department visit, or time of day were observed. Full understanding of the diagnosis was noted in 73% of the parents who received the information sheet and 72% of the parents in our previous study who did not. Corresponding rates of understanding of the treatment instructions were 92% and 82%. On statistical analysis, the distribution of the diagnosis-specific information sheet significantly improved parental understanding of the treatment instructions (P=0.025), but not of the diagnosis (P=0.54). CONCLUSIONS: Although overall parental understanding of emergency department discharge instructions is good, understanding of the treatment instructions can be further improved with the use of diagnosis-specific information sheets.

Adult↗
PubMed2005

Pediatric advanced life support (PALS) courses in Israel: ten years of experience.

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 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 based on 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.

Emergency Medicine↗
PubMed2004

Waiting for Saddam.

Explore the source record for details and available documents.

Chemical Warfare↗
PubMed2004

Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial.

BACKGROUND: Despite high levels of breastfeeding initiation in Australia, only 46 percent of women are still breastfeeding (exclusively or partially) 6 months later, with marked differences between social groups. This study aimed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding. METHODS: A randomized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted, in which 981 primiparas who attended a public, tertiary women's hospital in Melbourne, Australia, were randomized to one of two interventions or to standard care (327 in each group). The interventions were a 1.5-hour class on practical aspects of breastfeeding using a previously tested tool (Practical Skills), and two 1-hour classes exploring family and community attitudes toward, and experiences of, breastfeeding (Attitudes). Both interventions took place in interactive small groups when women were in mid-pregnancy. Breastfeeding initiation was ascertained by interview 2 to 4 days after birth, and breastfeeding duration was assessed by telephone interview 6 months after birth. RESULTS: Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299). CONCLUSIONS: In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.

Adult↗
PubMed2003

Do parents understand emergency department discharge instructions? A survey analysis.

BACKGROUND: Understanding discharge instructions is crucial to optimal healing but may be compromised in the hectic environment of the emergency department. OBJECTIVES: To determine parents' understanding of ED discharge instructions and factors that may affect it. METHODS: A convenience sample of parents of children discharged home from the ED of an urban tertiary care pediatric facility (n = 287) and a suburban level II general hospital (n = 195) completed a 13 item questionnaire covering demographics, level of anxiety, and quality of physician's explanation. Parents also described their child's diagnosis and treatment instructions and indicated preferred auxiliary methods of delivery of information. Data were analyzed using the BMPD statistical package. RESULTS: Full understanding was found in 72% and 78% of the parents at the respective centers for the diagnosis, and in 82% and 87% for the treatment instructions (P = NS between centers). There was no statistical correlation between level of understanding and parental age, gender, education, level of anxiety before or after the ED visit, or time of day. The most contributory factor to lack of understanding was staff use of medical terminology. Parents suggested further explanations by a special discharge nurse and written information as auxiliary methods. CONCLUSIONS: Overall, parental understanding of ED discharge instructions is good. However, there remains a considerable number (about 20%) who fail to fully comprehend the diagnosis or treatment directives. This subset might benefit from the use of lay terminology by the staff, institution of a special discharge nurse, or use of diagnosis-specific information sheets.

Adult↗
PubMed2002

Does the pediatric advanced life support course improve knowledge of pediatric resuscitation?

OBJECTIVE: To determine whether the pediatric advanced life support (PALS) course contributes to the knowledge required by health care providers for pediatric resuscitation and whether differences in achievement exist between professional groups. METHODS: Physicians, nurses, and paramedics from across Israel who registered for PALS were administered a standardized test both before and on completion of the course. Pretest and posttest results were compared by statistical analysis. A score of 80 or higher was considered a passing grade. RESULTS: Paired pretest and posttest results were available for 370 participants (72.5%): 128 physicians, 158 nurses, and 84 paramedics. The percentage of participants who passed the course was 83.5% for the entire cohort, 85.9% for physicians, 78.5% for nurses, and 89.3% for paramedics. Physicians and paramedics had higher pretest and posttest scores than nurses. There was a significant improvement in mean posttest scores compared with pretest scores for the entire group (86.6 +/- 9.8 vs 78.0 +/- 12.7, P < 0.001) and when results were stratified by profession. A significantly greater proportion of participants passed the posttest than the pretest both for the entire cohort (83.5% vs 61.9%, P < 0.0001) and by profession. CONCLUSIONS: The pediatric advanced life support course significantly increases immediate short-term knowledge of pediatric resuscitation for all professional groups. This finding supports the use of PALS as an educational tool. Further studies are required to determine the effect of PALS on actual performance and outcome of resuscitation.

Allied Health Personnel↗
PubMed2002

Breastfeeding and Staphylococcus aureus: three case reports.

This paper presents three case reports of breastfeeding women with Staphylococcus aureus (S. aureus) infections. The first case is a woman who developed recurrent staphylococcal skin infections, misdiagnosed as a fungal infection by her caregivers. The second case is a woman who experienced recurrent mastitis following a severe wound infection in her caesarean section scar; both she and her baby were carriers of S. aureus. The third case is a woman who experienced mastitis and a breast abscess, while her baby and other members of the family developed recurrent boils and skin infections with a methicillin-resistant S. aureus (MRSA). A wide range of staphylococcal infections may occur in the postpartum period: mastitis, abscess, caesarean scar infection, boils and skin infection. Some cases of recurrent infections may be related to nasal carriage in mother or infant. Microscopy can be useful in differentiating bacterial infections from fungal infections and confirming nasal carriage. When mothers or infants are nasal carriers of Staphylococci health professionals may recommend nasal mupirocin (Bactroban) and bathing with antiseptic washes to reduce recurrent staphylococcal infections.

Adult↗
PubMedDate not supplied

The impact of terrorism on children: a two-year experience.

OBJECTIVES: To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases. METHODS: Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors' institutions (pediatric triage); and (3) Israel Trauma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate. INTRODUCTION: During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources. RESULTS: During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5-10 minutes in urban areas and 15-20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained "first-responders" and volunteer, off-duty professionals, in addition to "scoop and run" on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services. CONCLUSION: Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pediatric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.

Algorithms↗