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Biomedical subjects

Mayer Brezis

Publications and source records attributed to Mayer Brezis.

10 recordsLinked to original sources
PubMed2005

A prospective study assessing the efficacy of abdominal computed tomography scan without bowel preparation in diagnosing intestinal wall and luminal lesions in patients presenting to the emergency room with abdominal complaints.

AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints. METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded. RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization. Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67). CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.

Abdomen↗
PubMed2005

Undertreatment of acute pain in the emergency department: a challenge.

OBJECTIVE: Evaluation and improvement of pain management in our emergency department (ED). DESIGN: This was a "before-after" study. For each subject, the nurse, the physician, and the patient were asked to rate the initial intensity of the pain on a Visual Analogue Score (VAS). The timing and the type of analgesics administered were then recorded and follow-up VAS was performed. SETTING: A teaching, community-based, 400-bed hospital. STUDY PARTICIPANTS: 140 patients admitted for acute pain related to orthopedic injuries. MAIN OUTCOME MEASURES: The gap between the VAS expressed by the patient and estimated by the staff, the proportion of patients receiving analgesics, and the length of time delays between admission and analgesic administration. INTERVENTION: The intervention included education of medical and nursing staffs, insertion of a VAS template in the patient's chart, initiation of routine VAS assessment and re-assessment, and implementation of a protocol for pain management with standing orders for nurses. RESULTS: The VAS gap between the patient and the nurse decreased significantly from 1.91 2.04 to 1.03 1.97 after the intervention (P = 0.01). The percentage of patients receiving analgesics rose from 70 to 82% following the intervention. Time from admission to analgesia decreased from 80 +/- 68 min (mean +/- SD) before the intervention, to 58 +/- 37 min after the intervention (P = 0.05). CONCLUSION: Inadequate pain management in the ED appears related to poor staff assessment of pain and may be improved by routine VAS recording and by a nurse-based pain protocol.

Acute Disease↗
PubMed2004

General medicine practitioners' attitudes towards "do not attempt resuscitation" orders.

OBJECTIVE: To examine whether "all-or-none" guidelines for cardiopulmonary resuscitation (CPR) are being applied by practitioners on general medical wards (GMWs). HYPOTHESIS: Do not attempt resuscitation (DNAR) orders are rarely related to patient preferences. Limited resuscitation efforts are being practiced to circumvent the need for DNAR orders. DESIGN: A surprise opinion survey (presented below), based on case vignette and practice description, and performed by remote control votes. SETTING: The multi-centre forum for practitioners on GMWs within the greater Jerusalem district. PARTICIPANTS: 79/85 clinicians practicing/training on GMWs in six teaching hospitals, who attended the forum and responded within 3 min to the survey. RESULTS: Fifty-eight practitioners (73%) assigned a DNAR order for a patient unable to express a preference and only 43 (55%) complied with the request of a competent patient for a DNAR order (P < 0.05]; 95% CI: 2-34). During the past year, only five practitioners (9% of respondents) had performed CPR solely when pathophysiological benefit was expected, 31 (59%) had performed limited CPR efforts and only 13 (28%) had discussed the subject of DNAR with patients and their next of kin >5 times. CONCLUSIONS: (1) DNAR orders are rarely discussed with patients and their next of kin in GMWs within the region examined; (2) even when DNAR is discussed, physicians tend to confer DNAR orders based on their personal value judgements rather than on patient preferences; (3) practitioners on GMWs perform CPR when no pathophysiological benefit is expected; (4) limited resuscitation efforts are performed frequently in GMWs.

Attitude of Health Personnel↗
PubMed2002

Proximal tubular injury attenuates outer medullary hypoxic damage: studies in perfused rat kidneys.

The straight segment (S3) of the proximal tubule is predominantly damaged during renal ischemia-reflow, whereas medullary thick ascending limbs (mTALs) are principally affected in other models of hypoxic acute tubular necrosis (ATN). Since the latter injury pattern largely depends on the extent of reabsorptive activity during hypoxic stress, we hypothesized that proximal tubular damage might attenuate downstream mTAL injury by means of diminished distal solute delivery for reabsorption. In isolated rat kidneys perfused for 90 min with oxygenated Krebs-Henseleit solution, mTAL necrosis developed in 75 +/- 3% of tubules in the mid-inner stripe of the outer medulla. By contrast, S3 segments in the outer stripe were minimally affected, with tubular fragmentation involving some 5 +/- 2% of tubules. In kidneys subjected in vivo to proximal tubular injury and subsequently used for isolated perfusion studies, the injury pattern was inverted: following 20 and 30 min ischemia and reflow for 24 h, S3 fragmentation rose to 18 +/- 16% and 72 +/- 13%, while mTAL damage was reduced to 33 +/- 10 and 24 +/- 8%, respectively. In kidneys subjected in vivo to D-serine S3 necrosis rose to 100%, while mTAL damage fell to 1 +/- 1% (p < 0.001). Substantial S3 tubular collapse (involving approximately 30% of tubules) and inner stripe interstitial hemorrhage were also noted, exclusively in kidneys subjected to ischemia-reflow. Proximal tubular necrosis alone or in combination with collapse inversely correlated with mTAL necrosis (R = -0.51 and -0.72, respectively, p < 0.003). This cogent inverse association might imply that disruption of the proximal nephron attenuates downstream mTAL necrosis by a reduction of distal tubular reabsorptive workload.

Animals↗
PubMed2002

Principles for planning the teaching of evidence-based medicine/clinical epidemiology for MPH and medical students.

Medical decision-making requires increasing skills in communication, information retrieval, and formulating and answering focused clinical questions. Medical students need increasing exposure to the principles of evidence-based medicine and methodologic training in epidemiology and biostatistics in order to cope with the explosion of medical information and in order to appraise, interpret, and perform clinical research. This review summarizes the principles applied to teaching these subjects to medical students, as well as to students in Master's programs who will pursue careers in public health or clinical research.

Biometry↗