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Biomedical subjects

P Shvartzman

Publications and source records attributed to P Shvartzman.

9 recordsLinked to original sources
PubMed1992

[Quality control in primary care: an instrument for constructing a database].

An instrument for constructing a database and defining standards for quality control in primary care medicine is presented. A questionnaire adapted from a U.S. Department of Health and Human Services form will be used randomly at least twice a year for screening all patient-staff contacts in most Kupat Holim clinics in the Negev Region (small rural clinics excepted). Analysis of the responses will enable definition of standards for measuring the quality of primary care. The tool is simple, inexpensive, not too time-consuming, and can provide the required data. A pilot study to test the tool was carried out in 3 primary care clinics serving an insured population of 17,763. The study surveyed 474 patient visits to the clinics, of which 57% were consultations with a physician. The younger patients usually saw the physician, while the older tended to visit the nurse. The most common reason for clinic visits was an acute condition, and only 4% of visits were for administrative reasons. 28% of the patients were not prescribed any medication and 27% were prescribed only 1 drug. The majority of problems were dealt with at the clinic level and only a few were referred to specialists or to external diagnostic services.

Adolescent↗
PubMed1992

[Characteristics and perceptions of physician managers in Israel].

In a survey of 120 physician managers (PM) of the Israel Ministry of Health and the General Sick Fund (Kupat Holim), demographic and managerial characteristics and perceptions of what is important for effective performance were studied. Medical directors of hospitals, districts and Kupat Holim clinics were included. The majority of the respondents had some training in medical management. 33% are family physicians, 15% are internists, 33% have degrees in public health, 17% are board certified in medical management, and 8% are pediatricians. None of the district and hospital medical directors of the General Sick Fund is a woman, but 40% of medical directors in Ministry of Health districts are women. More than 50% of PMs are not satisfied with the dualistic management that exists mainly in the General Sick Fund. 42% of the respondents stated that 8 or more years after residency is the most appropriate time to assume managerial roles. The average score of those who chose medical management from the point of view of job satisfaction was 7.4 +/- 2.3, but the rated satisfaction from performance as a PM in the health care system today is 4.2 +/- 2.6 (on a 1-10 scale). The most important managerial characteristics perceived by the respondents were credibility, ability to communicate and delegate, and leadership.

Female↗
PubMed1992

The interrupted consultation.

This paper focuses attention, in a modest empirical way, on a hitherto unexplored phenomenon. Widespread in Israel, the interrupted patient-physician consultation may or may not be found extensively elsewhere. It is assumed that interruptions coming from the social environment affect communication and hence diagnosis and therapy, as well as satisfaction of both doctor and patient. Observations were conducted in a random sample of 100 consultations, averaging 9.4 minutes, of four physicians in a neighbourhood health centre in Israel. Interruptions were recorded in 94 cases, with an average of 1.36 interruptions per consultation. Contrary to Israeli myth, most interruptions were not by other patients but by clinic staff. The phenomenon is considered in terms of cultural practice and the consequences of group practice, nurse autonomy and medical student teaching. Further research is proposed to study the extent, sources and consequences of interruptions in family practice and, if warranted, methods of coping.

Communication Barriers↗
PubMed1991

Outbreak of pertussis in a closed population with a high vaccination rate.

An outbreak of pertussis encompassing 78 cases in a population of 964 persons living on kibbutz is described. The attack rate was 36.1% among children aged 4 to 11 years, although all had been fully vaccinated. Female predominance and seasonal incidence conformed with what has been reported in the literature. The age distribution, however, was markedly different from that usually observed, indicating that local factors may influence the epidemiology of whooping cough. Despite the seeming paradox of the disease breaking out in a population with a high immunization rate, our results suggest that the vaccine had a protective effect in all age-groups. The incidence of pertussis in Israel in 1987 was considerably higher than that in the United States for the same year, and raises the question of changing the recommendations for vaccination here.

Adolescent↗
PubMed1989

Unsuspected source of vitamin K in patients treated with anticoagulants: a case report.

The administration of warfarin requires careful attention. The concurrent intake of drugs can either enhance or compete with its anticoagulant effect. Less frequently encountered are the effects from vitamin K added to food, intake of foods with naturally occurring high levels of vitamin K and diets deficient in vitamin K. We report a case in which loss of anticoagulant control was caused by a dietary supplement taken during a weight reducing diet by a patient who was receiving warfarin following a pulmonary embolus. A review of the literature reveals several similar cases. Amounts of vitamin K in food supplements and in foods with large amounts of naturally occurring vitamin K are tabulated along with suggestions for surveillance of patients taking anticoagulants.

Adult↗
PubMed1988

Complications of chiropractic treatment for back pain.

Back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. Rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. Physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.

Back Pain↗