Biomedical subjects

Shlomo Vinker

Publications and source records attributed to Shlomo Vinker.

At least 19 recordsLinked to original sources

PubMed2006

Risk factors for photodynamic therapy of predominantly classic choroidal neovascularization in age-related macular degeneration.

PURPOSE: To investigate the influence of various risk factors for age-related macular degeneration (AMD) on the rate of undergoing photodynamic therapy (PDT). DESIGN: An observational population based cohort study. METHODS SETTINGS: A district of the largest health maintenance organization (HMO) in Israel. STUDY POPULATION: All HMO members in the district, older than 50 years on January 1, 2001, who did not terminate their membership until May 31, 2005 (139,894 members); of those, 283 underwent PDT for AMD during the study period (775 procedures). OBSERVATION PROCEDURES: We extracted information from the chronic disease registry of the HMO as well as demographic information including age, gender, country of birth, place of residency, and social security economic status. MAIN OUTCOME MEASURES: Effect of various risk factors for AMD on the rate of PDT. RESULTS: The age-adjusted proportion of patients requiring PDT was significantly higher in hypertensives (P = .03, chi2 test), in hyperlipidemics (P = .002), in ischemic heart disease patients (P = .002) and among males (P = .03) and Ashkenazi Jews (P = .02). No significant difference in PDT rates was noted in diabetics, congestive heart failure (CHF), and chronic renal failure (CRF) patients. PDT rates were lower in the lower socioeconomic class (P = .002). Logistic regression found a significant effect of age, hyperlipidemia, hypertension, socioeconomic status, and gender on the rate of PDT, while ischemic heart disease (IHD), diabetes, CHF, CRF, place of birth, and place of residence did not contribute significantly to the model. CONCLUSIONS: Advanced age, hypertension, hyperlipidemia, male gender, and socioeconomic status are risk factors for undergoing PDT for predominantly classic neovascular AMD.

Age Factors↗

PubMed2006

Topical beta-blockers are not associated with an increased risk of treatment for depression.

PURPOSE: To investigate the effect of topical beta-blockers on the prevalence of depression among glaucoma patients. DESIGN: Retrospective observational population-based cohort study. PARTICIPANTS: We reviewed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (Central District of Clalit Health Services) who were older than 20 years (317,469 members). METHODS: We documented all antiglaucoma prescriptions (n = 274,023) and all antidepressant prescriptions (n = 16,948) filled by glaucoma patients in the district between January 1, 2001 and December 31, 2003. We included only those patients who filled at least 6 consecutive antiglaucoma prescriptions at least once every 2 months (n = 6597; 5846 [88.6%] were treated with topical beta-blockers). Depressed patients were defined as patients that filled at least four prescriptions for antidepressants during the study period (n= 810, 12.3% of all glaucoma patients). MAIN OUTCOME MEASURE: Relationship of topical beta-blocker use and prevalence of depression among glaucoma patients. RESULTS: No significant demographic differences were noted between glaucoma patients treated and not treated with topical beta-blockers. Of those treated and not treated with beta-blockers, 12.2% (12.7% after age-adjustment) and 12.7%, respectively, were also receiving drug therapy for depression (P = 0.7, chi-square test). With stratification by age, treatment with topical beta-blockers did not influence the prevalence of depression in any age group. Logistic regression analysis revealed a significant effect of age, place of birth, and gender on the prevalence of depression, but the prevalence of use of topical beta-blockers had no significant effect. CONCLUSIONS: Use of topical beta-blockers by glaucoma patients does not appear to increase the risk of depression in this population.

Administration, Topical↗

PubMed2006

Increased risk for herpetic eye disease in patients with allergic conjunctivitis.

PURPOSE: To evaluate the risk of ocular surface herpetic eye disease (osHED) in allergic eye disease. METHODS: We calculated the risk for osHED in 11,205 patients on antiallergic ocular topical agents compared with 453,069 controls based on filled prescriptions for topical acyclovir between 2001 and 2003. RESULTS: Significantly more allergic patients, of all age groups, received treatment for osHED (p < 0.01). The age and gender adjusted relative risk for allergic patients to suffer an osHED event was 2.31 (95% CI: 1.84-2.90), raising to 3.55 (95% CI: 2.0-6.4) in patients that filled > or = 4 antiallergic prescriptions. CONCLUSIONS: Patients treated for allergic eye disease have an increased risk of osHED.

Acyclovir↗

PubMed2006

Prevalence of methylphenidate use among Israeli children: 1998-2004.

BACKGROUND: Use of methylphenidate for the treatment of attention-deficit hyperactivity disorder (ADHD) has increased throughout the world in the past decade. In Israel, as elsewhere, there is much debate regarding the diagnosis of ADHD and methylphenidate use. The aim of this study was to examine methylphenidate use rates for the treatment of ADHD among children in Israel during the years 1998-2004 with a special focus on prescriptions among girls. STUDY DESIGN AND METHODS: This was a longitudinal population-based prevalence study wherein we reviewed the computerised database of a major health maintenance organisation (HMO). Subjects studied included all children living in the central district of Clalit HMO in Israel who were prescribed methylphenidate in the 7-year period from 1998-2004. MAIN OUTCOME MEASURES AND RESULTS: The overall 1-year prevalence rate of methylphenidate use in children aged 0-18 years increased from 0.7% in 1998 to 2.5% in 2004, an increase by a factor of 3.54 (95% CI 3.31, 3.79). In 1998, the rate of methylphenidate prescription ranged from 0.20% among schoolgirls to 1.2% among boys, a 6-fold difference. In 2004, the rate of methylphenidate prescription ranged from 1.1% among schoolgirls to 3.8% among boys; the sex difference had narrowed to only 3.45. Except for kindergarten girls, methylphenidate utilisation increased for all ages from kindergarten to high school, both among boys and among girls. CONCLUSION: The continuous increasing rate of methylphenidate use in Israel, especially among girls, represents a significant public health issue. There is a need for future research into the relationship between sex and ADHD diagnosis and treatment.

Adolescent↗

PubMed2006

Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?

OBJECTIVES: Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists. METHODS: The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD. RESULTS: 7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02). CONCLUSION: Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.

Adrenergic beta-Antagonists↗

PubMed2006

The role of periodic mortality case review sessions in a primary care teaching clinic.

BACKGROUND: Maintaining a death register and holding staff discussions about patients who died can aid the physician in audit and research, which will lead to improved care of the terminally ill and the bereaved and to the development of prevention strategies. These issues are important for students and residents as well. OBJECTIVES: To review the value of mortality-case discussions in primary care clinics, particularly teaching clinics. METHODS: The clinic death register, instituted in 1998, includes age, gender, cause of death, place of death, relevant illnesses, and support provided to the patient before the death. In the half-yearly sessions, the data are reviewed, and individual cases that had an emotional impact on the staff, or information that can bring about changes in future care are discussed by the clinic staff and trainees. RESULTS: In our clinic 233 deaths occurred during a 6 year period (1998-2003). The crude all-cause mortality rate was 7.1/1000. The median age was 80 years old. Neoplastic causes were slightly more frequent than cardiovascular causes of death. Only 15% died at home; 20% lived alone and 70% lived with a spouse or family members before the death. Topics discussed in the mortality review meetings include identifying pre-suicidal patients, when to hospitalize the sick elderly, dealing with the anger of bereaved families, and ensuring proper home care for terminal patients. CONCLUSIONS: We recommend keeping a death register and conducting mortality review sessions in order to improve the quality of care, emotional support of the staff, and training students and residents about the complex issues surrounding the death of patients.

Adult↗

PubMed2006

[The increase in requests for laboratory tests in the community--are there any effective intervention programs?].

In recent years there is a steady increase in requests for laboratory tests by primary care physicians. This increase does not necessarily have a diagnostic and therapeutic yield. There is a relationship between background characteristics of the family physicians and their utilization of laboratory tests. Various studies have been conducted in order to understand the physician's motives for ordering laboratory tests in attempts to reduce their number. Interventions to reduce laboratory test utilization yield different and sometimes opposing results. We reviewed the literature dealing with laboratory test utilization and interventions to reduce it.

Clinical Laboratory Techniques↗

PubMed2006

[The effects of violence and terrorism on chronic physical illness].

Over the past few years more than a thousand Israeli civilians were murdered and thousands were wounded in recurrent terrorist attacks. Many others had been exposed to the terrorists' attacks, either directly or indirectly. However, the impact of the terror on physical illness had not yet been explored. Stress may cause diseases like hypertension or ischemic heart diseases and may exaggerate asthma, inflammatory bowel diseases and others; this is in addition to posttraumatic disorders, depression and anxiety. This article reviews the influence of stress, and especially conflicts, on chronic physical illness and aims to encourage further research on this subject in Israel.

Chronic Disease↗

PubMed2005

Herpetic eye disease in diabetic patients.

PURPOSE: To study the incidence of herpetic eye disease (HED) of the ocular surface in diabetics. DESIGN: Observational historical cohort study. SETTING: A district of the largest health maintenance organization in Israel (the Central District of Clalit Health Services). PARTICIPANTS: We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus. METHODS: All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event. MAIN OUTCOME MEASURES: Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender. RESULTS: After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21 per thousand) compared with nondiabetics (4.27 per thousand; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency. CONCLUSIONS: Ocular surface HED is significantly more common among patients with diabetes mellitus. Poor glycemic control correlates with increased consumption of ocular acyclovir in diabetic patients.

Acyclovir↗

PubMed2005

Influence of intense multidisciplinary follow-up and orlistat on weight reduction in a primary care setting.

BACKGROUND: Obesity is the most common health problem in developed countries. Recently, several physicians' organizations have issued recommendations for treating obesity to family physicians, including instructions in nutrition, physical activity and medications. The aim of this study was to examine if effective weight-reducing treatment can be given by a family physician. It compares regular treatment with intensive treatment that include close follow-up and orlistat treatment. METHODS: The study was conducted in three primary care clinics. 225 patients were divided into three groups according to their choice. Group A received a personal diet with fortnightly meetings with the family physician and dietitian and orlistat treatment. Group B received a general diet, monthly meetings with the family physician only and orlistat treatment. Group C received a personal diet, monthly meetings with the dietitian only and no drug treatment. The primary endpoint was reduction of at least 5% of the initial weight during the study period. RESULTS: A greater percentage of patients in group A achieved their weight reduction goals than in other groups (51%, 13% and 9% in groups A, B and C, respectively, p < 0.001). There was a significant reduction in triglycerides in all groups, a significant reduction of low density lipids (LDL) in groups A and B and no significant difference in high density lipids (HDL) in any group. CONCLUSIONS: Significant weight reduction was obtained in a family physician setting. Further research is needed to evaluate if, by providing the family physician with the proper tools, similar success can be achieved in more clinics.

Adult↗

PubMed2005

An interactive course to enhance self-efficacy of family practitioners to treat obesity.

BACKGROUND: Physicians' awareness of their important role in defusing the obesity epidemic has increased. However, the number of family practitioners who treat obesity problems continues to be low. Self-efficacy refers to the belief in one's ability to organize and execute the courses of action required to produce given attainments. Thus, practitioners who judge themselves incapable of managing obesity do not even try. We hypothesized that practitioners' self-efficacy and motivation would be enhanced as a result of participating in an interactive course designed to enrich their knowledge of obesity management. METHODS: Twenty-nine family practitioners participated in the course, which was accompanied by qualitative interviews. The difference between the physicians' pre-course and post-course appraisals was tested by paired t-test. The interviews were analyzed by qualitative methods. RESULTS: Post-course efficacy appraisals were significantly higher than pre-course appraisals (p < 0.0005). A deeper insight on the practitioners' self-efficacy processes was gained through reflection of the practitioners on their self-efficacy during the interviews. CONCLUSIONS: Up-to-date information and workshops where skills, attitudes and social support were addressed were important in making the program effective.

Adult↗

PubMed2005

Dry eye in diabetic patients.

PURPOSE: To compare the prevalence of keratoconjunctivitis sicca (KCS) in a prospective cohort of 22,382 diabetic patients with that in the general population. DESIGN: Prospective, observational, cohort study. METHODS SETTING: A district of israel's largest health maintenance organization. STUDY POPULATION: We followed the electronic medical records of all patients in the district older than 50 years (159,634 patients) between January 1 and December 31, 2003. Of those, 22,382 (14.0%) had diabetes. OBSERVATION PROCEDURE: The proportion of ocular lubrication consumers was compared among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tests), and glycemic control was correlated with the consumption of ocular lubrication. MAIN OUTCOME MEASURES: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and ocular lubrication use. RESULTS: After age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, compared with nondiabetic patients (13.8%, P < .001). The difference was significant for all age groups and for both sexes (P < .001). A similar significant difference was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. Ocular lubrication consumption increased with poorer glycemic control (mean annual HbA1c levels). Multivariate analysis revealed this effect to be independent of age, sex, place of birth, or place of residence. CONCLUSIONS: KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients.

Aged↗

PubMed2005

The effect of combination pharmacotherapy on the prescription trends of glaucoma medications.

PURPOSE: To describe prescription trends within a managed care setting for glaucoma medications and to examine the effect of introduction of Cosopt--a fixed combination of dorzolamide and timolol. PATIENTS AND METHODS: All prescriptions dispensed to any of the 470,350 members of an Israeli health maintenance organization were monthly scanned for patients treated for glaucoma, between January 2000 and May 2003. The monthly mean number of glaucoma patients was 3899 +/- 104 (mean +/- SD). All topical glaucoma prescriptions were documented, and the monthly prescription rate of each medication was calculated and plotted. The monitored glaucoma medications were: beta-adrenergic antagonists, dorzolamide, latanoprost, pilocarpine, brimonidine, Cosopt, and others. RESULTS: beta-adrenergic antagonists were the top prescribing drug (>35% of all glaucoma prescriptions). The prescription rates of pilocarpine and beta-adrenergic antagonists were in constant decline, while latanoprost and brimonidine increased steadily. The introduction of Cosopt changed the prescription trends of dorzolamide from increasing to rapidly decreasing, and accelerated the long-term decline of beta-adrenergic antagonists. Concomitant with the introduction of Cosopt the prescription rate of beta-adrenergic antagonists temporarily increased. This was due to a total increase in glaucoma prescriptions. When Cosopt was introduced, 37.5% of patients were prescribed Cosopt together with beta-adrenergic antagonists, and 16.5% also received dorzolamide. Thereafter the co-prescription decreased steadily. CONCLUSIONS: Introduction of a combination drug should be accompanied by physicians', pharmacists', and patients' education to prevent its inappropriate usage together with its components.

Antihypertensive Agents↗

PubMed2005

Linkage between the Israeli Defense Forces primary care physician demographics and usage of secondary medical services and laboratory tests.

BACKGROUND: The primary care physicians in the Israeli Defense Forces, as in the Israeli civilian health system, have two major subpopulations. Graduates of Israeli schools of medicine, and graduates of foreign medical schools, most of them in Eastern Europe. OBJECTIVE: To evaluate differences in the referral patterns of primary care physicians according to their graduation institution and demographic characteristics. METHODS: The study took place in one primary care practice in central Israel. The referrals to consultations and laboratory tests over a period of 1 year were evaluated. Physicians that had less than 37 encounters were excluded from the study. Data were extracted from the central computerized databases of the Medical Corps and Israeli Defense Forces. RESULTS: Sixty-eight physicians had a total of 18,402 encounters that resulted in 23,845 outcomes. There were no associations between demographic and training backgrounds of the physicians and their actual referral rates to consultations and laboratory tests. CONCLUSION: The background data of the primary care physicians does not predict their referral patterns and their role as "gate keepers".

Adolescent↗

PubMed2005

The role of primary care physicians in the Israel Defense Forces: a self-perception study.

BACKGROUND: The health system of the medical corps of the Israel Defense Force is based primarily upon primary healthcare. In recent years, health management organizations have considered the primary care physician responsible for assessing the overall health needs of the patient and, accordingly, introduced the term "gatekeeper." OBJECTIVES: To describe and analyze how PCPs in the IDF view their roles as primary care providers and to characterize how they perceive the quality of the medical care that they provide. METHODS: We conducted a survey using a questionnaire that was mailed or faxed to a representative sample of PCPs. The questionnaire included demographic background, professional background, statements on self-perception issues, and ranking of roles as a PCP in the IDF. RESULTS: Statements concerning commitment to the patient were ranked higher than statements concerning commitment to the military organization. Most physicians perceive the quality of the medical care service that they provide as high; they also stated that they do not receive adequate continuous medical education. CONCLUSIONS: Our survey shows that PCPs in the IDF, like civilian family physicians, perceive their primary obligation as serving the needs of their patients but are yet to take on the full role of "gatekeepers" in the IDF's healthcare system. We conclude that the Medical Corps should implement appropriate steps to ensure that PCPs are prepared to take on a more prominent role as "gatekeepers" and providers of high quality primary medical care.

Adult↗

PubMed2005

[Lag Ba-Omer bonfires--is there any association between the tradition and asthma and COPD exacerbations].

BACKGROUND: Air pollution is a potential cause of asthma and COPD exacerbations. On the evening of Lag Ba-Omer, when there were bonfire parties throughout the country, significant air pollution was reported. OBJECTIVES: To evaluate the association of the air pollution caused by Lag Ba-Omer bonfires party (8th May 2004) and asthma and COPD exacerbations in the Rehovot area. METHODS: Data on air quality and pollution levels was retrieved from the monitoring system of the Ministry of the Environment for the period of Lag Ba-Omer (May 2004). All visits to the Kaplan Medical Center Emergency Department, local after-hours first aid clinics and hospital admissions in May 2004 were evaluated. The daily rate of visits and admissions with the diagnosis of asthma or COPD exacerbation was recorded. RESULTS: Data from the Rehovot monitoring station revealed worsening in the air pollution indices in the two days after Lag Ba-Omer. On the same days of the week, a week earlier and a week later, the air quality was good. There was no increase in asthma or COPD visits to after-hours first aid clinics and no increase in hospitalizations. An increase in the rate of visits due to asthma and COPD to the emergency department was noted in the days after Lag Ba-Omer in comparison to the control days (15/277 (5.4%) vs. 14/593 (2.4%), p < 0.05). CONCLUSION: There was an increase in emergency department visits due to asthma and COPD without an increase in hospital admissions in the days of air pollution after Lag Ba-Omer. Further studies should focus on a possible increase in self medication and family physician visits in the period around Lag Ba-Omer.

Air Pollution↗

PubMed2005

[Intervention project to improve control of hypertension among diabetic patients--experience in a primary care clinic].

BACKGROUND: Hypertension in diabetics is a recognised risk factor for vascular disease, both of large and small vessels. Tight control of blood pressure (BP), aiming at 130/80, reduces both morbidity and mortality from vascular disease. OBJECTIVE: Tight control of BP in diabetics aiming at 130/80. TARGET POPULATION: Type 2 diabetics with BP over 130/80, whether undergoing treatment or not, in the Shoham primary care clinic. METHODS: Patients meeting the above criteria were identified by scanning their files. Their compliance to treatment and dose adjustment was followed. Preferred first line drugs were ACE inhibitors and diuretics. RESULTS: A total of 91 of the 115 (79%) diabetics were identified as also being hypertensive. The objective of BP 130/80 or less was achieved in 26% of cases at the beginning of the research and in 53% after 6 months (p<0.001). Prior to the intervention, the average BP in the hypertensives was 142.1+/-17.6/80.6+/-8.3 and they were being treated with an average of 1.5+/-1.2 drugs. Twenty-one patients (23%) were receiving no drug treatment. After 6 months the average BP in these patients was 132.2+/-14.2/77.6+/-6.1 and they were being treated with an average of 2.0+/-1.2 drugs. Six (6.5%) patients were without drug treatment. The average diastolic and systolic pressure was significantly lower after the intervention (p<0.001 and p=0.001 respectively) and more anti-hypertensive drugs were being used (p=0.001) CONCLUSION: Through good clinical team co-operation it is possible to successfully treat hypertension in diabetics. It is important to implement the guidelines of treating hypertensive diabetics.

Aged↗

PubMed2005

Acute respiratory infections: can a non-physician practitioner triage and treat patients by using an algorithm? Experience in a military primary care clinic.

BACKGROUND: Acute respiratory viral infections are minor self-limited diseases. Studies have shown that patients with ARVI can be treated as effectively by non-physician practitioners as by physicians. OBJECTIVES: To examine whether a military medic, using a structured questionnaire and an algorithm, can appropriately triage patients to receive over-the-counter medications and refer more complicated cases to a physician. METHODS: The study group comprised 190 consecutive soldiers who presented to a military primary care clinic with symptoms of ARVI. Using a questionnaire, a medic recorded the patient's history and measured oral temperature, pulse rate and blood pressure. All patients were referred to a doctor. Physicians were "blind" to the medic's anamnesis and to the algorithm diagnosis. We compared the medic's anamnesis and therapeutic decisions with those of the doctors. RESULTS: Patients were young (21.1 +/- 3.7 years) and generally healthy (93% without background illness). They usually had a minor disease (64% without fever) that was mostly diagnosed as viral ARVI (83% of cases). Ninety-nine percent were also examined by a physician. According to the patients' data, the medics showed high overall agreement with the doctors (83-97.9%). The proposed algorithm could have saved 37% of referrals to physicians, with a sensitivity of 95.2%. Had the medics been allowed to examine the pharynx for an exudate, the sensitivity might have been 97.6%. CONCLUSIONS: Medics, equipped with a questionnaire and algorithm but without special training and without performing a physical examination, can appropriately triage patients and thereby reduce the number of referrals to physicians.

Acute Disease↗