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Biomedical subjects

Z Stern

Publications and source records attributed to Z Stern.

47 records · Page 3Linked to original sources
PubMed1978

Ambulatory ECG monitoring and bicycle ergometry: correlation with findings on coronary arteriography.

Ambulatory ECG monitoring during everyday activities (AEM) and a multistage submaximal bicycle ergometric test (BET) was performed on a series of 48 patients suffering from precordial symptoms or pain. The results of these tests were compared with the results of coronary arteriography. In 20 subjects with a negative AEM and BET the coronary arteriography was normal in 18, moderately pathological (30-60% narrowing) in 1, and severely pathological (greater than 60% narrowing) in another. In 23 subjects in whom both AEM and BET disclosed ST-T alterations, 20 had severely pathological and 1 moderately pathological coronary arteriograms; normal coronary arteries were found in only 2 subjects. Only 5 of the total of 48 patients of the series showed a discrepancy between the results of AEM and BET. The findings on coronary arteriography confirmed that patients with a normal AEM and BET have a very high probability of having normal coronary arteries, while if both tests are positive the patient will most likely have advanced coronary pathology. When the two tests were concordant, the number of false positive and false negative results were slightly less than if ergometry was performed alone. Although AEM does not provide the quantitative aspect of effort testing, it does have the advantage of avoiding the risk of unusual physical effort for the patient.

Activities of Daily Living↗
PubMed1975

Diagnostic accuracy of ambulatory ECG monitoring in ischemic heart disease.

Fifty patients with precordial pain were evaluated by 24 hour ambulatory ECG monitoring during normal everyday activities, and by coronary arteriography. The monitoring was regarded as positive if deviation of the ST segment of 1 mm or more from the resting pattern was observed, or if major T wave inversion occurred. Comparison of the results of the two tests showed a good correlation. Among the 32 patients with positive abnormalities on ECG monitoring, 28 had severe coronary disease (greater than 60% obstruction). Among the 18 patients with negative monitoring, only three had severe coronary disease. All seven patients with major T inversion had significant coronary obstruction. The type of chest pain and the resting ECG were less indicative of coronary pathology. The good correlation demonstrated between the ambulatory ECG monitoring and coronary arteriograms validates the monitoring as a reliable tool for uncovering latent ischemic heart disease (IHD) and for evaluation of patients with established IHD.

Adult↗
PubMedDate not supplied

Report of a continuous quality improvement program in a tertiary-care medical center.

OBJECTIVE/DESIGN: Changes in the health system in Israel have led to an increasingly competitive environment, decentralization, and economic constraints. We evaluated the use of a continuous quality improvement (CQI) program. SETTING: Three medical departments and three administrative wings in a 700-bed, tertiary-care, teaching hospital in Jerusalem. INTERVENTION: The program was planned as a short-term pilot project for long-term extension throughout the institution. The objectives were improved institutional efficiency and provision for change. The program was implemented through departmental improvement teams under a hospital management team and a steering committee, guided by an outside consultant firm. RESULTS: The Orthopedics Department experienced a 3-day reduction in patient length of stay (P<.008). The Emergency Room experienced a significant reduction in time to discharge through reduced waiting times for consulting physicians (P<.007) and for blood tests (P<.001). The Office of Patient Admissions streamlined procedures for admission and discharge, accomplished physical restructuring, and installed a telephone hot line. In Medical Records, a significant improvement in records availability was realized. In Outpatient Clinics, reductions in waiting times were realized, but were not statistically significant. The Supply Division showed savings on monthly orders and increased efficiency, with 95% of orders completed promptly and accurately. CONCLUSIONS: Several factors were identified as essential to the success of the program, including staff cooperation and commitment. We conclude that the CQI program was a useful tool to help our tertiary-care medical center adjust to changes in the Israeli healthcare system. It also served as a valid vehicle for maintaining and furthering optimal quality of care.

Emergency Service, Hospital↗
PubMedDate not supplied

A methodology model for quality management in a general hospital.

A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

Hospitals, General↗
PubMedDate not supplied

Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay.

OBJECTIVE: An evaluation of the impact of a social work preadmission program on length of stay (LOS) of orthopedic patients undergoing elective total hip or total knee replacement surgeries (under diagnosis-related groups [DRGs]) at the Hadassah Ein-Kerem Hospital in Jerusalem is Israel. INTERVENTION: The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning, coordination of nursing and physiotherapy evaluations, ensuring completion of all medical tests prior to admission, and additional psychosocial follow-up during hospitalization to carry out the original discharge plan or prepare alternatives. PATIENTS: The intervention patients were divided into two groups in order to see changes over time: May through December 1994 (n = 48), and January through December 1995 (n = 81). The comparison groups included patients operated on at the same hospital during 1993 (n = 51) and during January through April 1994 (n = 21) and at the Hadassah Mount Scopus Hospital during the same time periods. Patients in the comparison groups received usual social work intervention, as necessary, only after hospitalization. RESULTS: Mean LOS was reduced significantly in the intervention patient groups, as compared to the preintervention patient groups in the same hospital, from 14.2 days (standard deviation [SD], 4.7) in 1993 and 14.7 (SD, 5.1) in January through April 1994 to 10.9 (SD, 3.0) in May through December 1994 and to 9.1 (SD, 2.8) in 1995 (P < .01). Length of stay also was reduced in the comparison hospital, but by 1995 was longer than in the intervention patients. No differences in LOS by gender, age, or marital status were found. Length of stay was significantly longer for those undergoing total hip replacement as compared to those undergoing total knee replacement in all the groups. CONCLUSIONS: Preadmission screening and case management by a social worker can contribute to the efforts to decrease LOS of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.

Aged↗
PubMedDate not supplied

Surgical treatment of a solitary giant hemangioma of the liver presenting as an avascular mass.

A clinically silent giant hepatic hemangioma was diagnosed following, and as a result of, minor trauma. Liver scan, arteriography and liver biopsy were suggestive of an avascular mass, but laparotomy established that the tumor was a hemangioma. Surgical treatment and complete recovery followed. These benign primary hepatic tumors are usually discovered incidentially. Their presentation and management are discussed.

Adult↗