[The Evolution of Medical Practice].

The Evolution of Medical Practice: Book Review.

Perioperative Cannabis Use in Bariatric Patients: A Review of Outcomes and Proposed Clinical Pathway for Management.

Legalization of marijuana has led to increased prevalence of medical and recreational cannabis use, underscoring the importance for anesthesiologists, surgeons, and perioperative physicians to understand the effects of this drug in patient care. Bariatric surgical patients represent a unique target population to understand peri-operative cannabis use and its effects as these patients undergo an extensive preoperative psychological and nutritional evaluation. Standardized guidelines on cannabis use in bariatric surgery are lacking and many clinicians remain uncertain on how to handle cannabis use in the peri-operative period.

Echinococcal Cyst Rupture in a 3-Year-Old Boy With a Minor Abdominal Trauma Identified by a Point-of-Care Ultrasound E-Fast Examination: A Case Report and Literature Review.

Point-of-care ultrasound is now widely used in adult and pediatric emergency departments as part of the rapid evaluation and treatment of patients in urgent care settings. It has been shown to be a powerful tool to aid in decision making in both trauma and acute medical situations. We describe a case of a 3-year-old boy who presented with abdominal pain and fever after a minor abdominal trauma, highlighting the use of point-of-care ultrasound to arrive at the diagnosis of a ruptured echinococcal cyst.

Fetal brain volumes and neurodevelopmental outcome of intrauterine growth restricted fetuses.

Objective: This study aims to investigate the correlation of MRI measured fetal brain volumetrics with long-term neurodevelopmental outcome, among intrauterine growth restricted (IUGR) and apparently healthy fetuses.

Study Design: A historical cohort study at a single tertiary referral medical center during 6 years period, of fetuses diagnosed with IUGR due to placental insufficiency, and apparently healthy fetuses, who had fetal brain MRI scan. The volumes of the supratentorial brain region, both hemispheres and the cerebellum were measured by 3D MRI semi-automated volume measurements.

Twin discordance: a study of volumetric fetal brain MRI and neurodevelopmental outcome.

Objective: This study employed magnetic resonance imaging (MRI) to compare brain volumes of discordant twins and examined their neurodevelopment after birth by using a validated exam.

Study Design: A prospective historical cohort study of discordant dichorionic diamniotic (DCDA) or monochorionic diamniotic (MCDA) twin fetuses, who undergone an MRI scan to evaluate growth restriction in the discordant twin (weight < 10 centile) during 6 years period, at a single tertiary center. Twenty-seven twin pairs were included in the volumetric study and 17 pairs were included in the neurodevelopmental outcome examination.

[THE TIME HAS COME! COMPLEMENTARY MEDICINE IN MEDICAL TRAINING IN ISRAEL].

The use of complementary and alternative medicine (CAM) has become increasingly popular in most Western countries. As a result, safety-related issues associated with these practices have become more apparent, including adverse effects and negative interactions with conventional medical therapies. The potential dangers associated with CAM are further exacerbated by the absence of high-quality clinical research on the subject; a lack of a basic understanding of the principles of CAM among physicians; and a reluctance of patients to disclose their use of CAM, including those modalities being used in parallel with conventional medical treatments.

No-shows in ambulatory clinics and non-utilized appointments for elective operations in selected surgical departments at a tertiary hospital in Israel.

Background: The phenomenon of a patient missing a medical appointment without notification is called a "no-show". In contrast, "non-utilized appointments" are a broader phenomenon including all appointments that didn't occur as registered - whether due to actions taken by providers or patients. Both no-shows and non-utilized appointments can lead to reduced quality of care, loss in productivity, financial losses and impaired patient outcomes.

Ethnic-based separation in maternity Departments in Israel - a balanced practical view.

Ethnic-based separation in public hospitals in Israel is a sensitive issue that was recently brought forward by the media and was recently discussed in the Israel Journal of Health Policy Research.The above paper maintains that ethnic separation in inpatient rooms does take place some of the time and this runs contrary to the ethos of neutrality in medicine. The authors recommend implementing a national policy that prohibits ethnic-based separation in hospital inpatient rooms.

Emergency with Resiliency Equals Efficiency - Challenges of an EMT-3 in Nepal.

The 7.8 MW (moment magnitude scale) earthquake that hit Nepal on April 25, 2015 caused significant casualties and serious damage to infrastructure.The Israeli Emergency Medical Team (IEMT; later verified as EMT-3) was deployed 80 hours after the earthquake.

Pulmonary Embolism for the Cardiologist: Emphasis on Diagnosis.

Purpose Of Review: Pulmonary embolism (PE) is a common condition with high morbidity and mortality particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting similarly to other cardiovascular conditions. The aim of this review is to summarize the clinical presentation, diagnostic algorithms, and imaging studies utilized to efficiently make or exclude the diagnosis of pulmonary embolism.

[Promoting research in a medical center--the management narrative].

Promoting research within a medical institute is a delicate balance between the importance of facilitating academia and maximizing resources towards the primary goal of a hospital--healing sick people. Shaare Zedek Medical Center have successfully adopted a "niche" approach to research in which the hospital invests in selected talented clinicians-scientists rather than futile expectation that all clinicians would be engaged in high impact research. Moreover, these research excellence centers are developing into a driving force to also foster research endeavors of other clinicians and residents in the hospital.

The use of adenosine in the treatment of a high-flow vein of Galen malformation in an adult.

The treatment of high-flow vein of Galen aneurysmal malformations (VGAM) remains a therapeutic challenge for the neurosurgeon and the neurointerventionalist, as it is associated with high morbidity and mortality rates despite recent advances in open cranial surgery and interventional neuroradiology. A 37-year-old patient presented with a history of non-specific headaches. He had a history of heart failure since birth that was caused by an untreated VGAM.

[Complementary and alternative medicine--time for research and regulation].

The usage of complementary and alternative medicine [CAM] is increasing in popularity in the modern world. In this issue of Harefuah, seven articles relate to various aspects of CAM: the use of various modalities of CAM in four community clinics in Northern Israel, an assessment of the needs and expectations of patients on chemotherapy from the integration of CAM in palliative oncological care, a description of a series of quality research studies relating to CAM in hemato-oncological disorders and autoimmune diseases and a discussion of ethical dilemmas and issues relating to Jewish law. Other authors review the history of clinical studies with an emphasis on mind-body connection and the placebo effect.

International medical evacuation in children: a primary care pediatric clinic's 3-year experience.

Background: The decision whether to immediately evacuate children who have become ill is a challenge for pediatricians working in countries with limited medical resources. The aim of this study is to describe the injuries and diseases that required evacuation of children from our clinics in Ho Chi Minh City and Hanoi to tertiary critical care hospitals over a 3-yr period.

Methods: A retrospective chart review was performed of all patients aged less than 17 yr who underwent an international medical evacuation between April 1, 2006, and February 28, 2009.

Public and private patients in Jerusalem hospitals: who operates on whom?

Background: Debate continues in Israel as to whether to allow patients in public hospitals to choose their physician in return for an additional, out-of-pocket payment. One argument against this arrangement is that the most senior physicians will devote most of their time to private patients and not be sufficiently available to public patients with complex cases.

Objectives: To analyze the patterns of surgical seniority in Jerusalem hospitals from a number of perspectives, including the extent to which: a) opting for private care increases the likelihood of being treated by a very senior surgeon; b) public patients undergoing complex operations are being treated by very senior surgeons, c) the most senior surgeons allocate a significant portion of their time to private patients.

[Patient satisfaction and hospital services evaluation: comparison of and private patients].

"Sharap" is a private medical service integrated within our public clinic and hospital services. Clients may choose their physician by paying a fee in addition to what their health insurance agency (Kupat Holim) pays for. All other hospital services are supplied to all patients alike.

A pregnant woman with hepatitis A and Guillain-Barré.

Guillain-Barré syndrome (GBS) is often preceded by an infectious disease. A case of GBS after hepatitis A in a pregnant woman is described. The patient was treated with intravenous immunoglobulin and had full recovery with no neurologic sequelae.

Infective endocarditis associated with upper endoscopy: case report and review.

We describe a 73-year-old male who developed native valve infective endocarditis due to Staphylococcus capitis as a consequence of repeated oesophageal dilatation. The patient was treated with appropriate antibiotic therapy but his condition deteriorated and he died. We review 10 previously reported cases of infective endocarditis associated with upper endoscopy and discuss the issue of prophylaxis of high risk patients prior to upper endoscopy involving various invasive procedures, e.

Lipoamide dehydrogenase deficiency: a newly discovered cause of acute hepatitis in adults.

Lipoamide dehydrogenase deficiency is a rare disease, manifested in early childhood by lactic acidemia, progressive neurological damage and death in most cases. We report a case of lipoamide dehydrogenase deficiency in a 34-year-old Ashkenazi-Jewish woman. The deficiency manifested as acute hepatitis without cognitive impairment or acidosis.

A genogram with an attitude.

The approach described in this paper is predicated on the fundamental belief that in order to become competent and ethical practitioners, students must understand themselves and how they see others. They must be given tools and skills that facilitate examination of their own assumptions and beliefs about themselves, others, and how the world works. It is also essential that students examine how these assumptions and beliefs will influence the way they choose to conduct therapy.