Yaron Bar-Dayan

Angiogenesis in pterygium: Morphometric and immunohistochemical study

Objective. To evaluate the role of angiogenesis in the pathogenesis of pterygium by comparing the expression of von-Willebrand factor (vWF) and vascular endothelial growth factor (VEGF) in pterygium, and in normal superior bulbar conjunctiva. Methods. 23 human samples from pterygium and the superior bulbar conjunctiva were stained using rabbit anti-vWF and anti-VEGF antibodies. The density of vWF and VEGF positive vessels, VEGF staining intensity and the number of VEGF positive stromal, epithelial and vascular endothelial cells were evaluated. Results. Pterygium specimens had higher average vWF and VEGF positive microvascular counts per high power field (P = 0.0012), higher average VEGF staining intensity scores in epithelial, stromal and endothelial cells (p < 0.0001) and higher VEGF positive cell counts (P < 0.0001) than normal conjuctiva. Conclusions. Over-expression of VEGF in pterygium tissue, together with the abundance of vWF-stained new vessels, may support previous suggestions that angiogenesis may play a role in the formation of pterygium.

Assessing levels of hospital emergency preparedness

INTRODUCTION Emergency preparedness can be defined by the preparedness pyramid, which identifies planning, infrastructure, knowledge and capabilities, and training as the major components of maintaining a high level of preparedness. The aim of this article is to review the characteristics of contingency plans for mass-casualty incidents (MCIs) and models for assessing the emergency preparedness of hospitals. CHARACTERISTICS OF CONTINGENCY PLANS Emergency preparedness should focus on community preparedness, a personnel augmentation plan, and communications and public policies for funding the emergency preparedness. The capability to cope with a MCI serves as a basis for preparedness for non-conventional events. Coping with chemical casualties necessitates decontamination of casualties, treating victims with acute stress reactions, expanding surge capacities of hospitals, and integrating knowledge through drills. Risk communication also is important. ASSESSMENT OF EMERGENCY PREPAREDNESS An annual assessment of the emergency plan is required in order to assure emergency preparedness. Preparedness assessments should include: (1) elements of disaster planning; (2) emergency coordination; (3) communication; (4) training; (5) expansion of hospital surge capacity; (6) personnel; (7) availability of equipment; (8) stockpiles of medical supplies; and (9) expansion of laboratory capacities. The assessment program must be based on valid criteria that are measurable, reliable, and enable conclusions to be drawn. There are several assessment tools that can be used, including surveys, parameters, capabilities evaluation, and self-assessment tools. SUMMARY Healthcare systems are required to prepare an effective response model to cope with MCIs. Planning should be envisioned as a process rather than a production of a tangible product. Assuring emergency preparedness requires a structured methodology that will enable an objective assessment of the level of readiness.

Response of Thai hospitals to the tsunami disaster.

The disaster caused by the Tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters. The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients. Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims. Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed. Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system.

Seizures as a presenting symptom of phaeochromocytoma in a young soldier

New onset of seizures in young adults is frequently related to alcohol withdrawal, toxic exposure, central nervous system trauma and neoplasm. We describe a young soldier presenting to the emergency department with seizures and transient coma. On admission, he had hypertension, marked leukocytosis, hyper-glycaemia, acidosis, elevated creatinine and elevated creatine phosphokinase of muscle origin. A thorough work-up revealed elevated urinary catecholamines, and a left adrenal mass was found on MRI and MIBG scan. The patient underwent laparoscopic adrenalectomy and completely recovered. This is the first description of seizures as a presenting symptom of phaeochromo-cytoma.

The relationship between demographic/educational parameters and perceptions, knowledge and earthquake mitigation in Israel

Perceptions, knowledge and mitigation are factors that might play a role in preventing injury and loss of life during a major earthquake.(2) Little is known about the relationships between different demographic and educational parameters and these factors. A national representative sample of 495 adults was investigated in order to determine the relationship between demographic and educational parameters in terms of the perceived threat, perceived coping, knowledge and mitigation of earthquakes in Israel. Compared to females, males perceived the threat of earthquakes to be lower (t = 3.183, p = 0.002), manifested higher levels of perceived coping (t = 2.55, p = 0.011), and had higher levels of earthquake related knowledge (t = 2.047, p = 0.041). We conclude that there are gender differences in perceptions and knowledge regarding earthquakes.

Integrating epidemiological and engineering approaches in the assessment of human casualties in earthquakes

Earthquakes pose substantial risks of human health. Preparedness and mitigation strategies can reduce earthquake-related injuries and deaths and information from casualty models that predict earthquake outcomes can help communities prepare. This study identifies epidemiologic and medical risk factors for earthquake casualties, and compares them with engineering casualty models for the purpose of providing evidence that integrates these approaches. It aims to improve earthquake casualty modeling and to offer better accurate estimations. Epidemiological studies that used analytical designs and reported risk factors related to earthquake-induced casualties and studies that examined the association between medical preparedness and earthquake-induced casualties were reviewed. Engineering casualty estimation models were reviewed to identify which risk factors were considered in the models. Epidemiological studies identified the following risk factors: gender, age, socioeconomic status, physical disability and human behavior. Medical preparedness factors were also related to earthquake-induced injury and death. Global casualty estimation models do not currently consider these factors. This study provides evidence that integrating demographic and socioeconomic characteristics of the population and levels of medical preparedness into the existing casualty estimation models may improve their accuracy.

Disaster Healthcare System Management and Crisis Intervention Leadership in Thailand–Lessons Learned from the 2004 Tsunami Disaster

INTRODUCTION Quarantelli established criteria for evaluating the effectiveness of disaster management. OBJECTIVES The objectives of this study were to analyze the response of the healthcare system to the Tsunami disaster according to the Quarantelli principles, and to validate these principles in a scenario of a disaster due to natural hazards. METHODS The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research team to study the response of the Thai medical system to the disaster. The analysis of the disaster management was based on Quarantellis 10 criteria for evaluating the management of community disasters. Data were collected through personal and group interviews. RESULTS The three most important elements for effective disaster management were: (1) the flow of information; (2) overall coordination; and (3) leadership. Although pre-event preparedness was for different and smaller scenarios, medical teams repeatedly reported a better performance in hospitals that recently conducted drills. CONCLUSIONS In order to increase effectiveness, disaster management response should focus on: (1) the flow of information; (2) overall coordination; and (3) leadership.

Preparedness for anthrax attack: the effect of knowledge on the willingness to treat patients

Little is known about the factors that may impact on the willingness of physicians and nurses to treat patients during a bioterrorism attack. This survey was conducted among 76 randomly selected nurses and physicians in the emergency rooms of three public hospitals in order to analyse the relationship between knowledge, profession and the willingness to treat anthrax. The study finds that the willingness of physicians and nurses to come to work is 50% greater among the group with the highest knowledge about anthrax (P < 0.0001). Within that group, the willingness to treat patients suspected of being infected with anthrax was 37% greater (P < 0.0001) and the willingness to treat patients diagnosed with anthrax was 28% greater (P = 0.004) than in the other groups. These results imply that enhancement of knowledge among health care workers may improve their willingness to come to work and treat patients infected with anthrax during a bioterrorism attack.

Relationship Between Standards of Procedures for Pandemic Flu and Level of Hospital Performance in Simulated Drills

STUDY OBJECTIVE Standard operating procedures are the basis of a consistent response to varied threats. The aim of this study is to investigate the relationship between the quality of standard operating procedures developed by hospitals for the management of a pandemic influenza outbreak and the level of performance in a H5N1 flu drill. METHODS Standard operating procedures developed by all general hospitals in Israel for the management of pandemic influenza were evaluated with a tool developed for this purpose. The hospital standard operating procedure score was then compared with the score obtained by the hospital in a simulated drill. RESULTS Cronbachs alpha was used to determine the reliability of the standard operating procedure evaluation scores and the scores obtained on the drill. Reliability of both scores was high (>0.70). Hospital standard operating procedure scores were found to be moderately related to the scores obtained on the simulated drill. An important relationship was found between performance on the drill and the following components of the standard operating procedure: protection of staff and patients, staffing coordination and control, and infrastructure maintenance and minimizing overload. Hospital characteristics were not found to be important in determining either the hospital standard operating procedure score or performance on the simulated drill. CONCLUSION A reasonably strong relationship was found between quality of the standard operating procedures developed by hospitals to deal with a pandemic influenza and performance on a pandemic drill. Components of the standard operating procedure that dealt with areas that were relatively unfamiliar to staff or topics that were perceived by personnel as posing a risk to their well-being were found to be more important. The quality of the standard operating procedures was found to be important in relation to performance in a pandemic flu drill; therefore, we suggest investing effort in developing standard operating procedures that are comprehensive and cover relatively new domains in detail.

The effect of different educational interventions on schoolchildren's knowledge of earthquake protective behaviour in Israel

Knowledge of appropriate behaviour during an earthquake is crucial for prevention of injury and loss of life. The Israeli Home Front Command conducts a yearly earthquake education programme in all Israeli schools, using three types of educational interventions: lectures, drills and a combination of the two. The aim of this study was to evaluate the effectiveness of these interventions in providing students with knowledge. We distributed a questionnaire to 2,648 children from the 5th and 6th grades in 120 schools nationwide. Knowledge scores for both 5th and 6th grades were increased, regardless of type of intervention, compared to the non-exposure group. A combined intervention of lectures and drills resulted in the highest knowledge scores. Our findings suggest that for the age group studied a combination of lectures and drills will likely prepare students best for how to behave in the event of an earthquake.