Yosefa Bar-Dayan

Ocular parameters as an objective tool for the assessment of truck drivers fatigue

Ocular parameters are influenced by sleep derivation and the use of chemical substances which are two major causes for traffic accidents. We assessed the use of these parameters as an objective screening tool for a drivers fitness for duty. Pupillary diameter, pupil reaction to light and saccadic velocity were measured in 29 army truck drivers every morning for two months and compared to baseline measurements taken while the subjects were alert. An index which expressed the difference between study and baseline measurements was calculated, and drivers with significant deviation from baseline were disqualified and interviewed. Non-disqualified drivers served as controls. Twenty-nine percent of disqualified drivers reported sleeping less than the minimum of 7h required by army regulations compared with 8% of control drivers (p=0.01). Disqualified drivers had worse sleep quality the night before the test (Groningen Sleep Quality Scale, p=0.03) and incurred more accidents per driving day during their service (0.023 vs. 0.015 accidents/day, p=0.03). Two disqualified drivers admitted to using alcohol or sleeping pills. Thus, these ocular parameters may serve as a screening tool for drivers that are at high risk for driving. Drivers who were disqualified even once, tend to be involved in more motor vehicle accidents than their peers.

Using electronic health records to save money

OBJECTIVES Health information technology, especially electronic health records (EHRs), can be used to improve the efficiency and effectiveness of healthcare providers. This study assessed the cost-savings of incorporating a list of preferred specialty care providers into the EHRs used by all primary care physicians (PCPs), accompanied by a comprehensive implementation plan. METHODS On January 1, 2005, all specialty clinic providers at the Israeli Defense Forces were divided into one of four financial classes based on their charges, class 1, the least expensive, being the most preferred, followed by classes 2-4. This list was incorporated into the EHRs used by all PCPs in primary care clinics. PCPs received comprehensive training. Target referral goals were determined for each class and measured for 4 years, together with the total cost of all specialist visits in the first year compared to the following years. Quality assessment (QA) scores were used as a measure of the programs effect on the quality of patient care. RESULTS During 2005-2008, a marginally significant decline in referrals to class 1 was observed (r=-0.254, p=0.078), however a significant increase in referral rates to class 2 was observed (r=0.957, p=0.042), concurrent with a decrease in referral rates to classes 3 and 4 (r=-0.312, p=0.024). An inverse correlation was observed between year and total costs for all visits to specialists (2008 prices; r=-0.96, p=0.04), and between the mean cost of one specialist visit over the 4 years, indicating a significant reduction in real costs (2008 prices; r=-0.995, p=0.005). QA was not affected by these changes (r=0.94, p=0.016). CONCLUSIONS From a policy perspective, our data suggest that EHR can facilitate effective utilization of healthcare providers and decrease costs.

Weight disorders and associated morbidity among young adults in Israel 1990–2003

Background:  The aim of this study was to evaluate the change in prevalence of weight disorders and associated morbidity among young adults.

Back disorders among Israeli youth: a prevalence study in young military recruits

BACKGROUND CONTEXT Back problems are reported with increasing frequency in adults and adolescents. Most information is from self-reported questionnaires or studies with small sample sizes. Reports were usually focused on specific diseases and biased toward overdiagnosis. PURPOSE To assess the prevalence of common back disorders among a large cohort of 17-year-old males and females recruited by the Israel Defense Forces (IDF). STUDY DESIGN A retrospective cross-sectional prevalence study. PATIENT SAMPLE Seventeen-year-old Israeli male and female military recruits reporting as directed by the IDF for preinduction medical examination between January 01, 1998 and December 31, 2006. OUTCOME MEASURES Military functional limitation Grades 1 to 7 per diagnosis category. METHODS Military recruits were examined and classified based on medical and orthopedic diagnoses. They were referred for orthopedic consultation as necessary. Four orthopedic classifications were used: spinal deformity (including kyphosis and scoliosis), back pain (including neck and radicular syndromes), spondylolysis/olisthesis, and limitations resulting from trauma or spinal surgery. Data were coded into a central database, and descriptive statistics are presented. RESULTS The overall prevalence of back disorders among 828,171 17-year-old military recruits (61.5% male) was 16.8%. Back disorders resulting in significant functional limitation were diagnosed in 0.8% of recruits. The most prevalent diagnoses were spinal deformities (kyphosis and scoliosis, females 11.9%, males 11.5%) and back pain (females 3.0%, males 5.6%). Most of these diagnoses were rated as mild. CONCLUSIONS When using objective criteria, overall back disorders in a large population of 17-year-old recruits were 17%, considerably lower than most reports. Back morbidity severe enough to prevent combat duty occurred at a rate of less than 1%, suggesting that serious back morbidity is not a frequent finding in this age group. LEVEL OF EVIDENCE Symptom prevalence study, Level III.

Degenerative Disease In Lumbar Spine Of Military Parachuting Instructors

Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study. Past radiographs were examined and compared to current anterolateral and lateral views of the lumbar spine, in order to determine the prevalence of degenerative changes and document possible progression. Doubtful radiographic changes in the lumbar spine were identified in 47.4 percent of the parachuting instructors, mild degeneration in 9.6 percent, moderate degenerative disease in 10.9 percent and severe radiographic changes in 5.5 percent. Schmorll nodes were found in 8.1 percent of the subjects. Traction spurs - osteophytes were identified in 6.8 percent. The degenerative changes correlated with age and the number of jumps. Spondylolysis of L5-S1 and L3- L4 segments were observed in 12.2 and 1.4 percent respectively. Progressive spondylolisthesis was found in 2 subjects. No correlation was found between the severity of radiographic changes and either the prevalence and the severity of low back pain. The present findings provide a rational for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis. Further study has to be done comparing parachuting instructors to a nonparachuting group, or equivalent physically active individuals, in order to assess the effect of sport-background on the development of degenerative changes.

Error in Drugs Consumption Among Older Patients

The cost effectiveness of generic drugs has promoted their use worldwide. However, the large variety of bioequivalent generic and brand-name drugs found in the marketplace increases the complexity and frequency of mistakes in drug consumption. This clinical study investigated the prevalence of various mistakes in drug consumption by patients using a hospital setting. This prospective clinical trial used a hospital setting to identify errors in drug consumption. Six hundred patients who were hospitalized for a minimum of 48 hours in the Internal Medicine Departments were checked at various time points. The medications prescribed by their physician was determined and compared to the medications each patient carried on their person for de facto consumption. Drug consumption errors were found in 13 cases (2.17%), most of which involved duplicate drugs. In 6 of these (46.1%), patients consumed different drugs from the same therapeutic family. In 5 cases (38.5%), patients used chemically similar medications with different names, and in 2 cases (15.4%), patients consumed different drugs from various therapeutic families to treat the same medical condition. Ten of the thirteen cases (76.9%) had the potential to cause serious adverse drug events. More errors were found in female patients (53.8%), elderly patients, and those consuming a large variety of drugs. Variations in names, colors, shapes, and sizes of various drugs cause confusion and errors in drug consumption among patients. Some of these errors have the potential to cause severe, adverse drug effects and can increase morbidity and mortality worldwide.

The Use of a CoolSense Device to Lower Pain Sensation During Finger Pricking While Measuring Blood Glucose in Diabetes Patients—A Randomized Placebo

BACKGROUND Patients with type 1 diabetes and a significant portion of patients with type 2 diabetes must use subcutaneous insulin injections, in order to maintain normoglycemia and to prevent immediate and long-term complications. For these patients, testing blood glucose levels more frequently is necessary to safely achieve glycated hemoglobin targets. In the current study, the effects of a CoolSense™ device (CoolSense Medical Ltd., Tel Aviv, Israel) were examined in relieving pain caused by needle-pricking for glucose measurements in adult patients with diabetes. SUBJECTS AND METHODS One hundred seventy-seven patients assessed the severity of pain they experienced during needle-pricking. The patients were randomly divided into an experimental group or a control group that used either a cooled CoolSense instrument or a non-cooled device, respectively. Participants were asked to rank the severity of their pain by a questionnaire developed for this study. Blood glucose levels were monitored as a control. RESULTS The majority of participants (58.3-71.7%; P<0.001) reported significant ache during measurements, the desire for an instrument that relieves pain, and its negative influence on their quality of life. Significant differences were indicated in pain perception between the experimental group and the control group that served as placebo, with no differences in blood glucose measurements in the groups. CONCLUSIONS The CoolSense instrument significantly reduces subjective pain felt by patients and can therefore serve as an additional tool for clinicians to help ease the needle-pricking pain. Future study is needed in order to provide information regarding the practical use of the instrument and its effect on hyper- and hypoglycemia.

Relationship Between Sources of Information and the Willingness of Healthcare Workers to Risk their Lives for a Patient During the Peak of A/H1N1 Pandemic in Israel §

Background: The willingness of healthcare workers to risk their lives for a patient if a fatal transformation of the virus would occur is a major concern, especially during a pandemic where the need for adequate staffing is crucial and where the public atmosphere might increase anxiety and fear of exposure. Objective: To examine the relationships between the source of information about the disease and the willingness of healthcare workers to risk their lives for a patient with a fatal A/H1N1 flu, during the winter A/H1N1 pandemic in Israel. Methods: A questionnaire was distributed to healthcare workers in 21 hospitals and 40 primary clinics in Israel between November 26, 2009 and December 10, 2009 (the peak of the winter A/H1N1 flu outbreak). Results: The questionnaire was completed by 1147 healthcare workers. The most common source of information reported was television (65%), followed by speaking with colleagues and reading the Ministry of Health regulations (63%) each, internet (61%), and newspapers (51%). The least common sources of information were reading a scientific article (35%) and attending a professional lecture (31%). Willingness to risk ones life was significantly higher in healthcare workers who reported that their source of information about the disease was reading a scientific article, Ministry of Health regulations, a professional lecture, or a colleague. Willingness was not significantly different among health care workers who reported that their source of information about the disease was television programs, a newspaper article, or general internet sites. Conclusions: Willingness to risk ones life for a patient is directly related to professional sources of information and is not related to nonprofessional information obtained from mass media.

Diverse Influences on Parachuting Injuries in Israel

Background Parachuting is known to be relatively safe and has a low injury rate. There are some parameters influencing parachuting casualties. In order to determine the influences of type of jump and parachute, effect of equipment carried, time of jump and wind speed, we conducted a retrospective study at the Parachuting Training Center of Israel, assessing 53832 military parachute jumps. Methods Two categories of injuries were defined: major (fractures, dislocation, head trauma, ligamentous tears) and minor (contusion, bruises, sprain injuries). Results The overall injury rate was 0.6 percent. The commonest major injuries were ankle fractures and head trauma, while ankle sprain was the most common minor injury. The lowest rate of injury was found in free falls jumpers (0.2 percent) and highest amongst manoeuvres (1.1 percent). The highest injury rate occurred when using an Israeli version of “T-10” military parachute (0.7 percent) and the lowest with free fall parachutes (0.2 percent). Extra equipment carried during jumps caused higher injury rate (0.8 percent) compared to jumps without equipment (0.5 percent) using the “T-10” military parachute. Injury rates were greater at night (1.0 percent) compared to day jumps (0.5 percent). In day jumps commonest major injury was ankle fracture, while in night jumps it was head trauma. The commonest minor injury in day and night jumps was ankle sprain. At wind speed of 0-4 Knots parachuting injuries were higher compared with wind speeds of 5-8, 9-12 and 13-16 Knots with injury rates of 0.8, 0.5 and 0.6 percent respectively. Conclusions Diverse factors influence the injury rate in parachuting. Identifying such factors may enable us to change them in order to minimize the number of injured parachutists.