Harefuah
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Catheter-related bloodstream infection (CR-BSI) is a significant source for morbidity and mortality in addition to increased hospital costs. Patients in intensive care units (ICUs) have a greater risk for CR-BSI. Continuous monitoring and control of intravascular central catheters insertion (CCI) by using checklists have a key role in reducing the rate of infections and improving patient health care quality and safety. ⋯ The continuous monitoring of the rate of CR-BSI and using checklists in every CCI process may reduce the morbidity, mortality, hospital stay, and lower hospital costs associated with centrally placed vascular catheters.
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This case report illustrates a primary upper extremity DVT of the right subclavian vein in an otherwise healthy young male. The pathogenesis of primary upper extremity DVT may be anatomical, such as thoracic outlet syndrome, vascular microtrauma e.g. effort thrombosis, or both. After examining the patient's clinical presentation and imaging results, a diagnosis of effort thrombosis, or "Paget-Schroetter syndrome" was made. Due to the clear insulting factor, the mild clinical presentation, and the fast response to anti-coagulant treatment, a conservative treatment was followed, which included anti-coagulation and close follow-up, as advised by the American College of Chest Physician's evidence-based clinical practice guidelines.
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The palliative care philosophy accepts the dying process as a natural phase in the life cycle and provides quality end of life care for terminal patients and their family members. Prolonged exposure to the physical symptoms and pain, as well as the psychological, spiritual, and existential suffering of the dying patient, may be fertile ground for the development of post-traumatic stress symptoms among palliative care teams. ⋯ This review presents the current knowledge about the prevalence and causes of work-related stress outcomes among palliative care teams and measurement tools that are available. The literature review discusses secondary traumatization in palliative care teams and relevant messages for the development of treatment options, burnout prevention programs and support interventions for professionals who lead the care for terminal patients in Israel.
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Bacterial infections are a major threat to pediatric oncology patients with fever and neutropenia. Current management consists of empiric broad-spectrum antibiotics and prompt medical evaluation. Local bacterial susceptibility rates were published in 2005, and the local protocol (piperacillin and amikacin) was established as an adequate empiric treatment with -100% efficiency against the common pathogens in our pediatric hemato-oncology ward. ⋯ The currently applied empiric antimicrobial protocol is an optimal first line regimen, considering the susceptibility of the most common pathogens. Judicious use of carbapenems for gram negative bacteria and glycopeptides or other novel antimicrobial agents in cases of CONS bacteremia is required.
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During the last generation the population in Israel has doubled and the number of hospital beds per capita has declined to the lowest number in the OECD. This has implications on the number of physicians and nurses, as well as the nation's capacity to educate medical staff, while there are no increases in the infrastructure. Shortening the length of stay for acute medical conditions to an average of about three to four days is the main consequence of this situation. ⋯ During the last decades, the number of geriatricians in Israel has doubled, obligatory clerkship in Geriatric Medicine is part of the medical schools' curriculum and Geriatric Medicine is part of the board curriculum in Internal Medicine and Family Medicine. Thus, Geriatric Medicine maintains the art of medical practice, using the recent knowledge in biology and medical sciences, and dealing with the population with the highest level of morbidity and lowest function. The Geriatric Medicine approach to the old person who needs medical help has to lead medical practice in the near future, so that we can preserve the great achievements of medicine during the twentieth century.