Harefuah
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Multicenter Study
[Percutaneous discectomy and intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence].
Within the framework of evidence-based medicine, high quality randomized trials and systematic reviews are needed for new medical treatment. Clinicians should conscientiously, explicitly and judiciously use the best current evidence in making decisions about the care of individual patients. This paper summarizes the best available evidence from systematic reviews and randomized controlled trials concerning two minimally invasive procedures: percutaneous discectomy and percutaneous intradiscal radiofrequency thermocoagulation. ⋯ Results of systematic reviews were retrieved from four leading evidence-based databases: the National Institute for Clinical Excellence--NICE, which is an independent organization responsible for providing national guidance on treatments, the Cochrane Library, which is the largest library world-wide for systematic reviews and randomized controlled trials, the Center for Review and Dissemination (CRD) at the University of York, which undertakes reviews of research about the effects of interventions in health and social care and finally, a search via Medline. The results from those systematic reviews and randomized trials shows that, at present, unless or until better scientific evidence is available, automated percutaneous discectomy and laser discectomy should be regarded as research techniques. Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.
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Mechanical ventilation is one of the most important technologies used in critically ill patients. In many patients, the use of mechanical ventialtion and weaning from mechanical ventialtion may be complicated by occurence of positive end expiratory pressure (PEEP) which is created by the mechanical and physiological properties of the pulmonary system and the mechanical ventilator. In order to minimize the detrimental effects of spontaneous PEEP, which is also termed intrinsic PEEP (PEEPi) or autoPEEP, clinicians should be aware of the mechanisms leading to PEEPi, and the possible ways of diminishing it. This review will present some aspects of PEEPi including the most common ways of reducing it and it's deleterious effects.
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Each year, many children suffer from injuries caused by bicycles, scooters, skateboards, and roller skates accidents. Head injury is the most common cause of death and serious disability in bicycle-related crashes. In various studies the use of bicycle helmets has been proven to be the most effective measure in preventing head injury: the use of bicycle helmets reduced the risk of head and brain injury by 85-88%. Legislation that mandates the use of helmets has been shown to effectively increase helmet use and, therefore, significantly decrease head injuries among riders. COST-BENEFIT: Legislation requiring helmets will save $44.2 million (direct benefit) to society over a 5-year period, and save approximately 57 lives, 2,544 hospitalizations, and 13,355 emergency room visits. BICYCLE-RELATED DEATHS AND INJURIES IN ISRAEL: Data from trauma registry of 10 hospitals of the Israeli Center for Trauma and Emergency Medicine research indicate that 649 children ages 17 years and under were injured in a bicycle-related accidents (58-serious, 77-medium injury). Bicycle-related injuries accounted for approximately 33% of motor vehicle accidents among children ages 17 years and under. ⋯ Many countries have legislation requiring helmets for riders. In Israel, there is no law requiring helmets. On a telephone survey, conducted by 'Beterem', a high support rate for a law requiring bicycle helmets (89%) was found among parents to children up to 15 years of age. Based on the evidence of the effectiveness of helmets as a means for reducing head injuries in cyclists, and the importance of a law to this effect, the medical community in Israel should act to promote the legislation requiring helmets for children on bicycles, scooters, skateboards, roller skates, and rollerblades.
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Saving life demands only two hands and some basic knowledge. A qualified person can open airways, resuscitate, massage a heart and call for help. A person with cardio-pulmonary resuscitation (CPR) training can sustain an ailing person's heart and brain for a short time. However, knowledge of CPR guidelines and skills is not enough; medical and nursing practitioners must practice and train regularly to hone those skills. Western Galilee Hospital has developed simulator programs for surprise CPR training exercises in all hospital departments and units. ⋯ It is our belief that surprise resuscitation drills are the key to improve functioning during actual emergency resuscitation, both on a departmental and a general hospital level.
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Chronic Obstructive Pulmonary Disease (COPD) is a common disease that tends to occur worldwide. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 level, gradual reduction of the levels of oxygen and pH in arterial blood, and a consequent rise in the Dead Space Fraction (DSF) of the lungs. ⋯ Evaluation of Dead Space Fraction does not provide a factor in estimating the length of treatment for patients with acute respiratory failure due to Chronic Obstructive Pulmonary Disease (COPD).