Harefuah
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Due to the lack of international consensus regarding the efficiency of various methods for prevention of low back pain (LBP), this article describes the Israeli guidelines for prevention of L.B.P., based on the recommendations of the European Commission, COST Action B13. ⋯ The recommendations of the European committee, COST B13, served as the main source of information. The European group based its conclusions on systematic reviews mainly from the Cochrane, Embase, and Medline databases, and other smaller databases for more specific topics. The search covered the years 1966-2003. Information was also gathered through personal contacts with experts in the field. Additional searches were conducted for recent RCT's, published following the most recent systematic reviews. The final recommendations were sent to be reviewed by international experts in LBP. Summary of recommendations for the general population: Physical exercise is recommended for prevention of sick leave due to LBP and for the occurrence or duration of further episodes (Level A). There is insufficient consistent evidence to recommend for or against any specific type or intensity of exercise (Level C). Information and education on back problems, if based on bio-psychosocial principles, should be considered (Level C), but information and education focused principally on a biomedical or biomechanical model cannot be recommended (Level C). Back schools based on traditional biomedical/biomechanical information, advice and instruction are not recommended for prevention in LBP (Level A). High intensity programs, which comprise both an educational/skills program and exercises, can be recommended for patients with recurrent and persistent back pain (Level B). Lumbar supports or back belts are not recommended (Level A). There is no robust evidence for or against recommending any specific chair or mattress for prevention in LBP (Level C), though persisting symptoms may be reduced with a medium-firm rather than a hard mattress (Level C). There is no evidence to support recommending manipulative treatment for prevention in LBP (Level D). Shoe insoles are not recommended for the prevention of back problems (Level A). There is insufficient evidence to recommend for or against correction of leg length (Level D). Despite the intuitive appeal of the idea, there is no evidence, at this time, that attempts to prevent LBP in schoolchildren will have any impact on LBP in adults (Level D).
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Transthoracic electrical cardioversion (ECV), traditionally using monophasic waveform (MW) shock, has an important role in the treatment of symptomatic atrial flutter (AFI). Biphasic waveform (BW) shock has been demonstrated to be more successful than MW shock for termination of atrial fibrillation, but data about its use for ECV of AFI are limited. ⋯ There were no significant differences in the success rates of conversion of atrial flutter to sinus rhythm by BW or MW shock. We recommend 50 joules for starting energy of ECV of AF1 regardless of waveforms type.
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Nutritional support has become an integral part of the treatment in the critically ill patient. Appropriate nutrition will prevent the development of malnutrition and diminish the appearance of syndromes related to the lack of vitamins and minerals. This will reduce the length of hospital stay and is associated with lower incidence of complications and pressure ulcers. This review provides a practical approach to the critically ill patients' nutritional support, based on primary literature in this field.
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Brucellosis is a zoonotic disease that causes systemic symptoms and can involve many organs and tissues. The major sources of infection are consumption of unpasteurized diary products and occupational contact. Brucella is a small, gram-negative coccobacillus that grows slowly in vitro. ⋯ The standard treatment for acute and chronic brucellosis is a combination of doxycycline with a second drug such as rifampicin or gentamicin, in order to cure, prevent complications and relapse. Although the rate of occurrence is ever-decreasing due to vaccination of animals, nonetheless, the disease has not been eradicated in Israel. This review focuses on the clinical presentation, diagnosis, and mainly on complications of brucellosis and the available therapeutic options.
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Domestic violence against women is a worldwide phenomenon affecting women of all age groups and socio-economic backgrounds. It may take the form of mental, as well as physical or sexual abuse. Pregnant women are not excluded from being abused. ⋯ Nevertheless, the efforts to protect and help these women will remain futile without early recognition, identification and referral of such women by the attending physicians. Among physicians, the obstetrician/gynecologists have a unique role, since on many occasions they serve as the primary care physicians of women who suffer from domestic violence. They are therefore able to recognize and offer help to these women.