Harefuah
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Since time immemorial the attitude toward the dying patient has been one of the most difficult issues in medical ethics. The diversity of philosophical, religious, social and legal approaches does not enable one to reach a universal consensus to solve the many problems involved in end-of-life decisions. Within the health care system in Israel there is currently no consensual practice concerning the dying patient. ⋯ It establishes a clear position on euthanasia, physician-assisted suicide, withdrawing treatment and withholding treatment. It establishes a hierarchy of decision-making agents, and it validates advanced medical directives. It also promotes a legally-binding requirement of modern palliative care.
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This study was designed to evaluate the current practice of preoperative laboratory testing in healthy children undergoing elective surgery in a single tertiary general hospital, and compare it to the guidelines published by the American and Israeli societies of pediatric anesthesia. We also evaluated the effects of a pre-designed educational program on that practice. This was a prospective, two stage study. ⋯ The incidence of non-indicated tests performed, was also reduced significantly (by 23.1%, P = 0.015). We conclude that the use of unnecessary testing of children before elective surgery is common. A training program designed to address this issue can lead to a reduction in unnecessary testing.
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ECMO is used as a method for mechanical life support in the face of extreme cardiopulmonary failure. Most children and neonates that require ECMO do so because of respiratory failure unresponsive to conventional supportive measures. Less then 16% of the patients require ECMO support for the failing heart. The Sheba Medical Center, is one of two centers in Israel authorized by the Ministry of Health to use ECMO technique and is the only center that also performs pediatric cardiac surgery. ⋯ Our experience is in accord with the reported international experience. Following cardiac surgery for congenital cardiac anomalies, low cardiac output, unresponsive to maximal conventional medical support, is a rare but life threatening condition. Extracorporeal membrane oxygenation serves as a rescue mechanical support for these patients and due to improved and sophisticated intensive care, can serve as a bridge to recovery. The availability of ECMO provides an extra margin of safety in the very complex cases of open-heart surgery.
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In Israel, as in other developed countries, injuries are a leading cause of death and disabilities among children and youth between 1-19 years of age and the leading cause for Potential Years of Life Lost up to 65 years of age. In 1997, 225 children died as a result of accidental injuries, compared to 151 cases of death due to other internal causes. The most prevalent cause of death being motor vehicle accidents, rating 3:100,000: drowning--1:100,000 and falls, burns, suffocation and poisonings--less than 1:100,000 each. ⋯ It is wise to look at injuries as a heterogeneous group of illnesses, with different etiology, risk groups, and 'preventive treatments'--a group of diseases which are all preventable. It is very important that a national strategy for child safety be established accompanied by an adequate budget. Above all, it requires a lot of faith and commitment for the only vision: making the world a safer place for children.
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The State of Israel controlled a protective security zone in southern Lebanon from 1982 until May 2000, when the Israel Defense Forces (I.D.F.) evacuated this area within two days. Officers and soldiers of the South Lebanese Army, a local militia, which had formerly cooperated with the I.D.F., chose to come to Israel with their families. The provision for the health needs of this displaced population of over 5,861 persons was coordinated by the Northern Region Health Office of the Ministry of Health. ⋯ The experience accrued by the Northern Region Health Office over the years in provision of care to displaced populations at short notice was implemented. Cooperation within the health sector and between the health services and the military and defense forces was invaluable and essential to deal successfully with this unusual situation.