Harefuah
-
The undergraduate medical curriculum does not include supervised training in emergency services. Medical students and residents are expected to acquire skills and experience related to emergency medicine during their clerkships in the clinical wards. Consequently, Israeli medical graduates often have difficulty in coping with common situations in primary care and emergency medicine. ⋯ Both the positive feedback of the trainees and the practical relevance of the program and its feasibility, suggest that it may be a worthwhile addition to the undergraduate and graduate clinical curriculum. However, we have no data for evaluating the outcome. We feel that all aspects of emergency medicine should be included in the teaching programs of the various clinical specialties, and suggest that the emergency room should be used as a teaching setting during the clinical clerkship, the internship and residency training.
-
Congenital diaphragmatic hernia (Bochdalek) is a congenital malformation usually presenting early after birth with a mortality of 50-70%. It is rarely diagnosed after the neonatal period, when the prognosis is considered favorable. We operated on 11 children past the neonatal period, ranging from 6 months to 5.5 years of age. 9 had presented with respiratory symptoms and were operated on semi-electively with excellent results. 2, operated on for strangulation of bowel incarcerated in the hernia, eventually died (aged 7 months and 1 year, respectively). Early diagnosis is important, as early surgery is recommended, even in those without symptoms.
-
The diagnostic approach to sore throat and its treatment by 7 doctors was studied in 692 community clinic patients. Redness of the throat, the commonest clinical feature in all age groups, was present in 88%. The prevalence of other clinical findings varied in the different age groups. 54% of the patients, most of whom were less than 13 years old, were treated initially with antibiotics. ⋯ From 11 (13%) of the throat cultures taken from children under the age of 4, beta hemolytic streptococci (BHS) were grown. Based on throat cultures, antibiotics had been given unnecessarily in 53% of those in whom it was initially prescribed, and wrongly withheld in 10% of those who initially did not receive them. This study reveals an urgent need for a rapid and accurate method of detecting BHS in patients with sore throat.