Israel journal of medical sciences
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An off-line system for automating the problem-oriented record implemented at Kibbutz Shuval is described. The Shuval problem-oriented record consists of acute and chronic problem lists, a preprinted data base collected by patients and nurses, problem-oriented plan flow sheets, problem-oriented progress notes and a regular record audit. The mean conversion time from a traditional record to a problem-oriented record was 17 min for a child's record and 25 min for an adult's. ⋯ Transfer of data took, on the average, 10 min (range, 5 to 30 min) for a child's record. The following five types of analysis can be performed with the Shuval automated problem-oriented record: administrative, patient care, epidemiologic, demographic and clinical research. Coupled with the manual problem-oriented record, the Shuval automated record provides many advantages of an on-line problem-oriented record at considerably less cost.
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Health services in Israel are provided by various organizations. In most areas, curative, preventive and welfare services are under the administration of separate agencies. Even in small towns, health and social services are provided by many agencies. ⋯ A model is suggested for the organization of comprehensive primary health care at the local level, with integrated curative, preventive and social services. Development of neighborhood health centers with comprehensive services may provide more effective and efficient care for the individual and family and may serve as a suitable framework for the development of community health care programs. The importance of surveillance of the health status of the community and the need for a relevant record system is stressed.
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Ultrasound and other modalities were used to evaluate lateral masses in the neck in 26 patients. Accurate diagnosis of solid and fluid-filled masses, both with and without pulsatile components, was achieved through ultrasound studies. Computed tomography was particularly helpful in cases with bone involvement.
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Splenic rupture is the most frequent intraabdominal injury following blunt abdominal trauma. Massive hemorrhage commonly occurs from injuries to this friable vascular organ. The mortality rate from simple splenic rupture is 1%. ⋯ Fifteen patients were operated on more than 48 h after sustaining the injury. A detailed analysis of these 15 patients revealed that in only three did the evidence support delayed hemorrhage following traumatic rupture of the spleen. In the other 12 patients, there was a delay in recognition of the intraabdominal injury, almost entirely the result of "diagnostic error." Careful clinical inquiry and peritoneal lavage are the mainstays of early diagnosis and therapy and should help to eliminate any delay in the diagnosis of a ruptured spleen.
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A 23-year-old pregnant woman with class III rheumatic heart disease, with mitral stenosis, underwent mitral valve replacement with cardiopulmonary bypass during the 32nd week of gestation. Fetal heart rate and uterine activity were recorded during the operation. ⋯ Problems associated with maternal extracorporeal circulation during pregnancy are discussed. Long-term effects on the fetus are presently unknown.