Charles Weissman | The Hebrew University of Jerusalem (original) (raw)

Papers by Charles Weissman

Israel Journal of Health Policy Research, 2018

Background: The greatest challenges facing healthcare systems include ensuring a sufficient suppl... more Background: The greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel's periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences. Methods: Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University-Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians' union contract would attract students to residencies in the periphery. Results: Completed questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period. Forty-eight of the students indicated interest in residencies in the country's periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery. Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported that they did not yet know the geographic area where they wished to do their residency, as compared to only 22% among those not interested in incentives.

Israel Journal of Health Policy Research

Background The Israeli physician workforce faces multiple challenges. These include planned polic... more Background The Israeli physician workforce faces multiple challenges. These include planned policies reducing physician on-call from 26 to 18 h and, from 2026, allowing only graduates of Ministry of Health approved foreign medical schools to take the Israeli licensing examination and an ongoing physician shortage (2019: Israel had 3.19 physicians/1000 persons vs. OECD average of 3.49 physicians/1000 persons). This study examines the potential impact of these planned policies on the Israeli anesthesiology workforce. Methods Surveys conducted among 34 public and private Israeli hospital anesthesiology department chairs collected data on their department's number of weekday on-call anesthesiologists and current shortage of anesthesiologists. A subsequent survey collected data on each anesthesiologist in the workforce, including the country where they studied medicine. Results Each weekday night there were 114 on-call anesthesiologists; 72 residents and 42 attendings. Using producti...

Military Medicine, 2019

Introduction: Emergency field ventilation using bag-valve face mask devices can be difficult to p... more Introduction: Emergency field ventilation using bag-valve face mask devices can be difficult to perform, especially in bearded individuals. In view of the increasing numbers of servicemen and civilians sporting a beard or moustache, the issue of finding a technical solution for ventilation in this population has gained importance. We therefore developed a novel adaptor that enables the direct connection of a bag-valve device to a Guedel-type oropharyngeal airway device thereby directly connecting the oral airway to the bag valve, eliminating the need for a face mask. The objective of this study was to compare the efficacy of the bag-valve-Guedel adaptor (BVGA) to the common face mask in healthy bearded volunteers. Methods: This study was a randomized-by-sequence, crossover-controlled trial (NCT02768246) approved by the local IRB (0051-16-HMO). All subjects signed an informed consent before participation. Twenty-five healthy bearded men (age 28 ± 7) were recruited. After randomizatio...

Journal of Clinical Anesthesia, 1990

This study examines whether epidural anesthesia is more effective than general anesthesia using a... more This study examines whether epidural anesthesia is more effective than general anesthesia using an inhalation agent in controlling cardiovascular responses during femoral-popliteal bypass surgery. Nineteen patients were randomized into two groups: general anesthesia (n = 10) and epidural anesthesia (n = 9). The patients who underwent general anesthesia received sodium pentothal and succinylcholine for induction of anesthesia and 60% N 2 0, 40% O 2 , and 1 % to 1.5% isojlurane for maintenance. Fifteen minutes before extubation, the patients received morphine sulfate 0.05 mglkg intravenously (IV). The group that underwent epidural anesthesia received anesthesia to T-IO (through a catheter placed in the L4-5 interspace using 3% 2-chloroprocaine). Thirty minutes after the last dose, 0.05 mglkg IV was administered. Hemodynamic variables were recorded at selected intervals during the operation and for 60 minutes in the recovery room. In the general anesthesia group, mean arterial pressure (MAP) and rate pressure product (RPP) significantly decreased (p < 0.05) during the operation as compared with preoperative values. Following intubation and skin incision, 5 minutes after extubation, and after 60 minutes in the recovery room, MAP, heart rate (HR), and RPP were significantly greater (p < 0.05) as compared with intraoperative periods. In the epidural anesthesia group, there were clinically important decreases in MAP and RP P after reaching T-10 and skin incision. The general anesthesia patients showed higher MAP, HR, and RPP 5 minutes after extubation and after 60 minutes in the recovery room. Epidural anesthesia patients showed stable hemodynamic patterns throughout the study. This study demonstrates that epidural anesthesia allows for a more stable intraoperative and postoperative course as compared to the general anesthesia technique used, especially at the end of surgery and in the recovery room.

Critical Care Medicine, 1982

Critical Care Medicine, 1988

Anesthesia & Analgesia, 1993

Critically ill patients often are subjected to interventions that acutely increase oxygen demand ... more Critically ill patients often are subjected to interventions that acutely increase oxygen demand and require increased output of the cardiac and respiratory systems. This study explored whether alfentanil could attenuate the response to chest physical therapy, a procedure that increases oxygen consumption by 40%-50%. Patients were examined during two consecutive therapy sessions. In random order, they received either a placebo or alfentanil(30 or 60 pg/kg) 2 min before treatment. In Group 1 (n = 11, 30 pg/kg alfentanil) only the arterial blood pressure increases induced by chest physical therapy were attenuated. In Group 2 (n = 12, 60 pg/kg) alfentanil attenuated the increases in heart rate, central venous pressure, and pulmonary artery systolic pressures as well as systemic blood pressure. Neither dose of alfentanil altered the increases in oxygen consumption, carbon dioxide elimination, oxygen delivery, or extraction ratio. Thus alfentanil attenuated the hemodynamic responses to chest physiotherapy in a dose-dependent fashion. This was likely due to its vagotonic actions. In contrast, alfentanil had no effect on the balance between oxygen demand and delivery during chest physiotherapy. There was thus a dissociation between the hemodynamic and metabolic responses. (Anesth Analg 1993;77:1122-9) ritically ill patients frequently are subjected to interventions that acutely increase the tissue C demand for oxygen and require the respiratory and cardiovascular systems to increase their outputs. Yet, in many of these patients, organ function may be compromised and adversely affected by the responses to increases in the oxygen demand. For example, Matthews et al. (1) found that after resection of an aortic abdominal aneurysm, ST segment depression occurred most often after chest physiotherapy, a procedure known to cause a 40%-50% increase in oxygen consumption (2). It thus would seem that attenuating the acute increase in oxygen demand may be beneficial to a critically ill patient. Chest physiotherapy serves as a useful model to examine different ways of reducing the stressful nature of some intensive care unit interventions. This study explored the effects of two doses (30 and 60 &kg) of alfentanil. Because of its rapid onset and short duration of action, alfentanil theoretically should

Introduction: Understanding ” what is most important” to medical-students can help improve reside... more Introduction: Understanding ” what is most important” to medical-students can help improve residence learning and working conditions. Such information is needed to facilitate policy planning that will encourage the next generation of physicians to specialize in medical-fields that are experiencing shortages. The hypothesis was, there are significant changes in medical students’ preferences, regarding the considerations for choosing a medical specialty in 2020 as compared to students a decade earlier. Methods: A time comparison cross-sectional study of 5 -year medical students from two universities took place in 2010 and 2020. A questionnaire was used to examine various aspects of the specialty selection process. Results: 335 medical-students answered the survey (237 and 98 in 2010 and 2020, respectively). Medical students in 2020 in comparison to 2010, were 2.26 time less likely to choose a residency because of its potential for a high income (P<0.05), had significantly more inte...

Critical Care Medicine, 1981

Anesthesia & Analgesia, 1989

There has been increasing interest in the nutritional support of the critically ill patient. The ... more There has been increasing interest in the nutritional support of the critically ill patient. The day-today variation in resting energy expenditure (REE) was studied over a 3-5-day period in 17 postoperative mechanically ventilated critically ill patients to gain insight as to how often caloric intake should be reassessed, whether changes observed over 3-5 days are of sufficient magnitude to make frequent adjustments in caloric intake, and what factors are associated with large alterations in metabolic rate. REE was measured daily for 3-5 days, and the percent ziariation in REE f(highest REElowest daily REE)i(lowest daily REE) x 1001 calculated. The variation ranged from 4 to 56%, and on further analysis two distinct groups were identified, one with a mean variation of 12 k 4% (SD) (range 4-18%) and the other with a mean variation of 46 * 8% (range 37-56%). The former group was clinically stable, whereas the latter was not. Clinically stable patients need less frequent measuremetits tlran those who are more ill, but when designing a nutritional regimen for them, at least 20-25% should be added to the REE, 15% to account for day-today variation and 5-10% for activity.

BMC medical education, Jan 18, 2017

During their final year of medical school, Israeli students must consider which specialty to choo... more During their final year of medical school, Israeli students must consider which specialty to choose for residency. Based on the vocational counseling literature we presumed that choices are made by selecting from a cluster of related specialties while considering professional and socio-economic issues. Questionnaires distributed to final-year medical students at two Israeli medical schools ascertained inclinations toward various medical specialties and the importance of various selection criteria. Analysis focused on seven specialties where >20% of students reported they had positive inclinations. For each such specialty, the specialty and selection criteria query were compared using unpaired two-tailed Student's t-tests to determine differences between students with positive inclinations toward the specialty with those not so inclined. These data were placed in tables, with the significant differences highlighted to facilitate visual recognition of cluster patterns. Complete...

Anesthesia & Analgesia, 2014

Acta Anaesthesiologica Scandinavica, 2019

The post-anesthesia care unit (PACU), an integral component of the surgical care system, cares fo... more The post-anesthesia care unit (PACU), an integral component of the surgical care system, cares for patients after surgery and other procedures. The PACU's ability to accommodate patients immediately upon surgery completion is crucial for efficient operating room (OR) activity. 1 PACUs become bottlenecks due to both inflow and outflow issues. Inflow problems occur when PACU beds are unavailable requiring patients to wait in the OR until one becomes available. Lack of beds can be due to full occupancy, insufficient beds, and insufficient nursing staff. Outflow problems are due to an inability to discharge patients from the PACU because of clinical or administrative issues, eg, no available floor beds. Inflow and outflow are tightly coupled so that poor outflow reduces inflow. PACU and OR activity are closely linked since numbers, types, and sequences of surgeries influence subsequent PACU operations. Among parameters affecting PACU activity is the PACU length-ofstay (LOS)-duration-of-surgery (DOS) relationship. When the DOS of the second case of the day is longer than the PACU-LOS of the first case, a PACU bed should be ready upon the completion of surgery. However, if PACU-LOS of the first case is longer than DOS of the second one, a second PACU bed will be needed, resulting in patients "stacking." Therefore, the PACU-LOS/DOS ratio is among the determinants of the number of PACU beds and nurse staffing patterns required for ensuring efficient egress from the ORs.

Journal of cardiothoracic and vascular anesthesia, 2017