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Papers by Jochanan Benbassat
Journal of Occupational and Environmental Medicine, 1989
Decisions regarding professional fitness after an incidental detection of a clinical disorder are... more Decisions regarding professional fitness after an incidental detection of a clinical disorder are often problematic. The added risk of an occupational error related to the detected disorder may be smaller than the risk of an error due to lack of experience if a veteran is replaced by a novice. In this paper, we examine the choice between grounding or granting a waiver to an experienced fighter pilot with an incidental finding of premature ventricular contractions. The decision considers the probability of sudden incapacitation during flight and of pilot error-related air accidents in novices and veterans. Although deliberately biased in favor of grounding the veteran, the analysis indicates that the risk of sudden death or incapacitation in an experienced fighter pilot with an incidentally detected illness should be increased ten-fold to 46-fold to justify his or her replacement by a novice. In the specific case considered, the analysis suggests that the risk of an air accident due to sudden death or incapacitation of a veteran with incidentally detected premature ventricular contractions is similar to the estimated added risk of an error-related air accident if she or he is grounded and replaced by a novice. When reliable data on the frequency of human error by age and experience become available, the proposed model may be applied to other situations in which trained professionals develop a potentially disabling disease.
Archives internationales de pharmacodynamie et de thérapie
Israel journal of medical sciences
Israel journal of medical sciences
Israel journal of medical sciences
Israel journal of medical sciences
We attempted to identify all cases with polymyositis and/or dermatomyositis (PM-DM) admitted to h... more We attempted to identify all cases with polymyositis and/or dermatomyositis (PM-DM) admitted to hospitals in Israel during 1960-76. The diagnosis of PM-DM was retrospectively confirmed in 86 Jewish patients. The age-adjusted incidence rates increased from 1.30 in 1960-64 to 2.57 in 1970-74, with an overall incidence of 2.18 new cases diagnosed annually per 10(6) population. The male:female ratio in this series was 0.59. Females predominated among patients younger than 60 years of age, while males and females aged 60 or more appeared to be equally affected. The age distribution was heterogeneous with modes in the second and seventh decades. The annual incidence of PM-DM increased from 0.47 cases per 10(6) persons in the third decade to a peak of 6.32 in the seventh. The incidence of childhood PM-DM among non-Western Jews(of African or Asian origin) was significantly higher than that among Western Jews (of European or American origin). On the other hand, the incidence of adult PM-DM among Western Jews exceeded that among Jews of non-Western extraction.
Israel journal of medical sciences
An effort was made to identify all cases of biopsy-proven temporal arteritis (TA) diagnosed in Is... more An effort was made to identify all cases of biopsy-proven temporal arteritis (TA) diagnosed in Israel during 1960-78. A total of 46 Jewish patients was found, none of them under 50 yr of age. The age-standardized annual incidence rate of biopsy-proven TA among Jews in Israel rose from 1.6 in 1960-64 to 8.6 in 1975-78, with an overall incidence of 4.9 new cases diagnosed annually/10(6) population greater than or equal to 50 yr. The male:female ratio was 0.95. The annual incidence was 0.2 cases/10(6) population aged 50 to 59 yr, and 11.6/10(6) population greater than or equal to 70 yr of age. We feel that apparent increase in the incidence of TA is due to increased awareness of the disease rather than to an increase in morbidity.
Israel journal of medical sciences
Hospital discharge rates among the total and the aged Jewish populations in Israel from 1954 to 1... more Hospital discharge rates among the total and the aged Jewish populations in Israel from 1954 to 1972 were studied in relation to the main diagnosis. The disease entities studied included selected acute and chronic diseases, and diseases of old age. The hospital discharge rates for acute diseases did not change throughout the period surveyed, but the rates for chronic diseases and for those disorders that are prevalent in old age did increase gradually from 1954-72, and more markedly among the aged than among the total population. These increasing rates may result from higher expectations of modern medicine, reluctance to care for the elderly within the family, and the vacuum in hospital bed occupancy caused by the decline in infectious diseases. In view of the increasing costs of hospital services, we suggest that at least some of the patients with chronic diseases should receive the care they need at home, in nursing homes, or through other less expensive extended-care facilities.
Thorax
A 60 year old woman non-smoker with bronchial asthma of 6 years' duration, treated with aminophyl... more A 60 year old woman non-smoker with bronchial asthma of 6 years' duration, treated with aminophylline, salbutamol, and oral corticosteroids, was admitted because of increasing dyspnoea and productive cough. On examination she was in moderate respiratory distress with inspiratory and expiratory wheezes. Her chest radiograph was interpreted as normal. Two consecutive sputum examinations requested by a junior doctor reveal "malignant" cells.
Harefuah
The undergraduate medical curriculum does not include supervised training in emergency services. ... more 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. In response to the perceived need of emergency training, we modified the undergraduate teaching program of the clinical clerkship. During their medical clerkship, students spent several weeks in the emergency ward. Residents were similarly assigned to the emergency ward on a rotating basis for 3-month periods. 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.
Israel journal of medical sciences
Harefuah
For critically ill patients on assisted respiration caring behavior is particularly important. In... more For critically ill patients on assisted respiration caring behavior is particularly important. In this paper we review the literature on patient satisfaction with medical care and with their communication with the nursing staff. Communication skills of staff of intensive respiratory care units were studied by direct observation, debriefing of hospitalized patients and by interview of discharged patients. Direct observation showed that nurses spent only a small proportion of their time talking to patients. The interactions dealt with technical rather than emotional matters and consisted mostly of negative and discouraging comments rather than positive and supporting messages. Debriefing of hospitalized intubated patients revealed a high degree of overall satisfaction with care on the one hand, and complaints of communication problems, anxiety and anger on the other. Lastly, interviews with discharged patients revealed that as many as a quarter of those who could remember their hospitalization reported feelings of anxiety, anger, distrust in the staff and difficulty in communication. These findings suggest that the nursing staff needs improved communication skills. There is evidence that the judicious use of communication techniques may improve patient satisfaction, reduce anxiety and reduce duration of treatment.
Gastroenterology
The red blood cell composition was determined in 25 patients with acute viral hepatitis and in 26... more The red blood cell composition was determined in 25 patients with acute viral hepatitis and in 26 normal subjects. The potassium concentration was 83.4 +/- 4.11 mmol/kg red cells (mean +/- SD) in hepatitis red blood cells and 79.7 +/- 4.74 mmol/kg red cells in the control samples (P < 0.005). There were no significant differences between the sodium content of normal and hepatitis red blood cells. 22Na-Efflux was determined in red blood cells of 17 patients with acute viral hepatitis and 18 normal subjects. The mean sodium efflux rate constant was 0.212 +/- 0.036 in red cells of patients with hepatitis and 0.295 +/- 0.046 in the control samples (P < 0.001). This difference resulted from a reduction in both the active and residual portions of the red blood cell sodium pump in the patients with viral hepatitis. Red blood cells of patients with acute viral hepatitis accumulated sodium at a significantly slower rate than normal red blood cells. The increase in osmotic fragility after 24 hr incubation at 37 degrees C in the absence of glucose was less prominent in hepatitis red blood cells than in normals. The findings of a reduced sodium efflux and slower accumulation of sodium during incubation, suggest that red blood cells from patients with viral hepatitis are less permeable to sodium, thereby leading to a new steady-state, characterized by a reduced sodium efflux.
Journal of Occupational and Environmental Medicine, 1989
Decisions regarding professional fitness after an incidental detection of a clinical disorder are... more Decisions regarding professional fitness after an incidental detection of a clinical disorder are often problematic. The added risk of an occupational error related to the detected disorder may be smaller than the risk of an error due to lack of experience if a veteran is replaced by a novice. In this paper, we examine the choice between grounding or granting a waiver to an experienced fighter pilot with an incidental finding of premature ventricular contractions. The decision considers the probability of sudden incapacitation during flight and of pilot error-related air accidents in novices and veterans. Although deliberately biased in favor of grounding the veteran, the analysis indicates that the risk of sudden death or incapacitation in an experienced fighter pilot with an incidentally detected illness should be increased ten-fold to 46-fold to justify his or her replacement by a novice. In the specific case considered, the analysis suggests that the risk of an air accident due to sudden death or incapacitation of a veteran with incidentally detected premature ventricular contractions is similar to the estimated added risk of an error-related air accident if she or he is grounded and replaced by a novice. When reliable data on the frequency of human error by age and experience become available, the proposed model may be applied to other situations in which trained professionals develop a potentially disabling disease.
Archives internationales de pharmacodynamie et de thérapie
Israel journal of medical sciences
Israel journal of medical sciences
Israel journal of medical sciences
Israel journal of medical sciences
We attempted to identify all cases with polymyositis and/or dermatomyositis (PM-DM) admitted to h... more We attempted to identify all cases with polymyositis and/or dermatomyositis (PM-DM) admitted to hospitals in Israel during 1960-76. The diagnosis of PM-DM was retrospectively confirmed in 86 Jewish patients. The age-adjusted incidence rates increased from 1.30 in 1960-64 to 2.57 in 1970-74, with an overall incidence of 2.18 new cases diagnosed annually per 10(6) population. The male:female ratio in this series was 0.59. Females predominated among patients younger than 60 years of age, while males and females aged 60 or more appeared to be equally affected. The age distribution was heterogeneous with modes in the second and seventh decades. The annual incidence of PM-DM increased from 0.47 cases per 10(6) persons in the third decade to a peak of 6.32 in the seventh. The incidence of childhood PM-DM among non-Western Jews(of African or Asian origin) was significantly higher than that among Western Jews (of European or American origin). On the other hand, the incidence of adult PM-DM among Western Jews exceeded that among Jews of non-Western extraction.
Israel journal of medical sciences
An effort was made to identify all cases of biopsy-proven temporal arteritis (TA) diagnosed in Is... more An effort was made to identify all cases of biopsy-proven temporal arteritis (TA) diagnosed in Israel during 1960-78. A total of 46 Jewish patients was found, none of them under 50 yr of age. The age-standardized annual incidence rate of biopsy-proven TA among Jews in Israel rose from 1.6 in 1960-64 to 8.6 in 1975-78, with an overall incidence of 4.9 new cases diagnosed annually/10(6) population greater than or equal to 50 yr. The male:female ratio was 0.95. The annual incidence was 0.2 cases/10(6) population aged 50 to 59 yr, and 11.6/10(6) population greater than or equal to 70 yr of age. We feel that apparent increase in the incidence of TA is due to increased awareness of the disease rather than to an increase in morbidity.
Israel journal of medical sciences
Hospital discharge rates among the total and the aged Jewish populations in Israel from 1954 to 1... more Hospital discharge rates among the total and the aged Jewish populations in Israel from 1954 to 1972 were studied in relation to the main diagnosis. The disease entities studied included selected acute and chronic diseases, and diseases of old age. The hospital discharge rates for acute diseases did not change throughout the period surveyed, but the rates for chronic diseases and for those disorders that are prevalent in old age did increase gradually from 1954-72, and more markedly among the aged than among the total population. These increasing rates may result from higher expectations of modern medicine, reluctance to care for the elderly within the family, and the vacuum in hospital bed occupancy caused by the decline in infectious diseases. In view of the increasing costs of hospital services, we suggest that at least some of the patients with chronic diseases should receive the care they need at home, in nursing homes, or through other less expensive extended-care facilities.
Thorax
A 60 year old woman non-smoker with bronchial asthma of 6 years' duration, treated with aminophyl... more A 60 year old woman non-smoker with bronchial asthma of 6 years' duration, treated with aminophylline, salbutamol, and oral corticosteroids, was admitted because of increasing dyspnoea and productive cough. On examination she was in moderate respiratory distress with inspiratory and expiratory wheezes. Her chest radiograph was interpreted as normal. Two consecutive sputum examinations requested by a junior doctor reveal "malignant" cells.
Harefuah
The undergraduate medical curriculum does not include supervised training in emergency services. ... more 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. In response to the perceived need of emergency training, we modified the undergraduate teaching program of the clinical clerkship. During their medical clerkship, students spent several weeks in the emergency ward. Residents were similarly assigned to the emergency ward on a rotating basis for 3-month periods. 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.
Israel journal of medical sciences
Harefuah
For critically ill patients on assisted respiration caring behavior is particularly important. In... more For critically ill patients on assisted respiration caring behavior is particularly important. In this paper we review the literature on patient satisfaction with medical care and with their communication with the nursing staff. Communication skills of staff of intensive respiratory care units were studied by direct observation, debriefing of hospitalized patients and by interview of discharged patients. Direct observation showed that nurses spent only a small proportion of their time talking to patients. The interactions dealt with technical rather than emotional matters and consisted mostly of negative and discouraging comments rather than positive and supporting messages. Debriefing of hospitalized intubated patients revealed a high degree of overall satisfaction with care on the one hand, and complaints of communication problems, anxiety and anger on the other. Lastly, interviews with discharged patients revealed that as many as a quarter of those who could remember their hospitalization reported feelings of anxiety, anger, distrust in the staff and difficulty in communication. These findings suggest that the nursing staff needs improved communication skills. There is evidence that the judicious use of communication techniques may improve patient satisfaction, reduce anxiety and reduce duration of treatment.
Gastroenterology
The red blood cell composition was determined in 25 patients with acute viral hepatitis and in 26... more The red blood cell composition was determined in 25 patients with acute viral hepatitis and in 26 normal subjects. The potassium concentration was 83.4 +/- 4.11 mmol/kg red cells (mean +/- SD) in hepatitis red blood cells and 79.7 +/- 4.74 mmol/kg red cells in the control samples (P < 0.005). There were no significant differences between the sodium content of normal and hepatitis red blood cells. 22Na-Efflux was determined in red blood cells of 17 patients with acute viral hepatitis and 18 normal subjects. The mean sodium efflux rate constant was 0.212 +/- 0.036 in red cells of patients with hepatitis and 0.295 +/- 0.046 in the control samples (P < 0.001). This difference resulted from a reduction in both the active and residual portions of the red blood cell sodium pump in the patients with viral hepatitis. Red blood cells of patients with acute viral hepatitis accumulated sodium at a significantly slower rate than normal red blood cells. The increase in osmotic fragility after 24 hr incubation at 37 degrees C in the absence of glucose was less prominent in hepatitis red blood cells than in normals. The findings of a reduced sodium efflux and slower accumulation of sodium during incubation, suggest that red blood cells from patients with viral hepatitis are less permeable to sodium, thereby leading to a new steady-state, characterized by a reduced sodium efflux.