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The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. Guidelines for Chronic Low Back Pain (CLBP) care were never published in Israel previously, contrary to the Acute Low Back Pain (ALBP) guidelinges. This year, such guidelines are disseminated sponsored by the IMA. In the present paper a summary of the new CLBP care guideline is reported. To each recommendation an evidence level is attached, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will stay valid with periodic updating. Clinical practice guidelines are not intended to replace careful clinical judgment and personal acquaintance with the patient in. They may support decisions by bringing a summary of the existing evidence in the domain.

Physicians in Nazi Germany were among the first to join the Nazi party and the SS, and were considered passionate and active supporters of the regime. Their actions included development and implementation of the racial theory thus legitimizing the development of the Nazi genocide plan, leadership and execution of the sterilization and euthanasia programs as well as atrocious human experimentation. Nazi law allowed the use of humans and their remains in research institutions. One of the physicians whose involvement in the Nazi regime was particularly significant was Eduard Pernkopf. He was the head of the Anatomy Institute at the University of Vienna, and later became the president of the university. Pernkopf was a member of the Nazi party, promoted the idea of "racial hygiene", and in 1938, "purified" the university from all Jews. In Pernkopfs atlas of anatomy, the illustrators expressed their sympathy to Nazism by adding Nazi symbols to their illustrations. In light of the demand stated by the "Yad Vashem" Institute, the sources of the atlas were investigated. The report, which was published in 1998, determined that Pernkopfs Anatomy Institute received almost 1400 corpses from the Gestapo's execution chambers. Copies of Pernkopfs atlas, accidentally exposed at the Rappaport School of Medicine in the Technion, led to dilemmas concerning similar works with a common background. The books initiated a wide debate in Israel and abroad, regarding ethical aspects of using information originated in Nazi crimes. Moreover, these findings are evidence of the evil to which science and medicine can give rise, when they are captured as an unshakable authority.

Physician health is a matter of interest for patients' physicians and their teams, managers and policy-makers. It has an impact on public health, physician impairment, patient safety, resource allocation and malpractice litigation. International medical literature, unlike Israel publications, is extensively preoccupied with the domain. Based on 2 MD thesis dissertations, Ministry of Health data and a literature search, the present review addresses many issues. It deals with: physicians' physical and mental health internationally and in Israel, prevention and health promotion, burn-out, the professional lifespan and career, health services utilization, legal and administrative aspects, boundaries, physicians' characteristics and vulnerability, interpersonal relations, care provided by physicians, physicians as patients and finally the impaired physician. International recommendations as well as a proposal for a local action plan are presented.

The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. A decade ago, Guidelines for Acute Low Back Pain (ALBP) care were published in Israel. This year, updated and upgraded guidelines were disseminated, sponsored by the IMA. In the present paper a summary of the new ALBP is reported, as well as a comparison with the prior 1996 guidelines. An evidence tag is attached to each recommendation, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will remain valid with periodic updating. Clinical practice guidelines are not intended to replace your careful clinical judgment and personal acquaintance with the patient in front of you. They may support your decisions by bringing you a summary of the existing evidence in the domain.

Background: In recent years, the Israel Defense Forces IDF developed special training programs for junior military physicians at the beginning of their service and CME courses for senior military physicians. The Objective Structured Clinical Examination (OSCE) is a well established assessment tool in medical education that can be of vast use in military training programs for primary care physicians., Aim: To evaluate the OSCE as an assessment tool of military primary care physicians., Methods: Forty-one military primary care physicians completed a 10-station OSCE. The clinical scenario choices were based on the most prevalent problems in the annual statistics of the Israeli Medical Corps between the years 1988-1998. Each station consisted of two parts: a doctor-SP (standardized patient) encounter and a written exercise. Both parts were evaluated by checklists designed and validated by a committee of OSCE experts and senior military physicians., Results: The overall reliability of the exam was alpha = .88. The examinees highly valued the relevance of the scenarios to their every day practice (4.38 out of 5.0) and the reliability of the standardized patients (4.0 out of 5.0). A total of 92% request feedback on their performance., Conclusions: This pilot study found the OSCE to be a feasible, valid and reliable tool that can serve to assess the capability of physicians to deal with major issues in military primary health care. The OSCE can also play a major role in structured feedback provided to these physicians.

Background: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems., Objectives: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use., Methods: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues., Results: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%., Conclusions: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations.

Number needed to treat--NNT--is a bridging tool between statistical results from clinical trials and the physician daily work. This number represents the number of patients we need to treat with the experimental therapy in order to prevent one of them from developing the bad outcome. The concept is a useful measure of the clinical effort our patient and we must expend in order to help them avoid bad outcomes to their illness. For example, the NNT for antibiotic treatment of otitis media is 8, which means that we have to treat eight children with antibiotic and only one out of the eight will benefit the treatment. In a medical world that uses the Evidence Based Medicine as essential tool, we believe that the NNT is an important tool and very efficient for choosing the best treatment method.