88 results on '"Ofer Merin"'
Search Results
2. Mixed effect of increasing outflow of medical patients from an emergency department
- Author
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Joseph Mendlovic, Todd Zalut, Gabriel Munter, Ofer Merin, Amos M. Yinnon, and David E. Katz
- Subjects
Reimbursement ,Emergency department ,Medical patients ,Medical departments ,Early morning discharge ,Length of stay ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background and aim Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25–30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments. Methods We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED. Results Implementation of the first stage led to an increased morning discharge rate from a baseline of 2–4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8–12 per department), providing significant relief for the ED. However, the additional workload for the IM departments’ medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42–44, included constant hallway housing, and often midday peaks of 48–50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning. Conclusion We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.
- Published
- 2021
- Full Text
- View/download PDF
3. Cognitive Flexibility Predicts PTSD Symptoms: Observational and Interventional Studies
- Author
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Ziv Ben-Zion, Naomi B. Fine, Nimrod Jackob Keynan, Roee Admon, Nili Green, Mor Halevi, Greg A. Fonzo, Michal Achituv, Ofer Merin, Haggai Sharon, Pinchas Halpern, Israel Liberzon, Amit Etkin, Talma Hendler, and Arieh Y. Shalev
- Subjects
Post-Traumatic Stress Disorder (PTSD) ,neurocognitive functioning ,cognitive flexibility ,resilience factors ,risk factors ,cognitive training intervention ,Psychiatry ,RC435-571 - Abstract
Introduction: Post-Traumatic Stress Disorder (PTSD) is a prevalent, severe and tenacious psychopathological consequence of traumatic events. Neurobehavioral mechanisms underlying PTSD pathogenesis have been identified, and may serve as risk-resilience factors during the early aftermath of trauma exposure. Longitudinally documenting the neurobehavioral dimensions of early responses to trauma may help characterize survivors at risk and inform mechanism-based interventions. We present two independent longitudinal studies that repeatedly probed clinical symptoms and neurocognitive domains in recent trauma survivors. We hypothesized that better neurocognitive functioning shortly after trauma will be associated with less severe PTSD symptoms a year later, and that an early neurocognitive intervention will improve cognitive functioning and reduce PTSD symptoms.Methods: Participants in both studies were adult survivors of traumatic events admitted to two general hospitals’ emergency departments (EDs) in Israel. The studies used identical clinical and neurocognitive tools, which included assessment of PTSD symptoms and diagnosis, and a battery of neurocognitive tests. The first study evaluated 181 trauma-exposed individuals one-, six-, and 14 months following trauma exposure. The second study evaluated 97 trauma survivors 1 month after trauma exposure, randomly allocated to 30 days of web-based neurocognitive intervention (n = 50) or control tasks (n = 47), and re-evaluated all subjects three- and 6 months after trauma exposure.Results: In the first study, individuals with better cognitive flexibility at 1 month post-trauma showed significantly less severe PTSD symptoms after 13 months (p = 0.002). In the second study, the neurocognitive training group showed more improvement in cognitive flexibility post-intervention (p = 0.019), and lower PTSD symptoms 6 months post-trauma (p = 0.017), compared with controls. Intervention- induced improvement in cognitive flexibility positively correlated with clinical improvement (p = 0.002).Discussion: Cognitive flexibility, shortly after trauma exposure, emerged as a significant predictor of PTSD symptom severity. It was also ameliorated by a neurocognitive intervention and associated with a better treatment outcome. These findings support further research into the implementation of mechanism-driven neurocognitive preventive interventions for PTSD.
- Published
- 2018
- Full Text
- View/download PDF
4. Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol
- Author
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Naomi B. Fine, Michal Achituv, Amit Etkin, Ofer Merin, and Arieh Y. Shalev
- Subjects
post-traumatic stress disorder ,cognitive-affective remediation ,neuroplasticity ,executive function ,emotion bias ,emotional regulation ,Psychiatry ,RC435-571 - Abstract
Background: The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD. Administering targeted neurocognitive training shortly after trauma exposure is a daunting challenge. This work describes a study design addressing that challenge. The study evaluated the direct effects of cognitive remediation training on neurocognitive mechanisms that hypothetically underlay PTSD, and the indirect effect of this intervention on emerging PTSD symptoms. Method: We describe a study rationale, design, and methodological choices involving: (a) participants’ enrolment; (b) implementation and management of a daily self-administered, web-based intervention; (c) reliable, timely screening and assessment of treatment of eligible survivors; and (d) defining control conditions and outcome measures. We outline the rationale of choices made regarding study sample, timing of intervention, measurements, monitoring participants’ adherence, and ways to harmonize and retain interviewers’ fidelity and mitigate eventual burnout by repeated contacts with recently traumatized survivors. Conclusion: Early web-based interventions targeting causative mechanisms of PTSD can be informed by the model presented in this paper.
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- 2018
- Full Text
- View/download PDF
5. Aortic bifurcation tear following blunt trauma in childhood
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Shlomo Yellinek, Dimitri Gimelrich, Ofer Merin, Petachia Reissman, and Marc Arkovitz
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Aortic trauma ,Pediatric trauma ,Aortic bifurcation ,Blunt aortic trauma ,Retroperitoneal hematoma ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
Rupture of the abdominal aorta from blunt trauma is rare and aortic biforcation tear is extremely rare. We will present the management of a 2 year old boy who suffered blunt abdominal trauma and was operated in urgent fashion in our institution.
- Published
- 2015
- Full Text
- View/download PDF
6. Global Disaster Response and Emergency Medical Teams
- Author
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Evan Avraham Alpert and Ofer Merin
- Published
- 2024
7. Contributors
- Author
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Axel Adams, Clara Affun-Adegbulu, Rakan S. Al-Rasheed, Yasser A. Alaska, Abdulaziz D. Aldawas, Saleh Ali Alesa, George A. Alexander, Abdullah Ahmed Alhadhira, Fahad Saleha Alhajjaj, Hazem H. Alhazmi, Zainab Abdullah Alhussaini, Nawfal Aljerian, Majed Aljohani, Khaldoon H. AlKhaldi, Eyad Alkhattabi, Bryant Allen, Austin Almand, Moza M. Alnoaimi, Mohammad Alotaibi, Evan Avraham Alpert, Yasir A. Alrusayni, Mai Alshammari, Loui K. Alsulimani, Siraj Amanullah, Arian Anderson, David Arastehmanesh, Ali Ardalan, Killiam A. Argote-Araméndiz, Andrew W. Artenstein, Olivia E. Bailey, Russell Baker, Satchit Balsari, Gregory T. Banner, Fermin Barrueto M, Susan A. Bartels, Joshua J. Baugh, Frederic Berg, Vijai Bhola, William Binder, Michelangelo Bortolin, Vincent Bounes, Michael Bouton, Natasha Brown, Frederick M. Burkle, Jr, Lynn Barkley Burnett, Michele M. Burns, Nicholas V. Cagliuso, Sr, John Cahill, David W. Callaway, Duane C. Caneva, Srihari Cattamanchi, Alejandra Caycedo, Edward W. Cetaruk, Sneha Chacko, James C. Chang, Crystal Chiang, David T. Chiu, Gregory R. Ciottone, Jonathan Peter Ciottone, Melissa A. Ciottone, Robert A. Ciottone, Robert G. Ciottone, Vigen G. Ciottone, Alexander Clark, Jonathan Clark, Sean P. Conley, Joanne Cono, Arthur Cooper, Scott B. Cormier, Michael F. Court, Cord W. Cunningham, Fabrice Czarnecki, Supriya Davis, Timothy E. Davis, Gerard DeMers, Sharon Dilling, Ahmadreza Djalali, Timothy Donahoe, Joseph Donahue, Caleb Dresser, Jason Dylik, Benjamin Easter, Alexander Eastman, Laura Ebbeling, Chigozie Emetarom, Nir Eyal, Andrew J. Eyre, David J. Freeman, Franklin D. Friedman, Christie Fritz, Frederick Fung, Fiona E. Gallahue, Stephanie Chow Garbern, Mark E. Gebhart, William A. Gluckman, Craig Goolsby, Robert M. Gougelet, Fredrik Granholm, P. Gregg Greenough, Jennifer O. Grimes, Steve Grosse, Shamai A. Grossman, John T. Groves Jr, Tee L. Guidotti, George Guo, Sarah Haessler, Matthew M. Hall, John W. Hardin, Mason Harrell, Alexander Hart, MD, Melissa Harvey, Attila J. Hertelendy, PhD, Nishanth S. Hiremath, Jordan Hitchens, Christopher P. Holstege, Simon T. Horne, Steven Horng, Amer Hosin, Hans R. House, Pier Luigi Ingrassia, Fadi S. Issa, Irving 'Jake' Jacoby, Rajnish Jaiswal, Gregory Jay, J. Lee Jenkins, Josh W. Joseph, Shane Kappler, Mark E. Keim, Julie Kelman, Andrew R. Ketterer, Anas A. Khan, Ramu Kharel, Chetan U. Kharod, Thomas D. Kirsch, Anita Knopov, Max Kravitz, J. Austin Lee, Jay Lemery, Evan L. Leventhal, Jesse Loughlin, Stephanie Ludy, Brian J. Maguire, Selwyn E. Mahon, Paul M. Maniscalco, Philip Manners, Leonard Jay Marcus, Colton Margus, Taha M. Masri, Jeff Matthews, Sean D. McKay, Zeke J. McKinney, Robert K. McLellan, Eric J. McNulty, Faroukh Mehkri, Mandana Mehta, Rebecca A. Mendelsohn, Ofer Merin, Andrew Milsten, Dale M. Molé, Michael Sean Molloy, Ilaria Morelli, Jerry L. Mothershead, John Mulhern, Nicole F. Mullendore, Nicholas J. Musisca, Sonya Naganathan, Larry A. Nathanson, Erica L. Nelson, Lewis S. Nelson, Bradford A. Newbury, Kimberly Newbury, Ansley O’Neill, Robert Obernier, Jacopo M. Olagnero, Leonie Oostrom-Shah, Catherine Y. Ordun, Scott Parazynski, Andrew J. Park, Robert Partridge, Jeffrey S, James P. Phillips, Emily Pinter, David P. Polatty IV, Patrick Popieluszko, William Porcaro, Lawrence Proano, Peter B. Pruitt, Moiz Qureshi, Luca Ragazzoni, Murtaza Rashid, Paul Patrick Rega, Michael J. Reilly, Marc C. Restuccia, James J. Rifino, Paul M. Robben, Joy L. Rosenblatt, Kevin M. Ryan, Heather Rybasack-Smith, Richard James Salway, Daniel Samo, Leon D. Sanchez, Shawn M. Sanford, Ritu R. Sarin, Deesha Sarma, Jesse Schacht, Valarie Schwind, Geoffrey L. Shapiro, Joshua Sheehan, Brian Shreve, Grigor Simonyan, Devin M. Smith, E. Reed Smith, MD, Jack E. Smith, MA, Montray Smith, Peter B. Smulowitz, Angela M. Snyder, Joshua J. Solano, Bryan A. Stenson, Charles Stewart, M. Kathleen Stewart, Patrick Sullivan, Jared S. Supple, Derrick Tin, Jonathan Harris Valente, Kathryn M. Vear, P.R. Vidyalakshmi, Faith Vilas, Gary M. Vilke, Janna H. Villano, Amalia Voskanyan, C. James Watson, Nancy Weber, Scott G. Weiner, Brielle Weinstein, Eric S. Weinstein, Jordan R. Werner, Roy Karl Werner, MD, James D. Whitledge, Sage W. Wiener, Lauren Wiesner, Kenneth A. Williams, Robyn Wing, Richard E. Wolfe, Wendy Hin-Wing Wong, Robert Woolard, Prasit Wuthisuthimethawee, and Nadine A. Youssef
- Published
- 2024
8. Mixed effect of increasing outflow of medical patients from an emergency department
- Author
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Gabriel Munter, Todd Zalut, Amos M. Yinnon, David Katz, Ofer Merin, and Joseph Mendlovic
- Subjects
medicine.medical_specialty ,Medicine (General) ,Evening ,Medical patients ,R5-920 ,Health care ,Humans ,Medicine ,Original Research Article ,Israel ,Reimbursement ,Aged ,Morning ,business.industry ,Emergency department ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,Workload ,Overcrowding ,Early morning discharge ,Patient Discharge ,humanities ,Hospitalization ,Crowding ,Emergency medicine ,Length of stay ,Public aspects of medicine ,RA1-1270 ,Emergency Service, Hospital ,business ,Medical departments - Abstract
Background and aim Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25–30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments. Methods We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED. Results Implementation of the first stage led to an increased morning discharge rate from a baseline of 2–4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8–12 per department), providing significant relief for the ED. However, the additional workload for the IM departments’ medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42–44, included constant hallway housing, and often midday peaks of 48–50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning. Conclusion We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.
- Published
- 2021
9. Implementing the Sphere Project’s standards for patient’s healthcare rights in the disaster zone: The experience of the Israeli field hospital in post-quake Nepal
- Author
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Eran Mashiach, Shai Schul, Evan Avraham Alpert, Deganit Kobliner-Friedman, Reuven Kedar, and Ofer Merin
- Subjects
Right to health ,business.industry ,media_common.quotation_subject ,General Medicine ,Certification ,Public relations ,Disasters ,Dignity ,Nepal ,Right to Health ,Informed consent ,Political science ,Health care ,Earthquakes ,Humans ,Confidentiality ,Obligation ,Israel ,business ,Mobile Health Units ,media_common ,Accreditation - Abstract
Emergency medical teams (EMTs) encounter chaos upon arriving at the scene of a disaster. Rescue efforts are utilitarian and focus on providing the technical aspects of medical care in order to save the most lives at the expense of the individual. This often neglects the basic healthcare rights of the patient. The Sphere Project was initiated to develop universal humanitarian standards for disaster response.The increase in the number of EMTs led the World Health Organization (WHO) to organize standards for disaster response. In 2016, the WHO certified the Israel Defense Forces Field Hospital (IDF-FH) as the first to be awarded the highest level of accreditation (EMT-3). This paper presents the IDF-FH’s efforts to protect the patient’s healthcare rights in a disaster zone based on the Sphere Principles.These core Sphere Principles include the right to professional medical treatment; the right to dignity, privacy, and confidentiality; the right for information in an understandable language; the right to informed consent; the obligation to maintain private medical records; the obligation to adhere to universal ethical standards, to respect culture and custom and to care for vulnerable populations; the right to protection from sexual exploitation and violence; and the right to continued treatment.
- Published
- 2021
10. Application of information technology within a field hospital deployment following the January 2010 Haiti earthquake disaster.
- Author
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Gad Levy, Nehemia Blumberg, Yitshak Kreiss, Nachman Ash, and Ofer Merin
- Published
- 2010
- Full Text
- View/download PDF
11. New Trends in Terrorism-Related Injury Mechanisms: Is There a Difference in Injury Severity?
- Author
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Hany Bahouth, Boris Kessel, Igor Jeroukhimov, Adi Givon, Michael Rozenfeld, Yoram Klein, Guy Lin, Avraham I. Rivkind, Gad Shaked, Kobi Peleg, Ofer Merin, Ricardo Alfici, M. Weiss, Milad Karawani, Alexander Becker, Miklosh Bala, Yuri Mnouskin, Dror Soffer, Michael D. Stein, and Galit Sivak
- Subjects
medicine.medical_specialty ,Explosions ,Poison control ,Wounds, Penetrating ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Blast Injuries ,Intensive care ,Injury prevention ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Retrospective Studies ,Multiple Trauma ,business.industry ,Human factors and ergonomics ,030208 emergency & critical care medicine ,social sciences ,Terrorism ,Emergency medicine ,Emergency Medicine ,business ,Automobiles - Abstract
Study objective The latest wave of terrorism worldwide has seen significant use by terrorists of mundane, "low-technology" weapons, such as utility knives and civilian vehicles. How do the injuries they produce compare with that of more conventional terrorism mechanisms, such as use of firearms and explosives? We compare injury patterns of the most frequent terrorism-related injury mechanisms in an Israeli data set. Methods This was a retrospective study of 1,858 patients hospitalized because of terrorism events, which were recorded in the Israeli National Trauma Registry between January 1997 and December 2016. The events were divided into 4 groups based on weapon used: explosions, shootings, stabbings, and vehicular attacks. The groups were compared in terms of injuries sustained, use of hospital resources, and clinical outcomes. Results Explosion-related and vehicular terrorism resulted in a higher proportion of multiple injuries, whereas stabbings and shootings mostly led to isolated injuries. Victims of vehicular attacks had a high proportion of severe head injuries, whereas stabbing victims had a high volume of vascular injuries. All mechanisms involved significant damage to extremities; however, among stabbing victims injury was mainly to the upper extremities, whereas among vehicular attack victims it was mostly to the lower extremities. The overall injury severity of the compared groups was similar, leading to comparable levels of intensive care use and inhospital mortality. Certain similarities in victims' characteristics were observed between the shootings and stabbings and between explosions and vehicular attacks. Conclusion Despite differences between various terrorist attack mechanisms, the resulting injury severity and inhospital mortality are very similar, with stabbings and vehicular attacks causing injuries as serious as those caused by conventional weapons.
- Published
- 2019
12. The need for cardiac surgery differential tariffs in Israel at the era of aging population and emerging technology: Importance of procedure type and patient complexity as assessed by EuroSCORE
- Author
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S. Tager, Shuli Silberman, Ofer Merin, Rachel Tauber, Francis B. Mimouni, Daniel Fink, E. Jacobzon, and Joseph Mendlovic
- Subjects
medicine.medical_specialty ,Medicine (General) ,Aging ,PROCEDURE related group (PRG) ,law.invention ,Cream skimming ,Case mix index ,R5-920 ,law ,medicine ,Humans ,Original Research Article ,Cardiac Surgical Procedures ,Israel ,Fixed cost ,Reimbursement ,health care economics and organizations ,Aged ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,EuroSCORE ,Regression analysis ,Cardiac surgery ,Intensive care unit ,Emergency medicine ,Public aspects of medicine ,RA1-1270 ,business - Abstract
Background Reimbursement for cardiac surgical procedures in Israel is uniform and does not account for diversity in costs of various procedures or for diversity in patient mix. In an era of new and costly technology coupled with higher risk patients needing more complex surgery, these tariffs may not adequately reflect the true financial burden on the caregivers. In the present study we attempt to determine whether case mix and complexity of procedures significantly affect cost to justify differential tariffs. Methods We included all patients undergoing cardiac surgery at Shaare Zedek Medical Center between the years 1993–2016. Patients were stratified according to (1) type of surgery and (2) clinical profile as reflected by the predicted operative risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Approximate cost of each group of patients was estimated by the average number of days in the Intensive Care Unit and days in the postoperative ward multiplied by the respective daily costs as determined by the Ministry of Health. We then added the fixed cost of the components used in the operating room (manpower and disposables). The final estimated cost (the outcome variable) was then evaluated as it relates to type of surgery and clinical profile. ANOVA was used to analyze cost variability between groups, and backward regression analysis to determine the respective effect of the abovementioned variables on cost. Because of non-normal distribution, both costs and lengths of stay were Log-transformed. Results Altogether there were 5496 patients: 3863, 836, 685 and 112 in the isolated CABG, CABG + valve, 1 valve and 2 valves replacement groups. By ANOVA, the costs in all EuroSCORE subgroups were significantly different from each other, increasing with increased EuroSCORE subgroup. Cost was also significantly different among procedure groups, increasing from simple CABG to single valve surgery to CABG + valve surgery to 2-valve surgery. In backward stepwise multiple regression analysis, both type of procedure and EuroSCORE group significantly impacted cost. ICU stay and Ward stay were significantly but weakly related while EuroSCORE subgroup was highly predictive of both ICU stay and ward stay. Conclusions The cost of performing heart surgery today is directly influenced by both patient profile as well as type of surgery, both of which can be quantified. Modern day technology is costly yet has become mandatory. Thus reimbursement for heart surgery should be based on differential criteria, namely clinical risk profile as well as type of surgery. Our results suggest an urgent need for design and implementation of a differential tariff model in the Israeli reimbursement system. We suggest that a model using a fixed, average price according to the type of procedure costs, in addition to a variable hospitalization cost (ICU + ward) determined by the patient EuroSCORE or EuroSCORE subgroup should enable an equitable reimbursement to hospitals, based on their case mix.
- Published
- 2021
13. A nation-wide study on the prevalence of non-collision injuries occurring during use of public buses
- Author
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Yoram Klein, Boris Kessel, M. Weiss, Guy Lin, Michael D. Stein, Dror Soffer, Maya Siman-Tov, Y. Mnouskin, I. Karawani, Inbar Marom, G. Sivak, Hany Bahouth, Avraham I. Rivkind, Igor Jeroukhimov, Alexander Becker, Miklosh Bala, Irina Radomislensky, Ofer Merin, Gad Shaked, Kobi Peleg, and Ori Kapra
- Subjects
Population ,Poison control ,Transportation ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,0502 economics and business ,Injury prevention ,medicine ,030212 general & internal medicine ,Safety, Risk, Reliability and Quality ,education ,050210 logistics & transportation ,education.field_of_study ,business.industry ,Health Policy ,05 social sciences ,technology, industry, and agriculture ,Public Health, Environmental and Occupational Health ,medicine.disease ,Pollution ,Public transport ,Body region ,Medical emergency ,business ,Risk assessment ,human activities ,Safety Research - Abstract
Introduction Bus public transportation is preferred for its perceived safety. Data from several countries, however, alarm of non-collision injuries associated with bus use. The aim of the current study was to estimate the prevalence of non-collision bus injuries, and compare and identify population group at high risk for severe injuries, to serve as a basis for policy makers. Methods A retrospective analysis of the Israeli National Trauma Registry cohort for the years 2015–2017 was carried out. Database consists of 20 hospitals nationwide. Casualties hospitalized following a non-collision injury on a bus were identified. Demographic, injury characteristics, and hospital resources utilization were compared according to the place of injury; inside the bus or during boarding or alighting. Results During follow up, 704 hospitalized non-collision related bus casualties were recorded. Most of the casualties (75%) fell inside the bus and 25% during boarding or alighting. The majority (67%) of hospitalized patients were 60 years old or above, mostly injured while boarding or alighting the bus, and 72% were women. Frequent injured body regions were lower extremities, head and torso. Passengers injured inside bus sustained more chest injuries, but less lower extremities injuries, compared to those boarding or alighting the bus. More hospital resources were required to treat passengers injured while boarding or alighting the bus. Conclusions This systematic registry-based analysis of non-collision bus injuries confirms the greater risk of being injured while using bus transportation among women and older passengers. Primary attention for prevention policies should be given to injuries occurring during boarding or alighting of the bus. Additional policy recommendations are discussed.
- Published
- 2019
14. A look at electric bike casualties: Do they differ from the mechanical bicycle?
- Author
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Maya Siman-Tov, G. Sivak, Hany Bahouth, Y. Mnouskin, Avraham I. Rivkind, Boris Kessel, Alexander Becker, Yoram Klein, Miklosh Bala, Guy Lin, Kobi Peleg, I. Karawani, Dror Soffer, Michael D. Stein, Irina Radomislensky, Igor Jeroukhimov, Gad Shaked, Ofer Merin, and M. Weiss
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Psychological intervention ,Transportation ,Trauma registry ,03 medical and health sciences ,0302 clinical medicine ,Risk groups ,0502 economics and business ,Medicine ,National level ,030212 general & internal medicine ,Young adult ,Safety, Risk, Reliability and Quality ,Prospective cohort study ,Road user ,050210 logistics & transportation ,Rehabilitation ,business.industry ,Health Policy ,05 social sciences ,Public Health, Environmental and Occupational Health ,Pollution ,Emergency medicine ,business ,human activities ,Safety Research - Abstract
Objective To evaluate and compare, at the national level, injury trends and, characteristics and to identify high risk groups of electric bike (E-bike) and mechanical bicycle (M-bike) related hospitalizations as a key message for public policy. Methods Historic prospective study based on data from the Israel National Trauma Registry (INTR), between 1.1.2013 and 31.12.2017. All hospitalized casualties were E-bikers and M-bikers. Results During the study period, 1733 E-bikers and 7259 M-bikers were hospitalized. Arab children (age 0–15) and young adults (age 16–29) were at higher risk for E-bike and M-bike casualties respectively. The hospitalization rate per 1000 vehicles was lower for E-bikers in comparison to M-biker. However, during the five year period a dramatic increase in E-bike related hospitalizations was reported coinciding with a decrease of M-bike related casualties. Among M-bikers, the decrease in hospitalization rate was for accidents on both inter and intra-city roads, but not on unpaved roads, which remained stationary, suggesting that the transportation mode is changing. In comparison to the M-bikers, E-bikers were at greater risk for enduring head injuries (OR 1.16 95% CI 1.00–1.25) and lower extremity injuries (OR 1.37 95% CI 1.23–1.52), to undergone surgery (OR 1.13 95% CI 1.00–1.26), having longer hospital stays (OR 1.44 95% CI 1.23–1.68) and being discharged to rehabilitation center (OR 1.43 95% CI 1.09–1.86). Conclusion During the last five years in Israel there is a dramatic increase in E-bike related hospitalized casualties corresponding to a substantial increase in E-bike usage. In comparison to M-bikers, there is a lower casualty rate but these casualties are more severely injured and utilize more hospital resources. It is of utmost importance to identify these high risk groups in an effort to develop culturally appropriate interventions for these road users, including training, awareness and helmet enforcement. Policy change recommendations are discussed.
- Published
- 2018
15. Ethical Dilemmas in Field Hospital Deployments
- Author
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Avraham Steinberg, Ofer Merin, and Dan Hanfling
- Subjects
Field (Bourdieu) ,Engineering ethics ,Psychology - Published
- 2020
16. Hyponatremia Predicts Poor Outcomes in Patients With Chronic Kidney Disease Undergoing Heart Operation
- Author
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Daniel Fink, Ehud Jacobson, Chani Waldenberg, Ofer Merin, Shuli Silberman, Tal Grenader, Daniel Bitran, and Linda Shavit
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Preoperative Care ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Cardiac Surgical Procedures ,Renal Insufficiency, Chronic ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Incidence ,Acute kidney injury ,EuroSCORE ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Hyponatremia ,business ,Glomerular Filtration Rate ,Low sodium ,Kidney disease - Abstract
Background Preoperative hyponatremia adversely affects outcomes of cardiothoracic operation. However, in patients with chronic kidney disease, the association of sodium levels on postoperative events has never been evaluated. We investigated the impact of preoperative hyponatremia on outcomes after cardiac operation in patients with non–dialysis-dependent chronic kidney disease. Primary end points were operative mortality and acute kidney injury that required dialysis. Secondary end points were major infection and long-term survival. Methods The study is observational and includes all patients with stage III to IV chronic kidney disease (non-dialysis) undergoing cardiac operation between February 2000 and January 2016. Patients were stratified into two groups by preoperative sodium levels: sodium less than 135 mEq/L and sodium of 135 mEq/L or more. Results There were 1,008 patients (mean estimated glomerular filtration rate [GFR]: 43 ± 14 mL • min−1 • 1.73 m−2) with 92 patients (9%) in the low-sodium group. Patients with low sodium had higher operative mortality (p = 0.0004), need for new dialysis (p = 0.0008), and infection (p = 0.002). Predictors of operative mortality were European System for Cardiac Operative Risk Evaluation (EuroSCORE) (hazard ratio [HR] 1.03. 95% confidence interval [CI]: 1.02 to 1.05, p Conclusions Preoperative hyponatremia is a predictor of increased mortality and other adverse events in patients with non–dialysis-dependent chronic kidney disease undergoing cardiac operation. These findings are similar to those in hyponatremic patients without kidney disease.
- Published
- 2018
17. Outcomes of transcatheter aortic valve implantation compared with surgical aortic valve replacement in geriatric patients with chronic kidney disease
- Author
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Daniel Fink, Daniel Bitran, Rachel Tauber, Linda Shavit, Shuli Silberman, and Ofer Merin
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Aortic valve replacement ,Risk Factors ,medicine ,Humans ,In patient ,Hospital Mortality ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Significant difference ,Acute kidney injury ,Aortic Valve Stenosis ,General Medicine ,Prognosis ,medicine.disease ,Cardiac surgery ,Surgery ,Treatment Outcome ,Nephrology ,Aortic Valve ,Aortic valve stenosis ,Female ,business ,Kidney disease - Abstract
Background Transcatheter aortic valve implantation (TAVI) is a less invasive treatment modality for patients with severe aortic valve stenosis (AS) who are at a higher risk if they have surgery. Preoperative chronic kidney disease (CKD) influences outcomes of cardiac surgery and is associated with a higher mortality and more complicated hospital course. The aims of our study were to evaluate the comparative outcomes of TAVI versus surgical aortic valve replacement (SAVR) in geriatric patients with preoperative CKD. Materials and methods We prospectively collected data on patients > 75 years of age who underwent either SAVR or TAVI at Shaare Zedek Medical Center, Jerusalem, Israel. The outcomes studied were postoperative acute kidney injury (AKI), in-hospital and long-term mortality, and major neurologic and infectious morbidity. Results A total of 318 patients were analyzed, of those, 199 and 119 underwent SAVR and TAVI, respectively. In patients with CKD, there was no statistically significant difference in postoperative AKI. SAVR patients had significantly higher in-hospital mortality (OR 5.9; 95% CI 1.6 - 29.6, p = 0.02), postoperative infection (OR 4.2; 95% CI 1.6 - 12.4, p = 0.005), and longer duration of hospital stay. Mortality at 1 and 2 years was lower in the SAVR group, although the difference was not statistically significant (p = 0.059). Conclusion For elderly patients with CKD who are at a higher risk if they have surgery. TAVI offers a good alternative with lower procedural risk. .
- Published
- 2018
18. The spectrum of bacteria and mechanisms of resistance identified from the casualties treated in the Israeli field hospital after the earthquake in Nepal, 2015: A retrospective analysis
- Author
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Eli Schwartz, Tarif Bader, Tamar Lachish, Tami Halperin, Assaf Rokney, Livnat Kashat, Olga Snitser, Marc V. Assous, and Ofer Merin
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Gram-negative bacteria ,medicine.drug_class ,Gram-positive bacteria ,030231 tropical medicine ,Antibiotics ,Drug resistance ,Microbial Sensitivity Tests ,beta-Lactamases ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Nepal ,Drug Resistance, Multiple, Bacterial ,Gram-Negative Bacteria ,medicine ,Earthquakes ,Humans ,030212 general & internal medicine ,Israel ,Retrospective Studies ,biology ,Resistance (ecology) ,Bacteria ,Public Health, Environmental and Occupational Health ,biology.organism_classification ,Enterobacteriaceae ,Anti-Bacterial Agents ,Infectious Diseases ,Mobile Health Units - Abstract
Background On the April 25, 2015, a 7.8 magnitude earthquake struck Nepal. Soon-after, the Israel Defense Force (IDF) dispatched a tertiary field-hospital to Kathmandu. The field-hospital was equipped with a clinical laboratory with microbiology capabilities. Limited data exists regarding the spectrum of bacteria isolated from earthquake casualties. We aimed to identify the spectrum of bacteria and their mechanisms of resistance in-order to allow preparedness of antibiotic treatment protocols for future disaster scenarios. Methods – The field-laboratory phenotypically processed cultures from sterile and non-sterile sites as needed clinically. Later-on, the isolates were brought to Israel for quality control, definite identification and molecular characterization including mechanisms of resistance. Results A total of 82 clinical pathogens were isolated from 56 patients; 68% of them were Gram negative bacilli. The most common isolates were Enterobacteriaceae (55%) −36% carried bla-NDM and 33% produced Extended-spectrum beta-lactamase (ESBL), mostly blaCTX-M-15. Enterococcus spp were the main Gram positive bacteria isolated (22 isolates), yet, none were vancomycin resistant. The overall level of resistance was 27% MDR and 23% extensively drug resistant (XDR) bacteria. Conclusions – Gram negative bacteria were the predominant organism cultured from the casualties, of them 77% were MDR or XDR. NDM was the most common resistance mechanism. The Antibiotic inventory of a field-hospital should be set to cover a wide and unexpected spectrum of bacteria, including resistant organisms. This report adds important information to the scarce reports of bacterial resistance in Nepal.
- Published
- 2019
19. Preoperative aldosterone receptor blockade and outcomes of cardiac surgery in patients with chronic kidney disease
- Author
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Rachel Tauber, Ofer Merin, Daniel Bitran, Linda Shavit, Shuli Silberman, and Daniel Fink
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac Output, Low ,Spironolactone ,030204 cardiovascular system & hematology ,Preoperative care ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,Preoperative Care ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Cardiac Surgical Procedures ,Renal Insufficiency, Chronic ,Propensity Score ,Dialysis ,Aged ,Mineralocorticoid Receptor Antagonists ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Acute kidney injury ,Retrospective cohort study ,EuroSCORE ,General Medicine ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Cardiac surgery ,Nephrology ,Cardiology ,Female ,business ,Kidney disease - Abstract
BACKGROUND AND AIMS Recent clinical evidence demonstrates that chronic low-dose mineralocorticoid receptor antagonists (MRA), when added to optimal treatment, result in reductions in cardiovascular mortality. However, continuation of MRAs before cardiac surgery in patients with CKD has never been evaluated and its potential benefit or harm in this specific clinical setting is largely unknown. MATERIALS AND METHODS This is an observational study that included adult CKD patients undergoing cardiac surgery. Patients were divided into two groups according to preoperative use of spironolactone (SPL). The studied outcomes were postoperative acute kidney injury (AKI) requiring dialysis, mortality, and major morbidities (cardiovascular, neurologic, and infectious). RESULTS Data on 698 patients with preoperative CKD stage III and IV were analyzed: 99 received SPL preoperatively and 599 did not. At baseline, patients on SPL had higher EuroScore and had more complicated surgery. No significant differences in the incidence of postoperative AKI, myocardial infarction (MI), cardiovascular accident (CVA), sepsis, and mortality were detected between groups in both univariate and multivariate analyses. However, incidence of postoperative low cardiac output state (p
- Published
- 2018
20. Neutrophil-Lymphocyte Ratio: Prognostic Impact in Heart Surgery. Early Outcomes and Late Survival
- Author
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Linda Shavit, Ulfat Abu-Yunis, Rachel Tauber, Daniel Fink, Daniel Bitran, Tal Grenader, Shuli Silberman, and Ofer Merin
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart Diseases ,Neutrophils ,Lymphocyte ,030204 cardiovascular system & hematology ,Disease-Free Survival ,Leukocyte Count ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,In patient ,Lymphocytes ,Cardiac Surgical Procedures ,Israel ,Aged ,Retrospective Studies ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,fungi ,Retrospective cohort study ,Middle Aged ,Prognosis ,Predictive value ,Surgery ,Cardiac surgery ,Survival Rate ,medicine.anatomical_structure ,ROC Curve ,030220 oncology & carcinogenesis ,Preoperative Period ,Female ,Christian ministry ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
The neutrophil-lymphocyte ratio (NLR) is a recognized marker of inflammation associated with poor outcomes in various clinical situations. We analyzed the prognostic significance of preoperative elevated NLR in patients undergoing cardiac surgery.We performed a retrospective review of 3,027 consecutive patients undergoing cardiac surgery. Receiver-operating-characteristic was used to determine the cutoff value for elevated NLR. Multivariate regression was used to determine the predictive value of preoperative NLR on clinical outcomes. Cox proportional hazards functions were used to determine predictors of late events. Late survival data to 16 years was obtained from the Ministry of Interior.The cutoff value for elevated NLR was 2.6. Patients with elevated NLR were older (p0.0001), had a higher incidence of cardiac comorbidity (p0.0001), and higher European System for Cardiac Operative Risk Evaluation score (p0.0001). An elevated NLR emerged as an independent predictor of operative mortality (hazard ratio [HR] 2.15, 95% confidence interval [CI]: 1.51 to 3.08, p0.0001); pleural effusion (HR 1.42, 95% CI: 1.13 to 1.80, p = 0.003); low output syndrome (HR 1.54, 95% CI: 1.23 to 1.93, p = 0.0002); prolonged ventilation (HR 1.49, 95% CI: 1.23 to 1.82, p = 0.0001); or composite outcomes (HR 1.61, 95% CI: 1.36 to 1.91, p 0.0001). The NLR emerged as an independent predictor of late mortality (HR 1.19, 95% CI: 1.11 to 1.28; p0.0001).Elevated NLR is associated with a higher incidence of adverse outcomes after cardiac surgery. It is a predictor of operative as well as late mortality. Further studies are warranted to determine whether prophylactic treatment with antiinflammatory agents can prevent such outcomes. It may be warranted to include the baseline NLR as another variable in risk stratification of patients about to undergo cardiac surgery.
- Published
- 2018
21. Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades
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Samuel N. Heyman, Tarif Bader, Michael Naor, and Ofer Merin
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Male ,media_common.quotation_subject ,Personnel Staffing and Scheduling ,0211 other engineering and technologies ,02 engineering and technology ,Hospitals, Military ,Military medicine ,Disasters ,Body of knowledge ,03 medical and health sciences ,0302 clinical medicine ,Medical Staff, Hospital ,Humans ,Operations management ,030212 general & internal medicine ,Israel ,Function (engineering) ,media_common ,Improvisation ,Flexibility (engineering) ,021110 strategic, defence & security studies ,Emergency management ,Hospitals, Packaged ,business.industry ,Principal (computer security) ,Medical Missions ,General Medicine ,Relief Work ,Health Planning ,Software deployment ,Female ,business ,Mobile Health Units - Abstract
Objective: The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide. Methods: Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions. Results: A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers. Conclusion: The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.
- Published
- 2017
22. Terrorist Stabbings—Distinctive Characteristics and How to Prepare for Them
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Adi Leiba, Alon D Schwarz, Avraham Yitzhak, Roman Sonkin, Eli Jaffe, Ofer Merin, and Hagai Frenkel
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Poison control ,Wounds, Stab ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Injury prevention ,medicine ,Emergency medical services ,Humans ,030212 general & internal medicine ,Israel ,Child ,Stab wound ,Aged ,Retrospective Studies ,business.industry ,Civil Defense ,030208 emergency & critical care medicine ,social sciences ,Middle Aged ,medicine.disease ,Surgery ,body regions ,Preparedness ,Terrorism ,cardiovascular system ,Emergency Medicine ,Female ,Medical emergency ,Emergency Service, Hospital ,business - Abstract
Background The number of terror attack incidents is on the increase worldwide. The knife is one of the weapons most commonly used among terrorists. Appropriate preparation in trauma units for coping with the increasing numbers of terrorist-inflicted stabbings is different from the preparation suitable for civilian stabbings. Therapeutic and logistic guidelines need to be adjusted to accommodate those differences. Objectives: Characterize the unique injuries related to terrorist stabbing, and suggest preparedness actions. Methods Retrospective data on all terrorist-inflicted stabbing incidents between September 2015 and May 2016 were retrieved from the database of the national Israeli emergency medical services and from the Israeli Defense Forces Medical Corps records. Results There were a total of 414 civilian victims (34 fatalities) of terror incidents. Of these, 161 involved stabbings during 106 separate incidents. There was more than 1 stab wound per patient in approximately 60% of cases, and more than 1 victim in approximately 40% of cases. Unlike civilian stabbings, terrorist stabbings were characterized by more commonly occurring to the upper part of the body, being executed by large knives with high force, and involving multiple and more severe injuries. Conclusion There is a clear distinction between the characteristics of wounds resulting from civilian stabbings and those incurred by acts of terror. Terrorists intend to injure as many random victims as possible, and trauma units need to be prepared to cope with the simultaneous admission of multiple patients with penetrating and often life-threatening knife wounds.
- Published
- 2017
23. Internet-delivered computerized cognitiveaffective remediation training for the treatment of acute and chronic posttraumatic stress disorder: Two randomized clinical trials
- Author
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Gregory A. Fonzo, Ofer Merin, Michal Achituv, Rachael Wright, Naomi B. Fine, Arieh Y. Shalev, Yevgeniya V. Zaiko, and Amit Etkin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Chronic posttraumatic stress disorder ,Psychological intervention ,MEDLINE ,law.invention ,Stress Disorders, Post-Traumatic ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,Outcome Assessment, Health Care ,Medicine ,Humans ,Biological Psychiatry ,Cognitive Behavioral Therapy ,business.industry ,Internet delivered ,Cognition ,Fear ,Middle Aged ,Cognitive Remediation ,030227 psychiatry ,Facial Expression ,Psychiatry and Mental health ,Posttraumatic stress ,Acute Disease ,Chronic Disease ,Physical therapy ,Female ,business ,Facial Recognition ,030217 neurology & neurosurgery ,Internet-Based Intervention - Abstract
Treatment of posttraumatic stress disorder (PTSD) is time and cost-intensive. New, readily implementable interventions are needed. Two parallel randomized clinical trials tested if cognitive/affective computerized training improves cognitive/affective functions and PTSD symptoms in acute (N = 80) and chronic PTSD (N = 84). Adults age 18-65 were recruited from an Israeli hospital emergency room (acute) or from across the United States (chronic). Individuals were randomized to an active intervention (acute N = 50, chronic N = 48) that adaptively trains cognition and an affective positivity bias, or a control intervention (acute N = 30, chronic N = 36) of engaging computer games. Participants, blind to assignment, completed exercises at home for 30 min/day over 30 days (acute) or 45 min/day over 45 days (chronic). Primary outcomes were computerized cognitive/affective function metrics. Secondary outcomes were Clinician-Administered PTSD Scale (CAPS) total scores. In chronic PTSD, the active arm demonstrated facilitated speed of fearful face identification (F = 20.96, q 0.001; d = 1.21) and a trend towards improvement in total PTSD symptoms (F = 2.91, p = 0.09, d = 0.47), which was due to improvement in re-experiencing symptoms (F = 6.14, p = 0.015; d = 0.73). Better cognitive performance at baseline moderated the training effect and was associated with more favorable improvements on both metrics. Cognitive and affective training does not have widespread benefit on symptoms and cognitive/affective functions in PTSD. Future studies targeting re-experiencing a priori, stratifying on cognitive capacity, and with modified methods to infer on mechanisms and optimized training parameters may be warranted. ClinicalTrials.gov Identifiers: NCT01694316NCT02085512.
- Published
- 2019
24. Emergency with Resiliency Equals Efficiency - Challenges of an EMT-3 in Nepal
- Author
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Avraham Yitzhak, Ofer Merin, Bader Tarif, and Jonathan Halevy
- Subjects
Adult ,Male ,Emergency Medical Services ,International Cooperation ,0211 other engineering and technologies ,Disaster Planning ,02 engineering and technology ,Emergency Nursing ,Hospitalization rate ,law.invention ,03 medical and health sciences ,Disaster area ,Young Adult ,0302 clinical medicine ,Nepal ,law ,medicine ,Earthquakes ,Humans ,030212 general & internal medicine ,Israel ,021110 strategic, defence & security studies ,Wound debridement ,business.industry ,Middle Aged ,medicine.disease ,Intensive care unit ,Emergency Medicine ,Wounds and Injuries ,Medical team ,Female ,Medical emergency ,business - Abstract
The 7.8 MW (moment magnitude scale) earthquake that hit Nepal on April 25, 2015 caused significant casualties and serious damage to infrastructure.The Israeli Emergency Medical Team (IEMT; later verified as EMT-3) was deployed 80 hours after the earthquake. A Forward Disaster Scout Team (FDST) that was dispatched to the disaster area a few hours after the disaster relayed pre-deployment information.The EMT staff was comprised of 42 physicians. A total of 1,668 patients were treated. The number of non-trauma cases increased as the days went by. The hospitalization rate was 31%. Wound debridement procedures were the most common operations performed.YitzhakA, MerinO, HalevyJ, TarifB. Emergency with resiliency equals efficiency- challenges of an EMT-3 in Nepal. Prehosp Disaster Med. 2018;33(6):673–677.
- Published
- 2018
25. Are casualties from mass-casualty Motor Vehicle Crashes different from casualties of other Motor Vehicle Crashes?
- Author
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Alexander Becker, I. Grevtsev, N. Abbod, Michael D. Stein, Gad Shaked, Ofer Merin, Igor Jeroukhimov, A. Schwartz, A. Braslavsky, M. Weiss, Adi Givon, Kobi Peleg, Yoram Klein, M. Ben Eli, Boris Kessel, Avraham I. Rivkind, Hany Bahouth, Y. Mnouskin, M. Karawani, Moran Bodas, Guy Lin, Dror Soffer, and Miklosh Bala
- Subjects
medicine.medical_specialty ,Population ,Transportation ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,medicine ,030212 general & internal medicine ,Safety, Risk, Reliability and Quality ,education ,education.field_of_study ,business.industry ,Health Policy ,Mortality rate ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,Retrospective cohort study ,Mass Casualty ,Pollution ,Mass-casualty incident ,Emergency medicine ,Body region ,business ,human activities ,Safety Research ,Motor vehicle crash - Abstract
Introduction Mass Casualty Incidents (MCI) by Motor Vehicle Crashes (MVCs) are most common type of MCIs. Casualties from MCIs usually require more hospitalization resources. The purpose of this study was to compare the injury characteristics, survivability, and medical resource utilization of casualties from Mass-Casualty Motor Vehicle Crashes (MC-MVCs) and casualties from other (non MCI) MVCs. Methods This retrospective cohort study examined a population of 50,321 Israeli casualties hospitalized due to MVCs between 1998 and 2017, of which 595 (1.2%) were admitted from a MC-MVC. Analysis included type of motor vehicle involved and collision circumstances, injury characteristics, hospital resource utilization, and demographics. Results The results suggest that most casualties from MC-MVCs were bus passengers who were injured when the vehicle rolled over. Injuries from MC-MVCs were more urgent as almost two times more MC-MVCs casualties were rushed directly from the emergency room into the operating rooms and intensive care units than casualties of regular MVCs. Mortality rate was higher in MC-MVCs compared to regular MVCs (2.69% compared to 1.46%, respectively; p = .013). Severe injuries (ISS≥16) were more frequent in MC-MVCs (23.40% versus 15.53%, p Conclusions This study demonstrates that hospitals receiving casualties from MC-MVCs should expect not only a multitude of casualties, rather also the need to treat more urgent and severe injuries, in more body regions per casualty, and expect higher admissions rates to intensive care units and operation rooms under MCI conditions.
- Published
- 2020
26. Planning the unplanned: The role of a forward scout team in disaster areas
- Author
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Avraham Yitzhak, Bader Tarif, Ofer Merin, and David Dagan
- Subjects
Engineering ,business.industry ,030208 emergency & critical care medicine ,Geology ,Plan (drawing) ,Geotechnical Engineering and Engineering Geology ,Checklist ,Task (project management) ,03 medical and health sciences ,0302 clinical medicine ,Software deployment ,Order (business) ,Operations management ,Medical team ,030212 general & internal medicine ,business ,Safety Research ,Situation analysis - Abstract
Planning the mode of operation, manpower, and equipment, for a foreign medical team in a disaster-stricken area can be a difficult task, due to the chaotic nature of disasters. The important objective of arriving to the disaster-stricken area as soon as possible, in order to assist to as many victims as possible, is in constant tension with another important objective of arriving fully equipped and ready to such areas. Forward disaster scout teams (FDSTs) dispatched a few hours after the disaster are able to help plan foreign medical teams (FMTs) by gathering and relaying preliminary information after performing a situation analysis, locating the site of deployment for the FMT, and enabling logistic self-sufficiency. The purpose of this article is to share the lessons we have learned from our relatively long-standing experience of deployments in disaster-stricken areas. We also recommend a “to-do” checklist for FDSTs so that they perform their task of facilitating FMT readiness effectively.
- Published
- 2016
27. Ethical and Surgical Dilemmas in Patients with Neglected Surgical Diseases Visiting a Field Hospital in a Zone of Recent Disaster
- Author
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David Dagan, Guy Lin, Tal Marom, and Ofer Merin
- Subjects
medicine.medical_specialty ,Philippines ,Alternative medicine ,Medically Underserved Area ,Poison control ,030204 cardiovascular system & hematology ,Suicide prevention ,Occupational safety and health ,Disasters ,03 medical and health sciences ,0302 clinical medicine ,Poverty Areas ,Injury prevention ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Child ,Retrospective Studies ,Medical treatment ,Cyclonic Storms ,business.industry ,Neglected Diseases ,Human factors and ergonomics ,medicine.disease ,Surgery ,Surgical Procedures, Operative ,Chronic Disease ,Female ,Medical emergency ,business ,Mobile Health Units - Abstract
The massive typhoon Haiyan (Yolanda) ripped across the central Philippines on November 8, 2013, and damaged infrastructure including hospitals. The Israeli Defense Forces field hospital was directed by the Philippine authorities to Bogo City in the northern part of the island of Cebu, to assist the damaged local hospital. Hundreds of patients with neglected diseases sought for medical treatment which was merely out of reach for them. Our ethical dilemmas were whether to intervene, when the treatment we could offer was not the best possible.Each patient had an electronic medical record that included diagnosis, management and aftercare instructions. We retrospectively reviewed all charts of patients.Over 200 patients presented with neglected chronic diseases (tuberculosis, goiter, hypertension and diabetes). We limited our intervention to extreme values of glucose and blood pressure. We had started anti-tuberculosis medications, hoping that the patients will have an option to continue treatment. We examined 85 patients with a presumed diagnosis of malignancy. Without histopathology and advanced imaging modality, we performed palliative operations on three patients. Eighteen patients presented with inguinal hernia. We performed pure tissue repair on seven patients with large symptomatic hernias. We examined 12 children with cleft lip/palate and transferred two of them to Israel. We operated on one child with bilateral club feet. Out of 37 patients with pterygium, our ophthalmologist repaired the nine patients with the most severe vision disturbance.Medical delegations to disaster areas should prepare a plan and appropriate measures to deal with non-urgent diseases.
- Published
- 2016
28. Challenges in Implementing International Standards for the Field Hospital Emergency Department in a Disaster Zone: The Israeli Experience
- Author
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Deganit Kobliner, Ofer Merin, Eran Mashiach, Tarif Bader, Giora Weiser, Eran Tal-Or, and Evan Avraham Alpert
- Subjects
Emergency Medical Services ,Referral ,media_common.quotation_subject ,International Cooperation ,Language barrier ,Disaster Planning ,Certification ,Disasters ,03 medical and health sciences ,0302 clinical medicine ,Cultural diversity ,medicine ,Humans ,030212 general & internal medicine ,Israel ,Sophistication ,Accreditation ,media_common ,business.industry ,030208 emergency & critical care medicine ,Emergency department ,medicine.disease ,Triage ,Emergency Medicine ,Medical emergency ,business ,Mobile Health Units - Abstract
Background Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpatient as well as inpatient surgical emergency care in addition to inpatient referral care. In November 2016, the WHO certified the Israel Defense Forces Field Hospital as the first FMT Type-3. Objectives The objectives of this article are to describe the challenges in implementing these international standards for the field hospital emergency department in a disaster zone. Discussion There are general standards for all levels of FMTs, as well as specific requirements for the FMT-3. These include a mechanism of appropriate triage, two operating suites, 40 regular beds, four to six intensive care unit beds, radiology facilities, and various staff specialties. Despite the sophistication of the field hospital, there are many challenges. Logistical challenges include constructing the hospital in a disaster zone and equipment issues. There are staff challenges such as becoming oriented to a new and difficult environment. Patient challenges include cultural differences, language barriers, and issues of follow-up. There are often ethical challenges unique to the disaster zone. Conclusion By presenting the experience and challenges of the first FMT Type-3, we hope that more countries can join this initiative and improve disaster care throughout the world.
- Published
- 2018
29. Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol
- Author
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Amit Etkin, Ofer Merin, Michal Achituv, Arieh Y. Shalev, and Naomi B. Fine
- Subjects
lcsh:RC435-571 ,neuroplasticity ,emotional regulation ,Psychological intervention ,Review Article ,神经可塑性 ,Burnout ,认知情感矫正 ,情绪调节 ,Study Protocol ,03 medical and health sciences ,cognitive-affective remediation ,0302 clinical medicine ,lcsh:Psychiatry ,Intervention (counseling) ,执行功能 ,emotion bias ,Post-traumatic stress disorder ,función ejecutiva ,Retraining ,Cognition ,regulación emocional ,Executive functions ,030227 psychiatry ,reparación cognitivo-afectiva ,• Protocol of early neurocognitive intervention for acute trauma.• Study rational and design.• Barriers and challenges to early computerized neurocognitive intervention: specifically ,participant enrolment, efficient implementation and management of daily self-administered, web-based intervention, reliable and timely screening and in-depth assessment of survivors at significant risk of PTSD and defining control conditions.• Discussion of assessment and outcome measures ,executive function ,Cognitive remediation therapy ,创伤后应激障碍 ,neuroplasticidad ,情绪偏差 ,sesgo emocional ,Trastorno por estrés postraumático ,Psychology ,Neurocognitive ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
El período inmediatamente posterior a los eventos traumáticos es un período de mayor plasticidad neuronal, después del cual algunos sobrevivientes siguen con trastorno de estrés postraumático (TEPT) mientras que otros se recuperan. La evidencia señala que las deficiencias en reactividad emocional, regulación de las emociones y funciones ejecutivas más amplias contribuyen de manera crítica al TEPT. La evidencia que comienza a hacer su aparición sugiere además que los mecanismos neuronales que subyacen a estas funciones siguen siendo plásticos en la edad adulta y que la reeducación específica de estos sistemas puede mejorar su eficacia y reducir la probabilidad de desarrollar un TEPT. La administración de entrenamiento neurocognitivo específico poco después de la exposición al trauma es un desafío desalentador. Este trabajo describe un diseño de estudio que aborda ese desafío. El estudio evaluó los efectos directos del entrenamiento en reparación cognitiva sobre los mecanismos neurocognitivos que hipotéticamente subyacen al TEPT y el efecto indirecto de esta intervención en los síntomas de TEPT que surgen. Método: Describimos una justificación para el estudio, unas opciones de diseño y una metodología que implican (a) inscribir a los participantes; (b) implementar y administrar una intervención diaria autoadministrada, basada en la web; (c) detectar y evaluar, de modo oportuno y fiable, el tratamiento de los sobrevivientes que resultan elegibles; y (d) definir las condiciones de control y las medidas de los resultados. Resumimos la justificación de las decisiones que se tomaron con respecto a la muestra del estudio, el momento de la intervención, las mediciones, el seguimiento del compromiso de los participantes y el modo de armonizar y retener la fidelidad de los entrevistadores y mitigar el agotamiento debido al contacto repetido con sobrevivientes recientemente traumatizados. Conclusión: las intervenciones tempranas basadas en la web que se dirigen a los mecanismos que causan el TEPT pueden basarse en el modelo presentado en este documento.发生创伤事件之后的短时期内神经可塑性得到增强,在此之后有些幸存者出现创伤后应激障碍(PTSD),而有的则会康复。有证据指出,情绪反应、情绪调节和广义的执行功能损伤是造成 PTSD 的关键。越来越多的证据进一步指出,这些功能背后的神经功能在成年期依然保持可塑性,针对这些系统的再训练可能提高它们的效能,并减少出现 PTSD 的可能性。在创伤暴露后的短期内进行神经认知训练是个充满挫败的挑战。本文描述的研究设计将应对这项挑战。本研究评估了认知矫正训练对PTSD理论上的神经认知机制的直接效果,和间接干预正在出现的 PTSD 症状的效果。方法:我们描述了研究原理、设计和方法选择,包括a)被试招募; b)实施和管理一个每天进行的自助网络干预; c)对合适的幸存者进行可靠及时的筛选和治疗评估;d) 定义控制条件和结果测量。我们列出了关于研究样本、干预时间、测量、评估被试配合度的选择背后的原理,以及如何平衡和保持面试者的真实性、通过反复联系最近经历创伤的幸存者达到减轻其倦怠的方法。结论:本文描述了一个针对 PTSD的致病机制的早期网络干预模型。.
- Published
- 2018
30. Preoperative Hemoglobin and Outcomes in Patients with CKD Undergoing Cardiac Surgery
- Author
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Daniel Bitran, Daniel Fink, Sharbel Hitti, Meyer D. Lifschitz, Itzchak Slotki, Linda Shavit, Rachel Tauber, Ofer Merin, and Shuli Silberman
- Subjects
Male ,medicine.medical_specialty ,Epidemiology ,Anemia ,Population ,Critical Care and Intensive Care Medicine ,Preoperative care ,Hemoglobins ,Postoperative Complications ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Renal Insufficiency, Chronic ,Prospective cohort study ,education ,Aged ,Transplantation ,Univariate analysis ,education.field_of_study ,business.industry ,Original Articles ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Treatment Outcome ,Nephrology ,Cardiothoracic surgery ,Female ,business - Abstract
Preoperative anemia adversely affects outcomes of cardiothoracic surgery. However, in patients with CKD, treating anemia to a target of normal hemoglobin has been associated with increased risk of adverse cardiac and cerebrovascular events. We investigated the association between preoperative hemoglobin and outcomes of cardiac surgery in patients with CKD and assessed whether there was a level of preoperative hemoglobin below which the incidence of adverse surgical outcomes increases.This prospective observational study included adult patients with CKD stages 3-5 (eGFR60 ml/min per 1.73 m(2)) undergoing cardiac surgery from February 2000 to January 2010. Patients were classified into four groups stratified by preoperative hemoglobin level:10, 10-11.9, 12-13.9, and ≥ 14 g/dl. The outcomes were postoperative AKI requiring dialysis, sepsis, cerebrovascular accident, and mortality.In total, 788 patients with a mean eGFR of 43.5 ± 3.7 ml/min per 1.73 m(2) were evaluated, of whom 22.5% had preoperative hemoglobin within the normal range (men: 14-18 g/dl; women: 12-16 g/dl). Univariate analysis revealed an inverse relationship between the incidence of all adverse postoperative outcomes and hemoglobin level. Using hemoglobin as a continuous variable, multivariate logistic regression analysis showed a proportionally greater frequency of all adverse postoperative outcomes per 1-g/dl decrement of preoperative hemoglobin (mortality: odds ratio, 1.38; 95% confidence interval, 1.23 to 1.57; P0.001; sepsis: odds ratio, 1.31; 95% confidence interval, 1.14 to 1.49; P0.001; cerebrovascular accident: odds ratio, 1.31; 95% confidence interval, 1.00 to 1.67; P=0.03; postoperative hemodialysis: odds ratio, 1.38; 95% confidence interval, 1.11 to 1.75; P0.01). Moreover, preoperative hemoglobin12 g/dl was an independent risk factor for postoperative mortality (odds ratio, 2.6; 95% confidence interval, 1.1 to 7.3; P=0.04).Similar to the general population, preoperative anemia is associated with adverse postoperative outcomes in patients with CKD. Whether outcomes could be improved by therapeutically targeting higher preoperative hemoglobin levels before cardiac surgery in patients with underlying CKD remains to be determined.
- Published
- 2014
31. Lessons Learned From an Obstetrics and Gynecology Field Hospital Response to Natural Disasters
- Author
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Yitshak Kreiss, Shir Dar, Doron Goldberg, Ophir Cohen-Marom, Ofer Merin, Moshe Pinkert, and Avi Abargel
- Subjects
Male ,medicine.medical_specialty ,education ,Poison control ,Economic shortage ,Suicide prevention ,Occupational safety and health ,Disasters ,Obstetrics and gynaecology ,Pregnancy ,Injury prevention ,medicine ,Humans ,Natural disaster ,Highly skilled ,Humanitarian aid ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Human factors and ergonomics ,Delivery, Obstetric ,medicine.disease ,Obstetrics ,Pregnancy Complications ,Gynecology ,Emergency medicine ,Female ,Medical emergency ,business ,Limited resources ,Mobile Health Units - Abstract
Field hospitals were deployed by the Israel Defense Forces as part of the international relief efforts after major seismic events, one in Haiti (2010) and one in Japan (2011). The teams treated a total of 44 pregnant and 24 nonpregnant women and performed 16 deliveries and three cesarean deliveries under extreme conditions. Half of all deliveries were complicated by preeclampsia and 31% were preterm (at 30-32 weeks of gestation). It is imperative that obstetrician-gynecologists be included among humanitarian aid delegations sent to sites of natural disasters. The complicated cases we encountered required highly skilled obstetricians and led to a shortage of specific medications for these women. Cases that would have been considered routine under normal conditions created unanticipated ethical and practical issues in the face of very limited resources. The aim of this commentary is to share the experiences and lessons learned by our field hospital obstetrics and gynecology teams after the major earthquakes in Haiti and Japan. We present what we consider to be the 10 most important lessons learned and propose that they serve as guidelines in preparing for essential needs in other natural disaster settings.
- Published
- 2013
32. Morbidity among the Israeli Defense Force response team during Nepal, post-earthquake mission, 2015
- Author
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Eli Schwartz, Ofer Merin, Aviad Bar, Tamar Lachish, and Heli Alalouf
- Subjects
Adult ,Male ,education ,030231 tropical medicine ,Developing country ,Economic shortage ,Public healthcare ,03 medical and health sciences ,Potable water ,0302 clinical medicine ,Nepal ,Environmental health ,Surveys and Questionnaires ,Earthquakes ,Medicine ,Humans ,030212 general & internal medicine ,Israel ,Travel ,Chi-Square Distribution ,business.industry ,Significant difference ,General Medicine ,medicine.disease ,Relief Work ,Military Personnel ,Female ,Medical emergency ,Morbidity ,business ,Mobile Health Units ,Personnel hospital - Abstract
Background On 25 April 2015, a 7.8-magnitude earthquake struck Nepal. Soon after, the Israel Defense Force (IDF) dispatched a rapid-response team and opened a tertiary field hospital in Kathmandu. There is limited data regarding the spectrum of diseases among rescue teams to disease-stricken areas. The aim of this study was to assess the morbidity among the field-hospital staff during the mission. Methods The rescue team was deployed for a 2-week mission in Kathmandu. Pre-travel vaccinations were given prior to departure. The field-hospital was self-equipped including food and drinking water supply with a self-serving kitchen, yet had a shortage of running water. A Public Healthcare and Infectious-Diseases team was present and active during the entire mission. A survey assessing the morbidities and risk-factors throughout the mission was performed at the last day. Results One hundred thirty-seven (69%) team members completed the questionnaire. Medical complaints were recorded in 87 of them (64%). The most common symptoms were gastrointestinal (GI) (53% of all responders, 84% of the 87 with symptoms). Respiratory symptoms were recorded in 16% and fever in only 8%. There was no significant difference in the rate or spectrum of morbidity between the medical and the non-medical staff. Conclusions The Israeli field hospital was a stand-alone facility, yet 53% of its' staff suffered from GI complaints. Prevention of morbidity and specifically of GI complaints upon arrival to a disaster-stricken area in a developing country is difficult. Medical teams in such missions should be acquainted with treating GI complaints.
- Published
- 2016
33. Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention
- Author
-
Oded Olsha, Kobi Peleg, Alexander Becker, Adi Givon, Ofer Merin, William P. Schecter, Michael Stein, Avraham I. Rivkind, M. Weiss, Igor Jeroukhimov, Boris Kessel, Yoram Klein, Hany Bahouth, Fernando Turégano-Fuentes, Michael Ben Ely, Y. Mnouskin, Itamar Ashkenazi, Guy Lin, Gad Shaked, Alexander Braslavsky, Dror Soffer, Ricardo Alfici, Milad Qarawany, and Miklosh Bala
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Intracranial Pressure ,Traumatic brain injury ,medicine.medical_treatment ,Poison control ,Explosions ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Blast Injuries ,Injury prevention ,Brain Injuries, Traumatic ,medicine ,Humans ,Glasgow Coma Scale ,Young adult ,Israel ,Child ,Craniotomy ,Aged ,Monitoring, Physiologic ,Aged, 80 and over ,business.industry ,Head injury ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Triage ,nervous system ,Child, Preschool ,Emergency medicine ,Physical therapy ,Surgery ,Female ,Terrorism ,business ,030217 neurology & neurosurgery ,Needs Assessment - Abstract
Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion.To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention.Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015.Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score.Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores.Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.
- Published
- 2016
34. [LESSONS FROM PREPAREDNESS OF HOSPITALS TO SNOWSTORMS]
- Author
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Ofer, Merin, Sara, Goldberg, Amos, Peyser, Moshe, Gros, Gali, Weiss, Aria, Bitan, Salman, Zarka, and Kelin, Shapira
- Subjects
Disasters ,Snow ,Humans ,Disaster Planning ,Israel ,Hospitals - Abstract
Snowstorms are not a usual scene in Israel, which normally enjoys relatively warm weather, even in the winter. In the last two years we faced three severe snowstorms that had a major impact on the routine daily life in Israel. Roads were blocked, people experienced long electricity power failures, and secondary to slippery conditions, there was more than a threefold increase of orthopedic injuries. These storms confronted hospitals with unique challenges, both medical and logistic. Hospitals must be prepared to cope with the challenge of maintaining continuation of care. We propose four phases of preparedness strategy: at the beginning of the winter, once there is a weather forecast warning, during the storm itself, and returning to norm. This manuscript deals with the lessons learned by two hospitals in Safed and Jerusalem dealing with snowstorms.
- Published
- 2016
35. Pediatric ventilation in a disaster
- Author
-
Ofer Merin, Tarif Bader, Amir Ytzhak, Yitshak Kreiss, Amit Assa, Alon Farfel, and Ram Sagi
- Subjects
Male ,Critical Illness ,Decision Making ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Sampling Studies ,Task (project management) ,law.invention ,Resource (project management) ,law ,Patient-Centered Care ,Intensive care ,Earthquakes ,Humans ,Mass Casualty Incidents ,Medicine ,Israel ,Child ,Mass disaster ,Retrospective Studies ,Abdomen, Acute ,Asphyxia Neonatorum ,Respiratory Distress Syndrome, Newborn ,Hospitals, Packaged ,business.industry ,Ethical decision ,Infant, Newborn ,Infant ,Pneumonia ,Prognosis ,medicine.disease ,Respiration, Artificial ,Haiti ,Myocarditis ,Mass-casualty incident ,Child, Preschool ,Ventilation (architecture) ,Female ,Medical emergency ,Emergencies ,Triage ,Risk assessment ,business ,Infant, Premature - Abstract
Medical resources may be overwhelmed in a mass disaster situation. Intensive care resources may be limited even further. When the demand for a certain resource, like ventilators, exceeds its availability, caregivers are faced with the task of deciding how to distribute this resource.Ethical dilemmas arise when a practical decision necessitates ranking the importance of several ethical principles. In a disaster area, the greatest good for the greatest number principle and the goal of equal distribution of resources may take priority over the needs of the individual. Nonetheless, regardless of the interventions available, it is a prime goal to keep the patients' comfort and dignity as much as possible.In the mass disaster of the Haiti earthquake of January 2010, The Israeli Defense Forces Medical Corps field hospital was one of the first to respond to the call for help of the Haitian people with surgical and intensive care capabilities. It was the only facility able to ventilate children and neonates in the first week after the earthquake, although this ability was relatively limited. SPECIAL ARTICLE: Five case scenarios that we confronted at the pediatric ward of the field hospital are presented: two children with respiratory compromise due to pulmonary infection, one premature baby with respiratory distress syndrome, an asphyxiated neonate, and a baby with severe sepsis of a probable abdominal origin. In normal circumstances all of them would have been ventilated but with limited resources we raised in each case the question of ventilating or not.To help in the evaluation of each case we used a decision-support tool that was previously developed for ventilator allocation during an influenza pandemic. This tool takes into account several factors, including the illness severity, prognosis, and the expected duration of ventilation.Applying ethical priorities to analyze the decision-making problems leads to the understanding that an individualized approach with an ongoing assessment of the patient condition and the availability of resources, rather than a strict predefined decision rule, will give patients a better chance of survival, and will assist in allocating scarce resources.
- Published
- 2012
36. Global responsibility in mass casualty events: The Israeli experience in Japan
- Author
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Ofer Merin, MD, Nehemia Blumberg, MD, David Raveh, MD, Ariel Bar, MD, Masafumi Nishizawa, MD, and Ophir Cohen-Marom, MD
- Subjects
General Medicine - Abstract
Objective: To describe humanitarian aid following the 2011 earthquake and tsunami in Japan.Setting: A field hospital deployed in a small Japanese coastal village devastated by a major tsunami.Patients: Thousands of Japanese refugees with minimal access to medical care.Results: After well-coordinated diplomatic efforts, our medical delegation was the first foreign team to deploy in Japan. Our facility served as a regional referral center for specialized medical treatment.Conclusions: Following major disasters, even highly modernized countries will face an urgent surge in the need of medical resources.These situations emphasize the need for global responsibility to provide assistance.
- Published
- 2012
37. Improvised Neonatal Care-Realizing the Gaps in a Disaster Zone
- Author
-
David Dagan, Dov Albukrek, Ofer Merin, Giora Weiser, and Joseph Mendlovic
- Subjects
media_common.quotation_subject ,Research methodology ,Philippines ,Population ,Emergency Nursing ,Disasters ,03 medical and health sciences ,Health services ,0302 clinical medicine ,Ingenuity ,Nursing ,030225 pediatrics ,Neonatal Nursing ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Natural disaster ,education ,Pregnancy outcomes ,media_common ,Improvisation ,education.field_of_study ,business.industry ,Cyclonic Storms ,Infant, Newborn ,medicine.disease ,Emergency Medicine ,Medical emergency ,business ,Psychology - Abstract
The treatment of newborns in a disaster zone can be extremely challenging. The effects of the disaster combine with local health care disparity to give these neonates little chance of survival in the event of even minor complications. Rescue teams arriving at such locations must be prepared to handle and to aid these difficult situations using improvisation and ingenuity to overcome many of the unexpected hurdles. A discussion of the difficulties faced in the Philippines following a typhoon and recommendations for future teams are presented.MendlovicJ,AlbukrekD,DaganD,MerinO,WeiserG.Improvised neonatal care‒realizing the gaps in a disaster zone.Prehosp Disaster Med.2016;31(1):111–113.
- Published
- 2015
38. Perceptions on Medical Clowns in the Israeli Field Hospital after the Nepal Earthquake
- Author
-
Joseph Mandelovitch, Giora Weiser, Ofer Merin, Avigail Davidov, and Uri Ilan
- Subjects
Medical education ,business.industry ,Field (Bourdieu) ,Perception ,media_common.quotation_subject ,Emergency Medicine ,Optometry ,Medicine ,Emergency Nursing ,business ,media_common - Published
- 2017
39. September/October 2011
- Author
-
Ophir Cohen-Marom, Ofer Merin, David Raveh, Ariel Bar, Masafumi Nishizawa, and Nehemia Blumberg
- Subjects
Economic growth ,Delegation ,business.industry ,Humanitarian aid ,media_common.quotation_subject ,Refugee ,Poison control ,Human factors and ergonomics ,General Medicine ,medicine.disease ,Suicide prevention ,Occupational safety and health ,Medicine ,Medical emergency ,business ,Social responsibility ,media_common - Abstract
Objective: To describe humanitarian aid following the 2011 earthquake and tsunami in Japan. Setting: A field hospital deployed in a small Japanese coastal village devastated by a major tsunami. Patients: Thousands of Japanese refugees with minimal access to medical care. Results: After well-coordinated diplomatic efforts, our medical delegation was the first foreign team to deploy in Japan. Our facility served as a regional referral center for specialized medical treatment. Conclusions: Following major disasters, even highly modernized countries will face an urgent surge in the need of medical resources.These situations emphasize the need for global responsibility to provide assistance.
- Published
- 2011
40. Triage in Mass-Casualty Events: The Haitian Experience
- Author
-
Itay Wiser, Yitshak Kreiss, Ian N. Miskin, Ofer Merin, and Guy Lin
- Subjects
medicine.medical_specialty ,business.industry ,Poison control ,Emergency Nursing ,medicine.disease ,Triage ,Suicide prevention ,Haiti ,Occupational safety and health ,Disaster area ,Mass-casualty incident ,Emergency medicine ,Injury prevention ,Earthquakes ,Emergency Medicine ,Humans ,Mass Casualty Incidents ,Medicine ,Observational study ,Medical emergency ,business - Abstract
Introduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources.Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay.Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources.Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17).Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.
- Published
- 2011
41. Application of information technology within a field hospital deployment following the January 2010 Haiti earthquake disaster
- Author
-
Nehemia Blumberg, Ofer Merin, Yitshak Kreiss, Nachman Ash, and Gad Levy
- Subjects
Emergency Medical Services ,Contingency plan ,business.industry ,Emergency Medical Service Communication Systems ,Medical record ,Dashboard (business) ,Implementation Brief ,Information technology ,Health Informatics ,medicine.disease ,Haiti ,Health administration ,Disasters ,Radiology Information Systems ,Picture archiving and communication system ,Software deployment ,Earthquakes ,Hospital Information Systems ,Emergency medical services ,Electronic Health Records ,Humans ,Medicine ,Medical emergency ,Israel ,business - Abstract
Following the January 2010 earthquake in Haiti, the Israel Defense Force Medical Corps dispatched a field hospital unit. A specially tailored information technology solution was deployed within the hospital. The solution included a hospital administration system as well as a complete electronic medical record. A light-weight picture archiving and communication system was also deployed. During 10 days of operation, the system registered 1111 patients. The network and system up times were more than 99.9%. Patient movements within the hospital were noted, and an online command dashboard screen was generated. Patient care was delivered using the electronic medical record. Digital radiographs were acquired and transmitted to stations throughout the hospital. The system helped to introduce order in an otherwise chaotic situation and enabled adequate utilization of scarce medical resources by continually gathering information, analyzing it, and presenting it to the decision-making command level. The establishment of electronic medical records promoted the adequacy of medical treatment and facilitated continuity of care. This experience in Haiti supports the feasibility of deploying information technologies within a field hospital operation. Disaster response teams and agencies are encouraged to consider the use of information technology as part of their contingency plans.
- Published
- 2010
42. FP248PREOPERATIVE CALCIUM AND OUTCOMES OF PATIENTS UNDERGOING CARDIAC SURGERY
- Author
-
Daniel Bitran, Chani Waldenberg, Shuli Silberman, Daniel Fink, Linda Shavit, and Ofer Merin
- Subjects
Transplantation ,medicine.medical_specialty ,Cardiac Surgery procedures ,chemistry ,Nephrology ,business.industry ,Medicine ,chemistry.chemical_element ,Calcium ,business ,Surgery ,Cardiac surgery - Published
- 2018
43. Hard times call for creative solutions: Medical improvisations at the Israel Defense Forces field hospital in Haiti
- Author
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Guy Lin, MD, Haim Lavon, MD, Reuven Gelfond, RN, BA, Avi Abargel, MD, MHA, and Ofer Merin, MD
- Subjects
General Medicine - Abstract
Mass disaster medicine is characterized by the need to manage limited resources that are far inadequate to meet the population’s demands. Under these hectic conditions, lack of specific medical equipment is expected and requires improvisation using available items.We describe the innovative use of medical improvisations at the Israel Defense Forces field hospital, working in the earthquake zone, Port-au-Prince, Haiti, on January 2010.Creative solutions were found to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries.We hope that the methods described will help to inspire medical teams working in disaster regions.
- Published
- 2010
44. O2C3: A unified model for emergency operations planning
- Author
-
Reuven Gelfond, Ofer Merin, Guy Lin, Haim Lavon, and Avi Abargel
- Subjects
Improvisation ,education.field_of_study ,Engineering ,business.industry ,Population ,Medical equipment ,Poison control ,General Medicine ,medicine.disease ,Suicide prevention ,Occupational safety and health ,Variety (cybernetics) ,Transplantation ,medicine ,Medical emergency ,education ,business - Abstract
Mass disaster medicine is characterized by the need to manage limited resources that are far inadequate to meet the population's demands. Under these hectic conditions, lack of specific medical equipment is expected and requires improvisation using available items. We describe the innovative use of medical improvisations at the Israel Defense Forces field hospital, working in the earthquake zone, Port-au-Prince, Haiti, on January 2010. Creative solutions were found to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries. We hope that the methods described will help to inspire medical teams working in disaster regions.
- Published
- 2010
45. Facilitating emergency hospital evacuation through uniform discharge criteria
- Author
-
Sandra, Keret, primary, Meital, Nahari, additional, Ofer, Merin, additional, Limor, Aharonson-Daniel, additional, Sara, Goldberg, additional, and Bruria, Adini, additional
- Published
- 2017
- Full Text
- View/download PDF
46. Ozone Administration Reduces Reperfusion Injury in an Isolated Rat Heart Model
- Author
-
Dani Bitran, Herzl Schwalb, Deborah Elstein, Eyal Attias, Shuli Silberman, Ofer Merin, and Ari Zimran
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ozone ,Hemodynamic measurements ,Ischemia ,Myocardial Reperfusion Injury ,In Vitro Techniques ,Ventricular Function, Left ,Rats, Sprague-Dawley ,chemistry.chemical_compound ,Heart Rate ,Coronary Circulation ,Internal medicine ,medicine.artery ,Ascending aorta ,Heart rate ,medicine ,Animals ,Cardiac Output ,Tromethamine ,business.industry ,Recovery of Function ,Rat heart ,medicine.disease ,Myocardial Contraction ,Rats ,Glucose ,chemistry ,Anesthesia ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Reperfusion injury ,Perfusion - Abstract
Background: Accumulating clinical experience with ozone administration for conditions associ- ated with ischemia has been encouraging. The aim of our study was to determine the effect of ozone on reperfusion injury in an isolated rat heart model. Methods: Isolated rat hearts were perfused with modified Krebs-Henseleit buffer solution via ascending aorta cannulation. After 15 minutes, perfusion was stopped and global ischemia was maintained for 30 minutes, following which perfusion was restarted, and contin- ued for 40 minutes. Baseline hemodynamic measurements (heart rate, left ventricular developed pressure (LVDP), dP/dt, and coronary flow) were taken prior to ischemia, and every 10 minutes after reperfusion was started. Eleven hearts were treated with ozone during reperfusion and eight hearts served as controls. In the treatment group, after 5 minutes of reperfusion, ozone was administered in distilled water via a side arm for 5 minutes. Results: Preischemic baseline hemodynamic measurements and coronary flow were similar in the two groups. Hearts treated with ozone during reperfusion exhibited better recovery than did controls. Mean (±SE) percent recovery for treatment and control groups, respectively, was: LVDP 69 ± 2% vs 51 ± 6% (p = 0.04); dP/dt 68.9 ± 13.3% vs 53.7 ± 20.4% (p = 0.05); and LVDPxHR 61.4 ± 3.3% vs 44.4 ± 3.5% (p = 0.02). Conclusion: In the isolated rat heart model, treatment with ozone during reperfusion enables better recovery than in controls. Although the mechanism by which ozone exerts its beneficial effect is not identified, it is possibly due to reduction in reperfusion injury. doi: 10.1111/j.1540-8191.2007.00419.x (J Card Surg 2007;22:339-342)
- Published
- 2007
47. Medicine in a Disaster Area: Lessons From the 2015 Earthquake in Nepal
- Author
-
Tarif Bader, Ofer Merin, and Avraham Yitzhak
- Subjects
business.industry ,Culture ,Relief Work ,Standard of Care ,Public relations ,Disaster Medicine ,Medicolegal issues ,Disaster area ,Nepal ,Informed consent ,Cultural diversity ,Internal Medicine ,Earthquakes ,Medicine ,business ,Natural disaster ,Disaster medicine ,Cultural competence - Published
- 2015
48. Case report: a brain abscess in a disaster zone- beyond the call of duty
- Author
-
Dov Albukrek, Giora Weiser, Ofer Merin, Joseph Mendlovic, David Dagan, and Manor Shpriz
- Subjects
Field hospital ,business.industry ,media_common.quotation_subject ,Psychological intervention ,Case Report ,medicine.disease ,Brain abscess ,Disaster ,Intervention (counseling) ,Medicine ,Referral center ,Medical emergency ,Decision process ,business ,Duty ,media_common - Abstract
We present a case of a child with a suspected brain abscess treated by a military field hospital in post-typhoon Philippines. We review our intervention and decision process both at the field hospital and following his transfer to a referral center. These interventions were critical for his successful outcome.
- Published
- 2015
49. Mobile in Situ Simulation as a Tool for Evaluation and Improvement of Trauma Treatment in the Emergency Department
- Author
-
Imri Amiel, Daniel Simon, Amitai Ziv, and Ofer Merin
- Subjects
medicine.medical_specialty ,media_common.quotation_subject ,education ,Manikins ,Coaching ,Education ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,medicine ,030212 general & internal medicine ,Emergency Treatment ,Simulation Training ,Simulation ,media_common ,Teamwork ,business.industry ,Medical simulation ,Debriefing ,Trauma center ,030208 emergency & critical care medicine ,Emergency department ,medicine.disease ,Quality Improvement ,Traumatology ,Surgery ,Medical emergency ,Clinical Competence ,business ,Psychology ,Emergency Service, Hospital ,Performance rating - Abstract
Background Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully. Methods The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention. Results The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005). Conclusion The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment.
- Published
- 2015
50. Salvage ECMO deployment for fatal aluminum phosphide poisoning
- Author
-
Yechiel Schlesinger, Sarit Shahroor, Gabriel Amir, Ofer Merin, Daniel L. Fink, Daniel Fink, and Einat Birk
- Subjects
Adult ,Male ,medicine.medical_specialty ,Fatal outcome ,business.industry ,Phosphines ,medicine.medical_treatment ,Gas Poisoning ,Infant ,General Medicine ,Extracorporeal Membrane Oxygenation ,Fatal Outcome ,Fumigation ,Child, Preschool ,Aluminum phosphide ,Emergency Medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Female ,Pesticides ,Intensive care medicine ,business ,Aluminum Compounds ,Child - Published
- 2015
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