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BACKGROUND:Israeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup. METHODS:Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency. RESULTS:Completed questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less. CONCLUSIONS:Medical school classes are composed of various subgroups, each with its own characteristics. It is important to differentiate between choosing a specialty and a residency program. Choosing a specialty is a uniquely personal decision with some spousal influence among married students. It is of central importance even among pre-military students not slated to begin residency for many years. In contrast, choosing a residency program is influenced by family, where one grew up and other family-related considerations.

Aims: Pregnancies complicated with gestational diabetes mellitus (GDM) or preeclampsia should be considered risk factors for subsequent morbidity later in a women’s life. Appropriate screening tests have been recommended for these women. We sought to evaluate whether primary care physicians document diagnoses of GDM or preeclampsia in the medical files during the post-partum period and to elicit whether appropriate screening tests were performed. Materials and methods: The medical records of 352 women discharged from the maternity ward with a diagnosis of GDM or preeclampsia were examined 12 weeks post-partum. We recorded whether a primary care visit occurred, if a relevant diagnosis was documented and if screening tests were conducted. Results: In our cohort, 89.2% of the GDM group and 81.0% of the preeclampsia group visited a primary care physician at least once. About 12.9% (n = 25) of the GDM group and 12.7% (n = 20) of the preeclampsia group were given a correct diagnosis; 40.7% of the GDM group underwent a diabetes screening test and 27.8% of the preeclampsia group underwent a blood pressure measurement. Conclusion: We concluded that diagnoses of GDM and pre-eclampsia are not well-documented by primary physicians and that recommended screening tests are not being sufficiently performed. [ABSTRACT FROM AUTHOR]

Abstract Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83%) questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in a large university medical center. Only 5% considered it important to do their residency in the country's peripheral areas, while 30% reported interest in a residency in the country's center. Conclusions The fifth year of a six-year medical school is an opportune time to provide students with information and guidance on the various specialties and selecting a residency program as they begin to solidify their perceptions and ideas about the various specialties. This study serves as an impetus to medical educators and healthcare leaders to become interested in students' career selection.

Reviews the anatomy of the knee joint as well as the most common knee fractures and ligament injuries. Reasons for the unnecessary use of radiography in knee trauma; Description of knee ligament injuries; Comparison of guidelines for the appropriate use of radiographs in acute knee injuries.

Probes on the need for routine radiologic examinations on cases of ankle trauma. Effect of health care cost; Percentage growth in ankle radiographs; Anatomy of the ankle; Several types of ankle injuries; Guidelines for the use of radiography developed in Ottawa, Ontario.

Reports developments related to medical research. Ethical approach in caring of people with SARS; Discovery on the higher pedestrian fatalities among men than women; Comparison between children with attention deficit hyperactivity disorder and adults with psychosocial disorder.

Introduction: Masked uncontrolled hypertension (MUCH), describes a mismatch between normal office measurements and out of range home blood pressure. Although it is often underdiagnosed, it is associated with high risk of hypertensive complications and morbidity. Ambulatory blood pressure monitoring (ABPM) is defined as the "reference standard" for diagnosing hypertension and is especially effective in cases of MUCH. Although there are many references on the advantages of ABPM, very few studies consider its limitations. To the best of our knowledge, false-positive ABPM has not previously been reported. We report a case in which a positive ABPM result obtained during a stressful situation became normal after being repeated in a non-stressful time. We, therefore, suggest implementing routine pre-test assessment of stressful situations in patients undergoing ABPM. This strategy will lead to improving the accuracy of ABPM and avoiding false-positive results.

Background: Research on synergistic effects of patient targeted interventions combined with physician-targeted interventions has been limited., Objectives: To compare a combined physician-patient intervention to physician feedback alone on a composite outcome of glycemic, lipid and blood pressure control., Methods: In this cluster study 417 patients with adult-type 2 diabetes from four primary care clinics were randomized to receive either a physician-only intervention or a combined physician-plus-patient intervention. Physicians in all clinics received diabetes-related quality performance feedback during staff meetings. Patients at combined-intervention clinics also received a letter encouraging them to remind their doctors to address essential aspects of diabetes care at the next visit. At 1 year follow-up, outcome measurements included hemoglobin A1c, low density lipoprotein-cholesterol and systolic blood pressure: namely, the proportion of patients with HbA1c 9%, LDL <130 mg/dl and SBP <140 mmHg both as separate outcomes and combined., Results: After adjusting for patient characteristics and baseline measures, follow-up levels of HbA1c (7.5% vs. 7.8%, P = 0.09), LDL (104.7 vs. 110.7 mg/dl, P < 0.05) and SBP (135.6 vs. 139.9, P = 0.10) were marginally better for combined-intervention patients compared to physician-only intervention patients. Significantly more patients in the combined-intervention (38.8%) than physician-only intervention (24.2%) met all three targets (HbA1c (9%, LDL (130 mg/dl and SBP <140 mmHg) as a single combined outcome (adjusted odds ratio 2.4, P < .01)., Conclusions: Compared to physician-feedback alone, a dual intervention combining a patient letter with physician feedback produced modest improvements in glycemic, lipid and blood pressure control individually, but substantial improvement in a combined measure of these three outcomes together. Using composite outcomes may detect meaningful improvements in the management of complex chronic disease.

Background: The association between low levels of 25-hydroxyvitamin D and non-specific musculoskeletal pain, including fibromyalgia syndrome, is controversial. Several studies have reported a "positive association" and two others found "no association.", Objectives: To test levels of 25OHD in patients with fibromyalgia syndrome and in matched controls., Methods: The study population comprised 68 premenopausal women with a diagnosis offibromyalgia and 82 age-matched premenopausal women without. The former were identified from the computerized medical databases of five primary care urban clinics in the south of Israel, and the control subjects were attending the participating clinics for regular periodic blood tests. For each patient, the matched control interview and blood test were performed within a week or two from the patient's interview and blood test, thus controlling for expected seasonal variations., Results: Serum 25OHD was measured using different cutoff levels and compared between the groups (< 30 ng/ml, < 20 ng/ml and <15 ng/ml). No statistically significant differences were found between the groups regardless of the cutoff level used. A logistic regression model for predicting women with 25OHD levels 20 ng/ml showed that all the variables examined in both groups (age, country of birth, education) were not statistically significant. We found the expected seasonal variations of 25OHD levels, though these were not statistically significant., Conclusions: We found no association between fibromyalgia and low 25OHD levels as previously suggested in other studies.

An insulin-treated patient with type 2 diabetes mellitus started a diet free of dairy products. Unexpectedly, she developed episodes of hypoglycaemia, without any change in her usual medication (insulin NPH at bedtime and Metformin). Laboratory tests showed an improvement of endogenous insulin secretion as demonstrated by the induction of hypoglycaemia and the elevation to normalisation of C-peptide levels. The patient was rechallenged with dairy products, leading to the lowering of the C-peptide levels back to abnormal levels, and an increase in HBA1C levels. The findings in our patient contrast with the insulinotropic effect of milk in healthy subjects described in the literature. The two main "milk debates" on the relation between milk (or its components) and diabetes are presented. Further observations will be needed to clarify the question of whether a diet free of dairy products can improve glycaemic control in other insulin-treated patients with type 2 diabetes.