Archives for August 2011

8.19.2011 – Around 20 rockets fired at Israel from Gaza in past day

defpro.com
13:43 GMT, August 19, 2011

Around 20 Grad and Qassam rockets were fired at Israel from the Gaza Strip on Thursday night (August 18) and Friday morning (August 19).

Most fell in open areas in the Ashdod, Ashkelon, Be’er Sheva and Kiryat Gat regions. But two rockets hit populated areas in Ashdod and seven people were wounded, including one critically.

All the wounded people were transported to Kaplan Hospital in Rehovot.

Overnight, Israeli Air Force (IAF) aircraft targeted seven sites in the Gaza Strip, in response the terrorist attacks that took place near Eilat in southern Israel on Thursday as well as rocket fire.

In northern Gaza, two terror activity sites and a weapons storage facility were struck. In southern Gaza, two smuggling tunnels, a terrorist tunnel and a terror activity site were struck.

“The IDF [Israel Defense Forces] will continue to prevent terrorism and will respond decisively and with force in the Gaza Strip,” IDF Spokesperson Brig. Gen. Mordechai said on Friday. “At the same time, we are setting up investigations to learn the lessons of Thursday’s events.”

08.15.2011 – Do tried-and-true methods trump imaging in the ER?

By Brendon Nafziger , DOTmed News Associate Editor
August 15, 2011

Doctors in an academic hospital’s busy emergency room judged a patient’s medical history and a physical exam more valuable than high-tech tests, like CT scans, in helping to reach a correct diagnosis, according to a new study.
The study, carried out in Israel and published in the Archives of Internal Medicine, found that 90 percent of all correct diagnoses made over a 53-day period involved only a physical exam, patient’s history and basic tests, such as blood and urine tests, ECG or a chest X-ray.
“In conclusion, four of five of internal medicine inpatients could be accurately diagnosed close to their admission on the basis of little other than the traditional clinical information,” write the authors, led by Dr. Ami Schattner, with the Kaplan Medical Center in Rehovot, Israel.

In the study, a senior resident with at least 4 years training and hospitalists with more than 20 years experience separately evaluated the same patient. Senior residents made correct diagnoses in 80 percent, and hospitalists in 84 percent of all the 442 newly admitted patients evaluated in the study.

Of all the tools used by the doctors, history was the most “potent,” deemed valuable for making the proper diagnosis on admission 20 percent of the time. Physical examinations, by themselves, were not highly regarded, deemed to have been useful in making diagnoses only 1 percent of the time, according to the study. But history’s diagnostic power doubled when it was combined with exams, doctors said, making it useful in 40 percent of all diagnoses in the study.

Few patients in the study had advanced imaging tests. Those who did, mostly had head CT scans, the researchers said. Even so, CT scans were judged useful for only about one-third of patients who got them, according to the study. (All told, imaging — which in the study meant CT scans and ultrasound — were deemed useful for correct diagnosis on admission in around 6 to 7 percent of all patients.)

“Our results do not mean that sophisticated studies need not be used after admission, but they do suggest that their choice should be guided by the clinical data on presentation,” the authors said.

In an accompanying note, Dr. Rita F. Redberg, the editor of the journal, said the study “reminds us of the value of lower-tech ways of making a diagnosis of patients seen in the emergency department.”

But in a separate response, Dr. Melvin Cheitlin, a cardiologist at the University of California, San Francisco, said he would have liked to see two extra bits of information: the number of hospitalists involved in the study, and a list of the diagnoses made and missed by the doctors.

“The high diagnostic accuracy using predominantly the traditional tools of history, physical examination, and basic laboratory tests would be less exciting if the majority of the patients had asthma, upper respiratory tract infections, urinary tract infections, or psychological problems,” he wrote in the journal.

Nonetheless, he said when he first read the article, “I mentally recognized that ‘I knew it all along.'”

“As a teacher of medical students, house staff and cardiology fellows I have become increasingly aware that there has been ever decreasing time spent teaching the basic skills of history taking and physical examination,” he said.

8.15.2011 – Israeli Research: Old-Fashioned MD Exams Better than Hi-Tech

Old-fashioned doctor-to-patient dialogue and exams often are more useful to hospital doctors than hi-tech scans, Israeli researchers say.

By Tzvi Ben Gedalyahu
First Publish: 8/15/2011, 4:37 PM
doctors (illustration)

doctors (illustration)
Flash 90

Direct-to-patient dialogue and physicians’ exams often are more useful to hospital doctors than hi-tech scans, according to an Israeli research team from the KaplanMedical Center in Rehovot, south of Tel Aviv.

The research, published in the Archives of Internal Medicine, revealed that doctors said that CT scans and ultrasounds in the emergency room not only cost lots ofmoney but also helped in diagnoses in only a small part of the cases studied.

The research team also said that radiation from CTs, which hospital doctors usually dismiss as minimal, might increase the risk of cancer.

“Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases,” wrote Kaplan research Ami Schattner and his research team. They spent two months following up on 442 patients who were treated in the emergency room and later were admitted to the hospital.

Each patient was examined by separately by two doctors, a resident and a senior physician, who talked with the patients about their medical history. They also had full access to results of emergency room scans.

After comparing the final diagnoses with the doctors’ initial decisions, the researchers discovered that the personal diagnoses were correct more than 80 percent of the time. It was not clear whether the level of the doctors’ specialization, experience and standing were factored into the results and whether that did or did not make a difference.

“Physicians may count more on their clinical faculties when making decisions about patients,” the study concluded.

The doctors told the researchers that in cases where the patients also underwent CT scans, the results were helpful in making final diagnoses in only one-third of the cases, while the physical exam and understanding patients’ medical histories were most important in approximately 60 percent of the cases.

Reporting the results of the research, Reuters quoted a University of Toronto cardiologist as saying, “The doctoring process is still a personal communication between the patient and the clinician”.

“As much as we want to… rely on the technology, it’s not the technology that helps us make a diagnosis.”

08.12.2011 – Study Finds Medical History Key to Correct Diagnosis

By Editor, On August 12th, 2011

Doctor with Patient Reviewing Medical History

A new study published in the Archives of Internal Medicine, a journal of the American Medical Association, found that patients’ medical history “emerged as the key element in formulating correct diagnosis” of medical conditions.

This obviously has important implications both for patients and for family caregivers. It suggests that patients will be well advised to become knowledgeable about the details of their own medical history, and that caregivers should know and be able to advise the doctor about the medical history of the person they are caring for.

The U.S. Surgeon General recommends creating a written individual and family health history, and provides an interactive online tool, My Family Health Portrait, to help you do so. The Surgeon General recommends printing out your “family health portrait” to share with your doctors. When visiting a doctor or being admitted to a hospital or emergency room yourself or when accompanying your loved one as a family caregiver, it would be wise to carry a written summary of the patient’s medical history with you. The US Department of Health & Human Services also recommends carrying a wallet card, listing the patient’s medications.

The new study conducted by Liza Paley MD, Ami Schattner MD and colleagues at the Department of Medicine A, Kaplan Medical Center, Rehovot and the Hebrew University Hadassah Medical School in Israel, is reported in the August issue of the Archives of Internal Medicine.

In a comment on their study, the researchers said, “Research continues to support the enduring value of the history and physical examination in diagnosis and in deciphering problems with multiple diagnostic alternatives.” “However,” they stated, “our study was the first to our knowledge to examine prospectively the value of the basic clinical methods for the diagnosis of the whole heterogeneous population of patients requiring an emergency admission to a general department of medicine.”

The Study Methodology

The researchers studied 442 patients admitted from the Emergency Department to a hospital affiliated with an academic department of medicine over 53 days. Each of the patients was examined within 24 hours of admission by a Senior Resident with four years of training. The examination included taking a full medical history, a physical examination, review of results of tests taken in the Emergency Department upon admission (including basic hematology and chemistry tests, urinalysis, electrocardiography [ECG], and chest radiography, and any additional tests performed), and a review of medical charts from previous admissions, all medications, and vital signs. The Senior Resident then recorded her diagnosis, and identified which of the factors above (medical history, test results, physical examination, medical charts, medications, etc) were most helpful in making the diagnosis.

A Hospital Physician with more than 20 years experience then repeated the process, and made his diagnosis based on all of the same factors, without seeing or having any knowledge of the Senior Resident’s diagnosis.

Within an average of two to seven months after discharge, the patient’s final diagnosis was verified by checking discharge summaries and records of any further hospital visits and calls to the patient’s primary physician.

The initial diagnoses of the Senior Resident and the Hospital Physician were then compared with the final diagnosis, to determine accuracy of the initial diagnoses, and to determine “the value of different elements (history, physical examination, and basic tests) for the diagnosis.” An experienced statistician analyzed the results.

Findings

As reported by the study’s authors, “The patient’s history emerged as the key element in formulating diagnosis either alone (approximately 20% of all diagnoses), in combination with the patient’s examination (another 40%, approximately), or in addition to the basic tests with or without the physical examination (33%).”

Based on these factors the Senior Resident made correct diagnoses in 80.1% of the cases, and the Hospital physician made correct diagnoses in 84.4% of the cases. They made correct identical diagnoses in 73.9% of the cases.

As to the importance of the factors other than the medical history, the study authors reported:

“The examination or basic tests alone were very seldom helpful. Used in conjunction, the physical examination doubled the diagnostic power of the history (19.5% to 39.0%; Table). The basic tests added a further 33%. Imaging was infrequently used in the ED (mainly head computed tomography) and had added little to determining diagnoses, being considered valuable in approximately 1 in 3 patients who had computed tomography performed.”

Conclusions & Implications

“We found that more than 80% of newly admitted internal medicine patients could be correctly diagnosed on admission and that basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases,” the study authors stated.

“Notwithstanding the great clinical diversity, 90% of all correct diagnoses were accomplished on presentation through a combination of the history, physical examination, and basic tests (excluding imaging studies),” they concluded.

“[Medical] History was the most potent single tool identified,” the researchers wrote.

The medical history plus the physical examination alone were the basis of the diagnosis in 60% of the cases, they found. Adding basic test results to these two factors “further increased the diagnostic yield,” they said. Basic test results they said were “implicated in a third of all diagnoses.” However, even though “a relatively small number of patients had ancillary investigations beyond ECG and CXR,” this “had no adverse effects on the clinicians’ performance.”

“In conclusion,” the authors stated, “4 of 5 of internal medicine inpatients could be accurately diagnosed close to their admission on the basis of little other than the traditional clinical information [medical history, physical examination, and basic tests].” “Physicians may count more on their clinical faculties when making decisions about patients,” the researchers concluded.

The important role that medical history plays in correct diagnosis, as found by this study, underscores for patients and caregivers the importance of making sure that you provide your doctors with an accurate, complete, and detailed medical history, as well as a complete list of all medications being taken.

 

Copyright © 2011 Care-Help LLC, publisher of HelpingYouCare™.

08.12.2011 – Most patients don’t need extra tests for diagnosis

A technician performs an electrocardiogram on a patient in the hallway of the emergency room at a hospital in Houston, Texas, July 27, 2009. REUTERS/Jessica Rinaldi

 By Genevra Pittman
NEW YORK | Fri Aug 12, 2011 4:45pm EDT
(Reuters Health) – Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, suggests a new study from Israel.

Doctors said that when tests such as CT scans and ultrasounds were given to patients right after they showed up at the ER, the imaging only helped in making a diagnosis in about one in three cases.

“The doctoring process is still a personal communication between the patient and the clinician,” said Dr. Matthew Sibbald, a cardiologist at the University of Toronto who wasn’t involved in the new study.

“As much as we want to …rely on the technology, it’s not the technology that helps us make a diagnosis,” he told Reuters Health.

Those types of imaging tests add heft to a hospital bill and research suggests the low levels of radiation from multiple CT scans might increase a person’s risk of cancer over the long term.

To see whether such scans were really helpful, researchers led by Dr. Ami Schattner of Kaplan Medical Center in Rehovot, Israel, followed all the patients who showed up in the ER of an Israeli teaching hospital and were subsequently admitted to the hospital.

Over about two months, 442 consecutive patients with a range of ailments made up the study group. Each was separately examined by two doctors, a resident and a senior physician, who also asked patients about past health problems.

Both doctors had access to results from all routine tests, including blood and urine analysis, and any extra scans that had been done when the patient first got to the ER.

The researchers later looked at how accurate the clinicians were in their decisions, compared to the final diagnoses patients were given during or after their hospitalization. They also asked the doctors what factors they relied on most when diagnosing each patient.

Both clinicians made the correct diagnosis between 80 and 85 percent of the time.

Only about one in six patients had extra testing (mostly CT scans, usually of the head) done in the ER — the rest just had simple blood, urine or heart tests.

But even for the patients who did have extra scans, the doctors said the results helped to make a diagnosis only about one-third of the time.

Instead, patient history alone or history plus a physical exam were most important to a doctor’s correct diagnosis in almost 60 percent of cases.

When basic tests were included, they were the basis of more than 90 percent of correct diagnoses along with history and exams.

CT scans are important in some cases, such as when a person has a head injury and doctors want to rule out bleeding, Sibbald said. But, “they’re done so routinely,” he added. “I think it’s important to realize that just getting an image of somebody isn’t a diagnosis.”

And doing extra scans isn’t harmless. Even if each scan only exposes patients to a small amount of radiation, it can add up, along with radiation from similar screening and other scans, over a lifetime.

In addition, Sibbald said, “you run the risk of just finding odd lumps or bumps which leads to more imaging.”

CT scans typically cost a few hundred dollars each and use of the test continues to rise — especially in the U.S.

An estimated 72 million CT scans were done in the U.S. in 2007.

Sibbald said that a patient history is still the most essential piece of information for doctors. “Without the history, they’re defenseless,” he said. “They haven’t had a chance to frame what they’re looking at.”

“Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases,” Schattner and his colleagues wrote in Archives of Internal Medicine.

“Physicians may count more on their clinical faculties when making decisions about patients,” they concluded.

SOURCE: bit.ly/psJFk7 Archives of Internal Medicine, online August 8, 2011.

08.01.2011 – A Game-changer in Breast Cancer Detection

Abigail Klein Leichman August 1st 2011

Israel21C

Health/Medicine - RUTH breast cancer detection device

 

Early detection is the key to improving breast cancer survival rates, but mammography is not the ideal method to accomplish this goal. On this point, medical experts across the globe agree.

Not as clear is what could do the job without the disadvantages of mammography, which often causes pain or discomfort; emits radiation; cannot properly image dense breast tissue; relies on a radiologist’s interpretation of the image; and is not recommended for routine screening of women under age 40 or 50.

Of several approaches being developed worldwide, an Israeli solution pioneered by electro-optical engineer Boaz Arnon holds particular promise in providing a game-changing device for early detection of breast cancer.

Arnon’s mother, Ruth, succumbed to the disease in 2004. Through Real Imaging, the company he founded in 2006, he was determined to offer an accurate alternative that would address all issues of concern and still be cost-effective.

Appropriately named RUTH, the device he invented uses a new trademarked platform he calls MIRA (functional Multidimensional Infra-Red Analysis). Built on principles from existing technologies and mathematics, MIRA enables functional quantitative analysis of 3D and infrared signals emitted from cancerous and benign breast tissue.

“Our solution is not sensitive to age or breast density, and works without radiation,” Arnon says. “We image the patient from a distance of 70 centimeters (25.5 inches), with no physical contact or radiation, and we have developed an automatic method that aims to detect breast cancer early, easily and as cheaply as possible.”

No more guesswork

“Physicians should be highly praised for their success rate in diagnosing breast cancer with the tools available today,” says Arnon, “but still, the death rate from breast cancer is unacceptable.”

Breast cancer is by far the most frequent cancer among women, with an estimated 1.38 million new cancer cases diagnosed in 2008 (accounting for 23 percent of all cancers), and is now the most common cancer both in developed and developing regions.

Though a medical doctor will oversee screenings with RUTH, “automatic” is one of its most key features. Results will not have to be interpreted by human eyes, thanks to the device’s unique process of calibration using mathematical algorithms formulated from three-dimensional models of hundreds of women with and without malignancies. The algorithms provide unprecedented accuracy, as Real Imaging has demonstrated in blind studies.

“Our sensitivity results show 90 percent accuracy for women of all ages,” says Arnon. By comparison, mammography usually is about 80 percent accurate, and not even that high in younger patients.

“This is not guesswork; it is science. We have proof we can explain clinically that our method is working,” he says.

More than 2,000 women have been involved in clinical trials for RUTH since 2007 at six Israeli hospitals: Hadassah-Ein Kerem in Jerusalem, Sheba Medical Center at Tel Hashomer, Beilinson Hospital and Assuta Medical Center in Tel Aviv, Meir Medical Center in Kfar Saba and Kaplan Medical Center in Rehovot. The entire procedure takes only a few minutes.

“We now have the fifth generation of the RUTH device,” says Arnon. “Before the end of this year, we will probably have one [being tested] in Europe as well.”

On sale as soon as 2012

The company aims to achieve CE approval this year, certifying that its product has met the health, safety, and environmental requirements of the European Union, and will submit the product for approval from the US Food and Drug Administration the following year.

Arnon hopes to start sales next year. His previous major successful invention was Lumio, a virtual keyboard that can be projected on a surface.

He expects RUTH to cost less than mammography equipment but to be used, initially, as an adjunct to that existing methodology. The device is manufactured in Israel and the company of 30 employees is based in Airport City near Tel Aviv. Arnon reveals that the proprietary technology might have other useful applications, “but right now we’re concentrating on this one. If we succeed in this area, we will have achieved our goal.”

Privately held until recently, Real Imaging raised $13 million from private investors in England, the United States, and Israel. The firm is now being publicly traded on the Tel Aviv Stock Exchange following a reverse merger in May.

“We did quite a lot to bring this technology to reality,” says Arnon. The company’s management team includes people with expertise in manufacturing, physics, mathematics and finance, and is chaired by Prof. Moshe Many, vice chairman of TEVA Pharmaceuticals and president of the Ashkelon Academic College.

Real Imaging’s scientific advisory board consists of two US physicians—Edward Sickles, who served as chief of the Breast Imaging Section at the UCSF Medical Center in San Francisco for almost 30 years, and Michael Linver, director of mammography for X-Ray Associates of New Mexico and clinical professor of radiology at the University of New Mexico.

Abigail Klein Leichman writes for Israel21C, from where this article is adapted.