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Objective: The administration of tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS) within three hours from onset of neurological symptoms is presently accepted as the standard treatment for suitable individuals, since it has been shown that it improves their outcome. The aim of this retrospective study was to report our experience with tPA administration in a subunit of a department of internal medicine adapted specifically for that goal., Setting: The study was carried out in a subunit of a department of internal medicine. This subunit was equipped with all necessary items for monitoring vital signs. The patients received 0.9mg/kg of tPA intravenously and remained under around-the-clock supervision by highly trained nurses., Subjects: Thirty one patients (11 women and 20 men), diagnosed with AIS between 2004 and 2008, and eligible for tPA treatment, were included in the study., Results: The interval from the onset of stroke to tPA administration (onset to treat time OTT) was 145±2.2min, whereas the interval from door-to-needle was 100±4min. Two patients (6.4%) died during hospitalization because of severe intracerebral hemorrhage. Three patients with hemiparesis (9.6%) developed minor hemorrhages detected by brain CT. The mean length of stay was 8.8±0.6days., Conclusions: Our results are comparable with those obtained in stroke units in other countries. The suggested model offers a possibility for appropriate and rapid thrombolysis for AIS in a community hospital lacking special stroke unit. Moreover, the suggested alternative does not require extensive economic investment, since there is no need for additional staff, and permits the use of already existing hospital facilities., (Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Patients' satisfaction with the functional capacity and attitude of the permanent staff working in the morning hours in the emergency department (ED) of a community hospital was compared with that of the staff working during the evening and night shifts. A total of 285 patients given care in the ED were interviewed according to a 'satisfaction' questionnaire regarding the function and attitude of the ED staff during the morning and evening/night shifts. The mean waiting time until a doctor was seen during the morning shift was 25 +/- 17 minutes for non-hospitalized patients and 25 +/- 8 minutes for the hospitalized ones, whereas during the evening and night hours the waiting times were 22 +/- 17 minutes and 19 +/- 13 minutes respectively. The number of laboratory examinations performed during the evening and night shifts markedly exceeded that carried out during the morning. The mean staying time in the ED for both non-hospitalized and hospitalized patients during the morning was by 23% shorter than that during the evening and night shifts. The patients expressed their overall satisfaction with the ED staff in both shifts with high evaluation marks. It is concluded that the survey indicates that the permanent ED staff during the morning hours are more efficient compared with those working during the evening and night shifts.

The cost of medical care is constantly increasing. Therefore, ways of saving expenses should be considered. The aim of the present study is to evaluate the possibility than an awareness of the cost of drugs for treatment of hypertension may affect physicians' prescription decisions. A questionnaire containing the clinical data of a young and an elderly imaginary patient with moderate hypertension was given to 30 family physicians and 30 hospital physicians together with a list of appropriate drugs (phase I). This was repeated as phase II except that for this stage the cost of the drugs was brought to the participants' attention. Knowing the cost of the drugs caused a decrease in prescription of the more expensive drugs for the younger patients; of 60% (family physicians) and 87% (hospital physicians). For their elderly patients family physicians preferred the less expensive drugs at both phases. 25% of the hospital doctors changed their preference towards less expensive drugs at phase II. For the younger patient, no correlation was found between the number of years of physicians' practice and the cost of the drugs chosen. For the elderly patient, physicians from both groups preferred less expensive drugs at phase II without any relation to their years of practice. The results of this study indicate that a knowledge of the price of the drugs may affect physicians' prescription decisions, a fact that may result in considerable saving by health providing organizations.

Plasma fibrinogen levels were measured in 1,175 Israeli schoolchildren, aged 9-18 years, originating from diverse ethnic groups. The Moslem children displayed striking differences in levels and age-patterns of fibrinogen compared to Jewish children. Lower mean plasma fibrinogen levels in boys aged 9-10, 13-14 and 16-18 were observed among Moslem boys, compared to their Jewish counterparts born in Israel. Moslem girls showed lower levels of fibrinogen than Jewish Israeli girls at ages 9-10 and 16-18. While the Jewish children displayed an age-associated fibrinogen pattern comparable at the three age groups, the levels for Moslem children increased pre-puberty and decreased post-puberty, peaking at 13-14 years. No significant difference in mean plasma fibrinogen was found between sexes within ethnic groups. A number of statistically significant but low correlations (-0.32 to 0.24) were found between plasma fibrinogen and high density lipoprotein cholesterol (HDL-C) as a percentage of total cholesterol, triglycerides, blood glucose, uric acid, blood pressure, Quetelet index and sports activity. The difference between fibrinogen levels might point to a possible ethnicity risk factor explanation rather than environmentally acquired factors.

In 1991, 3 patients of an overall patient population of 1400 were found to be suffering from active tuberculosis (TB). They were long-time residents of Israel and were not of Ethiopian origin. 2 had TB of the lymph-nodes of the head and neck and the third had pleural TB with involvement of the ribs. In each case TB was diagnosed retroactively; the original presumptive diagnosis was malignancy. This relative increased incidence of TB should increase our awareness of this disease.