Attitudes Toward the Use of Medical Cannabis and the Perceived Efficacy, Side-effects and Risks: A Survey of Patients, Nurses and Physicians

Gaps between physician and patient perceptions may lead to misunderstandings and mismanage of treatment. There are sparse data about the differences in opinions toward medical cannabis (MC) between patients and health professionals. The aim of this study was to examine the attitudes toward MC, its perceived efficacy, side effects and risk of dependency, among patients, nurses and physicians. A cross-sectional study of samples of 430 patients, 65 nurses and 65 physicians in two large medical centers in Israel. Questionnaires were administered on attitudes, perceived efficacy, side-effects and perceived risks of dependency. Compared with nurses and physicians, patients who were using MC had the most positive attitudes toward MC (p < .001). Younger age, high school education, being Jewish and ever using MC, were associated with more positive attitudes toward MC among patients (p < .001). Among nurses and physicians, having an oncology specialty predicted more positive attitudes toward MC. Physicians had a less positive attitude toward MC compared to nurses (p < .01). Our study provides evidence that physicians are less positive in their views toward MC compared to nurses and patients. More information and awareness to MC may reduce the gap in perceptions between physicians and patients.

Three Decades of Cannabis Research: What are the Obstacles?

During the past few years, thousands of articles have been published concerning medical cannabis useage. Unfortunately, most publications are case studies or small and poorly designed research projects. In attempting to understand the reasons behind this situation, the obstacles impeding the use of medical cannabis and related research merit more in-depth examination. This editorial looks at some of the issues.

Cannabis for the Treatment of Inflammatory Bowel Disease: A True Medicine or a False Promise?

Cannabis is the most widely used recreational drug worldwide and is used by some patients with inflammatory bowel disease (IBD) to ameliorate their disease. Whereas epidemiological studies indicate that as many as 15% of IBD patients use cannabis, studies inspecting cannabis use in IBD are few and small. We have conducted several studies looking at the use of cannabis in IBD. In Crohn's disease, we demonstrated that cannabis reduces the Crohn's disease activity index (CDAI) by >100 points (on a scale of 0-450).Two small studies in ulcerative colitis showed a marginal benefit. However, no improvement was observed in inflammatory markers or in endoscopic score in either disease. Many questions regarding cannabis use in IBD remain unanswered. For example, cannabis is a complex plant containing many ingredients, and the synergism or antagonism between them likely plays a role in the relative efficacy of various cannabis strains. The optimal doses and mode of consumption are not determined, and the most common form of consumption, i.e. smoking, is unacceptable for delivering medical treatment. Cannabis is a psychotropic drug, and the consequences of long-term use are unknown. Despite all these limitations, public opinion regards cannabis as a harmless drug with substantial medical efficacy. In Israel, the number of licenses issued for the medical use of cannabis is rising rapidly, as are the acknowledged indications for such use, but good-quality evidence for the effectiveness of cannabis is still lacking. Further studies investigating the medical use of cannabis are urgently needed.

[Rheumatic fever and Kawasaki disease among children in Israel]

BACKGROUND

Rheumatic Fever (RF) and Kawasaki Disease (KD) are the two leading causes of childhood acquired heart disease in developed countries.

AIM

The objective of this paper is to characterize the epidemiologic changes and estimate the incidence rate of RF and KD among children in Israel in the past two decades.

METHODS

Using the Israel National Hospital Discharges Register (NHDR), we investigated the epidemiologic features of RF and KD among children in Israel under 18 years of age, between the years 1996 and 2012. Incidence rates were calculated using the corresponding Central Bureau of Statistics (CBS) data.

RESULTS

The average annual incidence rates of RF and KD were, respectively, 2 and 2.03 cases per 100,000 children under 18 years of age. During the study period, the incidence rate of RF declined by over 50%, while the incidence rate of KD increased by more than 40%. The hospitalization rate of RF and KD diagnoses in children showed similar trends.

CONCLUSIONS

The incidence rates of RF and KD had undergone significant changes in the past two decades. These changes probably reflect increased awareness of preventing RF and diagnosing KD among health professionals. Due to the high risk of chronic heart disease associated with inadequately treated children, it is important to maintain high awareness among healthcare professionals and provide timely diagnosis of both conditions.

[Audit of general hospitals and private surgical clinics in Israel]

BACKGROUND

Supervision and inspection of medical facilities are among the responsibilities of the Ministry of Health (MOH) anchored in the "Public Health Act 1940". In order to implement the law, the General Medical Division of the MOH began the process of auditing hospitals and private surgical clinics prior to considering the reissue of their license.

OBJECTIVES

The audit aimed to implement the law, activate supervision on general hospitals and private surgical clinics, provide feed-back to the audited institution and upgrade quality assurance, regulate medical activities according to the activities elaborated in the license and recommend the license renewal.

METHODS

Prior to the audits, 20 areas of activity were chosen for inspection. For each activity a check list was developed as a tool for inspection. Each area was inspected during a 4-5 hour visit by a MOH expert, accompanied by the local service manager in the institution under inspection. A comprehensive report, summarizing the findings was sent to the medical institute, requesting correction in those areas where improvements were needed. Recommendation for license renewal was sent to the Director of Licensing Division Ministry of Health.

RESULTS

Between June 2003 and July 2006, 91 structured audits took place. A total of 47 general hospitals and 24 private surgical clinics were visited at least once. Most general hospitals were found abiding, functioning according to the required standards and eligible for license renewal. Licenses of institutions that complied with the standards determined by the audit teams, were renewed. Two private hospitals in central Israel, that were given an overall poor evaluation, were issued with a temporary license and subsequently re-audited 4 times over the next two years. Generally, the standards in private surgical clinics were lower than those found in general public hospitals. In one clinic the license was not renewed, and in another an order was issued to cease surgical procedures requiring general anesthesia.

CONCLUSIONS

The evaluations were mainly qualitative, deliberately avoiding numerical rating. In order to improve the process in the future and facilitate common scale rating to establish an equitable comparison system between institutions, it will be necessary to develop more quality measures and compulsory standards, based on the measures used during the first round of audits. Publication of the results of such comparisons, will elevate medical performance, and ultimately improve the quality of services and medical care in Israel.

Morbidity and mortality of post-tonsillectomy bleeding: analysis of cases

OBJECTIVES

To analyse the circumstances of mortality in post-tonsillectomy bleeding cases, in order to better manage serious problems during resuscitation.

DESIGN

Reports of inquiry committees on post-tonsillectomy mortalities.

SETTING

State of Israel Ministry of Health committees.

PARTICIPANTS

Senior otolaryngologists and related professionals, and the involved medical staff who participated in the inquiry committees.

MAIN OUTCOMES MEASURES

Identification of actions causing undesirable effects on resuscitation outcomes.

RESULTS

In recent years, the post-tonsillectomy mortality rate in Israel has been one in 12,000. The two main causes of death have been severe haemorrhagic shock and airway obstruction.

CONCLUSIONS

Active bleeding should be treated, rather than waiting for spontaneous resolution. An efficient airway should be established early during resuscitation, either by intubation (within two minutes) or by cricothyroidotomy. The two main factors endangering the patient's life during resuscitation are severe blood loss, interfering with effective cardiac output, and airway obstruction. Blood loss should be quickly substituted.

An analysis of referrals received by a psychiatric unit in a general hospital Part 1

In order to receive holistic health care, patients requiring psychiatric care, need to be referred to psychiatric services.OpsommingTen einde holistiese gesondheidsorg te ontvang, moot pasiente, wat psigiatriese sorg benodig, na psigiatriese dienste verwys word. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Analysis of referrals received by a psychiatric unit in a general hospital Part 2

The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses. Opsomming Hierdie navorsing het gepoog om verwysings te ontleed wat deur 'n psigiatriese eenheid in 'n algemene hospitaal in die Wes Kaap ontvang is. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.