Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy.

Low back pain (LBP) is a major cause of discomfort and disability. Physicians' attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians' attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.

Twenty Thousand Needles Under the Sea. Trigger Point Dry Needling Aboard an Israeli Navy Submarine: A Case Report.

Nonspecific lower back pain affects a major part of the population at a certain point of their life. The intensity of pain can be debilitating and it causes a significant burden on society. Trigger point dry needling is a method of alleviating such pain by the introduction of needles into trigger points in muscles. A growing body of evidence supports its use in myofascial pain and specifically lower back pain. Submarine Medicine is a unique field due to the special characteristics and the environment of the submarine. It poses challenges that are not always seen by primary care physicians. Here, we present a case of a 40-yr-old senior submarine officer who complained of pain in his lower back and pelvis before departing on a mission. The pain persisted in spite of treatment with nonsteroidal anti-inflammatory drugs and he was then treated by the submarine's physician with trigger point dry needling. The officer showed rapid improvement following this treatment, both regarding pain and the range of motion.

Real time medical learning using the WhatsApp cellular network: a cross sectional study following the experience of a division's medical officers in the Israel Defense Forces.

BACKGROUND: Primary care medical officers (MOs) are expected to maintain self-education while serving in their units in order to maintain professional standards. With the rise of smartphone use in the Israel Defense Forces (IDF), the WhatsApp application can facilitate medical learning. To date, there has been no description of the use of this tool by MOs in a military setting. This paper aims to describe the pattern of use of a WhatsApp application group by IDF's MOs. METHODS: We collected all the information (textual and visual) uploaded to a WhatsApp group called "The Division's Physicians", originally established two years earlier, during a randomly selected sample month. We analyzed the pattern of its use and explored the association between the number of questions and responses uploaded to the group and the duration of service of their senders. RESULTS: In December 2014, the "The Division's Physicians" WhatsApp group had 41 participants. We identified 478 messages classified as questions and 531 messages classified as responses. The number of questions asked by MOs in their first 2 months of service in the battalion (median = 14.5) and the number of questions asked by MOs with more than one year of their first assignment (median = 10.5) were significantly higher than the number of questions (median = 1.0) asked by MOs in their second assignment or later (p values for comparisons were 0.008 and 0.012 respectively). We also found that both the number of responses provided by MOs with more than one year of service in the battalion (median = 21) and the number of responses provided by MOs in their second assignment or later (median = 5) were significantly higher than the number of responses (median = 1) provided by MOs within their first 2 months of service in the battalion (p value for comparisons were 0.024 and 0.039 respectively). CONCLUSION: We conclude from our preliminary study that a WhatsApp group can facilitate the transfer of knowledge from more experienced MOs to those with less experience.

The role of empirical albendazole treatment in idiopathic hypereosinophilia - a case series.

Hypereosinophilia is usually defined as a blood eosinophil count >1500/µL. A broad variety of conditions are associated with hypereosinophilia. The present report describes three cases of hypereosinophilia, in which a thorough history, physical examination, laboratory and imaging investigations were unable to detect any abnormalities. Albendazole was empirically administered in all three cases, with complete normalization of eosinophil counts thereafter. Empirical treatment with albendazole for patients presenting with hypereosinophilia should be strongly considered.

L'hyperéosinophilie est généralement définie comme une numération d'éosinophiles sanguins supérieure à 1 500/µL. Diverses affections s'y associent. Le présent rapport en décrit trois cas, dans lesquels des antécédents approfondis, un examen physique et des examens de laboratoire et d'imagerie n'ont pas décelé d'anomalies. L'albendazole a été administré de manière empirique dans les trois cas, et la numération d'éosinophiles s'est entièrement normalisée. Il faudrait envisager un traitement empirique à l'albendazole chez les patients présentant une hyperéosinophilie.