The Nazareth Community Oncology Unit: The Oncology Nurse's Role to Provide Care in the Environment of COVID-19.

The Community Oncology Unit (COU) in Nazareth, Israel, provides complete medical treatments to patients who live in the rural area of the country. During the COVID-19 pandemic, oncology nurses face additional challenges in facilitating cancer care. Pertinent adjustments are being made at the COU to maintain patients' safety and enable continuous oncology therapy by coordinating patients' COVID-19 testing and vaccination program.

Evaluation of telehealth service for patients with congestive heart failure in the north of Israel.

AIMS: This research was conducted to evaluate the impact of a telehealth service on re-hospitalization of patients with congestive heart failure at New York Heart Association II-IV. METHODS AND RESULTS: The telehealth service for congestive heart failure patients was designed to follow the patients after their daily weighing and to provide a response in cases of non-compliance or deviation from baseline weight. A weighing scale was installed in the patient's house together with a communication module connected to the telemedicine control centre through a telephone line. The control centre is staffed by skilled nurses whose responses to patients are guided by programmed algorithm. Over a year, we evaluated the changes in the frequency of hospital admission and of primary care visits, and quality of life of 141 individuals who were eligible for the telehealth service for congestive heart failure. A decline was noted in the average number of hospitalizations per patient (from 4.7 to 2.6, p < 0.001). Scores of parameters of quality of life were improved (average score for first through fourth quarterly administration: 64, 50, 16, 16, p < 0.001 by the Minnesota Living with Heart Failure Questionnaire). CONCLUSIONS: During the year of use in telehealth service for congestive heart failure parameters of hospitalization were improved, together with parameters of quality of life.

Teaching internal medicine in the community.

BACKGROUND: Teaching Internal Medicine is mainly hospital-based. Chronic diseases are treated mostly in community-based ambulatory care. This study describes our experience during the first year of teaching Internal Medicine in the community, with a focus on chronic disease management. METHODS: This was an observational study describing the content of clinical exposure and the feedback from students after a two-week clerkship in community health centers. RESULTS: Over a period of three months, 54 students spent two weeks in health centers singly or in pairs. The disciplines covered were: Endocrinology, Gastroenterology, Pulmonology, Rheumatology and Geriatrics. In their feedback, the students most frequently noted knowledge acquired in the management of diabetes, infectious diseases and cardiology. The teaching content was determined by the case-mix of patients. The spectrum of conditions was wide. Students who were used to more structured hospital-based study found it difficult to cope with this mode of learning by discovery. DISCUSSION: Future research should concentrate on the transition between the different modes of learning as students move from the hospital to the community setting.

Management of kidney disease in patients with diabetes in the primary care setting.

AIMS: To evaluate the performance of general practitioners (GPs) in the care of diabetic patients in areas represented or unrepresented by quality indicators. METHODS: An observational study in primary care practices. The study population was comprised of GPs who cared for 1799 patients with diabetes mellitus co-existing with stage 3 chronic kidney disease, hypertension, and cardiovascular disease. The performance of GPs was monitored twice during a 6-month interval using a regional computerized clinical data base according to the measurement and treatment of blood pressure, LDL-cholesterol level, proteinuria, hematuria, and anemia. RESULTS: Those parameters which were familiar to the GPs for several years as part of the Quality Indicators Program (QIP) were measured and treated at a high rate compared to parameters not included in the QIP. For example, measurement of blood pressure and testing for glycosylated hemoglobin were 99% and 98% respectively at the end point. In contrast the rate of performance of specific kidney disease-focused activities, such as referral of patients with proteinuria to nephrologic consultation was 36% at the end point. CONCLUSION: Good performance in areas monitored by Quality Indicators does not imply good quality of care in other areas for the same patients. Attention should be paid to initiating activities to raise the awareness of GPs with respect to important health parameters which are not included in the Quality Indicators Program.