Isr Med Assoc J
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Clinical Trial Controlled Clinical Trial
Postoperative loco-regional radiation therapy for breast cancer patients with four or more involved lymph nodes or extracapsular extension.
Post-mastectomy loco-regional radiation to the chest wall and draining lymphatics, combined with adjuvant chemotherapy and hormonal therapy, significantly improve survival in patients with node-positive breast cancer. However, the actual benefit of post-mastectomy radiotherapy and the desired extent of treatment are still debatable. ⋯ Radiotherapy to the breast/chest wall and to the draining lymphatics, in addition to surgery and adjuvant therapy, significantly reduced the risk of local and regional recurrence in high risk breast cancer patients with four or more involved lymph nodes or ECE.
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Comparative Study
Approach to benign paroxysmal positional vertigo in old age.
Benign paroxysmal positional vertigo is a common and treatable vestibular disorder characterized by attacks of positional vertigo. Although elderly patients often complain about unsteadiness, the symptom of positional vertigo is seldom reported. Several studies on BPPV in the elderly reveal a low success rate in the treatment of this entity. ⋯ Our study shows that BPPV characteristics and treatment effectiveness, as measured by negative Dix-Hallpike maneuver, are not age-dependent and there is no need for a special approach or cautiousness in prognosis prediction. It is important to search actively for this condition since treatment leads to amelioration of unsteadiness and improved well-being in these patients.
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Comparative Study
Spending on medicines in Israel in an international context.
Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. ⋯ Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.