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Papier I, Chermesh I, Mashiach T, Gruenwald I, Banasiewicz T. Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics. J Clin Nurs 2024. [PMID: 38379370 DOI: 10.1111/jocn.17076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/30/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
AIM To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake. DESIGN Retrospective cohort study. METHODS The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition. RESULTS Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use. CONCLUSION The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation. RELEVANCE IN CLINICAL PRACTICE Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk. IMPACT The study impacts the quality of care for patients at risk of malnutrition. REPORTING METHOD We adhered to the STROBE Checklist for cohort studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Irena Papier
- Nursing Administration, Rambam Health Care Campus, Haifa, Israel
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Affiliated with Technion-Israel Institute of Technology, the Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel
| | - Ilan Gruenwald
- Neuro-Urology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Papier I, Chermesh I, Mashiach T, Banasiewicz T. Evaluation of prevalence of food intake monitoring during acute hospitalization and its association with malnutrition screening scores of inpatients who were not considered for enteral/parenteral nutrition. Nutrition 2023; 110:112031. [PMID: 37028148 DOI: 10.1016/j.nut.2023.112031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Malnutrition risk can be recognized by nurses using screening tools and food intake monitoring. We measured the prevalence of food intake reporting and its association with malnutrition screening scores or other patient characteristics. METHODS This retrospective cohort study collected hospital database information regarding patients aged ≥18 y who were hospitalized for ≥ 7 consecutive days and were orally fed or had medical records that no tube feeding or parenteral nutrition had been administered. Data were collected and statistically analyzed focusing on food intake reporting, Malnutrition Universal Screening Tool (MUST) scores, oral nutritional intervention, and other secondary characteristics. RESULTS Out of 5155 patients admitted to two internal medicine departments over 1 y (July 1, 2018, through August 31, 2019), 1087 fulfilled the inclusion criteria with a mean age of 72.4 ± 14.6 y; of these, 74.6% had sufficient food intake reports. No food intake was reported for one-third of patients with MUST scores ≥ 2. There were no differences between the groups of patients with and without reported food intake with regard to MUST scores, sex, mean albumin level, comorbidity, length of stay, all-cause in-hospital mortality, hospital-acquired pressure injury, or the rate of oral nutritional intervention. MUST scores ≥ 2 were not significantly associated with intake reporting. Increased probability of having food intake reported was found in patients ages ≥70 y (adjusted odds ratio = 1.36; P = 0.036 [95% CI, 1.02-1.82]) and those who had Norton scores ≤ 13 (adjusted odds ratio = 1.60; P = 0.013 [95% CI, 1.10-2.31]). However, the model had a weak predictive efficacy (area under the curve = 0.577; P < 0.0001 [95% CI, 0.538-0.616]). CONCLUSIONS More adherence to food intake monitoring guidelines is needed.
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Papier I, Sagi-Dain L, Chermesh I, Mashiach T, Banasiewicz T. Absence of oral nutritional support in low food intake inpatients is associated with an increased risk of hospital-acquired pressure injury. Clin Nutr ESPEN 2022; 51:190-198. [PMID: 36184204 DOI: 10.1016/j.clnesp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Hospital-acquired pressure injury (HAPI) incidence is a common burden in hospitals. Decreased food intake leading to malnutrition compromises body tissues involved in pressure injury occurrence. However, most tools for predicting pressure injuries do not include daily food intake monitoring nor consider further nutritional interventions. This study aimed to investigate clinical practices for food intake monitoring and its association with predicting HAPI risk, together with Norton Scale use, and whether the initiation or absence of oral nutritional supplements (ONS), separately from other nutritional interventions, was associated with HAPI incidence in low food intake inpatients, who consumed less than 50% of requirements. METHODS This observational cohort study covered a one-year period (08/2018-07/2019). Demographic and clinical data were extracted from computerized files of patients hospitalized ≥7 days, aged ≥60 years, and who ate orally. Patients receiving enteral or parenteral nutrition were excluded. Differences were studied between groups without and with HAPI grade ≥2. Subgroups divided by Norton Scale and intake, Norton Scale and albumin levels, food intake and initiation (or not) of any nutritional intervention versus ONS only, were examined for the consistency of association with HAPI. RESULTS Of the 5155 admissions during the study period, 895 patients fulfilled the inclusion criteria: 48% female, mean age 77.6 ± 9.1 years, 11% with MUST score ≥2. Nutritional intake was reported in 76% of patients, of them 22% had low food intake, and 9% of the study group developed HAPI grade ≥2. Regarding HAPI incidence, no differences were found between groups divided by MUST scores. Independent risk factors significantly associated with HAPI were Norton <14, albumin levels <3 g/dl, and low food intake. Not providing ONS in low food intake patients had an adjusted 3.49-fold (95%CI 1.57-7.75) increase in HAPI risk (6-fold for non-adjusted relative risk). CONCLUSION Failure to initiate ONS as part of nutritional support in low food intake patients is associated with high HAPI risk in these patients. Consequently, monitoring of daily food intake for identifying low intake patients should be integrated into routinely used tools such as the Norton Scale, and adherence to nutritional protocols should be addressed.
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Affiliation(s)
- Irena Papier
- Nursing Department, Rambam Health Care Campus, Haifa, Israel.
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel.
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland.
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Shouval A, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Mashiach T, Almog R, Elkayam O. Real-world effectiveness of tofacitinib in patients with rheumatoid arthritis: a prospective observational study. Clin Exp Rheumatol 2021; 39:1378-1384. [DOI: 10.55563/clinexprheumatol/do2uxu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Aniela Shouval
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, and Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Ramat Gan, Israel
| | | | - Devy Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Almog
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Israel.
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Elalouf O, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Hakakian O, Mashiach T, Almog R, Elkayam O. High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis. Biologics 2021; 15:279-287. [PMID: 34321864 PMCID: PMC8312506 DOI: 10.2147/btt.s290169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022]
Abstract
Purpose To evaluate the association between body mass index (BMI) and tumor necrosis factor α (TNF-α) blockers retention in patients with rheumatoid arthritis (RA). Patients and Methods This prospective cohort study analyzed data about patients with RA who initiated TNF blockers from the Israeli registry of inflammatory diseases from 2011 to 2019. Patients were grouped by BMI: normal (BMI <24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), obese (BMI 30–34.9 kg/m2) and morbid obese (BMI ≥35 kg/m2). Treatment cessation due to inefficacy was defined as an “event” and therapy with a drug above 3 months was defined as a “course.” Kaplan–Meier survival curve was used to describe drug survival. Event-free survival was calculated using Cox regression with a hazard ratio and confidence interval of 95%. Results The final analysis included 521 RA patients (80% females) treated with etanercept, infliximab, adalimumab or golimumab. Eight hundred and eighteen treatment initiations were included in the final analysis, 334 (41%) in the normal weight group, 261 (32%) in the overweight, 144 (17%) in the obese and 79 (10%) in the morbid obesity group. Three hundred and twenty-six (40%) treatment initiations were with etanercept, 215 (26%) with adalimumab 197 (24%) with infliximab, and 80 (10%) with golimumab. BMI was inversely associated with drug survival. Morbid obese patients were more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67–3.10, p<0.01). This association remained significant for each drug type (except for golimumab) in a subgroup analysis. Adalimumab switch rate was higher compared to etanercept with HR =1.51 (95% CI 1.20–1.91, p<0.01), no other significant differences were noted between the other drugs. Conclusion Morbid obese RA patients have lower TNF-α blocker retention compared to normal weight patients.
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Affiliation(s)
- Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel
| | | | - Devy Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | | | - Odelia Hakakian
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Almog
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Feld J, Elkayam O, Druyan A, Reitblat T, Balbir-Gurman A, Hadad A, Gazitt T, Elias M, Furer V, Mashiach T, Zisman D. POS0974 IMPROVEMENT IN THE DIAGNOSTIC DELAY OF AXIAL SPONDYLOARTHRITIS, RESULTS FROM REAL WORLD DATA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Diagnostic delay is a major challenge in axial spondyloarthritis (axSpA) with an extended interval of 8-10 years in Europe and 14 years in the United States between symptom onset and disease diagnosis (1, 2).Objectives:To assess the delay in the diagnosis of axSpA over time in a real world axSpA cohort diagnosed in the last 3 decades and to evaluate factors associated with this delay.Methods:A cohort of axSpA patients was recruited from a national multicenter registry of inflammatory arthritis. This cohorts’ demographic, clinical and diagnostic variables were studied. The diagnostic delay was defined as the time interval between the year of first symptom and year of diagnosis. The mean and median diagnostic delay were calculated. A survival analysis was performed evaluating the association between the demographic, clinical and diagnostic variables on the diagnostic delay.Results:Of the 373 axSpA patients in the registry, 198 (47%) are men. Ankylosing spondylitis fulfilling New York criteria was diagnosed in 73% of the patients. HLA-B*27 positivity was found in 64% of patients. The majority of the patients (63%) reported symptom onset between the age of 21-45, 21% before the age of 21 and 16% after the age of 45. Nine percent were diagnosed before the age of 21, 28% between 21-30, 23% between 31-40, 21% between 41-50 and 18% after the age of 50. One hundred and ten patients were diagnosed before 2000, 133 between 2001-2009 and 130 between 2010-2020. The mean and median delay in diagnosis was 9.1, 6 (±8.4) years when diagnosed before 2000, 5, 4 (±4.1) years when diagnosed 2001-2009, and 2, 1 (±1.5) years when diagnosed 2010-2020, respectively (graph 1). The only variable which was found to be associated with a shorter delay was the interval between symptom onset and first rheumatology consult: HR of 5.86 (4.3-8, p<0.001) if the rheumatology visit was within the first year of symptoms, HR 3.5 (2.4-5, p<0.001) if assessed 2-3 years after symptom onset. Additionally, age <21 at symptom onset was associated with a shorter delay (p=0.005). Sex, type of axSpA (radiographic vs. non radiographic axSpA), level of education, and HLA-B*27 positivity were not associated with a delay in diagnosis.Conclusion:Delay in axSpA diagnosis has significantly improved in this real-world cohort during the last decade. The most significant factor associated with a faster diagnosis was the time of the first rheumatology consult relative to symptom onset. Increasing the awareness of disease manifestations and early referral to a rheumatology service can improve the diagnosis delay of axSpA.References:[1]Sorensen J, Hetland ML, all departments of rheumatology in D. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2015;74(3):e12.[2]Deodhar A, Mittal M, Reilly P, Bao Y, Manthena S, Anderson J, et al. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016;35(7):1769-76.Graph 1.The improvement in the delay in diagnosis of axial spondyloarthropathy over the last 3 decadesDisclosure of Interests:None declared.
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Lopez-Alonso R, Qi S, Mashiach T, Weiler-Sagie M, Yahalom J, Dann EJ. The presence of a bulky mediastinal mass of 7 cm or greater in diameter confers an adverse prognosis to patients with advanced Hodgkin lymphoma in case of negative interim PET/CT. Leuk Lymphoma 2021; 62:1313-1324. [PMID: 33478289 DOI: 10.1080/10428194.2021.1872069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the PET-adapted therapy era, a bulky mediastinal mass (BMM) is not considered a risk factor in patients with advanced-stage Hodgkin lymphoma (HL). The current retrospective study aimed to estimate the prognostic significance of BMM presence and size for disease-free survival (DFS) and determine the most accurate mass size cutoff (among 5 cm, 7 cm, 10 cm) to predict inferior DFS in such patients. The study included 196 advanced-HL patients treated at Rambam (n = 121) and Memorial Sloan Kettering Cancer Center (n = 75) between 2002 and 2016. At a median follow-up of 66.5 (1-222) months, 36 relapses occurred. In multivariate analysis, only the cutoff of 7 cm predicted inferior DFS and PFS (p < 0.007 and <0.038, respectively) in interim PET/CT (PET-2) negative (79%) patients. This study identifies the BMM size cutoff of 7 cm in any plane as most precise in predicting adverse prognosis in PET-2-negative patients with advanced-stage HL. More aggressive initial chemotherapy than ABVD improves such prognosis.
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Affiliation(s)
| | - Shunan Qi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tanya Mashiach
- Quality Assurance Unit, Rambam Health Care Campus, Haifa, Israel
| | | | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eldad J Dann
- Blood Bank and Apheresis Unit, Rambam Health Care Campus, Haifa, Israel.,Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Dabaja‐Younis H, Garra W, Shachor‐Meyouhas Y, Mashiach T, Geffen Y, Kassis I. The epidemiology of Staphylococcus aureus bacteraemia in Israeli children: Community- vs hospital-acquired or healthcare related infections. Acta Paediatr 2021; 110:210-218. [PMID: 32506515 DOI: 10.1111/apa.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Abstract
AIM Incidences of Staphylococcus aureus bacteraemia (SAB) in Israeli children are unknown. The characteristics of SAB in children have not been evaluated. METHODS SAB from children aged ≤18 years old, admitted to a tertiary hospital in Israel during 2002-2015, were included. The proportional rate of SAB was calculated per 1000 admissions. SAB were classified as community acquired (CA), hospital acquired (HA) and healthcare related (HCR). Patients' characteristics, antibiotic susceptibility and outcomes were assessed in each group. RESULTS The rate of SAB was stable, 1.48 per 1000 admissions. HA, CA and HCR-SAB comprised 53%, 25% and 22%, respectively. Only 27/185 (14.6%) were caused by methicillin-resistant S aureus (MRSA): 22%, 6% and 5% of HA, CA and HCR-SAB, respectively. Central venous catheter, recent surgery, immunodeficiency and age <6 years were the main risk factors for HA and HCR-SAB (adjusted OR: 68.9, 7.5, 5.8 and 5.5, respectively). Treatment duration for CA was >21 days: and for HA and HCR, 14-20 days. All-cause in-hospital mortality and 30-day mortality were documented in 10 (5%) and 3 (2%) episodes, respectively. CONCLUSION The rate of SAB; the proportions of CA, HA and HCR-SAB; and the proportion of MRSA was stable over the years. MRSA was mainly in HA-SAB. Thirty-day mortality was rare.
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Affiliation(s)
- Halima Dabaja‐Younis
- Pediatric Infectious Diseases Unit Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Haifa Israel
| | - Wakar Garra
- Pediatric Infectious Diseases Unit Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Haifa Israel
| | - Yael Shachor‐Meyouhas
- Pediatric Infectious Diseases Unit Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Haifa Israel
| | - Tanya Mashiach
- Quality Assurance Department Rambam Health Care Campus Haifa Israel
| | - Yuval Geffen
- Microbiology Laboratory Rambam Health Care Campus Haifa Israel
| | - Imad Kassis
- Pediatric Infectious Diseases Unit Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Haifa Israel
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Reiner Benaim A, Almog R, Gorelik Y, Hochberg I, Nassar L, Mashiach T, Khamaisi M, Lurie Y, Azzam ZS, Khoury J, Kurnik D, Beyar R. Analyzing Medical Research Results Based on Synthetic Data and Their Relation to Real Data Results: Systematic Comparison From Five Observational Studies. JMIR Med Inform 2020; 8:e16492. [PMID: 32130148 PMCID: PMC7059086 DOI: 10.2196/16492] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/01/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Privacy restrictions limit access to protected patient-derived health information for research purposes. Consequently, data anonymization is required to allow researchers data access for initial analysis before granting institutional review board approval. A system installed and activated at our institution enables synthetic data generation that mimics data from real electronic medical records, wherein only fictitious patients are listed. Objective This paper aimed to validate the results obtained when analyzing synthetic structured data for medical research. A comprehensive validation process concerning meaningful clinical questions and various types of data was conducted to assess the accuracy and precision of statistical estimates derived from synthetic patient data. Methods A cross-hospital project was conducted to validate results obtained from synthetic data produced for five contemporary studies on various topics. For each study, results derived from synthetic data were compared with those based on real data. In addition, repeatedly generated synthetic datasets were used to estimate the bias and stability of results obtained from synthetic data. Results This study demonstrated that results derived from synthetic data were predictive of results from real data. When the number of patients was large relative to the number of variables used, highly accurate and strongly consistent results were observed between synthetic and real data. For studies based on smaller populations that accounted for confounders and modifiers by multivariate models, predictions were of moderate accuracy, yet clear trends were correctly observed. Conclusions The use of synthetic structured data provides a close estimate to real data results and is thus a powerful tool in shaping research hypotheses and accessing estimated analyses, without risking patient privacy. Synthetic data enable broad access to data (eg, for out-of-organization researchers), and rapid, safe, and repeatable analysis of data in hospitals or other health organizations where patient privacy is a primary value.
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Affiliation(s)
| | - Ronit Almog
- Clinical Epidemiology Unit, Rambam Health Care Campus, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Yuri Gorelik
- Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel
| | - Irit Hochberg
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Laila Nassar
- Clinical Pharmacology and Toxicology Section, Rambam Health Care Campus, Haifa, Israel
| | - Tanya Mashiach
- Clinical Epidemiology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Mogher Khamaisi
- Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel.,Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,Diabetes Stem Cell Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Yael Lurie
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clinical Pharmacology and Toxicology Section, Rambam Health Care Campus, Haifa, Israel
| | - Zaher S Azzam
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine and Rappaport Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Johad Khoury
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Daniel Kurnik
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clinical Pharmacology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Rafael Beyar
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Rambam Health Care Campus, Haifa, Israel
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Khoury J, Bahouth F, Stabholz Y, Elias A, Mashiach T, Aronson D, Azzam ZS. Blood urea nitrogen variation upon admission and at discharge in patients with heart failure. ESC Heart Fail 2019; 6:809-816. [PMID: 31199082 PMCID: PMC6676277 DOI: 10.1002/ehf2.12471] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/27/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS Heart failure (HF) is one of the leading causes for hospitalization and mortality. After first admission with acute decompensated HF, some patients are in high risk for short-term and long-term mortality. These patients should be identified, closely followed up, and treated. It has been observed that blood urea nitrogen (BUN) on admission is a predictive marker for short-term mortality. Recently, it has been shown that higher BUN levels on discharge are also a bad prognostic predictor. However, the prognostic value of BUN alteration during hospital stay was not investigated; therefore, we aimed to investigate the effect of BUN variation during hospitalization on mortality. METHODS AND RESULTS A retrospective study included patients with first hospitalization with the primary diagnosis of HF. The patients were divided into four groups on the basis of the values of BUN on admission and discharge, respectively: normal-normal, elevated-normal, normal-elevated, and elevated-elevated. Four thousand seven hundred sixty-eight patients were included; 2567 were male (53.8%); the mean age was 74.7 ± 12.7 years. The 90 day mortality rate in the normal-normal group was 7% lower than that in the elevated-normal (14.6%) and normal-elevated (19.3%) groups; P value < 0.01. The 90 day mortality in the elevated-elevated group (28.8%) was significantly higher than that in the other groups; P < 0.001. During the 36 month follow-up, these results are maintained. While sub-dividing BUN levels into <30, 30-39, and >40 mg/dL, higher BUN levels correlated with higher 90 day mortality rate regardless of creatinine levels, brain natriuretic peptide, or age. Moreover, BUN on admission and on discharge correlated better with mortality than did creatinine and glomerular filtration rate at the same points. CONCLUSIONS The BUN both on admission and on discharge is a prognostic predictor in patients with HF; however, patients with elevated levels both on admission and on discharge have the worst prognosis. Moreover, worsening or lack of improvement in BUN during hospitalization is a worse prognostic predictor. To the best of our knowledge, this is the first trial to discuss the BUN change during hospitalization in HF.
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Affiliation(s)
- Johad Khoury
- Pulmonology Division, Lady Davis Carmel Medical Center, Haifa, Israel.,Internal Medicine Department B, Rambam Health Care Campus, PO Box 9602, Haifa, 31096, Israel
| | - Fadel Bahouth
- Internal Medicine Department H, Rambam Health Care Campus, Haifa, Israel.,Cardiology Department, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Stabholz
- Internal Medicine Department B, Rambam Health Care Campus, PO Box 9602, Haifa, 31096, Israel
| | - Adi Elias
- Internal Medicine Department B, Rambam Health Care Campus, PO Box 9602, Haifa, 31096, Israel
| | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Doron Aronson
- Cardiology Department, Rambam Health Care Campus, Haifa, Israel.,Bruce and Ruth Rappaport, Rambam Health Care Campus, Haifa, Israel
| | - Zaher S Azzam
- Internal Medicine Department B, Rambam Health Care Campus, PO Box 9602, Haifa, 31096, Israel.,Bruce and Ruth Rappaport, Rambam Health Care Campus, Haifa, Israel
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11
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Nasser R, Naffaa ME, Mashiach T, Azzam ZS, Braun E. The association between serum magnesium levels and community-acquired pneumonia 30-day mortality. BMC Infect Dis 2018; 18:698. [PMID: 30587164 PMCID: PMC6307202 DOI: 10.1186/s12879-018-3627-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background Community acquired pneumonia (CAP) is a common illness affecting hundreds of millions worldwide. Few studies have investigated the relationship between serum magnesium levels and outcomes of these patients. We aimed to study the association between serum magnesium levels and 30-day mortality among patients with CAP. Methods Retrospective overview of patients hospitalized with CAP between January 1, 2010 and December 31, 2016. Participants were analyzed retrospectively in order to identify the risk factors for a primary endpoint of 30-day mortality. Normal levels of magnesium levels in our laboratory varies between 1.35 and 2.4 mg/dl. Results 3851 patients were included in our cohort. Age > 75 years, blood urea nitrogen (BUN) > 20 mg/dl, hypoalbuminemia, and abnormal levels of magnesium were all associated with increased risk of 30-day mortality. Normal magnesium levels were associated with the lowest mortality rate (14.7%). Notably, within the normal levels, high normal magnesium levels (2–2.4 mg/dl) were correlated with higher mortality rates (30.3%) as compared to levels that ranged between 1.35–2 mg/dl (12.9%). Hypomagnesemia and hypermagnesemia were both associated with excess of 30-day mortality, 18.4 and 50%, respectively. Conclusion Hypomagnesemia and hypermagnesemia on admission were associated with an increased rate of 30-day mortality among adult patients hospitalized with CAP. Interestingly, magnesium levels within the upper normal limits were associated with higher mortality.
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Affiliation(s)
- Roni Nasser
- Department of Internal Medicine "B", Ramabm Health Care Campus, HaAliya HaShniya St 8, 3109601, Haifa, Israel.
| | | | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Zaher S Azzam
- Department of Internal Medicine "B", Ramabm Health Care Campus, HaAliya HaShniya St 8, 3109601, Haifa, Israel.,The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel
| | - Eyal Braun
- The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel.,Department of Internal Medicine "H", Ramabm Health Care Campus, Haifa, Israel
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12
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Epstein D, Nasser R, Mashiach T, Azzam ZS, Berger G. Increased red cell distribution width: A novel predictor of adverse outcome in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2018; 136:1-7. [DOI: 10.1016/j.rmed.2018.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/07/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
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13
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Epstein D, Borohovitz A, Merdler I, Furman M, Atalli E, Sorkin A, Stainfeld Y, Isenberg Y, Mashiach T, Shapira S, Weisshof R, Dann EJ. Prevalence of Iron Deficiency and Iron Deficiency Anemia in Strenuously Training Male Army Recruits. Acta Haematol 2018; 139:141-147. [PMID: 29478071 DOI: 10.1159/000485736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of our study were to determine the effect of strenuous physical training on the prevalence of iron deficiency anemia (IDA), iron deficiency (ID) with normal hemoglobin (Hb), and anemia without ID. METHODS Our study was a prospective observational study. We followed 115 healthy male recruits in the Israel Defense Forces elite units during 15 months of training. Blood samples were collected at recruitment and at 6-, 9- and 15-month follow-ups. RESULTS Upon recruitment, anemia (Hb < 14 g/dL), ID, and ID anemia (IDA) were diagnosed in 28, 31, and 9% of individuals, respectively. Sixty-three subjects (54%) were followed for 6 months; 9 of them (14%) developed new-onset IDA. Among them, the prevalence of anemia rose from 19 to 52%, and ID from 33 to 35%. At the 15-month follow-up, 29% had developed new-onset IDA and 65% showed evidence of ID. CONCLUSION We report a high prevalence of anemia, ID, and IDA among young healthy males participating in prolonged strenuous training programs. These findings can be partly explained by the physiological changes associated with strenuous physical activity. Further investigations aiming to develop specific diagnostic guidelines for this unique population are warranted.
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Affiliation(s)
- Danny Epstein
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | - Ariel Borohovitz
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Moran Furman
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Emmanuel Atalli
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Alex Sorkin
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Assaf HaRofeh Medical Center, Tzrifin, Israel
| | - Yaniv Stainfeld
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | - Yoni Isenberg
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | | | - Shachar Shapira
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | | | - Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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14
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Vornicova O, Naroditsky I, Boyango I, Shachar SS, Mashiach T, Ilan N, Vlodavsky I, Bar-Sela G. Prognostic significance of heparanase expression in primary and metastatic breast carcinoma. Oncotarget 2017; 9:6238-6244. [PMID: 29464068 PMCID: PMC5814208 DOI: 10.18632/oncotarget.23560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/26/2017] [Indexed: 12/25/2022] Open
Abstract
High levels of heparanase are detected in many types of tumors, associated with bad prognosis. Typically, heparanase levels are evaluated in a biopsy taken from the primary lesion, whereas its expression by the resulting metastases is most often unresolved. This becomes critically important as anti-heparanase compounds enter advanced clinical trials. Here, we examined the expression of heparanase in pairs of primary and the resulting distant metastases of breast carcinoma. Interestingly, we found that heparanase expression in the metastatic lesion does not always reflect its expression in the primary tumor. Accordingly, in some cases, the primary lesion was stained positive for heparanase while the metastasis stained negative, and vice versa. Heparanase discordance occurred in 38% of the patients, higher than that reported for hormone receptors, and was associated with bad prognosis. Thus, examination of heparanase levels in the tumor metastases should be evaluated for most efficient precision medicine applying heparanase inhibitors. Furthermore, we found that in stage I breast cancer patients strong heparanase staining is associated with shorter overall survival. Thus, heparanase levels can assist in the diagnosis and in determining the necessity and type of treatment in early stage breast cancer.
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Affiliation(s)
- Olga Vornicova
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Inna Naroditsky
- Departments of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Ilanit Boyango
- Cancer and Vascular Biology Research Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Neta Ilan
- Cancer and Vascular Biology Research Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Vlodavsky
- Cancer and Vascular Biology Research Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
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15
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Finkelstein R, Eluk O, Mashiach T, Levin D, Peskin B, Nierenberg G, Karkabi S, Soudri M. Correction to: Reducing surgical site infections following total hip and knee arthroplasty: an Israeli experience. Musculoskelet Surg 2017; 101:227. [PMID: 29027152 DOI: 10.1007/s12306-017-0508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the original article, one of the co-author's family name has been published incorrectly.
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Affiliation(s)
- R Finkelstein
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel. .,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - O Eluk
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel
| | - T Mashiach
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel
| | - D Levin
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - B Peskin
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - G Nierenberg
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - S Karkabi
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - M Soudri
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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16
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Khoury J, Arow M, Elias A, Makhoul BF, Berger G, Kaplan M, Mashiach T, Ismael-Badarneh R, Aronson D, Azzam ZS. The prognostic value of brain natriuretic peptide (BNP) in non-cardiac patients with sepsis, ultra-long follow-up. J Crit Care 2017; 42:117-122. [PMID: 28719839 DOI: 10.1016/j.jcrc.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Sepsis is a multifactorial syndrome with increasing incidence of morbidity and mortality. Identification of outcome predictors is therefore essential. Recently, elevated brain natriuretic peptide (BNP) levels have been observed in patients with septic shock. Little information is available concerning BNP levels in patients with critical illness, especially with sepsis. Therefore, this study aims to evaluate the role of BNP as a biomarker for long-term mortality in patients with sepsis. METHODS We studied 259 patients with sepsis and absence of heart failure. BNP levels were obtained for all patients. A long-term survival follow-up was done, and survival was evaluated 90days after admission, and during the subsequent 60months of follow-up. RESULTS Eighty-two patients died during the 90-day follow-up (31.7%), 53 died in the index hospitalization (20.5%). On multivariate analysis models, elevated values of BNP were a strong predictor of in-hospital mortality, 90-day and 60-month mortality in patients with sepsis. BNP was a better prognostic predictor than the Sepsis-related Organ Failure Assessment (SOFA) score for 90-day mortality, and a better predictor for 60-month mortality in low risk groups. CONCLUSION In the population of hospitalized patients with sepsis, BNP is a strong independent predictor of short- and long-term mortality.
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Affiliation(s)
- Johad Khoury
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Majd Arow
- Ruth & Bruce Rappaport Faculty of Medicine, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel
| | - Adi Elias
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Badira F Makhoul
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Gidon Berger
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Marielle Kaplan
- The Laboratory of Clinical Biochemistry, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tanya Mashiach
- Statistics Service, Rambam Health Care Campus, Haifa, Israel
| | - Reem Ismael-Badarneh
- Ruth & Bruce Rappaport Faculty of Medicine, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel; The Rappaport Family, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel
| | - Doron Aronson
- Heart Institute, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel
| | - Zaher S Azzam
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel; The Rappaport Family, Institute for Research in the Medical Sciences, Technion, Israel Institute of Technology, Haifa, Israel.
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17
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Schultz M, Meged-Book T, Mashiach T, Bar-Sela G. Distinguishing Between Spiritual Distress, General Distress, Spiritual Well-Being, and Spiritual Pain Among Cancer Patients During Oncology Treatment. J Pain Symptom Manage 2017; 54:66-73. [PMID: 28533159 DOI: 10.1016/j.jpainsymman.2017.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/21/2017] [Accepted: 03/22/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Spiritual distress is present in approximately 25% of oncology patients. OBJECTIVES We examined the extent to which this measure is identical to a variety of other measures, such as spiritual well-being, spiritual injury, spiritual pain, and general distress. METHODS Structured interview of oncology outpatients over 12 months, approached nonselectively. The presence or absence of spiritual distress was compared against spiritual pain and two spiritual well-being tools: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12-Item Scale (FACIT-Sp-12) and the Spiritual Injury Scale (SIS). We also examined whether a general distress visual analogue scale sufficed to identify spiritual distress. Other questions concerned demographic and clinical data. RESULTS Of 416 patients approached, 202 completed the interview, of whom 23% reported spiritual distress. All measures showed significant correlation (receiver operating characteristic, area under the curve: SIS 0.79; distress thermometer [DT] 0.68; FACIT-Sp-12 0.67), yet none were identical with spiritual distress (sensitivity/specificity: SIS 64%/79%; spiritual pain 72%/76%; DT 41%/76%; FACIT-Sp-12 57%/72%). Of the FACIT-Sp-12 subscales, only peace correlated with spiritual distress. A significant predictor of spiritual distress was patients' self-evaluation of grave clinical condition (odds ratio 3.3; 95% CI 1.1-9.5). Multivariable analysis of individual measure items suggests an alternative three-parameter model for spiritual distress: not feeling peaceful, feeling unable to accept that this is happening, and perceived severity of one's illness. CONCLUSION The DT is not sufficient to identify spiritual distress. The peace subscale of FACIT-Sp-12 is a better match than the measure as a whole. The SIS is the best match for spiritual distress, although an imperfect one.
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Affiliation(s)
- Michael Schultz
- Division of Oncology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tehilah Meged-Book
- Division of Oncology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tanya Mashiach
- Statistical Department, Rambam Health Care Campus, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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18
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Dann EJ, Bairey O, Bar-Shalom R, Mashiach T, Barzilai E, Kornberg A, Akria L, Tadmor T, Filanovsky K, Abadi U, Kagna O, Ruchlemer R, Abdah-Bortnyak R, Goldschmidt N, Epelbaum R, Horowitz NA, Lavie D, Ben-Yehuda D, Shpilberg O, Paltiel O. Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients. Br J Haematol 2017; 178:709-718. [PMID: 28589704 DOI: 10.1111/bjh.14734] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
This multicentre study evaluated 5-year progression-free (PFS) and overall survival (OS) in early and advanced Hodgkin lymphoma (HL), where therapy was individualized based on initial prognostic factors and positron emission tomography-computed tomography performed after two cycles (PET-2). Between September 2006 and August 2013, 359 patients aged 18-60 years, were recruited in nine Israeli centres. Early-HL patients initially received ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) ×2. Depending on initial unfavourable prognostic features, PET-2-positive patients received additional ABVD followed by involved-site radiotherapy (ISRT). Patients with negative PET-2 and favourable disease received ISRT or ABVD ×2; those with unfavourable disease received ABVD ×2 with ISRT or, alternatively, ABVD ×4. Advanced-HL patients initially received ABVD ×2 or escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone; EB) ×2 based on their international prognostic score (≤2 or ≥3). PET-2-negative patients further received ABVD ×4; PET-2-positive patients received EB ×4 and ISRT to residual masses. With a median follow-up of 55 (13-119) months, 5-year PFS was 91% and 69% for PET-2-negative and positive early-HL, respectively; 5-year OS was 100% and 95%, respectively. For advanced-HL, the PFS was 81% and 68%, respectively (P = 0·08); 5-year OS was 98% and 91%, respectively. PET-2 positivity is associated with inferior prognosis in early-HL, even with additional ABVD and ISRT. Advanced-HL patients benefit from therapy escalation following positive PET-2. EB can be safely de-escalated to ABVD in PET-2-negative patients.
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Affiliation(s)
- Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Osnat Bairey
- Rabin Medical Centre, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Abraham Kornberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assaf Harofeh Medical Centre, Zerifin, Israel
| | | | - Tamar Tadmor
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Bnai Zion Medical Centre, Haifa, Israel
| | | | - Uri Abadi
- Meir Medical Centre, Kfar Saba, Israel
| | - Olga Kagna
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Ron Epelbaum
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Netanel A Horowitz
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - David Lavie
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dina Ben-Yehuda
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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19
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Finkelstein R, Eluk O, Mashiach T, Levin D, Peskin B, Nierenberg G, Karkabi S, Soudri M. Reducing surgical site infections following total hip and knee arthroplasty: an Israeli experience. Musculoskelet Surg 2017; 101:219-225. [PMID: 28324232 DOI: 10.1007/s12306-017-0471-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the changes observed in surgical site infection (SSI) rates following total joint arthroplasty (TJA) after the introduction of an infection control programme and evaluate the risk factors for the development of these infections. DESIGN Prospective cohort study. SETTING Large tertiary medical centre in Israel. METHODS Data about SSIs and potential prophylaxis-, patient-, and procedure-related risk factors were collected for all patients who underwent elective total hip and total knee arthroplasty during the study period. Multivariant analyses were conducted to determine which significant covariates affected the outcome. RESULTS During the 76-month study period, SSIs (superficial and deep) occurred in 64 (4.4%) of 1554 patients. As compared with the 34 (7.7%) SSIs that occurred in the first 25 months, there were 23 (4.7%) SSIs in the following 25 months, and only 7 (1.3%) SSIs in the last third of the study (p = 0.058 and <0.001, respectively). A multiple logistic regression model indicated that risk factors for prosthetic joint infection were a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 (OR 1.8; 95% CI 1.1-3.1) or 2 (OR 2.8; 95% CI 1.2-11.8). The incidence of SSI was not correlated with the timing, nor the duration of antibiotic prophylaxis. CONCLUSIONS The introduction of preventive measures and surveillance coincided with a significant reduction in SSIs following TJA in our institution. The risk of infection correlated with higher scores in the NNIS System surgical patient risk.
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Affiliation(s)
- R Finkelstein
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel. .,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - O Eluk
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel
| | - T Mashiach
- Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel
| | - D Levin
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - B Peskin
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - G Nierenberg
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - S Karkabi
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel
| | - M Soudri
- Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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20
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Shachar SS, Mashiach T, Fried G, Drumea K, Shafran N, Muss HB, Bar-Sela G. Biopsy of breast cancer metastases: patient characteristics and survival. BMC Cancer 2017; 17:7. [PMID: 28052766 PMCID: PMC5210262 DOI: 10.1186/s12885-016-3014-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discordance in hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) status between primary tumors and metastatic sites for breast cancer is well established. However, it is uncertain which patient-related factors lead to biopsy when metastases are suspected and whether having a biopsy impacts survival. METHODS The medical charts of metastatic breast cancer (MBC) patients diagnosed January 2000-August 2014 were retrospectively reviewed. A biopsy was defined as a procedure where tissue was obtained and assessed for both HR and HER2. Both bivariate and multivariate analyses were performed to assess patient characteristics related to biopsy and whether having a biopsy was associated with improved survival. RESULTS Of 409 patients suspected of having MBC, 165 (40%) had a biopsy, and 34% of these had discordant HR or HER2 status when compared to the initial diagnosis. In multivariate analysis, having a biopsy was associated with: recurrence in years 2010-2014, disease-free interval of > =3 years, stage 0-IIA at presentation, suspected locoregional recurrence, being HR+/HER2-, or missing HR/HER2 at diagnosis. A similar multivariate analysis revealed that having a biopsy was associated with improved survival (HR = 0.67, p = 0.002). The association of biopsy and improved survival was noted in specific subgroups: patients with missing HR and HER2 data at initial diagnosis (p = 0.001), those without metastases in liver, lung or brain (p = 0.001), and being younger than 70 years old at recurrence (p < 0.001). CONCLUSIONS Specific clinical factors were associated with biopsy at the time of suspected recurrence. Having a biopsy was associated with reduced mortality.
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Affiliation(s)
| | - Tanya Mashiach
- Statistical Department, Rambam Health Care Campus, Haifa, Israel
| | - Georgeta Fried
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Karen Drumea
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Noa Shafran
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hyman B Muss
- University of North Carolina, Chapel Hill, NC, USA
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel. .,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, POB 9602, Haifa, 31096, Israel.
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21
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Ulanovsky I, Smolkin T, Almashanu S, Mashiach T, Makhoul IR. Hypothyroxinemia and Risk for Transient Tachypnea of Newborn. J Pediatr 2016; 179:266-268.e1. [PMID: 27659026 DOI: 10.1016/j.jpeds.2016.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/25/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
Transient tachypnea of newborn is associated with hypothyroxinemia in animals via decreased stimulation of beta-adrenergic receptors and Na-K-ATPase activity. In 26 549 term neonates, serum total thyroxine <14 ug/dL, male sex, and elective cesarean delivery were significantly associated with greater risk for transient tachypnea of newborn.
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Affiliation(s)
- Irena Ulanovsky
- Neonatology Department, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tatiana Smolkin
- Neonatology Department, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shlomo Almashanu
- National Newborn Screening Program, Public Health Services, Ministry of Health, Israel
| | - Tanya Mashiach
- Epidemiology Department, Rambam Health Care Campus, Haifa, Israel
| | - Imad R Makhoul
- Neonatology Department, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel; Epidemiology Department, Rambam Health Care Campus, Haifa, Israel.
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22
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Milo G, Shabad E, Nassar N, Mashiach T, Kaplan M, Assady S. SP253CLINICAL ESTIMATION OF KIDNEY FUNCTION IN PATIENTS WITH β-THALASSEMIA MAJOR. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw163.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Smolin B, Levy Y, Sabbach-Cohen E, Levi L, Mashiach T. Predicting mortality of elderly patients acutely admitted to the Department of Internal Medicine. Int J Clin Pract 2015; 69:501-8. [PMID: 25311361 DOI: 10.1111/ijcp.12564] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS This study addresses the common practice of providing aggressive treatments of limited clinical benefit and cost-effectiveness to seriously ill and frail elderly. We have created a statistical model of 6-month mortality risk prediction following acute hospitalisation admission, and identified a subset of patients with poorest prognosis that requires comfort-focused care. METHODS We have studied electronic medical records of 26,937 patients age 65 years or older, hospitalised in the internal medicine departments of one tertiary-care teaching medical center in Northern Israel from January 1, 2008 through December 31, 2011 and mortality data from the Israeli Internal Ministry Registry. Norton score records were employed for the performance status evaluation. Multivariate logistic regression analysis was used to predict the risk of 6-month mortality. RESULTS Variables associated with an increased risk of 6-month mortality included: metastatic cancer, age above 85 years, decreased values of blood albumin and haemoglobin, increased blood urea nitrogen and decreased physical/mental status and activity. The receiver operating characteristic area for the predicted probability of death was 0.845 and 0.847 in external validation cohort. Using predictive values of the logistic regression analysis, the study cohort was stratified into six groups with various predictive mortality risks. CONCLUSION The majority of deaths that have occurred within 6 months following the acute hospitalisation could be predicted on patient admission based on a few simple and easily obtained parameters. Earlier recognition of patients nearing the end of their lives may lead to better care and more efficient use of available resource.
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Affiliation(s)
- B Smolin
- Department of Internal Medicince D, Technion Faculty of Medicine, Rambam Health Care Campus, Haifa, Israel
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24
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Bar-Sela G, Danos S, Visel B, Mashiach T, Mitnik I. The effect of complementary and alternative medicine on quality of life, depression, anxiety, and fatigue levels among cancer patients during active oncology treatment: phase II study. Support Care Cancer 2014; 23:1979-85. [PMID: 25516212 DOI: 10.1007/s00520-014-2560-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND During the past decade, there has been growing interest in complementary and alternative medicine (CAM) among cancer patients and it is being integrated more frequently within conventional cancer centers. The long-term effect of mind-body therapies on quality of life (QoL), depression, anxiety, and fatigue was tested prospectively in this study. PATIENTS AND METHODS Cancer patients who received six weekly sessions of CAM during their oncological treatments participated in the study. The Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI) and QoL-EORTC-C30 were completed during the intervention and follow-up period. RESULTS Over a two-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. An improvement was demonstrated in the median of BFI from 4.8 to 3.9 (p < 0.001), HADS-Anxiety from 8 to 7 (p < 0.001) and HADS-Depression from 7 to 6 (p < 0.001) after 12 weeks. In addition, the median of global QoL improved from 50 to 67 (p < 0.001), and a significant improvement was noticed in several parameters on the functioning and symptoms scales of the QoL-EORTC-C30. CONCLUSION Cancer patients who completed six weekly sessions of CAM improved significantly on measured outcomes, regardless of their demographic characteristics.
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Affiliation(s)
- Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa, 31096, Israel,
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25
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Weisshof R, Mashiach T, Chermesh I. PP126-MON: Hypophosphatemia in IBD Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Braun E, Kheir J, Mashiach T, Naffaa M, Azzam ZS. Is elevated red cell distribution width a prognostic predictor in adult patients with community acquired pneumonia? BMC Infect Dis 2014; 14:129. [PMID: 24597687 PMCID: PMC3973886 DOI: 10.1186/1471-2334-14-129] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards. Methods The cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.
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Affiliation(s)
- Eyal Braun
- Departments of Medicine H and B, Rambam Health Care Campus, P,O, Box 9602, 31096 Haifa, Israel.
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27
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Kim EJ, Han JH, Koo HM, Doh FM, Kim CH, Ko KI, Lee MJ, Oh HJ, Yoo TH, Kang SW, Choi KH, Han SH, Assady S, Tchirkov M, Nasser R, Mashiach T, Ben Izhak O, Housset P, Guillemain R, Nochy D, Roland M, Amrein C, Karras A, Boussaud V, Pezzela V, Thervet E, Simic Ogrizovic SP, Basta Jovanovic G, Radojevic S, Bojic S, Naumovic R, Karim Z, Cyrine K, Rim G, Ezzeddine A, Hafedh H, Hayet K, Soumaya B, Mondher O, Fethi BH, Fethi EY, Taieb BA, Hedi BM, Fatma BM, Adel K, Housset P, Guillemain R, Roland M, Amrein C, Karras A, Boussaud V, Nochy D, Pezzela V, Thervet E, Penescu M, Mandache E, Zumrutdal A, Ozelsancak R, Canpolat T, Barbouch S, Mami I, Mayara M, Jerbi M, Harzallah A, Goucha R, Ben Maiz H, Kedher A, Comi N, Cianfrone P, Piraina V, Talarico R, Giannakakis K, Fuiano G, Lucisano G, Konat K, Szotowska M, Karkoszka H, Adamczak M, Wiecek A, Kwiecien K, Jercan O, Penescu M, Mogoanta L, Miller I, Pan X, Xu J, Ren H, Zhang W, Xu Y, Shen P, Chen X, Feng X, Chen N. Renal histopathology. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Koifman E, Mashiach T, Papier I, Karban A, Eliakim R, Chermesh I. Proactive screening in Israel identifies alarming prevalence of malnutrition among hospitalized patients—Action is needed. Nutrition 2012; 28:515-9. [DOI: 10.1016/j.nut.2011.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 07/01/2011] [Accepted: 07/29/2011] [Indexed: 11/16/2022]
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29
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Gez E, Rubinov R, Gaitini D, Meretyk S, Best LA, Mashiach T, Native O, Stein A, Kuten A. Immuno-chemotherapy in metastatic renal cell carcinoma: long-term results from the rambam and linn medical centers, Haifa, Israel. J Chemother 2007; 19:79-84. [PMID: 17309855 DOI: 10.1179/joc.2007.19.1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Nephrectomy, immuno-chemotherapy and resection of residual disease have been the treatment of choice for patients with metastatic renal cell carcinoma during the past decades. The aim of this study was to report the long-term results of this treatment approach. Sixty-two patients with metastatic renal cell carcinoma participated in a Phase II study. At diagnosis, 32 patients had localized disease, 30 had metastatic disease and 53 underwent nephrectomy. Metastatic sites were lungs, lymph nodes, bones and liver. Immuno-chemotherapy consisted of: interleukin-2, interferon alpha, 5-fluorouracil and vinblastine. All patients were evaluated for toxicity and response to treatment. CR was achieved in 4 patients and PR in 14. Seven patients, with maximum response to immuno-chemotherapy underwent resection of residual tumor and reached CR. Therefore, CR was achieved in 11 patients (18%) with a median survival of +67 months. Flu-like symptoms were the common side effects. Performance status and histology type significantly affected survival. Nephrectomy, immuno-chemotherapy and resection of residual disease are recommended for patients with metastatic renal cell carcinoma.
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Affiliation(s)
- E Gez
- Department of Oncology, Rambam Medical Center, Haifa, Israel.
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30
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Bar-Joseph G, Abramson NS, Kelsey SF, Mashiach T, Craig MT, Safar P. Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand 2005; 49:6-15. [PMID: 15675975 DOI: 10.1111/j.1399-6576.2005.00572.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high-dose to standard-dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional. METHODS The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: 'low SB user' sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and 'high SB user' sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min. RESULTS Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse (r = - 0.579 P = 0.018) from initiation of ACLS (r = - 0.685 P = 0.003) and from first epinephrine (r = - 0.611 P = 0.012) to SB administration. Mean ROSC rate in the 'high SB user' sites was 33.5% (CI = 30.0-37.0) compared to 25.7% (CI = 23.1-28.4) in the 'low SB user' sites. In the 'high SB user' sites, hospital discharge rate was 5.3% (CI = 3.6-7.0) compared to 3% (CI = 2.0-4.0) in the 'low SB user' sites, and 5.3% (CI = 3.6-7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2-3.0) in the 'low SB user' sites. Collapse to ACLS interval was 8.5 min (CI = 8.1-9.0) in the 'high SB user' sites compared to 10.2 min (CI = 9.8-10.6) in the 'low SB user' sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5-7.5) compared to 9.7 min (CI = 9.3-10.2). Multivariate regression analysis found that belonging to 'high SB user' sites independently increased the chances for ROSC (OR 1.36, CI 1.08-1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23-3.86). CONCLUSIONS Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long-term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.
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Affiliation(s)
- G Bar-Joseph
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
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31
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Hojat M, Gonnella JS, Nasca TJ, Fields SK, Cicchetti A, Lo Scalzo A, Taroni F, Amicosante AMV, Macinati M, Tangucci M, Liva C, Ricciardi G, Eidelman S, Admi H, Geva H, Mashiach T, Alroy G, Alcorta-Gonzalez A, Ibarra D, Torres-Ruiz A. Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships. Int J Nurs Stud 2003; 40:427-35. [PMID: 12667519 DOI: 10.1016/s0020-7489(02)00108-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.
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Affiliation(s)
- Mohammadreza Hojat
- Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA.
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