פרסומים על בסיס עבודות גמר
להלן רשימת פרסומים המתבססים על עבודות גמר.
לגישה אל המאמר(לקהילת אוניברסיטת בר אילן בלבד), נא הדבק את הכותר בחלון הנפתח, לאחר לחיצה על הקישור כאן.
1. Farah R, Bleier J, Gilbey P, Khamisy-Farah R. Common Laboratory Parameters for Differentiating Between Community-Acquired and Healthcare-Associated Pneumonia. J Clin Lab Anal 2016; 4: 1–4.
BACKGROUND AND OBJECTIVES:
The correct diagnosis of healthcare-associated pneumonia (HCAP) as opposed to community-acquiredpneumonia is essential for the selection of a correct empirical antimicrobial approach, reserving the broad-spectrum or highly potent antimicrobial therapies for resistant strains most commonly present in HCAP, whereas treating the less resistant strains, most commonly associated with community and long-term care facility-acquired infections, with a more targeted empirical approach. The standard approach today is to differentiate between the two based on the medical history of the past 90 days prior to admission. Measurable, quantitative assessment may be able to assist in this decision. The objective of this study is to find a measurable method of differentiating between community-acquired and healthcare-associatedpneumonias.
MATERIALS AND METHODS:
The records of 126 patients admitted with a diagnosis of pneumonia were divided into two groups based on the probable cause of their disease, in accordance with common practice. The routine laboratory work taken upon admittance was analyzed using logistical regression and Student's t-test.
We have found that the red blood cell distribution width and the neutrophil-to-lymphocyte ratio, both routine parameters obtained in a simple blood count, can each assist in differentiating between community-acquired and healthcare-associated pneumonias.
We have found two statistically significant parameters that may be used as adjuncts to the medical history, chest radiography and other parameters in forming an immediate clinical impression of a patient presenting with pneumonia.
2. Fink K, Shachar I Ben, Braun NM. Uterine preservation for advanced pelvic organ prolapse repair : Anatomical results and patient satisfaction .IBJU 2016; 42: 773–8. למאמר זה אין גישה
Objective: The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. Materials and Methods: This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient’s satisfaction. Results: Sixty-six patients with pelvic organ prolapse stage 3, including uterine prolapse of at least stage 2 (mean point C at+1.4 (range+8–(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at -6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. Conclusions: Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.
3. Padawer D, Pastukh N, Nitzan O, et al. Catheter-associated candiduria: Risk factors, medical interventions, and antifungal susceptibility. Am J Infect Control 2015; 43: e19–22.
Catheter-associated candiduria is a common clinical finding in hospitalized patients, especially in the intensive care unit. The objective of this study was to obtain demographic and clinical data regarding the prevalence of Candida spp in catheterized in-patients and themedical interventions provided to these patients in a northern Israeli hospital between 2011 and 2013.
Isolation and identification of microorganisms were performed on 1,408 urine culture samples 48 hours after catheter insertion.Antifungal Etest susceptibility tests were carried out on every Candida-positive urine sample. Demographic and clinical data were gathered to determine risk factors and medical interventions.
Candiduria was detected in 146 catheterized in-patients out of the 1,408 patients included in this study. C albicans was detected in most cases (69.1%). Fever was observed in 52 (35.61%) patients, and leukocyturia was observed in 48 cases (32.87%). Diabetes mellitus was associated with C albicans candiduria. There were 93 patients (63.69%) who did not receive any medical intervention for their candiduria.
Candida is the second leading pathogen causing catheter-associated urinary tract infection or asymptomatic colonization, whereas previous studies showed Candida as the third leading pathogen. Clinical signs and symptoms, such as fever and laboratory tests, cannot distinguish between asymptomatic colonization and infection. Because the management of catheter-associated candiduria is still controversial, additional studies should be carried out.
4. Rimon O, Avraham Y, Sharabi-Nov A, Luder A, Krupik D, Gilbey P. Video-otoscopy in children and patient-centered care: A randomized, controlled study. Int J Pediatr Otorhinolaryngol 2015; 79: 2286–9.
Medicine today is moving towards patient centered care and patient empowerment. This enhances patient autonomy, allows shared decision making and increases satisfaction. Current technology enables the caregiver to share visual data with the patients, making them more active participants in a medical encounter. It has been shown that higher patient satisfaction rate has a positive effect on outcome and patient compliance. Otoscopic examination is one of the most common procedures performed in the pediatric population. Video-otoscopy uses endoscopic technology to project the image of the tympanic membrane onto a monitor visible to both the physician and the patient. The objective of this studyis to assess whether video-otoscopy used in a pediatric emergency department can improve patient-centeredness and parental satisfaction with treatment.
A randomized, controlled study comparing video-otoscopy with conventional otoscopy was performed. Patients were randomized into 2 groups. In one, ear examination was performed by video-otoscopy and in the other by conventional otoscopy. Following examination, parents in both groups were asked to fill a questionnaire regarding their satisfaction with the otoscopic examination and the patient-centeredness of the encounter.
60 children were recruited and were randomized into two groups: 30 in the video-otoscopy group and 30 in the conventional otoscopy group. Parental satisfaction was significantly higher in the video-otoscopy group. The level of patient-centeredness was significantly higher in thevideo-otoscopy group. There was a positive correlation between patient-centeredness and parental satisfaction in both groups, with a significantly higher correlation in the video-otoscopy group.
Video-otoscopy was found to encourage patient-centered care and increase parental satisfaction with otoscopy. There is a significantly higher positive correlation between patient-centeredness and parental satisfaction when video-otoscopy is used.
5. Rubinstein G, Bentwich ME. The Enemy as a Patient: What can be Learned from the Emotional Experience of Physicians and Why does it Matter Ethically? Dev World Bioeth 2016; 8731: 197–8.
This qualitative research examines the influence of animosity on physicians during clinical encounters and its ethical implications. Semi-structured interviews were conducted with ten Israeli-Jewish physicians: four treated Syrians and six treated Palestinian terrorists/Hezbollah militants or Palestinian civilians. An interpretive phenomenological analysis was used to uncover main themes in these interviews. Whereas the majority of physicians stated they are obligated to treat any patient, physicians who treated Syrians exhibited stronger emotional expression and implicit empathy, while less referring to the presence of the Israeli-Arab conflict. In contrast, physicians who treated enemy combatants or Palestinian civilians showed the exact opposite. Linking these results to the "Implicit Bias" theory, the role of empathy and the beneficence principle in medical ethics, we argue that: (a) the unconscious decreased emotional involvement among the latter group of physicians is a deficiency that needs to be recognized; and (b) this deficiency undermines the principle of beneficence, thereby possibly influencing the fulfillment of the commitment to treat patients. Acknowledging and addressing the potential emotional and ethical deficiencies entailed in encounters with the so-called enemy-patients are of importance to the global medical community, since such encounters are increasingly an integral part of the current political realities faced by both the developed and developing worlds.
6. Orlin I, Rokney A, Onn A, Glikman D, Peretz A. Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure. Antimicrob Resist Infect Control. doi: 10.1186/s13756-017-0175-2. eCollection 2017.
Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students. The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical students.
Prospective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.
Among 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.
MSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains
7. Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke
1 Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
2 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Mean platelets volume (MPV) is a marker, which indicates platelet function, and is a potential link between inflammation and thrombosis. Previous studies have found a relation between high MPV levels and high risk of stroke. Another factor that has been associated with the risk of stroke is neutrophil to lymphocyte ratio (NLR). Several studies have reported an association between increased NLR and increased risk of cerebrovascular disease. It was found that NLR levels have a relation to the prognosis as well. Since both NLR and MPV have been associated with increased risk of cardiovascular disease, together they may predict the risk of stroke and the prognosis with higher sensitivity and specificity.
This is a descriptive retrospective study. Data were gathered from medical records of patients who applied the Ziv medical center and were diagnosed with stroke. Stroke severity was evaluated using the NIHSS (national institutes of health stroke scale). MPV and NLR levels of patients with stroke were compared to those of 30 healthy individuals.
Neutrophil to lymphocyte ratio levels were found significantly higher in patients with stroke compared with healthy individuals. NLR was also found higher in patients with moderate/severe stroke compared with those with minor stroke. No association was found between MPV level, the risk of stroke, and stroke prognosis. Moreover, an interaction effect between MPV and NLR level was not found.
Neutrophil to lymphocyte ratio is a good predictive factor of stroke and stroke prognosis. Further prospective studies are needed to establish the relationship between the MPV level and the risk of stroke. NLR and MPV interaction effect can be tested again in the future after establishing the association between MPV, the risk of stroke, and stroke prognosis.
© 2017 Wiley Periodicals, Inc.
Panminerva Med. 2017 Feb 9. doi: 10.23736/S0031-0808.17.03296-7. [Epub ahead of print]
8. Neutrophil lymphocyte ratio better addition to CRP than CD64 index as marker for infection in COPD.
1 Department of Internal Medicine B, Ziv Medical Center, Safed, Israel - Raymond.firstname.lastname@example.org.
2 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel - Raymond.email@example.com.
3 Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
4 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
5 Hematology Institute, Ziv Medical Center Associated with the Bar Ilan University Faculty of Medicine, Safed, Israel.
This study investigated the importance of neutrophil-lymphocyte ratio (NLR) and other new inflammatory markers including CD64 expression in patients with chronic obstructive pulmonary disease (COPD) for identifying the severity of inflammation and recognition of acute exacerbation and infection.
72 patients with a diagnosis of COPD exacerbation who were admitted to Internal Medicine B department, 13 stable COPD, and control group of 15 healthy persons were enrolled in the study. Complete blood count (CBC), measurement of C reactive protein (CRP), MPV, RDW and CD64 expression were determined within 2 hours of hospital admission.
NLR and other inflammatory markers, such as RDW, CRP and CD64 were found to be significantly elevated in exacerbated COPD compared to stable COPD and control participants. There was a significant correlation of NLR with CRP (r = 0.309, P < 0.001), For an NLR cutoff of 7.3, sensitivity for detecting exacerbation of COPD was 0.768 and specificity was 1-0.269 (AUC 0.793, P = 0.001) RDW was significant as NLR. CD64 is statistically significant (p= 0.002) the lack of significance was between AECOPD and stable COPD, but indexes were higher in the group of COPD patients wit complications.
Elevated NLR can be used as a marker similar to CRP, and RDW, in the determination of increased inflammation in acutely exacerbated COPD. NLR could be beneficial for the early detection of potential acute exacerbations in patients with COPD who have normal levels of traditional markers; CD64 was higher but did not reach statistical significance. MPV was not helpful.
9. Mobile Technology-Based Real-Time Teleotolaryngology Care Facilitated by a Nonotolaryngologist Physician in an Adult Population.
Raphael Yulzari, BSc1, Shlomi Bretler, MD1, Yaniv Avraham2, Adi Sharabi-Nov, MA, MPH3, Ella Even-Tov, MD1,2, and Peter Gilbey, MD1
Objectives: Telehealth can improve access to specialist care. Very few reports of the use of smartphones for teleotolaryngology exist. The objective of this study is to evaluate the use of mobile teleotolaryngology facilitated by a nonotolaryngologist physician.
Methods: A prospective study in adult patients attending a general otolaryngology outpatient clinic. The telehealth encounter with a remote otolaryngologist was facilitated by a final-year medical student simulating a general physician prior to the scheduled visit. The patient and the remote otolaryngologist rated their satisfaction with the encounter. The remote otolaryngologist formulated a diagnosis and rated the level of certainty of this diagnosis. Diagnoses from the telehealth
encounter and the face-to-face encounter were compared.
Results: Forty-eight patients with an average age of 42.5 years participated in this study. In 79.2% of the consultations, there was concordance between the diagnoses. The average patient and remote otolaryngologist satisfaction with the encounter was 9.5 ± 0.9 and 8.7 ± 1.3, respectively. Twenty-four of the 48 visits (50%) were defined as unnecessary. In the otology group, concordance rates and rates of preventable visits were highest.
Conclusions: Synchronous telehealth consultations, facilitated by a general physician, can be an alternative to visiting a general otolaryngology clinic, especially for otologic patients.
telehealth, telemedicine, telecare, smartphone, otolaryngology