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Weiniger C.F.,Hebrew University of Jerusalem | Weiniger C.F.,Stanford University | Spencer P.S.,University of California at Berkeley | Weiss Y.,Hadassah Hebrew University Medical Center | And 2 more authors.
Israel Journal of Health Policy Research | Year: 2014

Background: External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery.Methods: In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS.Results: Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs.Conclusions: The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. © 2014 Weiniger et al.; licensee BioMed Central Ltd.


Berkun Y.,Hadassah Hebrew University Medical Center | Eisenstein E.,Hadassah Hebrew University Medical Center | Ben-Chetrit E.,Hebrew University of Jerusalem
Clinical and Experimental Rheumatology | Year: 2012

The last two years have been marked by many studies trying to better characterise the clinical features of FMF in children and proposal of new treatment for those who are resistant to colchicine. In addition, many studies tried to address the potential effect of genetic modifiers on FMF and the potential effect of MEFV mutations on other inflammatory diseases. The main points arose from these studies include a breakthrough in the therapeutic approach for FMF and the lack of consistency regarding the reciprocal effect of MEFV mutations on other diseases and the effect of genetic modifiers on FMF. The highlights of these studies, their potential clinical implications and the unmet needs, which are still to be addressed, are summarised in this review. © Clinical and experimental rheumatology 2012.


Severinsky B.,Hadassah Hebrew University Medical Center | Yahalom C.,Hebrew University of Jerusalem | Sebok T.F.,Hadassah Hebrew University Medical Center | Tzur V.,Hebrew University of Jerusalem | And 2 more authors.
Optometry and Vision Science | Year: 2016

Purpose. To determine the benefits provided by centrally red-tinted contact lenses on visual acuity, contrast sensitivity (CS), photophobia, and quality of life in patients with degenerative retinal diseases. Methods. We evaluated the impact of centrally red-tinted hydrogel contact lenses on nine patients (aged 15 to 22 years) with severe photophobia and poor visual acuity. Each patient underwent a full eye examination with and without contact lenses, including visual acuity at distance and near, CS, eye movement recording for nystagmus, refraction, and a fundus examination. All patients completed a low visionYadapted VFQ 25YVersion 2000 quality-of-life questionnaire. Results. Seven of nine patients demonstrated improvement in binocular visual acuity as well as improvement in CS with the tinted contact lenses. Subjectively, all patients described a major improvement in their photophobia both outdoors and indoors, as well as a marked improvement in quality of life. Conclusions. Red-tinted contact lenses may dramatically improve visual functions, outdoor performance, and quality of life of patients suffering from retinal diseases. These lenses should be a part of the regular assessment in specialty clinics treating patients with low vision, glare, and photophobia. © 2015 American Academy of Optometry.


Levin P.D.,Hebrew University of Jerusalem | Moss J.,Hebrew University of Jerusalem | Stohl S.,Hebrew University of Jerusalem | Fried E.,Hebrew University of Jerusalem | And 3 more authors.
Chest | Year: 2013

Background: The sterile conditions used when inserting a central venous catheter (CVC) might be thought to decrease the contamination rate of blood cultures taken at CVC insertion; however, a previous retrospective study showed the opposite, that such blood cultures are contaminated more frequently than peripheral venipuncture blood cultures. The current study explored whether use of the CVC nonwire hub as a source of blood cultures decreased contamination while maintaining detection of true pathogens. Methods: A prospective, observational study was performed from June 2010 to May 2011 in the general ICU of an academic, tertiary referral center. The proportions of blood cultures taken from wire and nonwire CVC hubs growing contaminants and true pathogens were compared. Risk factors for blood culture contamination were identified, and multivariate analysis was used to identify independent predictors of blood culture contamination. Results: Among 313 blood cultures taken from 227 CVCs in 139 patients, 27 of 141 wire hub (19%) vs nine of 172 nonwire hub (5%) cultures were contaminated (P < .001). Only hub of blood culture origin was associated with contamination on multivariate analysis (OR, 4.3; 95% CI, 1.9-9.5; P < .001). True pathogens grew in 19 of 141 wire hub (13%) vs 27 of 172 nonwire hub (16%) cultures (P = .581). Conclusions: A higher proportion of blood cultures taken from the CVC lumen exposed to the guidewire were contaminated when compared with nonwire hub cultures; detection of true pathogens was equivalent. To limit detrimental sequelae of blood culture contamination, blood cultures obtained at CVC insertion should be taken from the nonwire hub. © 2013 American College of Chest Physicians.


Keidar A.,Hadassah Hebrew University Medical Center | Hecht L.,Hebrew University of Jerusalem | Weiss R.,Hebrew University of Jerusalem
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2011

Purpose of review: Bariatric surgery is gaining acceptance as an effective and well tolerated treatment of morbid obesity in adults yet experience in obese children is still lacking. The purpose of this review is to highlight recent findings in this exciting field and identify the knowledge gaps. Recent findings: One randomized controlled trial and several case series have been published in the last 2 years regarding bariatric surgery for obese adolescents. These studies demonstrate relative safety along with significant weight loss. In addition, the vast majority of obesity-related comorbidities are resolved following these procedures. Adverse psychological effects of these procedures are probably more common than those in adults and need to be addressed. Summary: These publications indicate that bariatric surgical procedures, mainly gastric banding and gastric bypass, when performed on the right patients by skilled surgeons along with the appropriate ancillary staff, show positive metabolic effects and are well tolerated. Precise patient selection criteria, choice of the procedure and the extent of the multidisciplinary preoperative and postoperative care, are yet to be defined. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Drenger B.,Hebrew University of Jerusalem | Drenger B.,New York University | Ostrovsky I.A.,Hebrew University of Jerusalem | Barak M.,Rambam Health Care Campus | And 3 more authors.
Anesthesiology | Year: 2011

Background: The possibility of restoring sevoflurane postconditioning (sevo-postC) cardioprotection in diabetic animals is uncertain. We hypothesized that attenuation of myocardial injury by sevo-postC might be hindered by inhibition of signal transducer and activator of transcription (STAT) 3-regulated activity of phosphatidylinositol 3-kinase (PI3K) in diabetic animals. To determine whether postC cardioprotection can be restored by normoglycemia, we treated rats with insulin. Methods: Diabetic or nondiabetic rats were randomly subjected to 30-min ischemia/reperfusion, with ischemic postC or sevo-postC, with and without mitochondrial adenosine triphosphate-dependent potassium channel blocker 5-hydroxy decanoate sodium and PI3K antagonist wortmannin. The infarct area, phosphorylated STAT3, and apoptosis were examined. Studies were repeated after insulin treatment. Results: Ischemic postC and sevo-postC significantly reduced infarct size by 50% in the nondiabetic rats (P < 0.002), a phenomenon completely reversed by 5-hydroxy decanoate sodium and wortmannin. Diabetes mellitus blocked the protective effect of postC, and insulin treatment to achieve normoglycemia did not restore cardioprotection. Phosphorylated STAT3 nuclear retention was significantly increased after ischemia-reperfusion and was further enhanced in response to ischemic postC (P < 0.05) but was significantly reduced in diabetic rats (by 43%; P < 0.01). Conclusions: The effective reduction in infarct size and apoptosis in the nondiabetic rat heart by postC was completely abrogated in diabetic rats. This inhibition is not relieved by insulin-induced normoglycemia. The PI3K pathway and mitochondrial adenosine triphosphate-dependent potassium channel activation are involved in the mechanism of postC. In diabetic rats, STAT3 activation was strongly reduced, as was postC cardioprotection, suggesting that the inability of insulin to restore postC may be attributed to diabetes-induced STAT3-mediated inhibition of PI3K signaling. Copyright © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.


Raz N.,Hadassah Hebrew University Medical Center | Hallak M.,Hadassah Hebrew University Medical Center | Ben-Hur T.,Hadassah Hebrew University Medical Center | Levin N.,Hadassah Hebrew University Medical Center
Journal of Visualized Experiments | Year: 2014

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to assess changes in myelination at the central nervous system (CNS). However, standard measurements, including routine visual tests and MRI scans, are not sensitive enough for this purpose. We present two visual tests addressing dynamic monocular and binocular functions which may closely associate with the extent of myelination along visual pathways. These include Object From Motion (OFM) extraction and Time-constrained stereo protocols. In the OFM test, an array of dots compose an object, by moving the dots within the image rightward while moving the dots outside the image leftward or vice versa. The dot pattern generates a camouflaged object that cannot be detected when the dots are stationary or moving as a whole. Importantly, object recognition is critically dependent on motion perception. In the Time-constrained Stereo protocol, spatially disparate images are presented for a limited length of time, challenging binocular 3-dimensional integration in time. Both tests are appropriate for clinical usage and provide a simple, yet powerful, way to identify and quantify processes of demyelination and remyelination along visual pathways. These protocols may be efficient to diagnose and follow optic neuritis and multiple sclerosis patients. In the diagnostic process, these protocols may reveal visual deficits that cannot be identified via current standard visual measurements. Moreover, these protocols sensitively identify the basis of the currently unexplained continued visual complaints of patients following recovery of visual acuity. In the longitudinal follow up course, the protocols can be used as a sensitive marker of demyelinating and remyelinating processes along time. These protocols may therefore be used to evaluate the efficacy of current and evolving therapeutic strategies, targeting myelination of the CNS.


Nechushtan H.,Hadassah Hebrew University Medical Center | Vainer G.,Hadassah Hebrew University Medical Center | Stainberg H.,Hadassah Hebrew University Medical Center | Salmon A.Y.,Hadassah Hebrew University Medical Center | And 2 more authors.
Breast | Year: 2014

50-70% of tumors of the so called "triple negative" subtype of breast cancer express EGFR. We hypothesized that addition of anti EGFR to Taxanes will result in increased effectiveness in EGFR expressing tumors. Here we set out to obtain data regarding the safety, tolerability and also the effectivity of the combination of weekly Taxane treatments with Cetuximab -an anti EGFR antibody in this subgroup of breast cancer. 18 triple negative breast cancer patients were treated with weekly Cetuximab and Taxane therapy. Addition of Cetuximab resulted in controllable Dermatologic toxicity in most patients -with grade 3 in two patients. Some impressive results were noted including one CR, one near CR and regression of chemotherapy and radiation resistance skin metastasis. Median TTF -and overall survival -6 and 12 months. Administration of Taxane Cetuximab weekly therapy for triple negative breast cancer patients is feasible. Use of anti EGFR-Taxane combinations should be assessed in larger clinical trials in this patient population perhaps in a similar manner to the lung cancer patients only in those with strong EGFR expression. © 2014 Elsevier Ltd.


Iecovich E.,Ben - Gurion University of the Negev | Jacobs J.,Hadassah Hebrew University Medical Center | Jacobs J.,Hebrew University Hadassah Medical School | Stessman J.,Hadassah Hebrew University Medical Center | Stessman J.,Hebrew University Hadassah Medical School
International Journal of Aging and Human Development | Year: 2011

We examined the influence of changes in loneliness and social support networks upon mortality during 18 years of follow-up among an elderly cohort and determined the gender-specific nature of this relationship. The study is based on data collected from the Jerusalem Longitudinal Study (1990-2008), which has followed a representative sample of 605 community-dwelling elderly people. Subjects were randomly selected from an age homogenous cohort born 1920-1921 and were aged 70, 78, and 85 when data were collected at baseline in 1990 and at follow-up in 1998 and 2005. All-cause mortality from age 70-88 was determined according to the National Death Registry. Sense of loneliness was found to be stable among the majority of the respondents. Loneliness among men was found in bivariate analyses to be a risk factor for mortality. Although multivariate analyses found that loneliness was not a significant predictor of mortality, nonetheless several social network factors (marital status at the baseline and living arrangements) were found to predict mortality among men. Loneliness and solitude among elderly men can be a risk factor of mortality. The findings imply that attention should be given to this high risk group. © 2011, Baywood Publishing Co., Inc.


PubMed | Hebrew University of Mexico, Hadassah Hebrew University Medical Center, University of South Florida and Hadassah University Medical Center
Type: | Journal: Journal of pediatric psychology | Year: 2017

OBJECTIVE: Cross-national replication of the high rates of overweight/obesity among U.S. pediatric cancer survivors (PCS) is limited. Predictors of weight trajectories of Israeli PCS were examined from diagnosis and end of active cancer treatment to 3 years posttreatment. METHODS: World Health Organization-derived body mass index (z-BMI) values were calculated at each time point from medical records of 135 Israeli PCS (M diagnosis age=11.4). A three-section piecewise multilevel model including age, ethnicity, gender, treatment length, and diagnosis as predictors was used to estimate z-BMI trajectories. RESULTS: Most participants remained at a healthy weight at all time points. Differing weight trajectories emerged for PCS diagnosed with lymphoma/leukemia versus other cancer diagnoses from diagnosis to end of treatment, but similar weight change patterns were observed posttreatment. CONCLUSION: Replication of U.S. PCS weight trajectories was not observed in Israeli PCS, suggesting the importance of exploring environmental risk factors contributing to obesity among PCS.

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