Dror Y.,Hebrew University of Jerusalem |
Almashanu S.,Israeli Ministry of Health |
Lubart E.,Geriatric Medical Center |
Lubart E.,Tel Aviv University |
And 5 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2013
Background: Refeeding of elderly frail patients after food deprivation is commonly associated with a high mortality rate. Objective: To evaluate the effect of refeeding on metabolite fluctuation of blood carnitine fatty acids (15 compounds) and free amino acids (14 compounds). Methods: Metabolite fluctuation was followed up in an exploratory, cohort, and noninterventional study in elderly and frail patients (84.5 ± 5 years) after a long period of food deprivation. Patients in the study group were refed by enteral nutrition (EN) and were followed up during 7 days for blood metabolites (n = 27). Patients in the control group (n = 26) had been fed by EN for more than 3 months. Refeeding was initiated with 10 kcal/kg/d and gradual increases of 200 kcal/d for 3 days afterwards. Blood metabolites were assayed in a sample of 25 μL. Results: On food deprivation, the concentrations of all even monocarboxylic carnitine fatty acids were much higher in the study group than in the EN control group (P <.01). Upon refeeding, a remarkable decrease in all carnitine fatty acids was observed. In addition, significant daily fluctuations were observed for most metabolites in the study group of the refed patients as compared with the EN control group (P <.01). The highest fluctuations were observed following refeeding in the 7 patients who later died. Conclusion: A significant metabolic instability is observed on refeeding even with a slow refeeding schedule of 10 kcal/kg/d. Measurement of metabolomics parameters may be used for the evaluation of malnutrition, refeeding status, and optimization of the enteral formula. © 2012 American Society for Parenteral and Enteral Nutrition.
Rachman-Elbaum S.,Hebrew University of Jerusalem |
Porat-Katz B.S.,Hebrew University of Jerusalem |
Kachal J.,Israeli Ministry of Health |
Stark A.H.,Hebrew University of Jerusalem
European Journal of Clinical Nutrition | Year: 2016
Use of electronic health records necessitates a systematic approach for documentation of the Dietetic Care Process (DCP). However, no standardized system exists in Israel. The authors propose a novel documentation system developed by an expert advisory committee and tailored to a specific patient population. In this pilot study, 12 experienced Israeli Registered Dietitians (RDs) (median years of practice=23.0; s.d.=8.8; practice in geriatric populations median=13.0; s.d.=8.5) were recruited to evaluate the new tool for DCP documentation. Participants completed an explanatory short course online and evaluated the utility of the tool. There was full agreement that the proposed tool is necessary and an effective method for documenting the DCP within geriatric populations in clinical practice. In conclusion, a novel, tailored and sectoral tool designed for standardized documentation of dietetic care was recommended for implementation by an experienced group of RDs with substantive clinical experience in geriatric populations. © 2016 Macmillan Publishers Limited.
Yinnon A.M.,Hebrew University of Jerusalem |
Wiener-Well Y.,Hebrew University of Jerusalem |
Jerassy Z.,Hebrew University of Jerusalem |
Dor M.,Israeli Ministry of Health |
And 12 more authors.
Journal of Hospital Infection | Year: 2012
Background: Two detailed checklists were developed, based on published infection control guidelines, for daily use by infection control practitioners in departments and operating rooms. Aim: To assess the impact of the checklists on nosocomial infection rates in three hospitals over the course of one year. Methods: The checklists included 20 subheadings (±150 items). Project nurses conducted rounds in the study (but not control) departments; during each round, the nurses selected 15-20 items for observation, marked the checklists according to appropriateness of observed behaviour and provided on-the-spot corrective education. Rates of adherence to the checklist, antibiotic use, number of obtained and positive cultures, and positive staff hand and patient environment cultures were reported monthly as a report card to relevant personnel and administrators. The rate of nosocomial infections was determined in the first and last months. Results: The baseline nosocomial infection rate was similar in the study and control departments: 37/345 (11%) and 26/270 (10%) respectively. In the last month, the rate in the study department decreased to 16/383 (4%) (. P < 0.01); in the control it decreased insignificantly to 21/248 (8%) (not significant). No significant trends were detected in the number of obtained cultures, positive cultures, or antibiotic use. Adherence to guidelines ranged from 75% to 94% between the hospitals (. P < 0.001): the overall rate increased from 80% to 91% (. P < 0.01). Conclusions: The use of checklists during the conduct of infection control rounds, combined with monthly reports, was associated with a significant decrease in nosocomial infections in study departments. © 2012 The Healthcare Infection Society.
Feldman B.S.,Clalit Research Institute |
Cohen-Stavi C.J.,Clalit Research Institute |
Leibowitz M.,Clalit Research Institute |
Leibowitz M.,New York University |
And 7 more authors.
PLoS ONE | Year: 2014
Aims: This study assesses the attributable impact of adherence to oral glucose medications as a risk factor for poor glycemic control in population subgroups of a large general population, using an objective medication adherence measure. Methods: Using electronic health records data, adherence to diabetes medications over a two-year period was calculated by prescription-based Medication Possession Ratios for adults with diabetes diagnosed before January 1, 2010. Glycemic control was determined by the HbA1c test closest to the last drug prescription during 2010-2012. Poor control was defined as HbA1c>75 mmol/mol (9.0%). Medication adherence was categorized as "good" (>80%), "moderate" (50-80%), or "poor" (<50%). Logistic regression models assessed the role medication adherence plays in the association between disease duration, age, and poor glycemic control. We calculated the change in the attributable fraction of glucose control if the non-adherent diabetic medication population would become adherent by age-groups. Results: Among 228,846 diabetes patients treated by oral antiglycemic medication, 46.4% had good, 28.8% had moderate, and 24.8% had poor adherence. Good adherence rates increased with increasing disease duration, while glycemic control became worse. There was a strong inverse association between adherence level and poor control (OR = 2.50; CI = 2.43-2.58), and adherence was a significant mediator between age and poor control. Conclusions: A large portion of the diabetes population is reported to have poor adherence to oral diabetes medications, which is strongly associated with poor glycemic control in all disease durations. While poor adherence does not mediate the poorer glycemic control seen in patients with longer-standing disease, it is a significant mediator of poor glycemic control among younger diabetes patients. A greater fraction of poorly controlled younger patients, compared to older patients, could be prevented if at least 80% adherence to their medications was achieved. Therefore, our results suggest that interventions to improve adherence should focus on this younger sub-group. © 2014 Feldman et al.
Ponizovsky A.M.,Israeli Ministry of Health |
Levov K.,Talbieh Mental Health Center |
Schultz Y.,Talbieh Mental Health Center |
Radomislensky I.,Israeli Ministry of Health
American Journal of Orthopsychiatry | Year: 2011
This study examined the adult attachment styles, interpersonal distance from potential attachment figures and strangers, coping strategies, perceived social support, and stress-related self-variables among patients diagnosed with adjustment disorders (AJD). Seventy patients at an outpatient clinic and 61 matched controls completed a battery of standardized questionnaires. Univariate and multivariate statistical analyses were used to evaluate the parameters of interest. Using attachment theory (J. Bowlby, 1988) and the dynamic stress-vulnerability model of depressive disorder (G. W. Brown & T. O. Harris, 1989) as the analytical frameworks, the authors hypothesized that participants with AJD would: (a) display more insecure attachment styles, (b) be less tolerant of close interpersonal proximity, (c) use more emotion-oriented coping strategies, (d) display lower self-efficacy and self-esteem, and (e) perceive less social support from family, friends, and significant others. We further hypothesized that these variables would be predictive of depressive symptoms. All of the hypotheses were confirmed. The results suggest that the insecure fearful-avoidant attachment style is associated with severe depressive symptoms in patients with AJD. However, other psychosocial factors, such as low self-esteem and poor social support from friends, were more predictive of AJD symptoms. The findings warrant further studies on the risk and protective effects of these factors in the development of AJD and other stress-induced disorders. © 2011 American Orthopsychiatric Association.