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Haifa, Israel

Shupak A.,Lin Medical Center
Otology and Neurotology | Year: 2014

OBJECTIVE: To evaluate the role of otoacoustic emissions (OAEs) in the prediction of idiopathic sudden sensorineural hearing loss (ISSNHL) outcome.STUDY DESIGN: Open-label prospective study.SETTING: Tertiary referral medical center.PATIENTS: Fifteen ISSNHL patients (age: 57.6 ± 16.2 years) were prospectively followed 7 days, 14 days, and 3 months post-presentation and the commencement of treatment.INTERVENTION: Pure-tone audiometry, TEOAEs (Transient Evoked OAEs), and DPOAEs (Distortion Product OAEs) testing.MAIN OUTCOME MEASURES: The pure-tone threshold averages of the three most affected frequencies, detectability, and the signal-to-noise ratios (SNRs) values of the TEOAEs and DPOAEs were calculated. The main outcome measures were pure-tone hearing improvement, sensitivity, and specificity of the OAEs measures towards ISSNHL outcome.RESULTS: Patients having detectable TEOAEs on the first follow-up evaluation had average hearing improvement of 62 ± 41% whereas those with no response improved only by 11 ± 15% (P < 0.001). For the DPOAEs hearing improvement, results were 71 ± 37% and 10 ± 14%, respectively (P < 0.001). The sensitivity of recordable TEOAEs on the seventh day of follow-up towards the prediction of significant hearing improvement reached 71% and the specificity 100%. For the DPOAEs, the corresponding values were 83% and 100%. Univariate analysis showed significant contribution for the variance in hearing improvement by both TEOAEs and DPOAEs and their interaction (P values of 0.043, 0.005, and 0.009, respectively).CONCLUSION: The results suggest potential role of TEOAEs and DPOAEs evaluation in the early stage of treatment in the prediction of ISSNHL outcome. Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company


Ben-Arye E.,Technion - Israel Institute of Technology | Ben-Arye E.,Lin Medical Center | Visser A.,Rotterdam University
Patient Education and Counseling | Year: 2012

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient-provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool - research, education, and clinical practice - are perceived in the light of open, non-judgmental patient-health care provider-CM practitioner communication and a patient-centered bio-psycho-social-cultural-spiritual agenda. © 2012 Elsevier Ireland Ltd.


Frenkel M.,University of Texas M. D. Anderson Cancer Center | Ben-Arye E.,Lin Medical Center | Ben-Arye E.,Technion - Israel Institute of Technology | Cohen L.,University of Texas M. D. Anderson Cancer Center
Integrative Cancer Therapies | Year: 2010

In recent years, there has been an increased interest in complementary and alternative medicine (CAM) use among people with cancer. Many are looking for informed advice and desire communication with their physicians about CAM use. Communication is crucial in establishing trust with patients, gathering information, addressing patient emotions, and assisting patients in decisions about care. The quality of communication in cancer care has been shown to affect patient satisfaction, decision making, patient distress and well-being, compliance, and even malpractice litigation. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. A communication approach that fosters a collaborative relationship that includes adequate information exchange, responds to emotional needs, and manages uncertainty can lead to informed decisions about CAM use. This type of communication can help facilitate an open discussion with cancer patients and their families about integrating CAM use into their care and help physicians fulfill their roles in caring, comforting, and healing, even when cure is not possible. In this article, the authors discuss a possible model of effective patient-physician communication about CAM use in cancer care based on a comprehensive overview of the literature. © The Author(s) 2010.


Touma Z.,Center for Prognosis Studies in the Rheumatic Diseases | Eder L.,Center for Prognosis Studies in the Rheumatic Diseases | Zisman D.,Lin Medical Center | Feld J.,Lin Medical Center | And 5 more authors.
Arthritis Care and Research | Year: 2011

Objective. Vitamin D insufficiency appears to be a pandemic problem and is more common in inhabitants of high latitude compared to low latitude areas. We aimed to determine the prevalence of vitamin D deficiency/insufficiency in patients with psoriatic arthritis (PsA), its seasonal and geographic variation, and the possible association with demographics and disease activity. Methods. This study was conducted in a northern geographic area and in a subtropical region from March 2009 to August 2009. Most subjects were assessed in both winter and summer. Demographics, clinical data, skinphototype, and serum 25-hydroxyvitamin D (25[OH]D) levels were determined. Multivariate linear and logistic mixed models were used to assess the relationship with serum 25(OH)D levels. Results. In total, 302 PsA patients were enrolled. Two hundred fifty-eight patients were evaluated during the winter, while 214 patients were evaluated during the summer. 25(OH)D levels in winter and summer were adequate (north: 41.3% winter and 41.4% summer, south: 42.1% winter and 35.1% summer), insufficient (north: 55.7% winter and 58.6% summer, south: 50.9% winter and 62.2% summer), and deficient (north: 3% winter and 0% summer, south: 7% winter and 2.7% summer) among patients. There was no association between 25(OH)D levels, geographic and seasonal interaction, race, employment status, and skin phototype or disease activity in both seasons. No association between disease activity in summer and vitamin D levels in winter could be found. Conclusion. A high prevalence of vitamin D insufficiency among PsA patients was found. There was no seasonal variation in 25(OH)D levels among PsA patients in the southern and northern sites. No association could be established between disease activity and vitamin D level. © 2011, American College of Rheumatology.


Kafri N.,Lin Medical Center | Valfer R.,Lin Medical Center | Nativ O.,Lin Medical Center | Shiloni E.,Carmel Medical Center | And 2 more authors.
Surgery for Obesity and Related Diseases | Year: 2011

Background Success in maintaining weight loss after bariatric surgery requires the ability to implement long-term changes in eating habits and lifestyle. However, no data are available on patients' eating ability and behavioral aspects after laparoscopic sleeve gastrectomy. Methods A total of 60 patients who had undergone laparoscopic sleeve gastrectomy from 2007 to 2009 completed a questionnaire on habits, weight loss, health behaviors (e.g., physical activities, meal schedules), food selection, food tolerance, eating style, and satisfaction with personal changes. The patients were divided into 2 groups: those with <1 year of postoperative follow-up (group 1, n = 35) and those with >1 year of postoperative follow-up (group 2, n = 25). Results The percentage of excess weight loss was 66.9% ± 21.6% and 70.9% ± 15.3% for groups 1 and 2, respectively. Most of the patients reported changing their eating habits, eating regular solid food, engaging in physical activity, and taking multivitamins. A trend was seen toward greater rates of healthy food consumption on a daily basis and significantly better food tolerance over time. The data showed lower rates of health-promoting behavior and diet restraint with longer follow-up. Both groups reported high satisfaction with the results of their surgery. Group 1 demonstrated a greater level of self-confidence than group 2 about controlling their new weight. Conclusion Patients have the ability to maintain a healthy diet beyond the first year after laparoscopic sleeve gastrectomy. These findings also underline the importance of long-term maintenance programs. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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