Israel Medical Center Research Articles

Prevalence and characteristics of mistreatment during childbirth in two Israeli hospitals.

This study aimed to investigate the prevalence and characteristics of mistreatment during childbirth in Israeli medical centers, addressing gaps in quantitative data within developed countries. A new questionnaire, incorporating demographic, obstetric, and mistreatment-related questions, was developed and distributed to postpartum women in two Israeli hospitals. Mistreatment categories included physical, sexual, and verbal abuse, failure to meet professional standards, poor rapport between women and providers, and health system conditions. Statistical analysis examined associations with clinical and demographic variables. Of 422 analyzed questionnaires, most prevalent categories associated with mistreatment during childbirth were failure to meet professional standards (51.9%) and poor rapport between women and providers (33.2%). Cesarean section, complications during childbirth, and planned birth mode were significantly associated with mistreatment. Painful vaginal examinations, inadequate pain relief, and lack of explanations were common concerns. Factors like educational preparation, previous vaginal delivery, and doula support were linked to specific mistreatment subcategories. This study revealed a considerable prevalence of mistreatment during childbirth in Israeli medical centers, emphasizing the urgent need for reform in maternity care. Addressing specific issues, such as improving communication, consent procedures, and pain management during childbirth, is crucial for enhancing the overall birthing experience. The findings contribute valuable insights to promote respectful maternity care practices in Israel.

The personal and the national: Lessons learned in the aftermath of the October 7 attacks in Israel.

On October 7, 2023, terrorist organizations led by Hamas, launched an extensive attack on Israel. Within days following the initial attack, there was a clear need to provide psychological support to individuals who were exposed to the horrors of the October 7 attacks. Tel-Aviv Sourasky Medical Center - Ichilov, a tertiary medical center, launched an emergency mental health service to provide psychological first aid to the first-line victims of the war. As the fighting spread, the services were extended to the entire population. The intervention we provided was guided by an integrated approach that promotes introspection and connectedness to one's environment and community, enhancing cognitive functions, emotional regulation and utilizing available resources to reduce distress. The main themes that emerged shifted between feelings of helplessness and a sense of agency; a breach in basic trust and renewed trust, guilt and self-compassion; anger, abandonment and alienation versus solidarity and connecting to the present and the future, despair versus hope and loss versus acceptance and connectedness. The following account reflects our experiences from the unique cooperation between the Mount Sinai Medical Center in New York and the Tel Aviv Medical Center in Israel starting from the days following the October 7 attacks, as well as lessons learned at the individual and system level discussed in light of previous literature and experience.

P0796 Comparison of Disease Severity, Treatment, and Outcomes in Elderly and Younger Patients Hospitalized with Acute Severe Ulcerative Colitis (ASUC)

Abstract Background Acute severe ulcerative colitis (ASUC) is a life-threatening complication that requires prompt and effective treatment. Disease severity, treatment approaches, and outcomes may differ between elderly patients (aged ≥60 years) and younger patients. This study aims to compare these factors in a cohort of hospitalized ASUC patients. Methods A retrospective cohort study was conducted including all patients admitted between 1/2018-12/2023, with ASUC who failed oral steroid therapy to Rabin Medical Center in Israel, a large tertiary referral center. Baseline disease severity was assessed using hemoglobin, albumin, and C-reactive protein (CRP). Treatments analyzed included the use of rescue therapies such as infliximab and calcineurin inhibitors for patients failing intravenous corticosteroid therapy. Outcomes such as colectomy and mortality associated with ASUC were recorded. Results 158 patients met the inclusion criteria and were stratified into two groups: elderly patients (≥60 years, n=16) and younger patients (<60 years, n=142).Elderly patients had a mean age of 72.9 years compared to 32.1 years in younger patients. Baseline hemoglobin levels were similar between the two groups (11.7 g/dL in elderly vs. 11.8 g/dL in younger patients). Albumin levels were also similar in elderly patients (3.6 g/dL) compared to younger patients (3.8 g/dL) as were CRP levels (5.7 mg/dl vs 5.8 md/dl) respectively. The use of infliximab was less common in elderly patients (12.5%, n=2) compared to younger patients (24.6%, n=35). Calcineurin inhibitors (ciclosporin or tacrolimus) were used in only 1 elderly patient (6.25%) but were used in almost 15 % (n=19) of younger patients. No elderly patients underwent colectomy during admission, while 7.0% (n=10) of younger patients did. Mortality was higher in elderly patients, with a case fatality rate of 12.5% (n=2), compared to no reported mortality in younger patients. Conclusion Elderly patients hospitalized with ASUC had similar baseline disease severity but received less rescue therapies and had worse outcomes compared to younger patients, including a higher mortality rate. These findings suggest that while disease severity may be comparable across age groups, elderly patients may experience greater complications, underscoring the need for tailored treatment approaches in this population.

Identifying factors associated with disparities in accessing an Integrative Oncology program

Introduction: Integrative oncology (IO) programs provide patients with evidence-based complementary medicine therapies within a supportive and palliative cancer care setting. This study retrospectively examined characteristics of patients with lung cancer predicting utilization of a freely-provided IO consultation at two medical centers in Israel. Methods: Electronic medical files of 832 patients with lung cancer attending/not attending the IO consultation were searched for socio-demographic (age, gender, country of birth, place of residence, primary language spoken) and personal health (Body Mass Index; smoking; disability) characteristics; cancer-related parameters (primary tumor site, localized vs. metastatic); and reported pain- and emotional-related concerns. Results: Only 120 (14.4%) of eligible patients attended the IO consultation, with multivariate analysis finding a significantly lower likelihood of attendance among patients who were older (OR: 0.98, 95%CI=0.96-0.99; p=0.02); male (OR: 0.53, 95%CI=0.34-0.83; p=0.005); primarily non Hebrew-speaking (i.e., primarily Arabic or Russian speakers; OR: 0.34, 95%CI=0.14-0.82; p=0.016); without disability (OR: 0.52, 95%CI=0.33-0.92; p=0.025); and not reporting pain (OR=0.40,95%CI=0.17-0.98-; p=0.046). Conclusions: The present study suggests that age, gender and culture-related factors (reflected by the patient's primary language) may contribute to disparities in accessing a freely-provided IO consultation, as shown in a diverse population of patients with lung cancer from two medical centers in Israel. Further research is needed to better understand the role of these programs within a diverse, equitable and inclusive setting of effective and safe integrative care of oncology patients.

Antibiotic resistance genotype, phenotype, and clinical outcomes in patients with Gram-negative infections at Rabin Medical Center in Israel.

While there have been several studies that attempt to find clinical predictors of outcomes in patients hospitalized with bacterial infections, less has been done to combine clinical data with genomic mechanisms of antibiotic resistance. This study focused on a hospitalized patient population in Israel with infections due to medically important bacterial pathogens as a way to build a framework that would unite clinical data with both bacterial antibiotic susceptibility and genomic data. Merging both clinical and genomic data allowed us to find both bacterial and clinical factors that impact certain clinical outcomes. As genome sequencing of bacteria becomes both rapid and commonplace, near real-time monitoring of resistance determinants could help to optimize clinical care and potentially improve outcomes in these patients.

BlaGES-producing ST654 comprises a quarter of all carbapenem-resistant Pseudomonas aeruginosa in blood isolates from 15 hospitals.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are of major clinical concern. We analyzed 85 P. aeruginosa blood isolates non-susceptible to carbapenems collected during 2021-2023 from 15 medical centers in Israel. We aimed to determine the prevalence of high-risk clones, examine clonality, test antibiotic susceptibility, and assess the presence of acquired resistance genes, including carbapenemases. Whole-genome sequencing was performed using Illumina sequencing technology. Susceptibly was determined using the broth microdilution method. In the entire sample, 43.5% were high-risk clones. A main clade (27.1% of isolates) found in multiple hospitals comprised 19 isolates belonging to the high-risk ST654 clone and four closely related isolates. The isolates in this main clade harbored a broad set of resistance genes, including GES-type genes, and 91% had a mutated outer membrane protein (OprD). Isolates in the main clade were uniformly tobramycin (TOB) resistant and 83% were ceftolozane/tazobactam resistant. In the entire sample, we found high resistance to most antipseudomonal agents, including new beta-lactam/beta-lactamase inhibitor combinations. No uniform susceptibility to an antipseudomonal agent was found. Carbapenemases were carried by 9.4% of isolates (5.9% blaGES-5 and 3.5% blaNDM-1) and oprD was mutated in 67% of isolates. Thus, the epidemiology of CRPA is explained by a combination of clonal expansion of a dominant high-risk clade and sporadic occurrence of mutated strains. Our findings highlight the importance of susceptibility testing using a wide panel of antibiotics when CRPA is detected. Prevention measures tracking and controlling emerging high-risk clades and clones are crucial to limit the spread of CRPA.

Transformations in Benign Prostatic Hyperplasia Surgical Practices: A Longitudinal Study of Trends and Predictions

Introduction: The workload for benign prostatic hyperplasia (BPH) surgery is expected to rise with an increase in life expectancy and a growing population. Surgical modalities for BPH have evolved, shifting toward minimally invasive transurethral procedures. This study aimed to investigate the trends in BPH surgical procedures across medical centers in Israel. Methods: Data from seven academic medical centers in Israel from 2010 to 2022 were analyzed. Procedures included open prostatectomy, transurethral prostatectomy (TURP), holmium laser enucleation of the prostate (HoLEP), and photovaporization of the prostate (PVP). Statistical analyses were employed, including t tests, ANOVA, and ARIMA models. Results: Over 12 years, 13,478 BPH procedures were performed. TURP was the most common (72%), followed by open surgery (12%), HoLEP (12%), and PVP (3%). Annual procedures increased by approximately 5% each year, with a cumulative surge of 63% cases by 2022. The average patient’s age remained stable. TURP and HoLEP showed continual growth, while open surgery declined. HoLEP exhibited a shorter length of hospital stay compared to other modalities. Predictive models suggest open prostatectomy will cease within 2 years, while TURP and HoLEP will continue to rise. Conclusion: This study highlights a significant increase in BPH surgical procedures over time, with a notable preference for TURP and HoLEP. The findings emphasize the importance of size-independent techniques like HoLEP for optimal healthcare management in the future.

The Epidemiology of PCR-Confirmed Cutaneous Leishmaniasis in Israel: A Nationwide Study.

Leishmaniasis, mainly cutaneous leishmaniasis (CL), is endemic in Israel. In recent years, the diagnosis of leishmaniasis has transitioned to a molecular diagnosis. To summarize all cases of leishmaniasis and the identified species seen in Israel based on molecular diagnosis. A retrospective study was performed of patients diagnosed with leishmaniasis between January 2017 and December 2022. All five medical centers in Israel in which Leishmania diagnosis is performed were included: Soroka, HaEmek, Hadassah, Rambam, and Sheba, all utilized molecular diagnostic methods. Data on the annual number of cases, species, age, and gender were retrieved. During the years 2017-2022, a total of 4168 cases of leishmaniasis were diagnosed, which corresponds with ~7/100,000 inhabitants. L. (L.) major and L. (L.) tropica accounted for 84% and 14%, respectively. During the years 2020-2021, L. (L.) infantum emerged as a new form of cutaneous disease [2.7% of cases during this period]. Visceral L. (L.) infantum was found in five cases. Imported New World leishmaniasis accounted for 1% of the cases. L. (L.) major affected more males (67%) while L. (L.) tropica commonly affected more children and caused more facial lesions. The mean annual number of cases during these years is ~700. The dominant species is L. (L.) major. Since 2020, cutaneous L. (L.) infantum is an emerging infection in Israel.

Greenness Exposure and Mortality Risk in a Cardio-Oncologic Population.

Knowledge is lacking on the relationship between greenness and mortality in cancer survivors who experience coronary artery disease (CAD), a cardio-oncologic population. We aimed to investigate the association between residential greenness exposure and all-cause mortality in a cardio-oncologic population. Cancer survivors undergoing percutaneous coronary intervention at the Rabin Medical Center in Israel between 2004 and 2014 were included in the study. Clinical data were collected from medical records during index hospitalization and from the Israeli National Cancer Registry. Residential greenness was estimated by the normalized difference vegetation index (NDVI), a satellite-based index derived from Landsat imagery at a 30-meter spatial resolution, with larger values indicating higher levels of vegetative density (ranging between -1 to 1). Mortality follow-up data were obtained through the end of 2021. Cox models were used to assess the hazard ratios (HRs) for all-cause mortality per 1SD increase in NDVI. Among 1,331 patients analyzed [mean (SD) age, 75.6 (10.2) years, 373 (28%) females], the mean (SD) NDVI within a 300-meter radius was 0.12 (0.03). During a median follow-up period of 12.0 (IQR 9.2-14.7) years, 883 (66%) participants died. After adjustment for potential confounding factors, including residential socioeconomic status, air pollution, and smoking, NDVI was inversely associated with mortality hazard [HR (95% CI) = 0.93 (0.86, 0.99); p=.042]. The association was stronger among individuals with more recently (<10 years) diagnosed cancer [HR (95% CI) = 0.89 (0.81, 0.98); p=.019]. In a cohort of cardio-oncologic patients, greenness was independently associated with lower mortality.

Anterior Chamber Intraocular Lens Implantation Versus Four-Flanged Scleral Fixation Technique for Patients With Loss of Capsular Support During Routine Cataract Surgery.

To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].

Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses.

Nurses accompany patients throughout the breaking bad news process. The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization. A cross-sectional comparative study. Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%). Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented. The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.

Effect of Added Inhaled Corticosteroids to Systemic Steroids on COPD Exacerbation Outcomes.

COPD exacerbations are a major cause of morbidity and mortality. Although inhaled corticosteroids (ICS) have a role as long-term treatment, their efficacy in exacerbations, particularly as an adjunct to systemic steroids, remains unclear. In this retrospective observational study, we analyzed data from 870 subjects admitted with COPD exacerbations to a tertiary medical center in Israel from January 2018-January 2023. We investigated the impact of adding ICS to standard systemic steroid treatment on hospital length of stay, intubation rates, and 30-d mortality using propensity score matching to account for confounders. The cohort, after matching, included 354 subjects treated with systemic steroids and ICS and 121 treated with systemic steroids alone. All characteristics were similar between the groups. Our analysis showed no differences in 30-d mortality (7.1% vs 5.8%, P = .63) or secondary outcomes (intubation, hospital length of stay, and readmission rates) between the groups. Subgroup analyses based on different eosinophil levels did not alter these findings. In multivariate analysis among the general cohort, eosinophil count < 150 cells/μL (adjusted odds ratio 0.45 [95% CI 0.21-0.87], P = .02) and high Charlson score (adjusted odds ratio 1.19 [95% CI 1.02-1.37], P = .02) were independent predictors for 30-d mortality. Despite the known benefits of ICS in managing chronic COPD, we did not find an added value of ICS to systemic steroids in exacerbations. These results underscore the necessity for individualized treatment strategies and further research into the role of ICS in COPD exacerbations.

Cardiac surgery during wartime in Israel

BackgroundThe war that began on October 7th, 2023, has impacted all major tertiary medical centers in Israel. In the largest cardiac surgery department in Israel there has been a surprising increase in the number of open-heart procedures, despite having approximately 50% of surgeons recruited to military service. The purpose of this study is to characterize this increase in the number of operations performed during wartime and assess whether the national crisis has affected patient outcomes.MethodsThe study was based on a prospectively collected registry of 275 patients who underwent cardiac surgery or extracorporeal membrane oxygenation (ECMO) during the first two months of war, October 7th 2023 – December 7th 2023, as well as patients that underwent cardiac surgery during the same period of time in 2022 (October 7th, 2022 – December 7th, 2022).Results120 patients (43.6%) were operated on in 2022, and 155 (56.4%) during wartime in 2023. This signifies a 33.0% increase in open-heart procedures (109 in 2022 vs. 145 in 2023, p-value 0.26). There were no significant differences in the baseline characteristics of patients when comparing the 2022 patients to those in 2023. No significant differences between the two groups were found with regards to intraoperative characteristics or the type of surgery. However, compared to 2022, there was a 233% increase in the number of transplantations in the 2023 cohort (p-value 0.24). Patient outcomes during wartime were similar to those of 2022, including postoperative complications, length of stay, and mortality.ConclusionsPatients who underwent cardiac surgery during wartime presented with comparable outcomes when compared to those of last year despite the increase in cardiac surgery workload. There was an increase in the number of transplants this year, attributed to the unfortunate increase in organ donors.

Vaginal Progesterone for Pregnancy Prolongation After Arrested Preterm Labor

Women with arrested preterm labor (APTL) are at very high risk for spontaneous preterm delivery (SPTD), the leading cause of neonatal mortality and morbidity. To date, no maintenance therapy has been found to be effective for pregnancy prolongation. A few clinical trials with considerable methodological limitations have demonstrated some efficacy for 400 mg vaginal micronized progesterone (VMP) in women with APTL. To investigate the effectiveness of daily 400 mg VMP for the prolongation of pregnancy after APTL. This randomized clinical trial was conducted between December 19, 2018, and February 27, 2023, in 3 university-affiliated medical centers in Israel. Participants included women with singleton and twin pregnancies after APTL following tocolysis at 24 weeks 0 days to 34 weeks 0 days' gestation. Women with a history of preterm delivery or asymptomatic cervical shortening in the current pregnancy were excluded. Participants were randomly allocated to receive VMP 200 mg twice a day or no treatment until 36 weeks 6 days' gestation. The primary end points were mean number of days from study enrollment to delivery and the rate of SPTD prior to 37 weeks' gestation. A total of 129 participants were enrolled (65 in the VMP group and 64 in the no-treatment group). Mean (SD) age was 27.6 (5.1) years. Between the VMP and no-treatment groups, there was no difference in pregnancy prolongation (mean [SD], 40.0 [17.8] vs 37.4 [20.3] days; P = .44) and the rate of SPTD (16 [25%] vs 19 [30%]; relative risk, 0.8; 95% CI, 0.5-1.5; P = .52). In twin pregnancies, including 12 and 15 pairs in the VMP and no-treatment groups, respectively, VMP prolonged pregnancy (mean [SD], 43.7 [18.1] vs 26.1 [15.2] days; P = .02), postponed the delivery week (36.5 [1.4] vs 34.7 [2.2] weeks; P = .01), shortened the length of stay in the neonatal intensive care unit (4.9 [10.6] vs 13.2 [18.5] days; P = .03) and overall hospital stay (8.3 [9.6] vs 15.1 [17.2] days; P = .03), and was associated with a higher birth weight (2444 [528] vs 2018 [430] g; P = .01). These findings show that VMP given in a dosage of 200 mg twice a day following APTL is not an effective treatment to prolong pregnancy or prevent SPTD. However, VMP demonstrated beneficial effects in twin pregnancies, warranting further investigation. ClinicalTrials.gov Identifier: NCT02430233.

Association between prenatal phthalate exposure and ano-genital indices among offsprings in an Israeli cohort

BackgroundIn-utero phthalate exposure was shown to be associated with shortened anogenital distance (AGD) in male newborns, but findings among female are inconsistent. While phthalate exposure among pregnant women in Israel is widespread, no study has examined the association with offspring AGD. The objective of the current study was to investigate the association between maternal phthalates urinary concentration and offspring AGD at time of delivery among a birth cohort in Israel. MethodsWe measured spot urinary concentration of monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexylphthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP) among women presenting to the delivery room at Shamir Medical Center in Israel. Birthweight, length and AGD were measured in all newborns using a standardized protocol. Each AGD measurement was adjusted to weight (ano-genital index). Confounders included socio-demographic characteristics, comorbidities and obstetrical history. Univariate and multivariate analyses assessed the associations between phthalates, confounders and AGD. ResultsOverall, 193 mother and infant were analyzed. All newborns were born at term and had normal Apgar scores. Mean maternal age was 32 ± 4.7 years old. Mean birth weight and pregnancy week were 3183 ± 498 g and 39 ± 1.3, respectively. Median (IQR) urinary phthalate concentration adjusted to creatinine (ug/g) were 3.96 (2.2–6.6), 1.22 (0.7–2), 10.84 (7–20.4), 6.36 (3.3–11.2) and 0.64 (0.4–1.1) for MBP, MBzP, MECPP, MEHHP and MEOHP, respectively. Univariate comparison showed a significant association between higher than median MBzP concentration, higher Ano-Fourchetal index (AFI: 4.4 vs. 4.1, p = 0.037) and Ano-clitoral index (ACI: 11.5 vs. 10.4, p = 0.032) in infants. Total urinary phthalates concentration ≥26.25 μg/g was significantly associated with smaller penile width index (3.5 vs. 3.7, p = 0.022), higher ACI (11.6 vs. 10.3, p = 0.013) and a trend towards significance for higher AFI (4.3 vs. 4.1, p = 0.055). Following multivariate linear regression only PWI remained significantly associated with total phthalate urinary concentration. ConclusionsMaternal urinary phthalates concentration at delivery were not associated with female AGD, but total urinary phthalate concentration were inversely associated with penile width.

Association between Group B Streptococcus and Clinical Chorioamnionitis by Gestational Week at Delivery-A Multicenter Cohort Study.

In the era of group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP), GBS colonization has been associated with a lower risk of chorioamnionitis, possibly due to a protective effect of IAP. We sought to confirm this finding and assess whether this association varies by gestational week at delivery. We performed a retrospective cohort study of term (37.0-42.6 weeks), singleton parturients with known GBS status who delivered from 2005 to 2021 at two academic medical centers in Israel. We excluded patients who underwent planned cesarean, out of hospital birth, or had a fetal demise. Patients received GBS screening and IAP for GBS positivity as routine clinical care. The primary outcome was a diagnosis of clinical chorioamnionitis as determined by the International Classification of Diseases 10th Revision code, compared between GBS-positive and -negative groups, and assessed by gestational week at delivery. Of 292,126 deliveries, 155,255 met inclusion criteria. In total, 30.1% were GBS positive and 69.9% were negative. GBS-positive patients were 21% less likely to be diagnosed with clinical chorioamnionitis than GBS-negative patients, even after controlling for confounders (1.5 vs. 2.2%, adjusted odds ratio: 0.79, 95% confidence interval: 0.68-0.92). When assessed by gestational week at delivery, there was a significantly greater difference in rates of clinical chorioamnionitis between GBS-positive versus GBS-negative groups with advancing gestational age: 1.5-fold difference at 38 to 40 weeks, but a twofold difference at 42 weeks. The risk of clinical chorioamnionitis remained stable in the GBS-positive group, but increased significantly in the GBS-negative group at 41- and 42-week gestation (2.0 vs. 2.9%, p < 0.01 at 41 weeks; up to 3.9% at 42 weeks, p < 0.01). In a large multicenter cohort with universal GBS screening and IAP, GBS positivity was associated with a lower risk of chorioamnionitis, driven by an increasing rate of chorioamnionitis among GBS-negative patients after 40 weeks. · GBS positivity and IAP may be associated with lower risk of chorioamnionitis.. · GBS-positive patients were less likely to be diagnosed with chorioamnionitis.. · This difference increased with advancing gestational age after 40 weeks..

What do physicians think about the white coat, about patients' view of the white coat, and how empathetic are physicians toward patients in hospital gowns? An enclothed cognition view.

The receipt of the white coat by medical students is a significant milestone. Extensive research has focused on the white coat, its purity, representation of authority and professionalism, its role in consolidating a medical hierarchy, and the professional status attributed to physicians wearing it. Studies suggest that the white coat is a symbol of medical competence, and patients expect physicians to wear it. Research, however, has paid little attention to what physicians think about their white coat, how they perceive the patient's view of the white coat and the hospital gown, within the patient-physician power asymmetry, which is the focus of the current study. In total, 85 physicians from three Israeli medical centers completed a questionnaire (62% Muslims, 33% Jewish, and 5% Christians; 68% men, ages ranging from 21 to 73 years). Employing the enclothed cognition theory and adopting a within-person approach, we found that the more physicians perceived the white coat as important, the more they attributed a positive view of the white coat to patients and the more they perceived the patient's view of the hospital gown as positive. In addition, the higher the perceived importance of the white coat, the higher the reported empathy of physicians toward inpatients, which is consistent with the hospital's values of care. Interestingly, although medicine is a symbol of protection and care for others, the symbolic meaning of the white coat was potent enough to elicit empathy only when physicians perceived it as important. This study extends the theoretical knowledge on the theory of enclothed cognition in healthcare regarding self-perceptions and professional conduct.

Diagnosis, treatment, and long-term outcomes of pediatric pemphigus: a retrospective study at tertiary medical centers.

Pediatric pemphigus is a rare bullous disease that representsa diagnostic and therapeutic challenge; evidence on patients' response to various treatments and long-term surveillance data are lacking. We aimed to investigate pediatric pemphigus patients' characteristics, diagnosis, therapeutics, response, and long-term follow-up. This is a retrospective study of all pemphigus patients aged <18 years, diagnosed between 2000 and 2023, from three tertiary medical centers in Israel. The diagnosis was confirmed by positive immunofluorescence. Twelve pediatric pemphigus patients were included (mean age 10.7 ± 4.3 years, male:female ratio 1:1). Mean diagnostic delay was 11.1 ± 12.6 months (range 1.8-36 months). Most patients had pemphigus vulgaris with mucosal involvement (58.3%). First-line treatment for all patients included systemic corticosteroids (sCS), with a treatment duration (including tapering down) of 28 ± 18.4 months. Hospitalization did not yield better outcomes. Only three patients achieved sustained complete response with sCS treatment (25.0%), and the rest required additional therapeutics, most commonly rituximab. Rituximab showed a good safety profile and therapeutic response. Follow-up was recorded up to 18.1 years after diagnosis (mean: 5.6 years). Three of five patients with information available more than 5 years after the pemphigus diagnosis still exhibited disease symptoms. Pediatric pemphigus is associated with a significant diagnostic delay. While sCS can induce remission in most patients as a first-line treatment, long-term disease control requires additional immunomodulators. Long-term follow-up reveals a chronic yet mostly benign disease course in this population and advocates for the use of rituximab in pediatric pemphigus patients.

Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center

BackgroundMolar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences.MethodsA retrospective study was conducted of data recorded during 2007–2021 in an academic medical center in Israel. The study population comprised 167 women diagnosed with complete or partial moles, for whom data were obtained through histological examination and P57 immunostaining. Maternal age and ethnicity were extracted from electronic medical records. Incidence rates were calculated per 10,000 live births, and a nested case-control study compared demographic characteristics and molar pregnancy incidences between Arab and Jewish women. Statistical analyses included age-adjusted comparisons, relative risk calculations and multivariate logistic regression.ResultsThe overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 18–25). Among Arab women, the overall risk was 21 (95% CI 17–25), and for PM and CM: 14 (95% CI 11–17) and 7 (95% CI 5–10), respectively. Among Jewish women, the overall risk was 23 (95% CI 18–29), and for PM and CM: 12 (95% CI 8–17) and 11 (95% CI 7–16), respectively. Among Arab women compared to Jewish women, the proportion of all the partial moles was higher: (65.3% vs. 51.6%, p = 0.05). The incidence of partial mole was higher among Arab than Jewish women, aged 35–39 years (26 vs. 8 per 10,000, p = 0.041), and did not differ in other age groups. After adjusting for age, the relative risk of partial moles was lower among Jews than Arabs (0.7, 95% CI 0.4-1.0, p = 0.053). For Arab compared to Jewish women, the mean age at molar pregnancies was younger: 31.0 vs. 35.1 years. However, other factors did not differ significantly between Arab and Jewish women with molar pregnancies. In multivariate analysis, Jewish ethnicity was significantly associated with a higher risk of complete molar pregnancies (OR = 2.19, 95% CI 1.09–4.41, p = 0.028).ConclusionThis study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders. Further research should seek to elucidate the underlying factors contributing to these differences.

Measuring pain or discomfort during routine nursing care in lightly sedated mechanically ventilated intensive care patients: A prospective preliminary cohort study

BackgroundPain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications. ObjectivesTo evaluate whether clinical measurement tools can discern both pain and non-pain discomfort. MethodsA prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions. ResultsStatistically significant increases from baseline during interventions were observed [median change: 1.00 (-1–5), 1.5(-4–8.5), p < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4–6. ConclusionsStandard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.