Petah Tikva Research Articles

Characterizing and Predicting Outcomes in Critically Ill Patients Receiving Low or High Protein Doses with Moderate Energy Support: A Retrospective Study.

Finding the best energy and protein dose and timing for critically ill patients remains challenging. Distinct populations may react differently to protein load. This study aimed to characterize and predict outcomes of critically ill patients who received moderate energy and high or low protein doses during their stay in the intensive care unit (ICU). The cohort included 646 adult patients (70% men and 30% women) hospitalized in Beilinson Hospital ICU (Petah Tikva, Israel) for over 5 days between 2011 and 2018. Patients received 10-20 kcal/kg/day and were classified into two groups: low (LP) and high (HP) protein support (≤1 g/kg/day vs. >1 g/kg/day), the LP group comprising 531 patients (82%) and the HP group 115 patients (18%). Multiple logistic regression was used to describe associations between patients' characteristics and 90-day survival in the LP and HP groups. Among LP, increased age, APACHE II, and receiving supplemental parenteral nutrition (SPN) were associated with decreased survival (OR = 0.986, 95% CI [0.973, 0.999]; OR = 0.915, 95% CI [0.886, 0.944], OR = 0.579, 95% CI [0.366, 0.917]). Trauma admission was associated with increased survival (OR = 1.826, 95% CI [1.001, 3.329]). Among HP, increased age was associated with decreased survival (OR = 0.956, 95% CI [0.924, 0.998]). Higher BMI was associated with improved survival (OR = 1.137, 95% CI [1.028, 1.258]). Likewise, in the HP group, the BMI of elderly survivors was higher compared to non-survivors (27.1 ± 6.2 vs. 24.7 ± 4.8, t (113) = 2.3, p < 0.05). Our results show that in patients with moderate energy support and low protein administration, survivors were younger, with a lower APACHE II score, mainly suffering from trauma and without renal failure. In the patients receiving high protein support, younger patients with a high BMI not suffering from sepsis were more likely to survive. We suggest confirming these findings with prospective RCTs.

The Effects of Primary Tumor Location on Survival after Liver Resection for Colorectal Liver Metastasis in the Mediterranean Population.

(1) Background: There is an abundance of literature available on predictors of survival for patients with colorectal liver metastases (CRLM) but minimal information available on the relationship between the primary tumor location and CRLM survival. The studies that focus on the primary tumor location and CRLM survival exhibit a great deal of controversy and inconsistency with regard to their results (some studies show statistically significant connections between the primary tumor location and prognosis versus other studies that find no significant relationship between these two factors). Furthermore, the majority of these studies have been conducted in the West and have studied more diverse and heterogenous populations, which may be a contributing factor to the conflicting results. (2) Methods: We included patients who underwent liver resection for CRLM between December 2004 and January 2019 at two university-affiliated medical centers in Israel: Carmel Medical Center (Haifa) and Rabin Medical Center (Petach Tikvah). Primary tumors located from the cecum up to and including the splenic flexure were labeled as right-sided primary tumors, whereas tumors located from the splenic flexure down to the anal verge were labeled as left-sided primary tumors. (3) Results: We identified a total of 501 patients. Of these patients, 225 had right-sided primary tumors and 276 had left-sided primary tumors. Patients with right-sided tumors were significantly older at the time of liver surgery compared to those with left-sided tumors (66.1 + 12.7 vs. 62 + 13.1, p = 0.002). Patients with left-sided tumors had slightly better overall survival rates than those with right-sided tumors. However, the differences were not statistically significant (57 vs. 50 months, p = 0.37 after liver surgery). (4) Conclusions: The primary tumor location does not significantly affect patient survival after liver resection for colorectal liver metastasis in the Mediterranean population.

Some children with congenital cytomegalovirus may benefit from additional imaging in addition to ultrasound.

Acta PaediatricaAccepted Articles BRIEF REPORT Some children with congenital cytomegalovirus may benefit from additional imaging in addition to ultrasound Ori Snapiri, Corresponding Author Ori Snapiri [email protected] orcid.org/0000-0001-7238-0696 Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Correspondence Ori Snapiri, MD, MPH, Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva 49202, Israel. Email: [email protected]Search for more papers by this authorChen Rosenberg Danziger, Chen Rosenberg Danziger Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, IsraelSearch for more papers by this authorLiora Kornreich, Liora Kornreich Department of Radiology, Schneider Children's Medical Center, Petah Tiqva, IsraelSearch for more papers by this authorNimrod Zacks, Nimrod Zacks orcid.org/0000-0003-4811-689X Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel The Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, IsraelSearch for more papers by this authorEfraim Bilavsky, Efraim Bilavsky orcid.org/0000-0003-2955-3453 The Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author Ori Snapiri, Corresponding Author Ori Snapiri [email protected] orcid.org/0000-0001-7238-0696 Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Correspondence Ori Snapiri, MD, MPH, Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva 49202, Israel. Email: [email protected]Search for more papers by this authorChen Rosenberg Danziger, Chen Rosenberg Danziger Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, IsraelSearch for more papers by this authorLiora Kornreich, Liora Kornreich Department of Radiology, Schneider Children's Medical Center, Petah Tiqva, IsraelSearch for more papers by this authorNimrod Zacks, Nimrod Zacks orcid.org/0000-0003-4811-689X Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel The Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, IsraelSearch for more papers by this authorEfraim Bilavsky, Efraim Bilavsky orcid.org/0000-0003-2955-3453 The Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author First published: 09 May 2023 https://doi.org/10.1111/apa.16820 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/apa.16820. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Nutrition and health in infants and children: old and new challenges after the lockdown

aInstitute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel bLMU – Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Department Pediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany Correspondence to Prof. Raanan Shamir, Director, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Professor of Pediatrics, Chair, Eduarda and Dr Moshe Ishay Institute for the Study of the Effects of Natural Food on Quality of Life and Human Health, Lea and Arieh Pickel Chair for Pediatric Research, Faculty of Medicine, Tel Aviv University, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, 14 Kaplan St. Petach Tikva, Tel Aviv 4920227, Israel. E-mail: [email protected]

Editorial introductions.

Editorial introductions.

The effect of preoperative anxiety and ovarian stimulation on gastric antrum size: a prospective observational study

Pulmonary aspiration is a potentially lethal perioperative complication related to gastric size and contents. Several perioperative factors are believed to increase gastric size, while others are less studied. This prospective observational study aimed to investigate the effect of preoperative anxiety and hormone-induced ovarian stimulation on gastric size examined by gastric ultrasound. We recruited 49 female patients undergoing hormone-induced ovarian stimulation and oocyte retrieval for in vitro fertilization at Rabin Medical Centre, Petah Tikva, Israel. Preoperatively, women ranked their anxiety level using a verbal numeric anxiety score (VNS). In addition, we recorded the extent of ovarian stimulation and measured the antral cross-sectional area (CSA) using gastric ultrasound. There was no substantial correlation between preoperative VNS anxiety and antral CSA (p = .697). Moreover, the number of follicles, blood estradiol, and progesterone levels did not correlate with antral CSA (p = .590, p = .104, and p = .511, respectively). In conclusion, neither preoperative anxiety nor extensive ovarian stimulation affects gastric size in fasting healthy patients. However, further studies are warranted in this area to define these findings better. Trial registration: Clinicaltrials.gov, identifier: NCT04833530

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Diabetes Technology and Therapy in the Pediatric Age Group.

Diabetes Technology and Therapy in the Pediatric Age Group.

Appropriating Canaanism: Ruth Patir’s Reanimation of Judean Pillar Figurines

This article addresses a body of works by the video artist Ruth Patir, in which Israeli womanhood in the 2020s is interrogated through Iron Age female statuettes, known as Judean Pillar Figurines. By means of motion capture technology and 3D animation, Patir features contemporary Israeli women uncannily moving and speaking through the bodies of millennium-old female figurines, whose history and function are still under debate. In Petah Tikva (2020), Patir situates these hybrid figures in a modern IVF clinic, offering a biopolitical perspective on Israeli society’s compelling maternal impulse. Marry Fuck Kill (2019), in turn, ponders Israeli women’s legitimation of their femininity, across the generational gap between the artist and her mother, here cast in the role of an imposing Iron Age figurine. The paper addresses Patir’s work in both biopolitical and phenomenological terms, arguing that the sensual appeal of the archaeological objects often undermines the videos’ political critique.

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

BackgroundVessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities.ObjectiveTo describe our...

BIOIMPEDANCE - BASED CLINICAL DECISION MAKING IN HEMODIALYSIS PATIENTS DECREASES EPISODES OF HYPOTENSION

Objective: Intradialytic hypotension and exaggerated fluid removal during hemodialysis (HD) are related to organ ischemia and resultant increased morbidity and mortality. Fluid overload and congestion due to less than optimal fluid removal, are associated with adverse outcomes. Previous studies performed did not assess clinical decision making that is based mainly on hemodynamics. Thus, our aim was to recruit only new HD patients, and to examine the effect of bioimpedance based management within the first 90 days, a critical timeframe in dry weight determination and HD prescription. Design and method: The study incorporated 20 new HD patients in an established HD unit. Patients were randomized into standard clinical approach versus hemodynamic monitoring using a whole body bioimpedance device (NICaS, NI Medical, Petah Tikva, Israel). Intradialytic cardiac output, cardiac power, total body water and peripheral resistance were measured during the 1st dialysis session. Each measured session consisted of start, mid and end of dialysis recordings. Hemodynamic measurements during the pilot study interval (three months) were done also at the investigator discretion, whenever decisions on dry weight, diuretic or anti-hypertensive medications were needed. Control group patients were treated conservatively, without bioimpedance or any noninvasive hemodynamic monitoring. We recorded hypotensive episodes (&lt;90/60 mmHg, while pre-dialysis blood pressure &gt; = 90/60 mmHg) cardiovascular hospitalizations and cardiovascular related death. Results: Twenty patients completed the study (12 study, 8 control) thus far. Within a period of three months, there were 81 hypotensive episodes (6.75 episodes per patient per period) in the study group VS 93 (11.625 episodes per patient per period) in the control group (p &lt; 0.05). There were 3 hospitalizations due to cardiovascular events in the control group and one case of cardiovascular death, while study group had no deaths and one hospitalization due to CV complication. Conclusions: These preliminary results suggest that clinical decision making based on bio-impedance monitoring, when applied to new HD patients from the very beginning of their HD treatments, might confer a benefit in reducing hypotensive episodes and resultant hospitalizations. Our study is ongoing in order to further clarify these promising results.

Validation of the multi-metric D-index change in the assessment of keratoconus progression

To validate the effectiveness of the multi-metric D-index by Pentacam in detecting keratoconus (KC) progression. This was a retrospective study of KC patients at the Rabin Medical Center, Petah Tikva, Israel, during 2016-2018 with at least two corneal tomography examinations six months apart. Agreement between clinical diagnosis of progression (1.5D increase in mean keratometric value, 1D increase in Kmax, a 5% decrease in central corneal thickness (CCT), worsening of visual acuity by more than one line, or deterioration of manifest corneal astigmatism > 1.5D) and the D-index was evaluated. Receiver operating characteristic (ROC) analysis was used to find the D-index's optimal cutoff value to show progression. We included KC eyes in the stable group (N = 7) and the progression group (N = 54). Patient demographics and tomographic parameters at baseline were similar between the groups. The D-index change was significantly higher in the progression group than in the stable group (median + 1 and 0.0, respectively, p = 0.024). Based on the ROC analysis, the optimal D-index cutoff change within at least six months was 0.32 (59.3% sensitivity and 100% specificity (area under the curve [AUC] = 0.771, Youden = 0.592). Subjects with a D-index change above this value had a 21.1-fold increase in odds for corneal ectasia progression requiring CXL (OR: 21.1, 95%CI 1.17-398.8, p = 0.038). The multi-metric D-index can serve as a clinically feasible parameter to detect KC progression and guide patients' referral for further interventions.

Effects of Long-Term Deutetrabenazine Treatment in Patients with Tardive Dyskinesia and Underlying Psychiatric or Mood Disorders

Deutetrabenazine is FDA-approved for the treatment of tardive dyskinesia (TD) in adults. In two 12-week pivotal trials (ARM-TD/AIM-TD), deutetrabenazine significantly improved Abnormal Involuntary Movement Scale (AIMS) scores and was well-tolerated. This post hoc analysis examined the efficacy and safety of long-term deutetrabenazine treatment in TD patients with comorbid psychiatric illness, including schizophrenia/schizoaffective disorder and mood disorders (bipolar/depression/other). Patients who completed ARM-TD or AIM-TD enrolled in the 3-year, open-label extension (OLE) study. Deutetrabenazine was titrated based on dyskinesia control and tolerability. Change from baseline in total motor AIMS score, Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and adverse events (AEs) were analyzed in subgroups by comorbid psychiatric illness. A total of 337 patients in the OLE study were included in the analysis: 205 patients with schizophrenia/schizoaffective disorder (mean age, 55years; 50% male; 6.4years since diagnosis; 92% taking DRA) and 131 patients with mood disorders (mean age, 60years; 35% male;4.6years since diagnosis; 50% taking DRA). At week 145, mean±SE dose was 40.4±1.1mg/day for schizophrenia/schizoaffective disorder (n=88) and 38.5±1.2mg/day for mood disorders (n=72). Mean±SE change from baseline in AIMS score at week 145 was -6.3±0.49 and -7.1±0.58, 56% and 72% achieved PGIC treatment success, and 66% and 82% achieved CGIC treatment success in schizophrenia/schizoaffective disorder and mood disorder patients, respectively. Overall AE incidence (exposure-adjusted incidence rates [incidence/patient-years]) was low: any, 1.02 and 1.71; serious, 0.10 and 0.12; leading to discontinuation, 0.07 and 0.05). Long-term deutetrabenazine treatment provided clinically meaningful improvements in TD-related movements, with a favorable safety profile, regardless of underlying comorbid psychiatric illness. Teva Pharmaceutical Industries Ltd., Petach Tikva, Israel.

Abnormal Kidney Function in Anorexia Nervosa

Source: Gurevich E, Steiling S, Landau D. Incidence of impaired kidney function among adolescent patients hospitalized with anorexia nervosa. JAMA Netw Open. 2021;4(11):e2134908. doi:10.1001/jamanetworkopen.2021.34908Investigators from Schneider’s Children’s Medical Center of Israel, Petach Tikva, Israel, and Sackler School of Medicine, Tel Aviv, Israel, conducted a retrospective study to assess kidney function in children and adolescents hospitalized with anorexia nervosa (AN) and identify predictors of impaired kidney function (IKF) in these patients. For the study, discharge diagnoses were used to identify youths, 9-18 years old, hospitalized at Schneider’s Children’s Medical Center of Israel for AN between 2010 and 2019. Only youths with a first-time hospitalization for AN were included in the study. Patients with AN were age- and sex-matched to a random sample of control children with normal serum creatinine (SCr) levels, hospitalized for other reasons during the same period. The medical records of study participants were reviewed and data on demographics, BMI, and SCr abstracted. In patients with AN, data on free triiodothyronine (FT3) level and minimal heart rate (HR) also were collected. Kidney function was assessed in study participants using maximal SCr levels, minimal estimated glomerular filtration rate (eGFR) and SCr/BMI ratio during the hospitalizations. These parameters were compared in AN patients and controls using chi-square or Fisher exact tests. AN patients were classified as having IKF if their minimal eGFR during the hospitalization was <90 mL/min/1.73 m2. Stepwise regression was used to identify predictors of IKF in AN patients.A total of 395 youths with AN and 495 controls were included in the analyses. The mean age of AN patients was 14.6 ± 2.2 years, and 298 (81.6%) were female. The median BMI percentile in those with AN was 12.3, compared to 49 in controls (P <0.001). Parameters of kidney function were significantly different between AN patients and controls including maximal SCr (mean values, 0.68 ± 0.15 mg/dL and 0.54 ± 0.14 mg/dL, respectively; P <0.001), SCr/BMI (mean values, 4% ± 1.2% and 2.8% ± 1.1%, respectively; P <0.001), and minimal eGFR (mean values, 99.8 ± 22.0 mL/min/1.73 m2 and 124 ± 26.5 mL/min/1.73 m2, respectively; P <0.001). Among those with AN, 146 (37%) met criteria for IKF compared to 0 control patients. In the group of AN patients, those with IKF had a significantly lower minimal HR than those without IKF (mean, 44 vs 56 beats per minute; P = 0.001) and lower FT3 levels (mean, 3.5 vs 4.1 pmol/L; P = 0.001); there was no significant difference between groups for mean BMI. Independent predictors of IKF in AN patients included SCr/BMI ratio, minimal HR, and systolic and diastolic blood pressure.The authors conclude that IKF is common in youths hospitalized with AN.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.AN has a prevalence rate between 0.1% and 2.2%.1 As previously reported, IKF is a known complication of AN with multifactorial etiologies including chronic dehydration, electrolyte derangements, and abuse of certain medications.2 Chronic hypokalemia has been associated with acute kidney injury (AKI) and chronic kidney disease.2 Other electrolyte abnormalities reported with AN and during refeeding include hypophosphatemia, hypomagnesemia, and hyponatremia. (See AAP Grand Rounds. 2021;45(2):16.)2,3 Kidney biopsy has shown interstitial fibrosis, evidence of ischemic injury, and hypokalemic nephropathy.2The biggest limitation of the current study, and all studies of AN, is the inability to accurately determine eGFR. Using creatinine and correction of eGFR per body surface is likely inaccurate due to low muscle mass. The prevalence of IKF in AN may increase or decline depending on the accuracy of eGFR. Using nuclear GFR may be more precise, although cumbersome, or perhaps measurement of serum cystatin C.4,5 Cystatin C, a low molecular weight protein secreted by all nucleated cells, is independent of muscle mass.4,5 BMI was used to correct for low muscle mass in the current study, although this method has not been verified. It is interesting to note that admission BMI did not correlate with eGFR, but minimal heart rate did. Does this suggest that cardiac abnormalities may contribute to reduction in kidney perfusion in AN?Although the current study was performed in Israel, AN is universal. AKI has been associated with longer hospitalization and increased morbidity not only in AN but also in other non-AN conditions.6In adolescent patients hospitalized with recently diagnosed AN, kidney function often is impaired and needs to be followed closely.The global pandemic of COVID-19 has been associated with a marked increase incidence of eating disorders.7 Social distancing, changes in food access and habits, and social pressure exerted through the internet appear to be contributory. Recent AAP guidelines outline the pediatrician’s role in detection and management of children and adolescents with disordered eating.8

A Novel Hypertension Management Algorithm Guided by Hemodynamic Data

A Novel Hypertension Management Algorithm Guided by Hemodynamic Data

Losartan to slow the progression of mild-to-moderate Alzheimer’s disease through angiotensin targeting: the RADAR RCT

Background Medications that modify the renin–angiotensin system may reduce Alzheimer’s disease pathology and reduce the rate of disease progression. Objective This study investigated whether taking the antihypertensive drug losartan, in addition to normal care, would slow the progression of Alzheimer’s disease when compared with a placebo. Design A double-blind multicentre randomised controlled trial, after a 4-week open-label phase, with follow-up at 14 days and at 3, 6, 9 and 12 months. The primary outcome was based on measured imaging differences in brain volume between baseline and 12 months. Setting Twenty-three NHS hospital trusts across England, Scotland and Northern Ireland. Participants Patients diagnosed with mild-to-moderate Alzheimer’s disease were eligible to participate if they met the following criteria: (1) aged ≥ 55 years; (2) a Mini Mental State Examination score of 15–28; (3) a modified Hachinski Ischaemic Score of ≤ 5; (4) a previous computerised tomography, single-photon emission computed tomography or magnetic resonance imaging scan consistent with a diagnosis of Alzheimer’s disease; (5) a study companion who was willing to participate in the study; and (6) capacity to consent for themselves. Patients were ineligible if they were (1) taking or intolerant to renin–angiotensin system-related medications, (2) unlikely to undergo magnetic resonance imaging or (3) unlikely to complete the trial protocol. People who had blood pressure outside the normal ranges, defined cardiovascular issues, impaired liver or renal function, or a primary neurodegenerative disease that was not Alzheimer’s disease were also excluded, as were women who had not reached menopause and were unwilling to take relevant protocol-specific safety precautions. Intervention The intervention was either 100 mg of overencapsulated losartan (Teva Pharmaceuticals Industries Ltd, Petah Tikva, Israel) daily or a matched placebo for 12 months. Main outcome measures Difference in brain atrophy, represented by measurement of whole-brain volume before and following 12 months of treatment post randomisation, was measured using volumetric MRI and determined by boundary shift interval analysis. Secondary outcomes included changes in rates of Alzheimer’s disease progression (as assessed using the ADAS-Cog, Mini Mental State Examination and Neuropsychiatric Inventory), the volume of white matter hyperintensities, cerebral blood flow (assessed by magnetic resonance imaging), blood pressure, magnetic resonance imaging measures of atrophy and association with measures of cognitive decline, and drug compliance and tolerability. Results A total of 261 participants entered the open-label phase, of whom 211 were randomised to the intervention (n = 105) or placebo (n = 106) arms. Of the 197 people (93%) who completed the study, 81% (n = 171) had a valid primary outcome. The difference in brain volume between arms was consistent with chance (–2.79 ml, 95% confidence interval –6.46 to 0.89 ml; p = 0.19), and there was no evidence of benefit for any of the secondary outcome measures. Limitations Our study had 82% power to detect treatment-based changes and, as a result, may have been underpowered or, more likely, the intervention, which may not have crossed the blood–brain barrier as much as expected, may have been given too late or for an insufficient amount of time in the disease process to influence the outcomes. Conclusions Losartan administered over 12 months did not alter brain atrophy in Alzheimer’s disease. Future work Other related ‘sartans’ could be tested in patient groups with mild cognitive impairment and for longer to fully test this hypothesis. Trial registration Current Controlled Trials ISRCTN93682878 and EudraCT 2012-003641-15. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

Screening for postoperative vital signs abnormalities, and particularly hemodynamic ones, by continuous monitoring: protocol for the Biobeat-Postop cohort study

Background: Postoperative hypotension associated with postoperative morbidity and early mortality has been studied previously. Hypertension and other hemodynamic, respiratory, and temperature abnormalities have comparatively understudied during the first postoperative days. Methods: This bi-centre observational cohort study will include 114 adult patients undergoing non-cardiac surgery hospitalized on an unmonitored general care floor and wearing a multi-signal wearable sensor, allowing remote monitoring (Biobeat Technologies Ltd, Petah Tikva, Israel). The study will cover the first 72 hours after discharge of the patient from the post-anaesthesia care unit. Several thresholds will be used for each variable (arterial pressure, heart rate, respiratory rate, oxygen saturation, and skin temperature). Data obtained using the sensor will be compared to data obtained during the routine nurse follow-up. The primary outcome is hemodynamic abnormality. The secondary outcomes are postoperative respiratory and temperature abnormalities, artefacts and blank/null outputs from the wearable device, postoperative complications, and finally, the ease of use of the device. We hypothesize that remote monitoring will detect abnormalities in vital signs more often or more quickly than the detection by nurses’ routine surveillance. Discussion: A demonstration of the ability of wireless sensors to outperform standard monitoring techniques paves the way for the creation of a loop which includes this monitoring mode, the automated creation of alerts, and the sending of these alerts to caregivers. Trial registration: ClinicalTrials.gov, NCT04585178. Registered on October 14, 2020

Screening for postoperative vital signs abnormalities, and particularly hemodynamic ones, by continuous monitoring: protocol for the Biobeat-Postop cohort study

Background: Postoperative hypotension associated with postoperative morbidity and early mortality has been studied previously. Hypertension and other hemodynamic, respiratory, and temperature abnormalities have comparatively understudied during the first postoperative days. Methods: This bi-centre observational cohort study will include 114 adult patients undergoing non-cardiac surgery hospitalized on an unmonitored general care floor and wearing a multi-signal wearable sensor, allowing remote monitoring ( Biobeat Technologies Ltd, Petah Tikva, Israel). The study will cover the first 72 hours after discharge of the patient from the post-anaesthesia care unit. Several thresholds will be used for each variable (arterial pressure, heart rate, respiratory rate, oxygen saturation, and skin temperature). Data obtained using the sensor will be compared to data obtained during the routine nurse follow-up. The primary outcome is hemodynamic abnormality. The secondary outcomes are postoperative respiratory and temperature abnormalities, artefacts and blank/null outputs from the wearable device, postoperative complications, and finally, the ease of use of the device. We hypothesize that remote monitoring will detect abnormalities in vital signs more often or more quickly than the detection by nurses’ routine surveillance. Discussion: A demonstration of the ability of wireless sensors to outperform standard monitoring techniques paves the way for the creation of a loop which includes this monitoring mode, the automated creation of alerts, and the sending of these alerts to caregivers. Trial registration: ClinicalTrials.gov, NCT04585178. Registered on October 14, 2020

MP02-13 EFFECTS OF GENDER AND AGE ON LOWER URINARY TRACT SYMPTOMS (LUTS): INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-13 EFFECTS OF GENDER AND AGE ON LOWER URINARY TRACT SYMPTOMS (LUTS): INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT Chen Shenhar, Petah Tikva Israel, Stefanie van Uem, Abdelrahman S. Abdalla, Ashu Mohammad, Bertha H. Chen, Elizabeth A. Kidd, and Amy D. Dobberfuhl Chen ShenharChen Shenhar More articles by this author , Petah Tikva IsraelPetah Tikva Israel More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Bertha H. ChenBertha H. Chen More articles by this author , Elizabeth A. KiddElizabeth A. Kidd More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe how specific items in the AUASI and the ICIQ FLUTS / MLUTS differ based on gender and age, in a patient population seeking care for LUTS. METHODS: Subjects were prospectively enrolled into the Stanford WSDM observational LUTS cohort from a functional urology clinic and answered questionnaires. Data were analyzed in SAS using logistic regression to model effects of gender and age on LUTS and quality of life. RESULTS: A total of 304 patients (178 female, 126 male) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. A logistic regression model by gender, adjusted for age (Figure 1), demonstrated a greater number of women with urgency using both instruments (AUASI OR 2.27, 95% CI 1.55-3.33; ICIQ OR 2.25, 95% CI 1.42-3.56). Women reported more voiding symptoms than men, including straining (AUASI OR 1.70, 95% CI 1.10-2.62; ICIQ OR 1.79, 95% CI 1.04-3.06). Incontinence was only represented by the ICIQ, where women reported more incontinence than men (ICIQ stress urinary incontinence (UI) OR 6.14, 95% CI 2.55-14.77; ICIQ unaware UI OR 2.18, 95% CI 1.03-4.62; ICIQ sleep UI OR 1.99, 95% CI 1.02-3.90; ICIQ urge UI OR 1.94, 95% CI 1.16-3.26). After adjusting for gender (Figure 2), nocturia was more likely to occur in older patients captured by the ICIQ (ICIQ nocturia OR 1.13, 95% CI 1.01-1.26). Urgency and urge UI occurred more in older subjects in the ICIQ domain for urgency (ICIQ urgency OR 1.16, 95% CI 1.02-1.32; ICIQ urge UI OR 1.23, 95% CI 1.06-1.43). Younger subjects were more likely to report hesitancy (ICIQ OR 0.74, 95% CI 0.65-0.84) and straining (AUASI OR 0.75, 95% CI 0.67-0.84; ICIQ OR 0.82, 95% CI 0.71-0.94). CONCLUSIONS: The AUASI and the ICIQ FLUTS / MLUTS differ based on sex and age in a patient population seeking care for LUTS. The ICIQ questionnaires capture symptom specific bother and incontinence. Further research is needed to better classify gender and age specific impact on LUTS outcomes not captured by the AUASI. Source of Funding: NIH 1L30DK115056-01, Stanford Women's Health and Sex Differences in Medicine (WSDM) Seed Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e16-e17 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Petah Tikva Israel More articles by this author Stefanie van Uem More articles by this author Abdelrahman S. Abdalla More articles by this author Ashu Mohammad More articles by this author Bertha H. Chen More articles by this author Elizabeth A. Kidd More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement Loading ...

MP63-04 CROSS VALIDATION OF THE AUASI AND ICIQ FEMALE AND MALE LOWER URINARY TRACT SYMPTOM (LUTS) QUESTIONNAIRES: INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-04 CROSS VALIDATION OF THE AUASI AND ICIQ FEMALE AND MALE LOWER URINARY TRACT SYMPTOM (LUTS) QUESTIONNAIRES: INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT Chen Shenhar, Petah Tikva Israel, Abdelrahman S. Abdalla, Stefanie van Uem, Ashu Mohammad, Bertha H. Chen, Elizabeth A. Kidd, and Amy D. Dobberfuhl Chen ShenharChen Shenhar More articles by this author , Petah Tikva IsraelPetah Tikva Israel More articles by this author , Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Bertha H. ChenBertha H. Chen More articles by this author , Elizabeth A. KiddElizabeth A. Kidd More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To correlate and cross validate gender matching LUTS items in the AUASI and the ICIQ FLUTS / MLUTS questionnaires in a patient population seeking care for LUTS. METHODS: Subjects were prospectively enrolled into the Stanford WSDM observational LUTS cohort from a functional urology clinic and answered questionnaires. Data were analyzed in SAS to correlate and cross validate gender matching items from the ICIQ FLUTS / MLUTS against same domain AUASI items using Spearman’s correlation. RESULTS: A total of 304 patients (178 female, 126 male) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. A correlation model stratified by gender (Table 1) found significant correlation between gender for all matching items of each instrument (p values < 0.0001). Correlation plots were stratified by gender accounting for number of observations within each item strata (Figure 1). Scores for nocturia correlated closely for both females (r=0.92) and males (r=0.94). Straining showed the second best correlation for females (r=0.82) while for males it was intermittency (r=0.76). The worst correlation was found with daytime frequency in females (r=0.56) and urgency in males (r=0.60). CONCLUSIONS: Items of the AUASI and the ICIQ questionnaires demonstrated significant gender correlations; however there were specific differences in the strength of association for common questions (e.g., urgency, frequency), likely reflective of the difference in question stem for each of these items. Additionally, differences in correlation varied between the female and male gender, suggesting that LUTS questions are interpreted differently among genders. Further research is needed to identify reasons for gender specific biases in the quantification of bother attributed to each item of the AUASI and ICIQ questionnaires. Source of Funding: NIH 1L30DK115056-01, Stanford Women's Health and Sex Differences in Medicine (WSDM) Seed Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1102-e1103 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Petah Tikva Israel More articles by this author Abdelrahman S. Abdalla More articles by this author Stefanie van Uem More articles by this author Ashu Mohammad More articles by this author Bertha H. Chen More articles by this author Elizabeth A. Kidd More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...