Avi Porath | Ben Gurion University of the Negev (original) (raw)
Papers by Avi Porath
Cancer Causes & Control, Aug 17, 2011
Purpose Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregn... more Purpose Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregnancy, is increasing in prevalence. Data regarding the cancer risk associated with GDM are sparse and limited to cancers of the breast and pancreas. This study was conducted to examine the risk of incident overall and site-specific malignancies associated with prior GDM in a historical cohort of women in a large health maintenance organization in Israel. Methods All pregnant women aged 15-50 years who underwent 50-g glucose challenge tests between 13 March 1995 and 27 May 2009, without history of malignancy, diabetes, and infertility, were included. Clinical and demographic parameters at index date including age, socioeconomic level, BMI, and parity were collected. Diagnosis of gestational diabetes was based on the 100-g oral glucose tolerance test using Carpenter and Coustan criteria. Cancer diagnoses were obtained from the Israel Cancer Register through linkage data. Results Among the 185,315 women who had undergone glucose challenge during the study period, 11,264 (6.1%) were diagnosed with GDM. During a total follow-up period of 1.05 million person-years (mean = 5.19 ± 3.9, median = 4.3), 2,034 incident cases of cancer were identified. GDM was associated with a hazard ratio (HR) of 7.06 (95% CI: 1.69-29.45) for pancreatic cancer (nine cases) and a HR of 1.70 (95% CI: 0.97-2.99) for hematological malignancies (177 cases). The association between GDM and hematological malignancies was limited to women with 5 or more years of follow-up (HR = 4.53; 95% CI: 1.81-11.31). Conclusion GDM is associated with an increased risk of pancreatic cancer and hematologic malignancies. Keywords Gestational diabetes mellitus Á Cancer risk Á Pancreatic cancer Á Lymphoma Abbreviations GDM Gestational diabetes mellitus DM Diabetes mellitus GCT Glucose challenge test OGTT Oral glucose tolerance test HMO Health maintenance organization MHS Maccabi healthcare services NHL Non-hodgkin's lymphoma AML Acute myeloid leukemia Tal Sella and Gabriel Chodick equally contributed to the study and manuscript.
Investigative Ophthalmology & Visual Science, Jun 23, 2017
PubMed, Nov 1, 1995
Since the limited accessibility of general intensive care units creates a situation in which medi... more Since the limited accessibility of general intensive care units creates a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective cohort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Center, a facility with 810 beds, of which 170 beds are in medical wards, including an 8-bed intensive cardiac care unit and a 5-bed general intensive care unit, 119 patients were referred to the MICU, directly from the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU directly from the emergency room. The mean disease severity, as measured by the APACHE II score, was 12.9, and the mean intensity of care for these patients, as measured by the TISS scale, was 12.6. Twenty-one of the 119 patients died during hospitalization (17.6%). This mortality rate conformed to the mortality risk of 15.5%, which was calculated using prognostic formulae. The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalization in the MICU was one-third that in the general intensive care unit and double the cost in a ward. Medical patients in critical condition can be treated in an MICU, with a savings in expenses and without impairing the patient's chances for survival.
Social Science Research Network, 2022
Israel Medical Association Journal, Aug 1, 2008
American Journal of Bioethics, Nov 22, 2007
Pacing and Clinical Electrophysiology, Feb 1, 1992
Angiology, Aug 1, 1987
A patient with a right atrial thrombus and recurrent pulmonary emboli sec ondary to permanent pac... more A patient with a right atrial thrombus and recurrent pulmonary emboli sec ondary to permanent pacemaker insertion is described. Possible precipitating factors were damage to the subclavian vein, congestive heart failure, paroxys mal atrial fibrillation, and immobilization. Venography demonstrated a large atrial thrombus in the superior vena cava and right atrium. The patient was successfully treated with heparin and subsequently with warfarin and dipyrida mole.
American Heart Journal, Jul 1, 1999
Previous studies have demonstrated that both the sympathetic and the parasympathetic branches of ... more Previous studies have demonstrated that both the sympathetic and the parasympathetic branches of the autonomic nervous system affect the frequency of sudden death and cardiovascular mortality after myocardial infarction. 1,2 Different methods for measuring autonomic nervous system activity in patients after myocardial infarction have been reported. 3-8 These methods include tests of heart rate variability measured by 24hour Holter monitoring, 4-7 heart rate variability measurements over a briefer period of 2 to 15 minutes, 8 and assessment of baroreflex activity. 3 However, these tests require Holter monitoring with an elaborate analytic system, including computerized power spectral analysis or intravenous administration of phenylephrine with constant blood pressure and heart rate monitoring. During deep breathing, changes in heart rate occur primarily because of alterations of vagal-cardiac activity. 9 An impairment of this system can lead to depressed heart rate variability. 10 In an era of sophisticated tests of the autonomic system, the purpose of this study was to evaluate prospectively a simple autonomic test (originally used to determine diabetic autonomic neuropathy) that measures changes in heart rate during deep breathing 11,12 as a clinical test for risk stratification of patients after myocardial infarction. Methods Deep breathing test The deep breathing heart rate variability test was conducted 5.1 ± 2.5 days after a first myocardial infarction, with the patient in a supine position connected to the limb leads of a standard electrocardiogram (ECG). Patients had to be in stabilized condition and at least 1 day after ambulation had begun. All tests were performed in the morning in the patient's room after the patient had been in the supine position for 10 minutes. Before beginning the test, patients were taught to breathe at a rate of 6 respiration cycles per minute: 5 seconds for each inhalation and 5 seconds for each exhalation. All tests and measurements were per
PubMed, Nov 15, 1994
Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymp... more Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymphomas. In 30 of them follow-up was available. We review the demographic, clinical, histological and immunohistochemical features of the 30 extranodal lymphomas according to site of origin. Comparison is made between these extranodal lymphomas and nodal non-Hodgkin's lymphomas and cases of Hodgkin's disease first diagnosed in the head and neck area.
Journal of Glaucoma, Jul 1, 2019
A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performa... more A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established. Purpose: The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization. Methods: This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses. Study population: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated. Main outcome measures: VF performance rates. Results: A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, nonglaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95 ± 6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95 ± 0.37 annual tests) began. Conclusion: There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.
PubMed, May 1, 2007
Background: Cardiovascular disease remains the most common cause of death in the industrialized w... more Background: Cardiovascular disease remains the most common cause of death in the industrialized world. The REACH study is an international registry of outpatients from 44 countries, including Israel, with risk factors for cardiovascular morbidity or with stable atherosclerotic clinical syndromes. Objectives: To compare the prevalence and treatment of cardiovascular risk factors between Israeli patients enrolled in REACH and international controls. Methods: Consecutive eligible outpatients aged 45 years or older with established coronary artery disease, cerebrovascular disease, or peripheral arterial disease, or with at least three atherosclerosis risk factors were enrolled. Results: Altogether, 381 Israeli patients were enrolled in the registry. The mean age of the Israeli participants was 70 years and 71% were men. Among the Israeli patients there was a higher percentage with hypercholesterolemia (86% vs. 72%) who were overweight (45% vs. 40%) and obese (69% vs. 47%), but fewer former smokers (33% vs. 42%). The percentage of patients with hypertension taking at least one medication was similar in the two groups, but there was a difference regarding which antihypertensive was used. Israeli patients took more beta-blockers (62% vs. 49%) and angiotensin-converting enzyme inhibitors (60% vs. 48%) but fewer angiotensin II receptor blockers (12% vs. 25%). A higher percentage of Israeli patients were taking at least one antiplatelet agent (88% vs. 79%) and a higher percentage of patients from Israel were on statins (85% vs. 69%). Conclusions: Israeli patients with atherothrombotic disease had a higher prevalence of hypercholesterolemia and obesity than other patients and were treated appropriately compared to patients from other countries.
Andrologia, Apr 24, 2009
The spermatozoa densities of the ejaculates obtained daily for five days from infertile males wer... more The spermatozoa densities of the ejaculates obtained daily for five days from infertile males were compared to the spermatozoa densities of the ejaculates obtained from normozoospermic donors. The density distribution of the spermatozoa was established on Percoll columns of discontinuous densities. The density dispersion patterns of five consecutive days from each donor within a donor group were used to establish the main, daily density dispersion patterns. The five, daily, mean dispersion patterns were used to create 3dimensional graphs of density dispersion variations. The 3-dimensional graphs from the infertile male groups show negligible daily variations as compared to that of the healthy males. The absence of wide daily variations is suggested to be considered as a sign of faulty epididymal functioning. Unterschiede der Sperrnatozoendichte bei Mannern rnit Norrnozoo-, Asthenozoo-und Oligo-Asthenozoosperrnie Zusammenfassung: In den Ejakulaten von infertilen Mannern, bei denen 5 Tage lang taglich die Spermatozoendichte bestimmt wurde, wurde mit der Spermatozoendichte von Ejakulaten verglichen, welche von Normozoospermie-Spendern stammten. Die Dichteverteilung der Spermatozoen wurde auf Percoll-Saulen von unterschiedlichen Dichtegraden festgesetzt. Die Steuerungsmuster der Spermatozoendichte von 5 aufeinander folgenden Tagen wurde fur jeden Spender innerhalb einer Spendergruppe dazu benutzt , um das hauptsachliche, tagliche Dichtungsstreuungsmuster festzusetzen. Die 5 Streuungsmuster, welche taglich gewonnen wurden, wurden dazu benutzt , um dreidimensionale Schaubilder der Dichtestreuuag darzustellen. Diese dreidimensionalen Schaubilder zeigten in der Gruppe der infertilen Miinner unbedeutende Tagesschwankungen im~vergleich zu denen der gesunden Manner. Das Fehlen von groBeren Tagesschwankungen muB wohl als ein Zeichen einer fehlerhaften Nebenhodenfunktion gewertet werden.
PubMed, Sep 1, 2003
Background: Among the diseases imported by the Ethiopian immigrants to Israel are many parasite i... more Background: Among the diseases imported by the Ethiopian immigrants to Israel are many parasite infections. Hookworm infections, caused by the nematodes Necator americanus and Ancylostoma duodenale, involve the gastrointestinal tract, causing iron-deficiency anemia. Objectives: To evaluate the rate of iron-deficiency anemia related to hookworm infections among immigrants from an endemic area. Methods: We retrospectively studied the medical records of all Ethiopians over the age of 18, who immigrated to Israel in the early 90's, in two primary care clinics of Clalit Health Services in Ofakim. Results: Sixty patients (64%) had evidence of A. duodenale infection. The mean hemoglobin level was 11.92.3 g/dl in the Ancylostoma group and 13.81.6 g/dl in the control group (p = 0.0001). Analyzing the data according to the patient's sex revealed significant differences in the hemoglobin levels between the Ancylostoma group and the control group. Patients infected with A. duodenale had significantly lower mean corpuscular volume (MCV) and serum iron, and were likely to have eosinophilia and hypoalbuminemia. Conclusion: Among the Ethiopian immigrant population, Ancylostoma duodenale infection is a common cause of iron deficiency anemia. In young patients it should be ruled out before invasive and expensive investigations are performed.
Expert Review of Pharmacoeconomics & Outcomes Research, Nov 2, 2019
Background: Agreements between payers and pharmaceutical/medical device companies are widely impl... more Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018. Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented. Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the prespecified threshold and the companies reimbursed the health-plans accordingly. Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
PubMed, Nov 1, 2004
The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, p... more The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, performed by mobile intensive cardiac care units of Magen David Adom (MDA) teams in the framework of a national survey conducted in the period February and March 2000. During the survey, MDA performed 539 resuscitations, 485 of which were performed by mobile intensive care units of MDA, and they constitute the study population of the present analysis. The average age of the patients was 70.5 years, and 68% were men. The mean response time of the mobile intensive care units was 10.3 minutes. In 14% of the cases, a bystander initiated basic cardiac life support before the arrival of the MDA team. Upon arrival of the resuscitation team, 242 patients (50%) had asystole, 19% ventricular tachycardia (VT)/ventricular fibrillation (VF), 13% pulseless electrical activity (PEA), and 18% had other severe arrhythmias. One hundred and ninety-nine patients (41%) were transferred alive to the hospital after successful resuscitation. Hospital summaries were obtained for 148 of these patients. The cause of cardiac arrest was cardiac in 64% of the cases and 48% of the patients who reached the hospital had a previous history of heart disease. Fifty-three patients (11%) were discharged alive from the hospital. Patients discharged alive were younger, more promptly resuscitated, 78% had a cardiac cause of death and 38% of them were in ventricular tachycardia/fibrillation when first seen by the resuscitation team. The rate of successful resuscitation to discharge in the sub-group with VT/VF was 21%, and only 4% for patients in asystole, which is in line with other studies. However, the rate of initiation of resuscitation by bystanders is low in Israel. These data may help the medical staff and the health policy providers in Israel.
Supportive Care in Cancer, Jun 22, 1999
To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventi... more To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventing chemotherapy-induced febrile neutropenia in the heterogeneous population of adult cancer patients treated in our institution, all adult cancer patients with either a solid tumor or lymphoma who were admitted for chemotherapy in our institution between 1 January 1994 and 31 July 1995 were retrospectively studied. We compared the characteristics of chemotherapy cycles in which G-CSF was given as prophylaxis and of those with no prophylaxis. In all, 1,079 chemotherapy cycles given to 209 patients were analyzed. Prophylaxis with G-CSF was given in 66 cycles (6%). Patients receiving G-CSF were significantly younger and were more likely to have lymphomas. Febrile neutropenia developed in 40 cycles (4%). There was no difference in the rates of febrile neutropenia, infection, hospitalization or mortality between the study groups in general, and cycles administered to patients being treated for lymphomas in particular. The routine use of prophylactic G-CSF in a mixed cancer patient population with a low incidence of febrile neutropenia is not justified and should be reserved for individual patients with a high likelihood of developing febrile neutropenia.
Cancer Causes & Control, Aug 17, 2011
Purpose Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregn... more Purpose Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregnancy, is increasing in prevalence. Data regarding the cancer risk associated with GDM are sparse and limited to cancers of the breast and pancreas. This study was conducted to examine the risk of incident overall and site-specific malignancies associated with prior GDM in a historical cohort of women in a large health maintenance organization in Israel. Methods All pregnant women aged 15-50 years who underwent 50-g glucose challenge tests between 13 March 1995 and 27 May 2009, without history of malignancy, diabetes, and infertility, were included. Clinical and demographic parameters at index date including age, socioeconomic level, BMI, and parity were collected. Diagnosis of gestational diabetes was based on the 100-g oral glucose tolerance test using Carpenter and Coustan criteria. Cancer diagnoses were obtained from the Israel Cancer Register through linkage data. Results Among the 185,315 women who had undergone glucose challenge during the study period, 11,264 (6.1%) were diagnosed with GDM. During a total follow-up period of 1.05 million person-years (mean = 5.19 ± 3.9, median = 4.3), 2,034 incident cases of cancer were identified. GDM was associated with a hazard ratio (HR) of 7.06 (95% CI: 1.69-29.45) for pancreatic cancer (nine cases) and a HR of 1.70 (95% CI: 0.97-2.99) for hematological malignancies (177 cases). The association between GDM and hematological malignancies was limited to women with 5 or more years of follow-up (HR = 4.53; 95% CI: 1.81-11.31). Conclusion GDM is associated with an increased risk of pancreatic cancer and hematologic malignancies. Keywords Gestational diabetes mellitus Á Cancer risk Á Pancreatic cancer Á Lymphoma Abbreviations GDM Gestational diabetes mellitus DM Diabetes mellitus GCT Glucose challenge test OGTT Oral glucose tolerance test HMO Health maintenance organization MHS Maccabi healthcare services NHL Non-hodgkin's lymphoma AML Acute myeloid leukemia Tal Sella and Gabriel Chodick equally contributed to the study and manuscript.
Investigative Ophthalmology & Visual Science, Jun 23, 2017
PubMed, Nov 1, 1995
Since the limited accessibility of general intensive care units creates a situation in which medi... more Since the limited accessibility of general intensive care units creates a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective cohort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Center, a facility with 810 beds, of which 170 beds are in medical wards, including an 8-bed intensive cardiac care unit and a 5-bed general intensive care unit, 119 patients were referred to the MICU, directly from the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU directly from the emergency room. The mean disease severity, as measured by the APACHE II score, was 12.9, and the mean intensity of care for these patients, as measured by the TISS scale, was 12.6. Twenty-one of the 119 patients died during hospitalization (17.6%). This mortality rate conformed to the mortality risk of 15.5%, which was calculated using prognostic formulae. The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalization in the MICU was one-third that in the general intensive care unit and double the cost in a ward. Medical patients in critical condition can be treated in an MICU, with a savings in expenses and without impairing the patient's chances for survival.
Social Science Research Network, 2022
Israel Medical Association Journal, Aug 1, 2008
American Journal of Bioethics, Nov 22, 2007
Pacing and Clinical Electrophysiology, Feb 1, 1992
Angiology, Aug 1, 1987
A patient with a right atrial thrombus and recurrent pulmonary emboli sec ondary to permanent pac... more A patient with a right atrial thrombus and recurrent pulmonary emboli sec ondary to permanent pacemaker insertion is described. Possible precipitating factors were damage to the subclavian vein, congestive heart failure, paroxys mal atrial fibrillation, and immobilization. Venography demonstrated a large atrial thrombus in the superior vena cava and right atrium. The patient was successfully treated with heparin and subsequently with warfarin and dipyrida mole.
American Heart Journal, Jul 1, 1999
Previous studies have demonstrated that both the sympathetic and the parasympathetic branches of ... more Previous studies have demonstrated that both the sympathetic and the parasympathetic branches of the autonomic nervous system affect the frequency of sudden death and cardiovascular mortality after myocardial infarction. 1,2 Different methods for measuring autonomic nervous system activity in patients after myocardial infarction have been reported. 3-8 These methods include tests of heart rate variability measured by 24hour Holter monitoring, 4-7 heart rate variability measurements over a briefer period of 2 to 15 minutes, 8 and assessment of baroreflex activity. 3 However, these tests require Holter monitoring with an elaborate analytic system, including computerized power spectral analysis or intravenous administration of phenylephrine with constant blood pressure and heart rate monitoring. During deep breathing, changes in heart rate occur primarily because of alterations of vagal-cardiac activity. 9 An impairment of this system can lead to depressed heart rate variability. 10 In an era of sophisticated tests of the autonomic system, the purpose of this study was to evaluate prospectively a simple autonomic test (originally used to determine diabetic autonomic neuropathy) that measures changes in heart rate during deep breathing 11,12 as a clinical test for risk stratification of patients after myocardial infarction. Methods Deep breathing test The deep breathing heart rate variability test was conducted 5.1 ± 2.5 days after a first myocardial infarction, with the patient in a supine position connected to the limb leads of a standard electrocardiogram (ECG). Patients had to be in stabilized condition and at least 1 day after ambulation had begun. All tests were performed in the morning in the patient's room after the patient had been in the supine position for 10 minutes. Before beginning the test, patients were taught to breathe at a rate of 6 respiration cycles per minute: 5 seconds for each inhalation and 5 seconds for each exhalation. All tests and measurements were per
PubMed, Nov 15, 1994
Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymp... more Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymphomas. In 30 of them follow-up was available. We review the demographic, clinical, histological and immunohistochemical features of the 30 extranodal lymphomas according to site of origin. Comparison is made between these extranodal lymphomas and nodal non-Hodgkin's lymphomas and cases of Hodgkin's disease first diagnosed in the head and neck area.
Journal of Glaucoma, Jul 1, 2019
A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performa... more A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established. Purpose: The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization. Methods: This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses. Study population: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated. Main outcome measures: VF performance rates. Results: A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, nonglaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95 ± 6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95 ± 0.37 annual tests) began. Conclusion: There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.
PubMed, May 1, 2007
Background: Cardiovascular disease remains the most common cause of death in the industrialized w... more Background: Cardiovascular disease remains the most common cause of death in the industrialized world. The REACH study is an international registry of outpatients from 44 countries, including Israel, with risk factors for cardiovascular morbidity or with stable atherosclerotic clinical syndromes. Objectives: To compare the prevalence and treatment of cardiovascular risk factors between Israeli patients enrolled in REACH and international controls. Methods: Consecutive eligible outpatients aged 45 years or older with established coronary artery disease, cerebrovascular disease, or peripheral arterial disease, or with at least three atherosclerosis risk factors were enrolled. Results: Altogether, 381 Israeli patients were enrolled in the registry. The mean age of the Israeli participants was 70 years and 71% were men. Among the Israeli patients there was a higher percentage with hypercholesterolemia (86% vs. 72%) who were overweight (45% vs. 40%) and obese (69% vs. 47%), but fewer former smokers (33% vs. 42%). The percentage of patients with hypertension taking at least one medication was similar in the two groups, but there was a difference regarding which antihypertensive was used. Israeli patients took more beta-blockers (62% vs. 49%) and angiotensin-converting enzyme inhibitors (60% vs. 48%) but fewer angiotensin II receptor blockers (12% vs. 25%). A higher percentage of Israeli patients were taking at least one antiplatelet agent (88% vs. 79%) and a higher percentage of patients from Israel were on statins (85% vs. 69%). Conclusions: Israeli patients with atherothrombotic disease had a higher prevalence of hypercholesterolemia and obesity than other patients and were treated appropriately compared to patients from other countries.
Andrologia, Apr 24, 2009
The spermatozoa densities of the ejaculates obtained daily for five days from infertile males wer... more The spermatozoa densities of the ejaculates obtained daily for five days from infertile males were compared to the spermatozoa densities of the ejaculates obtained from normozoospermic donors. The density distribution of the spermatozoa was established on Percoll columns of discontinuous densities. The density dispersion patterns of five consecutive days from each donor within a donor group were used to establish the main, daily density dispersion patterns. The five, daily, mean dispersion patterns were used to create 3dimensional graphs of density dispersion variations. The 3-dimensional graphs from the infertile male groups show negligible daily variations as compared to that of the healthy males. The absence of wide daily variations is suggested to be considered as a sign of faulty epididymal functioning. Unterschiede der Sperrnatozoendichte bei Mannern rnit Norrnozoo-, Asthenozoo-und Oligo-Asthenozoosperrnie Zusammenfassung: In den Ejakulaten von infertilen Mannern, bei denen 5 Tage lang taglich die Spermatozoendichte bestimmt wurde, wurde mit der Spermatozoendichte von Ejakulaten verglichen, welche von Normozoospermie-Spendern stammten. Die Dichteverteilung der Spermatozoen wurde auf Percoll-Saulen von unterschiedlichen Dichtegraden festgesetzt. Die Steuerungsmuster der Spermatozoendichte von 5 aufeinander folgenden Tagen wurde fur jeden Spender innerhalb einer Spendergruppe dazu benutzt , um das hauptsachliche, tagliche Dichtungsstreuungsmuster festzusetzen. Die 5 Streuungsmuster, welche taglich gewonnen wurden, wurden dazu benutzt , um dreidimensionale Schaubilder der Dichtestreuuag darzustellen. Diese dreidimensionalen Schaubilder zeigten in der Gruppe der infertilen Miinner unbedeutende Tagesschwankungen im~vergleich zu denen der gesunden Manner. Das Fehlen von groBeren Tagesschwankungen muB wohl als ein Zeichen einer fehlerhaften Nebenhodenfunktion gewertet werden.
PubMed, Sep 1, 2003
Background: Among the diseases imported by the Ethiopian immigrants to Israel are many parasite i... more Background: Among the diseases imported by the Ethiopian immigrants to Israel are many parasite infections. Hookworm infections, caused by the nematodes Necator americanus and Ancylostoma duodenale, involve the gastrointestinal tract, causing iron-deficiency anemia. Objectives: To evaluate the rate of iron-deficiency anemia related to hookworm infections among immigrants from an endemic area. Methods: We retrospectively studied the medical records of all Ethiopians over the age of 18, who immigrated to Israel in the early 90's, in two primary care clinics of Clalit Health Services in Ofakim. Results: Sixty patients (64%) had evidence of A. duodenale infection. The mean hemoglobin level was 11.92.3 g/dl in the Ancylostoma group and 13.81.6 g/dl in the control group (p = 0.0001). Analyzing the data according to the patient's sex revealed significant differences in the hemoglobin levels between the Ancylostoma group and the control group. Patients infected with A. duodenale had significantly lower mean corpuscular volume (MCV) and serum iron, and were likely to have eosinophilia and hypoalbuminemia. Conclusion: Among the Ethiopian immigrant population, Ancylostoma duodenale infection is a common cause of iron deficiency anemia. In young patients it should be ruled out before invasive and expensive investigations are performed.
Expert Review of Pharmacoeconomics & Outcomes Research, Nov 2, 2019
Background: Agreements between payers and pharmaceutical/medical device companies are widely impl... more Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018. Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented. Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the prespecified threshold and the companies reimbursed the health-plans accordingly. Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
PubMed, Nov 1, 2004
The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, p... more The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, performed by mobile intensive cardiac care units of Magen David Adom (MDA) teams in the framework of a national survey conducted in the period February and March 2000. During the survey, MDA performed 539 resuscitations, 485 of which were performed by mobile intensive care units of MDA, and they constitute the study population of the present analysis. The average age of the patients was 70.5 years, and 68% were men. The mean response time of the mobile intensive care units was 10.3 minutes. In 14% of the cases, a bystander initiated basic cardiac life support before the arrival of the MDA team. Upon arrival of the resuscitation team, 242 patients (50%) had asystole, 19% ventricular tachycardia (VT)/ventricular fibrillation (VF), 13% pulseless electrical activity (PEA), and 18% had other severe arrhythmias. One hundred and ninety-nine patients (41%) were transferred alive to the hospital after successful resuscitation. Hospital summaries were obtained for 148 of these patients. The cause of cardiac arrest was cardiac in 64% of the cases and 48% of the patients who reached the hospital had a previous history of heart disease. Fifty-three patients (11%) were discharged alive from the hospital. Patients discharged alive were younger, more promptly resuscitated, 78% had a cardiac cause of death and 38% of them were in ventricular tachycardia/fibrillation when first seen by the resuscitation team. The rate of successful resuscitation to discharge in the sub-group with VT/VF was 21%, and only 4% for patients in asystole, which is in line with other studies. However, the rate of initiation of resuscitation by bystanders is low in Israel. These data may help the medical staff and the health policy providers in Israel.
Supportive Care in Cancer, Jun 22, 1999
To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventi... more To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventing chemotherapy-induced febrile neutropenia in the heterogeneous population of adult cancer patients treated in our institution, all adult cancer patients with either a solid tumor or lymphoma who were admitted for chemotherapy in our institution between 1 January 1994 and 31 July 1995 were retrospectively studied. We compared the characteristics of chemotherapy cycles in which G-CSF was given as prophylaxis and of those with no prophylaxis. In all, 1,079 chemotherapy cycles given to 209 patients were analyzed. Prophylaxis with G-CSF was given in 66 cycles (6%). Patients receiving G-CSF were significantly younger and were more likely to have lymphomas. Febrile neutropenia developed in 40 cycles (4%). There was no difference in the rates of febrile neutropenia, infection, hospitalization or mortality between the study groups in general, and cycles administered to patients being treated for lymphomas in particular. The routine use of prophylactic G-CSF in a mixed cancer patient population with a low incidence of febrile neutropenia is not justified and should be reserved for individual patients with a high likelihood of developing febrile neutropenia.