shachaf shiber - Academia.edu (original) (raw)

Papers by shachaf shiber

Israel Journal of Health Policy Research, Sep 18, 2018

Background: Previous studies have shown that, in a variety of health care settings, patients ofte... more Background: Previous studies have shown that, in a variety of health care settings, patients often do not understand what health care professionals tell them about their diagnoses and care plans; this is particularly true among male patients. Emergency department (ED) settings present unique challenges to communication with patients due to the rapid pace of activity, substantial changes in personnel over the course of the day and the week, and the need for fast decision-making processes. The aim of our study was to investigate the extent to which patients in an Israeli ED comprehended their plan of care and whether there were gender differences in this regard. Methods: We conducted a questionnaire-based prospective study, in which patients admitted to the ED at Rabin Medical Center were evaluated during the years 2014-2016. The primary outcome was patients' comprehension of their plan of care, stratified by gender of patients. Plan of care included information related to diagnosis, treatment and discharge instructions. The secondary outcome was patients' satisfaction with the instruction process. Results: One hundred seventy seven ED patients met study criteria and were asked to participate in the study; 85% of them agreed to do so. Overall, 150 ED patients aged 18-80 were recruited [75 men (50%) and 75 women (50%)]. 80% of the respondents reported a satisfactory understanding of their plan of care. Overall, no gender-related differences were found. Differences between men and women concerning satisfaction with the instructions provided by nurses were found among non-Hebrew speakers, but not among Hebrew speakers. Conclusion: Contrary to most earlier studies, patients at our ED demonstrated a high degree of self-reported adequate comprehension concerning their plan of care, and overall no gender-related differences were found. These finding may be due in part to improved training of the medical staff to better communicate with the patients and to answer their questions. In addition, patients may feel more comfortable than in the past about asking the medical staff questions regarding their plan of care and diagnosis. The main implication of this study is that physician education programs should continue to emphasize patient-physician communications skills and improving methods for providing patients with information.

Journal of Thrombosis and Thrombolysis, Dec 14, 2017

Lower extremity deep vein thrombosis (DVT) is a frequent cause of admission to the emergency depa... more Lower extremity deep vein thrombosis (DVT) is a frequent cause of admission to the emergency departments (ED). Although the gold standard for diagnosis is the Duplex ultrasound examination, the current study used for diagnosis of DVT in the ED by emergency physicians is the point-of-care compression ultrasound (POCUS). To compare the sensitivity and specificity of the two-point and three-point compression ultrasound (2PCUS and 3PCUS respectively) for diagnosis of lower extremity DVT in an ED management. We prospectively recruited outpatients who were admitted to the ED with suspected lower extremity DVT. Each patient underwent 2PCUS and 3PCUS performed by a trained ED physician. The ED physician recorded the results and then referred the patient to the vascular clinic for the Duplex ultrasound examination. 195 patients recruited to this study between July 2015 and June 2016 in the ED of Rabin Medical Center-Beillinson Hospital, Israel. DVT was diagnosed by Duplex examination in 48 of 195 patients (24.6%). There were significant correlations among the findings regarding the deep veins on both the 2PCUS and 3PCUS tests and on the Duplex examination (p < 0.001). DVT at any vein was correctly diagnosed with the 2PCUS in 38 of48 patients with positive findings on Duplex examination and incorrectly diagnosed (false positive) in 2 of 133 patients without DVT (sensitivity 82.76%, specificity 98.52%). DVT was correctly diagnosed with the 3PCUS in 43 of 48 DVT and incorrectly diagnosed (false positive) in 2 of133 patients without DVT (sensitivity 90.57%, specificity 98.52%). The sensitivity of the 3PCUS was significantly higher than the 2PCUS (p < 0.001), while the specificity was similar. A short training is satisfactory for achieving a good clinical capability to identify DVT by ED physicians. The 3PCUS examination preformed in the ED, is a noninvasive, accurate and quick diagnostic test for evaluation of patients presenting with signs and symptoms suggestive of a DVT. By Using 3PCUS, the ED physicians may decrease time to diagnosis, definitive care and length of stay in the ED.

Clinical Microbiology and Infection

Open Forum Infectious Diseases, 2021

Background Identifying infectious etiology is often challenging, yet essential for patient manage... more Background Identifying infectious etiology is often challenging, yet essential for patient management, including antibiotic use. Studies have shown that a host signature comprising TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10) and C-reactive protein (CRP) accurately differentiates bacterial from viral infection with negative predictive value >98%. Performance data was lacking in chronic obstructive pulmonary disease (COPD) patients with suspected lower respiratory tract infection (LRTI). Methods Adults aged >18 years with suspected LRTI were prospectively recruited at 3 medical centers (OBSERVER; grant #684589; NCT003011515). Reference standard infection etiology was adjudicated by 3 independent experts based on clinical, laboratory, microbiological, radiological and follow-up data. Host signature generates a bacterial likelihood score (0-100), providing three results: viral (0-35), equivocal (35-65) and bacterial (65-100). Experts w...

Israel Journal of Health Policy Research, 2018

Prehospital and Disaster Medicine, 2017

Journal of the Pancreas, 2018

To determine the prevalence and risk factors of new-onset diabetes mellitus in patients after a f... more To determine the prevalence and risk factors of new-onset diabetes mellitus in patients after a first episode of acute pancreatitis. Methods A retrospective study design was used. Patients diagnosed with a first episode of acute pancreatitis in the emergency department of a tertiary medical center in 2010-2016 were followed for the occurrence of diabetes mellitus. Clinical data were collected from the medical records and compared between patients with and without a subsequent diagnosis of diabetes. Results Of 500 patients who presented with a first episode of acute pancreatitis during the study period, 41 (8.2%) were subsequently diagnosed with diabetes and 29 (5.6%), with pre-diabetes, and 312 (62.4%) had normal glucose levels; the remainder had pre-existing diabetes. Mean duration of follow-up was 6.7±3.1 years, and mean interval between diagnoses was 1.46±1.4 years. Compared to the patients with normal glucose levels, the diabetes group was characterized by older age (64±17 years vs. 54±21 years, p<0.01) and higher blood pressure values (systolic: 147±21 mmHg vs.131±23 mmHg, p<0.01; diastolic: 83±15 mmHg vs.74±13 mmHg, p=0.013) at presentation to the emergency department, higher score on the Bedside Index for Severity in Acute Pancreatitis (BISAP; 1.22±0.85 vs. 0.88±0.87, p=0.02), and higher rate of non-biliary pancreatitis (45% vs. 26.8%, p=0.02). Conclusions Risk factors for the development of diabetes after a first episode of acute pancreatitis include high blood pressure, high BISAP score, and non-biliary etiology. These findings in patients who present to the emergency department with acute pancreatitis should alert the clinician to the need for close monitoring for diabetes.

Open Access Emergency Medicine

Journal of Women's Health

JAC-Antimicrobial Resistance

Background Sepsis is a life-threatening organ dysfunction syndrome caused by the body's respo... more Background Sepsis is a life-threatening organ dysfunction syndrome caused by the body's response to infection. Timely and appropriate sepsis management, including appropriate treatment of bacterial infection, improves outcomes. MeMed BV (BV), a test for differentiating between bacterial and viral infection, is based on computational integration of the circulating levels of three proteins (TRAIL, IP-10, CRP). Here we evaluate its ability to differentiate bacterial from viral infection in sepsis patients. Methods This was a sub-analysis of sepsis patients recruited prospectively in the Apollo study (NCT04690569). Apollo eligibility required the attending physician's clinical suspicion of acute infection and reported fever. Sepsis was defined as two or more SIRS criteria and a suspected bacterial or viral infection classified by expert adjudication. A bacterial or viral classification required at least 2/3 experts to assign the same aetiology label with confidence ≥90% or all 3...

Mediators of Inflammation, 2021

Background and Aims. Plasma levels of soluble triggering receptor expressed on myeloid cells (sTR... more Background and Aims. Plasma levels of soluble triggering receptor expressed on myeloid cells (sTREM-1) reflect innate immune cell activation. We sought to evaluate sTREM-1 levels in patients with acute coronary syndrome (ACS) and their predictive value for disease severity and outcome. Methods. Plasma sTREM-1 levels were prospectively measured by ELISA in 121 consecutive patients with new-onset (≤24 h) chest pain at arrival to the emergency department (ED) and 73 healthy controls. Secondary endpoints were the association of plasma levels of sTREM-1 with day 30 and month 6 major adverse cardiovascular events (MACE) defined as death, ACS, stroke, and need for coronary revascularization, as well as with CAD severity. The primary endpoint of the study was the association of plasma sTREM-1 level at the time of admission to the ED with a diagnosis of ACS at day 30. Results. Fifty-nine patients (48.7%) were diagnosed with ACS and 62 (51.3%) with nonspecific chest pain (NSCP). Median plasma...

PLOS ONE, 2021

Given rising antibiotic resistance and increasing use of delayed prescription for uncomplicated l... more Given rising antibiotic resistance and increasing use of delayed prescription for uncomplicated lower urinary tract infections (UTI), patients at risk for treatment failure should be identified early. We assessed risk factors for clinical and microbiological failure in women with lower UTI. This case-control study nested within a randomized clinical trial included all women in the per-protocol population (PPP), those in the PPP with microbiologically confirmed UTI, and those in the PPP with UTI due to Escherichia coli. Cases were women who experienced clinical and/or microbiologic failure; controls were those who did not. Risk factors for failure were assessed using multivariate logistic regression. In the PPP, there were 152 clinical cases for 307 controls. Among 340 women with microbiologically confirmed UTI, 126 and 102 cases with clinical and microbiological failure were considered with, respectively, 214 and 220 controls. Age ≥52 years was independently associated with clinical...

Infectious Diseases, 2021

Background Few studies have addressed external validity of randomized controlled trials in infect... more Background Few studies have addressed external validity of randomized controlled trials in infectious diseases. We aimed to assess the external validity of an investigator-initiated trial on treatment for uncomplicated urinary tract infection. Methods In the original study, women (n = 513) with urinary tract infection were randomized to nitrofurantoin or fosfomycin treatment in three countries between 2013 and 2017. In the present study we compared women who were screened for enrolment but excluded to women who participated in the trial, both groups in Israel. The primary outcome was the rate of emergency department index visits resulting in hospitalization within 28 days. Results We compared 127 included to 110 excluded patients. The most common reasons for exclusion were logistic difficulties in recruitment and antibiotic use in the preceding month. Included patients tended to be older [39 (IQR 29–59) vs. 35.5 (IQR 24–56.25 years)], more likely to have history of recurrent infecti...

Clinical Immunology, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Journal of Clinical Gastroenterology, 2021

Goal: The aim was to assess proactive specialized inflammatory bowel diseases (IBD) emergency dep... more Goal: The aim was to assess proactive specialized inflammatory bowel diseases (IBD) emergency department (ED) consultation and multidisciplinary IBD team (IBD-MDT) intervention on IBD-related patient outcomes after discharge. Background: Despite advances in patient care, IBD-related ED visits have increased and substantially contribute to the IBD burden. Methods: Consecutive patients with IBD (below 50 y) who visited the ED during November 2017 to April 2018 (intervention group) were compared with patients with IBD that visited the same ED during 2014 to 2017 (standard-care group). The primary outcomes were hospitalization and ED revisits at 30, 90, and 180 days. Results: The intervention group (45 patients, mean age 32.43±8.6 y, 57.8% male) and the standard-care group (237 patients) had comparable baseline characteristics, including age, sex, and IBD type, and similar rates of hospital admissions from the ED (46.7% vs. 38.8%, P=0.32). The intervention group more frequently underwen...

Background: Necrotizing fasciitis (NF) is a life-threatening infection with high morbidity and mo... more Background: Necrotizing fasciitis (NF) is a life-threatening infection with high morbidity and mortality rates which should be diagnosed and treated with surgical and antibiotic therapy. Many studies have addressed NF and its subtypes, but few have reviewed the clinical, radiological and pathological differences between the poly-microbial and the mono-microbial groups. Objective: The objective of our study is to describe a relatively large cohort of patients with NF and study and compare the clinical, radiological and pathological differences between the poly-microbial (Pm) and the mono-microbial (Mm) groups.Methods: The charts of hospitalized patients with NF diagnosis from 2002-2019 at the Rabin Medical Center were reviewed. The primary outcome was all-cause mortality at 90 days, secondary outcomes included duration of hospitalization, intensive care unit (ICU) admission, LRINEC score and the need for vasopressor use. Results: 81 patients with NF were included in the study, 54(66....

Open Forum Infectious Diseases, 2020

Background Challenges in determining the etiology of acute exacerbations of chronic obstructive p... more Background Challenges in determining the etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant overuse of antibiotics. A new host-response assay that integrates the levels of three proteins (TRAIL, IP-10, and CRP) was shown to exhibit high performance in distinguishing between bacterial and viral disease in two double-blind pediatric validation studies. Here we sought to evaluate its ability to differentiate bacterial from viral infection in adult COPD patients with suspicion of lower respiratory tract infection (LRTI). Methods The study population included 492 febrile adult patients prospectively recruited in “Observer”, an EU Horizon 2020 funded study (grant #684589). Patient etiology was determined by majority expert panel based on clinical, laboratory, multiplex PCR, radiological and follow-up data. We compared the expert panel diagnosis with the assay that gives three possible outcomes: viral, bacterial (including viral with bacteri...

Toxin Reviews, 2018

Background: Daboia (Vipera) palaestinae envenomation (DPE) is the most common snake-bite in Israe... more Background: Daboia (Vipera) palaestinae envenomation (DPE) is the most common snake-bite in Israel. Current practice has supported antivenom treatment, including those with local or systemic manifestations. Objective: To evaluate a conservative approach vs. fixed dose D. palaestinae antivenom for patients with advance local (AL)/mild systemic (MS) manifestations. Methods: Retrospective analysis of 41 patients bitten by D. palaestinae who were treated with expectant management or administration of a fixed-dose of 50 mL antivenom. Results: Antivenom was withheld in 16/21 patients (76%) with AL or MS reaction. After expectant management, no adverse events were recorded. Conclusion: We found that a selective approach towards antivenom administration yields similar clinical outcomes in patients following DPE.

Open Forum Infectious Diseases, 2019

Background Antibiotic overuse in LRTI is a major healthcare care problem, contributing to antimic... more Background Antibiotic overuse in LRTI is a major healthcare care problem, contributing to antimicrobial resistance. A novel assay that integrates blood levels of three immune-proteins TRAIL\IP-10\CRP was developed to assist in differentiating bacterial from viral disease. The assay exhibited high performance in blinded validation studies focusing on children. We performed a preliminary analysis of the ongoing OBSERVER study, evaluating the assay’s potential to reduce antibiotic misuse in adult patients presenting with suspicion of LRTI. Methods OBSERVER (NCT03011515) is an EU Horizon 2020 funded study (grant No. 684589), the first to validate the signature in adult LRTI patients. For every participant recruited at the emergency departments of three hospitals in Israel, we collected medical history, physical examination, routine lab, imaging, and respiratory multiplex PCR data. The assay outcomes are bacterial, viral or equivocal. Reference standard outcome of bacterial, viral, indet...

The Journal of Emergency Medicine, 2018

Background: Medical treatment of hungerstrike patients, especially those in incarceration facilit... more Background: Medical treatment of hungerstrike patients, especially those in incarceration facilities, may pose clinical and treatment challenges for the treating physicians. Objective: The aim of our study is to describe the epidemiology and clinical and laboratory characteristics of hunger-strike prisoners presenting to the emergency department (ED) and to describe etiologies of hospitalization and complications among this group. Method: We retrospectively examined clinical and laboratory manifestations of 50 hunger-strike prisoners who were referred for evaluation to the ED after a longstanding fast. Results: After a mean of 38 (28-44) days of a hunger strike, the most common complaints were chest pain and abdominal pain (14/60 [23.3%], 13/60 [21.6%], respectively). Mean weight loss percentage was 18.5%, and most patients were bradycardic (25/40 [62.5%]), and some hypothermic (16/50, [32%]). We describe several laboratory disturbances observed in these patients; leukopenia was the most common hematologic manifestation (31/50 [62%]), and a prolonged international normalized ratio was observed in 12/29 (41.3%) patients. We hospitalized 12% of the patients; the most common hospitalization cause was bradycardia (3/6 [50%]). Conclusions: Our study found that the most common clinical symptom was chest pain, which has not been previously reported among hunger strikers. We observed a substantial number of laboratory disturbances due to muscle wasting and protein loss and due to presumed vitamin and micronutrient deficiencies. We suggest monitoring electrocardiograms for heart rate, blood count, chemistry, coagulation tests, and vitamin levels.