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Brosh-Nissimov T, Ma'aravi N, Leshin-Carmel D, Edel Y, Ben Barouch S, Segman Y, Cahan A, Barenboim E. Combination treatment of persistent COVID-19 in immunocompromised patients with remdesivir, nirmaltrevir/ritonavir and tixegavimab/cilgavimab. J Microbiol Immunol Infect 2024; 57:189-194. [PMID: 37805361 DOI: 10.1016/j.jmii.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 10/09/2023]
Abstract
We present a retrospective study on the treatment outcomes of severely immunocompromised patients with persistent COVID-19. The study analyzed data from 14 patients who received a combination of tixegavimab/cilgavimab and antiviral medications. Response was evaluated based on symptom improvement, PCR cycle-threshold values, and C-reactive protein levels. Eleven patients achieved complete clinical and virological resolution, while three showed partial responses. The study suggests a potential association between non-response and tixegavimab/cilgavimab neutralization. The findings underscore the need for tailored treatment approaches and further research on optimal strategies for managing persistent COVID-19, as well as the development of antivirals and variant-specific monoclonal antibodies.
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Affiliation(s)
- Tal Brosh-Nissimov
- Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel.
| | - Nir Ma'aravi
- Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | | | - Yonatan Edel
- Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Sharon Ben Barouch
- Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Yafit Segman
- Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Amos Cahan
- Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Erez Barenboim
- Samson Assuta Ashdod University Hospital, Ashdod, Israel
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Kleinhendler E, Cohen MJ, Moses AE, Paltiel O, Strahilevitz J, Cahan A. Erratum to "Empiric antibiotic protocols for cancer patients with neutropenia: a single-center study of treatment efficacy and mortality in patients with bacteremia" [International Journal of Antimicrobial Agents Volume 51/1 (2018) 71-76]. Int J Antimicrob Agents 2023; 62:106928. [PMID: 37537004 DOI: 10.1016/j.ijantimicag.2023.106928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Eyal Kleinhendler
- Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel; Department of Medicine, Sourasky Medical Center, Tel-Aviv, Israel
| | - Matan J Cohen
- Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Amos Cahan
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; IBM T.J Watson Research Center, Yorktown Heights, New York, USA
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Shapiro Ben David S, Shamai-Lubovitz O, Mourad V, Goren I, Cohen Iunger E, Alcalay T, Irony A, Greenfeld S, Adler L, Cahan A. A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients. Vaccines (Basel) 2023; 11:1355. [PMID: 37631923 PMCID: PMC10458143 DOI: 10.3390/vaccines11081355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project's effectiveness in improving the pneumococcal vaccination rate among IP. An automated population-based registry of IP was developed and validated at Maccabi Healthcare Services, an Israeli health maintenance organization serving over 2.6 million members. Included were transplant recipients, patients with asplenia, HIV or advanced kidney disease; or those receiving immunosuppressive therapy. A personalized electronic medical record alert was activated reminding clinicians to consider vaccination during IP encounters. Later, IP were invited to get vaccinated via their electronic patient health record. Pre- and post-intervention vaccination rates were compared. Between October 2019 and October 2021, overall PCV13 vaccination rates among 32,637 IP went up from 11.9% (n = 3882) to 52% (n = 16,955) (p < 0.0001). The PPSV23 vaccination rate went up from 39.4% (12,857) to 57.1% (18,652) (p < 0.0001). In conclusion, implementation of targeted automated patient- and clinician-facing alerts, a remarkable increase in pneumococcal vaccine uptake was observed among IP. The outlined approach may be applied to increase vaccination uptake in large health organizations.
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Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Orna Shamai-Lubovitz
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Vered Mourad
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Iris Goren
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Erica Cohen Iunger
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Tamar Alcalay
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Angela Irony
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Shira Greenfeld
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Amos Cahan
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod 774762, Israel;
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Brosh-Nissimov T, Tzur A, Grupel D, Cahan A, Ma'aravi N, Heled-Akiva M, Jawamis H, Leskes H, Barenboim E, Sorek N. Clinical impact of the accelerate PhenoTest® BC system on patients with gram-negative bacteremia and high risk of antimicrobial resistance: a prospective before-after implementation study. Ann Clin Microbiol Antimicrob 2023; 22:62. [PMID: 37516885 PMCID: PMC10387206 DOI: 10.1186/s12941-023-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/23/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The Accelerate PhenoTest® BC system (AXDX) is a novel assay for rapid bacterial identification and antimicrobial susceptibility (AST). We report an evaluation of its impact on treatment of patients with Gram-negative bacteremia (GNB) with a high risk of antimicrobial resistance (AMR). METHODS A prospective single-center evaluation before and after implementation of AXDX in addition to standard-of-care (SOC) microbiology and antimicrobial stewardship program (ASP). Patients with GNB reported during laboratory working hours and prespecified risk factors for AMR were included. The primary outcome was an ASP-oriented beneficial antimicrobial change, defined as either an escalation of an inappropriate empiric treatment or de-escalation of a broad-spectrum treatment of a susceptible organism. Main secondary outcomes were time to an appropriate treatment, antimicrobial treatment duration, length of stay (LOS) and mortality. RESULTS Included were 46 and 57 patients in the pre- and post-intervention periods, respectively. The median time to an AST-oriented beneficial change was 29.2 h vs. 49.6 h, respectively (p < 0.0001). There were no significant differences in the time to appropriate treatment, LOS or mortality. Antimicrobial treatment duration was longer during the intervention period (10 vs. 8 days, p = 0.007). AXDX failed to correctly identify pathogens in all 6 cases of polymicrobial bacteremia. In two cases patient care was potentially compromised due to inappropriate de-escalation. CONCLUSIONS AXDX implementation resulted in a 20.4-hour shorter time to an ASP-oriented beneficial antimicrobial change. This should be weighed against the higher costs, the lack of other proven clinical benefits and the potential harm from mis-identification of polymicrobial bacteremias.
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Affiliation(s)
- Tal Brosh-Nissimov
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel.
- Faculty of Health Sciences, Ben Gurion University in the Negev, Be'er Sheva, Israel.
| | - Anka Tzur
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Daniel Grupel
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
- Faculty of Health Sciences, Ben Gurion University in the Negev, Be'er Sheva, Israel
| | - Amos Cahan
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Nir Ma'aravi
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Maya Heled-Akiva
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Hasan Jawamis
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Hanna Leskes
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Erez Barenboim
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
| | - Nadav Sorek
- Samson Assuta Ashdod University Hospital, Harefua st. 7, Ashdod, 7747629, Israel
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David SSB, Shamai-Lubovitz O, Mourad V, Goren I, Iunger EC, Alcalay T, Irony A, Greenfeld S, Adler L, Cahan A. 98. A nationwide intervention to improve pneumococcal vaccination rate among immunocompromised individuals. Open Forum Infect Dis 2022. [PMCID: PMC9751560 DOI: 10.1093/ofid/ofac492.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Immunocompromised individuals (ICI) are at high risk for infections, some of which are preventable by vaccines. The Israeli MOH recommends PCV13 and PPSV23 vaccines for ICI, but vaccine coverage is suboptimal. The aim of this study was to assess the effectiveness of a project to improve pneumococcal vaccination (PV) rate among ICI in outpatient settings. Methods An automated validated, population-based registry of patients with ICI was developed in an Israeli health organization, Maccabi Healthcare Services, serving over 2.5 million members. Included in the registry were patients aged 18 and above, receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD); and patients with asplenia. Based on the registry and the Israeli MOH vaccination guidelines, a nationwide quality improvement project aimed at improving PV was implemented which began in October 2019. As part of the project, ICI were waived the need for preapproval for PCV13. During an eligible patient visit, physicians and nurses were prompted with an EHR alert reminding them to consider providing pneumococcal vaccine. In addition, eligible patients were invited via their patient health record (both desktop and mobile) to vaccinate. Vaccination rates during pre- and post-intervention periods were compared using the Chi square test. Results A total of 32,297 ICI were identified. Of them, 22,721 were on IT, 1651 PLWH, 1829 were TR ,5267 had AKD, and 1920 were asplenic. During the period October 2019 to October 2021, PCV13 vaccination rates went up from 12% to 54.1% (p< 0.0001), and PPSV23 vaccination rate improved from 44.7% to 62.6% (P < 0.0001). Conclusion Using one of the first real-world automated registries for ICI and implementation of targeted automated patient and provider alerts, markedly improved pneumococcal vaccine uptake was observed in this vulnerable population. Similar interventions may be used to increase the adherence for other vaccines, including COVID-19 vaccines. Disclosures Shirley Shapiro Ben David, MD, pfizer: Grant/Research Support Limor Adler, MD, pfizer: Grant/Research Support.
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Affiliation(s)
| | | | - Vered Mourad
- Maccabi Healthcare Services, Tel Aviv, Tel Aviv, Israel
| | - Iris Goren
- Maccabi Healthcare Services, Tel Aviv, Tel Aviv, Israel
| | | | - Tamar Alcalay
- Maccabi Healthcare Services, Tel Aviv, Tel Aviv, Israel
| | - Angela Irony
- Maccabi Healthcare Services, Tel Aviv, Tel Aviv, Israel
| | | | - Limor Adler
- Maccabi Healthcare Services, Tel Aviv, Tel Aviv, Israel
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Shapiro Ben David S, Goren I, Mourad V, Cahan A. Vaccination Coverage among Immunocompromised Patients in a Large Health Maintenance Organization: Findings from a Novel Computerized Registry. Vaccines (Basel) 2022; 10:vaccines10101654. [PMID: 36298519 PMCID: PMC9612260 DOI: 10.3390/vaccines10101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Immune-compromised patients (IPs) are at high risk for infections, some of which are preventable by vaccines. Specific vaccines are recommended for IP; however, the vaccination rate is suboptimal. The aim of this study is to describe the development of an IP registry and to assess vaccination rates in this population. A population-based registry of IPs was developed using an automated extraction of patient electronic health-record data in Maccabi Healthcare Services (MHS), an Israeli health maintenance organization serving over 2.4 million members. Included in the registry were patients receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD), and asplenic patients. We evaluated the full schedule for each vaccine's uptake rates for influenza, pneumococcal, meningococcal, and hepatitis B. On 1 October 2019, 32,637 adult immune-compromised patients were identified by the registry. Of them, 1647 were PLWH; 2354 were asplenic; 5317 had AKD; 23,216 were on IT; and 1824 were TR. Their mean age was 57 and 52.4% were females. The crude rate of immune compromise among adult MHS members was 2%. Vaccine coverage rate was overall low for PCV13, with only 11.9% of all IPs in the registry having received one dose. Influenza and PPV23 vaccination rates were higher (45% and 39.4%, respectively). Only 5.3% of all IPs received all three vaccines. Overall, low vaccination coverage was found among IPs. Our registry can serve to identify target-patient populations for interventions and monitor their effectiveness.
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Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-37952830
| | - Iris Goren
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Vered Mourad
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Amos Cahan
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel
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Stulman MY, Asayag N, Focht G, Brufman I, Cahan A, Ledderman N, Matz E, Chowers Y, Eliakim R, Ben-Horin S, Odes S, Dotan I, Balicer RD, Benchimol EI, Turner D. Epidemiology of Inflammatory Bowel Diseases in Israel: A Nationwide Epi-Israeli IBD Research Nucleus Study. Inflamm Bowel Dis 2021; 27:1784-1794. [PMID: 33438721 DOI: 10.1093/ibd/izaa341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are currently no nationwide data on the epidemiology of inflammatory bowel diseases (IBD) in Israel. We aimed to determine the population-based epidemiological trends of IBD in the diverse Israeli population. METHODS Health-administrative data were retrieved from all 4 Israeli health maintenance organizations, insuring 98% of the population, using validated identification algorithms. National trends were determined using Joinpoint regression analysis calculating annual percent change and average annual percent change (AAPC). RESULTS By 2019, there were 46,074 patients with IBD in Israel, corresponding to a national prevalence of 519/100,000 (0.52%), of whom 54.1% had Crohn disease (CD) and 45.9% had ulcerative colitis (UC). The number of Jewish patients doubled from 18,701 in 2005 (354/100,000) to 38,950 (589/100,000) in 2018 (AAPC, +4.0%; P < 0.05), and the number of Arab patients increased 3-fold from 1096 (102.1/100,000) to 3534 (240.7/100,000; AAPC, +6.8%; P < 0.05) during the same years. However, the increase rate has gradually decelerated over time (annual percent change during 2005-2008, 2009-2014, and 2005-2018 was +6.7%, +4.2%, and +2.3%, respectively; P < 0.05). Pediatric prevalence increased from 37.4 to 52.2/100,000, with CD predominating in both Jews and Arabs. The incidence of CD remained stable (from 15.9/100,000 to 14.9/100,000) and the incidence of UC decreased (15.4/100,000 to 10.5/100,000 (AAPC, -3.2%; P < 0.001)). In contrast, pediatric incidence of CD increased from 7.3/100,000 to 8.3/100,000 (AAPC, +1.9%; P < 0.05) and that of UC increased from 2.6 to 4.4/100,000 (AAPC, +5.8%; P < 0.05). CONCLUSIONS The IBD prevalence rate in Israel is still increasing but gradually decelerating, probably due to the decreasing overall IBD incidence. Nonetheless, incidence rate in children is still increasing. Ongoing narrowing in the rates between Jews and Arabs over time may indicate shared environmental factors.
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Affiliation(s)
- Mira Y Stulman
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Braun School of Public and Community Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Noa Asayag
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gili Focht
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilan Brufman
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Amos Cahan
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Healthcare Campus, Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Odes
- Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tivka, and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ran D Balicer
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,CHEO Inflammatory Bowel Disease Centre and CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Dan Turner
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Brosh-Nissimov T, Sorek N, Yeshayahu M, Zherebovich I, Elmaliach M, Cahan A, Amit S, Rotlevi E. Oropharyngeal shedding of herpesviruses before and after BNT162b2 mRNA vaccination against COVID-19. Vaccine 2021; 39:5729-5731. [PMID: 34481701 PMCID: PMC8445745 DOI: 10.1016/j.vaccine.2021.08.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Concerns were raised over an increase in Bell's palsy, herpes simplex and herpes zoster after BNT162b2 vaccination, all are manifestations of herpesviruses reactivation. As herpesviruses commonly reactivate in the oropharynx, we have hypothesized that oropharyngeal shedding of herpesviruses will increase after vaccination. METHODS Immune-competent Adults, excluding those using topical steroids or manifesting symptomatic herpesvirus infection, were sampled before BNT162b2 vaccination and one week after. Herpesviruses 1-7 shedding was tested with a multiplexed PCR. RESULTS In 103 paired samples the prevalence of herpesviruses was similar before and after vaccination: HSV1, 3.9% vs. 5.8% (p = 0.75); HSV2, 0% vs. 1% (p = not applicable, NA); VZV, 0% vs. 0% (p = NA); EBV, 14.6% vs. 17.5% (p = 0.63); CMV, 0% vs. 0% (p = NA); HHV6, 4.9% vs. 7.8% (p = 0.55); HHV7, 71.8% vs. 72.8% (p = 1); any herpesvirus, 73.8% vs. 74.8% (p = 1). DISCUSSION We did not find evidence for increased oropharyngeal reactivation of herpesviruses one week after BNT162b2.
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Affiliation(s)
- Tal Brosh-Nissimov
- Infectious Disease Unit, Samson Assuta Ashdod University Hospital, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
| | - Nadav Sorek
- Microbiology Laboratory, Samson Assuta Ashdod University Hospital, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Michal Yeshayahu
- Maccabi Healthcare Services, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | | | | | - Amos Cahan
- Infectious Disease Unit, Samson Assuta Ashdod University Hospital, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Erela Rotlevi
- Maccabi Healthcare Services, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Cahan A, Gottesman T, Katz MT, Masad R, Azulay G, Dicker D, Zeidman A, Berkov E, Tadmor B, Lev S. Development and validation of a knowledge-driven risk calculator for critical illness in COVID-19 patients. Am J Emerg Med 2020; 39:143-145. [PMID: 33039212 PMCID: PMC7510415 DOI: 10.1016/j.ajem.2020.09.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 01/27/2023] Open
Abstract
Facing the novel coronavirus disease (COVID-19) pandemic, evidence to inform decision-making at all care levels is essential. Based on the results of a study by Petrilli et al., we have developed a calculator using patient data at admission to predict critical illness (intensive care, mechanical ventilation, hospice care, or death). We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7%–99.9%; specificity: 81.9%, 95% CI, 74.1%–88.2%). Of 127 patients with non-critical illness, 104 were correctly identified. Our results indicate that published knowledge can be reliably applied to assess patient risk, potentially reducing the cognitive burden on physicians, and helping policymakers better prepare for future needs.
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Affiliation(s)
- Amos Cahan
- Kahun Medical Ltd, Tel Aviv, Israel; Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
| | - Tamar Gottesman
- Department of Infectious Diseases and Infection Control Unit, Hasharon Campus, Rabin Medical Center, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Dror Dicker
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine D, Hasharon Campus, Rabin Medical Center, Petach Tikva, Israel
| | - Aliza Zeidman
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Hasharon Campus, Rabin Medical Center, Petach Tikva, Israel
| | - Evgeny Berkov
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine C, Hasharon Campus, Rabin Medical Center, Petach Tikva, Israel
| | - Boaz Tadmor
- Research Authority, Rabin Medical Center, Petach Tikva, Israel
| | - Shaul Lev
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; General Intensive Care Unit, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel
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Cahan A, Lerner U, Fishbain B, Bursztyn M. Abstract P2053: Blood Pressure Variability is Higher When Pulse Rate is Lower, in a Large Outpatient Database. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p2053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Historically, guidelines for blood pressure measurement recommended adjusting the cuff deflation rate to the patient's heart rate (2-3 mmHg per heartbeat).Current guidelines recommend a fixed cuff deflation rate of 2 mmHg/sec.. In this study, we assess the association between pulse rate (PR) and BP variability. All BP measurements in adult patients with corresponding PR documentation were reviewed in a large outpatient database. In each category (6 categories between 40 and 99 bpm), patients with at least 3 BP readings within that category were included. In each category, systolic and diastolic BP coefficient of variance (corrected for sample size) was plotted against the PR category. There were 551,595 unique patients with a total of 4,760,000 measurements, and 860,522 groups of 3 measurements or more per patient within a PR category. BP normalized coefficient of variance was inversely related to PR (Figure), ranging 0.0043 to 0.0003 (Systolic), and 0.0024 to 0.0002 (Diastolic), for the lowest to highest heart rate category, respectively. BP variability is inversely associated with PR, especially in lower PR, likely reflecting less precise BP measurements where the "sample size" of pulse is small. The observed effect compromising precision might be accompanied by a concomitant reduced accuracy of BP measurement which is another theoretical implication of a smaller "sample size", leading to a systematic bias towards measuring lower and higher than real systolic and diastolic BP respectively.
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Affiliation(s)
- Amos Cahan
- Maccabi Healthcare services, Tel-Aviv, Israel
| | - Uri Lerner
- Maccabi Healthcare services, Tel-Aviv, Israel
| | - Barak Fishbain
- Technion – Israel Institute of Technology, Tel-Aviv, Israel
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Korem M, Goldberg NS, Cahan A, Cohen MJ, Nissenbaum I, Moses AE. Clinically applicable irreversible electroporation for eradication of micro-organisms. Lett Appl Microbiol 2018; 67:15-21. [PMID: 29679390 DOI: 10.1111/lam.12996] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 12/18/2022]
Abstract
Irreversible electroporation (IRE) damages cell membranes and is used in medicine for nonthermal ablation of malignant tumours. Our aim was to evaluate the antimicrobial effect of IRE. The pathogenic micro-organisms, Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa and Candida albicans were subjected to IRE. Survival was measured as a function of voltage and the number of pulses applied. Combined use of IRE and oxacillin for eradication of Staph. aureus was also tested. Log10 reduction in micro-organisms positively correlated with the number of applied pulses. The colony count of Strep. pyogenes and E. coli declined by 3·38 and 3·05 orders of magnitude, respectively, using an electric field of 2000 V and 100 pulses. Killing of Staph. aureus and P. aeruginosa was achieved with a double cycle of IRE (2000, 1500 V and repeated 1250 V respectively) of 50-100 IRE pulses. The addition of subclinical inhibitory concentrations of oxacillin to the Staph. aureus suspension prior to IRE led to total bacterial death, demonstrating synergism between oxacillin and IRE. Our results demonstrate that using IRE with clinically established parameters has a marked in vitro effect on pathogenic micro-organisms and highlights the potential of IRE as a treatment modality for deep-seated infections, particularly when combined with low doses of antibiotics. SIGNIFICANCE AND IMPACT OF THE STUDY Irreversible electroporation (IRE) is utilized in interventional radiology to treat cancer patients. In this study we evaluated in vitro the antimicrobial effect of IRE. We demonstrated that using IRE with clinically established parameters has a marked effect on pathogenic micro-organisms and is synergistic to antimicrobials when both are combined. Our results point to the potential of IRE as a treatment modality for deep-seated infections.
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Affiliation(s)
- M Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - N S Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Cahan
- IBM Research, Yorktown, NY, USA
| | - M J Cohen
- Clalit Health Services, Jerusalem, Israel
| | - I Nissenbaum
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Gottlieb A, Yanover C, Cahan A, Goldschmidt Y. Estimating the effects of second-line therapy for type 2 diabetes mellitus: retrospective cohort study. BMJ Open Diabetes Res Care 2017; 5:e000435. [PMID: 29299328 PMCID: PMC5730938 DOI: 10.1136/bmjdrc-2017-000435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Metformin is the recommended initial drug treatment in type 2 diabetes mellitus, but there is no clearly preferred choice for an additional drug when indicated. We compare the counterfactual drug effectiveness in lowering glycated hemoglobin (HbA1c) levels and effect on body mass index (BMI) of four diabetes second-line drug classes using electronic health records. STUDY DESIGN AND SETTING Retrospective analysis of electronic health records of US-based patients in the Explorys database using causal inference methodology to adjust for patient censoring and confounders. PARTICIPANTS AND EXPOSURES Our cohort consisted of more than 40 000 patients with type 2 diabetes, prescribed metformin along with a drug out of four second-line drug classes-sulfonylureas, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide-1 agonists-during the years 2000-2015. Roughly, 17 000 of these patients were followed for 12 months after being prescribed a second-line drug. MAIN OUTCOME MEASURES HbA1c and BMI of these patients after 6 and 12 months following treatment. RESULTS We demonstrate that all four drug classes reduce HbA1c levels, but the effect of sulfonylureas after 6 and 12 months of treatment is less pronounced compared with other classes. We also estimate that DPP-4 inhibitors decrease body weight significantly more than sulfonylureas and thiazolidinediones. CONCLUSION Our results are in line with current knowledge on second-line drug effectiveness and effect on BMI. They demonstrate that causal inference from electronic health records is an effective way for conducting multitreatment causal inference studies.
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Affiliation(s)
- Assaf Gottlieb
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Chen Yanover
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Amos Cahan
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Yaara Goldschmidt
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
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Cahan A, Anand V. Second thoughts on the final rule: An analysis of baseline participant characteristics reports on ClinicalTrials.gov. PLoS One 2017; 12:e0185886. [PMID: 29107973 PMCID: PMC5673198 DOI: 10.1371/journal.pone.0185886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 09/21/2017] [Indexed: 01/11/2023] Open
Abstract
Background ClinicalTrials.gov is valuable for aggregate-level analysis of trials. The recently published final rule aims to improve reporting of trial results. We aimed to assess variability in ClinicalTirals.gov records reporting participants’ baseline measures. Methods and findings The September 2015 edition of the database for Aggregate Analysis of ClinicalTrials.gov (AACT), was used in this study. To date, AACT contains 186,941 trials of which 16,660 trials reporting baseline (participant) measures were analyzed. We also analyzed a subset of 13,818 Highly Likely Applicable Clinical Trials (HLACT), for which reporting of results is likely mandatory and compared a random sample of 30 trial records to their journal articles. We report counts for each mandatory baseline measure and variability reporting in their formats. The AACT dataset contains 8,161 baseline measures with 1206 unique measurement units. However, of these 6,940 (85%) variables appear only once in the dataset. Age and Gender are reported using many different formats (178 and 49 respectively). “Age” as the variable name is reported in 60 different formats. HLACT subset reports measures using 3,931 variables. The most frequent Age format (i.e. mean (years) ± sd) is found in only 45% of trials. Overall only 4 baseline measures (Region of Enrollment, Age, Number of Participants, and Gender) are reported by > 10% of trials. Discrepancies are found in both the types and formats of ClinicalTrials.gov records and their corresponding journal articles. On average, journal articles include twice the number of baseline measures (13.6±7.1 (sd) vs. 6.6±7.6) when compared to the ClinicalTrials.gov records that report any results. Conclusions We found marked variability in baseline measures reporting. This is not addressed by the final rule. To support secondary use of ClinicalTrials.gov, a uniform format for baseline measures reporting is warranted.
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Affiliation(s)
- Amos Cahan
- IBM T.J Watson Research Center, Yorktown Height, NY, United States of America
- * E-mail:
| | - Vibha Anand
- IBM T.J Watson Research Center, Yorktown Height, NY, United States of America
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Anand V, Cahan A, Ghosh S. Clinical Trials.Gov: A Topical Analyses. AMIA Jt Summits Transl Sci Proc 2017; 2017:37-47. [PMID: 28815102 PMCID: PMC5543348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
ClinicalTrials.gov was established as a web-based registry for clinical trials of human participants in 2000. Mandatory registration started in 2008. Given more than a decade of registered trials, it's important to understand the "topic" areas and their evolution over time from this resource. This information may help in identifying current knowledge gaps. We use dynamic topic model (DTM) methods to discover topics and their evolution over last 17 years. Our model suggests that there are disease or organ specific trials such as 'Cardiovascular disorders', Heart & Brain conditions', or 'Breast & Prostate cancer' as well as trials registered for general health. General health trials are less likely to be FDA regulated, but both health and pain management, as well as surgical, heart, and brain trials have upward trend in recent years while advanced cancer trials have downward trended. Our model derives unique insights from metadata associated with each topic area.
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Affiliation(s)
- Vibha Anand
- IBM T.J. Watson Research Center, Cambridge, MA
| | - Amos Cahan
- IBM T.J. Watson Research Center, Cambridge, MA
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Cahan A. There is no escape from using probabilities in diagnosis-making. ACTA ACUST UNITED AC 2017. [PMID: 29536923 DOI: 10.1515/dx-2016-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amos Cahan
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
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Cahan A, Cimino JJ. A Learning Health Care System Using Computer-Aided Diagnosis. J Med Internet Res 2017; 19:e54. [PMID: 28274905 PMCID: PMC5362695 DOI: 10.2196/jmir.6663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/04/2017] [Accepted: 02/12/2017] [Indexed: 11/13/2022] Open
Abstract
Physicians intuitively apply pattern recognition when evaluating a patient. Rational diagnosis making requires that clinical patterns be put in the context of disease prior probability, yet physicians often exhibit flawed probabilistic reasoning. Difficulties in making a diagnosis are reflected in the high rates of deadly and costly diagnostic errors. Introduced 6 decades ago, computerized diagnosis support systems are still not widely used by internists. These systems cannot efficiently recognize patterns and are unable to consider the base rate of potential diagnoses. We review the limitations of current computer-aided diagnosis support systems. We then portray future diagnosis support systems and provide a conceptual framework for their development. We argue for capturing physician knowledge using a novel knowledge representation model of the clinical picture. This model (based on structured patient presentation patterns) holds not only symptoms and signs but also their temporal and semantic interrelations. We call for the collection of crowdsourced, automatically deidentified, structured patient patterns as means to support distributed knowledge accumulation and maintenance. In this approach, each structured patient pattern adds to a self-growing and -maintaining knowledge base, sharing the experience of physicians worldwide. Besides supporting diagnosis by relating the symptoms and signs with the final diagnosis recorded, the collective pattern map can also provide disease base-rate estimates and real-time surveillance for early detection of outbreaks. We explain how health care in resource-limited settings can benefit from using this approach and how it can be applied to provide feedback-rich medical education for both students and practitioners.
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Affiliation(s)
- Amos Cahan
- IBM TJ Watson Research Center, Yorktown Heights, NY, United States
| | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, United States
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Cahan A, Cahan S, Cimino JJ. Computer-aided assessment of the generalizability of clinical trial results. Int J Med Inform 2017; 99:60-66. [PMID: 28118923 DOI: 10.1016/j.ijmedinf.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND The effects of an intervention on patients from populations other than that included in a trial may vary as a result of differences in population features, treatment administration, or general setting. Determining the generalizability of a trial to a target population is important in clinical decision making at both the individual practitioner and policy-making levels. However, awareness to the challenges associated with the assessment of generalizability of trials is low and tools to facilitate such assessment are lacking. METHODS We review the main factors affecting the generalizability of a clinical trial results beyond the trial population. We then propose a framework for a standardized evaluation of parameters relevant to determining the external validity of clinical trials to produce a "generalizability score". We then apply this framework to populations of patients with heart failure included in trials, cohorts and registries to demonstrate the use of the generalizability score and its graphic representation along three dimensions: participants' demographics, their clinical profile and intervention setting. We use the generalizability score to compare a single trial to multiple "target" clinical scenarios. Additionally, we present the generalizability score of several studies with regard to a single "target" population. RESULTS Similarity indices vary considerably between trials and target population, but inconsistent reporting of participant characteristics limit head-to-head comparisons. CONCLUSION We discuss the challenges involved in performing automatic assessment of trial generalizability at scale and propose the adoption of a standard format for reporting the characteristics of trial participants to enable better interpretation of their results.
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Affiliation(s)
- Amos Cahan
- IBM T.J. Watson Research Center, Yorktown Heights, NY, United States.
| | - Sorel Cahan
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, United States
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Abstract
AbstractUncertainty is involved in each and every step of the diagnostic process. Trying to eliminate doubt altogether is too costly, is likely to fail, and may lead to patient harm. Acknowledging this, the threshold approach aims to optimize diagnosis-making by adopting the explicit use of probability estimates and by discouraging the pursuit of 100% certainty. Yet physicians are affected by cognitive biases which compromise their probabilistic reasoning and may lead to unreliable estimates. Health informatics tools helping to overcome human limitations by empowering physicians to handle probabilities are needed to increase the efficiency of diagnostic process.
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Affiliation(s)
- Amos Cahan
- IBM T.J. Watson Research Center (Cahan), Yorktown Heights, NY; National Library of Medicine (Cahan); National Institutes of Health Clinical Center (Cimino), Bethesda, Md.; Informatics Institute (Cimino), School of Medicine, University of Alabama at Birmingham, Birmingham, Ala.
| | - James J Cimino
- IBM T.J. Watson Research Center (Cahan), Yorktown Heights, NY; National Library of Medicine (Cahan); National Institutes of Health Clinical Center (Cimino), Bethesda, Md.; Informatics Institute (Cimino), School of Medicine, University of Alabama at Birmingham, Birmingham, Ala
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Cahan A, Cimino JJ. Visual assessment of the similarity between a patient and trial population: Is This Clinical Trial Applicable to My Patient? Appl Clin Inform 2016; 7:477-88. [PMID: 27437055 DOI: 10.4338/aci-2015-12-ra-0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/23/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A critical consideration when applying the results of a clinical trial to a particular patient is the degree of similarity of the patient to the trial population. However, similarity assessment rarely is practical in the clinical setting. Here, we explore means to support similarity assessment by clinicians. METHODS A scale chart was developed to represent the distribution of reported clinical and demographic characteristics of clinical trial participant populations. Constructed for an individual patient, the scale chart shows the patient's similarity to the study populations in a graphical manner. A pilot test case was conducted using case vignettes assessed by clinicians. Two pairs of clinical trials were used, each addressing a similar clinical question. Scale charts were manually constructed for each simulated patient. Clinicians were asked to estimate the degree of similarity of each patient to the populations of a pair of trials. Assessors relied on either the scale chart, a summary table (aligning characteristics of 2 trial populations), or original trial reports. Assessment time and between-assessor agreement were compared. Population characteristics considered important by assessors were recorded. RESULTS Six assessors evaluated 6 cases each. Using a visual scale chart, agreement between physicians was higher and the time required for similarity assessment was comparable. CONCLUSION We suggest that further research is warranted to explore visual tools facilitating the choice of the most applicable clinical trial to a specific patient. Automating patient and trial population characteristics extraction is key to support this effort.
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Affiliation(s)
- Amos Cahan
- IBM T.J. Watson Research Center, Yorktown Heights, NY; National Library of Medicine, Bethesda, MD; Informatics Institute
| | - James J Cimino
- University of Alabama at Birmingham, Birmingham, AL; National Institutes of Health Clinical Center, Bethesda, MD
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Ng K, Kakkanatt C, Benigno M, Thompson C, Jackson M, Cahan A, Zhu X, Zhang P, Huang P. Curating and Integrating Data from Multiple Sources to Support Healthcare Analytics. Stud Health Technol Inform 2015; 216:1056. [PMID: 26262355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As the volume and variety of healthcare related data continues to grow, the analysis and use of this data will increasingly depend on the ability to appropriately collect, curate and integrate disparate data from many different sources. We describe our approach to and highlight our experiences with the development of a robust data collection, curation and integration infrastructure that supports healthcare analytics. This system has been successfully applied to the processing of a variety of data types including clinical data from electronic health records and observational studies, genomic data, microbiomic data, self-reported data from surveys and self-tracked data from wearable devices from over 600 subjects. The curated data is currently being used to support healthcare analytic applications such as data visualization, patient stratification and predictive modeling.
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Affiliation(s)
- Kenney Ng
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | | | | | | | | | - Amos Cahan
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Xinxin Zhu
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Ping Zhang
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Paul Huang
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Korem M, Israel S, Gilon D, Cahan A, Moses AE, Block C, Strahilevitz J. Epidemiology of infective endocarditis in a tertiary-center in Jerusalem: a 3-year prospective survey. Eur J Intern Med 2014; 25:550-5. [PMID: 24931808 DOI: 10.1016/j.ejim.2014.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/25/2014] [Accepted: 05/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological features of infective endocarditis have changed during the last decades because of increases in the prevalence of health care exposure and of Staphylococcus aureus bloodstream infection. Consequently, the role of surgery is evolving. We aim to provide a contemporary profile of epidemiological, microbiological, and clinical features of infective endocarditis in a tertiary medical center, and identify predictors of mortality. METHODS A prospective observational cohort study of consecutive adult patients with definite endocarditis according to the modified Duke criteria. Data were collected from January 1, 2009 through October 31, 2011 following a predefined case report form designed by the ICE-PCS. RESULTS Among 70 endocarditis episodes, 25.7% involved prosthetic valves and 11.5% were device related. Forty-four percent of episodes were health-care associated. The predominant causative microorganism on native valve, prosthetic valve and device related endocarditis was Staphylococcus aureus (33.3%). Viridans group streptococci accounted for the majority of community-acquired endocarditis (36.1%). At least one complication occurred in 50% of the episodes. One third of the patients who had an indication for surgery were operated upon. Six month case fatality ratio was 40%. Sixty-five percent of patients with a contraindication to surgery died, compared with 9% and 28.5% who were treated surgically and medically, respectively. In multivariable analysis, age was a predictor of mortality. CONCLUSION Compared with other series, we observed more health-care associated endocarditis, and a higher mortality. Nearly half of all deaths were in patients who had a contraindication to surgery. Careful evaluation of contraindications to surgery is warranted.
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Affiliation(s)
- M Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - S Israel
- Internal Medicine Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Gilon
- Heart Institute and Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Cahan
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - A E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - C Block
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - J Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel.
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Shaulov A, Benenson S, Cahan A, Hiller N, Korem M. A 44-year-old man with cavitary pneumonia and shock. Neth J Med 2011; 69:402-406. [PMID: 21978987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- A Shaulov
- Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel
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Affiliation(s)
| | | | - Michael Bursztyn
- Department of Medicine, Mount Scopus Campus Hadassah–Hebrew University Medical Center Jerusalem, Israel (Cahan, Bursztyn)
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Abstract
OBJECTIVE Overactivity of the Forkhead transcription factor FoxO1 promotes diabetic hyperglycemia, dyslipidemia, and acute-phase response, whereas suppression of FoxO1 activity by insulin may alleviate diabetes. The reported efficacy of long-chain fatty acyl (LCFA) analogs of the MEDICA series in activating AMP-activated protein kinase (AMPK) and in treating animal models of diabesity may indicate suppression of FoxO1 activity. RESEARCH DESIGN AND METHODS The insulin-sensitizing and anti-inflammatory efficacy of a MEDICA analog has been verified in guinea pig and in human C-reactive protein (hCRP) transgenic mice, respectively. Suppression of FoxO1 transcriptional activity has been verified in the context of FoxO1- and STAT3-responsive genes and compared with suppression of FoxO1 activity by insulin and metformin. RESULTS Treatment with MEDICA analog resulted in total body sensitization to insulin, suppression of lipopolysaccharide-induced hCRP and interleukin-6-induced acute phase reactants and robust decrease in FoxO1 transcriptional activity and in coactivation of STAT3. Suppression of FoxO1 activity was accounted for by its nuclear export by MEDICA-activated AMPK, complemented by inhibition of nuclear FoxO1 transcriptional activity by MEDICA-induced C/EBPβ isoforms. Similarly, insulin treatment resulted in nuclear exclusion of FoxO1 and further suppression of its nuclear activity by insulin-induced C/EBPβ isoforms. In contrast, FoxO1 suppression by metformin was essentially accounted for by its nuclear export by metformin-activated AMPK. CONCLUSIONS Suppression of FoxO1 activity by MEDICA analogs may partly account for their antidiabetic anti-inflammatory efficacy. FoxO1 suppression by LCFA analogs may provide a molecular rational for the beneficial efficacy of carbohydrate-restricted ketogenic diets in treating diabetes.
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Affiliation(s)
- Ghadeer Zatara
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Rachel Hertz
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Maayan Shaked
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Nina Mayorek
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Etedal Morad
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Etty Grad
- Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amos Cahan
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Haim D. Danenberg
- Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Terry G. Unterman
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jacob Bar-Tana
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
- Corresponding author: Jacob Bar-Tana,
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Cahan A, Gilon D, Manor O, Paltiel O. Clinical experience did not reduce the variance in physicians' estimates of pretest probability in a cross-sectional survey. J Clin Epidemiol 2005; 58:1211-6. [PMID: 16223666 DOI: 10.1016/j.jclinepi.2005.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Revised: 12/10/2004] [Accepted: 02/28/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES In light of the increasing popularity of the threshold approach in clinical decision-making, this study assesses the role of expertise in physicians' agreement in estimating the probability of disease in patients. METHODS A cross-sectional survey of physicians of different specialties, attending weekly staff meetings in four teaching hospitals in Jerusalem, Israel. An anonymous questionnaire describing three case scenarios of patients with chest pain was administered and participants were asked to estimate pretest probabilities of disease. RESULTS Eighty-six physicians (practicing cardiology, internal medicine, and family medicine, as well as general practitioners and internists) out of 125 approached (response rate 69%). The mean estimated probabilities were very similar for residents and specialists; however, the standard deviation was higher for specialists in all three cases: 20.7, 21.0, and 19.1 among specialists and 16.4, 20.5, and 14.9 among residents, respectively. CONCLUSION This study, based on case scenarios, did not find that medical expertise improved agreement among doctors when estimating the probability of disease in patients-despite the common belief that senior physicians should have smaller interobserver differences in probability estimates. The wide variation observed calls into question the applicability of the threshold approach.
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Affiliation(s)
- Amos Cahan
- Faculty of Medicine, The Hebrew University of Jerusalem, Israel
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Abstract
BACKGROUND The "threshold approach" is based on a physician's assessment of the likelihood of a disease expressed as a probability. The use of Bayes' theorem to calculate disease probability in patients with and without a particular characteristic, may be hampered by the presence of subadditivity (i.e. the sum of probabilities concerning a single case scenario exceeding 100%). AIM To assess the presence of subadditivity in physicians' estimations of probabilities and the degree of concordance among doctors in their probability assessments. DESIGN Prospective questionnaire. METHODS Residents and trained physicians in Family Medicine, Internal Medicine and Cardiology (n = 84) were asked to estimate the probability of each component of the differential diagnosis in a case scenario describing a patient with chest pain. RESULTS Subadditivity was exhibited in 65% of the participants. The total sum of probabilities given by each participant ranged from 44% to 290% (mean 137%). There was wide variability in the assignment of probabilities for each diagnostic possibility (SD 16-21%). DISCUSSION The finding of substantial subadditivity, coupled with the marked discordance in probability estimates, questions the applicability of the threshold approach. Physicians need guidance, explicit tools and formal training in probability estimation to optimize the use of this approach in clinical practice.
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Affiliation(s)
- A Cahan
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Shiu MH, Cahan A, Fogh J, Fortner JG. Sensitivity of xenografts of human pancreatic adenocarcinoma in nude mice to heat and heat combined with chemotherapy. Cancer Res 1983; 43:4014-8. [PMID: 6409393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The sensitivity of two human pancreatic adenocarcinomas (Capan-1 and Capan-2) to heat and heat combined with chemotherapy was studied using xenografts of the tumors in the foot of athymic nude mice. Heat was applied by immersion of the tumor in a water bath at 43.5 degrees for 1 hr. A single i.p. dose of mitomycin C, cisplatin, 5-fluorouracil, or 0.9% NaCl solution was given at 1 hr prior to treatment. Heat treatment alone significantly suppressed tumor growth (p less than 0.001), with 35% of the tumors showing complete regression. Combined treatment using heat plus chemotherapy yielded significantly greater suppression of tumor growth (p less than 0.05) with mitomycin for both tumors and with cisplatin or 5-fluorouracil for Capan-1. Combined treatment also gave higher rates of complete tumor regression: 55 and 64%, respectively, for Capan-1 and Capan-2 as compared with 18 and 47% for the respective tumors treated by heat alone. These observations suggest that human pancreatic carcinomas are sufficiently sensitive to heat combined with chemotherapeutic treatment to warrant a clinical trial of these modalities.
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Raaf J, Bryan C, Monden M, Bray A, Kim JH, Chu F, Chaganti RS, Shank B, Cahan A, Fortner JG. Bone marrow and renal transplantation in canine recipients prepared by total lymphoid irradiation. Transplant Proc 1981; 13:429-33. [PMID: 7022866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Paige CJ, Figarella EF, Cuttito MJ, Cahan A, Stutman O. Natural cytotoxic cells against solid tumors in mice. II. Some characteristics of the effector cells. J Immunol 1978; 121:1827-35. [PMID: 361891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Fisher N, Cahan A. An Addition to the Family in which A(x) is Transmitted
through a Person of the Blood Group A(2)B. Vox Sang 1962. [DOI: 10.1159/000464806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cahan A, Jack J, Scudder J, Sargent M, Sanger R, Race R. A Family in which A(x) is Transmitted through a Person of the Blood Group A(2)B. Vox Sang 1957. [DOI: 10.1159/000478289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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