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Kornilov E, Orbach-Zinger S, Hoshen M, Weiniger C, Fein S, Fireman S, Firman S, Aviram A, Eidelman L. A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension. Int J Obstet Anesth 2019; 37:29-35. [DOI: 10.1016/j.ijoa.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
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Spitzer-Shohat S, Goldfracht M, Key C, Hoshen M, Balicer RD, Shadmi E. Primary care networks and team effectiveness: the case of a large-scale quality improvement disparity reduction program. J Interprof Care 2018; 33:472-480. [PMID: 30422722 DOI: 10.1080/13561820.2018.1538942] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Documentation of primary care teams' involvement in disparity reduction efforts exists, yet little is known about how teams interact or perceive their effectiveness. We investigated how the social network and structural ties among primary-care-clinic team members relate to their perceived team effectiveness (TE), in a large-scale disparity reduction intervention in Israel's largest insurer and provider of services. A mixed-method design of Social Network Analysis and qualitative data collection was employed. 108 interviews with medical, nursing, and administrative teams of 26 clinics and their respective managerial units were performed and information on the organizational ties, analyzing density and centrality, collected. Pearson correlations examined association between network measures and perceived TE. Clinics with strong intra-clinic density and high clinic-subregional-management density were positively correlated with perceived TE. Clinic in-degree centrality was also positively associated with perceived TE. Qualitative analyses support these findings with teamwork emerging as a factor which can impede or facilitate teams' ability to design and implement disparity reduction interventions. The study demonstrates that in an organization-wide disparity reduction initiative, cohesive intra-network structure and close relations with mid-level management increase the likelihood that teams perceive themselves as possessing the skills and resources needed to lead and implement disparity reduction efforts. List of abbreviations Team Effectiveness (TE); Clalit Health Services (Clalit); Social Network Analysis (SNA); Quality Improvement (QI); National Health Care Collaborative (NHPC); Tampa Bay Community Cancer Network (TBCCN).
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Affiliation(s)
- S Spitzer-Shohat
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University , Safed , Israel.,Center for Health and the Social Sciences, University of Chicago , IL , USA
| | - M Goldfracht
- Clalit Community Division, Clalit Health Services , Tel Aviv , Israel
| | - C Key
- Clalit Community Division, Clalit Health Services , Tel Aviv , Israel
| | - M Hoshen
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services , Tel Aviv , Israel
| | - R D Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services , Tel Aviv , Israel.,Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University , Beer-Sheva , Israel
| | - E Shadmi
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services , Tel Aviv , Israel.,Faculty of Social Welfare and Health Sciences, University of Haifa , Beer-Sheva , Israel
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Lavie G, Reges O, Hoshen M, Benis A, Leibowitz M, Balicer R. Statin therapy for primary prevention and its effect on new-onset diabetes, mace and all-cause mortality - A real-world population cohort study. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weinberg H, Reges O, Hoshen M, Leibowitz M, Balicer R, Haim M. P1086Creating a prediction model to identify patients at high risk of undetected non-valvular atrial fibrillation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1086] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spitzer-Shohat S, Shadmi E, Goldfracht M, Kay C, Hoshen M, Balicer RD. Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel. J Public Health (Oxf) 2017; 39:395-402. [PMID: 27165669 DOI: 10.1093/pubmed/fdw037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background An organization-wide inequity-reduction quality improvement (QI) initiative was implemented in primary care clinics serving disadvantaged Arab and Jewish populations. Using the Chronic Care Model (CCM), this study investigated the types of interventions associated with success in inequity reduction. Methods Semi-structured interviews were conducted with 80 staff members from 26 target clinics, and information about intervention types was coded by CCM and clinical domains (e.g. diabetes, hypertension and lipid control; performance of mammography tests). Relationships between type and number of interventions implemented and inequity reduction were assessed. Results Target clinics implemented 454 different interventions, on average 17.5 interventions per clinic. Interventions focused on Decision support and Community linkages were positively correlated with improvement in the composite quality score (P < 0.05). Conversely, focusing on a specific clinical domain was not correlated with a higher quality score. Conclusions Focusing on training team members in selected QI topics and/or tailoring interventions to meet community needs was key to the interventions' success. Such findings, especially in light of the lack of association between QI and a focus on a specific clinical domain, support other calls for adopting a systems approach to achieving wide-scale inequity reduction.
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Affiliation(s)
- S Spitzer-Shohat
- Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel
| | - E Shadmi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel.,Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel
| | - M Goldfracht
- Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel
| | - C Kay
- Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel
| | - M Hoshen
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel
| | - R D Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel.,Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Balicer R, Flaks-Manov N, Shadmi E, Hoshen M. ISQUA16-3059HEALTH INFORMATION EXCHANGE SYSTEMS AND LENGTH OF STAY IN READMISSIONS TO A DIFFERENT HOSPITAL. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.116] [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: 11/14/2022] Open
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Nutman A, Glick R, Temkin E, Hoshen M, Edgar R, Braun T, Carmeli Y. A case-control study to identify predictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia. Clin Microbiol Infect 2014; 20:O1028-34. [DOI: 10.1111/1469-0691.12716] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/01/2014] [Accepted: 06/08/2014] [Indexed: 01/31/2023]
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Amit BH, Krivoy A, Mansbach-Kleinfeld I, Zalsman G, Ponizovsky AM, Hoshen M, Farbstein I, Apter A, Weizman A, Shoval G. Religiosity is a protective factor against self-injurious thoughts and behaviors in Jewish adolescents: findings from a nationally representative survey. Eur Psychiatry 2014; 29:509-13. [PMID: 24908151 DOI: 10.1016/j.eurpsy.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/20/2014] [Revised: 04/08/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Few studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort. METHODS Self-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents (n=620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure. RESULTS Using multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ(2)=3.95, P=0.047), decreasing the likelihood of occurrence by 55% (OR=0.45, 95% CI 0.2-0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R(2)=0.164; likelihood ratio χ(2)=7.59; df=1; P<0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups. CONCLUSION This is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population.
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Affiliation(s)
- B H Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, PO Box 102, 4910002 Petah Tikva, Israel.
| | - A Krivoy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, PO Box 102, 4910002 Petah Tikva, Israel
| | | | - G Zalsman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, PO Box 102, 4910002 Petah Tikva, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | - A M Ponizovsky
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - M Hoshen
- Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - I Farbstein
- Child and Adolescent Psychiatry, Ziv Medical Center, Safed, Israel; Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - A Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - A Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, PO Box 102, 4910002 Petah Tikva, Israel
| | - G Shoval
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Geha Mental Health Center, PO Box 102, 4910002 Petah Tikva, Israel
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Sume GE, Hoshen M, Bita G, Kabore S, Nzima VN. Treatment outcome of TB/HIV positive and negative smear positive pulmonary tuberculosis patients treated using daily self-administered therapy in a Cameroonian district hospital. ACTA ACUST UNITED AC 2011; 86:469-75. [PMID: 21650070 DOI: 10.4314/eamj.v86i10.54977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In our previous study we found that half of the patients treated at the Nylon District Hospital tuberculosis (TB) treatment centre were seropositive. HIV does not only fuel the number of tuberculosis (TB) cases worldwide but it is also at least in part, responsible for the non-achievement of the 85% cure rate target. OBJECTIVE To compare the TB treatment outcome of smear positive pulmonary tuberculosis (SPPT) patients who did an HIV test and those who refused the test as well as compare the treatment outcomes between the HIV positive and HIV negative SPPT patients from 2003 to 2005, all of whom were treated as outpatients under routine programme conditions. DESIGN A retrospective study. SUBJECTS Four hundred and twenty patients were registered from 2003 to 2005 as having SPPT. SETTING The Nylon District Hospital, Cameroon. RESULTS Thirty five point two per cent of the 386 SPPT patients also had HIV. The overall cure rate, default rate and death rate were 69%, 23.6% and 3.3% respectively. SPPT/HIV co-infected patients were significantly more likely to default from treatment (28.7% versus 16.8%, OR 1.943, 95% CI 1.150-3.285) to die in the course of treatment (7.4% versus 0.4%, OR 23.714, 95% CI 2.894-194.330) or not to be cured (58.8% versus 78.8%, OR 0.404, 95% CI 0.250-0.652) compared to SPPT/HIV negative patients. Likewise SPPT patients not tested for HIV were significantly less cured (38.2% versus 71.8%, OR 0.21, 95% CI 0.099-0.445) and defaulted most (52.9% versus 21%, OR 4.773 95% CI 2.281-9.991) compared to SPPT patients tested for HIV. CONCLUSION SPPT patients infected with HIV or not tested for HIV in the course of TB treatment are likely to suffer from unfavorable treatment outcomes. Thus health personnel prescribing anti- TB drugs should be provided with the necessary expertise to diagnose and manage HIV so that TB/HIV co-infected patients benefit from an integrated package of care in and out of the hospital.
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Affiliation(s)
- G E Sume
- Regional Delegation of Public Health, Littoral Region, International Vaccination Centre, Douala, P.O. Box 1115, Douala, Cameroon
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Purim O, Hoshen M, Marshak G, Kundel Y, Morgenstern S, Halpern M, Aharonov R, Niv Y, Kushnir M, Brenner B. MicroRNAs as a potential prognostic factor in gastric cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10635] [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: 11/20/2022] Open
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Segura MF, Zakrzewski J, Belitskaya-Levy I, Gaziel A, Kushnir M, Hoshen M, Hanniford D, Cohen D, Osman I, Hernando E. Clinical relevance of miRNA expression in metastatic melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9006] [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: 11/20/2022] Open
Abstract
9006 Background: We recently reported the identification of a specific miRNA cluster frequently overexpressed in melanoma which enhances the metastatic behavior (Segura et al., 2009. PNAS. In press). In this study, we aim to define the clinical relevance of miRNA expression, in particular whether miRNAs can serve as prognostic biomarkers for melanoma patients. Methods: Total RNA was extracted from formalin-fixed paraffin embedded (FFPE) tissue samples from 61 metastatic melanoma specimens (25 lymph node, 16 soft tissue/skin, 13 brain and 7 visceral) accrued by the NYU Interdisciplinary Melanoma Cooperative Group (IMCG). RNA was hybridized into miRNA arrays (miRdicatorTM, Rosetta Genomics, Inc) containing probes for more than 600 miRNA sequences, including all the human miRNAs in the 9.0 version of miRBase. The Significance Analysis of Microarrays (SAM) was used to identify miRNAs significantly associated with survival, and the False Discovery Rate (FDR) approach was used to adjust for multiple comparisons. Results: We identified a signature of 18 miRNAs, whose up-regulation significantly associates with better prognosis (increased overall survival and post-recurrence survival) using the FDR of 0%. Quantitative RT-PCR on the same tissues has verified the array results in 15 out of 15 miRNAs analyzed. Some of these miRNAs were significantly associated with stage at recurrence, while others significantly correlated with the site of metastasis (i.e. visceral, brain, soft-tissue). Using cross-validation, we selected a miRNA signature consisting of 10 of these significant miRNAs with lowest misclassification error in predicting 1.5-year post-recurrence survival. We are currently validating these findings in a separate cohort of metastatic patients. Furthermore, we are investigating whether these ‘protective' miRNAs can be detected in the corresponding primary lesions and thus, whether they already hold prognostic value at early stages of the disease. Conclusions: Our data suggest a role for miRNAs as melanoma biomarkers, and support the development of miRNA- based monitoring assays. These analyses are also expanding our understanding of the molecular alterations underlying melanoma progression, by revealing miRNAs whose down-regulation associates with a more aggressive biological behavior. [Table: see text]
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Affiliation(s)
- M. F. Segura
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - J. Zakrzewski
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - I. Belitskaya-Levy
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - A. Gaziel
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - M. Kushnir
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - M. Hoshen
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - D. Hanniford
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - D. Cohen
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - I. Osman
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
| | - E. Hernando
- New York University School of Medicine, New York, NY; Rosetta Genomics, Rehovot, Israel
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Pass HI, Beck A, Hoshen M, Benjamin H, Cholakh H, Kostenko E, Zepeniuk M, Cohen D. Differential microRNA expression in pleural mesothelioma: Implications for early detection and prognostication. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yé Y, Sauerborn R, Séraphin S, Hoshen M. Using modelling to assess the risk of malarial infection during the dry season, on a local scale in an endemic area of rural Burkina Faso. Ann Trop Med Parasitol 2007; 101:375-89. [PMID: 17550643 DOI: 10.1179/136485907x176490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mathematical modelling has been used to assess the level of malarial transmission, during the dry season, in Nouna province, in north-western Burkina Faso. The data used were collected, at four sites (one semi-urban and three rural), from 867 children aged 6-60 months who were randomly selected. Almost all of the children (850) completed the follow-up, which involved the active detection of malaria (i.e. febrile, smear-positive malarial infection) throughout a single dry season (December 2003-May 2004). Light traps were used to sample the local populations of Anopheles vectors, in order to estimate the daily biting rate. The mathematical model was then used to simulate the incidence of malaria, which was compared with the observed incidence. At all four study sites, new cases of malaria were observed throughout the dry season, although the level of transmission was low. The monthly incidence of malaria estimated using the mathematical model was very close to the observed incidence. The fit was sensitive to daily mosquito survival and daily human parasite clearance. In Nouna province, effective interventions to prevent malaria should not be confined to the rainy season but must continue throughout the year. The focus should be on the clearance of parasitaemias, by the use of effective drugs, and on decreasing vector survival, by the use of vector-control methods.
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Affiliation(s)
- Y Yé
- African Population and Health Research Centre, PO Box 10787, 00100 GPO Nairobi, Kenya.
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