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Frostig T, Benjamini Y, Kehat O, Weiss-Meilik A, Mandel D, Peleg B, Strauss Z, Mitelpunkt A. Developing a length of stay prediction model for newborns, achieving better accuracy with greater usability. Int J Med Inform 2023; 180:105267. [PMID: 37918217 DOI: 10.1016/j.ijmedinf.2023.105267] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND One in ten newborn children is born prematurely. The elongated length of stay (LOS) of these children in the Neonatal Intensive Care Unit (NICU) has important implications on hospital occupancy figures, healthcare and management costs, as well as the psychology of parents. In order to allow accurate planning and resource allocation, this study aims to create a generalizable and robust model to predict the NICU LOS of preterm newborns. METHODS Data were collected from a large tertiary center NICU between 2011 and 2018 and relates to 5,362 newborns. The selected model was externally validated using a data set of 8,768 newborns from another tertiary center NICU. This report compares several models, such as Random Forest (RF), quantile RF, and other feature selection methods, including LASSO and AIC step-forward selection. In addition, a novel step-forward selection based on False Discovery Rate (FDR) for quantile regression is presented and evaluated. RESULTS A high-orderquantile regression model for predicting preterm newborns' LOS that uses only four features available at birth had more attractive properties than other richer ones. The model achieved a Mean Absolute Error (MAE) of 6.26 days on the internal validation set (average LOS 27.04) and an MAE of 6.04 days on the external validation set (average LOS 29.32). The suggested model surpassed the accuracy obtained by models in the literature. It is shown empirically that the FDR-based selection has better properties than the AIC-based step-forward selection approach. CONCLUSION This paper demonstrates a process to create a predictive model for NICU LOS in preterm newborns, where each step is reasoned. We obtain a simple and robust model for NICU LOS prediction, which achieves far better results than the current model used for financing NICUs. Utilizing this model, we have created an easy-to-use online web application to ease parents' worries and to assist NICU management: https://tzviel.shinyapps.io/calcuLOS.
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Affiliation(s)
- Tzviel Frostig
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
| | - Yoav Benjamini
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Sagol School of Neuroscience and the Edmond Safra Bioinformatics Center, Tel Aviv University Ramat Aviv, 69978, Tel Aviv, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Dror Mandel
- Departments of Neonatology and Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ben Peleg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Zipora Strauss
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Alexis Mitelpunkt
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Pediatric Rehabilitation, Department of Rehabilitation, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
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Shusterman E, Prozan L, Ablin JN, Weiss-Meilik A, Adler A, Choshen G, Kehat O. Neutrophil-to-lymphocyte ratio trend at admission predicts adverse outcome in hospitalized respiratory syncytial virus patients. Heliyon 2023; 9:e16482. [PMID: 37251466 PMCID: PMC10220360 DOI: 10.1016/j.heliyon.2023.e16482] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aims Severe cases of respiratory syncytial virus (RSV) infection are relatively rare but may lead to serious clinical outcomes, including respiratory failure and death. These infections were shown to be accompanied by immune dysregulation. We aimed to test whether the admission neutrophil-to-leukocyte ratio, a marker of an aberrant immune response, can predict adverse outcome. Methods We retrospectively analyzed a cohort of RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020d. Laboratory, demographic and clinical parameters were collected. Two-way analysis of variance was used to test the association between neutrophil-lymphocyte ratio (NLR) values and poor outcomes. Receiver operating characteristic (ROC) curve analysis was applied to test the discrimination ability of NLR. Results In total, 482 RSV patients (median age 79 years, 248 [51%] females) were enrolled. There was a significant interaction between a poor clinical outcome and a sequential rise in NLR levels (positive delta NLR). The ROC curve analysis revealed an area under curve (AUC) of poor outcomes for delta NLR of (0.58). Using a cut-off of delta = 0 (the second NLR is equal to the first NLR value), multivariate logistic regression identified a rise in NLR (delta NLR>0) as being a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score, with an odds ratio of 1.914 (P = 0.014) and a total AUC of 0.63. Conclusions A rise in NLR levels within the first 48 h of hospital admission can serve as a prognostic marker for adverse outcome.
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Affiliation(s)
- Eden Shusterman
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Lior Prozan
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Jacob Nadav Ablin
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amos Adler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Guy Choshen
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
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Shusterman E, Kliuk Ben-Bassat O, Zahler D, Kupershmidt A, Weiss-Meilik A, Kehat O, Ablin JN. Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus. J Nephrol 2023; 36:1349-1359. [PMID: 36971979 PMCID: PMC10041485 DOI: 10.1007/s40620-023-01591-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) complicates a substantial part of patients with COVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. METHODS We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection with COVID-19, influenza (A + B) or RSV. RESULTS We collected data of 2593 patients hospitalized with COVID-19, 2041 patients with influenza and 429 with RSV. Patients affected by RSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized with COVID-19 had higher mortality (18% with COVID-19 vs. 8.6% and 13.5% for influenza and RSV, respectively P < 0.001) and higher need of mechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48 h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. CONCLUSION Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses.
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Affiliation(s)
- Eden Shusterman
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel.
| | - Orit Kliuk Ben-Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | - Jacob N Ablin
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ritter E, Shusterman E, Prozan L, Kehat O, Weiss Meilik A, Shibolet O, Ablin JN. The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections. J Clin Med 2023; 12:jcm12093335. [PMID: 37176775 PMCID: PMC10179215 DOI: 10.3390/jcm12093335] [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: 04/03/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. AIMS we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). METHODS a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010-2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. RESULTS liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2-22), 3.45 (CI 1.7-7), 3.1 (CI 1.7-6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. CONCLUSION liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests' peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.
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Affiliation(s)
- Einat Ritter
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Eden Shusterman
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Lior Prozan
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Ahuva Weiss Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Oren Shibolet
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Jacob Nadav Ablin
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
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Galron E, Kehat O, Weiss-Meilik A, Furlan R, Jacob G. Diagnostic approaches to syncope in Internal Medicine Departments and their effect on mortality. Eur J Intern Med 2022; 102:97-103. [PMID: 35599110 DOI: 10.1016/j.ejim.2022.05.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
Most data on mortality and investigational approaches to syncope comes from patients presented to emergency departments (ED). The aim of this study is to report intermediate term mortality in syncope patients admitted to Internal Medicine Departments and whether different diagnostic approaches to syncope affect mortality. Methods and results A single-center retrospective-observational study conducted at the Tel Aviv "Sourasky" Medical Center. Data was collected from electronic medical records (EMRs), from January 2010 to December 2020. We identified 24,021 patients, using ICD-9-CM codes. Only 7967 syncope patients were admitted to Internal Medicine Departments and evaluated. Logistic regression models were used to determine the effects of diagnostic testing per patient in each department on 30-day mortality and readmission rates. All-cause 30-day mortality rate was 4.1%. There was a significant difference in the number of diagnostic tests performed per patient between the different departments, without affecting 30-day mortality. The 30-day readmission rate was 11.4%, of which 4.4% were a result of syncope. Conclusion Syncope patients admitted to Internal Medicine Departments show a 30-day all-cause mortality rate of ∼4%. Despite the heterogeneity in the approach to the diagnosis of syncope, mortality is not affected. This novel information about syncope patients in large Internal Medicine Departments is further proof that the diagnosis of syncope requires a logic, personalized approach that focuses on medical history and a few tailored, diagnostic tests.
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Affiliation(s)
- Ehud Galron
- Department of Medicine F. Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Recanati Autonomic Research Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Orli Kehat
- I-Medata AI Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Raffaello Furlan
- Internal Medicine, Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | - Giris Jacob
- Department of Medicine F. Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Recanati Autonomic Research Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
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Prozan L, Shusterman E, Ablin J, Mitelpunkt A, Weiss-Meilik A, Adler A, Choshen G, Kehat O. Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection. Sci Rep 2021; 11:21519. [PMID: 34728719 PMCID: PMC8563769 DOI: 10.1038/s41598-021-00927-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/14/2021] [Indexed: 12/11/2022] Open
Abstract
A high neutrophil to lymphocyte ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV). A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P < 0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.68, compared with 0.57 and 0.58 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 6.82) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 2.9, P < 0.001). NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.
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Affiliation(s)
- Lior Prozan
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel.
| | - Eden Shusterman
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Jacob Ablin
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Alexis Mitelpunkt
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Pediatric Rehabilitation Service, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Amos Adler
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Microbiology Laboratory, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Guy Choshen
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
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Zoabi Y, Kehat O, Lahav D, Weiss-Meilik A, Adler A, Shomron N. Predicting bloodstream infection outcome using machine learning. Sci Rep 2021; 11:20101. [PMID: 34635696 PMCID: PMC8505419 DOI: 10.1038/s41598-021-99105-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Bloodstream infections (BSI) are a main cause of infectious disease morbidity and mortality worldwide. Early prediction of BSI patients at high risk of poor outcomes is important for earlier decision making and effective patient stratification. We developed electronic medical record-based machine learning models that predict patient outcomes of BSI. The area under the receiver-operating characteristics curve was 0.82 for a full featured inclusive model, and 0.81 for a compact model using only 25 features. Our models were trained using electronic medical records that include demographics, blood tests, and the medical and diagnosis history of 7889 hospitalized patients diagnosed with BSI. Among the implications of this work is implementation of the models as a basis for selective rapid microbiological identification, toward earlier administration of appropriate antibiotic therapy. Additionally, our models may help reduce the development of BSI and its associated adverse health outcomes and complications.
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Affiliation(s)
- Yazeed Zoabi
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Edmond J Safra Center for Bioinformatics, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
| | - Dan Lahav
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Edmond J Safra Center for Bioinformatics, Tel Aviv University, 6997801, Tel Aviv, Israel.,The Blavatnik School of Computer Science, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.
| | - Amos Adler
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel. .,Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.
| | - Noam Shomron
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel. .,Edmond J Safra Center for Bioinformatics, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Henig O, Kehat O, Meijer SE, Chikly A, Weiss-Meilik A, Egoz E, Ben-Ami R, Paran Y. Antibiotic Use during the COVID-19 Pandemic in a Tertiary Hospital with an Ongoing Antibiotic Stewardship Program. Antibiotics (Basel) 2021; 10:antibiotics10091056. [PMID: 34572638 PMCID: PMC8472687 DOI: 10.3390/antibiotics10091056] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/22/2022] Open
Abstract
During the recent pandemic, the fact that the clinical manifestation of COVID-19 may be indistinguishable from bacterial infection, as well as concerns of bacterial co-infection, have been associated with an increased use of antibiotics. The objective of this study was to assess the effect of targeted antibiotic stewardship programs (ASP) on the use of antibiotics in designated COVID-19 departments and to compare it to the antibiotic use in the equivalent departments in the same periods of 2018 and 2019. Antibiotic consumption was assessed as days of treatment (DOT) per 1000 patient days (PDs). The COVID-19 pandemic was divided into three periods (waves) according to the pandemic dynamics. The proportion of patients who received at least one antibiotic was significantly lower in COVID-19 departments compared to equivalent departments in 2018 and 2019 (Wave 2: 30.2% vs. 45.6% and 44.9%, respectively; Wave 3: 30.5% vs. 47.8% and 50.1%, respectively, p < 0.001). The DOT/1000PDs in every COVID-19 wave was lower than during similar periods in 2018 and 2019 (179-282 DOT/1000PDs vs. 452-470 DOT/1000PDs vs. 426-479 DOT/1000PDs, respectively). Moreover, antibiotic consumption decreased over time during the pandemic. In conclusion, a strong ASP is effective in restricting antibiotic consumption, particularly for COVID-19 which is a viral disease that may mimic bacterial sepsis but has a low rate of concurrent bacterial infection.
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Affiliation(s)
- Oryan Henig
- Infectious Disease and Epidemiology Department, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.E.M.); (A.C.); (R.B.-A.); (Y.P.)
- Correspondence:
| | - Orli Kehat
- Medata AI Center, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (O.K.); (A.W.-M.); (E.E.)
| | - Suzy E. Meijer
- Infectious Disease and Epidemiology Department, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.E.M.); (A.C.); (R.B.-A.); (Y.P.)
| | - Amanda Chikly
- Infectious Disease and Epidemiology Department, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.E.M.); (A.C.); (R.B.-A.); (Y.P.)
| | - Ahuva Weiss-Meilik
- Medata AI Center, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (O.K.); (A.W.-M.); (E.E.)
| | - Eyal Egoz
- Medata AI Center, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (O.K.); (A.W.-M.); (E.E.)
| | - Ronen Ben-Ami
- Infectious Disease and Epidemiology Department, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.E.M.); (A.C.); (R.B.-A.); (Y.P.)
| | - Yael Paran
- Infectious Disease and Epidemiology Department, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (S.E.M.); (A.C.); (R.B.-A.); (Y.P.)
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Roberts M, Kehat O, Gross M, Lasri N, Issachar G, VandeWeerd ES, Peremen Z, Geva A. TECHNOLOGY TRANSLATING THE RELATIONSHIP BETWEEN QUALITY OF LIFE AND MEMORY USING A NOVEL EEG TECHNOLOGY. Innov Aging 2019. [PMCID: PMC6840274 DOI: 10.1093/geroni/igz038.1207] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Existing research has postulated a relationship between cognition and quality of life (QoL). Components of QoL such as satisfaction with social support may be particularly influential in memory for those with comorbidities. Additional research is needed to characterize the relationship between memory and QoL domains. Findings are presented from a clinical trial using BNA memory scores to assess brain health. BNA uses EEG technology and machine learning to map networks of brain functioning including working memory. Participants were older adults living in The Villages, an active lifestyle community in Florida, between the ages of 55-85, from 8/30/2017-3/11/2019. Participants were stratified into 2 groups: healthy (no CNS/psychiatric conditions; n=158) and multi-morbid (>1 CNS and/or psychiatric conditions; n=106) and compared across memory and QoL indicators. Subjective QoL was measured by the WHOQOL-BREF across 4 domains (physical, psychological, social, environmental). Scores on QoL domains were divided into 3 levels (high-medium-low) and tested for their relationship to BNA memory scores using ANOVA. Results indicate a relationship between health status, subjective QoL and BNA memory scores. Healthy subjects who scored high in the psychological QoL domain had significantly higher memory scores [F(2,152)=4.30,p=.02)]. In healthy subjects, satisfaction with social support (p=.001) had the strongest impact on memory for social QoL, while body image (p=.06) and concentration (p=.06) were the most salient predictors of psychological QoL and approached significance. Multi-morbid subjects who indicated high social ratings had higher memory scores (F(2,100)=3.75,p=.03) which relied heavily on satisfaction with social support (p=.003). Implications for policy and practice are discussed.
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Affiliation(s)
| | | | - Michaela Gross
- University of South Florida, Tampa, Florida, United States
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Reches A, Or-ly H, Weiss M, Stern Y, Baumeister J, Foss K, Ellis J, Laish B, Laufer O, Sadeh B, Ettinger M, Arthur T, Shaham G, Myer G, Kehat O, Shani-Hershkovich R, Peremen Z, Geva A. P 136 Brain network analysis of EEG data in the service of clinical assessment – utilizing big data and prior theoretical knowledge to identify a biomarker for mTBI in adolscents. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.209] [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: 10/18/2022]
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Sharvit A, Segal M, Kehat O, Stork O, Richter-Levin G. Differential modulation of synaptic plasticity and local circuit activity in the dentate gyrus and CA1 regions of the rat hippocampus by corticosterone. Stress 2015; 18:319-27. [PMID: 25815975 DOI: 10.3109/10253890.2015.1023789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Indexed: 11/13/2022] Open
Abstract
Depending on its severity, timing and context, stress has been shown to have a differential regional effect on hippocampal synaptic plasticity. While the focus of attention in most recent studies is on excitatory synapses and generation, modifications of inhibitory synapses and local interneurons cannot be ignored. We have now examined the effects of corticosterone (CORT) on extrinsic afferent and local circuit plasticity of the perforant path on the dentate gyrus (DG) and the ventral hippocampal commissure on CA1. Local circuit activity was measured by responses to paired-pulse stimulation. Control rats expressed afferent long-term potentiation (LTP) and local circuit plasticity in both the DG and CA1. Administration of a high dosage of CORT-reduced paired-pulse inhibition and increased facilitation in DG but not in CA1, whereas administration of a moderate CORT dosage had no effect. Moderate CORT doses caused enhancement of LTP in the DG but not in CA1, while high CORT doses converted LTP to long-term depression in the CA1 but had no effect in the DG. CORT blocked theta burst stimulation-induced local circuit plasticity otherwise found in control DG. These findings suggest that elevation of the level of CORT results in a regionally differentiated physiological response. In addition, the results indicate that CORT affects aspects of local circuit activity and plasticity in the DG but less so in the CA1. It is possible that these differentiated alterations underlie some of the behavioral consequences and memory processes under stressful conditions.
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Affiliation(s)
- Adva Sharvit
- a "Sagol" Department of Neurobiology , University of Haifa , Haifa , Israel
| | - Menahem Segal
- b Department of Neurobiology , Weizmann Institute of Science , Rehovot , Israel
| | - Orli Kehat
- c The Institute for the Study of Affective Neuroscience (ISAN), University of Haifa , Haifa , Israel
| | - Oliver Stork
- d Department of Genetics and Molecular Neurobiology , Institute of Biology, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
- e Center for Behavioural Brain Sciences , Magdeburg , Germany , and
| | - Gal Richter-Levin
- a "Sagol" Department of Neurobiology , University of Haifa , Haifa , Israel
- c The Institute for the Study of Affective Neuroscience (ISAN), University of Haifa , Haifa , Israel
- f Department of Psychology , University of Haifa , Haifa , Israel
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Lucas M, Ilin Y, Anunu R, Kehat O, Xu L, Desmedt A, Richter-Levin G. Long-term effects of controllability or the lack of it on coping abilities and stress resilience in the rat. Stress 2014; 17:423-30. [PMID: 24882609 DOI: 10.3109/10253890.2014.930430] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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] [Indexed: 02/05/2023] Open
Abstract
Findings suggest that stress-induced impaired learning and coping abilities may be attributed more to the psychological nature of the stressor, rather than its physical properties. It has been proposed that establishing controllability over stressors can ameliorate some of its effects on cognition and behavior. Gaining controllability was suggested to be associated with the development of stress resilience. Based on repeated exposure to the two-way shuttle avoidance task, we previously developed and validated a behavioral task that leads to a strict dissociation between gaining controllability (to the level that the associated fear is significantly reduced) and a fearful state of uncontrollability. Employing this protocol, we investigated here the impact of gaining or failing to gain emotional controllability on indices of anxiety and depression and on subsequent abilities to cope with positively or negatively reinforcing learning experiences. In agreement with previous studies, rats exposed to the uncontrollable protocol demonstrated high concentration of sera corticosterone, increased immobility, reduced duration of struggling in the forced swim test and impaired ability to acquire subsequent learning tasks. Achieving emotional controllability resulted in resilience to stress as was indicated by longer duration of struggling in the forced swim test, and enhanced learning abilities. Our prolonged training protocol, with the demonstrated ability of rats to gain emotional controllability, is proposed as a useful tool to study the neurobiological mechanisms of stress resilience.
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Affiliation(s)
- Morgan Lucas
- The Institute for the Study of Affective Neuroscience (ISAN), University of Haifa , Haifa , Israel
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