1
|
Soboh R, Gino-Moor S, Jiris N, Ginsberg S, Oliven R. Validation of a viable delirium detection test performed by nurses and physicians during routine patient care. BMC Geriatr 2024; 24:297. [PMID: 38549098 PMCID: PMC10976736 DOI: 10.1186/s12877-024-04884-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Delirium is a frequent mental impairment in geriatric patients hospitalized in acute care facilities. It carries a high risk of complications and is often the first symptom of acute illness. It is clearly important to identify the development of delirium at an early stage, and several short and effective diagnostic tests have been developed and validated for this purpose. Despite this, patients on hospital wards are seldom monitored for signs of emergent delirium, suggesting that compliance with guidelines would be improved by introducing a simpler and more user-friendly test. METHODS We recently implemented a simple delirium assessment tool, called RMA that can be introduced into the daily routine of ward staff without significantly adding to their workload. The nurses noted their impression of the patient's cognitive state in the electronic medical record, and during the morning round the ward physician administered a short attention test to any patients suspected of new cognitive impairment. In this study, we compared RMA test against the widely used and well validated 4AT. RESULTS RMA performed daily by the ward staff was found to be non-inferior to 4AT performed by an experienced rater. Compared to 4AT, R&M had a sensitivity of 93.9% and a specificity of 98.3%. An Altman-Bland plot indicated that both tests can be used interchangeably. CONCLUSIONS The RMA test is reliable, easy to administer, likely to boost compliance with guidelines, and is expected to raise awareness of delirium among the nurses and physicians directly involved in the diagnostic process.
Collapse
Affiliation(s)
| | - Sharon Gino-Moor
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Nizar Jiris
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Shira Ginsberg
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel
| | - Ron Oliven
- Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel.
- Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel.
| |
Collapse
|
2
|
Haring Y, Goldschmidt N, Taha S, Stemer G, Filanovsky K, Hellman I, Okasha D, Krayem B, Levi I, Rosenbaum H, Koren-Michowitz M, Yagna S, Nemets A, Gino-Moor S, Saban R, Cohen J, Halperin E, Wolach O, Dally N, Merkel D, Oster HS, Mittelman M. MDS-Related Anemia Is Associated with Impaired Quality of Life but Improvement Is Not Always Achieved by Increased Hemoglobin Level. J Clin Med 2023; 12:5865. [PMID: 37762806 PMCID: PMC10532166 DOI: 10.3390/jcm12185865] [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: 08/04/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Quality of life is impaired in MDS, but the role of hemoglobin level is unclear. To study the Hb-QoL correlation at diagnosis and 1 year later, patients filled out the EQ-5D questionnaire, assessing their mobility, self care, daily activities, pain/discomfort, and anxiety/depression, using scores of 0 (normal), 1 (mild/moderate), or 2 (poor). They also evaluated their health using a visual analogue scale, scoring from 0 (poor) to 100 (excellent). The anemia subgroups were: none/normal (Hb ≥ 12.5 g/dL), mild (10 ≤ Hb < 12.5), moderate (9 ≤ Hb < 10), severe (8 ≤ Hb < 9), or very severe (Hb < 8). LR-MDS patients (n = 127) and inpatient controls (n = 141) participated. The anemic patients had a poor QoL and the MDS patients had a lower QoL with a lower Hb. The controls had no QoL difference among the various anemia subgroups. In addition, the MDS QoL sharply decreased with an Hb of < 9. The MDS patients showed a wide QoL variability, i.e., different QoL scores in the same Hb subgroup, suggesting that other factors affect QoL (e.g., age and comorbidities). After 1 year (n = 61), the QoL was still poor for most MDS patients (including 27 patients with an increased Hb). In summary: (1) a poor QoL in MDS-anemia is non-linear, suggesting other influencing factors on QoL. (2) The sharp QoL drop with Hb < 9 g/dL challenges the transfusion Hb threshold. (3) The QoL in anemic MDS patients might differ from that in non-MDS patients. (4) Raising Hb, while recommended, does not guarantee an improved QoL.
Collapse
Affiliation(s)
- Yael Haring
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (Y.H.); (N.G.)
- MDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (S.T.); (D.M.)
| | - Noa Goldschmidt
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (Y.H.); (N.G.)
- MDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Shaimaa Taha
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (S.T.); (D.M.)
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Galia Stemer
- Galillee Medical Center, Bar-Ilan University, Nahariya 5290002, Israel;
| | | | | | - Doaa Okasha
- Haemek Medical Center, Afula 1834111, Israel;
| | - Baher Krayem
- Rambam Health Care Campus, Haifa 3109601, Israel;
| | - Itai Levi
- Soroka Medical Center, Be’er Sheva 84101, Israel;
| | | | | | - Shai Yagna
- Baruch Pade-Poriya Medical Center, Tiberias 1528001, Israel
| | | | | | | | - Joseph Cohen
- Laniado Medical Center, Netanya 4290200, Israel;
| | - Erez Halperin
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 4941492, Israel; (E.H.); (O.W.)
| | - Ofir Wolach
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 4941492, Israel; (E.H.); (O.W.)
| | - Najib Dally
- Ziv Medical Center, Bar-Ilan University, Zefad 5290002, Israel;
| | - Drorit Merkel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (S.T.); (D.M.)
- MDS Center, Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Howard S. Oster
- MDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (S.T.); (D.M.)
| | - Moshe Mittelman
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (Y.H.); (N.G.)
- MDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (S.T.); (D.M.)
| |
Collapse
|
3
|
Oliven R, Rotfeld M, Gino-Moor S, Schiff E, Odeh M, Gil E. Early Detection and Intervention for Patients with Delirium Admitted to the Department of Internal Medicine: Lessons from a Pilot Initiative. Dement Geriatr Cogn Dis Extra 2021; 11:134-139. [PMID: 34178018 PMCID: PMC8215981 DOI: 10.1159/000515958] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Older patients who arrive to the emergency room with delirium have a worse prognosis than others. Early detection and treatment of this problem has been shown to improve outcome. We have launched a project at our hospital to improve the care of patients who arrive delirious to the medical emergency room. The present article describes lessons that can be learned from this pilot initiative. Methods All patients older than 70 years admitted to the department of internal medicine were screened for delirium in the emergency room using the 4AT screening tool. Data of patients with a 4AT score ≥5 (or with incomplete score) were transferred to the geriatric unit of the hospital. On the ward, the presence of delirium was confirmed by a geriatric nurse that validated that the patient could walk with support and ordered mobilization and physiotherapy (M&P). Results Over the 2 and a half years (10 quarters) allocated for the pilot project, 1,078 medical patients with delirium were included in this survey. In 59.3%, the diagnosis of delirium could be confirmed only after admission. Due to budgetary constraints, only 54.7% received the allocated specific intervention − early M&P. Since it was decided that randomization was not appropriate for our initiative, we found that patients who received M&P had lower (better) 4AT scores on admission, and lower mortality. No significant difference was found between the patients who received M&P and the others in length of hospitalization and discharge to nursing homes. Retrospective comparison of the two groups did not enable to determine whether M&P was given to the patients for whom it was most effective. Conclusions It is often not possible to verify in the emergency room that the cognitive decline is indeed new, that is, is due to delirium, and measures must be taken to verify this point as soon as possible after admission. Due to numerous constraints, the availability of early M&P is often insufficient. Whenever resources are scarce and randomization is avoided, adequate criteria should be found for allocating existing dedicated staff to patients for whom early mobilization is likely to be most beneficial.
Collapse
Affiliation(s)
- Ron Oliven
- Geriatric Unit, Bnai Zion Medical Center, Haifa, Israel.,Department of Medicine, Bnai Zion Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | | | - Sharon Gino-Moor
- Department of Medicine, Bnai Zion Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Elad Schiff
- Department of Medicine, Bnai Zion Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Majed Odeh
- Department of Medicine, Bnai Zion Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Efrat Gil
- Geriatric Service, Clalit Health Services, Haifa and West Galilee, Haifa, Israel.,Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Ganzel C, Ram R, Gural A, Wolach O, Gino-Moor S, Vainstein V, Nachmias B, Apel A, Koren-Michowitz M, Pasvolsky O, Yerushalmi R, Danylesko I, Cohen Y, Peretz G, Moshe Y, Zektser M, Yeganeh S, Rowe JM, Ofran Y. Venetoclax is safe and efficacious in relapsed/refractory AML. Leuk Lymphoma 2020; 61:2221-2225. [DOI: 10.1080/10428194.2020.1761964] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Chezi Ganzel
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ron Ram
- Department of Hematology, Tel Aviv (Sourasky) Medical Center and Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gural
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Ofir Wolach
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Boaz Nachmias
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Arie Apel
- Department of Hematology, Assaf Harofeh Medical Center, Tzrifin, Israel
| | | | - Oren Pasvolsky
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Ronit Yerushalmi
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ivetta Danylesko
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yosef Cohen
- Department of Hematology, Laniado Medical Center, Netanya, Israel
| | - Galit Peretz
- Department of Hematology, Soroka Medical Center, Beer Sheva, Israel
| | - Yakir Moshe
- Department of Hematology, Tel Aviv (Sourasky) Medical Center and Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Zektser
- Department of Hematology, Soroka Medical Center, Beer Sheva, Israel
| | - Shay Yeganeh
- The Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Jacob M. Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
- Department of Hematology, Rambam Healthcare Campus, Haifa, Israel
| | - Yishai Ofran
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
5
|
Kreiniz N, Khateeb A, Gino-Moor S, Polliack A, Tadmor T. Acute Renal Failure Associated with Lenalidomide Treatment in Multiple Myeloma: A Rare Occurrence? Anticancer Res 2016; 36:2889-2892. [PMID: 27272801] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/26/2016] [Indexed: 06/06/2023]
Abstract
Renal failure is a frequent complication of multiple myeloma (MM). Recently, the combination of lenalidomide-dexamethasone has become one of the cornerstone regimens for the treatment of MM. Impairment of renal function exacerbation is a rare, but potential, complication of lenalidomide therapy in plasma cell dyscrasias. We present two patients who developed exacerbation of renal function during their first cycle of therapy with lenalidomide. In the first case, we present a 76-year-old-male with MM and impaired renal function, who declined two weeks after initiation of second-line therapy with lenalidomide. His renal functions improved after discontinuation of lenalidomide and with supportive care. In the second case, we describe a 61-year-old woman who was started on lenalidomide for relapsed MM and admitted to intensive care unit three weeks later due to severe renal failure. Despite intensive supportive care, her renal function deteriorated even more and she died. We conclude that renal failure is an uncommon, but serious, potential complication of lenalidomide therapy in plasma cell dyscrasias, particularly MM. Close monitoring of renal function is clearly recommended during this treatment.
Collapse
Affiliation(s)
| | - Ali Khateeb
- Internal medicine A, Bnai Zion Medical Center, Haifa, Israel
| | | | - Aaron Polliack
- Department of Hematology, Hadassah University, Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
6
|
Ofran Y, Leiba R, Ganzel C, Saban R, Gatt M, Ram R, Arad A, Bulvik S, Hellmann I, Gino-Moor S, Zuckerman T, Hoffman R, Horowitz N, Lavi N, Ringelstein S, Henig I, Hayun M, Rowe JM. Prospective comparison of early bone marrow evaluation on day 5 versus day 14 of the "3 + 7" induction regimen for acute myeloid leukemia. Am J Hematol 2015; 90:1159-64. [PMID: 26435038 DOI: 10.1002/ajh.24207] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 01/07/2023]
Abstract
Evaluation of early response during induction therapy for acute myeloid leukemia (AML) is used for prognostication and re-induction strategy, yet the optimal evaluation time point is unknown. Clearance of bone marrow (BM) blasts by day 14 of therapy does not ensure remission; thus, some patients requiring re-induction are neglected. This study aimed to examine the role of earlier BM evaluation during induction for predicting remission and overall survival. Results of BM testing on the 5th and 14th day of intensive induction were prospectively compared in 127 adult patients with AML. Re-induction was given, based on Day 14 results, to 25 patients. Reduction of the BM blast count to <5% as early as by the fifth day of induction was more specifically associated with the achievement of remission compared to Day 14 (88.2% vs. 60%, respectively). Rapid responders have a better 3-year overall survival (OS). Day 5 results are a stronger predictor of OS by multivariate analysis and better segregate long-term survivors than the Day 14th BM count (66% vs. 30%, P = 0.0001 and 48% vs. 37%, respectively, P = 0.04). The Day 5 evaluation of BM carries significant clinical information. The benefit of prescribing re-induction based on such early evaluation should be prospectively studied.
Collapse
Affiliation(s)
- Yishai Ofran
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Ronit Leiba
- Quality of Care Unit; Rambam Health Care Campus; Haifa Israel
| | - Chezi Ganzel
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Revital Saban
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Moshe Gatt
- Hematology Department; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Ron Ram
- Department of Hematology and bone marrow transplantation; Sourasky Medical Center, Tel Aviv University; Tel Aviv Israel
| | - Ariela Arad
- Department of Hematology; Sanz Medical Center - Laniado Hospital; Netanya Israel
| | - Shlomo Bulvik
- Department of Hematology; Sanz Medical Center - Laniado Hospital; Netanya Israel
| | - Ilana Hellmann
- Hematology department; Meir Medical Center; Kfar Saba Israel
| | | | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Ron Hoffman
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Netanel Horowitz
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Noa Lavi
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Shimrit Ringelstein
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
| | - Israel Henig
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
| | - Michal Hayun
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
| | - Jacob M. Rowe
- Department of Hematology and Bone Marrow Transplantation; Rambam Health Care Campus; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion, Haifa, Israel, Israel Institute of Technology
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| |
Collapse
|
7
|
Gil E, Tov N, Gino-Moor S, Goldenberg I, Matetzky S, Gottlieb S, Wolfovitz E. Age as a predictor of management and outcome in acute myocardial infarction patients without co morbidity – from ACSIS 2010. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.242] [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: 11/16/2022]
|
8
|
Gino-Moor S, Paz A, Pick N, Potasman I. Pulmonary coccidioidomycosis acquired during travel—a diagnostic and therapeutic challenge. Travel Med Infect Dis 2003; 1:53-7. [PMID: 17291883 DOI: 10.1016/s1477-8939(03)00011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Revised: 01/16/2003] [Accepted: 01/16/2003] [Indexed: 10/27/2022]
Abstract
Reports of coccidioidomycosis are rare outside the Western hemisphere. We report the case of a 57 year-old Israeli who had returned from California with pneumonia. As his condition had deteriorated despite macrolides and beta-lactams, coccidioidomycosis was suspected. Both sputum culture and serology confirmed the diagnosis. Conventional doses of fluconazole were marginally beneficial, and a complete resolution was achieved only with very high doses. Travel to the South-Western United States may expose travelers to this uncommon disease.
Collapse
Affiliation(s)
- Sharon Gino-Moor
- Department of Medicine C, Rappaport Faculty of Medicine, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Technion, Haifa 31048, Israel
| | | | | | | |
Collapse
|