The current study examined how functional and existential coping factors are related to the sense... more The current study examined how functional and existential coping factors are related to the sense of self-benefit among end-of-life (EOL) family caregivers caring for hospitalized older adults. A convenience sample of 92 family caregivers was interviewed in two Israeli hospitals using a structured questionnaire based on Pearlin's stress process model. Findings show that engagement in EOL existential tasks and motivations, such as life review, spirituality, multigenerational family relationships, and preparation for death, acted as a coping resource and was positively related with caregivers' sense of self-benefit. However, functional caregiving did not act as a significant stressor, as it was weakly related to caregivers' sense of self-benefit. Findings discuss the importance of training health professionals to recognize and discuss existential concerns with EOL family caregivers. [Journal of Gerontological Nursing, xx(x), xx-xx.].
OBJECTIVES Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA).... more OBJECTIVES Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA). In this review we evaluated longevity and the impact of several disease parameters on survival of GCA patients. METHODS Review of the medical literature during the period 1975-2018, using PubMed database. RESULTS Epidemiologic studies addressing the issue of survival in GCA patients used variable methods of calculating mortality rates in relation to background population or in relation to selected controls. Several epidemiologic studies found that survival of GCA patients was similar to that of the general population. Others reported increased mortality in patients with GCA, or in subgroups of GCA patients. 5-Year and 10-year survival rates differed considerably among studies: 5-year survival rates ranged between 60-90% (except for 2 extremes of 35% and 97%), and 10-year survival rates ranged between 48-81%. Reasons for these discrepancies are unclear, and may be related to differences ...
The incidence of primary systemic vasculitides varies among different geographic regions and ethn... more The incidence of primary systemic vasculitides varies among different geographic regions and ethnic origins. The aim of this study was to examine the incidence rates of vasculitides in the Jerusalem Jewish population, and to examine possible trends in incidence rates over a 20-year period. The clinical databases of inpatients at the 2 medical centers in Jerusalem were searched for patients with vasculitis diagnosed between 1990-2009. Individual records were then reviewed by one of the authors. The significance of trends in incidence rates throughout the study period was evaluated by Pearson correlation coefficient. The average annual incidence rate of polyarteritis nodosa was 3.6/million adults (95% CI 1.6-4.7). Incidence rates did not change significantly during this period (r = 0.39, p = 0.088). The incidence of granulomatosis with polyangiitis (GPA) was 4.1 (2.2-5.9) for the whole period, during which it increased significantly (r = 0.53, p < 0.05). The incidence of microscopi...
Complementary and alternative medicine has recently attracted attention due to its widespread use... more Complementary and alternative medicine has recently attracted attention due to its widespread use. In a recent study in Israel, almost a half of CAM users in the general population used it for joint diseases or back pain. To evaluate the prevalence of CAM use among patients with defined rheumatic diseases, and analyze the demographic features of CAM users, their reasons for using CAM and the use of specific CAM methods. We conducted face-to-face structured interviews of 350 patients attending rheumatology clinics, regarding past or present use of CAM, specifying the various CAM types they used, and reasons for using CAM. Demographic data including age, gender, country of birth and origin, and level of education were also collected. Altogether, 148 patients reported using CAM (42%). In general, homeopathy and acupuncture were the most commonly used types (44% and 41% of the patients, respectively). The mean number of CAM methods per patient was 1.9 +/- 1.1. CAM was more commonly used...
The purpose of this cross-sectional survey was to obtain and analyze data on self-perceived effic... more The purpose of this cross-sectional survey was to obtain and analyze data on self-perceived efficacy of different types of complementary alternative medicine (CAM) by patients with various rheumatologic conditions. Patients followed in rheumatology outpatient clinics were screened for the use of CAM. Patients reporting the use of CAM were asked to participate in face-to-face structured interviews, specifying the various CAM types they used, and grading their subjective impression of efficacy of each CAM type on a scale of 1-10. 350 consecutive patients were screened and 148 reported using CAM. In general, homeopathy and acupuncture were the most commonly used CAM types (44% and 41% of the CAM users, respectively). The mean number of different CAM methods used by a CAM user was 1.9 +/- 1.1. Patients with fibromyalgia used significantly more CAM methods (2.7 +/- 1.4, p = 0.005). On patients' self-perceived efficacy scale of 1-10, the mean score of the whole group was 5.3 +/- 3.2. ...
The "dying patient" law in Israel deals with end- of-life decisions. This prospective s... more The "dying patient" law in Israel deals with end- of-life decisions. This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients. During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome. Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questionnaires. Overall, 69, patients...
BACKGROUND The "dying patient" law in Israel deals with end- of-life decisions. AIM Thi... more BACKGROUND The "dying patient" law in Israel deals with end- of-life decisions. AIM This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients. METHODS During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome. RESULTS Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questi...
Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. Over several de... more Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. Over several decades there has been an increase in its incidence, although this trend has changed in North America, northern Europe and in Israel. The signs and symptoms of GCA can be classified into four general subsets: manifestations of cranial arteritis, extra-cranial arteritis, systemic symptoms and polymyalgia rheumatica (PMR). The diagnosis is based on clinical characteristics and established by the presence of inflammatory markers. However, the only specific diagnostic test is a temporal artery biopsy. The optimal length of the biopsy appears to be between 10- 20 mm. Bilateral biopsies may increase the diagnostic yield. Patients with "biopsy negative giant cell arteritis" are characterized by older age, more headaches at presentation and thrombocytosis. Some imaging modalities may aid in the diagnosis of GCA. The most commonly used is color duplex ultrasound of the temporal arteries, ...
Hydroxychloroquine (HCQ) is an antimalarial agent with immunomodulatory effects. It is widely use... more Hydroxychloroquine (HCQ) is an antimalarial agent with immunomodulatory effects. It is widely used in rheumatologic diseases, and has a very high efficacy/toxicity ratio. It is particularly important in the treatment of systemic lupus erythematosus (SLE) since it reduces new organ involvement and disease flares, and relieves skin and joint symptoms. Some patients develop hypersensitivity rash in response to HCQ. In such patients the drug is withdrawn and replaced by another medication. All the alternative medications for rheumatological patients are significantly more toxic than HCQ. We describe our initial experience of HCQ slow oral desensitization. All 4 patients who were recruited completed the procedure successfully without significant difficulty. Our results suggest that HCQ slow oral desensitization is safe, effective, and easy to perform.
BACKGROUND Social distancing was the predominant strategy used to mitigate the spread of coronavi... more BACKGROUND Social distancing was the predominant strategy used to mitigate the spread of coronavirus disease 2019 (COVID-19) at the start of the COVID-19 pandemic. METHODS Retrospective review of all positive blood cultures from January to July in the years 2017-2020. AIMS The object of this research was to study the impact of social distancing on the incidence of bacteraemia. The number of admitted patients with positive blood cultures in April-May 2020 in one tertiary medical centre was compared to the number during the same period in the previous three years (April-May 2017-2019). RESULTS There were fewer cases of Streptococcus bacteraemia as well as coagulase-negative Staphylococcus bacteraemia and other possible contaminated blood cultures, in April-May 2020. Compared to the previous three years, the incidence of Streptococcus pneumoniae bacteraemia among all bacteraemias was lower in April-May 2020 (5%) than in 2017-19 (12.0%, 95% confidence interval 10.3%-14.1%). In general, fewer cases of bacteraemia caused by oropharynx organisms were observed in April-May 2020; only six cases vs 31(95% confidence interval 10-53) during the same period in 2017-19. Only one case of Streptococcus pneumoniae bacteraemia was observed in April-May 2020, and its percentage among all bacteraemias was lower in April-May 2020 (0.4%) than during the same period in 2017-19 (3.3%). CONCLUSION The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted via respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria. This article is protected by copyright. All rights reserved.
The current study examined how functional and existential coping factors are related to the sense... more The current study examined how functional and existential coping factors are related to the sense of self-benefit among end-of-life (EOL) family caregivers caring for hospitalized older adults. A convenience sample of 92 family caregivers was interviewed in two Israeli hospitals using a structured questionnaire based on Pearlin's stress process model. Findings show that engagement in EOL existential tasks and motivations, such as life review, spirituality, multigenerational family relationships, and preparation for death, acted as a coping resource and was positively related with caregivers' sense of self-benefit. However, functional caregiving did not act as a significant stressor, as it was weakly related to caregivers' sense of self-benefit. Findings discuss the importance of training health professionals to recognize and discuss existential concerns with EOL family caregivers. [Journal of Gerontological Nursing, xx(x), xx-xx.].
OBJECTIVES Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA).... more OBJECTIVES Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA). In this review we evaluated longevity and the impact of several disease parameters on survival of GCA patients. METHODS Review of the medical literature during the period 1975-2018, using PubMed database. RESULTS Epidemiologic studies addressing the issue of survival in GCA patients used variable methods of calculating mortality rates in relation to background population or in relation to selected controls. Several epidemiologic studies found that survival of GCA patients was similar to that of the general population. Others reported increased mortality in patients with GCA, or in subgroups of GCA patients. 5-Year and 10-year survival rates differed considerably among studies: 5-year survival rates ranged between 60-90% (except for 2 extremes of 35% and 97%), and 10-year survival rates ranged between 48-81%. Reasons for these discrepancies are unclear, and may be related to differences ...
The incidence of primary systemic vasculitides varies among different geographic regions and ethn... more The incidence of primary systemic vasculitides varies among different geographic regions and ethnic origins. The aim of this study was to examine the incidence rates of vasculitides in the Jerusalem Jewish population, and to examine possible trends in incidence rates over a 20-year period. The clinical databases of inpatients at the 2 medical centers in Jerusalem were searched for patients with vasculitis diagnosed between 1990-2009. Individual records were then reviewed by one of the authors. The significance of trends in incidence rates throughout the study period was evaluated by Pearson correlation coefficient. The average annual incidence rate of polyarteritis nodosa was 3.6/million adults (95% CI 1.6-4.7). Incidence rates did not change significantly during this period (r = 0.39, p = 0.088). The incidence of granulomatosis with polyangiitis (GPA) was 4.1 (2.2-5.9) for the whole period, during which it increased significantly (r = 0.53, p < 0.05). The incidence of microscopi...
Complementary and alternative medicine has recently attracted attention due to its widespread use... more Complementary and alternative medicine has recently attracted attention due to its widespread use. In a recent study in Israel, almost a half of CAM users in the general population used it for joint diseases or back pain. To evaluate the prevalence of CAM use among patients with defined rheumatic diseases, and analyze the demographic features of CAM users, their reasons for using CAM and the use of specific CAM methods. We conducted face-to-face structured interviews of 350 patients attending rheumatology clinics, regarding past or present use of CAM, specifying the various CAM types they used, and reasons for using CAM. Demographic data including age, gender, country of birth and origin, and level of education were also collected. Altogether, 148 patients reported using CAM (42%). In general, homeopathy and acupuncture were the most commonly used types (44% and 41% of the patients, respectively). The mean number of CAM methods per patient was 1.9 +/- 1.1. CAM was more commonly used...
The purpose of this cross-sectional survey was to obtain and analyze data on self-perceived effic... more The purpose of this cross-sectional survey was to obtain and analyze data on self-perceived efficacy of different types of complementary alternative medicine (CAM) by patients with various rheumatologic conditions. Patients followed in rheumatology outpatient clinics were screened for the use of CAM. Patients reporting the use of CAM were asked to participate in face-to-face structured interviews, specifying the various CAM types they used, and grading their subjective impression of efficacy of each CAM type on a scale of 1-10. 350 consecutive patients were screened and 148 reported using CAM. In general, homeopathy and acupuncture were the most commonly used CAM types (44% and 41% of the CAM users, respectively). The mean number of different CAM methods used by a CAM user was 1.9 +/- 1.1. Patients with fibromyalgia used significantly more CAM methods (2.7 +/- 1.4, p = 0.005). On patients' self-perceived efficacy scale of 1-10, the mean score of the whole group was 5.3 +/- 3.2. ...
The "dying patient" law in Israel deals with end- of-life decisions. This prospective s... more The "dying patient" law in Israel deals with end- of-life decisions. This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients. During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome. Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questionnaires. Overall, 69, patients...
BACKGROUND The "dying patient" law in Israel deals with end- of-life decisions. AIM Thi... more BACKGROUND The "dying patient" law in Israel deals with end- of-life decisions. AIM This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients. METHODS During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome. RESULTS Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questi...
Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. Over several de... more Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. Over several decades there has been an increase in its incidence, although this trend has changed in North America, northern Europe and in Israel. The signs and symptoms of GCA can be classified into four general subsets: manifestations of cranial arteritis, extra-cranial arteritis, systemic symptoms and polymyalgia rheumatica (PMR). The diagnosis is based on clinical characteristics and established by the presence of inflammatory markers. However, the only specific diagnostic test is a temporal artery biopsy. The optimal length of the biopsy appears to be between 10- 20 mm. Bilateral biopsies may increase the diagnostic yield. Patients with "biopsy negative giant cell arteritis" are characterized by older age, more headaches at presentation and thrombocytosis. Some imaging modalities may aid in the diagnosis of GCA. The most commonly used is color duplex ultrasound of the temporal arteries, ...
Hydroxychloroquine (HCQ) is an antimalarial agent with immunomodulatory effects. It is widely use... more Hydroxychloroquine (HCQ) is an antimalarial agent with immunomodulatory effects. It is widely used in rheumatologic diseases, and has a very high efficacy/toxicity ratio. It is particularly important in the treatment of systemic lupus erythematosus (SLE) since it reduces new organ involvement and disease flares, and relieves skin and joint symptoms. Some patients develop hypersensitivity rash in response to HCQ. In such patients the drug is withdrawn and replaced by another medication. All the alternative medications for rheumatological patients are significantly more toxic than HCQ. We describe our initial experience of HCQ slow oral desensitization. All 4 patients who were recruited completed the procedure successfully without significant difficulty. Our results suggest that HCQ slow oral desensitization is safe, effective, and easy to perform.
BACKGROUND Social distancing was the predominant strategy used to mitigate the spread of coronavi... more BACKGROUND Social distancing was the predominant strategy used to mitigate the spread of coronavirus disease 2019 (COVID-19) at the start of the COVID-19 pandemic. METHODS Retrospective review of all positive blood cultures from January to July in the years 2017-2020. AIMS The object of this research was to study the impact of social distancing on the incidence of bacteraemia. The number of admitted patients with positive blood cultures in April-May 2020 in one tertiary medical centre was compared to the number during the same period in the previous three years (April-May 2017-2019). RESULTS There were fewer cases of Streptococcus bacteraemia as well as coagulase-negative Staphylococcus bacteraemia and other possible contaminated blood cultures, in April-May 2020. Compared to the previous three years, the incidence of Streptococcus pneumoniae bacteraemia among all bacteraemias was lower in April-May 2020 (5%) than in 2017-19 (12.0%, 95% confidence interval 10.3%-14.1%). In general, fewer cases of bacteraemia caused by oropharynx organisms were observed in April-May 2020; only six cases vs 31(95% confidence interval 10-53) during the same period in 2017-19. Only one case of Streptococcus pneumoniae bacteraemia was observed in April-May 2020, and its percentage among all bacteraemias was lower in April-May 2020 (0.4%) than during the same period in 2017-19 (3.3%). CONCLUSION The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted via respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria. This article is protected by copyright. All rights reserved.
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