Early neonatal sepsis requires rapid and efficient intervention to prevent morbidity and mortality. Management of such a case includes invasive blood examinations, elongation of maternal and neonatal length of stay, and empiric antibiotic therapy. These actions has major side effects. On 2017, Kaiser-Permanente started using a calculator that weighs the chances for early onset neonatal sepsis, and states the best investigation and follow-up regimn for the specific newborn infant. Eversince, policy of managing neonatal suspected early onset sepsis has chaged globally, including in Israel. Current knowledge regarding the local outcome since the use of the calculatir is scarce.
The goal of the study is to evaluate the change in management of suspected neonatal early onset sepsis, including its economic value, between periods before and after assimilation of the calculator in Hillel Yaffe nedica l center.

开始日期2024-12-01

申办/合作机构

Hillel Yaffe Medical Center

NCT05799677 / CompletedN/AIIT

The Effect of Reflexology in Patients With Viral Bronchiolitis

To test the influence of reflexology on bronchiolitis.

开始日期2023-01-01

申办/合作机构

Hillel Yaffe Medical Center

NCT06282276 / CompletedN/AIIT

Anti-fat Attitudes and Weight Stigma Among Orthopedic Surgeons and Their Correlation to the Therapeutic Approach to Patients With Obesity

Evidence shows that anti-fat attitudes and weight stigma are prevalent among healthcare professionals and may affect treatment decisions regarding patients with obesity. The present study aimed to examine the presence of anti-fat attitudes and weight stigma among orthopedic surgeons and their correlation to the therapeutic approach to patients with obesity. In this cross-sectional survey, 150 orthopedic surgeons will complete a web-based questionnaire. the questionnaire is based on Antifat Attitudes Questionnaire (AFA), developed by Crandall in 1994. In addition, the questionnaire will include a questionnaire developed by Bocquier in 200521 to explore weight stigma among physicians.

开始日期2022-10-01

申办/合作机构

Hillel Yaffe Medical Center

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2024-12-31·Human Vaccines & Immunotherapeutics

Factors associated with antibiotic use in children hospitalized for acute viral gastroenteritis and the relation to rotavirus vaccination

Article

作者: Mwassi, Basher ; Anis, Emilia ; Cohen, Dani ; Omar, Muna ; Kassem, Eias ; Abu-Jabal, Roula ; Muhsen, Khitam ; Shulman, Lester

Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0-59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008-2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011-2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1-20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31-0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73-5.23]), blood (3.29 [95% CI 1.85-5.86]) and urine cultures (7.12 [3.77-13.43]), levels of C-reactive protein (1.02 [1.01-1.02]) and leukocytes (1.05 [1.01-1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.

2024-11-01·International Journal of Obstetric Anesthesia

Peripartum anesthesia management and outcomes of patients with congenital heart disease: a single-center retrospective analysis (2009–2023)

Article

作者: Orbach-Zinger, S. ; Iluz-Freundlich, D ; Iluz-Freundlich, D. ; Houri, O. ; Chernov, P ; Orbach-Zinger, S ; Binyamin, Y. ; Fein, S ; Shmueli, A ; Vikhorova, Y. ; Azem, K. ; Schamroth-Pravda, N. ; Chernov, P. ; Heesen, P. ; Shmueli, A. ; Azem, K ; Schamroth-Pravda, N ; Garren-Tam, M ; Heesen, P ; Houri, O ; Binyamin, Y ; Vikhorova, Y ; Fein, S. ; Garren-Tam, M.

BACKGROUNDAdvances in medicine have enabled more patients with congenital heart disease (CHD) to become pregnant. However, these patients face significant challenges during the peripartum period. Current peripartum anesthesia guidelines for CHD patients mainly rely on case reports and small series.METHODSIn this retrospective study at a high-volume tertiary care center, we analyzed peripartum anesthetic approaches, postpartum hemorrhage (PPH) incidence, and maternal outcomes in CHD patients stratified by the modified World Health Organization (mWHO) classification.RESULTSAmong 85 473 deliveries between 2009 and 2023, 409 occurred in 282 patients with CHD. Cesarean deliveries were significantly more frequent in mWHO class III, p=0.005. Labor epidural analgesia was the most common analgesic modality for vaginal deliveries (epidural rate was 71.1% with no differences between mWHO classes). Anesthesia management for cesarean deliveries varied significantly by class p<0.001. While spinal anesthesia was predominant in classes I and II, combined spinal-epidural anesthesia was more common in class III. PPH incidence was 6.4%, with no significant difference across classes, and no association was found between mWHO class severity and PPH risk (OR 0.97; 95% CI; 0.93 to 1.02, p=0.2). Higher mWHO classes correlated with significantly higher intensive care unit (ICU) admission rates, longer hospital stays, and one-year cardiac hospitalizations.CONCLUSIONIn this retrospective study on the peripartum anesthetic management and outcomes of CHD patients stratified by mWHO class, cases with greater mWHO class were more likely to deliver preterm, by cesarean delivery, with a combined spinal-epidural anesthetic and an arterial line placement for that cesarean delivery. They overall had a longer hospital stay and were more likely to be admitted to the ICU. However, the overall risk of PPH did not increase with mWHO class severity.

2024-11-01·American Journal of Otolaryngology

Efficacy and safety of SENS-401 in sudden sensorineural hearing loss: The AUDIBLE-S randomized placebo-controlled phase IIb trial

作者: Kazmer, Igor ; Cohen-Vaizer, Mauricio ; Doweck, Ilana ; Kalcioglu, Mahmut Tayyar ; Honnet, Geraldine ; Glotin, Anne-Lise ; Hilly, Ohad ; Esteve-Fraysse, Marie Jose ; Fitoussi, Serge ; Chrobok, Viktor ; Braverman, Itzhak ; Elziere, Maya ; Laredo, Judith ; Komazec, Zoran

Safety and efficacy of SENS-401, a serotonin type 3 (5-HT₃) receptor antagonist and calcineurin inhibitor, in patients with acute sudden sensorineural hearing loss (SSNHL).Multicentre randomized, double blind, placebo-controlled trial enrolled adult subjects with sudden sensorineural hearing loss (SSNHL) or unilateral/bilateral acute acoustic trauma leading to SSNHL within 96 h of disease onset.Subjects were randomly assigned to one of the three oral dose groups: 29 mg, 43.5 mg or placebo given twice daily for 28 days.The primary endpoint was the change from baseline in Pure Tone Average (PTA) in the affected ear to the end of treatment visit (day 28).Subjects were further followed up 8 wk after the end of the treatment period (day 84).A total of 115 subjects were randomized.SENS-401 was well tolerated.Although the primary efficacy endpoint was not met at day 28, post-hoc analyses revealed clin. significant and meaningful efficacy outcomes with SENS-401 when compared to placebo in a substantial group of participants diagnosed with idiopathic SSNHL and who had received corticosteroid treatment.Notable improvements were observed in the PTA change from baseline, the complete hearing recovery rate, and the Word Recognition Score (WRS), particularly at day 84.The responder rate consistently favored treated subjects over those who received the placebo.While the primary endpoint was not achieved at the end of the treatment period, the study revealed consistently pos. efficacy results of clin. relevance in patients with idiopathic SSNHL who received SENS-401, particularly in the 8-wk follow-up phase after the completion of the treatment.

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