A. Shalom, M. Westreich and S. Sandbank
Background: Loss of an excised lesion can have devastating clinical and legal consequences. Previously, the incidence of pathological specimen loss was 1/1466 (0.07%) due to failure to place pathology specimens in correctly labeled containers. We theorized that a strict protocol for handling specimens would help reduce losses.
Objectives: To devise a protocol to reduce the loss of pathology specimens.
Methods: In this study, 7105 specimens excised by one plastic surgeon were sent to the pathology laboratory using a strict protocol, which included: using a carefully labeled specimen container, inserting the specimen into the container immediately after excision (not at the end of the procedure), positioning the specimen container close to the surgical field during the surgery, and both the nurse and surgeon signing their names on the container at the end of the procedure to confirm the contents and labeling.
Results: One Mohs specimen was accidentally thrown away by a pathology laboratory technician after the frozen section report was written (an incidence of 1/7105, 0.00014%). All specimens arrived in the pathology department and no lesions were lost in the operating room.
Conclusions: A strict written protocol for specimen handling significantly reduces loss of pathology specimens.
D. Merims, H. Nahari, G. Ben-Ari, S. Jamal, C. Vigder and Y. Ben-Israel
Background: Wandering is a common phenomenon among patients with dementia. While traditionally considered to be a behavioral problem, it also includes fundamental aspects of motor performance (e.g., gait and falls).
Objectives: To examine the difference in motor function and behavioral symptoms between patients with severe dementia who wander and those who do not.
Methods: We conducted a retrospective study reviewing the medical records of 72 patients with severe dementia, all residents of a dementia special care unit. Motor and behavioral aspects were compared between "wanderers" and “non-wanderers.”
Results: No difference was found in motor performance including the occurrence of falls between the wanderers and non-wanderers. A significant difference was found in aggressiveness and sleep disturbances, which were more frequent among the wanderers. There was no preference to wandering at a certain period of the day among the patients with sleep disturbances who wander.
Conclusions: In a protected environment wandering is not a risk factor for falls. Sleep disturbances and wandering co-occur, but there is no circumstantial association between the two symptoms.
H.S. Oster, M. Benderly, M. Hoffman, E. Cohen, A. Shotan and M. Mittelman
Background: Anemia is common in heart failure (HF), but there is controversy regarding its contribution to morbidity and mortality.
Objective: To examine the association of mild and severe anemia with acute HF severity and mortality.
Methods: Data were prospectively collected for patients admitted to all departments of medicine and cardiology throughout the country during 2 months in 2003 as part of the Heart Failure Survey in Israel. Anemia was defined as hemoglobin (Hb) < 12 g/dl for women and < 13 g/dl for men; Hb < 10 g/dl was considered as severe anemia. Mortality data were obtained from the Israel population registry. Median follow-up was 33.6 months.
Results: Of 4102 HF patients, 2332 had acute HF and available hemoglobin data. Anemia was common (55%) and correlated with worse baseline HF. Most signs and symptoms of acute HF were similar among all groups, but mortality was greater in anemic patients. Mortality rates at 6 months were 14.9%, 23.7% and 26.3% for patients with no anemia, mild anemia, and severe anemia, respectively (P < 0.0001), and 22.2%, 33.6% and 39.9% at one year, respectively (P < 0.0001). Compared to patients without anemia, multivariable adjusted hazard ratio was 1.35 for mild anemia and 1.50 for severe anemia (confidence interval 1.20–1.52 and 1.27–1.77 respectively).
Conclusions: Anemia is common in patients with acute HF and is associated with increased mortality correlated with the degree of anemia.
Z. Samra, L. Madar-Shapiro, M. Aziz and J. Bishara
Background: Clostridium difficile infection is considered the most common cause of nosocomial infectious diarrhea among adults in the developed world. It is responsible for virtually all cases of pseudomembranous colitis. The Tox A/B enzyme immunoassay (EIA) is the most widely used test for the detection of C. difficile toxins A and B. However, it is associated with poor sensitivity and an unacceptable high rate of false-negative results.
Objectives: To evaluate the performance of the C. DIFF QUIK CHEK COMPLETE® assay, designed to simultaneously detect C. difficile-produced glutamate dehydrogenase (GHD) and toxins A and B.
Methods: Using the C. DIFF QUIK CHEK COMPLETE assay, the Tox A/B EIA, and polymerase chain reaction (PCR), we tested 223 stool specimens from hospitalized patients with antibiotics-associated diarrhea. Sensitivity and specificity, and positive and negative predictive values (PPV, NPV) were calculated for the C. DIFF QUIK CHEK COMPLETE test and the Tox A/B EIA against PCR
Results: The C. DIFF QUIK CHEK COMPLETE test had a sensitivity of 83.5% and specificity of 94.3% compared to PCR for Tox A/B, with 93.7% correlation (PPV 98.5%, NPV 91.7%). The Tox A/B EIA yielded corresponding values of 72.1% and 93.1%, with 85.6% correlation (PPV 85.1%, NPV 85.8%).
Conclusions: Given the importance of an early and appropriate diagnosis of Clostridium difficile-associated infection, the C. DIFF QUIK CHEK COMPLETE test may be of huge benefit to practitioners.
G. Yaniv, G. Twig, O. Mozes, G. Greenberg, C. Hoffmann and Y. Shoenfeld
Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving multiple organs. One of the main sites of SLE morbidity is the central nervous system (CNS), specifically the brain. In this article we review several imaging modalities used for CNS examination in SLE patients. These modalities are categorized as morphological and functional. Special attention is given to magnetic resonance imaging (MRI) and its specific sequences such as diffusion-weighted imaging (DWI), diffuse tensor imaging (DTI) and magnetic resonance spectroscopy (MRS). These modalities allow us to better understand CNS involvement in SLE patients, its pathophysiology and consequences.
N. Roguin Maor
Background: Smoking is a serious health issue worldwide. Smoking trends among physicians predict similar trends in the general population. Little is known about current smoking rates among physicians.
Objectives: To investigate current smoking trends among Israeli physicians.
Methods: All practicing physicians at a tertiary university-affiliated medical center in central Israel were invited to complete a Web-based questionnaire on smoking habits and smoking-related issues via the institutional email. Findings were compared to those in the general population and between subgroups.
Results: Of the 90 responders (53 male, 88 Jewish), 54 (60%) had never smoked, 21 (23.3%) were past smokers, and 15 (16.7%) were current smokers. The rate of current smokers was lower than in the general population. The proportion of current smokers was higher among residents than attending physicians and among physicians in surgical compared to medical specialties. Past smokers accounted for 17.9% of the residents (average age at quitting 26.2 years) and 28.1% of the attending physicians (average age at quitting 33.0 years). Non-smokers more frequently supported harsh anti-smoking legislation.
Conclusions: The rate of smoking is lower in physicians than in the general population but has not changed over the last 15 years. Anti-smoking programs should particularly target physicians in surgical specialties.