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Article: [FUNCTIONAL INDEPENDENCE MEASURE SCALE SCORES IN SEVERELY DEPENDENT OLDER ADULTS UPON REHABILITATION COMPLETION FOLLOWING HIP FRACTURE].

Kashkosh, Rasekh / Gringauz, Irina / Weissmann, Jonathan / Justo, Dan

2020 Volume 159, Issue 9, Page(s) 639–644

Abstract: Introduction: Functional Independence Measure (FIM) is a scale used to evaluate functional status during rehabilitation. The association between FIM scale scores upon hip fracture rehabilitation completion and functional status of older adults according ...

Abstract	Introduction: Functional Independence Measure (FIM) is a scale used to evaluate functional status during rehabilitation. The association between FIM scale scores upon hip fracture rehabilitation completion and functional status of older adults according to the Israeli Ministry of Health (MOH) guidelines has never been studied. Aims: To study the association between FIM scale scores upon hip fracture rehabilitation completion and functional status of older adults. Methods: A retrospective cross-sectional study was conducted at the Geriatric-Orthopedic unit at the Sheba Medical Center. The medical charts of older adults (age ≥65) admitted for rehabilitation following hip fracture during 2007-2012 were studied. Age, gender, total FIM score upon rehabilitation completion, functional status upon rehabilitation completion according to the Israeli MOH guidelines, and moving to a nursing-home were documented. Results: The cohort included 453 older adults: 374 (82.6%) females; mean age 82.9±6.7 years. Most older adults were severely dependent upon rehabilitation completion (n=320, 70.6%) and 84 (26.3%) of whom moved to or returned to a nursing-home. Median total FIM scores upon rehabilitation completion was 100 (interquartile range (IQR): 92-111) in mildly dependent older adults, 72 (IQR: 53-87) in severely dependent community-dwelling older adults, and 39 (IQR: 29-58) in severely dependent nursing-home residents (p<0.001). Total FIM score of 85 (or less) had the highest sensitivity (78.4%) and specificity (91.0%) in representing severely dependent older adults. Conclusions: These findings may assist Israeli geriatricians to define the functional status of older adults upon hip fracture rehabilitation completion.
MeSH term(s)	Aged ; Aged, 80 and over ; Cohort Studies ; Cross-Sectional Studies ; Female ; Hip Fractures ; Humans ; Independent Living ; Recovery of Function ; Retrospective Studies ; Treatment Outcome
Language	Hebrew
Publishing date	2020-09-21
Publishing country	Israel
Document type	Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article ; Online: D-dimer and C-reactive Protein Blood Levels Over Time Used to Predict Pulmonary Embolism in Two COVID-19 Patients.

Becher, Yael / Goldman, Leonid / Schacham, Nadav / Gringauz, Irina / Justo, Dan

European journal of case reports in internal medicine

2020 Volume 7, Issue 6, Page(s) 1725

Abstract: The diagnosis of pulmonary embolism is challenging in symptomatic COVID-19 patients since shortness of breath, chest pain, tachycardia, tachypnoea, fever, oxygen desaturation and high D-dimer blood levels might be features of both diseases. We present ... ...

Abstract	The diagnosis of pulmonary embolism is challenging in symptomatic COVID-19 patients since shortness of breath, chest pain, tachycardia, tachypnoea, fever, oxygen desaturation and high D-dimer blood levels might be features of both diseases. We present two COVID-19 patients in whom pulmonary embolism was suspected (and diagnosed) due to a discrepancy between an increase in D-dimer blood levels and a decrease in C-reactive protein blood levels over time. We believe that an opposite change in the blood levels of both biomarkers over time may be used as a novel method to predict pulmonary embolism in COVID-19 patients. Learning points: The diagnosis of pulmonary embolism is challenging in COVID-19 patients since symptoms, signs and high D-dimer blood levels might be similar in both diseases.An increase in D-dimer blood levels and a decrease in C-reactive protein blood levels over time may be used as a novel method to predict pulmonary embolism in COVID-19 patients.
Keywords	covid19
Language	English
Publishing date	2020-05-20
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2020_001725
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Article: Interpretation of Heart and Lungs Sounds Acquired via Remote, Digital Auscultation Reached Fair-to-Substantial Levels of Consensus among Specialist Physicians.

Magor, Diana / Berkov, Evgeny / Siomin, Dmitry / Karniel, Eli / Lasman, Nir / Waldman, Liat Radinsky / Gringauz, Irina / Stern, Shai / Kassif, Reut Lerner / Barkai, Galia / Lewy, Hadas / Segal, Gad

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 19

Abstract: Background: Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to ... ...

Abstract	Background: Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to validate the level of consensus among physicians regarding the interpretation of remote, digital auscultation of heart and lung sounds. Methods: Seven specialist physicians considered both the technical quality and clinical interpretation of auscultation findings of pre-recorded heart and lung sounds of patients hospitalized in their homes. TytoCare Results: In total, 140 sounds (70 heart and 70 lungs) were presented to seven specialists. The level of agreement was measured using Fleiss' Kappa (FK) variable. Agreement relating to heart sounds reached low-to-moderate consensus: the overall technical quality (FK = 0.199), rhythm regularity (FK = 0.328), presence of murmurs (FK = 0.469), appreciation of sounds as remote (FK = 0.011), and an overall diagnosis as normal or pathologic (FK = 0.304). The interpretation of some of the lung sounds reached a higher consensus: the overall technical quality (FK = 0.169), crepitus (FK = 0.514), wheezing (FK = 0.704), bronchial sounds (FK = 0.034), and an overall diagnosis as normal or pathological (FK = 0.386). Most Fleiss' Kappa values were in the range of "fare consensus", while in the domains of diagnosing lung crepitus and wheezing, the values increased to the "substantial" level. Conclusions: Bio signals, as recorded auscultations of the heart and lung sounds serving the process of clinical assessment of remotely situated patients, do not achieve a high enough level of agreement between specialized physicians. These findings should serve as a catalyzer for improving the process of telemedicine-attained bio-signals and their clinical interpretation.
Language	English
Publishing date	2023-10-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13193153
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Article ; Online: Prerehabilitation alanine aminotransferase blood levels and one-year mortality rates in older adults following hip fracture.

Kashkosh, Rasekh / Gringauz, Irina / Weissmann, Jonathan / Segal, Gad / Swartzon, Michael / Adunsky, Abraham / Justo, Dan

International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation

2020 Volume 43, Issue 3, Page(s) 214–218

Abstract: Low alanine aminotransferase (ALT) blood levels prior to rehabilitation are associated with poor function in older adults following hip fracture. We hypothesized that low ALT blood levels prior to rehabilitation were also associated with one-year ... ...

Abstract	Low alanine aminotransferase (ALT) blood levels prior to rehabilitation are associated with poor function in older adults following hip fracture. We hypothesized that low ALT blood levels prior to rehabilitation were also associated with one-year mortality in this population. Included were 456 older adults (age ≥ 60 years, 82.5% women) admitted for rehabilitation following hip fracture. ALT blood levels were documented between one and six months prior to rehabilitation. Excluded were patients with ALT blood levels over 40 IU/L possibly consistent with liver injury. The main outcome was all-cause mortality one year following rehabilitation admission. The study group included 142 (31.1%) patients with low (≤10 IU/L) ALT blood levels and the control group included 314 (68.9%) patients with high-normal (11-40 IU/L) ALT blood levels. Overall, 52 (11.4%) patients died within one year following rehabilitation admission. Compared with the control group, patients with low ALT blood levels had significantly higher 1-year mortality rates [17.6 vs. 8.6%, odds ratio 2.27, 95% confidence interval (CI) 1.27-4.08]. Cox regression analysis showed that low ALT blood levels prior to rehabilitation were associated with one-year mortality (hazard ratio 1.88, 95% CI 1.08-3.28) together with age (hazard ratio 1.06, 95% CI 1.02-1.11), independent of gender. However, this association was no longer significant following adjustment also for peripheral vascular disease, admission and discharge functional independence measure scores, albumin serum levels, and length of rehabilitation. In conclusion, low ALT blood levels prior to rehabilitation are associated with one-year mortality in older adults following hip fracture. They may be used when only age and gender are known.
MeSH term(s)	Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Female ; Hip Fractures/enzymology ; Hip Fractures/mortality ; Hip Fractures/rehabilitation ; Hospitalization ; Humans ; Male ; Middle Aged
Chemical Substances	Alanine Transaminase (EC 2.6.1.2)
Language	English
Publishing date	2020-05-05
Publishing country	England
Document type	Journal Article
ZDB-ID	533323-4
ISSN	1473-5660 ; 0342-5282
ISSN (online)	1473-5660
ISSN	0342-5282
DOI	10.1097/MRR.0000000000000410
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Article ; Online: Alanine aminotransferase blood levels and rehabilitation outcome in older adults following hip fracture surgery.

Gringauz, Irina / Weismann, Jonathan / Justo, Dan / Adunsky, Abraham / Segal, Gad

International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation

2018 Volume 41, Issue 1, Page(s) 41–46

Abstract: Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip ... ...

Abstract	Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P<0.05). A logistic regression analysis adjusted for age and sex showed that patients with ALT more than 10 IU/l were more likely to have higher (second to fourth upper quartiles) total FIM scores (>50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56-1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.
MeSH term(s)	Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Cohort Studies ; Disability Evaluation ; Female ; Fracture Fixation, Intramedullary/rehabilitation ; Hemiarthroplasty/rehabilitation ; Hip Fractures/rehabilitation ; Hip Fractures/surgery ; Humans ; Logistic Models ; Male ; Middle Aged ; Patient Outcome Assessment ; Retrospective Studies
Chemical Substances	Alanine Transaminase (EC 2.6.1.2)
Language	English
Publishing date	2018-03
Publishing country	England
Document type	Journal Article
ZDB-ID	533323-4
ISSN	1473-5660 ; 0342-5282
ISSN (online)	1473-5660
ISSN	0342-5282
DOI	10.1097/MRR.0000000000000258
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Article: D-dimer and C-reactive protein blood levels over time used to predict pulmonary embolism in two covid-19 patients

Becher, Yael / Goldman, Leonid / Schacham, Nadav / Gringauz, Irina / Justo, Dan

Eur. J. Case Rep. Intern. Med.

Abstract	The diagnosis of pulmonary embolism is challenging in symptomatic COVID-19 patients since shortness of breath, chest pain, tachycardia, tachypnoea, fever, oxygen desaturation and high D-dimer blood levels might be features of both diseases. We present two COVID-19 patients in whom pulmonary embolism was suspected (and diagnosed) due to a discrepancy between an increase in D-dimer blood levels and a decrease in C-reactive protein blood levels over time. We believe that an opposite change in the blood levels of both biomarkers over time may be used as a novel method to predict pulmonary embolism in COVID-19 patients.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #596645
Database	COVID19

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Article ; Online: Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

Gringauz Irina / Cohen Refaela / Brom Adi / Davidi Avia / Hofstetter Liron / Avaki Chen / Segal Gad

Journal of Clinical Medicine, Vol 7, Iss 11, p

2018 Volume 386

Abstract: Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed ...

Abstract	Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL„ questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died ( p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality ( p = 0.029). There was a significant correlation ( p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.
Keywords	frailty ; sarcopenia ; survival ; internal medicine ; FRAIL questionnaire ; ALT ; Medicine ; R
Subject code	610
Language	English
Publishing date	2018-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department: A prospective study.

Justo, Dan / Schwartz, Natalia / Dvorkin, Eliyahu / Gringauz, Irina / Groutz, Asnat

Neurourology and urodynamics

2017 Volume 36, Issue 3, Page(s) 794–797

Abstract: Aim: To assess the incidence and associated risk factors of asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department.: Methods: Two hundred and two consecutive elderly women (mean age 84.4 ± 5.7 years) who ... ...

Abstract	Aim: To assess the incidence and associated risk factors of asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department. Methods: Two hundred and two consecutive elderly women (mean age 84.4 ± 5.7 years) who were admitted to four Internal Medicine departments at a tertiary medical center were prospectively enrolled. All patients underwent post-void residual urine (PVR) measurements on the morning following the admission day. The measurements were undertaken by using a portable ultrasound bladder scan. Asymptomatic urinary retention was defined as PVR ≥ 200 ml without lower urinary tract symptoms, or abdominal pain, in two consecutive measurements. Results: Asymptomatic urinary retention was diagnosed in 29 (14.4%) women (mean PVR: 353.1 ± 155.2 ml; range: 200-712 ml). The mean age, prevalence of chronic diseases, and the use of opioid and antimuscarinic drugs were similar in women with versus without asymptomatic urinary retention. A binary logistic regression analysis showed that asymptomatic urinary retention was significantly and independently associated with low mobility, measured by the functional independence measure (FIM) scale (odds ratio = 0.7, 95% confidence interval 0.6-0.9, P = 0.026), and hypothyroidism (odds ratio = 2.4, 95% confidence interval 1.0-5.8, P = 0.049). Among 174 (86.1%) patients in whom thyroid-stimulating hormone (TSH) serum levels were measured, a statistically significant correlation was demonstrated between TSH values and PVR measurements. Conclusions: Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department is not infrequent and is independently associated with hypothyroidism and low mobility. PVR measurements should, therefore, be considered in all women with a low level of mobility and/or hypothyroidism upon admission to the Internal Medicine department. Neurourol. Urodynam. 36:794-797, 2017. © 2016 Wiley Periodicals, Inc.
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	604904-7
ISSN	1520-6777 ; 0733-2467
ISSN (online)	1520-6777
ISSN	0733-2467
DOI	10.1002/nau.23029
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Article ; Online: Personalized diabetes management recommendations at hospital discharge based on a computerized, pre-hospitalization clinical profile analysis: A prospective, electronic health records-based study.

Wasserstrum, Yishay / Peles-Bortz, Anat / Dabahi, Sara / Gringauz, Irina / Tirosh, Amir / Zimlichman, Eyal / Segal, Gad

The International journal of health planning and management

2019 Volume 34, Issue 4, Page(s) e1854–e1861

Abstract: Background: While glycemic control of hospitalized diabetic patients is straightforward, personalization of management at discharge is challenging. Treatment guidelines base recommendations on the clinical profile of patients. We checked the feasibility ...

Abstract	Background: While glycemic control of hospitalized diabetic patients is straightforward, personalization of management at discharge is challenging. Treatment guidelines base recommendations on the clinical profile of patients. We checked the feasibility of implementing discharge recommendations, based on the clinical profile in the patients' electronic health records (EHR). Methods: A decision-making algorithm was devised according to current guidelines. It was incorporated into the EHR. A prospective follow-up of eligible diabetes patients was done. Results: During 15 months, 835 patients (HbA1c was 6.9% [6.2%-7.8%]) met our inclusion criteria. The rate of HbA1c acquisition increased from 55% during Q1 to 85%, 86%, 88%, and 87% thereafter. Also, the rate of incorporating personalized management recommendations to discharge letters increased: from 14.9% during Q1 to 42.9%, 43.0%, 47.2%, and 53.4% thereafter. Fifty-eight (17.3%) of patients who got personalized recommendations upon discharge were found to have HbA1c values that were over 1% deviating from suggested target HbA1c. They got the most stringent recommendations. Twenty-nine (50%) of them had available follow-up HbA1c values showing a significant drop in HbA1c: from 9.1% (8.4%-10.2%) to 8.5% (7.4%-9.5%), P = .03. Conclusions: Personalized, EHR algorithm-based, management recommendations for diabetes upon discharge from hospitalization are feasible and beneficial.
MeSH term(s)	Aged ; Algorithms ; Diabetes Mellitus, Type 2/therapy ; Electronic Health Records/statistics & numerical data ; Female ; Glycated Hemoglobin A/analysis ; Humans ; Male ; Patient Discharge ; Patient Discharge Summaries ; Precision Medicine/methods ; Prospective Studies
Chemical Substances	Glycated Hemoglobin A ; hemoglobin A1c protein, human
Language	English
Publishing date	2019-09-15
Publishing country	England
Document type	Journal Article
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.2906
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Article ; Online: The liver in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Davidov-Derevynko, Yana / Ben Yakov, Gil / Wieder, Anat / Segal, Gad / Naveh, Lior / Orlova, Natalia / Gringauz, Irina / Amit, Sharon / Mor, Orna / Klempfner, Robert / Rahav, Galia / Ben Ari, Ziv

European journal of gastroenterology & hepatology

2021 Volume 33, Issue 1S Suppl 1, Page(s) e313–e319

Abstract: Background: The ongoing outbreak of COVID-19 is associated with higher levels of morbidity and mortality among patients with comorbidities, including the metabolic syndrome. Liver impairment has been reported in up to 54% of hospitalized patients with ... ...

Abstract	Background: The ongoing outbreak of COVID-19 is associated with higher levels of morbidity and mortality among patients with comorbidities, including the metabolic syndrome. Liver impairment has been reported in up to 54% of hospitalized patients with COVID-19. The impact of COVID-19 on a preexisting chronic liver disease is an actively studied area of research. The contribution of our study is towards determining the predictors of severity and the outcome of liver injury among hospitalized patients with COVID-19 infection, including patients with a preexisting liver disease and COVID-19. Methods: This single center retrospective cohort study included all patients ≥18 years, admitted in Sheba Medical Center with confirmed COVID-19 infection. Demographic, clinical and laboratory data were obtained using the MDClone platform and rechecked after data decryption using electronic health records. Results: Of 382 patients with COVID-19, 66.4% had increased liver biochemistry. Mild increase was observed in 76.7%. The higher level of fibrosis-4 (FIB-4) at admission was independently associated with higher mortality rate. Preexisting liver disease was detected in 15.4% patients. Most common etiology was nonalcoholic fatty liver disease (78.7%). The mortality of hospitalized patients with preexisting liver disease was 16.7% compared to 6.8% in patients without preexisting liver disease (RR = 2.792, P = 0.01). In multivariate analysis, liver disease adjusted to age and BMI was associated with mortality with high statistical significance. Conclusions: Patients with preexisting chronic liver disease were at a higher risk of mortality. The FIB-4 level at admission was associated with worse prognosis. These findings should be reevaluated in a larger cohort of patients.
MeSH term(s)	COVID-19 ; Hospitalization ; Humans ; Liver ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000002048
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