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  1. Article ; Online: Prediction of acute hypertensive episodes in critically ill patients.

    Itzhak, Nevo / Pessach, Itai M / Moskovitch, Robert

    Artificial intelligence in medicine

    2023  Volume 139, Page(s) 102525

    Abstract: Prevention and treatment of complications are the backbone of medical care, particularly in critical care settings. Early detection and prompt intervention can potentially prevent complications from occurring and improve outcomes. In this study, we use ... ...

    Abstract Prevention and treatment of complications are the backbone of medical care, particularly in critical care settings. Early detection and prompt intervention can potentially prevent complications from occurring and improve outcomes. In this study, we use four longitudinal vital signs variables of intensive care unit patients, focusing on predicting acute hypertensive episodes (AHEs). These episodes represent elevations in blood pressure and may result in clinical damage or indicate a change in a patient's clinical situation, such as an elevation in intracranial pressure or kidney failure. Prediction of AHEs may allow clinicians to anticipate changes in the patient's condition and respond early on to prevent these from occurring. Temporal abstraction was employed to transform the multivariate temporal data into a uniform representation of symbolic time intervals, from which frequent time-intervals-related patterns (TIRPs) are mined and used as features for AHE prediction. A novel TIRP metric for classification, called coverage, is introduced that measures the coverage of a TIRP's instances in a time window. For comparison, several baseline models were applied on the raw time series data, including logistic regression and sequential deep learning models, are used. Our results show that using frequent TIRPs as features outperforms the baseline models, and the use of the coverage, metric outperforms other TIRP metrics. Two approaches to predicting AHEs in real-life application conditions are evaluated: using a sliding window to continuously predict whether a patient would experience an AHE within a specific prediction time period ahead, our models produced an AUC-ROC of 82%, but with low AUPRC. Alternatively, predicting whether an AHE would generally occur during the entire admission resulted in an AUC-ROC of 74%.
    MeSH term(s) Humans ; Intensive Care Units ; Critical Illness ; Blood Pressure ; Critical Care ; Hypertension/diagnosis
    Language English
    Publishing date 2023-03-08
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 645179-2
    ISSN 1873-2860 ; 0933-3657
    ISSN (online) 1873-2860
    ISSN 0933-3657
    DOI 10.1016/j.artmed.2023.102525
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Pediatric In-Hospital Cardiac Arrest-Can We Do Better?

    Pessach, Itai M / Paret, Gideon

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2019  Volume 20, Issue 3, Page(s) 293–294

    MeSH term(s) Cardiopulmonary Resuscitation ; Child ; Heart Arrest ; Hospitals, Pediatric ; Humans ; Intensive Care Units
    Language English
    Publishing date 2019-03-04
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000001856
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: COVID-19 in the Pediatric Population-Review and Current Evidence.

    Rabinowicz, Shira / Leshem, Eyal / Pessach, Itai M

    Current infectious disease reports

    2020  Volume 22, Issue 11, Page(s) 29

    Abstract: Purpose of review: Coronavirus disease 2019 (COVID-19) pandemic has major health and economic impacts. We review disease characteristics in children.: Recent findings: Children comprise 1-2% of the diagnosed cases, and typically suffer mild disease. ... ...

    Abstract Purpose of review: Coronavirus disease 2019 (COVID-19) pandemic has major health and economic impacts. We review disease characteristics in children.
    Recent findings: Children comprise 1-2% of the diagnosed cases, and typically suffer mild disease. The median age of infected children is 3.3-11 years, and male/female ratio is 1.15-1.55. Common symptoms in children include upper respiratory symptoms (26-54%), cough (44-54%), fever (32-65%), and gastrointestinal (15-30%) symptoms. Substantial proportion (4-23%) are asymptomatic. Death rates are up to 0.7%. Risk factors associated with severe disease are neonatal age group, male gender, lower respiratory tract disease, and pre-existing medical conditions. Vertical transmission was reported. Multisystem inflammatory syndrome (MIS), characterized by fever, multisystem organ involvement, and laboratory markers of inflammation, causes critical illness in > 50% of cases and is increasingly reported from endemic countries. Indirect effects of the coronavirus epidemic include higher rates of psychiatric morbidities, education loss, unhealthy lifestyle changes, and increased child neglect. Vaccines are in clinical trials and immunogenicity has not yet been shown in children.
    Summary: Overall, COVID-19 has lower incidence and causes milder disease in children compared with adult patients. MIS is a rare severe complication more common in children. More data on the efficacy and safety of antivirals in children are needed.
    Keywords covid19
    Language English
    Publishing date 2020-09-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2019948-X
    ISSN 1534-3146 ; 1523-3847
    ISSN (online) 1534-3146
    ISSN 1523-3847
    DOI 10.1007/s11908-020-00739-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The Safety of Pediatric Bedside Tracheostomy.

    Madgar, Ory / Kassif Lerner, Reut / Devons-Sberro, Stav / Nini-Perlstein, Namma / Baltzan, Amiad Levi / Rozendorn, Noa / Paret, Gideon / Pessach, Itai M / Alon, Eran E / Carmel, Eldar

    The Annals of otology, rhinology, and laryngology

    2024  , Page(s) 34894241252231

    Abstract: Objective: Traditionally, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, requiring the routine use of a formal operating room. Pediatric bedside tracheostomy in an intensive care unit (ICU) ... ...

    Abstract Objective: Traditionally, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, requiring the routine use of a formal operating room. Pediatric bedside tracheostomy in an intensive care unit (ICU) setting has not been widely reported, in contrast to the widespread adult bedside ICU tracheostomy. Transport of these critically ill, multiple life support systems dependent patients can be technically difficult, labor intensive, and potentially risky for these patients. Our study aimed to demonstrate the safety and efficacy of bedside tracheostomy in the pediatric ICU.
    Materials and methods: A retrospective analysis of all pediatric patients undergoing tracheostomy at a tertiary care center, between 1st of January 2013 and 31st of December 2019.
    Results: During the study period, 117 pediatric patients underwent tracheostomy, 57 (48.7%) were performed bedside while 60 (51.3%) were performed in the operating room. Patients' ages ranged from 2 weeks to 17 years of age, with a median age of 16 months. No case of bedside tracheostomy necessitated a shift to the operating room. There was no difference in 30-day morbidity and mortality between the 2 groups.
    Conclusions: Our results suggest that pediatric open bedside tracheostomy in an ICU setting is a safe procedure, with similar complications and outcomes compared to tracheostomy performed in the operating room.
    Language English
    Publishing date 2024-05-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120642-4
    ISSN 1943-572X ; 0003-4894
    ISSN (online) 1943-572X
    ISSN 0003-4894
    DOI 10.1177/00034894241252231
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Telemedicine Implementation in COVID-19 ICU: Balancing Physical and Virtual Forms of Visibility.

    Pilosof, Nirit Putievsky / Barrett, Michael / Oborn, Eivor / Barkai, Galia / Pessach, Itai M / Zimlichman, Eyal

    HERD

    2021  Volume 14, Issue 3, Page(s) 34–48

    Abstract: Objective: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care.: ... ...

    Abstract Objective: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care.
    Background: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies.
    Methods: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020.
    Results: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being.
    Conclusions: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.
    MeSH term(s) COVID-19/prevention & control ; COVID-19/therapy ; Facility Design and Construction/methods ; Facility Design and Construction/standards ; Humans ; Infection Control/methods ; Intensive Care Units/organization & administration ; Israel ; Organizational Case Studies ; Patient Isolation/methods ; SARS-CoV-2 ; Telemedicine/methods ; Telemedicine/organization & administration
    Language English
    Publishing date 2021-06-02
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2525547-2
    ISSN 2167-5112 ; 1937-5867
    ISSN (online) 2167-5112
    ISSN 1937-5867
    DOI 10.1177/19375867211009225
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety.

    Pilosof, Nirit Putievsky / Barrett, Michael / Oborn, Eivor / Barkai, Galia / Pessach, Itai M / Zimlichman, Eyal

    International journal of environmental research and public health

    2021  Volume 18, Issue 16

    Abstract: The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient ... ...

    Abstract The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research.
    MeSH term(s) COVID-19 ; Hospital Design and Construction ; Humans ; Infection Control ; Inpatients ; Intensive Care Units ; Pandemics ; SARS-CoV-2 ; Telemedicine
    Language English
    Publishing date 2021-08-08
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph18168391
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The relationship of x-linked primary immune deficiencies and autoimmunity.

    Pessach, Itai M

    Current allergy and asthma reports

    2010  Volume 10, Issue 5, Page(s) 311–319

    Abstract: It is well-known that autoimmunity is significantly more prevalent in females. Growing evidence indicates that genes located on the X chromosome may play a role in autoimmunity and immune dysregulation, as also indicated by the frequent association of ... ...

    Abstract It is well-known that autoimmunity is significantly more prevalent in females. Growing evidence indicates that genes located on the X chromosome may play a role in autoimmunity and immune dysregulation, as also indicated by the frequent association of autoimmune phenomena in patients with X-linked primary immune deficiencies (PIDs). Hence, this group of genetic disorders is of particular interest to study PID-causing genes in the setting of more complex autoimmune disorders. This review focuses on the mechanisms leading to the autoimmune phenomena that are associated with the different X-linked PIDs, and on the intriguing interplay between immune dysregulation and immune deficiency in this unique setting.
    MeSH term(s) Autoimmunity/genetics ; Chromosomes, Human, X/genetics ; Female ; Genes, X-Linked ; Genetic Diseases, X-Linked/genetics ; Humans ; Immunologic Deficiency Syndromes/genetics
    Language English
    Publishing date 2010-06-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057370-4
    ISSN 1534-6315 ; 1529-7322
    ISSN (online) 1534-6315
    ISSN 1529-7322
    DOI 10.1007/s11882-010-0127-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: COVID-19 in the Pediatric Population—Review and Current Evidence

    Rabinowicz, Shira / Leshem, Eyal / Pessach, Itai M.

    Current Infectious Disease Reports

    2020  Volume 22, Issue 11

    Keywords Infectious Diseases ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2019948-X
    ISSN 1534-3146 ; 1523-3847
    ISSN (online) 1534-3146
    ISSN 1523-3847
    DOI 10.1007/s11908-020-00739-6
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article: A Practical Clinical Score Predicting Respiratory Failure in COVID-19 Patients.

    Ashkenazi, Moshe / Zimlichman, Eyal / Zamstein, Noa / Rahav, Galia / Kassif Lerner, Reut / Haviv, Yael / Pessach, Itai M

    The Israel Medical Association journal : IMAJ

    2022  Volume 24, Issue 5, Page(s) 327–331

    Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in repeated surges of patients, sometimes challenging triage protocols and appropriate control of patient flow. Available models, such as the National Early Warning Score (NEWS), have ...

    Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in repeated surges of patients, sometimes challenging triage protocols and appropriate control of patient flow. Available models, such as the National Early Warning Score (NEWS), have shown significant limitations. Still, they are used by some centers to triage COVID-19 patients due to the lack of better tools.
    Objectives: To establish a practical and automated triage tool based on readily available clinical data to rapidly determine a distinction between patients who are prone to respiratory failure.
    Methods: The electronic medical records of COVID-19 patients admitted to the Sheba Medical Center March-April 2020 were analyzed. Population data extraction and exploration were conducted using a MDClone (Israel) big data platform. Patients were divided into three groups: non-intubated, intubated within 24 hours, and intubated after 24 hours. The NEWS and our model where applied to all three groups and a best fit prediction model for the prediction of respiratory failure was established.
    Results: The cohort included 385 patients, 42 of whom were eventually intubated, 15 within 24 hours or less. The NEWS score was significantly lower for the non-intubated patients compared to the two other groups. Our improved model, which included NEWS elements combined with other clinical data elements, showed significantly better performance. The model's receiver operating characteristic curve had area under curve (AUC) of 0.92 with of sensitivity 0.81, specificity 0.89, and negative predictive value (NPV) 98.4% compared to AUC of 0.63 with NEWS. As patients deteriorate and require further support with supplemental O2, the need for re-triage emerges. Our model was able to identify those patients on supplementary O2 prone to respiratory failure with an AUC of 0.86 sensitivity 0.95, and specificity 0.7 NPV 98.9%, whereas NEWS had an AUC of 0.76. For both groups positive predictive value was approximately 35.
    Conclusions: Our model, based on readily available and simple clinical parameters, showed an excellent ability to predict negative outcome among patients with COVID-19 and therefore might be used as an initial screening tool for patient triage in emergency departments and other COVID-19 specific areas of the hospital.
    MeSH term(s) COVID-19/complications ; COVID-19/diagnosis ; Humans ; Pandemics ; Respiratory Insufficiency/diagnosis ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy ; Retrospective Studies ; Triage
    Language English
    Publishing date 2022-05-21
    Publishing country Israel
    Document type Journal Article
    ZDB-ID 2008291-5
    ISSN 1565-1088 ; 0021-2180
    ISSN 1565-1088 ; 0021-2180
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Enhancing intensive care capacity: COVID-19 experience from a Tertiary Center in Israel.

    Leshem, Eyal / Klein, Yoram / Haviv, Yael / Berkenstadt, Haim / Pessach, Itai M

    Intensive care medicine

    2020  Volume 46, Issue 8, Page(s) 1640–1641

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/therapy ; Critical Care/organization & administration ; Hospital Bed Capacity ; Hospital Design and Construction ; Humans ; Inservice Training ; Intensive Care Units/organization & administration ; Israel ; Pandemics ; Pneumonia, Viral/therapy ; SARS-CoV-2 ; Telemedicine ; Tertiary Care Centers
    Keywords covid19
    Language English
    Publishing date 2020-05-25
    Publishing country United States
    Document type Letter
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-020-06097-0
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