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Older age, longer procedures and tandem endoscopic-ultrasound as risk factors for post-endoscopic retrograde cholangiopancreatography bacteremia

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World Journal of Gastroenterology 2020年第41期26卷 6402-6413页

作者： Liat Deutsch Shay Matalon Adam Phillips moshe leshno Oren Shibolet Erwin Santo The Sackler Faculty of Medicine Tel Aviv UniversityTel Aviv 6997801Israel Department of Gastroenterology and Hepatology Tel Aviv Sourasky Medical CenterTel Aviv 6423906Israel Department of Gastroenterology Assaf Harofe Medical CenterZeriffin 70300Israel Faculty of Management Tel Aviv UniversityTel Aviv 6997801Israel

BACKGROUND Clinically significant post-endoscopic retrograde cholangiopancreatography(ERCP) bacteremia(PEB) occurs in up to 5% of cases, while antibiotic prophylaxis is recommended only when an ERCP is unlikely to achieve complete biliary drainage. However, the current recommendations may not cover all potential risk factors for *** To identify novel risk factors for PEB and evaluate appropriateness of antibiotic *** A retrospective study of 1082 ERCP procedures performed between January 2012-December 2013 in a single tertiary medical center. Data collection included: Demographic and clinical characteristics such as pre and post procedure antibiotic treatment and bacterial blood cultures. Exclusion criteria were:(1) Age < 18 years;(2) Positive bacterial blood culture before ERCP;(3) Scheduled antibiotic treatment prior to ERCP;(4) Hospitalization longer than 14 d before ERCP;and(5) missing critical data. Stepwise Logistic Regression analysis and Decision Tree algorithms were used for prediction modeling of *** A total of 626 ERCPs performed in 434 patients were included. Mean age 66.49 ± 15.4 years and 46.5% were males. PEB prevalence was 3.7%. Antibiotic prophylaxis was administrated in 139/626(22.2%) cases but was indicated according to the guidelines only in 44/626(7%) cases. In all the PEB cases, prophylaxis was deemed not indicated. A stepwise logistic regression [receiver operating characteristic(ROC), 0.766], identified 3 variables as independent risk factors for PEB: Age at ERCP ≥ 75 years(OR, 3.780, 95%CI: 1.519-9.408, P = 0.004);Tandem EUS/ERCP with fine needle aspiration(FNA)(OR, 14.528, 95%CI: 3.571-59.095, P < 0.001);ERCP duration longer than 60 min(OR, 5.396, 95%CI: 1.86-15.656, P = 0.002). In a decision tree model(ROC, 0.778) the probability for PEB without any risk factors was 1% regardless of prophylaxis *** The prevalence of PEB in our study is similar to previous reports, despite the fact that anti

关键词： Endoscopic retrograde cholangiopancreatography Bacteremia Tandem-procedures Fine needle aspiration Antibiotic prophylaxis Biliary drainage

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Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

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World Journal of Gastroenterology 2016年第34期22卷 7813-7823页

作者： Efrat Broide Shay Matalon Ofra Kriger-Sharabi Vered Richter Haim Shirin moshe leshno The Kamila Gonczarowski Institute of Gastroenterology Assaf Harofeh Medical Center Faculty of Business Administration Tel-Aviv University

AIM To investigate the cost effectiveness of routine small bowel biopsies(SBBs) in patients with iron deficiency anemia(IDA) independent of their celiac disease(CD) serology test *** We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy(EGD) in all patients with IDA regardless their celiac serology status(strategy A) vs SBBs only in IDA patients with positive serology(strategy B). The main outcomes were quality adjusted life years(QALY),average cost and the incremental cost effectiveness ratio(ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results,a Monte Carlo simulation of 100 sample trials with 10,and an acceptability curve were *** Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness,strategy A was the dominant strategy,as long as the cost of SBBs stayed less than $67. In addition,the ICER of strategy A was preferable,providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA,regardless of their celiac antibody status.

关键词： Celiac disease Iron deficiency anemia Cost-effectiveness Esophagogastroduodenoscopy Markov model

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Increased fibrosis progression rates in hepatitis C patients carrying the prothrombin G20210A mutation

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World Journal of Gastroenterology 2011年第45期17卷 5007-5013页

作者： Nitsan Maharshak Philippe Halfon Varda Deutsch Hava Peretz Shlomo Berliner Sigal Fishman Shira Zelber-Sagi Uri Rozovski moshe leshno Ran Oren Department of Gastroenterology and Liver diseases Tel Aviv Sourasky Medical Center aff iliated to the Sackler School of Medicine Tel Aviv University Department of Virology Laboratoire Alphabio 23 Rue de Friedland Hpital Ambroise Paré The Hematology Institute Tel Aviv Sourasky Medical Center affi liated to the Sackler School of Medicine Tel Aviv University Clinical Biochemistry Laboratory Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine Tel Aviv University Internal Medicine "E" Tel Aviv Sourasky Medical Center affi liated to the Sackler School of Medicine Tel Aviv University

AIM: To examine whether hepatitis C virus (HCV)-infected patients who carry hypercoagulable mutationssuffer from increased rates of liver fi brosis. METHODS: We analyzed DNA samples of 168 HCV patients for three common hypercoagulable gene mutations: prothrombin 20210 (PT20210), factor V Leiden (FV Leiden) and methylene tetrahydrofolate reductase (MTHFR). The patients were consecutively recruited as part of the prospective "Fibroscore Study" in France. The effect of the various mutations on the rate of fi-brosis was analyzed statistically and was correlated with epidemiological, clinical and biochemical data such as grade and stage of liver biopsies, patients' risk factors for liver cirrhosis, and timing of infection. RESULTS: Fifty two of the patients were categorized as "fast fi brosers" and 116 as "slow fi brosers"; 13% of the "fast fi brosers" carried the PT20210 mutation as compared with 5.5% of the "slow fi brosers", with an odds ratio of 4.76 (P = 0.033; 95% CI: 1.13-19.99) for "fast" liver fibrosis. Carriage of MTHFR or FV Leiden mutations was not associated with enhanced liver fi brosis. CONCLUSION: Carriage of the PT20210 mutation is related to an increased rate of liver fi brosis in HCV patients.

关键词： Hepatitis C virus Liver fi brosis Hyperco-agulation Prothrombin 20210

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Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification

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World Journal of Gastroenterology 2013年第1期19卷 57-64页

作者： Shira Zelber-Sagi Muriel Webb Nimer Assy Laurie Blendis Hanny Yeshua moshe leshno Vlad Ratziu Zamir Halpern Ran Oren Erwin Santo Department of Gastroenterology Tel Aviv Sourasky Medical Center64239 Tel-AvivIsrael School of Public Health Faculty of Social Welfare and Health SciencesUniversity of Haifa31905 HaifaIsrael Liver Unit Ziv Medical CenterIsrael and Bar Ilan University13100 SafedIsrael The Sackler Faculty of Medicine Tel-Aviv University69978 Ramat AvivIsrael Université Pierre et Marie Curie H pital Pitié Salpêtrière75013 ParisFrance

AIM:To compare noninvasive methods presently used for steatosis detection and quantification in nonalcoholic fatty liver disease(NAFLD).METHODS:Cross-sectional study of subjects from the general population,a subgroup from the First Israeli National Health Survey,without excessive alcohol consumption or viral *** subjects underwent anthropometric measurements and fasting blood *** of liver fat was performed using four noninvasive methods:the SteatoTest;the fatty liver index(FLI);regular abdominal ultrasound(AUS);and the hepatorenal ultrasound index(HRI).Two of the noninvasive methods have been validated vs liver biopsy and were considered as the reference methods:the HRI,the ratio between the median brightness level of the liver and right kidney cortex;and the SteatoTest,a biochemical surrogate marker of liver *** FLI is calculated by an algorithm based on triglycerides,body mass index,γ-glutamyl-transpeptidase and waist circumference,that has been validated only vs *** < 30 rules out and FLI ≥ 60 rules in fatty ***:Three hundred and thirty-eight volunteers met the inclusion and exclusion criteria and had valid *** prevalence rate of NAFLD was 31.1% according to *** FLI was very strongly correlated with SteatoTest(r = 0.91,P < 0.001) and to a lesser but significant degree with HRI(r = 0.55,P < 0.001).HRI and SteatoTest were significantly correlated(r = 0.52,P < 0.001).The κ between diagnosis of fatty liver by SteatoTest(≥ S2) and by FLI(≥ 60) was 0.74,which represented good *** sensitivity of FLI vs SteatoTest was 85.5%,specificity 92.6%,positive predictive value(PPV) 74.7%,and negative predictive value(NPV) 96.1%.Most subjects(84.2%) with FLI < 60 had S0 and none had *** κ between diagnosis of fatty liver by HRI(≥ 1.5) and by FLI(≥ 60) was 0.43,which represented only moderate *** sensitivity of FLI vs HRI was 56.3%,specificity 86.5%,PPV 57.0%,and NPV 86.1%.The diagnostic accuracy of F

关键词： Steatosis Hepatorenal ultrasound index SteatoTest Fatty liver index Screening Agreement Sensitivity Specificity

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The Impact of Information Technology on Admission Decisions

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Computer Technology and Application 2011年第7期2卷 539-544页

作者： Ofir Ben-Assuli moshe leshno Itamar Shabtai The Faculty of Business Administration Ono Academic College Kiryat Ono 55451 Israel The Faculty of Management Tel-Aviv University Tel-Aviv 69978 Israel The School of Economics College of Management Academic Studies Rishon LeZion 75490 Israel

Information systems have been adopted in many fields including the health industry. Indeed, keeping abreast of the advances of the technological age, many medical organizations have invested heavily in information technologies （IT）, aiming at improving medical decision-making and increasing its efficiency. Despite their obvious advantages, the systems do not always immediately provide the vital medical information required for critical decision-making, and the decisions that are based on this partial information may result in a decreased level of quality of care and unnecessary costs. The objective of this research is to evaluate the contribution of IT to decision-makers （physicians） at the point of care of emergency departments （EDs） by investigating whether the information systems （IS） have improved the medical outcomes, in the complex and highly stressful environment of the ED, with time constraints and overcrowding. The authors evaluated the contribution of the medical information to admission decisions by using the track log-file analysis method. The results were obtained using a unique database containing referrals to the ED from seven main hospitals in Israel. The authors＇ results lead to the major conclusion that viewing medical history contributes to admission decisions and clearly reduces the number of avoidable admissions.

关键词： Medical informatics medical decision-making health informatics

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Almost Stochastic Dominance and Efficient Investment Sets

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American Journal of Operations Research 2012年第3期2卷 313-321页

作者： moshe Levy Jerusalem School of Business The Hebrew University Jerusalem Israel

A major drawback of Mean-Variance and Stochastic Dominance investment criteria is that they may fail to determine dominance even in situations when all “reasonable” decision-makers would clearly prefer one alternative over another. leshno and Levy [1] suggest Almost Stochastic Dominance (ASD) as a remedy. This paper develops algorithms for deriving the ASD efficient sets. Empirical application reveals that the improvement to the efficient sets implied by ASD is substantial (64% reduction for FSD). Direct expected utility maximization shows that investment portfolios excluded from the ASD efficient set would not have been chosen by any investors with reasonable preferences.

关键词： Stochastic Dominance Efficient Investment Set Investment Choice

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