Yan Press
Ben Gurion University of the Negev, Family Medicine, Faculty Member
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Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognitive function in older patients with mild cognitive impairment (MCI).Methods: Male and female subjects aged 65 years and older with a clinical... more
Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognitive function in older patients with mild cognitive impairment (MCI).Methods: Male and female subjects aged 65 years and older with a clinical diagnosis MCI were included in an exploratory randomized, double-blind, placebo-controlled trial. Eligible subjects were assigned to either treatment with immediate-release MPH or placebo. The active compound was administered in an increasing-dose stepwise fashion, namely 10 mg MPH on day 1, 20 mg on day 2, and 30 mg on day 3. Subjects remained under observation for 4 h following drug administration and were monitored for changes in blood pressure and for adverse events. Cognitive outcome measures included the Montreal Cognitive Assessment (MoCA) and the Neurotrax Mindstreams computerized cognitive assessment battery.Results: Of 17 subjects enrolled, 15 subjects completed the study, 7 in the active MPH group and 8 in the placebo group. The average ...
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Background: The rate of elderly individuals with mild cognitive impairment (MCI) has increased over recent decades. The Feuerstein Instrumental Enrichment (FIE) program for the elderly has been shown to be effective in various age groups... more
Background: The rate of elderly individuals with mild cognitive impairment (MCI) has increased over recent decades. The Feuerstein Instrumental Enrichment (FIE) program for the elderly has been shown to be effective in various age groups but is has never been tested as a treatment for MCI in elderly patients. The aim of this study was to assess the effect of the FIE on the cognitive and functional state of elderly patients with MCI. Methods: This was an interventional pilot study in community-dwelling patients aged ≥65 years diagnosed with MCI in the previous year. The protocol included 30 twice-weekly 90-min sessions with a full neurocognitive evaluation prior to the intervention (v1), at its conclusion (v2), and half a year later (v3). Results: Nine of the 15 recruited participants completed the study. The mean age was 76.2 years. Compared to v1 and v2, the only significant improvements found at v3 were in the “visual perception” subtest of the NeuroTrax test and the total score o...
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Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID‐19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began... more
Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID‐19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long‐term c...
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Background: The use of feeding tubes (FTs) in patients with advanced dementia does not yield positive health outcomes and can have a negative effect. Methods: A cross-sectional study assessed the knowledge and attitudes of physicians on... more
Background: The use of feeding tubes (FTs) in patients with advanced dementia does not yield positive health outcomes and can have a negative effect. Methods: A cross-sectional study assessed the knowledge and attitudes of physicians on the use of FTs for patients with advanced dementia. Results: 201 of 240 doctors (83.8%) participated in the study; 61.7% of the doctors claimed that FTs prevent aspiration, 51.7% that they prevent pneumonia, and 38.8% that they prevent weight gain. Almost one-third (32.3%) said that the decision to use FTs could be taken by a hospitalist or a primary physician (28.9%). Conclusion: We found large gaps in knowledge among doctors about the use of FTs and consequences in patients with advanced dementia.
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In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career. A questionnaire, based on methods adapted from marketing research, was used to provide insight into the... more
In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career. A questionnaire, based on methods adapted from marketing research, was used to provide insight into the medical specialty selection process. It was distributed to 6-year medical students from two Israeli medical schools. A response rate of 66% resulted in collecting 218 completed questionnaires. Nineteen of the students reported that they were interested in FM, 68% of them were women. When compared to students not interested in FM, the selection criteria of students interested in FM reflected greater interest in a bedside specialty which provides direct long-term patient care. These latter students were also more interested in a controllable lifestyle that allowed time to be with family and children and working outside the hospital especially during the daytime. These selection criteria aligned with their perceptions of FM, which they perceived as pro...
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Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quality of life, disability, and use of health care resources. Few studies have assessed the prevalence of GSs in Russia. The aim of this study is... more
Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quality of life, disability, and use of health care resources. Few studies have assessed the prevalence of GSs in Russia. The aim of this study is to assess the prevalence of GSs among older adults living in the community in Moscow. A cross-sectional study was conducted in four community clinics in Moscow. A total of 1,220 patients completed a screening questionnaire, and 356 of them also underwent a comprehensive geriatric assessment (CGA). The mean age of the 1,220 participants was 74.9±6.1 years; 75.5% were women. Based on the questionnaire, 58.3% reported visual or hearing impairment, 58.2% cognitive impairment, 46% mood disorder, 42% difficulty walking, 28.3% urinary incontinence, 21.3% traumatic falls (over the previous year), and 12.2% weight loss. The mean number of GSs per patient was 2.9±1.5. Based on CGA, a decline in Instrumental Activity of Daily Living score was identified in 34...
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In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatric syndromes (GS) including chronic pain. To assess the prevalence of chronic pain among individuals aged ≥65 years in the Southern District... more
In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatric syndromes (GS) including chronic pain. To assess the prevalence of chronic pain among individuals aged ≥65 years in the Southern District of Israel and to evaluate associations between chronic pain and other GS. A telephone interview was conducted on a sample of older adults who live in the community. The interview included the Brief Pain Inventory and a questionnaire on common geriatric problems. Of 419 elderly individuals who agreed to be interviewed 232 (55.2%) suffered from chronic pain. Of those who reported chronic pain, 136 participants (68.6%) noted that they had very severe or unbearable pain. There were statistically significant associations between the pain itself and decline in patient's functional status, increased falls, reduced mood, and cognitive decline. The results of this study show that chronic pain is very common in older adults and that it is associated with ...
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Research Interests: Biochemistry, Evolutionary Biology, Microbiology, Neuroscience, Emergency Medicine, and 15 moreDevelopmental Biology, Health Care, Biotechnology, Cancer, Cell Biology, Infectious Diseases, Medicine, Multidisciplinary, Home Care, Heart Failure, Hospitalization, CHF, PLoS one, Healthcare utilization, and Emergency Department
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Research Interests: Emergency Medicine, Medicine, Comorbidity, Delirium, Prospective studies, and 15 moreHumans, Moscow, Hospitalization, Female, Male, Risk factors, Health Status, Clinical Sciences, Intensive Care Unit, Aged, Risk Factors, Intensive Care Units, Hospital Mortality, Cognition disorders, and Socioeconomic Factors
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Injury from the thorn of a palm tree is characterized by a prolonged, painful inflammatory reaction. Even when the source of the inflammation is diagnosed, appropriate treatment is usually delayed because family doctors are not familiar... more
Injury from the thorn of a palm tree is characterized by a prolonged, painful inflammatory reaction. Even when the source of the inflammation is diagnosed, appropriate treatment is usually delayed because family doctors are not familiar with the entity. Penetration of a palm thorn into the earlobe is an unrecognized cause of local inflammation. We describe a case of injury from a palm tree thorn in this uncommon site. We present the technique of transillumination for the identification and removal of the palm thorn.
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The diagnostic recommendation for orthostatic hypotension (OH) is to measure blood pressure during the first 3 min after getting up from a lying position. There are no clear definitions as to the amount of time that the patient should lie... more
The diagnostic recommendation for orthostatic hypotension (OH) is to measure blood pressure during the first 3 min after getting up from a lying position. There are no clear definitions as to the amount of time that the patient should lie down before this, and the number of measurements to be taken in lying and standing positions. The aim of this study was to identify the optimal time to measure blood pressure when lying and standing. This was a prospective study of 99 patients aged 65 years and above in an urban primary care clinic. Blood pressure was measured at 1 min intervals over 10 min in the lying position and 7 min standing. OH was found in 37 patients (37.4%). Of these, 56.8% were identified in the 1st minute, 67.6% after 2 min and 83.8% after 3 min of standing. In all cases, participants with OH were asymptomatic. In the lying position, blood pressure stabilized after 7 min, but when the 7th minute was used as a reference for OH many cases were lost. To optimize the identi...
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Research Interests: Cognition, Life Style, Electronic Health Records, Medicine, Comorbidity, and 15 morePopulation, Humans, Internal Medicine, Blood Pressure, Female, Male, Body Mass Index, Health Status, Clinical Sciences, Aged, Prevalence, Retrospective Studies, Age Factors, Cross Sectional Studies, and Accidental falls
Acupuncture and public interest in this modality have increased over recent years in Israel and throughout the western world. To compare the knowledge and attitudes of physicians to medical students with regard to acupuncture. An... more
Acupuncture and public interest in this modality have increased over recent years in Israel and throughout the western world. To compare the knowledge and attitudes of physicians to medical students with regard to acupuncture. An anonymous questionnaire was completed by internists and medical students at the Soroka Medical Center. There were 122 respondents in all, 57 of them women (46.7%). The study sample included 40 physicians (33%), 39 fifth year medical students (32%) and 43 second year medical students (35%). The majority of participants (93.4%) had never received training in acupuncture and 84.4% had never undergone acupuncture therapy themselves. In these variables there were no significant differences between the physicians and the students. The participants' level of knowledge of acupuncture was very low, with 40% unable to answer even one question (of eight) correctly. Despite the poor level of knowledge and the lack of personal exposure to acupuncture, 90 participant...
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Research Interests: Primary Care, Perception, Depression, Dementia, Cognition, and 15 moreMedicine, Comorbidity, Activities of Daily Living, Memory, Neurocognitive, Humans, Female, Male, Clinical Sciences, Aged, Middle Aged, Physical examination, Geriatric Assessment, Montreal Cognitive Assessment, and Cognition disorders
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The health care of the growing number of older people in the population is predominantly provided by the family physician, who is usually faced with time limitations. A community-based Comprehensive Geriatric Assessment (CGA) unit has the... more
The health care of the growing number of older people in the population is predominantly provided by the family physician, who is usually faced with time limitations. A community-based Comprehensive Geriatric Assessment (CGA) unit has the potential to provide the family physician with the necessary support required in managing older patients. To describe and review the structure and clinical experience of a community-based CGA unit over a period of five years. The CGA unit comprises a multidisciplinary team that utilizes a comprehensive array of assessment instruments. Specific emphasis is placed on comorbidity, polypharmacy, cognitive and affective status, social support and daily function. Over a period of five years, 456 older patients were evaluated. The mean age was 76.7 +/- 6.1 years and 36.2% were women. A total of 6.57 +/- 2.72 new diagnoses were made, the most common being dementia (60.1%), recurrent falls (43.9%) and social problems (32.5%). There were an average of 7 reco...
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Streptococcal pharyngitis is a common problem among children and adolescents. There are differences in diagnostic and treatment approaches in streptococcal pharyngitis between family physicians and pediatricians. To our knowledge, this... more
Streptococcal pharyngitis is a common problem among children and adolescents. There are differences in diagnostic and treatment approaches in streptococcal pharyngitis between family physicians and pediatricians. To our knowledge, this issue has not been investigated in Israel. To evaluate the attitude to diagnosis and treatment of streptococcal pharyngitis among family physicians and pediatricians in the southern part of Israel, and to explore the possible differences between these two populations. The study population consisted of a convenience sample of family physicians and pediatricians employed by Clalit Health Services in the Negev area. Anonymous questionnaires were self-administered to family physicians during clinic staff meetings or during participation in courses. The study included pediatricians working at Soroka University Medical Center and in the Negev community clinics. The study included 52 family physicians and 50 pediatricians. The majority of the participants co...
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Sexual dysfunction is characterized by disturbances in sexual desire and/or psycho-physiological changes associated with the sexual response cycle in men and women. Studies suggest that it is prevalent in 10-52% of women and 25-63% of... more
Sexual dysfunction is characterized by disturbances in sexual desire and/or psycho-physiological changes associated with the sexual response cycle in men and women. Studies suggest that it is prevalent in 10-52% of women and 25-63% of men, and could have a tremendous impact on the individual, interpersonal relations, and on the family quality of life. To assess attitudes, knowledge and sexual dysfunction management by Israeli primary care physicians. Two hundred and ninety-two physicians from approximately 800 participants who attended a Family Medicine and General Practice conference took part in the study. A self-reply questionnaire was distributed among the participants and 179 completed the full questionnaire (61%). Seventy nine percent of the physicians thought the primary care physician should be the address for treating most sexual dysfunction problems. Physicians indicated that only 12% of their patients treated for sexual dysfunction were female. Significant differences wer...
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Geriatric consultation services are generally beneficial in improving the health and well-being of the elderly. We prospectively studied whether the active participation of family physicians (FPs) in the process of geriatric consultation... more
Geriatric consultation services are generally beneficial in improving the health and well-being of the elderly. We prospectively studied whether the active participation of family physicians (FPs) in the process of geriatric consultation would improve implementation rates and benefit the health care of the elderly. We carried out a comparative prospective intervention study in three urban academic family medicine clinics. Patients in the control clinics were evaluated by the consultant geriatrician, and a summary of the findings and recommendations were presented to the FP in a brief meeting. In the intervention clinic, the referring FP joined the geriatrician throughout the geriatric assessment. The percentage of implementation of suggested recommendations was evaluated. Information regarding the utilization of health services was provided from computerized data. Of the 212 patients included in the study, 107 were in the intervention group and 105 were controls. The overall rate of implementation was significantly higher for patients in the intervention group (329/445; 73.9%) than for patients in the control group (232/387; 59.9%), P < 0.0001. In the year after the geriatric assessment, those in the intervention group visited the FP less often. A model co-consultation actively involving the FP in the process of assessment of the older patient by the geriatrician improves the degree of implementation of recommendations without an increase in related heath care utilization and costs. This model should be further developed and studied.
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Research Interests: Cognitive Science, Depression, Executive Function, Irish, Handwriting, and 16 moreHumans, Older people, Female, Male, Clinical Sciences, Mini Mental State Examination, Aged, Cognitive impairment, Retrospective Studies, Agraphia, Geriatric Assessment, Intelligence tests, Memory Disorders, Neurosciences, Cognition disorders, and Mental Competency
Research Interests: Program Evaluation, Geriatrics, Primary Care, Primary Health Care, Resource Allocation, and 14 moreQuality of Healthcare Services, Israel, Library and Information Studies, Humans, Hospitalization, Aged, Patient Care Team, Public health systems and services research, Program Design, Patient Centered Care, Interdisciplinary Communication, Age Groups, Community Health Centers, and Health services for the aged
Research Interests: Mental Health, Complementary and Alternative Medicine, Informed Consent, Israel, Pain Management, and 19 moreHumans, Clinical research, Health Services, Complementary Therapies, Back Pain, Female, Male, Complementary Medicine, Patient Satisfaction, Medical Care, Physical Fitness, Aged, Middle Aged, Questionnaires, Adult, General practitioner, Cross sectional Study, Cross Sectional Studies, and Ambulatory Care
Research Interests: Treatment Outcome, Comorbidity, Prospective studies, Humans, Female, and 15 moreMale, Statistical Significance, Hip Fractures, Length of Stay, Health Status, Clinical Sciences, Aged, Hip fracture, Cognitive Function, Prognosis, Indexation, Linear Regression, Observational Study, Functional Status, and Surgical Treatment
Delirium is prevalent among elderly people presenting to an emergency department (ED). However, despite the fact that delirium is associated with longer hospital stays, an increased rate of institutionalization and higher mortality... more
Delirium is prevalent among elderly people presenting to an emergency department (ED). However, despite the fact that delirium is associated with longer hospital stays, an increased rate of institutionalization and higher mortality (especially in the case of undiagnosed delirium), this condition often goes undiagnosed by ED doctors. We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years in a large teaching hospital in Southern Israel via a retrospective chart review. Surprisingly we found no diagnosis of delirium in the medical charts of representative sample of 319 elderly people. Furthermore, only 12.5% of people received either an adequate or even a partially adequate mental status assessment by the ED doctors. We attribute these negative findings not to a low incidence of delirium but probably to a combination of a heavy workload along with a lack of adequate training of ED physicians. We suggest that part of the solution involves providing appropriate education to ED physicians as well as adding a geriatric consultant to the ED roster.