Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognit... 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 ...
Dementia and Geriatric Cognitive Disorders Extra, 2020
Background: The rate of elderly individuals with mild cognitive impairment (MCI) has increased ov... 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...
Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease ... 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...
Dementia and Geriatric Cognitive Disorders Extra, 2018
Background: The use of feeding tubes (FTs) in patients with advanced dementia does not yield posi... 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.
Israel journal of health policy research, Jan 12, 2018
In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shorta... 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...
Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quali... 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...
In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatr... 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 ...
The American journal of tropical medicine and hygiene, Jan 22, 2016
Injury from the thorn of a palm tree is characterized by a prolonged, painful inflammatory reacti... 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.
Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognit... 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 ...
Dementia and Geriatric Cognitive Disorders Extra, 2020
Background: The rate of elderly individuals with mild cognitive impairment (MCI) has increased ov... 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...
Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease ... 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...
Dementia and Geriatric Cognitive Disorders Extra, 2018
Background: The use of feeding tubes (FTs) in patients with advanced dementia does not yield posi... 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.
Israel journal of health policy research, Jan 12, 2018
In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shorta... 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...
Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quali... 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...
In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatr... 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 ...
The American journal of tropical medicine and hygiene, Jan 22, 2016
Injury from the thorn of a palm tree is characterized by a prolonged, painful inflammatory reacti... 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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