[COMPETENCY BASED MEDICAL EDUCATION - A NEW PARADIGM FOR ISRAELI PHYSICIAN TRAINING].

During the last decades the dominant paradigm, in which the duration of a rotation/course, the required content to be learnt (the material covered) and a test (usually a multiple choice one) evaluating the knowledge of the content, were paramount, is being replaced by a new paradigm: outcome/competency based medical education (CBME, OBME). In this paper the reasons for adopting this change in the developed world are presented, its nature and basic assumptions enumerated and national examples of its adoption from Scotland, Canada, UK and USA described. We will present in some detail the changes this approach entails, the new definitions it adopts, the learning outcomes it aspires to and how to evaluate them.

Low-dose ladostigil for mild cognitive impairment: A phase 2 placebo-controlled clinical trial.

Objective: Ladostigil reduces oxidative stress and microglial activation in aging rats. We assessed its safety and potential efficacy in a 3-year, randomized, double-blind, placebo-controlled phase 2 clinical trial in patients with mild cognitive impairment (MCI) and medial temporal lobe atrophy.

Methods: Patients 55 to 85 years of age with MCI, Clinical Dementia Rating (CDR) score of 0.

P-values and significance: The null hypothesis that they are not related is correct.

False signals and therapeutic optimism have led medicine down many a wrong pathway. Apart from the unnecessary costs of care and redundant research expenditure and efforts this has caused, therapies which were eventually discontinued may have come at a staggering cost of lives lost. Still most statistical information in the medical literature is presented with its p-values and little else.

Template for uniform reporting of emergency department measures, consensus according to the Utstein method.

Objective: To develop a template for uniform reporting of standardized measuring and describing of care provided in the emergency department (ED).

Methods: An international group of experts in emergency medicine, with broad experience from different clinical settings, met in Utstein, Norway. Through a consensus process, a limited number of measures that would accurately describe an ED were chosen and a template was developed.

Door To Detorsion Time Determines Testicular Survival.

Objective: To determine the importance of the duration of in-hospital management of patients with testicular torsion for testes survival. The time from onset of symptoms until surgery is a well-known factor determining testicular survival but there is no data regarding the contribution of in-hospital management duration to testicular survival. Unlike the time from onset of symptoms until seeking medical attention, the time from registration to the emergency department (ED) to the time of detorsion-"Door To Detorsion time" (DTD) is dependent on medical providers and should be minimized.

Intussusception in a pregnant patient caused by an ectopic pancreatic mass.

Small bowel obstruction is an uncommon disease in pregnant women and rare when it is caused by intussusception. Intussusception is a rare cause of intestinal obstruction in adult. When it occurs, it is almost always secondary to an underlying pathology acting as a lead point for invagination, such as polyps, hemartomas, lipomas, leiomyomas, Meckel's diverticulum, adenomas, strictures, and malignancies.

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare.

Epidemiology of obstetric critical illness.

Obstetric intensive care unit (ICU) admissions comprise only a small part of severe maternal morbidity. The incidence rate of both remains relatively unclear due to inconsistent definitions across publications, although this has begun to be addressed. There is a relative paucity of information regarding disease-specific survival following obstetric ICU admission, but outcomes are clearly related to the cause of admission and the quality of care.

Integrating Nanotechnology into Cancer Care.

Research activity in medical and cancer nanotechnology has grown dramatically over the past 15 years. The field has become a cradle of multidisciplinary investigations bringing together physicists, chemists, and engineers working with clinicians and biologists to address paramount problems in cancer care and treatment. Some have argued that the explosion in the number of research papers has not been followed by sufficient clinical activity in nanomedicine.

Prophylaxis and Treatment in Critically Ill Patients after Abdominal Surgery: A Survey of Practice.

To survey current intensive care unit (ICU) practice in initiating antifungal therapy for prophylaxis and treatment of suspected candidiasis after abdominal surgery. The goal was to establish the need to prioritize research toward standardized care of such patients. Online questionnaire survey of clinical practice based on theoretical case scenarios.

Work cessation after cancer diagnosis: a population-based study.

Background: Long-term work maintenance among cancer survivors is important for patients, their families and society.

Aims: To assess the risk of work cessation among workers at baseline in cancer survivors at 2 and 4 years after diagnosis compared with a matched cancer-free control group.

Methods: Baseline measurements for this historical prospective study were drawn from the Israeli Central Bureau of Statistics 1995 National Census, followed up until 2011.

Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception.

Background: The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage.

Low-dose fludarabine and cyclophosphamide combined with standard dose rituximab (LD-FCR) is an effective and safe regimen for elderly untreated patients with chronic lymphocytic leukemia: The Israeli CLL study group experience.

Chronic lymphocytic leukemia (CLL) is a disease of elderly patients. The fludarabine, cyclophosphamide, and rituximab (FCR) regimen is considered the treatment of choice for young fit patients with CLL; however, this combination is toxic for older patients. At the time this study was first planned and initiated, there was no standard chemo-immunotherapy regimen regarded as standard therapy for the less fit elderly patient with CLL.

Human Papillomavirus Vaccination Trends, Barriers, and Promotion Methods Among American Indian/Alaska Native and Non-Hispanic White Adolescents in Michigan 2006-2015.

Human papillomavirus (HPV) infection, the most common sexually transmitted disease in the US, is a preventable cause of cancer. HPV vaccination has the potential to prevent 90% of HPV-related cancer cases but is underutilized, especially among American Indian/Alaska Native (AI/AN) adolescents. The objectives of this study were to (1) describe trends and identify predictors of HPV vaccination initiation and completion in Michigan's AI and Non-Hispanic White children age 9 through 18 years and (2) to identify barriers to HPV vaccination and promotion methods at the tribal, state, and local levels in Michigan.

Temporal trends of geographic variation in mortality following cancer diagnosis: a population-based study.

Background: Inequalities among the western population, combined with the introduction of new treatment options for cancer, have challenged endeavors to provide equal care to patients with cancer. Israel's highly developed healthcare system and mandatory National Health Insurance afforded an opportunity to study geographic variation over time in mortality following cancer diagnosis.

Methods: This historical prospective cohort study included a nationally representative cohort that was assessed by the Israeli Central Bureau of Statistics 1995 census and followed until 2011.

Unemployment following breast cancer diagnosis: A population-based study.

Objectives: The population of breast cancer survivors is growing. In Western societies, many of these women are working age, and therefore, potentially desire to return to the work force. We aimed to evaluate the unemployment risk for up to 8 years following a breast cancer diagnosis and identify contributing socio-economic factors.

Golden Ratio and the Proportionality Between Pulmonary Pressure Components in Pulmonary Arterial Hypertension.

Background: The golden ratio (phi, Φ = 1.618) is a proportion that has been found in many phenomena in nature, including the cardiovascular field. We tested the hypothesis that the systolic over mean pulmonary artery pressure ratio (sPAP/mPAP) and the mean over diastolic pressure ratio (mPAP/dPAP) may match Φ in patients with pulmonary arterial hypertension (PAH) and in control patients.

Folate receptor targeting of radiolabeled liposomes reduces intratumoral liposome accumulation in human KB carcinoma xenografts.

Background: Active, ligand-mediated, targeting of functionalized liposomes to folate receptors (FRs) overexpressed on cancer cells could potentially improve drug delivery and specificity. Studies on folate-targeting liposomes (FTLs) have, however, yielded varying results and generally fail to display a clear benefit of FR targeting.

Method: Tumor accumulating potential of FTLs and NTLs were investigated in a FR overex-pressing xenograft model by positron emission tomography/computed tomography imaging.

Molecular pathogenesis of human CD59 deficiency.

Objective: To characterize all 4 mutations described for CD59 congenital deficiency.

Methods: The 4 mutations, p.Cys64Tyr, p.

In Vivo PET Tracking of Zr-Labeled Vγ9Vδ2 T Cells to Mouse Xenograft Breast Tumors Activated with Liposomal Alendronate.

Gammadelta T (γδ-T) cells are strong candidates for adoptive immunotherapy in oncology due to their cytotoxicity, ease of expansion, and favorable safety profile. The development of γδ-T cell therapies would benefit from non-invasive cell-tracking methods and increased targeting to tumor sites. Here we report the use of [Zr]Zr(oxinate) to track Vγ9Vδ2 T cells in vivo by positron emission tomography (PET).

Retrospective study to investigate fresh frozen plasma and packed cell ratios when administered for women with postpartum hemorrhage, before and after introduction of a massive transfusion protocol.

Background: Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol.

Methods: The retrospective PPH study cohort of two tertiary centers was identified using blood bank records, verified by patient electronic medical records. We identified women transfused with ≥3 units PRBC in a short time period within 24 hours of delivery.

Acute kidney injury secondary to traumatic rhabdomyolysis in a dog.

Objective: To describe the clinical course and successful management of a dog with crush syndrome, rhabdomyolysis, myoglobinuria, and associated acute kidney injury (AKI).

Case Summary: An 8-year-old female, neutered, mixed-breed dog was referred to the Veterinary Teaching Hospital due to crush injury and suspected AKI. Blood tests and urinalysis showed markedly increased serum creatine kinase activity, myoglobinuria, and AKI.

The Roots and Evolution of Ego-State Theory and Therapy.

The purpose of this article is to elucidate the origins of ego-state theory and therapy and to discuss the concept of human personality as a structure comprising numerous ego states. The historical roots of ego-state theory and therapy are reviewed. Also, the evolution of ego-state therapy from classic hypnotherapy to modern methods is identified.