Search

Eyal Walter,1 Ori Saban,1 Alan Jotkowitz,2 Tomer Batash,1 Jaime Levy1 1Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 2Department of Internal Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelCorrespondence: Jaime LevyDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, IsraelTel +972-26778641Email levjaime@gmail.comBackground: COVID-19 has erupted into our lives and forced rapid changes in all fields of medicine, causing a rush for publications that inevitably caused a shift away from the paradigm of evidence-based medicine (EBM). The objective of the present report is to assess and quantify this process.Methods: We compared the levels of EBM of the publications in the ophthalmic literature on COVID-19 at the beginning of the pandemic and compared it to those of articles published the prior year during April 2019 for the three highest ranking journals in the field of comprehensive ophthalmology.Results: COVID-19 publications ranked significantly lower (p< 0.001). Time between submission and acceptance was significantly shorter for the COVID-19 publications (p< 0.001), and significantly more publications were accepted without revisions (P< 0.001).Conclusion: Though a shift away from EBM may be unavoidable in the early stages of a pandemic, we suggest that for the benefit of reliable information and informed decision-making, it is time to go back to EBM.Keywords: COVID-19, pandemic, evidence-based medicine

Hamzah Aweidah,1 Khaled Safadi,1 Alan Jotkowitz,2 Itay Chowers,1,* Jaime Levy1,* 1Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 2Department of Internal Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel*These authors contributed equally to this workCorrespondence: Jaime LevyDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, IsraelEmail levjaime@gmail.comObjective: To present our hybrid telehealth medical retina clinic service with intravitreal injections (IVI) treatment as a safe alternative to in-person visits and examination during COVID-19 pandemic disease.Methods: Due to exposure to a COVID-19 positive retina fellow, our retina service, in quarantine, evaluated patients’ medical files and retinal scans using a telemedicine approach. A different protocol for patients coming for IVI during the COVID-19 pandemic was established for IVI administration.Results: During the 14-day quarantine period (between March 18th and March 31st 2020), the hybrid telehealth medical retina clinic performed 523 IVI to 394 patients with a mean age ± SD 70.96 ± 14.4 years. IVI were administered for neovascular age-related macular degeneration in 50.5% of the cases (199 patients), diabetic macular edema in 21.3% (84 patients), retinal vein occlusion in 17.5% (69 patients), and 10.7% for other retinal pathologies (42 patients). No ocular or systemic complications were observed.Conclusion: During disasters and pandemics, IVI can be provided safely using a hybrid telehealth medical retina clinic approach but only in the appropriate patient and health care system.Keywords: COVID-19, telemedicine, ophthalmology, intravitreal injections, hybrid telehealth medical retina clinic

Background/Aims: There is great demand for the beds in the new rehabilitation department in the authors' hospital. To determine ethical criteria for admission to the department, all senior rehabilitation physicians in the country were surveyed regarding their willingness to admit patients in various ethical scenarios. The aim was to determine whether there are consensus ethical principles governing whom to admit to the limited beds. Methods: The survey was administered to senior medical personnel responsible for admissions decisions. Out of the 54 people contacted, 30 completed the surveys (all were fully completed apart from one survey in which one clinical scenario was not answered). Results: Over 90% of respondents agreed to not admit non-compliant patients or to give precedence to those who were considered to be very important people, and 88% agreed on admitting a homeless patient. First come, first served was not considered an important criterion. Cronbach's alpha was <0.6. There was no consensus on most of the issues presented. Conclusions: It remains difficult to pinpoint what rehabilitation physicians consider ethical 'givens'. This research suggests that no specific ethical principle underlying the triage decisions in rehabilitative medicine can be discerned. Larger studies are warranted. Implications for practice: No ethically or specific principle underlying the triage decisions in rehabilitative medicine can be discerned. What one doctor may consider a clear ethical decision another physician may not concur. [ABSTRACT FROM AUTHOR]

Purpose. To describe the evolution of COVID-19 related publications in the field of ophthalmology. Methods. All articles published in the field of ophthalmology and relevant to COVID-19 were identified by conducting a search on PubMed and Scopus databases using the string ((ophthalmology) OR (eye) OR (ocular)) AND ((corona) OR (COVID-19) OR (pandemic)). Search was conducted on September 30, 2020. Each eligible publication was independently graded by two experienced ophthalmologists based on the level of evidence-based medicine (EBM), with scores ranging from 1 (the highest level of EBM) to 5 (the lowest level). The average level of EBM was also evaluated for each month from February through September. Finally, we analyzed the interval (in days) between submission and acceptance for publication as well as the percentage of manuscripts that required revision before being accepted. Results. Our search yielded a total of 425 relevant publications. Of these publications, 359 (84.5%), 59 (13.9%), and 7 (1.6%) were rated as level 5, 4, and 3, respectively; none of the publications was rated as level 1 or 2. From February 2020 through September 2020, we found a significant increase in the relative proportion of level 3 and 4 publications compared to level 5 publications (rho = 0.108, p=0.024). Moreover, the number of citations per article was significantly correlated with the level of EBM (rho = 2.44, p

Objective: Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology. Methods: In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications. Results: Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with “idiopathic” disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08–0.40, P