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The poem "My Self Defense" by Alex Galper, translated from the Russian by Igor Satanovsky and Mike Magazinnik, is presented. First Line: I am eating delicious borsht to protest wolfish capitalism; Last Line: Allow gays to get married or I am ordering a cappuccino with cream.

Background: Chronic obstructive pulmonary disease (COPD) exacerbations necessitating hospitalization are known to have a negative impact on post-discharge clinical outcomes. In the present study, we evaluated the potential benefits in applying Patient-Reported-Outcome-Measures (PROMS) in order to better these patients' post-hospitalization prognostication., Methods: This was a prospective, observational study., Results: Ninety-nine COPD patients were recruited (aged 9.7±73 years, 61.6% males). All patients filled two separate PROMS (EXACT & PROMIS GLOBAL 10) while 69 of them also filled a second battery of PROMS within 3 months post discharge. The median follow-up time was 14.3 months. The patients' characteristics found to have a statistically significant association with increased risk for 90-days re-hospitalization were: permanent use of oxygen at home [55.2% vs. 32.8%, p=0.045]; significant change in the dyspnea score of the EXACT [54(40-71) vs. 38(11-60), OR=1.115; 95CI 1.006-1.236, p=0.038] and significant change in the cough and sputum, score section of the EXACT [0 (-19-25) vs. -14 (-31-0), OR=1.095; 95CI 1.011-1.187, p=0.027]. Patients' characteristics found to have a statistically significant association with increased risk for 90-days mortality were: age [83±8.43 vs. 72.46±9.53, p=0.047], diagnosis of pneumonia during index hospitalization [60% vs. 14.9%, P=0.034] and low ALT blood activity [10IU (5.5-13.8) vs. 17IU (13-22.8), p=0.016]. Significant change in the EXACT score was associated with increased risk of long-term mortality [-3 (-8.8-9.5) vs. -9 (-21.5-0), OR=1.047; CI95% 1.005-1.091, p=0.03]., Conclusions: Assimilating PROMS, during and post-hospitalization due to COPD exacerbation could improve our prediction for negative clinical outcomes, both short- and long-term. This may offer better therapeutic interventions in the future. We recommend usage of the EXACT as part of the post-discharge follow-up of COPD patients.

Patient-reported outcomes measure patients' views of their health-related quality of life. With the increasing interest and usage of PRO's in the world, Sheba Medical Center is the pioneer in the field in Israel looking at the potential value in PRO implementation in routine practice as a quality improvement tool together with the opportunity to help drive changes in healthcare delivery. The PRO implementation process involves the multi-disciplinary ward or clinic staff in order to engage them and transform the process into a work routine. The collection methods and usage differ from one clinical area to another and require cultural adaptation in each area. Adjusted reporting and usage during patient encounter assist to improve patient enrolment and provide better and more accurate outcomes for the patient and the medical center.