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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]

Abstract COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various “co-morbidities” such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel’s population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country’s (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency. An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not “social”) distancing without exacerbating an older person’s sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a “double pandemic” this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person’s wish to “make way” for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population’s need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.

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

Historically speaking, in many societies a select few carried the burden of preserving and transferring knowledge. While modern society has broadened the scope of education, this is not enough in the medical sciences. We must ensure that all those who pursue a career in medicine become life-long learners who will grow and contribute well beyond their years in medical school. In considering how to attain this goal, we were intrigued by the similarities between generations-old wisdom of teaching and learning methods in Jewish culture and modern educational principles. Both aim to nurture a culture of learners. Our objective was to parallel the methodologies, pedagogic directives, and demands made of students in the Jewish tradition, to the principles used in medical education today. We surveyed the traditional Jewish culture of teaching and learning. We compared it to modern medical teaching methods and looked to see what lessons might be gleaned. In the traditional Jewish community, life is focused on education, and producing “learners” is the ideal. This culture of learning was developed over the generations and many educational methods are similar to modern ones. Some of the pedagogic principles developed successfully in Jewish society should be considered for adaptation in medical education. Further comparative research could help to expand the ways in which we teach medicine.