Background: Intra-abdominal abscess (IA) is an important clinical complication of Crohn’s disease (CD). A high index of clinical suspicion is needed as imaging is not routinely used during hospital admission. This study aimed to identify clinical predictors of an IA among hospitalized patients with CD using machine learning. Methods: We created an electronic data repository of all patients with CD who visited the emergency department of our tertiary medical center between 2012 and 2018. We searched for the presence of an IA on abdominal imaging within 7 days from visit. Machine learning models were trained to predict the presence of an IA. A logistic regression model was compared with a random forest model. Results: Overall, 309 patients with CD were hospitalized and underwent abdominal imaging within 7 days. Forty patients (12.9%) were diagnosed with an IA. On multivariate analysis, high C-reactive protein (CRP) [above 65 mg/l, adjusted odds ratio (aOR): 16 (95% CI: 5.51–46.18)], leukocytosis [above 10.5 K/μl, aOR: 4.47 (95% CI: 1.91–10.45)], thrombocytosis [above 322.5 K/μl, aOR: 4.1 (95% CI: 2–8.73)], and tachycardia [over 97 beats per minute, aOR: 2.7 (95% CI: 1.37–5.3)] were independently associated with an IA. Random forest model showed an area under the curve of 0.817 ± 0.065 with six features (CRP, hemoglobin, WBC, age, current biologic therapy, and BUN). Conclusion: In our large tertiary center cohort, the machine learning model identified the association of six clinical features (CRP, hemoglobin, WBC, age, BUN, and biologic therapy) with the presentation of an IA. These may assist as a decision support tool in triaging CD patients for imaging to exclude this potentially life-threatening complication.

Community-acquired pneumonia is among the most common infections affecting ulcerative colitis (UC) and Crohn’s disease (CD) patients. Data regarding epidemiology and outcomes of pneumonia in inflammatory bowel disease (IBD) patients is lacking. We aimed to investigate the epidemiology, natural history and predictors of adverse outcomes in IBD patients treated for pneumonia. This was a retrospective cohort study that included consecutive adult patients that were admitted to Sheba Medical Center for pneumonia from an electronic repository of all emergency department admissions between 2012 and 2018. Data included tabular demographic and clinical variables and free-text physician records. Pneumonia cases were extracted using ICD10 coding. We compared the characteristics and outcomes of IBD and non-IBD patients, and CD and UC patients. We also examined the association of clinical and laboratory variables with thirty-day mortality. Of 16,732 admissions with pneumonia, 97 were IBD patients (45-CD; 52-UC). IBD patients were younger than non-IBD patients (66.8 years vs. 70.2 years, p-value = 0.077). Comorbidities such as diabetes (16.5% vs. 22.8%, p = 0.142), hypertension (30.9% vs. 41.4%, p = 0.037) and congestive heart failure (15.5% vs. 19.2%, p = 0.35) were more prevalent among non-IBD patients. Use of immunosuppressant and biological medications was more common among IBD patients (corticosteroids [19.6% vs. 9.7%, p = 0.001], azathioprine [5.2% vs. 0.4%, p < 0.001], vedolizumab [2.1% vs. 0%, p < 0.001], tumour necrosis factor-α inhibitors [6.2% vs. 0%, p < 0.001]). Thirty-day mortality rate was similar among IBD patients and non-IBD patients (12.1% vs. 11.3%, p = 0.824). We found increased hospitalisation rate among IBD patients (92.8% vs. 85.6%, p = 0.045), but similar length of stay in hospital (6.2 days vs. 6.2 days, p = 0.989). Thirty-day mortality rate (11.1% vs. 11.5%, p = 0.947) and hospitalisation rate (93.3% vs. 92.3%, p = 0.846) were similar in CD and UC patients. On the other hand, CD patients were younger (57.6 years vs. 74.8 years, p < 0.01) and had a shorter length of stay in hospital (4.8 days vs. 7.5 days, p = 0.046) compared with UC patients. Using regression analysis model, bronchiectasis (Adjusted odds ratio [AOR] 109.6, p = 0.008, opioid use (AOR 13.0, p = 0.03) and PPIs use (AOR 5.9, p = 0.05) were independently associated with the risk of 30-day mortality in IBD patients. This is the first study to identify predictors of mortality in IBD patients with pneumonia. The rate of mortality and duration of stay were similar between IBD and non-IBD patients. Use of PPIs, opioids and presence of bronchiectasis were associated with a higher risk of mortality in IBD patients with pneumonia.

Abstract Background Patients with inflammatory bowel disease (IBD) have a greater risk of venous thromboembolism (VTE) events compared with the general population especially during flares, in both hospitalised and ambulatory patients. Although VTE prophylaxis (thromboprophylaxis) is recommended in hospitalised IBD patients, the implementation is not universal, especially for non-IBD-related hospitalisations. In this study, we aimed to present the rates of VTEs and thromboprophylaxis among hospitalised IBD patients. Methods We created an electronic data repository of all IBD patients who visited the emergency department (ED) of our tertiary medical centre between 2012 and 2018. Data included tabular demographic and clinical variables (reason for referral, VTEs, clinical characteristics, hospitalisation, lab results, treatment and outcome) as well as free-text physician records. For this study, we searched the data repository for VTE cases, using ICD10 coding. Results Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) Crohn's disease and 849 (35.3%) Ulcerative colitis patients. Thromboprophylaxis was administered in 463 hospitalisations (12.4% of IBD-related and 10.9% of non-IBD-related hospitalisations). 1.5% of patients (36/2405) who visited the ED had a new VTE. Thirty patients were diagnosed with a deep vein thrombosis (DVT), two patients with a pulmonary embolism (PE) and six additional patients were diagnosed with both a DVT and PE in the same hospitalisation. Eleven patients had a VTE during a non-IBD-related hospitalisation and six patients during an IBD-related hospitalisation (0.6% vs. 0.3%, respectively, pv = 0.12). Five patients (29.4%) developed VTEs after receiving thromboprophylaxis during hospitalisation. The majority (72.7%) of VTEs diagnosed during a non-IBD-related hospitalisation did not have additional thrombosis-related risk factors. One patient died during hospitalisation and two more patients died in the upcoming 30 days (unrelated to VTEs). Conclusion The rate of thromboprophylaxis in hospitalised IBD patients is low, despite posing life-threatening implications. Thromboprophylaxis should be implemented in IBD patients hospitalised for all indications.

Patients with Crohn’s disease are frequently subject to symptoms causing them to seek medical care in emergency departments (ED). Recurrent ED visits are common after initial discharge. The burden of recurrent ED visits of Crohn’s patients is high for the patient and the health care system. We aimed to identify the characteristics of patients with Crohn’s disease who return to the ED within 30 days from discharge. We created an electronic data repository of all IBD patients admitted to our tertiary medical centre in the time frame 2012 – 2018. Data included tabular demographic and clinical variables, as well as free-text physician records. For this study, we retrieved consecutive Crohn’s patients who were discharged from the ED. We included only patients with complains that can be attributed to Crohn’s disease exacerbation or complication. Patients without available blood test results were excluded, as well as pregnant women and patients under 18. Patients who returned to the ED in 30 days were compared with those who did not. Overall, 2148 patients visited our ED with complaints related to Crohn’s disease exacerbation or complication. 1435 (67%) were admitted for hospitalisation. Six hundred and ninety-five (33%) were discharged, of them, 110 (15.8%) returned to the ED within 30 days. Male gender, tachycardia (>100 bpm), pain score >4 (using numerical pain rating scale of 0–10), Albumin <3.5 gr/dl, elevated alkaline phosphatase (>120 IU/l), hyponatremia (<135 meq/l), and anaemia (defined as less than 13.5 gr/dl for males and less than 12.0 gr/dl for females) were found to be associated with ED returns. On multivariate analysis, anaemia (OR 2.44 [95% CI 1.24–4.8]), tachycardia (OR 2.88 [95% CI 1.33–6.2]), and elevated alkaline phosphatase (OR 2.68 [95% CI 1.25–5.78]) were independently associated with ED returns. Of patients with 0, 1, 2, and 3 risk factors for ED re-visits 10%, 17%, 30%, and 33% revisited the ED within 30 days from discharge, respectively. In our large tertiary centre cohort, recurrent ED visits within 30 days occurred in 16% of the patients. Tachycardia, anaemia and elevated alkaline phosphatase were found to be independently associated with recurrent visits. This model, if validated in prospective studies, may be implemented in order to minimise the burden of recurrent ED visits.

Objective: Blood pressure (BP) is severely elevated at 16.3% and moderately elevated at 27.2% of hospital emergency department (ED) visits. Among ED patients with elevated BP, 50% to 70% have chronic hypertension. The aim of our study was to determine whether elevated systolic blood pressure (SBP) in the ED is associated with increased in-hospital mortality among hypertensive patients. Design and method: We retrospectively retrieved records of adult hypertensive patients who were hospitalized in one medical center during a five-year period (1/2013 – 12/2017). Patients were grouped according to initial ED SBP measurements; <90, 90 – 109, 110 – 139, 140 – 159, 160 – 179, 180 – 199, 200 – 219 and >220, mmHg. We examined the association between SBP measurements in the ED and in-hospital mortality rate, adjusted for the following ED features: demographics, mode of arrival, chief complaint, heart rate, known co-morbidities, laboratory results and type of hospitalization ward. Results: Overall, 198,784 hospitalizations were retrieved. Of those, 71,562 (36%) had a prior history of HTN. Among hospitalized hypertensive patients, adjusted in-hospital mortality rates versus initial ED SBP showed a “J” shape curve. Adjusted mortality rates were: 14.6%, 7.7%, 5.3%, 4.2%, 3.8%, 3.8%, 3.9% and 4.1% for SBP values of <90, 90 – 109, 110 – 139, 140 – 159, 160 – 179, 180 – 199, 200 – 219 and >220, mmHg, respectively. Conclusions: SBP measurements in the range of 140 – 200 mmHg were not associated with increased mortality in hospitalized hypertensive patients. Thus, elevated SBP in these ranges should not be an indication for hospitalization.

We present a brief description of our recent work that was submitted for journal publication introducing a novel system for generation of virtual PET images using CT scans [1]. We combine a fully convolutional network (FCN) with a conditional generative adversarial network (GAN) to synthesize PET images from given input CT images. Clinically, such solutions may reduce the need for the more expensive and radioactive PET/CT scan. Quantitative evaluation was conducted using an existing lesion detection software, combining the synthesized PET as a false positive reduction layer for the detection of malignant lesions in the liver. Current results look promising showing a reduction in the average false positive per case while keeping the same true positive rate. The suggested solution is comprehensive and can be expanded to additional body organs, and different modalities.

AIM: To present the computed tomography (CT) imaging features of floating aortic thrombus with emphasis on clinical and radiographic predictors for systemic shower emboli. MATERIALS AND METHODS: A retrospective computerised search for patients with protruding thoracic aortic thrombus on CT was conducted. Clinical and demographic characteristics were retrieved from medical files. Patients were divided into two groups: symptomatic and asymptomatic, based on the presence or absence of documented systemic emboli at the time of diagnosis or during follow-up. CT imaging features were analysed: location and extent of systemic emboli, presence or absence of thrombus insertion calcification, percentage of thrombus circumference that is attached to the aortic wall and thrombus volume. Clinical and demographic variables and CT imaging features were analysed as potentially associated with symptomatic emboli. RESULTS: The symptomatic group included 6/15 (40%) patients and the asymptomatic group included 9/15 (60%) patients. Patients in the symptomatic group were significantly younger (symptomatic: 53.3 +/- 11.7 years, asymptomatic: 76.9 +/- 8.4 years, p = 0.003). All the symptomatic patients were women (100%), while 2/9 (22.2%) of the asymptomatic patients were women, (p = 0.007). A non-calcified insertion site was more frequent in the symptomatic group (symptomatic 4/6 [66.7%] versus asymptomatic group 1/9 [11.1%], p = 0.011). The percentage of thrombus circumference attached to the aortic wall was significantly smaller in symptomatic patients (symptomatic: 31.8 +/- 8.4%, asymptomatic: 43.7 +/- 5%, p = 0.003). CONCLUSION: The imaging features of symptomatic floating thrombus include a narrow base of attachment and lack of insertion calcification. Free-floating thrombus should be actively sought and diagnosed or excluded when performing CT andiography for emboli. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

The resident's perception of the nature of the socialization process during specialization in relation to hospital size and field of specialization was studied. A closed-type questionnaire was administered to 258 residents who in 1984 registered for Phase One of the National Board Examination during their training. The results indicate considerable homogeneity in their perception of the norms and rewards of the practice of medicine. No significant differences were found by field of specialization or size of hospital. However, there were significant differences in the nature of the actual training in relation to the size of the hospital. A great deal of direct training and a large routine workload was reported by residents in medium-sized hospitals as compared with large and small hospitals. Surprisingly, achievements of residents were not congruent with the pattern of training: the highest rate of success in the examination was achieved by residents in large hospitals, a lower rate in small hospitals, while the lowest was in medium-sized hospitals.

The present study compared two populations: medical students and faculty as to their definition of essential traits of the 'good physician'. Each group was further divided into the two phases of medical education. The preclinical phase included preclinical students and preclinical faculty, and the clinical phase included two faculty subgroups—surgeons and internists and students in their clinical clerkships.The study was conducted in two phases. In the first phase (the pilot study), faculty and students (n = 90) specified 24 traits in a random fashion. These traits were made the basis of a structured questionnaire which was administered in the second phase. In phase 2, all participants (n = 388) were requested to grade the five most important traits on a 1–4 scale.The results show a remarkable general agreement on the desirable traits among all participants. However, there is a significant difference in the ordering of the five most important traits among the subgroups. The jive most important traits perceived were: honesty, humane approach to patients, responsibility, knowledge and professional skill, and ability to discriminate between important and minor issues.The relation between our results and those of others on the implications of role models on the formation and the education of the ideal physician is discussed.

In view of low admission rate to medical schools, a large number of applicants are rejected annually. This population is denied the fulfillment of its occupational goal and must decide either to reapply to medical school or to choose a different occupational path. The present study focused on the possible career paths of rejected applicants, their persistence in reapplication and eventual admittance. The closeness to medicine of the alternative career was examined by two dimensions: the situs and the status. The career paths were viewed with respect to pre-admission cognitive criteria and occupational status of the alternative choices as compared to medicine. The study's random sample comprised one-third of the unaccepted applicants to the Tel-Aviv University School of Medicine for the 1970 academic year. The research follow-up (n = 208) of the applicants was conducted in 1981. The results showed a strong determination on the part of the unaccepted applicants to persist in their choice of medicine: 59% of the subjects reapplied and graduated from medical school either in Israel or in other countries. This group was found to be significantly more persistent in its number of reapplications than subjects who turned to an alternative career path. Thus, persistence was rewarding. When an alternative occupation was chosen, the tendency was towards careers unrelated to medicine but with a similarly high occupational status. No significant differences were found in the pre-admission cognitive criteria between those who studied medicine and those who chose an alternative career. Motivation and determination seemed to be the dominant factors in the attainment of one's choice of medicine as a profession.

This study points out the significant role of senior teachers in the process of instruction. It also asserts the consistency and reliability of student assessments of instruction, and the correlation between these assessments and the students' achievement. The study was conducted on groups rather than individual students. The assumption was that when teaching is carried out in groups, it is preferable to relate to the evaluation expressed by the whole group, and its correlation with achievement. The data included 51 student groups studying in 15 departments affiliated with the medical school in 12 hospitals: paediatrics (3), psychiatry (5), gynaecology (4) and surgery (3). The results emphasize the role of senior teachers in the process of instruction. It was found that a high positive correlation exists between senior teachers' direct involvement in teaching and students' academic achievements. However, a low correlation was found between students' assessments of the overall departmental teaching and their academic achievements. Thus, it appears that achievement is not directly influenced by the quality of teaching as perceived by the students, but rather by other factors, with the exception of a positive correlation between the contributions of the department heads to instruction and students' achievement.

This study deals with the effect of the degree of religiosity on attitudes toward and experience with sex and contraception among university students. Students defined their religious beliefs on the poles from orthodox religion to opposed-to-religion. Data were gathered by an anonymous questionnaire on sexual activity, attitudes toward sex, unwanted pregnancy and contraception. Orthodox and observant students left questions on sex unanswered. Female students were sexually active and used contraception in inverse relationship to their degree of religiosity. There was no parallel finding for males. The more religious the student the less sex was considered contributory to the relationship and the acceptance of abortion declined, but even among religious female students 48% chose abortions as a solution to an unwanted pregnancy.

A model is proposed which takes into account the effect of the finite skin depth in a determination of the phonon-limited electronic mean free path (EMFP) by means of the radiofrequency-size-effect amplitude. The model results in a temperature dependence of the inverse EMFP which obeys neither aTn nor anaT3+bT5 law, in general. Numerical examples show the pureT3 behavior usually expected is reasonable for small Fermi radii of curvature, but that more complicated behavior can be expected for Fermi surfaces having nearly free electron curvature. Existing data from the “lens” of Cd, obeying an apparentT5 law, are discussed in terms of the present model.