Attitudes Toward the Use of Medical Cannabis and the Perceived Efficacy, Side-effects and Risks: A Survey of Patients, Nurses and Physicians.

Gaps between physician and patient perceptions may lead to misunderstandings and mismanage of treatment. There are sparse data about the differences in opinions toward medical cannabis (MC) between patients and health professionals. The aim of this study was to examine the attitudes toward MC, its perceived efficacy, side effects and risk of dependency, among patients, nurses and physicians. A cross-sectional study of samples of 430 patients, 65 nurses and 65 physicians in two large medical centers in Israel. Questionnaires were administered on attitudes, perceived efficacy, side-effects and perceived risks of dependency. Compared with nurses and physicians, patients who were using MC had the most positive attitudes toward MC (p < .001). Younger age, high school education, being Jewish and ever using MC, were associated with more positive attitudes toward MC among patients (p < .001). Among nurses and physicians, having an oncology specialty predicted more positive attitudes toward MC. Physicians had a less positive attitude toward MC compared to nurses (p < .01). Our study provides evidence that physicians are less positive in their views toward MC compared to nurses and patients. More information and awareness to MC may reduce the gap in perceptions between physicians and patients.

Cannabis for the Treatment of Inflammatory Bowel Disease: A True Medicine or a False Promise?

Cannabis is the most widely used recreational drug worldwide and is used by some patients with inflammatory bowel disease (IBD) to ameliorate their disease. Whereas epidemiological studies indicate that as many as 15% of IBD patients use cannabis, studies inspecting cannabis use in IBD are few and small. We have conducted several studies looking at the use of cannabis in IBD. In Crohn's disease, we demonstrated that cannabis reduces the Crohn's disease activity index (CDAI) by >100 points (on a scale of 0-450).Two small studies in ulcerative colitis showed a marginal benefit. However, no improvement was observed in inflammatory markers or in endoscopic score in either disease. Many questions regarding cannabis use in IBD remain unanswered. For example, cannabis is a complex plant containing many ingredients, and the synergism or antagonism between them likely plays a role in the relative efficacy of various cannabis strains. The optimal doses and mode of consumption are not determined, and the most common form of consumption, i.e. smoking, is unacceptable for delivering medical treatment. Cannabis is a psychotropic drug, and the consequences of long-term use are unknown. Despite all these limitations, public opinion regards cannabis as a harmless drug with substantial medical efficacy. In Israel, the number of licenses issued for the medical use of cannabis is rising rapidly, as are the acknowledged indications for such use, but good-quality evidence for the effectiveness of cannabis is still lacking. Further studies investigating the medical use of cannabis are urgently needed.

CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.

PURPOSE: To describe the experience of five Israeli pediatric epilepsy clinics treating children and adolescents diagnosed as having intractable epilepsy with a regimen of medical cannabis oil. METHODS: A retrospective study describing the effect of cannabidiol (CBD)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1-18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2-11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained CBD and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The CBD dose ranged from 1 to 20mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. RESULTS: CBD treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75-100% reduction, 25 (34%) reported 50-75% reduction, 9 (12%) reported 25-50% reduction, and 19 (26%) reported <25% reduction. Five (7%) patients reported aggravation of seizures which led to CBD withdrawal. In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep. Adverse reactions included somnolence, fatigue, gastrointestinal disturbances and irritability leading to withdrawal of cannabis use in 5 patients. CONCLUSIONS: The results of this multicenter study on CBD treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted.

[Rheumatic fever and Kawasaki disease among children in Israel].

BACKGROUND: Rheumatic Fever (RF) and Kawasaki Disease (KD) are the two leading causes of childhood acquired heart disease in developed countries. AIM: The objective of this paper is to characterize the epidemiologic changes and estimate the incidence rate of RF and KD among children in Israel in the past two decades. METHODS: Using the Israel National Hospital Discharges Register (NHDR), we investigated the epidemiologic features of RF and KD among children in Israel under 18 years of age, between the years 1996 and 2012. Incidence rates were calculated using the corresponding Central Bureau of Statistics (CBS) data. RESULTS: The average annual incidence rates of RF and KD were, respectively, 2 and 2.03 cases per 100,000 children under 18 years of age. During the study period, the incidence rate of RF declined by over 50%, while the incidence rate of KD increased by more than 40%. The hospitalization rate of RF and KD diagnoses in children showed similar trends. CONCLUSIONS: The incidence rates of RF and KD had undergone significant changes in the past two decades. These changes probably reflect increased awareness of preventing RF and diagnosing KD among health professionals. Due to the high risk of chronic heart disease associated with inadequately treated children, it is important to maintain high awareness among healthcare professionals and provide timely diagnosis of both conditions.

Kawasaki disease in Israel.

OBJECTIVE: To characterize the epidemiology and estimate the incidence of Kawasaki disease (KD) among children in Israel. METHODS: Using the Israel National Hospital Discharge Register, we investigated the epidemiologic features of KD among children <18 years of age between 1996 to 2009 in Israel. Incidence rates were calculated using the corresponding census data. RESULTS: During 1996 through 2009, 685 children <18 years of age were hospitalized for KD in Israel. Of these children, 88% were aged <5 years; the male/female ratio was 1.7:1; and most cases occurred in late winter-early spring. The overall incidence of KD was 6.4 per 100,000 children <5 years of age. Since 2000, there was a gradual increase in KD incidence as well as in the ratio of KD-associated hospitalizations to all-cause pediatric hospitalizations. For male infants <1 year of age, KD rates almost doubled: from 5.8 per 100,000 cases in 1996-1998 to an average of 11.9 cases per 100,000 in the following years (P = 0.002). The overall proportion of patients with coronary artery aneurysm was 2.9%, higher rates of coronary artery aneurysm were observed in patients <1 or >5 years of age and in male patients. CONCLUSIONS: Major epidemiologic features of KD among Israeli children are similar to those reported for the white population in Europe and the United States. KD incidence increased during the study period, especially among male infants <1 year of age.

[Audit of general hospitals and private surgical clinics in Israel].

BACKGROUND: Supervision and inspection of medical facilities are among the responsibilities of the Ministry of Health (MOH) anchored in the "Public Health Act 1940". In order to implement the law, the General Medical Division of the MOH began the process of auditing hospitals and private surgical clinics prior to considering the reissue of their license. OBJECTIVES: The audit aimed to implement the law, activate supervision on general hospitals and private surgical clinics, provide feed-back to the audited institution and upgrade quality assurance, regulate medical activities according to the activities elaborated in the license and recommend the license renewal. METHODS: Prior to the audits, 20 areas of activity were chosen for inspection. For each activity a check list was developed as a tool for inspection. Each area was inspected during a 4-5 hour visit by a MOH expert, accompanied by the local service manager in the institution under inspection. A comprehensive report, summarizing the findings was sent to the medical institute, requesting correction in those areas where improvements were needed. Recommendation for license renewal was sent to the Director of Licensing Division Ministry of Health. RESULTS: Between June 2003 and July 2006, 91 structured audits took place. A total of 47 general hospitals and 24 private surgical clinics were visited at least once. Most general hospitals were found abiding, functioning according to the required standards and eligible for license renewal. Licenses of institutions that complied with the standards determined by the audit teams, were renewed. Two private hospitals in central Israel, that were given an overall poor evaluation, were issued with a temporary license and subsequently re-audited 4 times over the next two years. Generally, the standards in private surgical clinics were lower than those found in general public hospitals. In one clinic the license was not renewed, and in another an order was issued to cease surgical procedures requiring general anesthesia. CONCLUSIONS: The evaluations were mainly qualitative, deliberately avoiding numerical rating. In order to improve the process in the future and facilitate common scale rating to establish an equitable comparison system between institutions, it will be necessary to develop more quality measures and compulsory standards, based on the measures used during the first round of audits. Publication of the results of such comparisons, will elevate medical performance, and ultimately improve the quality of services and medical care in Israel.