A blockchain-based computerized network infrastructure for the transparent, immutable calculation and dissemination of quantitative, measurable parameters of academic and medical research publications.

Digital transformation of healthcare systems should rely on decentralized computer networks and take advantage of the unique characteristics of blockchain technology. Decentralization ensures process transparency and data transparency for all relevant stakeholders. These values are essential in the realms of populations' healthcare information communications and processing, control and tracking of medical logistics supply chains, clinical research management, and control of certified healthcare services organizations. Mounting decentralized processes onto a blockchain-based computerized network will endow the values of immutability, improved cybersecurity, and potential for incentivizing stakeholders for relevant, pre-determined activities. One of the most relevant processes that would benefit from a decentralized, blockchain-based architecture is the submission, review, and publishing of scientific manuscripts. Current structures and processes in this world are non-transparent, poorly incentivizing significant stakeholders such as manuscripts' reviewers, and many are potentially corrupted. In this review, we suggest a blockchain-based architecture for such systems and advocate further research and development in several domains of modern healthcare systems-offering medicine to become "the new guy on the block (chain)."

Dead Sea mud packs for chronic low back pain.

BACKGROUND: Low back pain (LBP) is chronic disease without a curative therapy. Alternative and complementary therapies are widely used in the management of this condition. OBJECTIVES: To evaluate the efficacy of home application of Dead Sea mud compresses to the back of patients with chronic LBP. METHODS: Forty-six consecutive patients suffering from chronic LBP were recruited. All patients were followed at the Soroka University Rheumatic Diseases Unit. The patients were randomized into two groups: one group was treated with mineral-rich mud compresses, and the other with mineral-depleted compresses. Mud compresses were applied five times a week for 3 consecutive weeks. The primary outcome was the patient's assessment of the overall back pain severity. The score of the Ronald & Morris questionnaire served as a secondary outcome. RESULTS: Forty-four patients completed the therapy and the follow-up assessments: 32 were treated with real mud packs and 12 used the mineral-depleted packs. A significant decrease in intensity of pain, as described by the patients, was observed only in the treatment group. In this group, clinical improvement was clearly seen at completion of therapy and was sustained a month later. Significant improvement in the scores of the Roland & Morris questionnaire was observed in both groups. CONCLUSIONS: The data suggest that pain severity was reduced in patients treated with mineral-rich mud compresses compared with those treated with mineral-depleted compresses. Whether this modest effect is the result of a "true" mud effect or other causes can not be determined in this study.

Online nephrology course replacing a face to face course in nursing schools' bachelor's program: a prospective, controlled trial, in four Israeli nursing schools.

BACKGROUND: Online learning is growing rapidly worldwide, especially in the health related sectors such as medicine and nursing. Our trial wished to measure the objective (i.e. final exam results, courseware usage patterns) and subjective (satisfaction) efficiency of online vs. face-to-face learning in a prospective, controlled trial, a first of its kind in Israel. MATERIALS AND METHODS: The trial tested a blended online course, teaching introduction to clinical nephrology. The course was filmed and edited into a learning platform to fit computer based learning. 90 nursing students, from 4 bachelor's nursing programs in Israel participated in the study. The intervention group included 32 students who studied using the online course, accompanied by 3 frontal meetings dealing with technical and content issues. The reference group included 58 students from 3 nursing programs, studying in a traditional face-to-face course. RESULTS: The final exam results were significantly higher in the intervention group compared with the reference group (9.6 ± 2.57 vs. 8.4 ± 2.72; p<0.05). Student satisfaction was very high in the intervention group: 97% thought the course was well organized, 100% thought the teacher taught clearly and consistently, 90% thought the teacher encouraged self-thinking,100% thought the teacher used clarifying examples, 91% thought the teaching aids helped the learning process and 97% thought the teaching method contributed to the learning process. The average usage of the online course was 4:10h vs. 14 academic hours (10:30 h) in the traditional course. The daily usage habits of the courseware were also followed, indicating that most learning took place between 12 PM and 1 AM, peaking between 5 PM and 7 PM, and dipping between 3 AM and 10 AM. CONCLUSIONS: The online course had higher efficiency compared to the traditional face-to-face course. The subjective feedback of the intervention group proves high satisfaction with online learning.

Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study.

OBJECTIVE: The study evaluates lipids profile changes during gestation in pregnancies with and without preeclampsia and/or gestational diabetes. STUDY DESIGN: Lipid profiles were assessed between year prior and after pregnancy in 9911 women without cardiovascular comorbidities. RESULTS: Lipid levels during gestation varied substantially with a nadir following conception and a peak at delivery. Compared to preconception levels total cholesterol levels increased from 164.4 mg/dL to 238.6 mg/dL and triglycerides (TGs) from 92.6 mg/dL to 238.4 mg/dL. The composite endpoint (gestational diabetes mellitus or preeclampsia) occurred in 1209 women (12.2%). Its prevalence increased with levels of TG-from 7.2% in the group with low TGs (<25th percentile adjusted for the gestational month) to 19.8% in the group with high TGs (>75th percentile), but was not associated with high-density lipoprotein levels. In multivariate analysis higher TGs levels, but not low high-density lipoprotein, were associated with the primary endpoint. CONCLUSION: Lipid levels change substantially during gestation. Abnormal levels of TGs are associated with pregnancy complications.

Primiparity, assisted reproduction, and preterm birth in twin pregnancies: a population based study.

OBJECTIVE: To determine the prevalence of pregnancy complications among primiparous patients with twin gestation in our population and to investigate the association between the increased rates of assisted reproduction (ART) in twin gestation and preterm birth (PTD). MATERIAL AND METHODS: A retrospective population based cohort study was designed, including all twin deliveries after 24 weeks gestation (n = 2,601). The study group included 666 primiparous women and the comparison group 1,935 multiparous women. Maternal characteristics and perinatal outcome were evaluated. Women with fetal malformations were excluded. A multiple logistic regressions analysis for independent risk factors was performed including factors that were significantly different between the study groups in the univariate analysis. Patient's data were obtained from computerized database and analyzed using SPSS statistical package. RESULTS: Primiparous women had a significantly higher rate of preeclampsia, chronic hypertension, ART, prelabor rupture of membranes (PROM) preterm deliveries (PTD), labor dystocia, cesarean section (CS) and vacuum extraction of the first twin than the multiparous group. Primiparous patients had a significantly lower gestational age at delivery and neonatal birth weight of the first and second twin. In multiple logistic regressions analysis primiparity and ART were independent risk factors for PTD, (OR 1.45, 95% CI 1.18-1.78; OR 1.36, 95% CI 1.09-1.71, respectively). CONCLUSIONS: (1) Primiparous patients with twin gestation represent a unique population with high rate of infertility and underlying diseases such as chronic hypertension in comparison to the multiparous women with twin gestation; (2) primiparity is an independent risk factor for prematurity in twin gestations; and (3) although primiparous women had an increased maternal complications, neonatal mortality rates were not significantly different from multiparous women.

Zollinger Ellison syndrome, treated with lansoprazole, during pregnancy.

BACKGROUND: Zollinger Ellison syndrome (ZES), an ulcerative disease of the upper gastrointestinal tract that involves the production of high levels of gastrin and gastric acid, is a rare, symptomatic, endocrine neoplastic disease. CASE: We report a rare case of gastrinoma that was first diagnosed during pregnancy in which the primary tumor was located in the liver. The ZES was well controlled with Zoton (Lansoprazole) following surgery. The patient had an uneventful pregnancy and delivery without significant complications. CONCLUSIONS: The present case suggests that treatment with Zoton for ZES during pregnancy is safe and effective.

Chronic hypertension is an independent risk factor for preeclampsia and preterm delivery in women with rheumatologic diseases: a population-based study.

OBJECTIVE: The objective was to determine the prevalence of maternal and perinatal complications among patients with rheumatologic diseases (RD) and to investigate the maternal risk factors for preeclampsia and preterm delivery among RD patients. STUDY DESIGN: A retrospective population-based cohort study was conducted. The study group comprised women with RD; the control group comprised patients without RD. The obstetric and neonatal outcomes of the groups were compared, and the data were obtained from a computerized database. RESULTS: During the study period, there were 179 deliveries by 125 women with RD. The prevalence of severe preeclampsia, chronic hypertension, pregestational diabetes, oligohydramnios, preterm deliveries and cesarean sections was significantly higher in the RD group than in the control group. Mean birth weight was significantly lower in the study group compared with the general population. Maternal RD was found to be an independent risk factor for preterm delivery and severe preeclampsia (OR 3.59; 95% CI: 2.52-5.11; OR 3.05; 95% CI: 1.44-6.45, respectively). The presence of chronic hypertension in patients with RD was found to be an independent risk factor for severe preeclampsia and preterm delivery (OR 12.2; 95% CI: 2.1-69.8; OR 3.8; 95% CI: 1.1-12.7, respectively). CONCLUSION: Chronic hypertension is an independent risk factor for preterm delivery and severe preeclampsia among RD patients.

Increased prevalence of gestational diabetes mellitus in in vitro fertilization pregnancies inadvertently conceived during treatment with long-acting triptorelin acetate.

Thirty-five pregnancies were inadvertently conceived during the midluteal application of the long-acting gonadotropin-releasing hormone agonist triptorelin acetate before ovarian stimulation for in vitro fertilization. Most of the conceptions occurred before the first or second IVF trial, and were associated with a significantly increased tendency to develop gestational diabetes. No increase in pregnancy wastage or appearance of congenital malformations occurred.