Dorith Shaham

Cost-Effectiveness of Baseline Low-Dose Computed Tomography Screening for Lung Cancer: The Israeli Experience

OBJECTIVEnReduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel.nnnMETHODSnA decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases-lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated.nnnRESULTSnBase-case incremental cost per QALY gained was

CT features of intrapulmonary lymph nodes confirmed by cytology

1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than

Leukocyte telomere length and coronary artery calcification in Palestinians

10,000 with probability 0.937 and is lower than

Incidence and cytological features of pulmonary hamartomas indeterminate on CT scan.

20,000 with probability 0.978.nnnCONCLUSIONSnOur analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.

Establishing a Medical Humanities Program in Israel: Challenges and Solutions

We retrospectively assessed the computed tomography features of intrapulmonary lymph nodes confirmed by cytology in 18 patients. The median size of the lymph nodes was 5.8 mm (range=3.3-8.5 mm). All were below the carina, and only one nodule, which was associated with an interlobar fissure, was over 20 mm from the chest wall. The nodules were oval, round, triangular, or trapezoidal; had sharply defined borders; were solid and homogenous; and were without calcification. Six nodules (33.3%) had a discrete thin tag extending to the pleura. Intrapulmonary lymph nodes can reliably be confirmed by fine needle aspiration with cytological diagnosis.

Thoracic Manifestations of Behçet Disease at CT

OBJECTIVEnShorter leukocyte telomere length (LTL) is associated with higher incidence of coronary heart disease (CHD) and increased mortality. We examined the association of LTL with coronary artery calcification (CAC), which reflects the cumulative burden of coronary atherosclerosis, in an urban Arab sample of Palestinians, a population at high risk of CHD.nnnMETHODSnUsing a cross-sectional design, a random sample of East Jerusalem residents, comprising 250 men aged 45-77 and women aged 55-76 and free of CHD or past stroke, was drawn from the Israel national population register. LTL was measured by Southern blots. CAC was determined by 16-slice multidetector helical CT scanning using Agatston scoring. We applied multivariable logistic modeling to examine the association between sex-specific tertiles of LTL and CAC (comparing scores >100 vs. <100, and the upper third vs. the lower 2 thirds), controlling for age, sex, education and coronary risk factors.nnnRESULTSnCAC, evident in 65% of men and 52% of women, was strongly associated with age (sex-adjusted Spearmans rho 0.495). The multivariable-adjusted odds ratios for CAC >100 (found in 30% of men and 29% of women) were 2.92 (95% CI 1.28-6.68) and 2.29 (0.99-5.30) for the lower and mid-tertiles of LTL vs. the upper tertile, respectively (Ptrend = 0.008). Findings were similar for CAC scores in the upper tertile (Ptrend = 0.006), and persisted after the exclusion of patients with diabetes or receiving statins.nnnCONCLUSIONSnShorter LTL was associated with a greater prevalence of asymptomatic coronary atherosclerosis in an urban Arab population-based sample. Mechanisms underlying this association should be sought.

Risk factors associated with postpartum ovarian vein thrombosis

Objective:u2002 Pulmonary hamartomas have a characteristic heterogeneous radiological appearance. However, when composed predominantly of undifferentiated mesenchymal fibromyxoid component, their homogeneous appearance on computed tomography is indeterminate for malignancy. Rendering an accurate preoperative diagnosis in these cases can alter management. The aim of this study was to determine the incidence and accuracy of cytodiagnosis for hamartomas ‘indeterminate’ by imaging.

The role of radiology in terror injuries

In the 2007–8 academic year, the Hebrew University – Hadassah Medical School established a three-year Medical Humanities program. We developed a spiral curriculum addressing three main concepts: moral reasoning, professionalism, and the social and cultural context of medicine, each of which is revisited during the entire period of studies on a higher level. The courses—encompassing topics applicable to medicine in general as well as subjects of special significance to physicians in Israel—are taught in a combination of frontal lectures, small group discussions, and early clinical exposure. Our interdisciplinary faculty includes physicians, nurses, social workers, psychologists, lawyers and members of the Faculty of Humanities. We believe that teaching the medical humanities enables graduating physicians to utilize the latest scientific and technological knowledge more empathetically and humanely, reminding them that medicine is not confined to mere tending to the sick, but includes an ethical philosophy common to all physicians who remain true to their art.