Doron Garfinkel

• M.D.
• Consultant at Tel Aviv University

Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europe and subse...

Background Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in older adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europ...

Objectives To evaluate polypharmacy in older people to determine whether the number of medications de-prescribed correlates with the extent of improvement in quality of life (QoL) and clinical outcomes. Design A prospective longitudinal cohort study of polypharmacy in people living in a community in Israel. Setting Participants aged 65 years or o...

Purpose: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing appro...

Background: There has been a rapid increase in vulnerable subpopulations of very old with co-morbidity, dementia, frailty, and limited life expectancy. Being treated by many specialists has led to an epidemic of inappropriate medication use and polypharmacy (IMUP) with negative medical and economic consequences. For most medications there are no e...

Objective Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to rep...

Background In complex older patients, inappropriate medication use and polypharmacy (IMUP) are commonplace and increasing exponentially. Reducing IMUP is a challenge in multiple clinical contexts, including acute admission and family practice, due to several key barriers. In the global effort against this epidemic, educational programs geared towar...

Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limited life expectancy, with the ma...

Background: Elderly patients are exposed to increased number of medications, often with no proof of a positive benefit/risk ratio. Unfortunately, this trend does not spare those with limited life expectancy, including end-stage cancer patients who require only palliative treatment. For many medications in this subpopulation, the risk of adverse dr...

Background: The aim of this study was to evaluate efficacy and safety of poly-de-prescribing (PDP) based on the Garfinkel method in older people with polypharmacy. Methods: A longitudinal, prospective, nonrandomized study in Israel was carried out between 2009 and 2016. Comprehensive geriatric assessments were performed at home in people age ⩾66...

The vicious circle of age-related diseases, many experts and guidelines/drugs fuels the 21st century iatrogenic epidemic of inappropriate medication use and polypharmacy. There are no evidence-based medicine (EBM) ‘guidelines’ for treating older people, and knowledge gaps regarding dosage requirements. For all drugs, the positive benefit/risk ratio...

Introduction: The objective of this pilot study was to evaluate the efficacy and safety of a novel method using an autologous whole blood clot formed with the RedDress Wound Care System (RD1, RedDress Ltd, Israel), a provisional whole blood clot matrix used in the treatment of chronic wounds of various etiologies. Methods and materials: Patients...

The positive benefit–risk ratio of most drugs is decreasing in correlation to very old age, the extent of comorbidity, dementia, frailty and limited life expectancy (VOCODFLEX). First, we review the extent of inappropriate medication use and polypharmacy (IMUP) globally and highlight its negative medical, nursing, social and economic consequences....

Background Diabetes is a major comorbidity in insomnia patients. The efficacy and safety of prolonged-release melatonin 2 mg in the treatment of glucose, lipid metabolism, and sleep was studied in 36 type 2 diabetic patients with insomnia (11 men, 25 women, age 46–77 years). Methods In a randomized, double-blind, crossover study, the subjects were...

Prolonged-release melatonin (PRM) 2 mg is indicated for insomnia in patients aged 55 years and older. A recent double-blind placebo-controlled study demonstrated 6-month efficacy and safety of PRM in insomnia patients aged 18-80 and lack of withdrawal and rebound symptoms upon discontinuation. To investigate the efficacy, safety, and withdrawal phe...

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate the...

We are delighted to see others look for ways to improve and broaden the use of the Garfinkel GP-GP model.1 - 2 Avoiding adverse events is a major motivator for reducing polypharmacy. Incorporation of risk assessment tools into the GP-GP model might improve the ability of physicians to identify medications particularly likely to cause problems for e...

Polypharmacy and inappropriate medication use is a problem in elderly patients, who are more likely to experience adverse effects from multiple treatments and less likely to obtain the same therapeutic benefit as younger populations. The Good Palliative-Geriatric Practice algorithm for drug discontinuation has been shown to be effective in reducing...

A comparison of inpatient end-of-life needs as perceived by terminally ill older adult patients, family, physicians and nurses, is lacking. This study aimed to compare the importance attributed to different end-of-life needs by terminally ill older adult patients in long-term care facilities, their families and care providers (physicians and nurses...

Scant attention has been paid to the decision-making process of caregivers in disclosing bad news to patients. The purpose of this study was to describe factors influencing this process and to ascertain whether physicians and nurses behave differently, based on Ajzen and Fishbein's (1980) theory of reasoned action (TRA). In this correlational quant...

To evaluate the efficacy of hip protectors (HP) in preventing hip fractures (HF) in patients with dementia. A case-control study. Four specialized dementia units. 206 physically independent patients with dementia. Beginning in January 2004, following the recommendation of the Israeli Ministry of Health, we recommended the use of HP (Hip Saver-nursi...

Previous research has consistently documented the contribution of both illness perceptions and social support to adjustment to illness. This study combines these two approaches by examining: (1) Do patient and spouse perceptions of the patient's heart disease differ? (2) Are each partner's perceptions of the patient's disease associated with his/he...

The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments. To improve drug therapy and minimize drug intake in nursing departments. We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119...

Melatonin plays a role in the biologic regulation of circadian rhythms, including sleep. Melatonin has also been shown to modulate vascular smooth muscle tone and to induce hemodynamic effects in humans. To evaluate whether melatonin plays a role in the circadian rhythm of blood pressure in hypertensive patients. Sixteen elderly patients with essen...

This pilot study investigated the impact of melatonin administration as a clinical intervention for improving sleep and alleviating sundowning in 11 elderly nursing home residents who suffer from dementia. Melatonin is a hormone produced and secreted by the pineal gland in response to darkness, which plays a major role in the induction and regulati...

Benzodiazepines are widely used in the elderly population for the initiation of sleep. However, very frequently, complaints about poor sleep maintenance persist despite benzodiazepine treatment. Melatonin, a hormone produced by the pineal gland at night, is involved in the regulation of the sleep/wake cycle. Melatonin production decreases with age...

Melatonin, produced by the pineal gland at night, has a role in regulation of the sleep-wake cycle. Among elderly people, even those who are healthy, the frequency of sleep disorders is high and there is an association with impairment of melatonin production. We investigated the effect of a controlled-release formulation of melatonin on sleep quali...

Although cadmium and zinc have similar chemical properties, they affect living organisms diversely: while zinc is an essential element for growth, development and functioning of all living cells, cadmium is a highly toxic material. Cadmium has an extremely long biological half-life and may be considered a cumulative toxin. It has been shown to have...

Macronodular liver cirrhosis and hepatocellular carcinoma were found in a 61-year-old male who had been exposed for 35 years to Trinitrotoluene (TNT). The question whether TNT had induced these pathological processes is raised.

Although most assays for measuring drug levels in serum determine the total concentration, effects from a drug are determined better by measuring the concentration of unbound (free) drug in serum. When the free fraction of a drug is constant, the total drug concentration may act as a good guide in predicting drug activity. However, if the free frac...

A review of the literature suggests that an intracellular zinc deficiency may be the primary cause of the aging process. Zinc-metalloenzymes play an important role in many aspects of cellular metabolism including DNA replication, repair and transcription. The main enzymes affected by zinc deficiency may be specific for each cell type. Depending on...

Imaging in a patient with multiple myeloma and Gaucher's disease showed space-occupying lesions in the liver and spleen. These were found to be plasmocytomas on histologic examination.

A husband suffering from temporal arteritis and his wife afflicted with polymyalgia rheumatica are reported. The possibiliy of the existence of an environmental factor rather than a genetic etiology is discussed. (C) Copyright 1984 Southern Society for Clinical Investigation

Observation d'une femme de 34 ans qui presentait une distension abdominale et des douleurs du quadrant superieur gauche. La splenectomie a fait disparaitre ces symptomes et confirme le diagnostic suggere par l'echographie

A markedly neutropenic patient with aplastic anemia who developed fever unresponsive to massive antibiotic treatment succumbed to mucormycosis pneumonia which could not be demonstrated by repeated chest X-ray examinations performed prior to his death. Roentgenologically invisible pneumonia may be a feature of mucormycosis.

A hypothyroid patient who also suffered from chronic obstructive lung disease and mild congestive heart failure was treated with 1 g/day theophylline administered orally. This was followed by a life-threatening theophylline intoxication as manifested by repeated epileptic fits and ventricular fibrillation which was successfully reverted to sinus rh...

The present report describes a patient who, following successful treatment for Hodgkin's lymphoma (HL), presented 4 years later with chronic lymphocytic leukemia (CLL).

• A patient with coexisting multiple myeloma and Gaucher's disease is described. Clinical features suggest that chronic, immunologic stimulation by glucocerebrosidase may rarely predispose to the development of multiple myeloma.(Arch Intern Med 1982;142:2229-2230)

A patient with the adult type of Gaucher's disease and ascites expired after massive and uncontrollable bleeding from esophageal varices. A liver biopsy performed after death showed massive liver infiltration with Gaucher's cells as well as fibrosis. To the best of our knowledge a similar fatal exsanguination due to bleeding from esophageal varices...

• A patient with coexisting multiple myeloma and Gaucher's disease is described. Clinical features suggest that chronic, immunologic stimulation by glucocerebrosidase may rarely predispose to the development of multiple myeloma. (Arch Intern Med 1982;142:2229-2230)

After 10 days of treatment with intravenous adenine arabinoside, complete healing of a severe labial herpes simplex infection was achieved in a patient with disseminated histiocytic lymphoma.Copyright © 1982 S. Karger AG, Basel

13 patients with adult non-lymphocytic leukemia (ANLL) who developed central nervous system (CNS) involvement during the course of their illness are reported and compared with a control group of 26 ANLL patients without CNS involvement. The incidence of CNS involvement was 13/510 patients (2.5%). Initial symptoms and signs and routine laboratory da...

Four pneumonic episodes, always located in the upper lobe of the left lung and presenting with identical clinical manifestations and laboratory findings, occurred within 8 months in a 53-year-old man. The diagnosis of Legionella pneumophila pneumonia was established only during the 4th episode. The treatment with tetracycline was followed by comple...

A 68 year-old woman, treated 30 years ago by collapse therapy for tuberculosis of the lung, presently developed the syndrome of inappropriate antidiuretic hormone scretion. The investigation revealed only an extensive right fibrothorax. The possible relation between the latter and her present illness is discussed.

In a survey in Israel of 50 patients with Wilson's disease, it was found that this disease occurred in all ethnic groups. In the Arab patients there was a significantly early age of onset and the disease followed a more severe course than that in the Jewish patients. The overall sex ratio of patients was nearly 1:1, and genetic analysis of 20 famil...