Characteristics of injuries related to traffic crashes in Israel before and during the COVID-19 pandemic.

OBJECTIVES: This study explored differences in patient characteristics, injury characteristics, treatment modalities, and treatment outcomes among patients who presented to the Emergency Department (ED) following traffic crashes during the COVID-19 period (from March 15, 2020 to March 15, 2022) in comparison to the previous corresponding period between 2017 and 2019. METHODS: The study is a retrospective chart review study. The study included a random sample of 610 patients who presented to the ED of a major hospital located in northern-central Israel following traffic crashes: 305 patients who presented during the COVID-19 period (from March 15, 2020 to March 15, 2022) and 305 patients who presented during the previous corresponding period (from March 15, 2017 to March 15, 2019). Socio-demographic data, data regarding the traffic crashes, and medical data of the patients were collected from their medical records, and the data were compared. RESULTS: In the context of the COVID-19 period, a notable surge in the percentage of cyclist victims was evident, marking an increase from 7.5% to 19% compared to the corresponding period. Conversely, the incidence of pedestrian victims during the COVID-19 period dropped to 19.7%, in contrast to 30.8% in the corresponding period. Notably, patients involved in pedestrian crashes amid the COVID-19 period exhibited a shorter hospital stay (M = 2.8 days, SD = 3.3) compared to the corresponding period (M = 4.3 days, SD = 7.1) [t = 1.8 (df = 141), p < 0.05]. However, a higher fatality rate was observed among these patients during the COVID-19 period compared to the corresponding period (6.7% vs. 0%) [χ2 = 6.4 (df = 1), p < 0.05]. CONCLUSIONS: The study reveals significant changes in traffic crashes characteristics during the pandemic period, including a notable increase in cyclist victims and a decrease in pedestrian incidents. These shifts may be attributed to factors such as changes in transportation patterns, increased use of bicycles for essential travel. Despite these changes, the proportion of severe crashes remained relatively consistent. These findings underscore the importance of understanding the underlying causes behind these shifts and highlight the ongoing need for public education and awareness initiatives to promote traffic safety, particularly for vulnerable road users, during pandemic periods.

Knowledge of the Mpox virus and conspiracy beliefs and their association with self-confidence in managing the virus among Israeli orthopedic surgeons.

In 2022, the Mpox viral outbreak signaled a global public health emergency. Infectious disease management and prevention are crucial tasks for healthcare workers. In their line of work, orthopedic surgeons could come across cases of the Mpox virus. The aim of the present study was to explore orthopedic surgeons' knowledge of the Mpox virus, their conspiracy beliefs regarding emerging viral infections, and their self-confidence in managing the Mpox virus. In this cross-sectional survey, 137 orthopedic surgeons completed an online questionnaire. The participants had low knowledge of the Mpox virus, providing on average 11.5 correct answers (SD = 2.68) of a possible 21. In addition, the participants tended to express moderate conspiracy beliefs and to have low self-confidence in managing the Mpox virus. Age 30 or older, a higher knowledge level, and lower conspiracy beliefs predicted greater self-confidence in managing the Mpox virus. In addition, a negative association was found between knowledge of the Mpox virus and conspiracy beliefs. Arab and younger orthopedic surgeons expressed stronger conspiracy beliefs. Interventions should include introduction of material regarding emerging tropical infections in medical curricula and in-service training programs. In addition, special attention should be paid to younger and Arab orthopedic surgeons, as these subgroups may endorse higher conspiracy beliefs.

Should I Ask Doctor Google? Reliability of Israeli Web-based Information Regarding General Orthopedic Injuries and Symptoms.

BACKGROUND: Websites serve as a source of medical information for a large part of the public, some claim to be a substitute for a physician's consultation. Many patients meet a physician after conducting internet research. Medical staff are concerned that internet sources of information are unreliable and may lead to erroneous decisions by patients. OBJECTIVES: To examine the reliability of web-based sources of information (through the Google™ search engine) regarding five common orthopedic complaints and injuries. METHODS: We performed a search of five common orthopedic complaints and injuries using the Google search engine. The reliability of web-based information was measured by the DISCERN tool, which is a valid and verified tool for examining the reliability of medical information sources to the public. The reliability of 47 websites was examined by two orthopedic surgeons and two senior residents. RESULTS: The overall average score given to the sites was 2.8, on a scale of 1 to 5. We found that the higher the site appeared in the search results, the higher the quality of its information. Commercial sites scored higher than general internet information sources. CONCLUSIONS: The internet network is a very broad source of information. For those who lack scientific education and training it is not easy to distinguish between reliable and unreliable or biased sources. The trend of searching for medical information and self-healing is increasing. We must strengthen the network with reliable sources by creating official scientific position papers by medical teams and promoting them online.

Injury and Sociodemographic Characteristics of Intimate Partner Violence in Women in Israel: A Single-Center Retrospective Cohort Study.

BACKGROUND: Intimate partner violence is a growing public health concern worldwide, and nurses are uniquely positioned to help identify and refer patients for services. Yet, intimate partner violence injury patterns and characteristics often go unrecognized. OBJECTIVE: The purpose of this study is to explore injury and sociodemographic characteristics associated with intimate partner violence in women presenting to a single emergency department in Israel. METHODS: This retrospective cohort study analyzed medical records of married women injured by their spouse who presented to a single emergency department in Israel from January 1, 2016, to August 31, 2020. RESULTS: In total, 145 cases were included, of which 110 (76%) were Arab and 35 (24%) were Jewish, with a mean age of 40. Patients' injury patterns consisted of contusions, hematomas, and lacerations to the head, face, or upper extremities, not requiring hospitalization, and having a history of emergency department visits in the past 5 years. CONCLUSION: Identifying intimate partner violence characteristics and patterns of injury will help nurses identify, initiate treatment, and report suspected abuse.

Mortality, Survival, and Readmissions During a 12-Month Follow-Up After Hip Fracture: Inpatient Rehabilitation Versus Home Rehabilitation.

PURPOSE: This study compared readmissions, survival, and mortality during a 12-month follow-up period of inpatient rehabilitation and home rehabilitation for older persons who had experienced a hip fracture. METHODS: This work was retrospective cohort research. Between January 1 and December 30, 2019, the medical records of 280 elderly patients who were admitted to a hospital with a hip fracture were analyzed. Of these patients, 74.3% received inpatient rehabilitation, whereas 25.7% received home rehabilitation. RESULTS: In terms of readmissions and death, there were no appreciable differences between the inpatient rehabilitation and home rehabilitation groups. The patients in the inpatient rehabilitation group were older; more likely to need assistance with activities of daily living; and were taking, on average, more prescription drugs on a daily basis than those in the home rehabilitation group. CONCLUSIONS AND CLINICAL RELEVANCE: In conclusion, as better outcomes were expected for the home rehabilitation group, which on average included less complicated patients, our findings suggest that the home rehabilitation pathway may not be a good alternative to the inpatient rehabilitation pathway.

Israeli Female Physicians' Motives for Choosing Orthopedics as Their Specialty Choice.

BACKGROUND: Orthopedics is not a popular field of specialization among female medical students. Therefore, the purpose of the study was to examine factors related to women's choice of orthopedics as their field of specialty, compared to those who chose other fields. METHODS: In this cross-sectional survey, 149 female medical residents from Israel-33 specializing in orthopedics and 116 in other fields-completed a questionnaire. A comparison was held between the two groups. RESULTS: Orthopedic residents were more likely to have received clinical training in this field during their medical studies and were more likely to have expressed a desire to specialize in orthopedics before and at the completion of their studies. In addition, orthopedic residents ascribed greater importance to job security when choosing a field of specialty and, in contrast, ascribed no importance at all to lifestyle. No difference was found between the two groups in their level of dissatisfaction as a result of their residency. However, orthopedic residents were more inclined to perceive gender discrimination in the field of orthopedics but, despite this, had a greater intention to recommend a residency in orthopedics. A negative association was found between the level of dissatisfaction as a result of the residency and intention to recommend a residency in orthopedics. CONCLUSIONS: Differences between the two groups point to potential factors that might have been related to women's choice of orthopedics as their field of specialty. The findings may help form strategies for attracting women to specialize in orthopedics.

Factors Associated With Referral of Children With a Femur Fracture to a Social Worker by an Orthopedist for Suspected Child Abuse.

OBJECTIVES: This article explores factors associated with referral of children with a femur fracture to a social worker by an orthopedist for suspected child abuse. METHODS: This retrospective chart review study included 131 children younger than 5 years who sustained a femur fracture and were hospitalized in a major 495-bed hospital located in the northern-central Israel from 2009 to 2021. Data on children who were referred to a social worker by the treating orthopedist and those who were not were compared. RESULTS: More than half the children studied (58.8%, n = 77) were referred to a social worker by an orthopedist for suspected child abuse. However, only a fifth of these cases were eventually reported to the authorities. Male sex (odds ratio [OR], 2.44), younger age of the child (OR, 0.95), and spiral femur fracture type (OR, 5.30) increased the likelihood of referral. In addition, treatment of the child by an orthopedic specialist (as compared with an orthopedic resident; OR, 3.12) and lengthier professional experience of the treating orthopedist (OR, 1.08) increased the likelihood of referral. CONCLUSIONS: Younger male children presenting with a spiral femur fracture have a higher likelihood to be referred to a social worker because of suspected child abuse by treating orthopedic specialists with lengthier professional experience. The findings point to the need to improve the capacity of orthopedic residents to report child abuse.

Knowledge, attitudes, detection, and reporting practices of elder abuse among orthopedists.

PURPOSE: The purpose of the present study is to explore orthopedists' level of knowledge regarding laws and directives related to the detection and reporting of elder abuse, their attitudes towards the detection and reporting of elder abuse, detection and reporting practices, and the associations between these variables. METHODS: In this cross-sectional study, 145 orthopedists employed in various Israeli hospitals-senior orthopedists, orthopedic residents, and orthopedic interns-completed a questionnaire. RESULTS: The orthopedists had a medium level of knowledge and held positive attitudes on the detection and reporting of elder abuse, but the actual number of cases they detected and reported was low. Senior orthopedists had the highest level of knowledge and also the most positive attitudes, followed by orthopedic residents, and then orthopedic interns. Common reasons for unwillingness to report cases of elder abuse differed between levels of training. A minority of the orthopedists had received training on the detection and management of elder abuse. Higher knowledge and more positive attitudes were found associated with a higher number of detected and reported cases of elder abuse. CONCLUSIONS: The importance of training orthopedists on the detection and management of elder abuse cannot be overemphasized. It seems that orthopedists should receive such training early in their career. LEVEL OF EVIDENCE: IV.

Reasons for Surgical Delay in Patients With Hip Fracture.

INTRODUCTION: 15% of patients with hip fracture older than 65 years in Israel have delayed surgery. The aim of this study was to determine which patient and/or organizational factors are associated with a delay of beyond 48 hours in hip fracture repair surgery. METHODS: A retrospective cohort study of 281 patients with hip fracture who underwent surgery during 2019-2020. Characteristics of patients with early surgery ( n = 40) and patients with delayed surgery ( n = 241) were compared. RESULTS: Presence of a cardiac disease (odds ratio [OR] = 1.38), pulmonary disease (OR = 1.21), or obesity (OR = 1.18) was identified as risk factors for surgical delay. Each additional comorbidity increased the risk. Most of the documented reasons for delay were medical, with antiplatelet therapy the most common ( n = 8, 20%). Unavailable operating rooms were another common reason for delays ( n = 8, 20%). In addition, a higher percentage of patients with delayed surgery were admitted in August and September (42.5%). CONCLUSIONS: It seems that most delays were for medical reasons. However, it is unclear whether allegedly clinically justified delays were indeed of benefit to the patients. Health care organizations should strive to minimize the impact of organizational factors on surgical delay.

[REGENERATIVE MEDICINE IN ORTHOPEDICS - UPDATES AND COMMON USES].

INTRODUCTION: Regenerative medicine is a medical field that aims to heal, rehabilitate, repair, and facilitate the regeneration of diseased and damaged cells, tissues and organs. Regenerative medicine is based on mobilizing the body's self-healing abilities. The use of regenerative medicine to treat various musculoskeletal conditions is an evolving field within orthopedics and sports medicine called 'ortho-biology' or 'ortho-regenerative medicine'. There are currently well-founded findings regarding the safety of ortho-biological treatments, their manner of action, effect, and potential effectiveness. However, there is need for more controlled studies with strong scientific proof in order to better understand the potential of these treatments and how to best use them.

Combined Effect of Seasonality and Hyponatremia on the Occurrence of Hip Fractures Among Older Adults.

Background: It is unclear whether climate may play a role in the association between hyponatremia on admission and increased mortality risk among hip fracture patients following a hip fracture repair surgery. We aimed (1) to explore if there is any combined effect of seasonality and hyponatremia on the occurrence of hip fractures among older adults and (2) to explore the effect of hyponatremia on admission on mortality rate at latest follow-up among hip fracture patients following a hip fracture repair surgery in the context of the subtropical climate of Israel. Methods: We conducted a retrospective cohort study of older patients who underwent a surgery for hip fracture repair in a major 495-bed hospital located in northern-central Israel in 2017-2020. Patients were divided into two groups: hyponatremic (n = 107) and normonatremic (n = 757) patients. Characteristics of the two groups were compared, as well as their survival probability. Results: Hyponatremic patients were most frequently hospitalized during winter season. Such seasonal variation was observed only among hyponatremic patients. Moreover, patients who were hospitalized during winter season were more likely to be hyponatremic on admission. Hyponatremia on admission was found as a significant independent predictor of mortality rate at latest follow-up (adjusted hazard ratio = 0.377 [0.26-0.52]), when compared to normonatremia. Conclusion: There is a combined effect of seasonality and hyponatremia on the occurrence of hip fractures among older adults, with hyponatremic patients being at a higher risk of sustaining a hip fracture during winter season than during other seasons. In addition, the association between hyponatremia on admission and mortality rate at latest follow-up among hip fracture patients has been confirmed.

Awareness, Knowledge, and Screening for Intimate Partner Violence Among Orthopedic Surgeons in Israel.

This study examines factors associated with screening of female patients for intimate partner violence (IPV) by orthosurgeons in a sample of 100 Israeli orthosurgeons. Findings reveal positive attitudes toward screening female patients but a significant lack of knowledge. Arab orthosurgeons held slightly more negative attitudes toward screening for IPV and had a more prominent lack of knowledge regarding screening for IPV, compared to their Jewish counterparts. Nationality and feeling uncomfortable asking female patients about IPV predicted screening for IPV. The importance of training orthosurgeons on the assessment and treatment of IPV cannot be overemphasized, especially among Arab orthosurgeons.

Association Between Type of Face Mask and Visual Analog Scale Scores During Pain Assessment.

AIMS: To examine the association between the type of mask worn by health care professionals and assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS). DESIGN: A nonrandomized controlled trial conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021. METHODS: In the intervention group (n = 83), pain assessment using the VAS was performed by a health care professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a health care professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician. RESULTS: Health care professionals wearing a standard non-transparent mask obtained higher VAS scores than health care professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask. CONCLUSIONS: This study supports the use of transparent face masks by health care professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.

[ROBOTIC TOTAL KNEE ARTHROPLASTY].

INTRODUCTION: Total Knee Arthroplasty (TKA) is one of the most common operations performed in the orthopaedic surgery field. TKA is usually performed as a result of primary osteoarthritis which causes pain and a major decrease in the patient's quality of life. TKA is considered a successful operation with a success rate of 80-85%. In recent years, orthopaedic surgeons have started to perform robotic assisted TKA. In Israel, these operations have been performed since 2019. In this article we reviewed this topic and the latest clinical data comparing a conventional TKA and robotic assisted TKA. In the world, there are several robotic systems in use. Four systems are in use in Israel. The robotic system assists in the pre-operative and intra-operative planning, in order to perform precise cuts of the femur and tibia. The precision helps to achieve better soft tissue balance reconstruction of the lower limb axis. While robotic surgery performed in Israel has been rising since the technology came into use in 2019, the clinical data are not showing a significant advantage to either one of the operations. Recent studies have shown evidence of better imaging results in the robotic-assisted operation, however, the clinical benefits are still in doubt, due to the lack of large and long-term studies.

Hip Fracture Following a Fall among Older Adults during the COVID-19 Pandemic.

BACKGROUND: Little is known regarding the impact of the coronavirus disease-2019 (COVID-19) pandemic on the incidence of hip fractures among older adults. OBJECTIVES: To compare the characteristics of patients with a hip fracture following a fall during the COVID-19 pandemic year and during the preceding year. METHODS: We conducted a retrospective cohort study of older patients who had undergone surgery for hip fracture repair in a major 495-bed hospital located in northern central Israel following a fall. Characteristics of patients who had been hospitalized in 2020 (pandemic year, n=136) and in 2019 (non-pandemic year, n=151) were compared. RESULTS: During the pandemic year, patients were less likely to have fallen in a nursing facility, to have had muscle or balance problems, and to have had a history of falls and fractures following a fall. Moreover, the average length of stay (LOS) in the hospital was shorter; however, the average time from the injury to hospitalization was longer. Patients were less likely to have acquired a postoperative infection or to have died. During the pandemic year, postoperative infection was only associated with prolonged LOS. CONCLUSIONS: The COVID-19 pandemic may have had a positive impact on the behavior of older adults as well as on the management of hip fracture patients. However, healthcare providers should be aware of the possible reluctance to seek care during a pandemic. Moreover, further research on the impact of the change in management during COVID-19 on hip fracture survival is warranted.

Characteristics of those who fall during orthopedic hospitalization - A retrospective case-control study.

BACKGROUND: The causes of falls are heterogeneous and represent an interaction between patient and environmental factors. This study aimed to explore the characteristics of patients who fell in an in-patient orthopedic department and explore possible reasons for their falls. METHODS: A retrospective case-control study of adults in an orthopedic in-patient setting at a major hospital, who sustained a fall. Sociodemographic and medical characteristics of randomly sampled patients who fell (cases, n = 128) and their controls (n = 128) were compared. RESULTS: Fallers were younger, had less comorbidities, took less medications, and had a shorter length of stay than non-fallers. Moreover, fallers' reasons for hospitalization were not necessarily associated with limited mobility. Fall events occurred most frequently from the patient's bed, in the bathroom and during night shifts. CONCLUSIONS: Our study portrays atypical fallers; that is, patients who had no obvious risk factors for falls and, thus, were not expected to fall. It appears that reduction in falls among high-risk patients may artificially create a population of atypical fallers. The patients may overestimate their abilities and avoid asking for assistance. Our findings suggest that emphasizing the importance of asking for assistance among both low-risk and high-risk patients as well as male and female patients should be an integral part of patient education in orthopedic departments.

Retrospective study of older patient characteristics that increase the likelihood that a fracture was associated with abuse.

Searching for clinical manifestations of elder abuse may help healthcare professionals identify cases of elder abuse. The aim of the present study was to explore characteristics of older patients with fractures that increase the likelihood that the fracture was associated with abuse. This is a retrospective chart review study of 1,000 patients aged 65 and older who presented to an emergency department in northern-central Israel with a fracture during 2019. The chart review included participant characteristics - sociodemographic data, medical data, data regarding the fracture, and data on the presence of forensic markers of elder abuse in individual patients. Descriptive statistics and regression models were used for the analyses. Older age, presence of dementia, and hand and facial fractures were associated with the presence of forensic markers, and were also found to predict having at least one forensic factor. This study provides further support for the creation of clinical guidelines for identification of elder abuse.

Effect of smoking cessation on visually evoked cerebral blood flow response in healthy volunteers.

BACKGROUND/AIMS: In our previous study, impaired visually evoked flow velocity response was demonstrated in young chronic smokers. Our aim was to study whether impaired cerebrovascular reactivity is reversible 6-18 months after smoking cessation. METHODS: Flow velocity changes, evoked by visual stimulus, were recorded in the posterior cerebral arteries in 15 smokers, 15 former smokers and 15 nonsmokers. The stimulation protocol consisted of 10 cycles with a resting phase of 20 s (baseline) and a stimulating phase of 40 s for each cycle. Relative changes of flow velocity were expressed in relation to baseline. Breath holding index, visual evoked potential and intima-media thickness were also examined. RESULTS: Repeated measures ANOVA revealed marked difference in the flow velocity time courses between the 3 groups (p < 0.01). The flow response was significantly worse in former smokers than in nonsmokers (p < 0.002), however, no significant difference was found between former and current smokers (p = 0.0556). CONCLUSION: This is the first transcranial Doppler study demonstrating long-term impairment of visually evoked cerebrovascular response after smoking cessation. These findings indicate that the impairment of neurovascular coupling caused by smoking is due to structural changes of the vessels, rather than acute effect of smoking.

Acetazolamide-induced vasodilation does not inhibit the visually evoked flow response.

Different methods are used to assess the vasodilator ability of cerebral blood vessels; however, the exact mechanism of cerebral vasodilation, induced by different stimuli, is not entirely known. Our aim was to investigate whether the potent vasodilator agent, acetazolamide (AZ), inhibits the neurovascular coupling, which also requires vasodilation. Therefore, visually evoked flow parameters were examined by transcranial Doppler in ten healthy subjects before and after AZ administration. Pulsatility index and peak systolic flow velocity changes, evoked by visual stimulus, were recorded in the posterior cerebral arteries before and after intravenous administration of 15 mg/kg AZ. Repeated-measures ANOVA did not show significant group main effect between the visually evoked relative flow velocity time courses before and after AZ provocation (P=0.43). Visual stimulation induced significant increase of relative flow velocity and decrease of pulsatility index not only before but also at the maximal effect of AZ. These results suggest that maximal cerebral vasodilation cannot be determined by the clinically accepted dose of AZ (15 mg/kg) and prove that neurovascular coupling remains preserved despite AZ-induced vasodilation. Our observation indicates independent regulation of vasodilation during neurovascular coupling, allowing the adaptation of cerebral blood flow according to neuronal activity even if other processes require significant vasodilation.