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Postoperative ileus is a common condition following abdominal surgery. Previous studies have shown the positive effects of coffee on gastrointestinal motility. The aim of this study was to assess whether caffeine is the stimulatory agent in coffee that triggers bowel motility and thus may reduce the duration of postoperative ileus. This was a single-centered, prospective, randomized controlled, double-blinded clinical trial. Patients scheduled to undergo elective laparoscopic colectomy between November 2017 and March 2019 were randomly assigned to receive either oral caffeine (100 mg three times daily) or placebo following the procedure. Primary endpoints were time to first flatus and time to first bowel movement. Secondary endpoints were time to tolerate a solid, low-residue diet and length of hospital stay. Registration number: NCT03097900. Seventy patients were included, [35 males, median age 56 years (range 19–79 years)]. After the exclusion of 12 patients, there were 30 patients in the caffeine group and 28 patients in the placebo group. The first passage of stool in the caffeine group occurred 18 h earlier than in the placebo group (p = 0.012); other endpoints did not reach statistical significance. No caffeine-related adverse events were observed. Caffeine consumption following colectomy is safe, leads to a significantly shorter time to first bowel movement, and may thus potentially lead to a shorter postoperative hospital stay.

Study objective The latest wave of terrorism worldwide has seen significant use by terrorists of mundane, "low-technology" weapons, such as utility knives and civilian vehicles. How do the injuries they produce compare with that of more conventional terrorism mechanisms, such as use of firearms and explosives? We compare injury patterns of the most frequent terrorism-related injury mechanisms in an Israeli data set. Methods This was a retrospective study of 1,858 patients hospitalized because of terrorism events, which were recorded in the Israeli National Trauma Registry between January 1997 and December 2016. The events were divided into 4 groups based on weapon used: explosions, shootings, stabbings, and vehicular attacks. The groups were compared in terms of injuries sustained, use of hospital resources, and clinical outcomes. Results Explosion-related and vehicular terrorism resulted in a higher proportion of multiple injuries, whereas stabbings and shootings mostly led to isolated injuries. Victims of vehicular attacks had a high proportion of severe head injuries, whereas stabbing victims had a high volume of vascular injuries. All mechanisms involved significant damage to extremities; however, among stabbing victims injury was mainly to the upper extremities, whereas among vehicular attack victims it was mostly to the lower extremities. The overall injury severity of the compared groups was similar, leading to comparable levels of intensive care use and inhospital mortality. Certain similarities in victims' characteristics were observed between the shootings and stabbings and between explosions and vehicular attacks. Conclusion Despite differences between various terrorist attack mechanisms, the resulting injury severity and inhospital mortality are very similar, with stabbings and vehicular attacks causing injuries as serious as those caused by conventional weapons.

Introduction Bus public transportation is preferred for its perceived safety. Data from several countries, however, alarm of non-collision injuries associated with bus use. The aim of the current study was to estimate the prevalence of non-collision bus injuries, and compare and identify population group at high risk for severe injuries, to serve as a basis for policy makers. Methods A retrospective analysis of the Israeli National Trauma Registry cohort for the years 2015–2017 was carried out. Database consists of 20 hospitals nationwide. Casualties hospitalized following a non-collision injury on a bus were identified. Demographic, injury characteristics, and hospital resources utilization were compared according to the place of injury; inside the bus or during boarding or alighting. Results During follow up, 704 hospitalized non-collision related bus casualties were recorded. Most of the casualties (75%) fell inside the bus and 25% during boarding or alighting. The majority (67%) of hospitalized patients were 60 years old or above, mostly injured while boarding or alighting the bus, and 72% were women. Frequent injured body regions were lower extremities, head and torso. Passengers injured inside bus sustained more chest injuries, but less lower extremities injuries, compared to those boarding or alighting the bus. More hospital resources were required to treat passengers injured while boarding or alighting the bus. Conclusions This systematic registry-based analysis of non-collision bus injuries confirms the greater risk of being injured while using bus transportation among women and older passengers. Primary attention for prevention policies should be given to injuries occurring during boarding or alighting of the bus. Additional policy recommendations are discussed.

POEM (Per Oral Endoscopic Myotomy) is rapidly becoming a valid option for surgical myotomy in achalasia patients. Several techniques to perform POEM are described, but all concentrate on the division of the circular muscle fibers in a proximal-to-distal fashion. Our aim is to present the distal-to-proximal, or the bottom-up technique using the Flush/Dual knife, which overcomes the disadvantages of the standard technique. A retrospective study on a prospectively maintained database was performed on all patients treated by POEM in our institution. Clinical presentation, operating time, adverse events, and outcomes were studied. POEM was performed on 105 achalasia patients. The first 15 cases were performed using the standard technique and were compared to the next 90 cases performed using the bottom-up technique. The average preop Eckardt scores in the standard and bottom-up groups were 9.5 and 8.8, respectively, declining to 1.4 and 0.5, 3 months post myotomy (p

Objective To evaluate and compare, at the national level, injury trends and, characteristics and to identify high risk groups of electric bike (E-bike) and mechanical bicycle (M-bike) related hospitalizations as a key message for public policy. Methods Historic prospective study based on data from the Israel National Trauma Registry (INTR), between 1.1.2013 and 31.12.2017. All hospitalized casualties were E-bikers and M-bikers. Results During the study period, 1733 E-bikers and 7259 M-bikers were hospitalized. Arab children (age 0–15) and young adults (age 16–29) were at higher risk for E-bike and M-bike casualties respectively. The hospitalization rate per 1000 vehicles was lower for E-bikers in comparison to M-biker. However, during the five year period a dramatic increase in E-bike related hospitalizations was reported coinciding with a decrease of M-bike related casualties. Among M-bikers, the decrease in hospitalization rate was for accidents on both inter and intra-city roads, but not on unpaved roads, which remained stationary, suggesting that the transportation mode is changing. In comparison to the M-bikers, E-bikers were at greater risk for enduring head injuries (OR 1.16 95% CI 1.00–1.25) and lower extremity injuries (OR 1.37 95% CI 1.23–1.52), to undergone surgery (OR 1.13 95% CI 1.00–1.26), having longer hospital stays (OR 1.44 95% CI 1.23–1.68) and being discharged to rehabilitation center (OR 1.43 95% CI 1.09–1.86). Conclusion During the last five years in Israel there is a dramatic increase in E-bike related hospitalized casualties corresponding to a substantial increase in E-bike usage. In comparison to M-bikers, there is a lower casualty rate but these casualties are more severely injured and utilize more hospital resources. It is of utmost importance to identify these high risk groups in an effort to develop culturally appropriate interventions for these road users, including training, awareness and helmet enforcement. Policy change recommendations are discussed.

Hadassah University Hospital (HUH) is the only level 1 trauma center in Jerusalem and has admitted the largest number of suicide bombing attack victims in Israel. With the current reality being that terrorist activity is a threat to civilians all over the world, not only to those in the Middle East, we feel it is imperative for physicians, surgeons, and hospitals to be aware of the magnitude of the threat and to be familiar with and prepared for the process of triage and treatment of large numbers of severely injured patients.

Introduction Mass Casualty Incidents (MCI) by Motor Vehicle Crashes (MVCs) are most common type of MCIs. Casualties from MCIs usually require more hospitalization resources. The purpose of this study was to compare the injury characteristics, survivability, and medical resource utilization of casualties from Mass-Casualty Motor Vehicle Crashes (MC-MVCs) and casualties from other (non MCI) MVCs. Methods This retrospective cohort study examined a population of 50,321 Israeli casualties hospitalized due to MVCs between 1998 and 2017, of which 595 (1.2%) were admitted from a MC-MVC. Analysis included type of motor vehicle involved and collision circumstances, injury characteristics, hospital resource utilization, and demographics. Results The results suggest that most casualties from MC-MVCs were bus passengers who were injured when the vehicle rolled over. Injuries from MC-MVCs were more urgent as almost two times more MC-MVCs casualties were rushed directly from the emergency room into the operating rooms and intensive care units than casualties of regular MVCs. Mortality rate was higher in MC-MVCs compared to regular MVCs (2.69% compared to 1.46%, respectively; p = .013). Severe injuries (ISS≥16) were more frequent in MC-MVCs (23.40% versus 15.53%, p Conclusions This study demonstrates that hospitals receiving casualties from MC-MVCs should expect not only a multitude of casualties, rather also the need to treat more urgent and severe injuries, in more body regions per casualty, and expect higher admissions rates to intensive care units and operation rooms under MCI conditions.

BACKGROUND: Other than the Advanced Trauma Life Support course, usually run for postgraduate trainees, there are few trauma courses available for medical students. It has been shown that trauma teaching for medical students is sadly lacking within the undergraduate curriculum. We stated that students following formal teaching, even just theory and some practice in basic skills significantly improved their management of trauma patients. METHODS: Hadassah-Hebrew University in Israel runs an annual 2-week trauma course for final-year medical students. The focus is on hands-on practice in resuscitation, diagnosis, procedures, and decision making. After engaging a combination of instructional and interactive teaching methods including practice on simulated injuries that students must assess and treat through the 2 weeks, the course culminates in a disaster drill where students work alongside the emergency services to rescue, assess, treat, and transfer patients. The course is evaluated with a written precourse and postcourse test, an Objective Structured Clinical Examination and detailed feedback from the drill. RESULTS: We analyzed student feedback at the end of each course during a 6-year period from 2007 to 2012. Correct answers for the posttest results were higher each year with good reliability as assessed by Chronbach's α and with significant variation from pretest scores assessed using paired-samples t tests. Best scores were achieved in knowledge acquisition and practical skills gained. Students were also asked whether the course contributed to self-preparedness in treating trauma patients, and this consistently achieved high scores. CONCLUSION: We believe that students benefit substantially from the course and gain lasting skills and confidence in trauma management, decision making, and organizational skills. The course provides students with the opportunity to learn and ingrain trauma principles along Advanced Trauma Life Support guidelines and prepares them for practice as safe doctors. We advocate the global implementation of a student trauma training course as a mandatory educational initiative and propose our course format as a model for similar courses. Language: en

Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion.To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention.Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015.Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score.Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores.Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.