Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness.

Objective: To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).

Setting: Tertiary referral hospital.

Design: Prospective, 3-component, before-and-after intervention study.

[PUBLICATION TRENDS AND IMPACT OF OPHTHALMOLOGY DEPARTMENTS IN ISRAEL: SUMMARIZING OVER A DECADE OF RESEARCH WITH AN INTERNATIONAL PERSPECTIVE (2011-2021)].

Background: A focused bibliographic analysis of Israel's ophthalmology research productivity has never been performed.

Objectives: To assess the research output of Israeli ophthalmology departments between the years 2011-2021 and compare to leading countries in the discipline.

Methods: The PubMed search engine was used to detect all medical articles published between the years 2011 and 2021, with at least one author from an Israeli ophthalmology department.

Incidence of Invasive Infections Among Hemato-Oncology Patients with Significant Burden of Candida in Stool.

Candidemia is a serious infection associated with increased mortality. It is unclear whether a high concentration of Candida in stool in patients with hematologic malignancies is associated with a higher risk for developing candidemia. In this observational historical study in patients hospitalized in hemato-oncology departments, we describe the association between gastrointestinal Candida colonization and the risk for candidemia and other severe outcomes.

The 100 Most-Cited Articles on Optic Neuritis: Trends of Subtypes, Authorship, and Time.

Background: Optic neuritis (ON) is an optic nerve inflammation that may lead to different degrees of vision loss. In recent decades, ON research facilitated a better understanding of the disease and its subtypes. This bibliometric analysis aimed to detect the 100 most-cited medical articles related to ON in the last 50 years (1972-2021) and describe publication trends arising from the list.

Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study.

Background: Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors.

Invasive fungal infections in critically ill COVID-19 patients in a large tertiary university hospital in Israel.

Unlabelled: An increasing number of studies have tried to determine the incidence of invasive fungal infections (IFIs) in COVID-19 patients. Challenges in the diagnosis of pulmonary aspergillosis in these patients have led to new definitions of COVID-19-associated pulmonary aspergillosis (CAPA). The aim of this study was to determine the incidence and outcomes of and risk factors for IFIs in critically-ill COVID-19 patients, using the new definitions, in a tertiary center in Israel.

A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management.

Background: Neuraxial protocols for cesarean delivery differ among institutions, with various means of assessing the block prior to incision and managing breakthrough intra-operative pain. The different approaches used to deal with these issues in Israel have not been assessed.

Methods: Questionnaires were distributed to all anesthesiologists working in obstetric units in Israeli hospitals.

The Timing of Limb Amputation in Nontraumatic Patients: Impact on Mortality and Postoperative Complication Rates.

Diabetes and peripheral vascular diseases are accompanied frequently by lower limb ischemia and in minority, need for amputation, as a treatment of last resort. Even after a decision has been made regarding amputation, the procedures are often repeatedly postponed due to more urgent surgeries and lack of operating room availability. This study assessed the possible relationship between the duration of time inpatients wait for semiurgent amputations and the incidence of postamputation complications.

Absence of prognostic value of lymphovascular space invasion in patients with endometrial cancer and negative sentinel lymph nodes.

Objective: To evaluate if the prognostic value of lymphovascular space invasion (LVSI) is different in endometrial cancer patients with negative lymph nodes following sentinel lymph node (SLN) mapping or lymph node dissection (LND) as staging procedure.

Material And Methods: A retrospective study of 510 patients diagnosed with endometrial carcinoma in our institution between 2007 and 2014. We excluded patients that were diagnosed with positive nodes (Stage IIIc).

Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study.

Background: We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor.

Methods: Chronic headache, backache, and disability were assessed 18-24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia.

Sonographic growth curves versus neonatal birthweight growth curves for the identification of fetal growth restriction.

Objective: Fetal growth restriction is suspected when the estimated fetal weight is <10th percentile for gestational age. Using a regional sonographic estimated fetal weight growth curve to diagnose fetal growth restriction has no known benefits; however, the traditional approach of using birthweight curves is misleading, since a large proportion of preterm births arise from pathological pregnancies. Our aim was to compare the diagnostic accuracies of sonographic versus birthweight curves in diagnosing fetal growth restriction.

Misidentification of Candida dubliniensis isolates with the VITEK MS.

The phylogenetic relatedness of Candida dubliniensis and C. albicans may lead to misidentification of C. dubliniensis and underestimation of its clinical significance.

Endometrial Cancer in Germline BRCA Mutation Carriers: A Systematic Review and Meta-analysis.

Objective: Risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations. The aim of this meta-analysis is to evaluate the risk of endometrial cancer (EC) in BRCA1 or BRCA2 germline mutation carriers and to examine the justifiability of prophylactic hysterectomy at the time of RRSO.

Data Sources: PubMed, Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.

Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons.

Purpose: The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk.

Characteristics and outcome of elderly patients admitted for acute Cholecystitis to medical or surgical wards.

Background: Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards.

Methods: This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016.

Prospective Audit of Empirical Antibiotic Therapy for Septic Patients.

Background: Antibiotic stewardship programs are necessary to test the appropriateness of local guidelines for empirical antibiotic treatment by audits.

Objectives: To assess whether compliance to local guidelines achieved a higher rate of appropriate antibiotic treatment and reduced morbidity and mortality, and whether infectious disease counseling improved the rate of appropriate treatment.

Methods: Our cohort comprised 294 patients with proven bacteremia.

Severe Maternal Morbidity Cases in Israel in a High-Volume High-Resource Referral Center: A Retrospective Cohort Study.

Background: Admission to an intensive care unit (ICU) is an objective marker of severe maternal morbidity (SMM).

Objectives: To determine the prevalence of obstetric ICU admissions in one medical center in Israel and to characterize this population.

Methods: In this retrospective study the files of women coded for pregnancy, birth, or the perinatal period and admission to the ICU were pulled for data extraction (2005-2013).

Gaucher disease, myelodysplastic syndrome and ICUS.

Gaucher disease is an inherited lysosomal storage disease commonly associated with hepatosplenomegaly and cytopenias. Progressive cytopenias may be interpreted as an indication of advanced disease and suggest the need to start Gaucher disease specific treatment. As bone marrow evaluation is not routinely performed in Gaucher disease, other causes of cytopenias such as myelodysplastic syndrome a stem cell disorder may be missed.

Modification of Blood Test Draw Order to Reduce Blood Culture Contamination: A Randomized Clinical Trial.

Background: Blood culture contamination leads to unnecessary interventions and costs. It may be caused by bacteria in deep skin structures unsusceptible to surface decontamination. This study was designed to test whether diversion of blood obtained at venipuncture into a lithium heparin tube prior to aspiration of blood culture reduces contamination.

Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?

In most countries there is a mismatch between demand for intensive care unit (ICU) beds and ICU bed availability. Because of a policy of low ICU-bed reimbursement this mismatch is much more profound in Israel, which arguably has the lowest number of ICU beds/1000 population of OECD countries. Increasing demand for mechanical ventilation has led to an ever-rising presence of ventilated patients in medical departments, which may reach up to 15% or more of medical beds, especially during winter months, posing serious challenges such as: delivery of adequate treatment, guaranteeing patient safety, nosocomial infections, emergence and spread of resistant organisms, dissatisfaction among family members and medical and nursing staff, as well as enormous direct and indirect expenses.

[PRINCIPLES OF APPROPRIATE ANTIBIOTIC USAGE IN ISRAELBY THE ISRAELI SOCIETY FOR INFECTIOUS DISEASES: TO WHOM ARE THEY DIRECTED?].

In this issue of Harefuah Nesher and Strahilevitz discuss the principles of appropriate antibiotic guidelines based on a position paper by the Israeli Society for Infectious Diseases (ISID). This editiorial discusses for whom this position paper was intended. The first and most obvious target would be the Infectious Disease (ID) physicians themselves.