Maximization of scope of practice and satisfaction among geriatric nurse practitioners in Israel.

BACKGROUND: There is an increasing demand for comprehensive geriatric care. Nurse practitioners (NPs), who undergo specialized training, are situated to provide such care. In Israel, the role of a geriatric nurse practitioner was introduced in the health care system 10 years ago. However, little is known about the rate of professional satisfaction and realization of full potential among these nurses. PURPOSE: The aims of this study are (1) to describe the geriatric NP workforce in Israel, (2) to measure the current geriatric scope of practice, and (3) to measure the geriatric NP satisfaction from their working environment. METHODOLOGY: For this cross-sectional study, a survey, comprising three sections relating to demographics, professional qualifications and scope of practice, and career satisfaction, was sent to 53 geriatric nurse practitioners in Israel who currently work as geriatric nurse practitioners. RESULTS: Forty-seven nurses participated in the survey. Almost 64% reported that they are satisfied with their position, and 72% reported that they are able to fulfill their full scope of practice. The mean score for scope of practice was 68.31 out of a possible score of 100. CONCLUSIONS: A number of qualifications were correlated with satisfaction at work, indicating that nurses tend to be more satisfied at work when they are able to fulfill their potential. IMPLICATIONS: Ensuring nurse practitioners' ability to realize their full potential should be a goal of the health care system. Interventions should be in place to encourage nurses to perform tasks related to their work, for which they are trained.

Experiential learning via a tour on the history of public health in Jerusalem in an epidemiology course for master of science in nursing students: A cross-sectional study.

AIM: The aim of this study was to evaluate the incorporation of an educational tour into the curriculum for master's nursing students. BACKGROUND: Experiential learning is an educational approach that emphasizes hands-on experiences outside the classroom. In a two-kilometer radius in Jerusalem are historical health institutions, established beginning in the 1830s through the British Mandate, from which much can be learned about the state of public health then and how it shaped modern institutions. DESIGN: This was a cross-sectional study. METHODS: This study utilized the feedback received by students through an evaluation survey sent out after the tour. The survey had questions on overall satisfaction, how the tour contributed to their knowledge, and the appropriateness of the tour as part of the course. Additionally, students were asked if the tour added to their experience and how in an open-ended question. RESULTS: High scores were given for overall satisfaction, contribution to knowledge and the appropriateness of the tour. Additionally, four points were raised in the open-ended question: national pride in healthcare leadership, socio-political aspects and conflicts, the role of funding, and personal inspiration and professional development. CONCLUSIONS: The tour evaluation emphasized the advantages of experiential learning, enabling a deep understanding of the healthcare system's historical development in a multicultural city, as well as lessons for the future.

Breast cancer mortality among ultra-orthodox and non-ultra-orthodox Israeli women: A retrospective cohort study.

Background: Breast cancer is the leading cause of cancer death in Israeli women. Previous studies found socioeconomic status and other risk factors impact breast cancer outcomes. The ultra-orthodox community is characterized by a longer life expectancy, lower rates of mammography performance, higher fertility rates and other sociodemographic variables that may be related to breast cancer mortality. This study examined disparities in breast cancer mortality between ultra-Orthodox and non-ultra-Orthodox Israeli women. Methods: This retrospective cohort study for breast cancer mortality included the all Jewish Israeli citizens women born between 1940 and 1960 and lived in communities with over 20,000 residents (n = 628,617). Data was collected from various sources, monitoring a period of 31 years; for each participants, their sociodemographic characteristics were compiled from the population registry, the tax authority, the education registry, and the Central Bureau of Statistics (CBS). Variables included religiosity, age, marital status, children, origin, education, and income. Multivariable Cox models evaluated predictors of mortality. Results: Of the 628,617 women in the study, 29,611 were ultra-Orthodox. Ultra-Orthodox women had higher marriage rates, more children, and lower secular education and income. Mortality was 108.8/100,000 overall, lower among ultra-Orthodox (83.4/100,000) than non-ultra-Orthodox women (110.1/100,000) despite their risk factors. Using a multivariate model to evaluate the association between ultra-Orthodoxy and breast cancer mortality, the study found higher breast cancer mortality rate among non-ultra-Orthodox women compared to ultra-Orthodox women (HR = 1.491; 99% CI = 1.232, 1.804). Associations with sociodemographic variables were different for each group. Conclusions: Although ultra-Orthodox women have socioeconomic risk factors, breast cancer mortality was lower than non-ultra-Orthodox women. Further research on potential cultural and religious factors influencing mortality is warranted. These findings highlight the importance of evaluating predictors within specific populations.

Well-Being of Israeli Nurse Practitioners During Times of Crisis: A Cross-Sectional Study.

Introduction: For healthcare workers, good work-related well-being positively affects enthusiasm, efficiency, and job satisfaction. Conversely, poor well-being is associated with burnout and negative patient outcomes. During times of crises, it is difficult to balance professional responsibilities with well-being. Objective: This study aimed to evaluate the degree of well-being among nurse practitioners in Israel who worked in COVID-19 units or allied units during the delta wave. Methods: This was a web-based, cross-sectional study. Nurse practitioners who worked within the COVID-19 units in Israeli hospitals were asked to complete several questionnaires: a sociodemographic questionnaire, the Subjective Happiness Scale, the Mental Health Continuum-Short Form, and the Center for Epidemiologic Studies-Depression. Results: Forty-nine nurse practitioners participated in the survey. Scores from the Subjective Happiness Scale and the Mental Health Continuum-Short Form indicate that most nurses have relatively positive mental health. Conversely, scores on the Center for Epidemiologic Studies indicated that participants are at risk for clinical depression. There was a positive moderate association between the number of years worked as a nurse practitioner and depression and a moderate negative association between the number of years worked as a nurse practitioner and happiness. Conclusions: Understanding how nurses' mental health is impacted during crises can provide healthcare systems with tools to prevent negative outcomes. This, in turn, may contribute to a lower burnout rate, higher satisfaction from work, and better patient outcomes.

Knowledge and attitudes towards patients with Alzheimer's disease across different educational levels of nursing and in different care settings: A cross-sectional study.

AIM: To evaluate Alzheimer's disease (AD) knowledge and attitudes among Israeli nursing students and nurses with different educational backgrounds working in varied geriatric settings BACKGROUND: Alzheimer's disease (AD) management and treatment relies on multidisciplinary care, providing comprehensive treatment to these patients. Nurses are vital to treatment provision. However, less nursing students are expressing interest to work with the geriatric population, including those with dementia. DESIGN: This was a cross-sectional study. METHODS: Participants were 231 nursing students and nurses of various educational backgrounds and from varied geriatric settings. Study measures included sociodemographic characteristics, the Alzheimer's disease Knowledge Scale, and the Dementia Attitude Scale. Participants were recruited via social media, nursing administrations in medical facilities, and snowballing methods. Overall scores by educational background and correlations between the measures and select sociodemographic variables were evaluated. RESULTS: The overall knowledge and attitudes towards dementia among Israeli nurses is moderate to high. The mean knowledge score was 23.32/30. The highest scores (for knowledge and attitude) were found among geriatric nurse practitioners. The lowest knowledge scores were found among registered nurses without a degree, while the lowest attitude scores was found among nursing students. CONCLUSIONS: Despite relatively high scores, there is still a need to minimize the gap in specific knowledge and attitude domains. There is a need for domain-specific training, such as risk factors related to dementia, and providing nurses of all educational backgrounds with the tools they need to feel comfortable in caring for AD patients.

Assessing the fulfillment of nurses' full potential in diverse geriatric settings-moving towards change.

BACKGROUND: In response to the aging population, the Department for Professional Development in the Nursing Division at the Israeli Ministry of Health has invested significant resources in training registered nurses for post-basic certification in the field of geriatrics. However, little is known about how the nurses implement the scope of practice in the field and how they maximize their full potential following the training. AIMS AND OBJECTIVES: To assess whether nurses' full potential is maximized in geriatric acute and long-term geriatric care, and community settings in Israel. DESIGN: A quantitative, cross-sectional study. METHODS: The study population is a convenience sample of registered nurses who completed post-basic certification in geriatric care (n = 287). The participants completed a self-administered questionnaire addressing socio-demographic and occupational characteristics, implementation of the scope of practice, and a professional satisfaction questionnaire. Baseline demographic variables were summarized using means and counts, with frequency counts and percentages used for the scope of practice. A one-way ANOVA was utilized to examine the differences between the workplace and the scope of practice. Chi-square was used to examine practice types and the workplace. RESULTS: Nurses in all surveyed geriatric settings reported average to high overall performance in independent decision-making activities and delegated duties. The majority (66%) reported very high satisfaction with the completion of the post basic certification education However overall performance differed significantly between the different geriatric settings. CONCLUSION: Most of the nurses with a post-basic geriatric certification are satisfied with their scope of practice, feel valued by colleagues and managers, and are able to practice independently within their professional scope. This can have a positive impact on the care of the older adult population. CLINICAL RELEVANCE: Administrators should ensure that nurses with a post-basic geriatric certification are able to maximize their scope of practice. Specifically, we recommend nurse managers to leverage the results of this study and advocate for nurses to fulfill their full potential in their scope of practice.

Disparities in Breast Cancer Mortality Rates in Israel among Urban and Rural Women.

Breast cancer is a leading cause of death. There are a number of risk factors for breast cancer mortality including parity, age, ethnicity, genetic history, and place of residence. This study examined the disparities in breast cancer-related mortality rates among women from urban areas compared to rural areas in Israel. This was a retrospective, follow-up study on mortality from breast cancer among 894,608 Israeli women born between the years of 1940 and 1960. Data was collected from the Israeli Central Bureau of Statistics, the Population Authority, the Education Ministry, and the Health Ministry. Over 80% of women lived in urban areas. A higher incidence of mortality from breast cancer in Israel was found among urban women compared to rural women (1047.8/100,000 compared to 837/100,000, respectively). Even after adjusting for sociodemographic variables, higher mortality rates were found among women from urban areas in Israel compared to women from rural areas in Israel. It is believed that environmental factors can partially explain the geographic variation of breast cancer incidence, and that breast cancer incidence is likely a complex interaction between genetic, environmental, and health factors.

A Comparative Analysis of Smoking Rates by Sex and Socioeconomic Status Among Ultra-Orthodox City Residents and Non-Ultra-Orthodox City Residents in Israel.

The aim of this cross-sectional study is to examine the differences in smoking rates between ultra-Orthodox Jews and non-ultra-Orthodox Jews and to understand the role of sex and socioeconomic status (SES) in predicting smoking among the two populations. The study population included all Maccabi Healthcare Services members aged 50 or older (N = 30,170) who lived in two cities in the center of Israel: Bnei Brak-a city with a high concentration of ultra-Orthodox, and Ramat Gan-a non-ultra-Orthodox city. After adjusting for age, sex, and SES, the prevalence of smoking in the ultra-Orthodox city was significantly lower than that in the non-ultra-Orthodox city. A significant interaction was found between sex and degree of religiosity in predicting smoking. The smoking differences between men and women in the ultra-Orthodox city were high compared with those in the non-ultra-Orthodox city. Similarly, a significant interaction was found between SES and degree of religiosity in predicting smoking. These results in the effects of sex and SES in predicting smoking between ultra-Orthodox Jews and non-ultra-Orthodox Jews require further research to better understand these differences and plan intervention programs tailored to different populations accordingly.

The Effects of Sociocultural Transitioning on Accessibility to Healthcare: The Case of Haredi Jews Who Leave Their Communities.

Minority groups and immigrants encounter complex issues when attempting to access healthcare. This study examines factors affecting access to healthcare by a group of individuals in Israel who decided to leave their Haredi Jewish communities. We conducted 23 semi-structured interviews with individuals disaffiliating from Haredi communities in Israel in order to identify hurdles encountered during the process of seeking healthcare. We focused on specific steps in this process, including recognizing the need for help, deciding to actually turn to the health system, interaction with the system, and behavior after referring to the health system. We identified approximately 20 factors which can be either barriers or catalysts affecting healthcare access at the various stages. These were then traced to religious upbringing, hurdles of sociocultural transition, and unique characteristics of individuals reshaping their lives. The findings can be instrumental in designing culturally adapted health programs for individuals leaving the Haredi community. Moreover, the methodology that we are proposing can serve other investigations studying access to healthcare among various groups undergoing sociocultural transitions.

Predictors of respiratory cancer-related mortality for Jews and Arabs in Israel.

BACKGROUND: Respiratory cancers, including lung, tracheal and bronchus cancers, are a leading cause of cancer-related mortality in Israel; however, incidence can differ among demographic groups. Despite the importance of sociodemographic characteristics and the interactions between them to incidence and mortality, this topic is understudied. This study analyzes sociodemographic disparities by sex and ethnicity among Jews and Arabs to understand cancer outcome differences stratified by SES, marital status, and number of children as potential contextual factors. METHODS: This retrospective cohort study analyzed respiratory cancer-related mortality rates among Israelis born between 1940 and 1960 over 21-years. The follow up period was between January 1, 1996 and 12.31.2016. Mortality rates for Jews and Arabs were calculated. Using a Cox Regression, a multivariate model was constructed to determine the association between ethnicity and respiratory cancer mortality. The study population was then divided into four groups, by sex and ethnicity, to determine the association between marital status, number of children, and SES with respiratory cancer mortality for each subgroup. RESULTS: The overall mortality rate was 0.6%. Arabs had higher mortality rates compared to Jews, even after adjusting for demographic factors including age, sex and SES (Adjusted Hazard Ratio (AHR) = 1.442, 99% confidence intervals (CI) = 1.354,1.546). Among men, a higher mortality rate was found among Arabs (AHR = 1.383, 99%CI = 1.295,1.477), while among women, Arabs had lower mortality rates (AHR = 0.469, 99%CI = 0.398,0.552). Significant mortality rate differences were observed by ethnicity and sex for each sociodemographic variable. CONCLUSIONS: This study highlights the importance and implications of understanding differences in respiratory cancer mortality between Jews and Arabs, a minority group in Israel, and is relevant for minority groups in general. There is a need to tailor interventions for these groups, based on differing underlying causes and contextual factors for these cancers. Cancer outcomes among these groups should also be studied separately, by sex, to better understand them.

Utilizing the ACCESS Model to Understand Communication With the Ultraorthodox Community in Beit Shemesh During the First Wave of COVID-19.

INTRODUCTION: The coronavirus pandemic has disproportionately negatively affected the ultraorthodox in Israel. Their unique characteristics and slow adoption of preventative health guidelines resulted in a significant increase in morbidity and mortality. To lower these rates, health and government authority figures employed methods to change the ultraorthodox community health behaviors. METHODOLOGY: This study utilizes the ACCESS model for transcultural nursing to analyze the response by authorities to high infection rates in the large ultraorthodox community in city of Beit Shemesh during the first wave of the outbreak (through early May). RESULTS: The authorities employed all model components to varying degrees and found moderate success in changing health behaviors of the ultraorthodox. DISCUSSION: Employing the ACCESS model as a response to the health care crisis among the ultraorthodox community in Beit Shemesh led to some success in increased compliance, thus lowering morbidity rates. However, not establishing strong respect and rapport hindered the process.

Religiosity Level and Mammography Performance Among Arab and Jewish Women in Israel.

This study compared mammography performance by religiosity level among Arab (weighted n = 103,347) and Jewish women (weighted n = 757,956) in Israel aged 50-74, using data from the 2017 National Social Survey of the Central Bureau of Statistics. In the Survey, women were asked regarding mammogram performance in the 2 years prior. Mammography performance was 78.2% among Jewish women and 64.8% among Arab women. Among Jewish women, self-identifying as "Very religious" and "Somewhat religious" was associated with lower mammography performance compared to being 'non-religious.' The association was in the opposite direction among Arab women. When tailoring interventions to increase mammography performance among ethnically diverse groups, planners should consider women's religiosity.

The "Sick immigrant" and "Healthy immigrant" phenomenon among Jews migrating from the USSR to Israel.

The "healthy immigrant" phenomenon finds that immigrants are in better health than natives, while the "sick immigrant" phenomenon finds the opposite. We examined this phenomenon using the relationship between immigration and mortality, stratified by income level, among Soviet immigrants to Israel in the 1990s, compared to veteran immigrants with similar ethnic origin. A retrospective cohort study of mortality during 1990-2016 was conducted among 63,847 immigrants born during 1940-1950 in the USSR or Eastern Europe, and who immigrated to Israel during 1990-1995. They were compared to a control group of 75,347 Israeli Jews born during the same period in the same countries or second-generation immigrants with parents from these countries and who immigrated by 1960. After adjusting for sex, age, income, and marital status, we found higher mortality rates among immigrants than non-immigrants for the total study population (adjusted hazard ratio (AHR) = 1.399, 99% confidence intervals (CI) = 1.341, 1.459) and among 19,033 men (AHR = 2.852, 99%CI = 2.619, 3.107) and 24,355 women (AHR = 1.705, 99%CI = 1.566, 1.857) with low incomes. The opposite relationship was found for 25,436 men (AHR = 0.710,99%CI = 0.617, 0.0.816) and for 12,922 women (AHR = 0.693,99%CI = 0.534, 0.900) with high incomes. When examining the total study population, we found evidence to support the "sick immigrant" phenomenon. However, both men and women in the high-income subgroup, and women in the middle-income subgroup, demonstrated the "healthy immigrant" phenomenon. Decision-makers in Israel should pay particular attention to immigrants from a low socioeconomic level. Our results emphasize the need for social stratification when examining the relationships between immigration and health outcomes.

Trust in the Israeli Healthcare System Among Arabs, Jewish Immigrants, and Non-immigrants.

BACKGROUND: Previous studies have shown that minorities and immigrants have low levels of trust in healthcare systems (HCSys), which might present a barrier in access to and utilization of healthcare services. We compared the levels of trust in Israel's HCSys among the Arab minority, immigrant Jews, and non-immigrant Jew sand draw on the integrative model of organizational trust to explore factors that can explain differences in the trust level within and between the study groups. METHOD: We obtained cross-sectional census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust based on a survey question: "Do you have trust in the HCSys?" We used logistic regression models to compare levels of trust in HCSys among the study groups, adjusting for components of the integrative model: characteristics (sex, age, education, religiosity, and healthcare service use), abilities (private health insurance ownership), integrity (discrimination, trusting the justice system and government), and perceived risk (self-reported health). RESULTS: Our findings revealed that Arabs (odds ratio (OR) = 4.20, 95% confidence intervals (CI) = 4.17, 4.23) and immigrant Jews (OR = 2.54, 95% CI = 2.51, 2.58) had more trust in the HCSys compared to non-immigrant Jews, even after adjusting for all the component variables. Different components of the integrative model explained trust in each population group. CONCLUSION: Minority and immigrant groups had greater trust in the HCSys compared to the non-immigrant group. These findings may indicate different expectations with respect to patient-caregiver relations and HCSys utilization and raise questions regarding access to HCS and quality of care among minority and immigrant groups.

Fasting plasma glucose in young adults free of diabetes is associated with cognitive function in midlife.

Background: Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults free of diabetes is scarce and based on middle-aged and older adults. We examined the association of FPG, measured at age 30, and of change in FPG from age 30 to 43, with cognitive function at age 50. Methods: 505 nondiabetic participants of the population-based Jerusalem Lipid Research Clinic (LRC) cohort study had baseline FPG, 2-h post-oral challenge plasma glucose (OGTT) and insulin determined at ages 28-32, and FPG and OGTT again at ages 41-46. Subsequently at ages 48-52, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery, using multiple linear regression and multivariable logistic models. Results: Hyperglycemia (FPG ≥ 5.6 mmol/l vs. <5.6 mmol/l) at baseline was associated with poorer global cognitive function in midlife (predominantly in the visual spatial and attention domains), independent of socio-demographic characteristics, life style variables, body mass index (BMI), and inflammatory and biochemical variables (standardized Beta = -0.121, P = 0.002, plinear trend(FPG continuous) =0.016). Similarly, increased odds for low-ranked (lowest fifth) global cognition was evident (ORper mmol/l FPG=2.31, 95% CI = 1.30-4.13, P = 0.005). Baseline OGTT, insulin resistance (HOMA-IR) and change in FPG and OGTT over 13 years were not associated with cognition. Conclusion: A higher FPG in young adults was associated with lower cognitive performance in midlife. Although we cannot dismiss the possibility of reverse causation, hyperglycemia at a young age may be a modifiable risk factor for low-ranked cognitive function in midlife.

Body Mass Index, Height and Socioeconomic Position in Adolescence, Their Trajectories into Adulthood, and Cognitive Function in Midlife.

BACKGROUND: Whether life course anthropometric indices relate to cognitive function in midlife remains insufficiently explored. Rarely was socioeconomic position (SEP) adequately accounted for. OBJECTIVE: To examine the association of the cumulative life course burden of high-ranked body mass index (BMI), its trajectory, and stature with cognitive function in midlife. METHODS: Weight and height were measured from age 17 across a 33-year follow-up. 507 individuals completed a NeuroTrax computerized cognitive assessment at ages 48-52. Life course SEP was assessed by multiple methods. Using mixed models we calculated the area under the curve (AUC), representing both the life-course burden of BMI (total AUC) and trends in BMI (incremental AUC) from age 17 to midlife. The associations of BMI and height with global cognition and its five component domains were assessed by multiple regression. RESULTS: Higher BMI in late adolescence and total AUC over the life course were associated with poorer global cognition (Standardized beta (Beta) = -0.111, p = 0.005 and Beta = -0.105, p = 0.018, respectively), adjusted for childhood and adulthood SEP, and demographic characteristics. The associations with higher adolescent and midlife BMI were both restricted to those with low childhood SEP (p < 0.05 for interaction). Short adolescent stature was related to poorer cognition (Beta = 0.115, p = 0.040), whereas late final growth in women was associated with better cognition (Beta = 0.213, p = 0.007). CONCLUSION: An adverse association of higher BMI with cognitive function began in adolescence and was restricted to low childhood SEP. Taller stature in both sexes and late growth in women were associated with better midlife cognitive performance.

Increase in the Inflammatory Marker GlycA over 13 Years in Young Adults Is Associated with Poorer Cognitive Function in Midlife.

BACKGROUND: Inflammatory markers are elevated in patients with dementia. Evidence for an association between inflammation and cognitive function in dementia-free individuals is sparse, inconsistent, and predominantly restricted to the elderly. Assessment of inflammatory markers in young adults as predictors of cognitive function in midlife, well before the onset of overt dementia, is lacking. Furthermore, rarely has the relation with longitudinal change in inflammatory markers been examined. OBJECTIVE: To examine the association of the inflammatory markers C-reactive protein (CRP), fibrinogen, white blood cell count (WBC) and GlycA, a novel NMR-determined biomarker of systemic inflammation, measured in young adulthood and of GlycA change over 13 years follow-up with cognitive function in midlife. METHODS: 507 participants of the Jerusalem Lipid Research Clinic (LRC) study were assessed at 3 time points over 18-22 years. First, the inflammatory variables GlycA, CRP, fibrinogen, and WBC were measured in blood samples drawn at ages 28-32. Then, in blood samples drawn a mean 13 years later (range, 12-16 years) at ages 41-46, GlycA was again measured (in 484 individuals). Subsequently at ages 48-52, on average 7 years later, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery. Multiple regression and multivariable logistic models were applied. RESULTS: Inverse unadjusted associations were shown for baseline levels and longitudinal change in inflammatory markers and measures of cognition. Multiple regression models were adjusted for age at cognitive assessment, sex, socio-demographic characteristics, baseline measures of leisure-time vigorous activity, smoking status and body mass index (BMI) at ages 28-32, change in smoking status and BMI between ages 28-32 and 41-46, and depression assessed at the time of cognitive testing. The highest quintile of GlycA change, but not the baseline inflammation measures, was inversely related to global cognition (standardized ß = -.109, p = .011) as well as to the information processing speed and memory domains (standardized ß = -.124, p = .008 and-.117, p = .014, respectively). The multivariable-adjusted odds ratio for low ranked global cognitive function (lowest fifth) comparing the extreme quintiles of GlycA change was 4.8 (95%CI, 1.7-13.5, p = .003; p for trend = .031). CONCLUSIONS: In this longitudinal study of a novel systemic inflammatory marker in a population-based cohort of young adults, GlycA increase over 13 years, but not baseline measures of inflammation, was associated with poorer cognitive function in midlife.

Vascular complications of supracondylar humeral fractures in children.

The purpose of this study was to analyze the vascular complications of 24 children with supracondylar humeral fractures treated in two affiliated hospitals and to propose a management plan. Exploration and repair of the brachial artery were undertaken in 11 of the 24 cases in which the pulse did not resume following reduction of the fracture. The repaired vessels were found to be patent on follow-up. Angiography was performed in six of the 24 cases and resulted in improved management in comparison with cases in which no angiography was performed. We believe that intra-operative angiography and vascular repair are indicated in most cases in which a palpable pulse does not resume after fracture reduction.