Asia Pacific Fragility Fracture Alliance Primary Care Toolkit: Empowering Fragility Fracture Education

Introduction: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort. Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https://apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic. Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world. Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkit materials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic, we are looking to present this material in more venues in 2022 and beyond. The toolkit is available free of charge at the above address.

APFFA primary care toolkit: Empowering fragility fracture education

Objective: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https:// apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkitmaterials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic we are looking to present this material inmore venues in 2022 and beyond. The toolkit is available free of charge at the above address Acknowledgements: Development of the PCP Education Toolkit and Education Directory was funded via an unrestricted grant from Amgen Asia to APFFA and its content was developed independently by APFFA.

A Case of Acute Interstitial Pneumonia during the COVID-19 Pandemic

IntroductionAcute respiratory distress syndrome (ARDS) typically has a precipitating cause. The most common histological finding in ARDS is diffuse alveolar damage (DAD). DAD is described as injury to the endothelium and alveolar cell lining. Acute interstitial pneumonia (AIP) is defined by the sudden development of bilateral pulmonary infiltrates without a precipitating cause with histological DAD. Case PresentationWe present the case of a 60-year old male with a past medical history of hypertension and hyperlipidemia who initially presented with dyspnea and a two week history of polyarthralgias. He was a current one pack per day smoker and worked an office job in the HVAC industry. His Chest CT showed impressive multi-lobe ground glass opacities. He was treated with oxygen, dual antibiotics and empiric steroids. Extensive infectious workup including PCR respiratory virus panel, fungal testing, urine antigens for Legionella and Streptococcus Pneumonia, and multiple COVID-19 tests were all negative. Autoimmune and vasculitis testing only had a positive ANA 1:160 titer with a nucleolar pattern. Left lung transbronchial biopsies with infectious bronchoalveloar lavage were non-diagnostic. A larger surgical pathology specimen was obtained through video assisted thorascopic surgery (VATS) with biopsies taken from three lobes. His pathology was consistent with organizing diffuse alveolar damage with hyaline membranes suggestive of the acute phase of DAD with no evidence of granulomas or vasculitis. In the idiopathic form, this is consistent with AIP. His severe hypoxic and hypercapneic respiratory failure was treated with permissive hypercapnea and high PEEP strategy (7.24pH/89 pCO2). Extracorporeal membrane oxygenation (ECMO) was considered but he was not a candidate. He developed a spontaneous left lung pneumothorax due to barotrauma. He was treated with high dose intravenous pulse dosed steroids with minimal improvement. His case was discussed with the transplant team, and he was not a candidate due to prolonged mechanical ventilation and inability to give consent. His code status was changed to comfort care and he passed away. DiscussionPatients diagnosed with AIP are treated with supportive care including mechanical ventilation and intravenous pulse dose corticosteroids. There have been cases of patients receiving single lung transplants for AIP and surviving. Extracorporeal membrane oxygenation (ECMO) can be considered as bridge to recovery or lung transplant in AIP. Although the patient we described was not a candidate for either. Despite being amidst the COVID-19 pandemic, other rare causes of fulminant respiratory failure still exist, such as AIP.