Orthopedic Surgery Resident Development and Implementation of a Virtual High-School Mentorship Program During the COVID-19 Pandemic.

As the world continues to battle the COVID-19 pandemic, health care providers are committed to providing care not only to our patients but also to our community. Schools in New York City (NYC) went remote on March 15, 2020. This can prove detrimental to student development and education. Numerous leaders in education and public health have noted that the remote learning will further widen educational and income disparities in those from underserved and underrepresented areas. A group of orthopedic residents who attended NYC public schools and were current house staff at a major academic tertiary medical center in NYC developed and implemented a virtual high-school mentorship program. This program incorporated weekly lectures and discussions given by health care providers to students interested in health care from NYC public high schools. The goal of this program was to provide mentorship during the COVID pandemic to a high-school audience where greater than 80% of students are considered to be living below the poverty level. Although school is now back in session, these programs should be continued in person. It is the aim of the authors that other orthopedic residents and health care providers implement similar programs in their communities.

Mask Use for Athletes: A Systematic Review of Safety and Performance Outcomes.

CONTEXT: With the current Centers for Disease Control and Prevention recommendations for mask use to minimize transmission of coronavirus 2019 (COVID-19) coupled with concern for future pandemics that would require mask wearing, providing data-driven guidance with respect to athletic performance is essential. OBJECTIVE: The purpose of this study was to perform a systematic review of existing literature on the use of face masks while exercising to assess the physiologic effects of face masks worn during athletic activities. DATA SOURCES: A systematic review was conducted of studies on face mask use during exercise according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Potential studies were identified through searches of MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases. STUDY SELECTION: Screening was completed independently by 2 coauthors who sought to identify studies that described the effects of oronasal mask use, if any, on sports/exercise/physical activity, for any age, gender, or level of sport. Articles describing mask effects without exercise, articles published before 1980, and non-English language studies were excluded. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Data extraction focused on physiologic parameters measured during physical activity performed while wearing a face mask. RESULTS: Twenty-two articles met all inclusion criteria. Study analysis revealed that the use of masks in healthy volunteers during exercise had no significant effect on physiologic parameters measured including heart rate (HR), respiratory rate (RR), oxygen saturation, and perceived exertion. Of the studies that investigated N95 masks in the healthy adult population, 2 reported modest changes in RR and maximum power output indicative of decreased athletic performance when subjects were exercising at maximum effort. Similar findings were seen in studies of subpopulations including children and pregnant women. CONCLUSION: Available data suggest that healthy individuals can perform moderate-to-vigorous exercise while wearing a face mask without experiencing changes in HR, RR, and oxygen saturation that would compromise individual safety or athletic performance. In the specific situation in which an N95 mask is worn, maximum power generated may be impaired. WHAT IS KNOWN ABOUT THE SUBJECT: To date, there has been no systematic review of the existing literature to provide a clear consensus on whether face mask use significantly impacts athletic performance. Mask use has been demonstrated safe in the workplace; however, the use of face masks during exercise has not been examined on a large scale, particularly with respect to physiologic parameters. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: This analysis highlights that available data suggest that healthy individuals can perform heavy exercise in face masks with minimal physiologic changes. This is the first systematic review of studies analyzing exercise use wearing masks. With the evidence presented here commonly cited concerns about both safety and performance decrements with mask use during physical activities may be allayed.

Telemedicine Utilization at an Academic Medical Center During COVID-19 Pandemic: Are Some Patients Being Left Behind?

Introduction: The purpose of this study was to examine the use of telemedicine at one academic health care center during the COVID-19 pandemic to identify opportunities to improve access to this novel delivery method of care. Methods: All patients who underwent telemedicine visits at one urban academic medical center between March 2020 and June 2020 were included. All departments were included including surgical and nonsurgical. Demographic data, primary language, and visit type were collected. Primary zip code was used as surrogate for socioeconomic status through use of the zip code median household income. The demographics of the New York metropolitan area were obtained through the U.S. Census Bureau and used as a control cohort. Results: A total of 362,413 telemedicine visits met inclusion criteria with the majority of visits performed in April and May; 127,851 (35.3%) and 110,166 (30.4%), respectively. The highest performing department was Internal Medicine, which performed 72,796 visits or 20% of the total cohort. In our cohort of telemedicine patients, 59.6% identified as White, 11.4% as Black, and 5.7% as Asian. This is less diverse than the overall population of the metropolitan area, which is 17.5% Black and 11.5% Asian. There was also a large gender gap in the utilization of telemedicine services in general, where women (60.2%) were more likely than men (39.8%) to utilize the virtual visits. In addition, although over a third of patients in the Metropolitan area have median household incomes of <50,000, this population only represented 13.6% of our total cohort. Conclusions: This study highlights both the capability of telemedicine to provide care at a large urban academic medical center during a pandemic in addition to identifying potential gaps in care with telemedicine. The disparities highlighted in our cohort stress the importance of outreach to non-White older patients of lower socioeconomic status.

Telemedicine Utilization by Orthopedic Patients During COVID-19 Pandemic: Demographic and Socioeconomic Analysis.

Background:The relaxation of telemedicine (TM) restrictions during the COVID-19 pandemic accelerated adoption of this technology by many orthopedic practices. The purpose of this study was to examine the demographics of the orthopedic patients who utilized TM visits during the COVID-19 pandemic to identify opportunities to improve access.Methods:All patients who underwent orthopedic TM visits at one urban academic medical center between January and April 2020 were included. Demographic data including primary zip code, primary language, and visit type were collected. The demographics of the TM cohort were compared with those of patients seen in the outpatient (OP) setting at the same institution the prior year as well as with patients in the metropolitan area (M).Results:Five thousand thirty-five TM visits met the inclusion criteria. The TM cohort was significantly younger than the OP cohort, with mean age of 48.7 ± 19.0 years for TM and 55.2 ± 18.0 years for OP, and with 22% of TM being 65 or older versus 35% of OP being 65 or older (p = 0.001). The TM cohort had a lower percentage of minority patients (41.3%) than the OP cohort (48.2%). The TM cohort had a significantly lower percentage of black 12.9% versus 14.1%, Asian. 5.1% versus 5.8%, and Spanish/Hispanic 1.9% versus 15.4%, than the M and the OP cohort from the prior year (p < 0.026, p < 0.001, p < 0.001). For socioeconomic status, only 13.8% of TM patients were from ZIP codes with median household incomes <50k. A total of 96.2% of TM visits were performed in English, where only 61% of individuals in the metropolitan area report English as their primary language.Conclusions:As the largest analysis of the use of TM in orthopedics, this study highlights both the future potential of TM and areas of improvement to ensure better access to care for all patient populations. Maintenance of the provisions to allow audio-only visits to be considered TM and billed as such is one important measure.

Modification of a Validated Risk Stratification Tool to Characterize Geriatric Hip Fracture Outcomes and Optimize Care in a Post-COVID-19 World.

OBJECTIVES: (1) To demonstrate how a risk assessment tool modified to account for the COVID-19 virus during the current global pandemic is able to provide risk assessment for low-energy geriatric hip fracture patients. (2) To provide a treatment algorithm for care of COVID-19 positive/suspected hip fractures patients that accounts for their increased risk of morbidity and mortality. SETTING: One academic medical center including 4 Level 1 trauma centers, 1 university-based tertiary care referral hospital, and 1 orthopaedic specialty hospital. PATIENTS/PARTICIPANTS: One thousand two hundred seventy-eight patients treated for hip fractures between October 2014 and April 2020, including 136 patients treated during the COVID-19 pandemic between February 1, 2020 and April 15, 2020. INTERVENTION: The Score for Trauma Triage in the Geriatric and Middle-Aged ORIGINAL (STTGMAORIGINAL) score was modified by adding COVID-19 virus as a risk factor for mortality to create the STTGMACOVID score. Patients were stratified into quartiles to demonstrate differences in risk distribution between the scores. MAIN OUTCOME MEASUREMENTS: Inpatient and 30-day mortality, major, and minor complications. RESULTS: Both STTGMA score and COVID-19 positive/suspected status are independent predictors of inpatient mortality, confirming their use in risk assessment models for geriatric hip fracture patients. Compared with STTGMAORIGINAL, where COVID-19 patients are haphazardly distributed among the risk groups and COVID-19 inpatient and 30 days mortalities comprise 50% deaths in the minimal-risk and low-risk cohorts, the STTGMACOVID tool is able to triage 100% of COVID-19 patients and 100% of COVID-19 inpatient and 30 days mortalities into the highest risk quartile, where it was demonstrated that these patients have a 55% rate of pneumonia, a 35% rate of acute respiratory distress syndrome, a 22% rate of inpatient mortality, and a 35% rate of 30 days mortality. COVID-19 patients who are symptomatic on presentation to the emergency department and undergo surgical fixation have a 30% inpatient mortality rate compared with 12.5% for patients who are initially asymptomatic but later develop symptoms. CONCLUSION: The STTGMA tool can be modified for specific disease processes, in this case to account for the COVID-19 virus and provide a robust risk stratification tool that accounts for a heretofore unknown risk factor. COVID-19 positive/suspected status portends a poor outcome in this susceptible trauma population and should be included in risk assessment models. These patients should be considered a high risk for perioperative morbidity and mortality. Patients with COVID-19 symptoms on presentation should have surgery deferred until symptoms improve or resolve and should be reassessed for surgical treatment versus definitive nonoperative treatment with palliative care and/or hospice care. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.