Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review.

The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.

Second and Third Pandemic Waves in Apulia: How COVID-19 Affected Orthopedic and Trauma Care-A Single-Center Study.

PURPOSE: In orthopedics and traumatology, as a direct consequence of the COVID-19 first wave, there was a massive reorganization and a stop to all elective activities, which were postponed. In this study, we aimed to analyze the impact of the COVID-19 pandemic on orthopedic surgery in Apulia during the second wave, from March to June 2021 (when Apulia was under social distancing restrictions), and during the third wave, from September to December 2021 (when Apulia was under no restrictions). We compared these months to the same periods in 2019 for an evaluation of the surgical decrease during the pandemic period. METHODS: We performed a retrospective analysis of major orthopedic procedures, day-surgery procedures and urgent procedures (trauma and non-traumatic amputation) performed during the second and third waves of the pandemic in our clinic, and we compared these data with the same procedures performed in the corresponding periods of 2019, before the pandemic. RESULTS: Surgical activity was significantly decreased during both periods; the only increase in surgical activity in 2021 compared to 2019 was in total hip, knee and shoulder arthroplasty, with a surge of +7.69% registered in the period September-December 2021. CONCLUSIONS: Longer waiting lists and limited healthcare resources were the big challenges for the orthopedic community, and they still represent a substantial issue to confront today.

Trauma in Children during Lockdown for SARS-CoV-2 Pandemic. A Brief Report.

PURPOSE: The national lockdown established by the Italian government began on the 11th of March 2020 as a means to control the spread of SARS-CoV-2 infections. The purpose of this brief report is to evaluate the effect of the national lockdown on the occurrence and characteristics of trauma in children during lockdown. METHODS: All children admitted to our paediatric orthopaedic unit with a diagnosis of fracture or trauma, including sprains and contusions, between 11 March 2020 and 11 April 2020, were retrospectively reviewed. Their demographic data, type of injury, anatomical location and need for hospitalisation were compared with the equivalent data of children admitted for trauma in the same period of 2018 and 2019. RESULTS: Sixty-nine patients with trauma were admitted in 2020, with a significant decrease in comparison with 2019 (n = 261) and 2018 (n = 289) (p < 0.01). The patients were significantly younger, and the rate of fractures significantly increased in 2020 (p < 0.01). CONCLUSIONS: Home confinement decreased admissions to the emergency department for trauma by shutting down outdoor activities, schools and sports activities. However, the rate of fractures increased in comparison with minor trauma, involved younger children and had a worse prognosis.

The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study.

BACKGROUND AND AIM: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in "Covid Centers''. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events.  Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian "Phase 1" (February 23rd - May 3rd 2020). RESULTS: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of  these were in treatment with anticoagulant/antiaggregant. CONCLUSIONS: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country.

The psychological and clinical impact of the COVID-19 pandemic on orthopaedic patients: An Italian gender-specific analysis.

This observational study aims to assess the impact of the COVID-19 pandemic on orthopaedic patients' psychology and clinical management, focusing on gender differences in the following items: (1) pain perception and therapeutic compliance during the pandemic, compared with the pre-pandemic period; (2) relationship doctorpatient (considering both general practitioners and orthopaedic surgeons); (3) patient referral to Orthopaedic emergency room. An Ad Hoc online questionnaire was developed and administered to patients referring to Orthopaedic emergency departments and Orthopaedic outpatient departments throughout Italy, between March and April 2020. The patients' psychological status during the pandemic was evaluated, mainly focusing on the following aspects, i.e., the fear of contracting the COVID-19 infection, the perceived risk of COVID-19 contagion and the compliance with the COVID-19 restrictions. Differences between genders were also assessed. 782 patients finally took part in the present study. A significant decrease of general practitioner and Orthopaedic surgeon clinical referral was recorded during the lockdown period, compared with pre-COVID period (p<0.001; p=0.031). Nonetheless, the number of phone calls to the general practitioner did not undergo substantial differences (p=0.093), compared to patients' the phone consult with orthopaedic surgeons (p=0.042). A significant correlation was found between the fear of COVID-19 contagion the perceived risk of contracting the infection (p<0.001). The COVID pandemic significantly impacted on orthopaedic patients' psychology and perception of the disease. During the lockdown, patients gave a higher priority to the pandemic event and significantly reduced the treatment of their orthopaedic disease.

The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war.

BACKGROUND: From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. METHODS: The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). RESULTS: Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. CONCLUSIONS: Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.

How the Italian Nursing students deal the pandemic Covid-19 condition.

BACKGROUND AND AIM OF THE WORK: Since December 2019, a new infectious disease known as Coronavirus disease (Covid-19) has rapidly spread globally until it has been declared a pandemic by the World Health Organization. At the same time, if we consider the University context, there is little attention paid during basic nursing education to emergency response, and faculty members report feeling poorly prepared to teach students about this topic. The present study aims to investigate how the Covid-19 pandemic condition influenced the psychological well-being of the Italian nursing students. METHODS: An online questionnaire was administered to Italian nursing students which contains two parts: a demographic section and the assessment to the psychological well-being nursing student with the Impact of Event Scale-Revised and the Patient Health Questionnaire-9. RESULTS: Given the emergency health situation from Covid-19, our initial concern was to find a large number of students with difficulties in mentally processing this situation even with problems such as depression, as their future profession is heavily involved in the management of this pandemic. Fortunately our results have denied our initial hypothesis since both the impact management levels of the event, assessed with the IES-R scale, and the depression levels, assessed with the PHQ-9 recorded values ​​that were almost normal. CONCLUSIONS: Nursing students are better able to face the situation since they find themselves in the role of spectators and not in the role of actors in the care of patients with Covid-19. If the training ameliorates psychological well being, therefore, it is necessary to provide and preserve nurses expertise to encourage teaching in nursing degree courses on maxi emergencies to prepare future nurses to face them adequately.

Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak.

BACKGROUND: The COVID-19 pandemic in Italy represents a unique threat in terms of psychological distress. This cross-sectional study aims to investigate the psychological health of Italian healthcare professionals during the COVID-19 outbreak. We assessed participants' current psychological distress and coping strategies in the midst of the COVID outbreak (March-April 2020), and also asked them to retrospectively report how they remember feeling before the COVID-19 outbreak (December 2019). We examined associations between psychological distress and coping strategies with mental health and infection perceptions. METHODS: Self-administered questionnaires were distributed online to healthcare professionals (N = 580) residing in different Italian regions from 26 March to 9 April 2020. The questionnaire measured changes in psychological states, coping strategies, and demographic variables testing variations in mental health and infection risk perception among Italian healthcare workers. RESULTS: Overall, approximately 33.5 per cent of healthcare professionals in our sample meet the threshold for psychiatric morbidity. Participants perceive their current psychological health to be worse during the COVID-19 emergency outbreak as compared to before the outbreak, and this was especially true among women. CONCLUSIONS: Both immediate and long-term monitoring psychological assistance services for healthcare workers should be implemented by national institutions to re-establish the psychological well-being and enhance the self-confidence and resilience of hospital personnel.