Making sense of the pandemic: Parent-child conversations in two cultural contexts.

The present study focused on parent-child conversations about COVID-19 related changes in children's lives in Estonia and Germany with an aim to understand how children's conceptual understanding of the disease and their emotional security is created and reflected in these interactions. Twenty-nine parent-child dyads from both cultural contexts provided self-recorded conversations. The conversations were analyzed for the type of explanations, emotional content, and valence. Estonian conversations were longer than those of German dyads. Explanatory talk appeared in both contexts but was general in nature. Conversations in both cultural contexts also included very few emotional references and tended to focus on both positive and negative aspects of the situation. The conversations show that parents tend to support children's coping with stressful situations by helping them conceptually understand COVID-19 and paying little attention to children's comprehension of feelings about the situation.

Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review.

OBJECTIVES: The goal of this study was to investigate whether the COVID-19 pandemic has affected hip fracture care at a Level I Trauma hospital. The secondary goal was to summarize the published hip fracture reports during the pandemic. DESIGN: A retrospective cohort study. SETTING: Level I Trauma Center. PATIENTS/PARTICIPANTS: Eighty-six operatively treated hip fracture patients age ≥65 years, occurring from January 17 to July 2, 2020. INTERVENTION IF ANY: N/A. MAIN OUTCOME MEASUREMENTS: We defined 3 phases of healthcare system response: pre-COVID-19 (period A), acute phase (period B), and subacute phase (period C). The primary outcome was 30-day mortality. Clinical outcomes including time to surgery (TTS) and length of stay (LOS) were extracted from the electronic medical record. RESULTS: Twenty-seven patients from Period A, 27 patients from Period B, and 32 patients from Period C were included. The 30-day mortality was not statistically different. The mean TTS was 20.0 +/- 14.3 hours and was the longest in Period C (22.1 +/- 9.8 hours), but the difference was not statistically significant. The mean LOS was 113.0 +/- 66.2 hours and was longest in Period B (120.9 +/- 100.6 hours). However, the difference was not statistically significant. CONCLUSIONS: The 30-day mortality, TTS, and LOS were not statistically different across multiple phases of pandemic at a level 1 trauma center. Our results suggest that we successfully adapted new protocol changes and continued to provide evidence-based care for hip fracture patients. Our results were comparable with that of other authors around the world.

[Mobile applications (apps) for diagnosis and treatment control in pediatric and adolescent medicine]. / Mobile Applikationen (Apps) zu Diagnosefindung und Therapiesteuerung in der Kinder- und Jugendmedizin: Chancen und Grenzen.

Digitalization is finding its way into medicine in many different forms. Whether patient-centered, networking, supporting medical personnel or in (clinical) research: digital technologies have become an integral part of everyday medical life not only since the pandemic triggered by the SARS-CoV-2 virus. For example, mobile smartphone applications are among the most frequent developments; however, the multitude of available products and the lack of time in medical practice often make a reliable assessment of the quality, safety and functionality difficult. This review article summarizes current developments in mobile technologies in the field of pediatrics and adolescent medicine and illustrates available applications with concrete examples. The aim is to encourage readers to make their own experiences and to sharpen their view of possible risks.

Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic.

OBJECTIVES: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. DESIGN: Retrospective cohort study. SETTING: A community hospital. PARTICIPANTS: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). MEASUREMENTS: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. RESULTS: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. CONCLUSION: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

Global orthopaedic trauma surgeons highlight telenomics during the COVID-19 era: A case for advancing telemedicine in orthopaedics.

The Coronavirus (COVID-19) pandemic sparked rapid widespread adoption of telemedicine throughout specialties, including orthopaedics. A succession of factors, starting with payers, followed by provider adoption, and reciprocated by patient approval, created newly accepted telehealth practices that have moved from trial to norm in a short time span. Orthopaedic surgeons believe telehealth will endure as a permanent change to their practice beyond the COVID-19 era, however, many permanent changes must take place by payers, providers, and patients to sustain telehealth into the future. The goal of this paper is to highlight the indelibility of telemedicine adoption in orthopaedic practices globally, characterize the chain of events that led to its large-scale adoption, and catalyze discussion around actionable next steps to sustain its benefits.

Global experience of orthopaedic trauma surgeons facing COVID-19: a survey highlighting the global orthopaedic response.

BACKGROUND: The COVID-19 (SARS-CoV-2) pandemic has significantly affected all aspects of healthcare, including orthopaedics. Due to the unique challenges presented by COVID-19 as well as the distinct timeframes that it will surge in different geographies, much can be learned from the experiences of orthopaedic professionals in many global settings. The goal of this project is to characterize the preparations, strategies, lessons, and personal experiences of orthopaedic trauma surgeons and departments across the world in combating COVID-19. In doing so, we will shed light on current practices and challenges, which may help us manage the current pandemic in addition to preparing for future global pandemics that may arise. METHODS: A 20-item questionnaire was sent out to 150 orthopaedic trauma surgeons representing 42 countries who were identified based on professional relationships and/or prior involvement in international meetings either led or participated by the senior author. RESULTS: The questionnaire was completed by 63 orthopaedic trauma surgeons representing 28 countries and 14 US states. The results of this study show that orthopaedic trauma departments across the world have been greatly impacted by COVID-19 with 91% of participating hospitals currently having a reduced case load compared with pre-COVID-19 and only 17% of respondents currently performing elective orthopaedic surgery. Furthermore, 30% of orthopaedic departments have deployed orthopaedic personnel to non-orthopaedic floors in order to help mitigate the increased patient load and 86% of respondents noted at least some shortage of PPE. Lastly 73% of participating orthopedic departments including those in LMICs, have incorporated telemedicine into their practice with a majority stating that it would most likely become a permanent change to their practice post-COVID-19. CONCLUSION: To our knowledge, this is the largest data set characterizing global COVID-19 situations and responses of orthopaedic trauma practices around the world. There is much to be learned from each of the participants' responses in order to persevere during the current pandemic, as well as to prepare for future pandemics as it relates specifically to orthopaedic trauma practices.

Ten Days to Implementation of 3D-Printed Masks for a Level-I Orthopaedic Trauma Practice During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has substantially impacted the global supply chain of personal protective equipment (PPE) for hospitals. At the time of our project, local and national recommendations for PPE were based on supply rather than provider or patient safety, and we intended to give providers a better option than scarves and cloth masks. Our objective was to utilize in-house 3D-printing capabilities to make 3D-printed face masks for our orthopaedic trauma providers that use filters that were verified to be nearly equivalent to the filtration material that is found in N95 masks. To meet this goal, we used open-source face-mask design files from the National Institutes of Health with use of an Ultimaker S3 desktop printer. We printed 50 reusable face masks with replaceable filter inserts and distributed them to physicians, physician assistants, and residents in a midwestern level-I trauma center. Our work highlights the innovative solutions that are being explored on a local level to confront the nationwide PPE shortage in the United States.