Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of "MRS BAD BONES".

BACKGROUND: Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. OBJECTIVE: This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. METHODS: A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, "MRS BAD BONES," which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. RESULTS: Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001). CONCLUSIONS: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The "MRS BAD BONES" mnemonic significantly improved management and could be used in a wider setting.

Posttraumatic stress disorder following asthma attack (post-asthma attack PTSD) and psychiatric co-morbidity: the impact of alexithymia and coping.

This study investigated the prevalence of post-asthma attack posttraumatic stress disorder (PTSD) and the severity of psychiatric co-morbidity among a group of college students and whether alexithymia and coping strategies would relate to health outcomes. This is a cross-sectional study in which 156 college students who had previously experienced asthma attack were recruited. They completed a demographic page, Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28, Toronto Alexithymia Scale and the COPE. They were also matched with 141 students without asthma. The results showed that 3% met the criteria for full-PTSD, 44% for partial and 53% for no-PTSD. There were no significant differences between the asthma and control groups in severity of psychiatric co-morbid symptoms. Path analyses showed that asthma severity was significantly correlated with PTSD and psychiatric co-morbidity. It was also correlated with alexithymia which was in turn associated with psychiatric co-morbidity but not PTSD. Coping strategies were not correlated with health outcomes. To conclude, people can develop PTSD symptoms and degrees of psychiatric co-morbid symptoms after suffering asthma attack. The severity of these symptoms relates to people's perceptions of asthma severity and alexithymia.

Posttraumatic stress disorder following myocardial infarction: personality, coping, and trauma exposure characteristics.

OBJECTIVE: This study aimed to investigate the interrelationship between trauma exposure characteristics of myocardial infarction (MI), MI patients' personality traits, coping strategies, post-MI PTSD, and general psychological distress. METHOD: One hundred and twenty MI patients were recruited from two general practices. The MI patients were interviewed using a MI experience questionnaire and completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the NEO-Five Factor Inventory (NEO-FFI), and the COPE Scale. RESULTS: Neuroticism was directly associated with post-MI PTSD and general psychological distress, while agreeableness did not link to the outcomes directly. Neuroticism influenced MI exposure characteristics which in turn influenced PTSD. Agreeableness affected PTSD and general psychological distress through MI exposure characteristics. Neuroticism influenced problem-focused coping which in turn affected general psychological distress. Agreeableness influenced problem-focused coping which in turn affected PTSD and general psychological distress. CONCLUSIONS: Patients developed PTSD and general psychological distress following MI. Neurotic and antagonistic personality traits combined with patients' subjective experiences of MI and usage of problem-focused coping influenced the severity of outcomes.

Coping with posttraumatic stress disorder and comorbidity after myocardial infarction.

OBJECTIVE: Literature on the relationship between coping strategies, posttraumatic stress after myocardial infarction (post-MI PTSD), and comorbidity is limited. This study aimed to fill this gap in literature by investigating this relationship. METHOD: One hundred twenty patients with MI were recruited from 2 general practices and interviewed using the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire, and the COPE Scale. RESULTS: Thirty-one percent had PTSD. Patients used acceptance-focused coping in that most of them accepted that the MI had happened and that it could not be changed. At the same time, some patients used avoidance-focused coping in that they disengaged themselves mentally and behaviorally from the traumatic effects of MI. When the variables of age, bypass surgery, mental health problems before MI, and angioplasty were held constant, the results showed that patients who used maladaptive coping strategies of emotion-focused and avoidance-focused copings tended to report more comorbid symptoms. Patients who underwent medical procedures or interventions such as bypass surgery and angioplasty tended to report more PTSD symptoms. CONCLUSIONS: The way in which MI patients' coping strategies relate to health outcomes has been shown to be symptom-specific. Using maladaptive coping strategies does not necessarily have a significant impact on PTSD symptoms. On the other hand, medical procedures or interventions for treating MI can play a major role in maintaining PTSD symptoms for patients with MI.

Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction.

More research is needed to further our understanding of posttraumatic stress responses and comorbidity following myocardial infarction (MI), and to help us identify more clearly the personality traits which indicate that a person is more prone to developing post-MI posttraumatic stress disorder (PTSD). This study aimed to 1) investigate the comorbidity of patients who suffered from different levels of posttraumatic stress disorder following myocardial infarction (i.e. post-MI PTSD), and 2) investigate to what extent patients with different levels of post-MI PTSD differed in their personality traits. One hundred and twenty MI patients from two general practices were recruited for the study. They were asked to complete the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). They were divided into a no-PTSD group, a partial-PTSD group and a full-PTSD group, according to the scores of the PDS. One hundred and sixteen members of the general public were also recruited for comparison purposes. They were asked to complete the GHQ-28. The results showed that patients with full-PTSD reported significantly more somatic problems, anxiety, social dysfunction and depression than the other two patient groups and the control group. When age, bypass surgery, mental health problems before MI and angioplasty were controlled for, patients with full-PTSD also reported greater symptom severity of the four GHQ subscales than the other two patient groups. Patients with full-PTSD were significantly more neurotic than those with no-PTSD and partial-PTSD. Patients with full-PTSD were less agreeable than patients with no-PTSD. Regression analyses showed that personality did not moderate the relationship between PTSD and comorbidity. To conclude, following MI, those with full-PTSD tend to report more severe comorbidity than those who have not developed PTSD fully. The former can also be distinguished from the latter by virtue of their specific personality traits.

Posttraumatic stress disorder and general health problems following myocardial infarction (Post-MI PTSD) among older patients: the role of personality.

OBJECTIVES: This study aimed to: (1) investigate the degree to which older MI patients experienced post-MI PTSD and general health problems, and to (2) identify the association between five personality traits, post-MI PTSD and general health problems among these older people. METHODS: The sample comprised 96 older MI patients and were recruited from two general practices. They were interviewed using the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). The control group comprised 92 older people who experienced no MI. They were assessed using the GHQ-28. RESULTS: The older MI patients experienced hyperarousal the most, followed by avoidance and re-experiencing symptoms. PDS revealed that 30% had full PTSD. The older patients were conscientious and agreeable individuals. They were also somewhat extraverted and open to experience. They also showed traits of neuroticism. Controlling for bypass surgery, heart failure, previous mental health difficulties, angina and angioplasty, regression analyses showed that neuroticism predicted re-experiencing and avoidance symptoms and general health total. Neuroticism and less agreeableness predicted hyperarousal symptoms. CONCLUSIONS: MI older patients could manifest PTSD symptoms and general health problems following their MI. Personality traits, particularly neuroticism and antagonism, played a role in the manifestation of these symptoms.