Associations between Lifestyle Changes and Adherence to COVID-19 Restrictions in Older Adults with Hypertension.

COVID-19 has changed people's routines and imposed new ways of living. This study investigated variations in lifestyles (namely, physical activity, diet, alcohol consumption, and cigarette smoking) between the prepandemic and the pandemic period in a sample of older adults with hypertension. Moreover, it investigated predictors of adherence to government restrictions during the first lockdown period, evidencing the role of relevant sociodemographic indicators and lifestyle changes. A sample of 105 older Italian adults (M_age = 70 years; SD = 5.83) with hypertension was enrolled from a previous longitudinal study and interviewed on the phone between May and August 2020. Updated information about sociodemographic indicators and lifestyle changes was collected. Adherence to restrictions was explored through several questions regarding compliance with home confinement, facemask use, and the observance of social distancing. Results evidenced that only 33% of the respondents abided by all the national restrictions. During the first pandemic peak, considerable changes in lifestyles occurred, particularly regarding physical activity, which diminished in 70% of the sample. Women, unemployed/retired people, and individuals who decreased their amount of physical activity reported higher adherence to rules. Maintaining a healthy lifestyle over time is essential for disease prevention. Therefore, it is essential to continue to inform the population about the importance of a healthy lifestyle, and it is necessary to provide guidelines to maintain and promote it even during housebound periods.

Redeployment of specialist surgeons in the COVID-19 pandemic in a general hospital: critical issues and suggestions.

BACKGROUND AND AIM: to gain experience and highlight any margins for improvement, we outlined the role played by specialist surgeons (with particular reference to orthopedic surgeons), redeployed in treating COVID-19 patients in the Emergency Department of a general hospital, with severe overcrowding due to the massive and continuous arrival of patients Methods: "on the field" experience of the Authors is reported, followed by a narrative review of the literature, mainly on the topic of health-personnel redeployment during an emergency Results: a brief chronological discussion of the progressive reorganization of the hospital, in relation to the progress of the epidemic in the area, is reported, with specific reference to the experience of orthopedic and other branches specialist surgeons, that was characterized by a high degree of uncertainty about what to do, worsened by organizational difficulties due to the incessant arrival of patients and subsequent overcrowding. Observations relating to the critical aspects that have emerged and the various solutions proposed or implemented, if they have been identified, as well as the problems still open, are then made and compared to current literature. CONCLUSIONS: The most significant aspect that we have tried to outline is the organizational difficulty, due to the rapid and unpredictable change in the situation: greater efficiency and flexibility, seen as the ability to overcome bureaucratic, logistical, regulatory or budgetary obstacles that prevent the rapid changes made necessary by the epidemic, could perhaps help to face better any subsequent pandemic wave, like the fierce one ongoing at the present moment.

Surgical treatment of peri-prosthetic femur fractures with dedicated NCB plates: our experience.

BACKGROUND AND AIM OF THE WORK: The incidence of periprostethic femur fractures has increased over the last years; the treatment includes an open reduction and internal fixation or revision implant. The treatment of these fractures can be complex, expensive and associated with risks of systemic and local complications. METHODS: We evaluated clinical and radiological results in patients treated in our department for periprosthetic femoral fractures from 2011 to 2017. We included 52 cases of periprosthetic fractures regardless of their classification with a mean follow-up of 2 years. The analisys of the result was performed using Harris Hip Score and searching for radiographic signs of loosening, infections or mechanical failure of the implants. RESULTS: There was no evidence of septic complications or mechanical failure in cases treated. The average HHS was equal to 92 points with a certificate pain relief and a sufficient independence in daily living activities. CONCLUSIONS: The treatment of periprosthetic fractures is complex: it depends on type of fracture, on stability of the stem and on the bone quality. A right classification of the fractures, a good experience of the surgeon in prosthetic and trauma surgery is the basis for the best treatment.

Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients.

BACKGROUND: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. METHODS: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. RESULTS: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients. CONCLUSIONS: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.

Uncemented fully hydroxyapatite-coated hip stem for intracapsular femoral neck fractures in osteoporotic elderly patients: a multicenter study.

There is still debate over the limits of age and bone stock quality of patients on whom to use an un-cemented straight stem coated with hydroxyapatite (HA). We studied a group of 244 patients with a displaced intracapsular fracture of the femoral neck who underwent cementless hemiarthroplasty or total hip arthroplasty. 143 patients were reviewed at the two-year follow up. A fully HA-coated stem for intracapsular hip fracture results in a satisfactory return to pre-injury mobility and a low complications rate. The advantage reported in the literature of a low mortality rate with use of an un-cemented implant in elderly patients was shown to be greater still on finding an immediate primary stability and rapid osteointegration of the implant.