Telepsychiatry

The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Telepsychiatry

The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A Leadership Perspective on the Plastic and Reconstructive Surgery Residency Application Cycle During the COVID-19 Pandemic.

Introduction: The purpose of this study was to identify leadership perspective on the impact of COVID-19 Plastic and Reconstructive Surgery (PRS) residency application cycle in 2020 and its future implications. Methods: A survey was sent to residency program leaders (RPL), consisting of program directors and division chiefs/chairs. The survey was sent weekly for 4 weeks and remained open for 28 days. Results: A total of 156 PRS RPL were emailed. Response rate was 24% (38/156). A total of 68% were division chiefs/chairs, and 42% were program directors. Ten percent were both division chiefs/chairs and program directors. Among them, 78% were male. Eighty-seven percent of RPLs reported changes in the number of away rotations, of which 91% reported less away rotations. Only 27% of programs provided virtual away rotations (VAR), and 88% of RPLs were not comfortable writing letters of recommendation after VARs. Hundred percent of cases reported that VARs influenced whether an applicant received an interview. A total of 24 RPLs (63%) reported no changes in how they viewed applications due to the pandemic. However, 5 (13%) reported USMLE scores were more important, 4 (11%) reported research was more important, and 4 (11%) reported LORs were more important. Sixty-six percent did not feel they relied heavily on home institution candidates. Seventy-six percent found virtual interviews to be effective in evaluating applicants, and 71% reported they would add virtual interviews in future interviews. Conclusions: During the 2020-2021 PRS residency application cycle, fewer away rotations were offered, and formerly in-person activities were moved to virtual platforms. Virtual activities caused difficulty assessing candidates for many residency programs.

Acute and Chronic Cardiovascular Manifestations of COVID-19: Role for Endotheliopathy.

SARS-CoV-2, the virus that causes coronavirus disease 19 (COVID-19), is associated with a bewildering array of cardiovascular manifestations, including myocardial infarction and stroke, myocarditis and heart failure, atrial and ventricular arrhythmias, venous thromboembolism, and microvascular disease. Accumulating evidence indicates that a profound disturbance of endothelial homeostasis contributes to these conditions. Furthermore, the pulmonary infiltration and edema, and later pulmonary fibrosis, in patients with COVID-19 is promoted by endothelial alterations including the expression of endothelial adhesion molecules and chemokines, increased intercellular permeability, and endothelial-to-mesenchyme transitions. The cognitive disturbance occurring in this disease may also be due in part to an impairment of the blood-brain barrier. Venous thrombosis and pulmonary thromboembolism are most likely associated with an endothelial defect caused by circulating inflammatory cytokines and/or direct endothelial invasion by the virus. Endothelial-targeted therapies such as statins, nitric oxide donors, and antioxidants may be useful therapeutic adjuncts in COVID-19 by restoring endothelial homeostasis.

Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events.

BACKGROUND AND AIMS: Currently there is limited knowledge on medical comorbidities and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of various morbidities on serious events in COVID 19. METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 28, 2020, to extract published articles that reported the outcomes of COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics". ICU admission, mechanical ventilation, ARDS, Pneumonia, death was considered serious events. The comorbidities assessed in the study were Hypertension (HTN), Diabetes mellitus (DM), Cardiovascular diseases (CVD), Chronic obstructive pulmonary disease (COPD) and Chronic Kidney disease (CKD). Subsequently, comparisons between comorbidity patient group and the non-comorbidity patient groups, in terms of serious events were made using the pooled estimates of odd's ratio (OR) RESULTS: We identified 688 published results and 16 studies with 3994 patients were included in the systematic review. Serious events were seen in 526(13.16%) patients. Presence of hypertension with OR 2.95, diabetes mellitus with OR 3.07, Cardio vascular disease with OR 4.58, COPD with OR 6.66 and Chronic kidney disease with OR 5.32 had significant association in patients with COVID 19 on having serious events. Presence of diabetes mellitus (OR 2.78)) had a significant impact on death in COVID 19 patients with a p-value 0.004. CONCLUSIONS: Presence of medical comorbidities in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical intubation and mortality. The presence of Diabetes mellitus has a significant impact on mortality rate in COVID-19 patients.