Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape.

BACKGROUND: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. METHODS: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. RESULTS: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. CONCLUSIONS: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Single-Tunnel Double-Bundle-Like Effect With Footprint Enhancing Anterior Cruciate Ligament Reconstruction.

The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability. It's one of the most commonly injured ligaments and also one of the most commonly performed arthroscopic procedures. Management of ACL injuries is one of the most frequently studied subjects in the literature. Surgical management of ACL injuries varies from extraarticular tenodesis to arthroscopic transtibial reconstruction to double-bundle reconstruction to anatomic single-bundle reconstruction. Although double-bundle ACL reconstruction gives more rotational stability than anatomic single-bundle, functional outcome of both are the same, but the complication rates are much higher for double-bundle reconstruction. Hence, anatomic single-bundle ACL reconstruction has gained popularity. The femoral and tibial footprint of the ACL varies in shape and size; it can be oval, elliptical, rectangular, C-shape, and more. But all available ACL reconstruction techniques prepare a circular tunnel; hence, the footprint coverage of the native ACL is maximum after double-bundle reconstruction and less after anatomic single-bundle reconstruction. So, to have the benefit of double-bundle reconstruction with a single tunnel, we propose our technique of a single-tunnel double-bundle-like effect, with the footprint enhancing ACL reconstruction using our newly designed tunnel dilators.

Author Correction: A cartridge based Point-of-Care device for complete blood count.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A cartridge based Point-of-Care device for complete blood count.

We demonstrate a proprietary lab-on-chip/µ TAS technology platform for a regulatory grade portable instrument for complete blood count (CBC) hematology tests including 3 part differential WBCs, RBCs, platelet and hemoglobin for rapid diagnostics at the point of care in resource-poor settings. Presently, diagnostics based on blood tests are confined to centralized laboratory settings, dependent on large footprint and expensive cytometers or on a microscope, requiring trained laboratory technicians. Consequently, such facilities are not present in rural and semi-urban settings, where there are opportunities and challenges in delivering efficient healthcare infrastructure at an affordable cost in resource-challenged environments. Our proposed design leverages advances in microfluidics and lab-on-chip fabrication techniques to miniaturize the conventional cytometer and bring down the cost significantly. The device can be operated autonomously, without skilled manpower, by primary healthcare professionals in the field and by patients (like glucose self-test devices). The instrument consists of a single-use chip, the size of a credit card, pre-loaded with reagents, in which the sample is loaded, and which is fluidically insulated from the environment. The controller, the size of a toaster, performs the necessary fluid handling and the impedance measurements to deliver the results in minutes.