Perspective on COVID-19: Finally, Telemedicine at Center Stage

Telemedicine in primary healthcare for the quality of care in times of COVID-19: a scoping review protocol

INTRODUCTION

Telemedicine gained strength in primary healthcare (PHC) during the COVID-19 pandemic. Thus, there is a need to know its scope, technologies used and impacts on people's health. This study will map telemedicine use in PHC around the world and its impacts on quality of care in the context of the COVID-19 pandemic.

METHODS

This is a scoping review protocol developed according to Arksey and O'Malley and Levac et al, based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The records will be mapped in the following multidisciplinary health sciences databases: Virtual Health Library, PubMed, Scopus, Web of Science, CINAHL and Embase. Searches will also be conducted on Google Scholar, preprint repositories and specific COVID-19 databases (grey literature). Quantitative data will be analysed using descriptive statistics, while thematic analysis will be performed for qualitative data. Preliminary findings will be presented to stakeholders to identify missing studies and develop effective dissemination strategies.

ETHICS AND DISSEMINATION

Results will be disseminated through publication in an open access scientific journal, scientific events, and academic and community newspapers. Ethical approval was obtained due to stakeholder consultation, but will not involve the direct participation of patients. Link to the protocol record in the Open Science Framework (OSF) (osf.io/q94en).

The Modality Preferred by Population of Health Services Provided During COVID-19 and Assessment of Satisfaction Among Adults in Kingdom of Saudi Arabia

Background During the COVID-19 pandemic, there was a great transition in the modalities of health care services, such as the telemedicine landscape, with some speed. Because of the lack of vaccines or effective therapies, social distancing and quarantine were the only widely accessible precautions, creating a compelling reason for alternatives for in-person care. Many countries applied teleconsultation or provided online applications during the COVID-19 pandemic. However, it is not currently known whether this available service has satisfied the patients' needs during the COVID-19 pandemic. Aim To detect the preferred modality of health services by the Saudi population during COVID-19 and to assess the satisfaction with respect to the provided health services in the Aseer region of Saudi Arabia. Methodology A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. The tool covered participants' socio-demographic data, participants' medical and family history, COVID-19 infection, health problems during the pandemic, received services, modalities of available services, and their satisfaction regarding the provided health service. Results A total of 2102 participants completed the study questionnaire. Exactly 773 (36.8%) respondents had a health problem during the COVID-19 pandemic. The most-reported modality of health services used was calling the 937 number, which is call center of the Ministry of Health (34.7%), followed by using health applications to get an appointment (33.9%). Also, 447 (88.7%) participants reported that the provided medical services were helpful. Regarding their satisfaction, 156 (31%) were just satisfied with the provided services and 280 (55.6%) were highly satisfied. Conclusions In conclusion, the current study showed a high level of public satisfaction regarding different modalities of health services provided during the COVID-19 pandemic in Saudi Arabia. This satisfaction was moderately high among telehealth users and those who had hospital visits for health care.

Language and Sentiment Regarding Telemedicine and COVID-19 on Twitter: Longitudinal Infodemiology Study

Background

The COVID-19 pandemic has necessitated a rapid shift in how individuals interact with and receive fundamental services, including health care. Although telemedicine is not a novel technology, previous studies have offered mixed opinions surrounding its utilization. However, there exists a dearth of research on how these opinions have evolved over the course of the current pandemic.

Objective

This study aims to evaluate how the language and sentiment surrounding telemedicine has evolved throughout the COVID-19 pandemic.

Methods

Tweets published between January 1, 2020, and April 24, 2021, containing at least one telemedicine-related and one COVID-19–related search term (“telemedicine-COVID”) were collected from the Twitter full archive search (N=351,718). A comparator sample containing only COVID-19 terms (“general-COVID”) was collected and sampled based on the daily distribution of telemedicine-COVID tweets. In addition to analyses of retweets and favorites, sentiment analysis was performed on both data sets in aggregate and within a subset of tweets receiving the top 100 most and least retweets.

Results

Telemedicine gained prominence during the early stages of the pandemic (ie, March through May 2020) before leveling off and reaching a steady state from June 2020 onward. Telemedicine-COVID tweets had a 21% lower average number of retweets than general-COVID tweets (incidence rate ratio 0.79, 95% CI 0.63-0.99; P=.04), but there was no difference in favorites. A majority of telemedicine-COVID tweets (180,295/351,718, 51.3%) were characterized as “positive,” compared to only 38.5% (135,434/351,401) of general-COVID tweets (P<.001). This trend was also true on a monthly level from March 2020 through April 2021. The most retweeted posts in both telemedicine-COVID and general-COVID data sets were authored by journalists and politicians. Whereas the majority of the most retweeted posts within the telemedicine-COVID data set were positive (55/101, 54.5%), a plurality of the most retweeted posts within the general-COVID data set were negative (44/89, 49.4%; P=.01).

Conclusions

During the COVID-19 pandemic, opinions surrounding telemedicine evolved to become more positive, especially when compared to the larger pool of COVID-19–related tweets. Decision makers should capitalize on these shifting public opinions to invest in telemedicine infrastructure and ensure its accessibility and success in a postpandemic world.

How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada)

The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics.

Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences

Background

The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship.

Objective

The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures.

Methods

This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model.

Results

We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001).

Conclusions

Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic.

Expansion of telehealth in primary care during the COVID-19 pandemic: benefits and barriers

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) pandemic remarkably accelerated the adoption of telemedicine in outpatient settings. Out of necessity, virtual care became a preferred and default modality of extending primary care services to health care consumers. Although telemedicine is not a new concept and had been used in many organizations and health systems, the COVID-19 pandemic scaled up its use in a variety of health care settings. Telehealth's use in primary care was particularly important because of the need to maintain continuity of care for successful coordination of chronic disease management. This article examines the benefits of telehealth, including continuity of care, convenience of access to care, screening and triaging, and social distancing and disease prevention. The utilization of telehealth and financial implications are discussed, including reimbursement and cost-effectiveness. Barriers and challenges are addressed, including methods for successful implementation of nurse practitioner (NP) in primary care practices as a response to the COVID-19 pandemic. The leadership role of the NP in telehealth is discussed and implementation guidance is provided.

Practical Guidance for Early Identification of Barriers in Surgical Telehealth Clinics

Early identification of and response to barriers in telehealth settings will help patients receive optimal care. Here, the authors, based on institutional experience, provide advice on such strategies. This guidance focuses on standardizing expectations, assessing technological knowledge and resource access, evaluating understanding and comfort with telehealth, and assessing social support.

A cross-sectional online survey on patients' satisfaction using store-and-forward voice and text messaging teleconsultation service during the COVID‑19 pandemic

AIM

This study aimed to evaluate the patients' satisfaction with using store-and-forward voice and text messaging teleconsultation service to provide primary health care to patients during the COVID-19 pandemic.

METHOD

A cross-sectional survey was conducted between October 1 and December 1, 2020, in Iran. The study population consisted of patients who used the service. Three hundred-ninety-six patients were enrolled in the study by convenience sampling. Data were collected by a researcher-made questionnaire. The face, comprehensibility, and content validity of the questionnaire were tested and met. The reliability of this questionnaire was confirmed (r = 0.9). Descriptive statistics and multinomial logistic regression were conducted. Data were analyzed using STATA 14.0 software.

RESULTS

In total, 396 patients responded to the online questionnaire. The mean age of patients was 37 ± 10.31 years. More than half of them had an academic degree (65.40 %). Teleconsultation was considered satisfactory by 172 patients (43.43 %), while more than half of the patients (56.57 %) were unsatisfied with teleconsultation. In terms of "quality of care provided" and "patient information privacy" components, around 41 % of patients were satisfied. However, the number of patients who feel satisfied with teleconsultation's similarity to a face-to-face encounter was lower (37.88 %). The results showed no significant relationship between age, gender, education, and overall satisfaction (p > 0.05). The association between overall satisfaction and health status was (AOR = 1.51, 95 % CI = 1.16-1.96).

CONCLUSION

More than half of patients from our study did not have a good experience with teleconsultation. This is also partially due to the use of existing communication platform, instead of custom-made solution. It is necessary to improve the services' quality and meet patients' needs to optimize patients' experience, particularly during a health crisis, resulting in better health outcomes and end-user satisfaction.

Telemedicine in the management of patients with chronic respiratory failure

Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure.

Educational aims

To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.

Perceived Usefulness of a Social Robot Augmented Telehealth Platform by Therapists in the United States

With the shortage of rehabilitation clinicians in rural areas and the ongoing COVID-19 pandemic, remote rehabilitation (telerehab) fills an important gap in access to rehabilitation, especially for the treatment of adults and children experiencing upper arm disability due to stroke and cerebral palsy. We propose the use of a socially assistive robot with arms, a torso, and a face to play games with and guide patients, coupled with a telepresence platform, to maintain the patient-clinician interaction, and a computer vision system, to aid in automated objective assessments, as a tool for achieving more effective telerehab. In this paper, we outline the design of such a system, Lil'Flo, and present a uniquely large perceived usefulness evaluation of the Lil'Flo platform with 351 practicing therapists in the United States. We analyzed responses to the question of general interest and 5 questions on Lil'Flo's perceived usefulness. Therapists believe that Lil'Flo would significantly improve communication, motivation, and compliance during telerehab interactions when compared to traditional telepresence. 27% of therapists reported that they were interested in using Lil'Flo. Therapists interested in using Lil'Flo perceived it as having significantly higher usefulness across all measured dimensions than those who were not interested in using it.

Meeting the Practice Challenges of COVID-19: MSW Students' Perceptions of E-Therapy and the Therapeutic Alliance

The COVID-19 pandemic prompted a radical shift in social work practice. Overnight, social work intervention models provided in-person gave way to the utilization of Information and Communication Technologies to facilitate direct practice in virtual environments (e-therapy). Social work's slow acceptance of e-therapy prior to the pandemic resulted in a lack of training for many social work practitioners and MSW student interns, who were required to make rapid transitions to using and operating in online environments. It appears likely that e-therapy will continue after the COVID-19 pandemic subsides, so integrating education about effective e-therapy techniques into social work curricula seems like a logical next step. A social worker's ability to establish the therapeutic alliance, which is at the heart of all helping relationships, will be central to this curricula. Understanding social work students' perceptions of e-therapy and the therapeutic alliance can help shape the development of this new curriculum. Using internal student email, students at two Research I universities were invited to participate in a fully online anonymous survey dealing with attitudes towards e-therapy and the therapeutic alliance. Surveys were conducted in 2018 and April-May 2020. Survey questions were based on the only prior comprehensive study of student attitudes towards e-therapy (Finn in J Soc Work Educ 38(3), 403-419. 10.1080/10437797.2002.10779107, 2002). Study results indicate that students have e-therapy experience, believe that a practitioner can build a good therapeutic alliance, and think that some form of e-therapy will continue after the pandemic. These results confirm that further exploration about the inclusion of e-therapy education and its efficacy in social work curricula requires urgent attention.

Measuring the Patients' Satisfaction About Telemedicine Used in Saudi Arabia During COVID-19 Pandemic

Background Many studies have found that telemedicine and telehealth services quality and patients' clinical outcomes, following telehealth visits, maybe comparable to those of traditional face-to-face office visits especially in a crisis like COVID-19 complete lockdown. Objective This study aimed to identify the patient's experience in using the telemedicine strategies during the COVID-19 pandemic and assess these patients' perception about their experience of using telemedicine in Saudi Arabia. Methods A cross-sectional survey study was done on 425 patients treated through telemedicine programs in Saudi Arabia from February to August 2020 during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was adopted and modified to elicit participants' socio-demographic data, participants' satisfaction and attitude toward telehealth and telemedicine, and their views on health care services. Results About 84.9% of the participants thought that telemedicine made healthcare easier during the COVID-19 pandemic. Almost half of the respondent was very satisfied with the ease of registration (52%), while 43.4% of respondents stated that they had the ability to talk freely over telemedicine. In the present study, The highest satisfaction was reported by 53.4% of respondents for ease registration, 40.1% for quality of the visual image, 41.9% for quality of the audio sound, and 44.8% for their ability to talk freely over telemedicine, respectively. The highest satisfaction was reported by 40.5% about the ability to understand the recommendations, 40.5% about the overall quality of care provided, 37.4% about the overall telemedicine consult experience. The results revealed a significant positive correlation between satisfaction and attitude scores. Conclusion This study revealed acceptable satisfaction and attitude of patients toward telemedicine programs in Saudi Arabia. However, more effort should be done by the Saudi Ministry of Health to increase the knowledge of patients about teleconsultation available services.

Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia

Objectives:

To evaluate the advantages and disadvantages of telemedicine among physicians during the COVID-19 pandemic. To assess the awareness about telemedicine among physicians and determine their opinions about telemedicine in the post-pandemic era.

Methods:

A cross-sectional study was conducted at government hospitals (King Faisal Medical Complex [KFMC]-King Abdulaziz Specialist Hospital [KASH]) in Taif, Kingdom of Saudi Arabia (KSA), from May-August 2020. Taif is a small city in the western region of KSA with a population of 689,000 and 2 main hospitals (KFMC & KASH) which also serve rural areas close to Taif city. A total of 36 physicians practiced telemedicine, only 25 physicians accepted to participate in this study.

Results:

Thirty-six percent of the responders believed that telemedicine could improve the effectiveness of therapeutic intervention and 44% believed that the quality of care was enhanced using telemedicine. Difficulty in reaching the correct diagnosis due to the lack of physical examination was one of the disadvantages that faced the participants.

Conclusion:

Telemedicine should be part of medical services but should not completely replace physicians’ personal interaction. Telemedicine could be continued for stable remotely residing patients even after the COVID-19 pandemic.

Feasibility and acceptance of a virtual multidisciplinary care programme for patients with type 2 diabetes during the COVID-19 pandemic

BACKGROUND AND AIMS

Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients' acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors.

METHODS

The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019.

RESULTS

During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively.

CONCLUSION

The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis

Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.

Socialization During the COVID-19 Pandemic: The Role of Social and Scientific Networks During Social Distancing

In the COVID-19 era, while we are encouraged to be physically far away from each other, social and scientific networking is needed more than ever. The dire consequences of social distancing can be diminished by social networking. Social media, a quintessential component of social networking, facilitates the dissemination of reliable information and fighting against misinformation by health authorities. Distance learning, telemedicine, and telehealth are among the most prominent applications of networking during this pandemic. Additionally, the COVID-19 pandemic highlights the importance of collaborative scientific efforts. In this chapter, we summarize the advantages of harnessing both social and scientific networking in minimizing the harms of this pandemic. We also discuss the extra collaborative measures we can take in our fight against COVID-19, particularly in the scientific field.

Current state and future perspectives of telemedicine use in surgery during the COVID-19 pandemic: A scoping review protocol

•

One of the potentially beneficial tools in reducing the risks for overwhelming the healthcare system is telemedicine.

•

Current use of telemedicine in surgery has not been adequately evaluated.

•

This review identifies challenges and potential solutions in the use of telemedicine.

•

The findings may potentially help in understanding the challenges and future directions of telemedicine use in surgery.

Introduction

The biggest concerns in the current pandemic are enormous workload pressure, psychological distress, caregiver burnout, and, even worse, transmission of the virus among healthcare workers. One of the potentially beneficial tools in reducing the above-mentioned risks for overwhelming the healthcare system is telemedicine. Although the role of telemedicine and related interventions as a crisis management tool has increased, the current state of the implementation of telemedicine in surgery and surgical subspecialties has not been adequately evaluated.

Objective and significance

The objective of this review is to screen the literature, extract expert opinions, qualitative, and quantitative data on the current use and future directions in the implementation of telemedicine in surgery and surgical subspecialties during the COVID-19 pandemic. The findings would potentially help in understanding the challenges and future directions of telemedicine use in surgery.

Methods and analysis

The databases to be searched include PubMed, EMBASE, and MEDLINE (via Ovid). In addition, ClinicalTrials.gov and medRxiv.org will be searched for any ongoing and/or unpublished studies. The reference lists of articles included in the review will be screened to assess the sensitivity of the search. Literature search, quality assessment, followed by data extraction will be performed by two independent researchers. The findings of the data synthesis will be reported in diagrams, tables, and text. This review will consider reports that include expert opinions, qualitative and quantitative data on the implementation of telemedicine in surgery and surgical subspecialties (including patients with surgical disease of any age) during the COVID-19 pandemic. In addition, future perspectives reported based either on the evidence provided by the data or on expert opinions will be considered.

Ethics and dissemination

This study does not require an institutional review board approval given its summary design nature. Findings of this systematic review will be published in a peer-reviewed journal.

Systematic review registration number

PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews.

Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits

OBJECTIVE

Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.

METHODS

An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.

RESULTS

A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).

CONCLUSIONS

This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.

Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic

Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.

Considerations on the Implementation of the Telemedicine System Encountered with Stakeholders' Resistance in COVID-19 Pandemic

Background: Non-face-to-face consultation, which ensures physical distance between patients and doctors, is increasing as a substitute mode for dealing with highly infectious diseases. Korea, with its remarkable Information and Communications Technology infrastructure, introduced telemedicine in 1988, yet it has not been formally accepted owing to stakeholders' resistance and legal restrictions. Purpose: This study aims to determine the feasibility of implementing the telemedicine system and find solutions of its development and resistance by stakeholders. Method and Material: The authors present a unique case of Korea where telemedicine, despite its solid technological base, has not yet gained a foothold 32 years after its first pilot project. A narrative review was condected according to the timeline of government-driven telemedicine adoption in Korea, and an analysis was performed on the tendency of stakeholder resistance. Results: The analysis revealed that the relevant stakeholders were classified into doctors, patients, governments and some political parties. Among stakeholders as a whole, private healthcare physicians, who provide over 90% of primary care in Korea, amount to the largest demographic against the implementation of telemedicine. Their resistance was found to be the product of policies and problems arising from the coexistence of telemedicine and conventional healthcare regimes. With the COVID-19 pandemic, policymakers are at odds with these stakeholders while implementing a pilot project. Conclusion: Fostering smooth policy implementation necessitates adopting an approach that reduces conflicts with private healthcare providers.

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.