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Telerehabilitation has been suggested to be equally effective than in-person rehabilitation, and could be helpful to increase participation and reduce barriers. People with multiple sclerosis (MS) often present urogenital dysfunctions, impairing independence and quality of life (QoL). Since the different available telerehabilitation protocols, the present study aimed to compare a live video urogenital rehabilitation intervention protocol (REMOTE) with a home-based pre-recorded video protocol (SELF). A randomized-controlled trial was performed, with 14 females with MS being allocated in the REMOTE group (36 ± 9 y) and 14 females in the SELF group (37 ± 7 y). Both telerehabilitation protocols were identical in terms of contents (including pelvic floor training and relaxation exercises), frequency and duration, consisting of 10 sessions of 45 min each, every 5 days. Questionnaires were administered at the beginning and the end of the study: Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI), Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire (ICIQ) symptoms and related QoL, the main outcome being ICIQ incontinence score. Despite most of the outcomes improved in both groups, REMOTE was found to be more effective than SELF in most of the SF-36 domains (from p < 0.001 pη2 0.555 to p = 0.044 pη2 0.147), FSFI (p = 0.001 pη2 0.373), ICIQ (p = 0.003 pη2 0.291). Despite the home-based pre-recorded videos could be effective in improving urogenital symptoms, live video urogenital rehabilitation results in larger improvements. Telerehabilitation should be encouraged for urogenital dysfunctions in females with MS, and pre-recorded videos could represent an alternative when live sessions are not available. Clinical trial registration This randomized controlled trial was registered on ClinicalTrials.gov with the number NCT05984095. [ABSTRACT FROM AUTHOR]

Introduction: The shortage of general practitioners (GPs) and the increasing prevalence of type 2 diabetes create significant pressure on primary healthcare services. To enable that medical services are available to all that need it, innovative solutions are needed. One of those, a Short Message Service (SMS)-supported basal insulin titration service is investigated in this study. The primary objective was to determine the percentage of subjects who achieved stable fasting blood glucose (FBG) within their individual target range with this service after week 16. Methods: This single-arm, 16-week study aimed to enroll 111 adults diagnosed with type 2 diabetes that needed insulin. The study subjects measured their FBG 4 consecutive days to establish a baseline, then received SMS prompts for daily FBG measurements and evening insulin injections until their FBG stabilized within the target range. Adjusting the insulin based on the FBG. Once stabilization was achieved, subjects continued with their optimal insulin dose for the remainder of the study. Sixteen weeks after the baseline, subjects measured FBG for 4 days before visit 4, where these values were read by the healthcare provider. Results: Out of the planned 111 subjects, only 30 were enrolled, with one withdrawal prior to service activation. Challenges in subject recruitment were attributed to the COVID-19 outbreak, limited eligibility, competing studies, and new medications delaying insulin initiation. Subjects were on average 59.97 years old, had an HbA1c of 9.29% a FBG of 205.64 mg/dl, and had diabetes for 10 years. Among the 29 subjects who started the service, 72% achieved successful titration at visit 4, with a median time of 49 days. Notable improvements were observed in HbA1c levels (decreased by 1.58%) and FBG levels (decreased by 64 mg/dl) over the 16-week study period. No adverse events or device-related issues were reported. Conclusions: Despite recruitment challenges, guided basal insulin titration holds promise for insulin therapy initiation in individuals. The findings emphasize the potential of tele-medical approaches, specifically through remote messaging, in managing diabetes and improving therapy adherence. [ABSTRACT FROM AUTHOR]

Use of telehealth assessments for toddlers at increased likelihood of autism spectrum disorder (ASD) began prior to the global COVID-19 pandemic; however, the value of telehealth assessments as an alternative to in-person assessment (IPA) became clearer during the pandemic. The Naturalistic Observation Diagnosis Assessment (NODA™), previously demonstrated as a valid and reliable tool to evaluate asynchronous behaviors for early diagnosis, was enhanced to add synchronous collection of behaviors to assist clinicians in making a differential diagnosis of ASD. This study was conducted to validate the information gathered through NODA-Enhanced (NODA-E™) as compared to a gold standard IPA. Forty-nine toddlers aged 16.0–32.1 months of age, recruited through community pediatric offices and a tertiary ASD clinic, participated in both NODA-E and IPA assessments. There was high agreement between the two assessment protocols for overall diagnosis (46 of 49 cases; 93.6%; κ =.878), specific diagnostic criteria for social communication and social interaction (SCI; range 95.9–98%; κ =.918—.959), and for two of four criteria specified for restricted and repetitive behaviors (RRB; range 87.8–98%; κ =.755 and.959). There was lower agreement for two subcategories of RRBs (range 65.3–67.3%; κ =.306 and.347). NODA-E is a tool that can assist clinicians in making reliable and valid early ASD diagnoses using both asynchronous and synchronous information gathered via telehealth and offers an additional tool within a clinician's assessment toolbox. [ABSTRACT FROM AUTHOR]

Purpose of Review: Researchers have examined how telemedicine affects endourological patients. This review analyzes the literature to determine telemedicine's benefits and limitations in endourology. Recent Findings: Many studies were devoted to describing the effect of telemedicine on endourological patient satisfaction, optimization of the clinical decision-making among patients with kidney and ureteric stones, the effectiveness of telemedicine in the management of patients with indications for PCNL, follow-up for patients with urolithiasis and describing financial effectiveness for the patients after BOO surgery. The authors describe phone calls, video calls, and online booking platforms as used as telemedicine technology. However, several concerns also exist, such as the necessity of internet connections and appropriate devices, different receptivity among certain subgroups, data safety, and different regulatory environments among countries. Summary: Telemedicine offers the potential to reduce patient travel time, expedite decision-making, and save costs in endourology. However, its everyday implementation is challenging due to various obstacles faced by patients and providers, hindering the realization of its full potential and necessitating a systematic approach to problem-solving. [ABSTRACT FROM AUTHOR]

The Rapid Campimetry (RC), a kinetic visual field test proved to reliably detect visual field defects within the central 10° degrees, the most crucial part for visual acuity and quality of life, affected even at very early stages of glaucoma, within a short measurement epoch, ~ 1 min. This study aims to further investigate RC correspondence with standard tests in glaucoma, namely standard automated perimetry (SAP) and optical coherence tomography (OCT) within 10° of visual field (VF). For this purpose, we included 41 participants, [21 glaucoma (GLA, mean age: 65.9 ± 12.4; 12 preperimetric eyes and 11 with VF defects) and 20 healthy controls (HC; mean age: 65.0 ± 10.3); 20 eyes]. At first, we compared the rate of detection/exclusion of VF defects in RC vs. SAP. Then, for those with VF defects (11 eyes), we investigated the 68-pointwise correspondence of 10 − 2 layout of RC and SAP. For functional and structural (SF) correspondence, pointwise correspondence of RC, SAP vs. OCTmacula [ macular ganglion cell thickness (GCL)] was also performed. Further, we compared sector-based correspondence of RC, SAP vs. OCTmacula accounting for GCL displacement at the fovea as well as sector-based correspondence with OCTdisc [peripapillary retinal nerve fiber layer thickness (pRNFL)]. Agreement estimates were reported along with Cohen Kappa () statistic. For overall performance, RC and SAP showed 100% agreement () for the exclusion of VF defects (HC and preperimetric GLA) and for detection of VF defects [11 eyes of 9 GLA, ( ]. Further, RC outperformed SAP in detection of arcuate scotomas, 7 vs. 5, respectively. Pointwise correspondence of VF defects (11 eyes), RC-SAP agreement reached 90% accuracy (). For SF correspondence, RC [SAP] showed 62% [69%] pointwise agreement with OCTmacula, (). For macular sector-based correspondence, SF correspondence improved and reached 83% [83%] agreement, (). For OCTdisc sector-based analysis, SF correspondence was highest, 100% [100%] agreement, (). Rapid Campimetry gave reproducible results in comparison to SAP and OCT with high potential as a screening VF method given its short testing duration, ~ 1 min in screening mode, and compatibility with telemedicine technologies upon future optimization and automation. [ABSTRACT FROM AUTHOR]

This perspective article explores how process mining can extract clinical insights from mobile health data and complement data-driven techniques like machine learning. Despite technological advances, challenges such as selection bias and the complex dynamics of health data require advanced approaches. Process mining focuses on analyzing temporal process patterns and provides complementary insights into health condition variability. The article highlights the potential of process mining for analyzing mHealth data and beyond. [ABSTRACT FROM AUTHOR]

The forward triage characteristic of telemedicine highlights its importance again in the COVID-19 pandemic. Telemedicine can provide timely emergency response in the case of environmental or biological hazards, and the patient's medical privacy data generated in this process can also accelerate the establishment of models for preventing and treating infectious diseases. However, the reuse process of telemedicine user privacy data based on federated learning also faces significant challenges. Differences in regions, economic levels, and grades lead to heterogeneous data and resource-constrained environments, seriously damaging the federated learning process. Besides, the weak password authentication of medical terminals and eavesdropping attacks on transmission channels may cause illegal access to terminals and platforms and leakage of sensitive data. This paper proposed a telemedicine data secure-sharing scheme based on heterogeneous federated learning. Specifically, we proposed a heterogeneous federated learning scheme with model alignment to guide telemedicine practice through the reuse of telemedicine data; in addition, we designed an SM9 threshold identity authentication scheme to guarantee that the patient's medical privacy data is protected from leakage during the federated learning process. We evaluated our scheme using two third-party medical datasets. The evaluation results indicate that this scheme can still assist the federated learning process in resisting data heterogeneity and resource constraints with almost no performance cost. [ABSTRACT FROM AUTHOR]

Purpose: To assess retinopathy of prematurity (ROP) practice patterns during the coronavirus (COVID-19) pandemic. Methods: A survey on ROP practice patterns during the COVID-19 pandemic was sent to the American Academy of Ophthalmic Executives, the International Pediatric Ophthalmology and Strabismus Council members, and to various national societies on May 19, 2020. The survey closed on the 31st of June 2020. Results: Two hundred ninety-two ophthalmologists from 41 countries responded to the survey. Most replies originated in Asia (48%) and North America (38%). During the COVID-19 pandemic compared to the pre-COVID-19 period, respondents reported a reduction of 15% in the number of NICU inpatients and 19.8% of the ROP outpatients' follow-up visits. The number of ROP outpatients' follow-up visits and inpatients' exams was significantly greater in North America than in Asia (72.0% versus 37.2% and 87.8% versus 49.6%, respectively, P < 0.001). Only 14% of the ophthalmologists adopted new screening guidelines, and 7.2% reported changing their preferred treatment. In 50% of responders, laser photocoagulation was the preferred treatment. A significantly higher percentage of ophthalmologists reported using telemedicine during the pandemic, 29.8% (n = 85/285), and 15.6% (44/282) prior to the pandemic (χ2 = 15.51, p < 0.001). Conclusions: During the COVID-19 pandemic, fewer ROP screening and follow-up visits were conducted on premature infants; these findings were especially prominent among physicians in Asia. Telemedicine usage increased during the pandemic. This study highlights the need to maintain screening protocols for ROP during pandemics. The utility of technological measures could enable this, along with adequate prevention of physical contact. [ABSTRACT FROM AUTHOR]

Purpose: To assess the repeatability, intra and interrater reproducibility of the DIPA-S eHealth© system for capturing and measuring clinical variables of scoliosis, including frontal trunk imbalance (FTI), sagittal trunk imbalance (STI), and angle of trunk rotation (ATR). Methods: Patients were photographed using the DIPA-S eHealth Capture© mobile application by family members, physiotherapists, or surgeons. Three photos were taken in each position: standing in the frontal and sagittal planes and in the axial plane in forward bending position of the trunk. The photos were analyzed by three independent evaluators using the DIPA-S eHealth Analysis© software. For repeatability, each photo was analyzed twice consecutively by the three evaluators. For intrarater reproducibility, only one evaluator reanalyzed the first photo from each plane with a 5-day interval. For interrater reproducibility, the three evaluators analyzed the first photo from each plane. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used (p < 0.05). Results: The sample comprised 262 images (n = 30). Repeatability was excellent for all three evaluators in all three planes (ICC 0.94 to 1.00). Intrarater reproducibility was excellent in all three planes (ICC 0.88 to 0.99). Interrater analysis was excellent for the frontal and axial planes (ICC 0.98 and 0.93), respectively. However, it was weak in the sagittal plane ICC 0.32. The SEM ranged from 0.02 to 17.6 and MDC from 0.03 to 34.6. Conclusion: The DIPA-S eHealth© Capture and Analysis system demonstrates reproducibility for use in the clinical assessment of scoliosis through teleconsultations. [ABSTRACT FROM AUTHOR]

Purpose: Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement. Method: Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up. Results: There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement. Conclusion: This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program. [ABSTRACT FROM AUTHOR]

Nowadays, many countries view profitable telemedicine as a viable strategy for meeting healthcare needs, especially during the pandemic. Existing appointment models are based on patients' structured data. We study the value of incorporating textual patient data into telemedicine appointment optimization. Our research contributes to the healthcare operations management literature by developing a new framework showing (1) the value of the text in the telemedicine appointment problem, (2) the value of incorporating the textual and structured data in the problem. In particular, in the first phase of the framework, a text-driven classification model is developed to classify patients into normal and prolonged service time classes. In the second phase, we integrate the classification model into two existing decision-making policies. We analyze the performance of our proposed policy in the presence of existing methods on a data set from the National Telemedicine Center of China (NTCC). We first show that our classifier can achieve 90.4% AUC in a binary task based on textual data. We next show that our method outperforms the stochastic model available in the literature. In particular, with a slight change of actual distribution from historical data to a normal distribution, we observe that our policy improves the average profit of the policy obtained from the stochastic model by 42% and obtains lower relative regret (18%) from full information than the stochastic model (148%). Furthermore, our policy provides a promising trade-off between the cancellation and postponement rates of patients, resulting in a higher profit and a better schedule strategy for the telemedicine center. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of telemedicine by a patient's own primary care provider (PCP) versus another available PCP is understudied. Objective: Examine the association between primary care visit modality with timeliness and follow-up in-person healthcare, including variation by visits with the patient's own PCP versus another PCP. Design and Participants: Cohort study including primary care visits in a large, integrated delivery system in 2022. Measures: Outcomes included timeliness (visit completed within 7 days of scheduling) and in-person follow-up (PCP visits, emergency department (ED) visits, hospitalizations) within 7 days of the index PCP visit. Logistic regression measured the association between visit modality (in-person, video, and audio-only telemedicine) with the patient's own PCP or another PCP and outcomes, adjusting for characteristics. Key Results: Among 4,817,317 primary care visits, 59% were in-person, 27% audio-only, and 14% video telemedicine. Most (71.3%) were with the patient's own PCP. Telemedicine visits were timelier, with modality having a larger association for visits with patient's own PCP versus another PCP (P < 0.001). For visits with patient's own PCPs, return office visit rates were 1.2% for in-person, 5.3% for video, and 6.1% for audio-only. For another PCP, rates were 2.2% for in-person, 7.3% for video, and 8.1% for audio. Follow-up ED visits ranged from 1.4% (in-person) to 1.6% (audio-only) with own PCP, compared to 1.9% (in-person) to 2.3% (audio-only) with another PCP. Differences in return office and ED visits between in-person and telemedicine were larger for visits with another PCP compared to their own PCP (P < 0.001). Follow-up hospitalizations were rare, ranging from 0.19% (in-person with own PCP) to 0.32% (video with another PCP). Conclusion: Differences in return office and ED visits between in-person and telemedicine were larger when patients saw a less familiar PCP compared to their own PCP, reinforcing the importance of care continuity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of applying digital health palliative care to improve symptoms, mood, and quality of life in patients with advanced cancer. Methods: We searched PubMed, Embase, Web of Science, Cochrane Library (CENTRAL), and CINAHL databases on November 16, 2023, to identify randomized controlled trials of the impact of palliative care applying digital health on patients with advanced cancer. The Cochrane Risk of Bias Tool version 1.0 was used to evaluate the quality of randomized controlled trials. Results: A total of 20 randomized controlled trials were included, of which 18 were meta-analyzed. Compared with usual care, palliative care applying digital health was effective in improving symptoms (SMD = -0.21, 95% CI: -0.37 to -0.06, P = 0.007) and reducing the intensity of pain (SMD = -0.49, 95% CI: -0.85 to -0.13, P = 0.008) in patients with advanced cancer, but no effective improvement in depressive symptoms, anxiety symptoms, or quality of life was found. Conclusions: Our systematic review provides evidence that palliative care applying digital health has great potential to improve symptoms in patients with advanced cancer, but more research is needed to explore its impact on mood and quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Digital exclusion is a growing challenge when deploying digital patient care pathways and a potential barrier to widespread implementation, especially in the field of smartphone-based self-monitoring of vision. This retrospective case series seeks to examine the characteristics of individuals who adhere to a smartphone home monitoring programme using the Alleye app for retinal disease, with a focus on digital exclusion, social deprivation and clinical outcomes. Methods: We conducted a retrospective analysis of 89 patients with retinal pathologies including diabetic retinopathy and retinal vein occlusions at Moorfields Eye Hospital participating in an Alleye home monitoring programme between April 2020 and November 2022. Postcodes were used to determine the Digital Exclusion Risk Index (DERI) and the Index of Multiple Deprivation (IMD) rebased for London. Clinical information from the electronic patient record and Alleye app usage data were extracted for each patient. Associations between the DERI/IMD, clinical parameters and app use were examined using multivariable regression models. Results: Mean DERI was 2.56 (standard deviation [SD] = 0.36), IMD was 6.25 (SD = 2.79), visual acuity (VA) in the better eye at study entry was 83.28 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (SD = 7.92), and mean follow-up was 344.46 days (SD = 260.13). During the observation period, 36% received an intravitreal injection (IVI) and VA fell by at least ten letters in approximately one in four patients. In 87.5% of patients requiring IVI, the use of the app increased. We found no association between clinical parameters and programme adherence for DERI or IMD. Conclusions: We found no association between high digital exclusion risk and high social deprivation with monitoring adherence to smartphone-based self-monitoring of vision, contrary to the currently available evidence. This suggests that smartphone-based self-monitoring of vision is accessible to population groups of varying digital exclusion and social deprivation risk, and can be safely employed to monitor clinical progression. [ABSTRACT FROM AUTHOR]

A large language model (LLM) is an artificial intelligence (AI) model that uses natural language processing (NLP) to understand, interpret, and generate human-like language responses from unstructured text input. Its real-time response capabilities and eloquent dialogue enhance the interactive user experience in human–AI communication like never before. By gathering several sources on the internet, LLM chatbots can interact and respond to a wide range of queries, including problem solving, text summarization, and creating informative notes. Since ophthalmology is one of the medical fields integrating image analysis, telemedicine, AI, and other technologies, LLMs are likely to play an important role in eye care in the near future. This review summarizes the performance and potential applicability of LLMs in ophthalmology according to currently available publications. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the feasibility, acceptability and preliminary efficacy of a standardized nurse delivered mobile phone intervention to improve adherence to antiretroviral treatment and clinical outcomes. Methods: Feasibility and acceptability of the phone intervention was assessed with rates of eligibility, completed visits, and attritions. Intervention fidelity was assessed by checking recorded calls and feedback. Efficacy was assessed using a randomized controlled trial in which 120 women living with HIV and psychosocial vulnerabilities, were randomized to Treatment as Usual (TAU = 60) or TAU plus the mobile phone intervention (N = 60). Trained basic nurses delivered the theory-guided, standardized mobile phone intervention for mental health issues and psychosocial risk factors to improve antiretroviral treatment (ART) adherence and retention in care and improve clinical outcomes. Blind raters performed the assessments at 6, 12 and 24 weeks post-randomization. Results: Adherence diminished over time in the TAU only group, while it was sustained in the TAU Plus group, only dropping at 24 weeks after the intervention had been discontinued. Among participants with depressive symptoms (CESD ≥ 16), the intervention had significant improvement in adherence rates (p < 0.01), psychological quality of life (p < 0.05) and illness perception (p < 0.05) compared to those in the TAU only group. Greater improvements of quality of life subscales were observed in the TAU Plus group among participants with less psychological vulnerability (PSV < 2). HIV RNA was not significantly different between the groups at week 24. Conclusions: The mobile-delivered counseling intervention was feasible and acceptable and shows promise among women living with HIV and psychosocial vulnerabilities in rural South India. Trial Registration: ClinicalTrials.gov Identifier: NCT02319330 [Registered on: December 18, 2014]. [ABSTRACT FROM AUTHOR]

Despite strong evidence in favor of physical activity (PA), adults with autism spectrum disorder (ASD) are not meeting established PA guidelines to engage in at least 150 min of moderate to vigorous PA per week. Barriers to daily PA engagement include limited access to health services, transportation, and reduced self-determined motivation. Telehealth provides a potential alternative to deliver PA programming in a more accessible platform for adults with ASD. This pilot randomized controlled trial (RCT) assessed the preliminary efficacy of a 10-week PA intervention program called Physical Activity Connections via Telehealth (PACT) that utilized telehealth and remote technology, including Fitbit wearable device use, peer-guidance, and individualized home exercise program among adults with ASD. Primary health outcomes, collected at baseline before randomization and post-intervention, included self-determined motivation assessment via Behavioral Exercise Regulation Scale (BREQ-2), self-report PA via Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLT-PAQ), steps per day PA via Fitbit device, body mass index (BMI), and waist-to-height ratio (WtHR). A total of 18 adults, 11 males, with a mean age of 26.4 years, with a primary diagnosis of ASD participated in the study. Although there were no changes in BMI or WtHR at post-intervention, participants receiving PACT, significantly increased both their self-report PA scores (GSLT-PAQ) from 26 to 68, (p = 0.002), and steps per day from 5,828 to 7,443, (p = 0.015) with a moderate effect size (d = 0.72). The results of this pilot study support peer supported telehealth-based PA intervention for adults with ASD to increase PA. [ABSTRACT FROM AUTHOR]

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring. [ABSTRACT FROM AUTHOR]

Background: A brief, parent-led, transdiagnostic cognitive behavioral therapy (CBT) approach demonstrated utility among youth struggling with emotional problems during the COVID-19 pandemic. Homework completion between sessions is directly associated with psychotherapy treatment outcomes in non-parent-led CBT interventions. The present study sought to examine the relationship between homework completion and treatment response in a parent-led transdiagnostic CBT protocol. Objective: The first aim was to determine if completion of between session CBT homework was associated with change in symptom severity. The second aim was to determine if pre-treatment anxiety severity, social anxiety severity, and depressive symptoms were associated with treatment outcomes. Methods: One-hundred twenty-nine parents of youth (ages 5–13) with significant emotional problems received 6 sessions of telehealth parent-led CBT during the COVID-19 pandemic. Data on children's anxiety symptomology, clinical severity, homework compliance, depression, family relationships, perceptions on the impacts of the pandemic, treatment response, and therapists rating of symptom improvement were collected. Results: Homework completion explained 9% of the variance in symptom improvement at post-treatment. Greater homework completion was associated with a significantly higher odds of treatment response (OR = 1.52, p =.001). Child anxiety severity, depressive symptoms, family relationships, and perceptions on the impacts of the COVID-19 pandemic were not significantly related to treatment outcome. Conclusions: Completion of homework predicted treatment outcomes in parent-led, transdiagnostic CBT for youth with emotional problems during the COVID-19 pandemic, while controlling for parent-rated anxiety, depression, family relationships, and COVID-related distress. Enhancing and targeting homework compliance between CBT sessions should be a central element of parent-led treatment. [ABSTRACT FROM AUTHOR]

The articles in this special issue of AIDS and Behavior focus on the collision between HIV/AIDS and COVID-19 as intersecting pandemics that profoundly impacted communities globally. This editorial highlights the complex interplay between these two public health crises. The pandemic disrupted access to HIV prevention, testing, and treatment services, potentially jeopardizing decades of progress. Mental health challenges and social vulnerability among people living with HIV (PWH) were exacerbated, with preexisting health disparities amplified, disproportionately affecting marginalized populations. However, despite these challenges, the pandemic also spurred innovation and adaptation in HIV prevention and care, with increased use of telehealth and other modalities. The enduring and actionable lessons learned from the collision of HIV and COVID-19 pandemics can prepare us for the next public health challenge with two calls for action. First, we call for integrated and equitable responses that address the multifaceted challenges faced by individuals and communities affected by HIV in the post-COVID-19 era. Second, we call for a strengthened commitment to building resilient health systems and community-engaged interventions that can withstand future challenges. [ABSTRACT FROM AUTHOR]

HIV care services have been interrupted by the COVID-19 pandemic in many states in the U.S. including South Carolina (SC). However, many HIV care facilities demonstrated organizational resilience (i.e., the ability to maintain needed health services amid rapidly changing circumstances) by addressing challenges to maintaining care during the pandemic. This study, therefore, aims to identify key facilitators for organizational resilience among AIDS Services Organizations (ASOs) in SC. In-depth interviews were conducted among 11 leaders, from 8 ASOs, across SC during the summer of 2020. The interviews were recorded after receiving proper consent and then transcribed. Utilizing a codebook based upon the interview guide, a thematic analysis approach was utilized to analyze the data. All data management and analysis were conducted in NVivo 11.0. Our findings demonstrate several facilitators of organizational resilience, including (1) accurate and timely crisis information dissemination; (2) clear and preemptive protocols; (3) effective healthcare system policies, management, and leadership; (4) prioritization of staff psychological wellbeing; (5) stable access to personal protective equipment (PPE); (6) adequate and flexible funding; and (7) infrastructure that supports telehealth. Given the facilitators of organizational resilience among ASOs in SC during the COVID-19 pandemic, it is recommended that organizations implement and maintain coordinated and informed responses based upon preemptive protocols and emerging needs. ASO funders are encouraged to allow a flexibility in spending. The lessons learned from the participating leaders enable ASOs to develop and strengthen their organizational resilience and experience fewer disruptions in the future. [ABSTRACT FROM AUTHOR]

In these crucial times of COVID-19, cryptographic and nature inspired innovations help to communicate confidential data in the wireless telemedicine. The novel corona virus had entirely shattered all segments of life in the entire world. In the medical sciences, patients are more advised to take telemedicine supports. Cardiac patients are very much prone to corona virus. They need to transmit confidential medical data for their online treatments. Such heterogeneous cardiac information is to be protected with patients' confidentiality. It is very noteworthy to impose high security features on the COVID-19 "New Normal" telecardiology. In this paper, we have designed a cryptographic system based on metaheuristic Harmony search algorithm and tree parity machines. It has been proposed to counter attack against different security hazards in online medical transactions during this tremendous flooded COVID-19 time. The proposed method has been modularized into four modules. These are: Neuro-Metaheuristic Session Key (NMSK) generation, Cryptographic Engineering, Frame format generation, and authentication and decryption phase. Harmony search with tree parity machines were used to generate the key i.e. NMSK. A new state-of-art sharing was proposed to dilute the information contents inside the telemedicine networks against the intruders. Moreover, the proposed state-of-art sharing exhibits the complete bi-partite graph property. A rigorous frame format has been placed before the encrypted message inside the COVID-19 telecardiology. Different types of statistical and mathematical tests were carried out on the proposed technique to prove its efficacy. Thus, the proposed cryptographic system acts as a reinforcement of security mechanism in COVID-19 telecardiology. [ABSTRACT FROM AUTHOR]

Introduction: In Irish orthopaedic centres without dedicated spinal services, the care of patients is facilitated through tertiary referral centres in Dublin, Cork & Galway. The outpatient waiting list for elective spinal opinion remains lengthy and challenging. Previous practice in University Hospital Waterford (UHW) necessitated an assessment with a local non-spinal orthopaedic specialist following a GP referral, incurring up to a 2-year wait prior to subspecialist spinal referral. These patients subsequently incurred a further wait for an appointment at the tertiary referral centre. A novel virtual spine clinic in collaboration with the Mater Misericordiae University Hospital (MMUH) was developed to fast-track this process. Aims and methods: A retrospective study was performed to audit efficiency by assessing time to initial consultation and time to virtual consultation, treatment outcomes, and patient satisfaction using an adapted patient-satisfaction questionnaire (PSQ-18) and a semi-structured interview. This study reflected the unique nature of patient experience in this pathway. Results: The median time from referral to being seen in an in-person rapid access physiotherapist combined orthopaedic clinic was 185 days. The median time from initial consultation to virtual consultation was 36 days. The median time interval from virtual consultation to intervention was 110 days. Twenty percent of patients underwent surgery, 14% were further seen in the MMUH outpatients, 7% managed with the trial of physiotherapy, 7% required no follow-up, and 50% planned for radiologically guided spinal injections. Discussion and conclusion: This novel pathway is efficient for orthopaedic units without a dedicated spinal service. This can easily be replicated across other orthopaedic centres with minimal cost implications. [ABSTRACT FROM AUTHOR]

Background: Blockchain technology provides a secure and decentralized platform for storing and transferring sensitive medical data, which can be utilized to enable remote medical consultations. Aim: A theoretical framework for creating a blockchain-based digital system created to facilitate telemedicine system. Results: This paper proposes a theoretical framework based on Hyperledger fabric for creating a blockchain-based digital entity to facilitate telemedicine services. The proposed framework utilizes blockchain technology to provide a secure and reliable platform for medical practitioners to interact remotely with patient transactions. Conclusion: The blockchain will serve as a one-stop digital service to secure patient data, ensure privacy, and facilitate payments. The proposed framework leverages the existing Hyperledger fabric platform to build a secure blockchain-assisted telemedicine platform. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing. The high prevalence makes its diagnosis a priority. To perform type III sleep studies, patients usually receive instructions from a technician. The switch to instructions through a video could save professionals time and make OSA diagnosis more accessible. This study aimed to compare the technical quality of type III sleep studies when instructions are provided by face-to-face technical teaching or via video. Methods: One hundred consecutive patients aged ≥ 18 years with suspected OSA were randomly assigned to receive device placement instructions in person by a technician or through video (50 in each group). The overall quality of the sleep studies was analyzed by determining the number of technically invalid studies. The recording quality of four sensors (pulse oximeter, nasal flow cannula, chest, and abdominal bands) was evaluated by checking for signal artifacts. Results: The majority (86%) of the studies were valid. 20% of the studies in the face-to-face group and 8% of the studies in the video-instruction group were technically invalid, but no statistically significant difference was found (p = 0.148). The quality of the oximetry signal was better in those who received video instructions (p = 0.05). Regarding the recording quality of the remaining sensors, no significant differences were found. Conclusions: Type III sleep studies with previous explanation through a video are as effective as those with an explanation performed by a technician, with associated advantages, without increased errors. The quality of the oximetry signal was better in the video group, a critical signal for OSA diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The digitization of medicine will play an increasingly significant role in future years. In particular, telemedicine, Virtual Reality (VR) and innovative Artificial Intelligence (AI) systems offer tremendous potential in imaging diagnostics and are expected to shape ultrasound diagnostics and teaching significantly. However, it is crucial to consider the advantages and disadvantages of employing these new technologies and how best to teach and manage their use. This paper provides an overview of telemedicine, VR and AI in student ultrasound education, presenting current perspectives and controversies. [ABSTRACT FROM AUTHOR]

Background: The integration of telemedicine in pain management represents a significant advancement in healthcare delivery, offering opportunities to enhance patient access to specialized care, improve satisfaction, and streamline chronic pain management. Despite its growing adoption, there remains a lack of comprehensive data on its utilization in pain therapy, necessitating a deeper understanding of physicians' perspectives, experiences, and challenges. Methods: A survey was conducted in Italy between January 2024 and May 2024. Specialist center members of the SIAARTI were sent an online questionnaire testing the state of the art of telemedicine for pain medicine. Results: One-hundred thirty-one centers across Italy reveal varied adoption rates, with 40% routinely using telemedicine. Regional disparities exist, with Northern Italy showing higher adoption rates. Barriers include the absence of protocols, resource constraints, and bureaucratic obstacles. Despite challenges, telemedicine has shown positive impacts on service delivery, with increased service volume reported. Technological capabilities, including image sharing and teleconsultation with specialists, indicate promising interdisciplinary potential. Conclusions: The integration of advanced telemedicine software utilizing artificial intelligence holds promise for enhancing telemonitoring and alert systems, potentially leading to more proactive and personalized pain management strategies. [ABSTRACT FROM AUTHOR]

The newly adopted EU AI Act represents a pivotal milestone that heralds a new era of AI regulation across industries. With its broad territorial scope and applicability, this comprehensive legislation establishes stringent requirements for AI systems. In this article, we analyze the AI Act's impact on digital medical products, such as medical devices: How does the AI Act apply to AI/ML-enabled medical devices? How are they classified? What are the compliance requirements? And, what are the obligations of 'providers' of these AI systems? After addressing these foundational questions, we discuss the AI Act's broader implications for the future of regulated digital medical products. [ABSTRACT FROM AUTHOR]

Background: Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and patients have a significant impact on the patient's experience of safety and inclusion. Understanding the patient perspective is crucial to developing good quality healthcare, but little is known about patient experiences of emergency care via VC in a rural context. The aim of this study was to explore patient experiences of emergency care via VC in northern rural Sweden. Methods: Using a qualitative approach, semi- structured interviews (n = 12) were conducted with individuals aged 18—89 who had received emergency care with a registered nurse (RN) on site and VC with a general practitioner (GP). The interviews were conducted between October 2021 and March 2023 at community hospitals (n = 7) in Västerbotten County, Sweden. Interviews were analysed with content analysis. Results: The analysis resulted in main categories (n = 2), categories (n = 5) and subcategories (n = 20). In the main category, "We were a team of three", patients described a sense of inclusion and ability to contribute. The patients perceived the interaction between the GP and RN to function well despite being geographically dispersed. Patients highly valued the opportunity to speak directly to the GP. In the main category, "VC was a two-sided coin", some experienced the emergency care through VC to be effective and smooth, while some felt that they received a lower quality of care and preferred face-to-face consultation with the GP. The quality of the VC was highly dependent on the RN's ability to function as the hub in the emergency room. Conclusion: Patients in rural areas perceived being included in 'the team' during VC, however they experienced disadvantages with the system on individual basis. The nursing profession plays an important role, and a proper educational background is crucial to support RNs in their role as the hub of the visit. The GP's presence via VC was seen as important, but to fully enable them to fulfil their commitments as medical professionals, VC needs to be further improved with education and support from technical devices. [ABSTRACT FROM AUTHOR]

Asynchronous teledermatology (TD) has shown promise in improving access to dermatological care, yet studies reveal varied methodologies and results. This study aimed to design a mobile app using the store-and-forward model, marking a pioneering effort in Iran to facilitate written documentation of patient history and skin lesion imagery for accurate diagnosis. Conducted from July 2022 to July 2023, this study involved the development and implementation of a smartphone app to collect clinical data and photographs from 89 patients at a dermatology clinic. Diagnoses made at the clinic served as the gold standard. Three dermatologists independently reviewed the app-recorded data, providing diagnoses that were compared to in-person assessments using the Kappa coefficient and agreement percentage. Lesions were predominantly located on the whole body (47%), with psoriasis (19.1%), acne vulgaris (11.2%), and eczema (10%) being the most common. The overall inter-observer Kappa value demonstrated excellent agreement at 0.856. The study's findings endorse the use of a mobile app for TD as an effective adjunct in regions with scarce dermatological services, such as Iran. To promote the broader application of TD, ongoing research is essential to further establish its reliability and practicality. [ABSTRACT FROM AUTHOR]

The Remote Assessment of Disease and Relapse – Alzheimer's Disease (RADAR-AD) consortium evaluated remote measurement technologies (RMTs) for assessing functional status in AD. The consortium engaged with the European Medicines Agency (EMA) to obtain feedback on identification of meaningful functional domains, selection of RMTs and clinical study design to assess the feasibility of using RMTs in AD clinical studies. We summarized the feedback and the lessons learned to guide future projects. [ABSTRACT FROM AUTHOR]

Evaluation of a team-based intervention in primary care that includes cognitive behavioural therapy elements and case management and was supported by eHealth components in patients with panic disorder with or without agoraphobia (PD ± AG) and/or depression. In a two-armed cluster-randomised controlled trial (cRCT), mental health conditions were assessed by the Mental Health Index (MHI-5), Patient Health Questionnaire (PHQ-9), Overall Anxiety Severity and Impairment Scale (OASIS), Panic and Agoraphobia Scale (PAS), Mobility Inventory for Agoraphobia (MIA), and Patient Assessment of Chronic Illness Care (PACIC) at baseline (T0), after 6 months (T1), and after 12 months (T2). Scores were analysed as differences from baseline using a mixed linear model with general practitioner (GP) as a random intercept and treatment, time point, and respective baseline value as fixed factors. The majority of participants (mean age 54 years, SD 12.8 years) were women (n = 40, 67.8%). We found consistent mean effects in favour of the intervention group (MHI-5 index, 6.66 [−7.38; 20.70]; PACIC, 15.92 [4.58; 27.26]; PHQ-9, −3.43 [−5.71; −1.14]; OASIS, −2.89 [−5.41; −0.37]). A cautious interpretation indicates promising effects of the intervention. Obstacles to recruitment included the workload for GPs and medical assistants (MAs), potential reservations regarding eHealth, and the onset of the COVID-19 pandemic. Trial registration: The study was registered at the German Clinical Trials Register (DRKS00016622) on February 22nd, 2019. https://drks.de/search/de/trial/DRKS00016622. [ABSTRACT FROM AUTHOR]

Introduction: The use of most commercially available automated insulin delivery (AID) systems is off-label in pregnancy. However, an increasing number of women with type 1 diabetes (T1D) use such devices throughout pregnancy and delivery. We analysed the data of six women with T1D from a single centre (Diabetology Outpatient Clinic of District-63/Asl Salerno, Italy) who were able to start and maintain AID therapy with the MiniMed™ 780G (Medtronic, Minneapolis, MN, USA) throughout the pregestational care period, pregnancy, delivery, and postpartum. Methods: We retrospectively collected data from six patients with T1D who received training and initiation on use of the MiniMed™ 780G and attended follow-up visits throughout pregnancy (these visits were virtual because of the COVID-19 pandemic). All patients maintained their devices in the closed-loop setting throughout pregnancy and during labour and delivery. We analysed data from the pregestational phase to the first 30 days postpartum. Results: All patients achieved the recommended metabolic goals before conception [median time in range (TIR) of 88% for 70–180 mg/dL; median pregnancy-specific TIR 63–140 mg/dL (ps-TIR) of 66% and maintained the ps-TIR until delivery (median ps-TIR 83%). All patients had slightly better metrics during the night than during the day, with a very low time below range of < 63 mg/dL. Optimal glycaemic values were also maintained on the day of labour and delivery (median ps-TIR 92.5%) and in the first 30 days postpartum, with no severe hypoglycaemia. The only neonatal complications were jaundice in one child and an interatrial defect in another child. Conclusion: In our well-selected and trained patients, use of the MiniMed™ 780G helped to achieve and maintain ps-metrics from the pregestational period to delivery despite the fact that the algorithm is not set to achieve the ambitious glycaemic values recommended for pregnancy. [ABSTRACT FROM AUTHOR]

The eHealth sector has witnessed significant growth due to technological advancements, facilitating care delivery in patients' homes and moving away from traditional hospital settings. Blockchain and the Internet of Things (IoT) play pivotal roles in enhancing healthcare services, offering features such as remote patient monitoring, streamlined electronic medical record (EMR) management, drug traceability, and effective disease control, particularly during events like the COVID-19 pandemic. The growing utilization of IoT devices brings about security challenges, including concerns related to data integrity and device authentication. This paper proposes the integration of blockchain technology as a robust solution. Leveraging its decentralized and tamper-resistant features, blockchain establishes trust among diverse IoT devices, ensuring the integrity of IoT data. Additionally, smart contracts enhance device authentication, fortifying overall security by addressing vulnerabilities associated with centralization. Regarding the management of eHealth, this survey begins with an overview of the industry, highlighting IoT-related challenges in healthcare. It explores various IoT applications in eHealth and discusses how blockchain can effectively address obstacles in healthcare management through IoT. Notably, the paper provides insights into examining consensus algorithm parameters within blockchain systems, clarifying the methodology used to assess and optimize these critical components. The survey extends to a thorough review of existing research on integrating blockchain-based IoT in eHealth. Finally, it presents an overview of challenges and potential solutions for implementing blockchain-based IoT in the eHealth sector. This comprehensive survey aims to empower stakeholders by providing insights to enhance patient care in this dynamic and evolving field. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) is rapidly permeating critical domains, enabling the interconnection and utilization of diverse devices on a large scale while streaming vast volumes of data. In domains like telehealth, intelligent transportation, and autonomous agriculture, ensuring the confidentiality, integrity, and authenticity of collected and exchanged data is paramount. However, the resource limitations and heterogeneous nature of IoT devices often render traditional cryptography-based techniques ineffective or even infeasible for secure data transmission. Consequently, there is an urgent need to develop and implement lightweight, secure, and scalable schemes for data transmission. In this paper, we propose a novel Lightweight Secure and Scalable Scheme (LS3) for data transmission in IoT environments. LS3 is comprised of three phases and utilizes an efficient combination of symmetric keys and Elliptic Curve Menezes–Qu–Vanstone asymmetric key agreement protocol. Through a comprehensive analysis, we demonstrate that LS3 excels in terms of security and scalability and outperforms other existing schemes in terms of computation and communication costs. [ABSTRACT FROM AUTHOR]

Background: The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. Objective: Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. Design: A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. Participants: A random national sample consisting of 564,580 primary care empaneled veterans in June 2021. Main Measures: Latent class membership. Key Results: We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p <.05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p <.05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). Conclusions: Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video. [ABSTRACT FROM AUTHOR]

Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice. [ABSTRACT FROM AUTHOR]

Background: Space travel is experiencing a renaissance with expanding commercial and international efforts. Space surgery will have growing relevance as mission frequency and distances increase beyond low Earth orbit. Methods: This white paper from the SAGES Space Surgery Task Force raises awareness among the SAGES membership regarding the challenges and opportunities surrounding this emerging field that anticipates surgical care in the most extreme, austere environments. Results: Innovation in technology and preventive medicine principles will enhance the effectiveness of space surgical care when the need arises. The impact of advancements in space and terrestrial medicine to support space exploration indicates the need for a surgeon to oversee medical/surgical invasive treatment to ensure astronaut health and mission success. Advanced technology, including semi- and autonomous robotic systems, may be a preferred way to deliver this care in the foreseeable future. There is currently a need to develop training curricula and flight-compatible supplies and technology for physicians that deliver surgical care to this special patient population. The protocols and technology developed to address the unique challenges of space travel will provide value for care in space as well as in extreme, austere terrestrial environments on Earth. Conclusion: Space surgery will continue to evolve as commercial and government programs explore further into space. The SAGES Space Surgery Task Force is favorably positioned to significantly contribute to addressing some capability gaps in delivering surgical care in space. [ABSTRACT FROM AUTHOR]

Various hospitals have adopted digital technologies in the healthcare sector for various healthcare-related applications. Due to the effect of the Covid-19 pandemic, digital transformation has taken place in many domains, especially in the healthcare domain; it has streamlined various healthcare activities. With the advancement in technology concept of telemedicine evolved over the years and led to personalized healthcare and drug discovery. The use of machine learning (ML) technique in healthcare enables healthcare professionals to make a more accurate and early diagnosis. Training these ML models requires a massive amount of data, including patients' personal data, that need to be protected from unethical use. Sharing these data to train ML models may violate data privacy. A distributed ML paradigm called federated learning (FL) has allowed different medical research institutions, hospitals, and healthcare devices to train ML models without sharing raw data. This survey paper overviews existing research work on FL-related use cases and applications. This paper also discusses the state-of-the-art tools and techniques available for FL research, current shortcomings, and future challenges in using FL in healthcare. [ABSTRACT FROM AUTHOR]

Objective: We studied the presence of psychological stress in patients with type 2 diabetes (T2D) and if could be attributed to the consumption of a pro-inflammatory diet. We evaluated the inflammatory potential of the habitual Mexican diet, addressed by tools with an approach to collecting information on e-Health. Methods: In this cross-sectional analytic study of 238 Mexican adults with T2D, the profile of the inflammatory diet was obtained by the Dietary Inflammatory Index (DII), and the presence of psychological stress by the Diabetes Distress Scale-17 (DSS) was assessed. Multivariable logistic regression analysis was performed to estimate the association between diabetes stress and DII score. Sensitivity analysis was performed by Energy–Density Dietary Inflammatory Index (E-DII). Results: We demonstrated that there is an association between a profile of stress and high-inflammatory values of the DII score after adjustment for potential confounders (OR 2.40, 95% CI 1.2, 4.6). Conclusion: Using e-Health through web-based tools to collect information showed benefits of the application as a method of dietary assessment. We provide evidence showing that better values of the DII score and physical activity may play a protective role against the presence of psychological stress; DII and E-DII scores qualify and label habitual diet into pro and anti-inflammatory and are associated with psychological stress in T2D. [ABSTRACT FROM AUTHOR]

Participants from an outpatient treatment program for cognitive disorders have been offered bridging measures because of limited access to the outpatient clinic during a Covid-19-caused lock-down. The aim of this study was to assess perceived stress, acceptance, and appreciation of the measures among patients and their caregivers compared to the previous bridging measure. Forty participants were offered treatment in person or online depending on their cognitive performance level. To evaluate acceptance, data collected from clinical routine was incorporated into a treatment observation. The evaluation of bridging measures by 25 participants was positive. Perceived stress was moderate to high among participants and has increased significantly compared to previous special treatment. Perceived stress in older patients had increased over the course of the pandemic. Bridging measures represented a treatment alternative and may offer previously untapped potential for location-independent psychosocial treatments in order to ameliorate both the patients' and their caregivers' convenience. [ABSTRACT FROM AUTHOR]

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This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost–benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost–benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy. [ABSTRACT FROM AUTHOR]

Background: In the Kingdom of Saudi Arabia (KSA), little is known about the adoption of virtual consultations (VCs), with most studies being survey-based leading to varying results. This study aims to utilise secondary collected data on the use of both kinds of VCs currently available, and to epidemiologically describe the adoption of these consultations. Methods: This retrospective study analysed data provided by the Ministry of Health between January 1st 2021 and June 30th 2022. For both the home-based and the hospital-based consultations, variables included the age and sex of patients, date of consultation, duration in minutes, closure status for the appointment and the governorate in which the patient is residing. A heat map was drawn to present patterns of utilisation across the country. Results: The total number of VCs for both types were 1,008,228. For both types, females were higher adopters (54.73%). Of the total number of consultations, 751,156 were hospital-based. Of these consultations, family medicine consultations were the most common (20.42%), followed by internal medicine. Maternity follow-up clinics were higher in home-based clinics. The proportion of patient no-shows was high overall (48.30%). Utilisation was high in urban governorates, and low in rural ones. Conclusion: Findings have several implications on health policy. It provides further evidence of the importance of family medicine, where it was the most common speciality even in hospital-based settings. The high variability in the adoption of consultations across rural and urban areas as well as the extremely high number of patient-no-shows warrants further investigation. [ABSTRACT FROM AUTHOR]

Objectives: Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC. Methodology: A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC. Results: Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency. Conclusion: Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care. [ABSTRACT FROM AUTHOR]

Telemedicine in heart failure (HF) management may positively impact health outcomes, but varied effects in studies hinder guidance in HF guidelines. Evidence on the effectiveness of telemedicine in HF subpopulations is limited. We conducted a scoping review to evaluate and synthesise evidence on the effectiveness of telemedicine across HF subpopulations that could guide telemedicine strategies in routine practice. Meta-analyses concerning randomised controlled trials (RCTs) with subgroup analyses on telemedicine effectives were identified in PubMed. We identified 15 RCTs, encompassing 21 different subgroups based on characteristics of HF patients. Findings varied across studies and no definite evidence was found about which patients benefit most from telemedicine. Subgroup definitions were inconsistent, not always a priori defined and subgroups contained few patients. Some studies found heterogeneous effects of telemedicine on mortality and hospitalisation across subgroups defined by: New York Heart Association (NYHA) classification, previous HF decompensation, implantable device, concurrent depression, time since hospital discharge and duration of HF. Patients represented in the RCTs were mostly male, aged 65–75 years, with HF with reduced ejection fraction and NYHA class II/III. Traditional RCTs have not been able to provide clinicians with guidance; continuous real-world evidence generation could enhance monitoring and identify who benefits from telemedicine. [ABSTRACT FROM AUTHOR]

Introduction: Continuous glucose monitoring (CGM) devices allow for 24-h real-time measurement of interstitial glucose levels and have changed the interaction between people with diabetes and their health care providers. The large amount of data generated by CGM can be analyzed and evaluated using a set of standardized parameters, collectively named glucometrics. This review aims to provide a summary of the existing evidence on the use of glucometrics data and its impact on clinical practice based on published studies involving adults and children with type 1 diabetes (T1D) in Spain. Methods: The PubMed and MEDES (Spanish Medical literature) databases were searched covering the years 2018–2022 and including clinical and observational studies, consensus guidelines, and meta-analyses on CGM and glucometrics conducted in Spain. Results: A total of 16 observational studies were found on the use of CGM in Spain, which have shown that cases of severe hypoglycemia in children with T1D were greatly reduced after the introduction of CGM, resulting in a significant reduction in costs. Real-world data from Spain shows that CGM is associated with improved glycemic markers (increased time in range, reduced time below and above range, and glycemic variability), and that there is a relationship between glycemic variability and hypoglycemia. Also, CGM and analysis of glucometrics proved highly useful during the COVID-19 pandemic. New glucometrics, such as the glycemic risk index, or new mathematical approaches to the analysis of CGM-derived glucose data, such as "glucodensities," could help patients to achieve better glycemic control in the future. Conclusion: By using glucometrics in clinical practice, clinicians can better assess glycemic control and a patient's individual response to treatment. Plain Language Summary: Continuous glucose monitoring (CGM) devices are used to monitor glucose levels in real time over 24 h. This has changed the way people with diabetes and their health care providers interact. These devices produce a large amount of data that can be analyzed and evaluated using standardized parameters called glucometrics, which include the time a patient's glucose is in range, below range, and above range, and how much it varies over 24 h. Clinicians can use these data to better assess glycemic control and a patient's individual response to treatment. In this article, we summarize evidence from published studies involving adults and children with type 1 diabetes in Spain to look at how the use of these data has affected clinical practice. Studies have shown that cases of severe low blood glucose in children with diabetes were greatly reduced after the introduction of CGM, resulting in a significant reduction in costs. Data from clinical practice in Spain show that CGM is associated with improved blood glucose markers. Many studies analyzed these data during the COVID-19 pandemic and showed that CGM and analysis of glucometrics were highly useful during this time. New glucometrics and approaches to the analysis of data from CGM could help patients achieve better blood glucose control. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)