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Purpose Methods Results Conclusions Examine the development, implementation and evaluation of just‐in‐time adaptive interventions (JITAIs) in behaviour change and evaluate the quality of intervention reporting.A scoping review of JITAIs incorporating mobile health (mHealth) technologies to improve health‐related behaviours in adults. We searched MEDLINE, Embase and PsycINFO using terms related to JITAIs, mHealth, behaviour change and intervention methodology. Narrative analysis assessed theoretical foundations, real‐time data capturing and processing methods, outcome evaluation and summarized JITAI efficacy. Quality of intervention reporting was assessed using the template for intervention description and replication (TIDieR) checklist.Sixty‐two JITAIs across physical activity, sedentary behaviour, dietary behaviour, substance use, sexual behaviour, fluid intake, treatment adherence, social skills, gambling behaviour and self‐management skills were included. The majority (71%) aimed to evaluate feasibility, acceptability and/or usability. Supporting evidence for JITAI development was identified in 46 studies, with 67% applying this to develop tailored intervention content. Over half (55%) relied solely on self‐reported data for tailoring, and 13 studies used only passive monitoring data. While data processing methods were commonly reported, 44% did not specify their techniques. 89% of JITAI designs achieved full marks on the TIDieR checklist and provided sufficient details on JITAI components. Overall, JITAIs proved to be feasible, acceptable and user‐friendly across behaviours and settings. Randomized trials showed tailored interventions were efficacious, though outcomes varied by behaviour.JITAIs offer a promising approach to developing personalized interventions, with their potential effects continuously growing. The recommended checklist emphasizes the importance of reporting transparency in establishing robust intervention designs. [ABSTRACT FROM AUTHOR]

In this study, a breathable and strain‐insensitive multi‐layered electronic skin (e‐skin) capable of real‐time detection and distinction of electrocardiogram (ECG) signals, temperature, and skin hydration is developed. Leveraging a scalable benchtop method, sensing elements are transferred onto porous and hydrophobic substrates, followed by multi‐layer stacking to enable multimodal sensing. The sensing elements, a combination of carbon nanotube and nanoporous carbon (CNT@NPC) ink, are applied using strain‐insensitive patterned masks, then spray‐coated with styrene–ethylene–butylene–styrene (SEBS) to create a hierarchical porous network through phase separation. The CNT@NPC networks exhibit an improvement in strain insensitivity with active sensing capabilities due to their adaptable molecular tuning capacity and exceptional electrical conductivity. The porous SEBS substrate offers strong bonding with CNT@NPC attributed to the π–π interactions and high kinetic energy dispersion from spray coating allowing effective transfer. This unique design facilitates breathability, and miniaturization that minimizes the interference between different sensing modalities, ensuring accurate and reliable data acquisition. The breathability (3.49 mg cm−2 h−1) and the non‐smearing nature of the multi‐layered e‐skin enables simultaneous monitoring of temperature (0.198% °C−1), skin hydration (relative humidity = 0.77% %−1), and ECG (26 ± 1 dB) with continuous data transmission to a remote smartphone interface. [ABSTRACT FROM AUTHOR]

Not surprisingly, incarceration's extreme separation and stress have significant negative effects on romantic relationships. Unfortunately, few programs have been developed to improve jailed individuals' romantic relationship with their non‐incarcerated partner. The present study investigated the effectiveness of the individual version of the digital OurRelationship program for incarcerated individuals. The current study is a program evaluation of services provided by PayTel Inc. (a provider of eLearning and communication devices in US jails) between June 2020 and November 2021. Of the 5411 individuals in a romantic relationship who started the program, 3034 completed it. Following completion of the program, 78% reported feeling “Mostly” or “Very Satisfied” with the program, and 77% reported “Slight” to “Strong” agreement that their relationship benefited from the program. Individuals' relationship confidence (d = 0.36) and relationship knowledge (d = 0.33) significantly improved during the program. Women and Latino/Hispanic and Asian/PI individuals experienced the largest pre‐post gains in relationship functioning. Furthermore, racial/ethnic minority groups tended to report higher satisfaction with the program. Overall, the high rates of program satisfaction and significant pre‐post changes—combined with their reduced barriers to dissemination—support the delivery of digital relationship programs for jailed individuals interested in strengthening their relationship. [ABSTRACT FROM AUTHOR]

There are routine hospital workflows that are not addressed by certain institutional electronic medical records, including the detection of patients requiring haemodialysis who are admitted under non‐nephrology services. In this study, the feasibility and performance of a clinician‐developed automated haemodialysis patient finder was evaluated. The programme ran with zero downtime for 6 months and had zero false negatives or false positives. This work demonstrates the potential benefits that may be gained when clinicians can meaningfully alter electronic clinical workflows. [ABSTRACT FROM AUTHOR]

Aims: Digital health transformation may enhance or impede person‐centred care and interprofessional practice, and thus the provision of high‐quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person‐centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. Methods: Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. Results: We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. Conclusions: While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition‐related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person‐centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential. [ABSTRACT FROM AUTHOR]

In this article we use an existential media framework to explore the asynchronous, written and digital form of GP‐patient communication that takes place through e‐consultations in a Danish general practice context. This approach acknowledges e‐consultation as more than a tool for information delivery and frames GP and patient not as skilful media users but as dependent co‐existers: Both thrown into and trying to navigate the digital healthcare ecology. Through a thematic analysis of 38 semi‐structured qualitative interviews with patients and GPs we carve out three themes unpacking the existential dimensions of e‐consultation: 1. Patient and GP are placed in a Culture of non‐stop connectivity and we show the ambivalences arising herein fostering both relief, reassurance and new insecurities. 2. Ethical challenges of responsible co‐existence points to dilemmas of boundary setting and caring for self and co‐exister in the digital encounter. 3. We‐experiences illustrates the potential of e‐consultation to signal GP presence, even when the GP is silent. We also discuss the existential ethics of care emerging from the contemporary digital healthcare ecology and call for empirically grounded studies of the existential dimensions tied to encounters in contemporary digital care infrastructures. [ABSTRACT FROM AUTHOR]

'Reflexivity', as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in health care has been well‐documented but inadequately theorised. In this article, we use Archer's theory of fractured reflexivity to understand digital disparities in data from a 28‐month longitudinal ethnographic study of 12 UK general practices and a sample of in‐depth clinical cases from 'Deep End' practices serving highly deprived populations. Through four composite patient cases crafted to illustrate different dimensions of disadvantage, we show how adverse past experiences and structural inequities intersect with patients' reflexive capacity to self‐advocate and act strategically. In some cases, staff were able to use creative workarounds to compensate for patients' fractured reflexivity, but such actions were limited by workforce capacity and staff awareness. Unless a more systematic safety net is introduced and resourced, people with complex needs are likely to remain multiply disadvantaged by remote and digital health care. [ABSTRACT FROM AUTHOR]

Contemporary technoscience is rife with hype—inflated claims that rapidly propagate in favor of the next "new thing." While scholars often strive to debunk and dispel hype, Tanzanian technologists working in health care face a different challenge: navigating hype. As these technologists embark on new projects in machine learning and other forms of AI, contending with hype becomes crucial. These actors operate on the margins of global technoscientific worlds, aiming to create novel African futures that promote technological sovereignty. To do so, they must grapple with hype and its political economy. For anthropologists, merely transforming these technologists' experiences into an ethnographic object won't teach us much; a much more illuminating task is to examine how their work can provoke us to refine and transform our own knowledge practices. This is especially important because their innovations can seem both inspiring and dispiriting, both entrenched in and opposed to the troublesome technological global order. [ABSTRACT FROM AUTHOR]

Background: Minority populations are utilizing mobile health applications more frequently to access health information. One group that may benefit from using mHealth technology is underserved women, specifically those on community supervision. Objective: Discuss methodological approaches for navigating digital health strategies to address underserved women's health disparities. Description of the innovative method: Using an intersectional lens, we identified strategies for conducting research using digital health technology and artificial intelligence amongst the underserved, particularly those with community supervision. Description of its effectiveness: We explore (1) methodological approaches that combine traditional research methods with precision medicine, digital phenotyping, and ecological momentary assessment; (2) implications for artificial intelligence; and (3) ethical considerations with data collection, storage, and engagement. Discussion: Researchers must address gendered differences related to health, social, and economic disparities concurrently with an unwavering focus on the protection of human subjects when addressing the unique needs of underserved women while utilizing digital health methodologies. Public contribution: Women on community supervision in South Central Texas helped inform the design of JUN, the mHealth app we reported in the case exemplar. JUN is named after the Junonia shell, a native shell to South Texas, which means strength, power, and self‐sufficiency, like the participants in our preliminary studies. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT‐i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia. Aims: To improve CBT‐i access in Australia, we aimed to develop and test a self‐guided interactive digital CBT‐i program. Methods: An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT‐i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ‐9), anxiety (GAD‐7), fatigue, sleepiness and maladaptive beliefs about sleep at 8‐week follow‐up. The control group accessed the intervention after the 8‐week follow‐up. Questionnaires were additionally administered at 16 and 24 weeks. Intent‐to‐treat mixed models and complete‐case chi‐squared analyses were used. Results: Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between‐group differences in baseline characteristics or missing 8‐week data (14.5%). After adjusting for baseline scores, CBT‐i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT‐i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT‐i group. Conclusions: This interactive digital CBT‐i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT‐i access and uptake. [ABSTRACT FROM AUTHOR]

Background: The uptake of traditional mental health services among older adults remains low. Digital peer support offers older adults a resource for engaging with others to independently support their mental well‐being. This qualitative study explored the uptake and engagement of a clinically moderated digital peer support platform (Breathing Space) for older adults with depressive symptoms and alcohol use concerns. Methods: Semi‐structured interviews with 30 participants aged 60–80 years explored participants' uptake and engagement with Breathing Space, a novel, moderated, private, and anonymous peer support platform. Data were analysed using reflective thematic analysis and are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. Results: Three themes were constructed to characterize participants' experiences: (i) navigating the complexities of peer‐peer online engagement; (ii) the function of anonymity in online connection; and (iii) experiences of app features and content. Conclusions: Future development of digital peer support for older adults would benefit from the following: (i) co‐design with older adults; (ii) providing choice over anonymity and increased options for interacting with peers; (iii) streamlining the basic functionality with popular platforms; (iv) providing options for users to curate their digital experience; and (v) providing telephone support for troubleshooting technical difficulties. Future research should explore the use of digital peer support among older adults who experience social exclusion challenges. [ABSTRACT FROM AUTHOR]

Policy makers and health professionals are grappling with the high costs of and demand for health care, questions of sustainability and value, and changing population demographics—in particular, ageing populations. Digital solutions, including the adoption of patient‐reported measures, are considered critical in achieving person‐centred and value‐based health care. However, the utility of patient‐reported measures and the data they produce may be subject to ageist beliefs, prejudices and attitudes, rendering these data ineffective at promoting improved patient experiences and outcomes for older adults. This article explores the ethical considerations raised in relation to patient‐reported measures and the digital agency of older patients. [ABSTRACT FROM AUTHOR]

Aim: To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management. Method: A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open‐ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio‐ecological systems framework. Results: At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual‐level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM. Conclusion: Findings suggest a demand for more supportive, person‐centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care. [ABSTRACT FROM AUTHOR]

Background: Mindfulness‐based interventions can improve psychological health; yet the mechanisms of change are underexplored. This pre‐registered remote RCT evaluated a freely accessible digital mindfulness programme aiming to improve well‐being, mental health and sleep quality. Health behaviour cognitions were explored as possible mediators. Methods: Participants from 91 countries (N = 1247, Mage = 27.03 [9.04]) were randomized to 30 days of mindfulness practice or attention‐matched control condition. Measures of well‐being, depression, anxiety, stress, sleep quality, barriers self‐efficacy, self‐regulation and behavioural predictors (e.g., attitudes and behavioural intentions) were taken at baseline, 1‐month (post‐intervention) and 2‐months (follow‐up). Linear regression examined intervention effects between and within groups. Longitudinal mediation analyses explored indirect effects through health behaviour cognitions. Results: Three hundred participants completed post‐intervention measures. Those receiving mindfulness training reported significantly better well‐being (Mdifference = 2.34, 95%CIs.45–4.24, p =.016), lower depression (Mdifference = −1.47, 95%CIs −2.38 to −.56, p =.002) and anxiety symptoms (Mdifference = −.77, 95%CIs −1.51 to −.02, p =.045) than controls. Improvements in well‐being and depression were maintained at follow‐up. Intervention effects on primary outcomes were mediated by attitudes towards health maintenance and behavioural intentions. Mediating effects of attitudes remained when controlling for prior scores in models of depression and well‐being. Conclusions: Digital, self‐administered mindfulness practice for 30 days meaningfully improved psychological health, at least partially due to improved attitudes towards health behaviours and stronger behavioural intentions. This trial found that digital mindfulness is a promising and scalable well‐being tool for the general population, and highlighted its role in supporting health behaviours. [ABSTRACT FROM AUTHOR]

Objectives: Digital health behaviour change interventions may be adapted from in‐person interventions, without appropriate consideration of how the digital context might differ. Drawing on the wider literature on behaviour change intervention development, this research aims to explore the digital adaptation process of health behaviour change interventions and the specific considerations for digital modes of delivery. Design: A qualitative interview study. Methods: Interviews with 15 intervention developers/facilitators were analysed using inductive thematic analysis. Results: Findings highlight a continuum of digitalization, where variation in technology available and human support influences considerations for digital adaptation. 'What vs how: "trying to do the impossible"' describes the balance between retaining the intervention's active ingredients while modifying for digital delivery. Through 'Trial and error', participants described an iterative process based on experience of delivery. 'Creating connection and engagement' emphasizes the importance of social support and the challenges of replicating this. Conclusions: Several considerations for digital adaptations are proposed including the involvement of end‐users (facilitators and recipients) during adaptation, the need to understand the original intervention and new context for use, and the different motivational needs of digital intervention recipients. [ABSTRACT FROM AUTHOR]

Purpose Methods Findings Conclusions Implications for nursing practice This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC‐MED care platform.The caring module was developed in three phases (2020–2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA‐I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries.The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support.The TEC‐MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross‐cultural validation of nursing taxonomies.The TEC‐MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence‐based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We developed MARVIN, an artificial intelligence (AI)‐based chatbot that provides 24/7 expert‐validated information on self‐management‐related topics for people with HIV. This study assessed (1) the feasibility of using MARVIN, (2) its usability and acceptability, and (3) four usability subconstructs (perceived ease of use, perceived usefulness, attitude towards use, and behavioural intention to use).In a mixed‐methods study conducted at the McGill University Health Centre, enrolled participants were asked to have 20 conversations within 3 weeks with MARVIN on predetermined topics and to complete a usability questionnaire. Feasibility, usability, acceptability, and usability subconstructs were examined against predetermined success thresholds. Qualitatively, randomly selected participants were invited to semi‐structured focus groups/interviews to discuss their experiences with MARVIN. Barriers and facilitators were identified according to the four usability subconstructs.From March 2021 to April 2022, 28 participants were surveyed after a 3‐week testing period, and nine were interviewed. Study retention was 70% (28/40). Mean usability exceeded the threshold (69.9/68), whereas mean acceptability was very close to target (23.8/24). Ratings of attitude towards MARVIN's use were positive (+14%), with the remaining subconstructs exceeding the target (5/7). Facilitators included MARVIN's reliable and useful real‐time information support, its easy accessibility, provision of convivial conversations, confidentiality, and perception as being emotionally safe. However, MARVIN's limited comprehension and the use of Facebook as an implementation platform were identified as barriers, along with the need for more conversation topics and new features (e.g., memorization).The study demonstrated MARVIN's global usability. Our findings show its potential for HIV self‐management and provide direction for further development. [ABSTRACT FROM AUTHOR]

This article explores the application of actor‐network theory (ANT) to the nursing profession, proposing a novel perspective in understanding nursing in the context of modern digital healthcare. Traditional grand nursing theories, while foundational, often fail to encapsulate the dynamic and complex nature of nursing, particularly in an era of rapid technological advancements and shifting societal dynamics. ANT, with its emphasis on the relationships between human and nonhuman actors, offers a framework to understand nursing beyond traditional paradigms. This article makes two key arguments: first, that nursing can be viewed as a highly organised social assemblage, where both human (nurses, patients and policymakers) and nonhuman actors (technologies, medical equipment, institutional policies) play a crucial role, and second, that ANT can be used to enhance existing nursing theory to better understand the role of technology in nursing practice. The article considers how ANT can provide a more holistic and adaptable model for describing the nursing profession, particularly in an era where technology plays an integral role in healthcare delivery. It discusses the implications of viewing nursing through ANT, highlighting the need for nursing education and practice to adapt to the interconnected and technologically advanced nature of modern healthcare. The article also acknowledges the limitations of ANT, particularly its potential oversimplification of the complex ethical dimensions inherent in nursing and its focus on observable phenomena. [ABSTRACT FROM AUTHOR]

Summary: Insomnia is a highly prevalent mental disorder, and is often co‐occurring with depression and anxiety disorders. Cognitive behavioural therapy for insomnia as treatment of choice for insomnia can also be applied digitally (digital cognitive behavioural therapy for insomnia), making it more accessible. This is a secondary data analysis of a two‐armed parallel randomized–controlled trial. In the primary publication, N = 238 participants meeting criteria for the 5th edition of Diagnostic and Statistical Manual of Mental Disorders chronic insomnia disorder were randomly assigned to either 8 weeks of digital cognitive behavioural therapy for insomnia + treatment‐as‐usual, or waitlist + treatment‐as‐usual. To determine the clinical effects of digital cognitive behavioural therapy for insomnia in populations with comorbid anxiety and depression symptoms, this secondary analysis focused on two subgroups: (1) participants with high initial depressive symptoms; and (2) participants with high initial anxiety symptoms. Symptoms of insomnia, depression and anxiety as primary outcome measures were obtained at baseline, 8 weeks post‐randomization and, in the intervention group only, at 6‐ and 12‐months follow‐up. At 8 weeks post‐randomization, the use of digital cognitive behavioural therapy for insomnia in both subgroups was associated with large reductions in insomnia severity in comparison to control (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Between‐group treatment effects were also observed for symptoms of depression in the depression subgroup (d = 1.59), and for symptoms of anxiety in the anxiety subgroup (d = 1.28). Within‐group effects were stable over time (d = 0.64–1.63). This secondary analysis shows that digital cognitive behavioural therapy for insomnia reduces insomnia and comorbid symptoms in participants with high initial symptoms of either depression or anxiety with sustained long‐term effects. [ABSTRACT FROM AUTHOR]

Summary: New sleep technologies are being developed, refined and delivered at a fast pace. However, there are serious concerns about the validation and accuracy of new sleep‐related technologies being made available, as many of them, especially consumer‐sleep technologies, have not been tested in comparison with gold‐standard methods or have been approved by health regulatory agencies. The importance of proper validation and performance evaluation of new sleep technologies has already been discussed in previous studies and some recommendations have already been published, but most of them do not employ standardized methodology and are not able to cover all aspects of new sleep technologies. The current protocol describes the methods of a Delphi consensus study to create guidelines for the development, performance evaluation and validation of new sleep devices and technologies. The resulting recommendations are not intended to be used as a quality assessment tool to evaluate individual articles, but rather to evaluate the overall procedures, studies and experiments performed to develop, evaluate performance and validate new technologies. We hope these guidelines can be helpful for researchers who work with new sleep technologies on the appraisal of their reliability and validation, for companies who are working on the development and refinement of new sleep technologies, and by regulatory agencies to evaluate new technologies that are looking for registration, approval or inclusion on health systems. [ABSTRACT FROM AUTHOR]

Pushing selected information to clinicians, as opposed to the traditional method of clinicians pulling information from an electronic medical record, has the potential to improve care. A digital notification platform was designed by clinicians and implemented in a tertiary hospital to flag dysglycaemia. There were 112 patients included in the study, and the post‐implementation group demonstrated lower rates of dysglycaemia (2.5% vs 1.1%, P = 0.038). These findings raise considerations for information delivery methods for multiple domains in contemporary healthcare. [ABSTRACT FROM AUTHOR]

A growing trend in bioethics highlights the importance of using big data science methods to advance normative insight. This has been called the "digital turn" in bioethics by Salloch and Ursin. Automated data processing can, for example, detect significant patterns of correlation that have escaped the attention of human scholars. Although we agree that such technological innovations could bolster existing methods in empirical bioethics (EB), we argue that it should not be conceptualized as a new turn but rather as a revivification, and possibly an amplification of entrenched debates in EB. We begin by highlighting some convergences between EB and digital bioethics that Salloch and Ursin seem to categorize as fundamental differences and end up with elaborating on some risks related to the integration of empirical findings with normative (philosophical) analysis in the digitalization trend. [ABSTRACT FROM AUTHOR]

Biological and clinical heterogeneity is a major challenge in research for developing new treatments for Alzheimer's disease (AD). AD may be defined by its amyloid beta and tau pathologies, but we recognize that mixed pathologies are common, and that diverse genetics, central nervous system (CNS) and systemic pathophysiological processes, and environmental/experiential factors contribute to AD's diverse clinical and neuropathological features. All these factors are rational targets for therapeutic development; indeed, there are hundreds of candidate pharmacological, dietary, neurostimulation, and lifestyle interventions that show benefits in homogeneous laboratory models. Conventional clinical trial designs accommodate heterogeneity poorly, and this may be one reason that progress in translating candidate interventions has been so difficult. We review the challenges of AD's heterogeneity for the clinical trials enterprise. We then discuss how advances in repeatable biomarkers and digital phenotyping enable novel "single‐case" and adaptive trial designs to accelerate therapeutics development, moving us closer to personalized research and medicine for AD. Highlights: Alzheimer's disease is diverse in its clinical features, course, risks, and biology.Typical randomized controlled trials are exclusive and necessarily large to attain arm comparability with broad outcomes.Repeated blood biomarkers and digital tracking can improve outcome measure precision and sensitivity.This enables the use of novel "single‐case" and adaptive trial designs for inclusivity, rigor, and efficiency. [ABSTRACT FROM AUTHOR]

Objective: The recent surge in popularity of large language models (LLMs), such as ChatGPT, has showcased their proficiency in medical examinations and potential applications in health care. However, LLMs possess inherent limitations, including inconsistent accuracy, specific prompting requirements, and the risk of generating harmful hallucinations. A domain‐specific model might address these limitations effectively. Study Design: Developmental design. Setting: Virtual. Methods: Otolaryngology–head and neck surgery (OHNS) relevant data were systematically gathered from open‐access Internet sources and indexed into a knowledge database. We leveraged Retrieval‐Augmented Language Modeling to recall this information and utilized it for pretraining, which was then integrated into ChatGPT4.0, creating an OHNS‐specific knowledge question & answer platform known as ChatENT. The model is further tested on different types of questions. Results: ChatENT showed enhanced performance in the analysis and interpretation of OHNS information, outperforming ChatGPT4.0 in both the Canadian Royal College OHNS sample examination questions challenge and the US board practice questions challenge, with a 58.4% and 26.0% error reduction, respectively. ChatENT generated fewer hallucinations and demonstrated greater consistency. Conclusion: To the best of our knowledge, ChatENT is the first specialty‐specific knowledge retrieval artificial intelligence in the medical field that utilizes the latest LLM. It appears to have considerable promise in areas such as medical education, patient education, and clinical decision support. The model has demonstrated the capacity to overcome the limitations of existing LLMs, thereby signaling a future of more precise, safe, and user‐friendly applications in the realm of OHNS and other medical fields. [ABSTRACT FROM AUTHOR]

In the dynamic domain of healthcare data management, safeguarding sensitive information while ensuring data efficiency is always of the highest priority. Healthcare data are frequently mishandled, posing significant risks. This research offers a new network that assesses the quality of visual data using robust features‐driven Mutual Entropy Gain (MEG). The proposed network addresses a critical gap in healthcare data management, significantly enhancing patient data security and operational efficiency in medical institutions. Our method begins with a thorough empirical investigation to find the optimal intermediate features for network input. We incorporate both distance entropy and probability entropy adopted and normalized in MEG, resulting in a comprehensive healthcare data quality evaluation. The results show that the network can distinguish between high‐quality and low‐quality data based on information content. Furthermore, our assessment reveals a large performance discrepancy between high and low‐quality data, even with variable datasets. Notably, using only half of the data achieves commendable accuracy when compared with using the complete dataset, demonstrating possible efficiency gains. This breakthrough has far‐reaching implications for healthcare providers, potentially reducing data storage costs, accelerating data processing times, and minimizing the risk of data breaches. In essence, our proposed network enhances efficiency and security in healthcare data and adapts to the evolving landscape of convergence ICT, paving the way for more robust, cost‐effective, and secure healthcare information systems that can significantly improve patient care and operational outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The COVID‐19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored‐approaches, especially for marginalized populations.A mixed‐methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two‐way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle–Ottawa score and Stenfors' framework.Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID‐19 while others were as part of trials.VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a ‘gold standard’ for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings. [ABSTRACT FROM AUTHOR]

ABSTRACT In digital healthcare engineering (DHE) for aging monopile‐type offshore wind turbines, predictive health analysis is essential for robust future maintenance planning. This paper presents the development of a DHE module for the predictive health analysis of corroded monopile‐type offshore wind turbines, focusing on wind and rotor blade rotation effects. An empirical formula for predicting time‐variant corrosion wastage is derived from a statistical analysis of a decade‐long corrosion wastage database and applied to predict the corrosion depth of a 5 MW monopile‐type offshore wind turbine, serving as an illustrative example. Nonlinear finite element analyses using LS‐DYNA are performed on the corroded turbine tower under combined wind‐induced loads and rotor‐induced thrust forces. Two types of corrosion wastage, pitting, and uniform (general) corrosion, are considered. The health condition of the corroded tower is evaluated based on serviceability limit state and ultimate limit state criteria. The methodology developed in this paper will be integrated into the DHE system currently being developed by the authors for aging monopile‐type offshore wind turbines. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Computerized cognitive tests may extend the reach of cognitive screening and monitoring to those with mobility issues or living in remote areas. Moreover, it could enable frequent and autonomous remote cognitive assessments in people with multiple sclerosis (pwMS) on account of its reduced economic and organizational costs. This may further improve our understanding of longitudinal trends and significantly improve the standard of care for pwMS living in remote areas or with mobility limitations. We aimed to evaluate the psychometric properties of an electronic Symbol‐Digit Modalities Test (eSDMT) designed to allow pwMS to perform a rapid cognitive assessment independently from home using their own PC/laptop.Sixty‐two participants underwent a neuropsychological evaluation, and then performed the eSDMT in the clinic. Forty‐two participants also repeated the eSDMT at home. We assessed concurrent validity (eSDMT vs. oral SDMT), test–retest reliability (in the clinic vs. at home), discriminant validity (pwMS with/without cognitive impairment), and other psychometric characteristics of the eSDMT (effect of age, sex, and education on test scores).We observed good‐to‐excellent concurrent validity (r ≥ 0.84, all p < 0.0001) and test–retest reliability (intraclass correlation coefficients [ICCs]>0.87, all p < 0.0001). Discriminant validity was excellent (area under the curves [AUCs] >0.84, all p < 0.0001). eSDMT scores were only slightly influenced by demographic characteristics (all R2 < 0.200).We provided evidence which supports the use of our eSDMT as a feasible, valid, and reliable remote assessment of cognitive function in pwMS. Future studies will investigate long‐term reliability and predictive power. [ABSTRACT FROM AUTHOR]

Patient‐reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person‐centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK‐air® (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut‐offs and responsiveness. Then, a multicentric, multinational, double‐blind, placebo‐controlled, randomised control trial (DB‐PC‐RCT) using an electronic VAS form was carried out. Finally, with the development of MASK‐air® in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ‐5D are included in the app. Additionally, two control‐medication scores for allergic symptoms of asthma (e‐DASTHMA) were validated for their criterion validity, cut‐offs and responsiveness. [ABSTRACT FROM AUTHOR]

Background: Digital self‐management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. Aim: To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self‐management app. Objectives: (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. Methods/Design: An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Results: Following a comprehensive data analysis, 10 sub‐themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. Conclusions: As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion. [ABSTRACT FROM AUTHOR]

Objective: Digital interventions such as remote monitoring of symptoms and physiological measurements have the potential to reduce the economic burden of asthma and chronic obstructive pulmonary disease (COPD) but their cost‐effectiveness remains unclear. This systematic review of randomised controlled trials (RCT) aims to assess whether digital health interventions can be cost‐effective in these patients. Design: Systematic review of RCTs. Study quality was assessed using RoB2 tool. Data Sources: Systematic search in three databases: PubMed, Scopus and Web of Science. Eligibility Criteria: Studies were eligible if they were RCTs with health economic evaluations assessing participants with asthma and/or COPD and comparing a digital health intervention to standard of care. Results: We included 35 RCTs, of which 21 were related to COPD, 13 to asthma and one to both diseases. Overall, studies assessed four categories of digital health interventions: (i) Electronic patient diaries (n = 4), (ii) real‐time monitoring (n = 19), (iii) teleconsultations (n = 6) and (iv) others (n = 6). Eleven studies performed a full economic evaluation analysis, while 24 studies performed a partial economic analysis. Most studies involving real‐time monitoring or teleconsultations presented economic results in favour of digital health interventions (indicating them to be cost‐effective or less expensive than the standard of care). Mixed results were obtained for electronic patient diaries. In the studies that conducted a full economic analysis, the incremental cost‐effectiveness ratio (ICER) ranged from 3530,93€/QALY and 286,369,28€/QALY. In the studies that conducted a partial economic analysis, the cost differences between the intervention group and the control group ranged from 0,12€ and 85,217,86€. Half studies with low risk of bias concluded that the intervention was economically favourable. Conclusion: Although costs varied based on intervention type, follow‐up period and country, most studies report digital health interventions to be affordable or associated with decreased costs. Trial Registration: PROSPERO: CRD42023439195 [ABSTRACT FROM AUTHOR]

Background: Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long‐term care. Method: Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire. Results: Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions. Conclusions: The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations. [ABSTRACT FROM AUTHOR]

The American College of Rheumatology and the US Food and Drug Administration co‐sponsored a public meeting in May 2022 about challenges in the clinical development of drugs for rheumatoid arthritis (RA) and psoriatic arthritis (PsA), focusing on innovative clinical trial designs, outcome measures, and data collection methods. Recommendations include early dose‐ranging studies and use of active comparators. Challenges and opportunities in assessing long‐term safety by leveraging real‐world data from electronic health records (EHRs) and claims data are discussed, along with insights from European registries and the evolving role of real‐world evidence and artificial intelligence in regulatory evaluations. Endpoints for assessing disease activity and outcome measures used in RA and PsA trials are explored, emphasizing challenges in defining remission, assessing clinical response, and evaluating structural progression. The need for outcome measures that better reflect treatment targets and the potential of advanced imaging in future trials are highlighted. Challenges with placebo‐controlled trials in RA are discussed and use of non‐inferiority clinical trial design, in which new drugs are evaluated with active comparators, is proposed. Pragmatic trials in RA and PsA, employing decentralized approaches, are highlighted for their real‐world relevance and administrative efficiencies. Strategies for identifying at‐risk populations for RA and the challenges of using EHRs and insurance claims data in drug development are discussed. Registry data and digital health technologies show promise in bridging the gap between clinical trials and real‐world effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To describe the association between day‐to‐day peak pain severity and clinical factors in individuals with chronic migraine (CM). Background: Little is known about how clinical factors relate to day‐to‐day pain severity in individuals with CM. Methods: Adults with CM were enrolled into this observational prospective cohort study that collected daily data about headache, associated symptoms, and lifestyle factors using a digital health platform (N1‐Headache™) for 90 days. "Migraine days" were defined as days in which a headache occurred that had features described by the International Classification of Headache Disorders criteria. On these days, peak pain severity was recorded on a 4‐point scale; on non‐headache days peak pain severity was imputed as "0/none". The associations between peak pain severity and 12 clinical factors were modeled and adjusted for sex, age, daily headache, presence of menstrual bleeding, day of the week, and disability. All numerical and Likert scale variables were standardized prior to analysis. Results: Data were available for 392 participants (35,280 tracked days). The sample was predominantly female (90.6%), with a mean (standard deviation) age of 39.9 (12.8) years. In the final multivariable model with random intercept and slopes, higher than typical self‐reported levels of standardized stress (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.04–1.11), standardized irritability (OR 1.05, 95% CI 1.02–1.08), standardized sadness (OR 1.05, 95% CI 1.02–1.07), fatigue (OR 1.25, 95% CI 1.15–1.36), eyestrain (OR 1.38, 95% CI 1.26–1.52), neck pain (OR 1.94, 95% CI 1.76–2.13), skin sensitivity (OR 1.61, 95% CI 1.44–1.80), and dehydration (OR 1.29, 95% CI 1.18–1.42) were associated with higher reported peak pain severity levels, while standardized sleep quality (OR 0.96, 95% CI 0.93–0.99) and standardized waking feeling refreshed (OR 0.84, 95% CI 0.81–0.88) were associated with lower reported peak pain severity levels. The inclusion of a random intercept and random slopes improved upon more parsimonious models and illustrated large differences in individuals' reporting of peak severity according to the levels of the associated clinical factors. Conclusion: Our data showed that the experience of CM, from a pain severity perspective, is complex, related to multiple clinical variables, and highly individualized. These results suggest that future work should aim to study a personalized approach to both medical and behavioral interventions for CM based on which clinical factors relate to the individual's experience of pain severity. Plain Language Summary: People with chronic migraine (CM) have a high frequency of attacks (≥15 days/month), yet little is known about their day‐to‐day experience of pain. We looked at the relationship between 12 clinical factors, including mood, sleep, stress, and day‐to‐day pain severity scores in adults with CM. We found that people's experience of pain severity and its relationship to different clinical factors was very individualized, with a lot of variability between people. [ABSTRACT FROM AUTHOR]

Background: Current outcome measures in digital mental health lack granularity, especially for single‐session interventions. This study aimed to address this by utilising natural language processing (NLP) methods to create a clear and relevant outcome measure. This paper describes the development of the Adult Session Wants and Needs Outcome Measure (Adult SWAN‐OM), a novel outcome measure for the Qwell digital mental healthcare platform to understand service user (SU) needs engaging in single‐session therapy (SST). Methods: The research employs a multi‐phased approach combining NLP methods with the typical stages of outcome measures development as follows: (1) assumption definition and validation with SUs and clinicians; (2) transcript theme extraction using the RoBERTa large language model (LLM) in conjunction with topic modelling to extract themes from 254 single‐session transcripts from 192 SUs; (3) clinical item refinement focus group; (4) content validity with clinicians and SUs to improve the relevance and clarity of the items; and (5) outcome measure finalisation in a workshop held with clinicians to consolidate the final wording. Results: Ninety‐six potential wants and needs were generated and distilled into 12 measure items. The outcome measure was shown to be relevant and clear to both SUs and clinicians when used in the context of SST. Conclusion: This study highlights the potential of combining NLP approaches with co‐creation methods in single‐session outcome measure development. We argue that the incorporation of clinical expertise and SU experience ensures the clarity and applicability of such measures and that this approach to capturing single‐session wants and needs promises novel insights for supporting digital mental health interventions. [ABSTRACT FROM AUTHOR]

Summary: Background and Objectives: Adoption and acceptance of digital health services (DHS) in the German population and in persons with skin diseases is unclear. Both factors were analyzed in this survey. Methods: A standardized survey with items on digital competences and attitudes, use and acceptance of DHS was applied to a representative sample of the German adult population. Bivariate and multivariate analyses were conducted. Results: Out of 2,101 participants, 29.9% reported having had skin diseases in the last 12 months. Among them, adoption and acceptance were at 43.6% and 52.3%, respectively. Both values are significantly higher compared to participants without skin diseases (29.2%; p < 0.01 and 45.5%; p < 0.01). 18.9% of participants with a skin disease used digital diagnostic support, but only 9.7% applied it for a skin disease (p < 0.01). For all participants, with and without skin disease, the DHS most commonly used were passive health monitoring (14.3%) and diagnostic support (11.5%), telemedicine was least used (4.7% video‐consultation, 2.5% store‐and‐forward). Use and acceptance were associated with young age, education, low data privacy concerns, digital confidence, having a skin disease, and high severity of skin disease. Conclusions: DHS for skin diseases are used rarely but have a high potential. [ABSTRACT FROM AUTHOR]

Patient‐reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person‐centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK‐air® (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut‐offs and responsiveness. Then, a multicentric, multinational, double‐blind, placebo‐controlled, randomised control trial (DB‐PC‐RCT) using an electronic VAS form was carried out. Finally, with the development of MASK‐air® in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ‐5D are included in the app. Additionally, two control‐medication scores for allergic symptoms of asthma (e‐DASTHMA) were validated for their criterion validity, cut‐offs and responsiveness. [ABSTRACT FROM AUTHOR]

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks—such as their extensive use and the relative ease it allows to share information quickly—facilitate the spread of misinformation. Research shows that inaccurate and misleading health‐related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health‐related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence‐based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media. [ABSTRACT FROM AUTHOR]

Pediatric chronic pain places a significant burden on children, their families, and healthcare services. Effective pain measurement is needed for both clinical management and research. Digital pain measurement tools have been developed for adult and adolescent populations however less is known about measurement in younger children. In this systematic review, we aimed to identify, describe, and evaluate (in terms of acceptability) digital tools for the assessment of chronic pain in children (5–11 years). We searched five databases (Cochrane Library, EMBASE, MEDLINE, PsycINFO, and CINAHL), between January 2014 and January 2022. We included empirical studies which included digital tool/s to assess pain in children aged between 5–11 years with chronic pain conditions. We independently double‐screened the papers to determine eligibility. We followed PRISMA guidelines for reporting. A total of five papers, covering four digital tools, were included. The digital tools used ranged from a static online survey to a highly interactive, personalized tablet application. Two studies were cross‐sectional and two collected longitudinal pain data via electronic devices outside the clinical setting. Digital features of the tools included: dynamic testing (n = 2), notifications/prompts (n = 1), data transmission (n = 1), remote monitoring (n = 1), accessibility (n = 1), data visualization/feedback (n = 1), personalization/customization (n = 1), gamification (n = 1) and data labeling (n = 1). Qualitative usability data was only available for one of the tools, which indicated its acceptability and highlighted preferred features/functions by child users (creative and personalizable features, gamification features), and parental users (symptom tracking). This review has highlighted the limited number of digital assessment tools available for children with chronic pain aged 5–11. This review identified some examples of technology enabling the capture of longitudinal, repeated measurement of multiple dimensions of pain (intensity, location, quality). We suggest directions for future research. [ABSTRACT FROM AUTHOR]

Background: Self‐management is a key component of successful chronic kidney disease (CKD) management. Here, we present the findings from the internal pilot of a multicentre randomised controlled trial (RCT) aimed to test the effect of a digital self‐management programme ('My Kidneys & Me' (MK&M)). Methods: Participants (aged ≥18 years and CKD stages 3‐4) were recruited from hospital kidney services across England. Study processes were completed virtually. Participants were randomised 2:1 to either intervention (MK&M) or control group. The first 60 participants recruited were included in a 10‐week internal pilot which assessed study feasibility and acceptability against pre‐specified progression criteria: 1) eligibility and recruitment, acceptability of 2) randomisation and 3) outcomes, 4) MK&M activation, and 5) retention and attrition rates. Semi‐structured interviews further explored views on trial participation. Results: Of the 60 participants recruited, 41 were randomised to MK&M and 19 to control. All participants completed baseline measures and 62% (n=37) completed post‐intervention outcome measures. All progression criteria met the minimum thresholds to proceed. Nine participants were interviewed. The themes identified were satisfaction with study recruitment processes (openness to participate, reading and agreeing to "terms and conditions"), acceptability of study design (remote study participation, acceptability of randomisation, completion of online assessment(s)), and methods to improve recruitment and retention (personalised approach, follow‐up communication). Conclusion: This internal pilot demonstrated the feasibility and acceptability of a virtually run RCT. Progression criteria thresholds to proceed to the definitive RCT were met. Areas for improvement were identified and protocol amendments were made to improve trial delivery. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common liver disease worldwide, affecting 30% of the population in Western countries. MASLD is considered the hepatic manifestation of the metabolic syndrome, pathophysiologically underpinned by insulin resistance and frequently co‐exists with hypertension, central obesity and dyslipidaemia. Currently, safe and effective pharmacotherapies for MASLD are limited, making weight loss with lifestyle changes the mainstay therapy. A Mediterranean diet (MedDiet) has emerged as an effective dietary pattern for preventing and managing MASLD, but most studies have been conducted in Mediterranean countries, necessitating further investigation into its benefits in Western populations. Additionally, the effect of holistic multimodal lifestyle interventions, including physical activity combined with the MedDiet, is not well established. Finally, MASLD's widespread prevalence and rapid growth require improved accessibility to interventions. Digital health delivery platforms, designed for remote access, could be a promising approach to providing timely support to individuals with MASLD. This narrative review summarises the current evidence related to the effects of the MedDiet in Western, multicultural populations with MASLD. This includes a detailed description of the composition, prescription and adherence to dietary interventions in terms of how they have been designed and applied. The evidence related to the role of physical activity or exercise interventions prescribed in combination with the MedDiet for MASLD will also be reviewed. Finally, recommendations for the design and delivery of dietary and physical activity or exercise interventions to inform the design of future randomised controlled trials to facilitate the optimal management of MASLD are outlined. [ABSTRACT FROM AUTHOR]

Summary: Adolescence is a high‐risk life stage for obesity. Digital strategies are needed to prevent and manage obesity among adolescents. We assessed if digital health interventions are contributing to disparities in obesity outcomes and assessed the adequacy of reporting of digital health equity criteria across four levels of influence within the digital environment. The systematic search was conducted on 10 major electronic databases and limited to randomized controlled trials (RCTs) or cluster‐RCTs for prevention or management of obesity among 10–19 year olds. Primary outcome was mean body mass index (BMI), or BMI z‐score change. The Adapted Digital Health Equity Assessment Framework was applied to all studies. Thirty‐three articles (27 unique studies with 8483 participants) were identified, with only eight studies targeting adolescents from disadvantaged populations. Post‐intervention, only three studies reported significantly lower BMI outcomes in the intervention compared to control. Of the 432 digital health equity criteria assessed across 27 studies, 82% of criteria were "not addressed." Studies are not addressing digital health equity criteria or inadequately reporting information to assess if digital health interventions are contributing to disparities in obesity outcomes. Enhanced reporting is needed to inform decision‐makers and support the development of equitable interventions to prevent and manage obesity among adolescents. [ABSTRACT FROM AUTHOR]

Policy Points The reinstitution of pre–COVID‐19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow‐up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender‐affirming care, and substance use treatments. The reinstitution of pre–COVID‐19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow‐up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender‐affirming care, and substance use treatments. [ABSTRACT FROM AUTHOR]

The article discusses the dual nature of artificial intelligence (AI) in healthcare, emphasizing both its potential to revolutionize emergency medicine through improved triage, diagnostics, and administrative tasks, and the risks associated with techno-solutionism and medico-legal concerns. It highlights the importance of structured and ethical AI implementation in Australia and Aotearoa New Zealand, noting the current lack of a comprehensive AI policy among most specialist medical colleges.

This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio‐economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well‐being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub‐themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub‐themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group. [ABSTRACT FROM AUTHOR]

Background: From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. Methods and Setting: We used the RE‐AIM framework to evaluate the strategy. The study started during a COVID‐19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. Results: We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow‐up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/μL. In total, 36.6% reported clinical events, and 20.4% presented with COVID‐19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow‐up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in‐person appointments. Conclusion: It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future. [ABSTRACT FROM AUTHOR]

Background: Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. Methods: We used a descriptive phenomenology approach using semi‐structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. Results: A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. Conclusion: Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. Patient or Public Contribution: This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation. [ABSTRACT FROM AUTHOR]

Introduction: Culturally and linguistically diverse population groups disproportionately experience higher weight and other non–weight‐related discrimination in healthcare settings outside of their ancestral country. Little is known about the experiences of individuals with Arab heritage. This study aimed to qualitatively explore the intersectional weight‐related healthcare experiences of individuals of Arab heritage with higher weight in Australia. Methods: A general inductive enquiry approach was used. Purposive, convenience and snowball sampling was used to recruit individuals of Arab heritage residing in Australia. Individuals were invited to participate in an online semistructured interview. Interviews were recorded, transcribed and thematically analysed. Results: Fifteen participants took part in the study. Of these participants, 93% were female (n = 14), 80% were aged between 18 and 44 years (n = 12), 73% were university educated (n = 11), 53% were born outside of Australia (n = 8) and all were Muslim (n = 15). Four main themes were identified: (1) appearance‐based judgement, (2) generalised advice and assumptions, (3) cultural responsiveness and (4) healthcare system constraints. Conclusion: Individuals of Arab heritage with higher weight in Australia, namely, females, often perceive their healthcare experiences as dismissive of their cultural and religious needs and driven by causality assumptions around weight. It is crucial that care delivered encompasses cultural humility, is weight‐inclusive and acknowledges systemic constraints. Cultural safety training benchmarks, healthcare management reform and weight‐inclusive healthcare approaches are recommended to assist healthcare providers in delivering effective, holistic and culturally safe care. Patient or Public Contribution: Insights gained from conversations with Arab heritage community members with lived experiences regarding weight‐related healthcare encounters informed the study design and approach. [ABSTRACT FROM AUTHOR]

Adolescents in low‐ and middle‐income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School‐based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out‐of‐school adolescents. A comprehensive scoping review was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents. Peer‐reviewed studies, institutional strategies, program evaluations, and programmatic reports in LMICs were reviewed, including gray literature. A total of 87 out of 270 identified publications and reports describing nutrition programs for adolescents were identified. Although nutrition programs targeted at adolescents were sparse, various innovative and inclusive delivery platforms were included, such as school feeding programs, school‐based anemia control, and nutrition‐friendly school initiatives; health facility–based, youth‐friendly health and nutrition services; social safety nets targeted at adolescents; community‐based approaches targeting youth development and peer education within youth centers and faith‐based settings; and technology‐based platforms, including digital health services and mass media communication sensitization and mobilization efforts. Existing delivery mechanisms and platforms in health and other sectors that target adolescents offer great potential to extend nutrition interventions to this vulnerable yet hard‐to‐reach population. [ABSTRACT FROM AUTHOR]

Introduction: Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know. Method: The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored. Findings: Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know. Conclusion: These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about. [ABSTRACT FROM AUTHOR]