Self-Management Using eHealth Technologies for Liver Transplant Recipients: Scoping Review.

BACKGROUND: Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex health care systems. eHealth technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow in this population due to the complexity of post-liver transplant management. OBJECTIVE: This study aims to examine the use of eHealth technologies in supporting self-management for liver transplant recipients and identify their benefits and challenges to suggest areas for further research. METHODS: Following the Arksey and O'Malley methodology for scoping reviews, we conducted a systematic search of 5 electronic databases: PubMed, CINAHL, Embase, PsycINFO, and Web of Science. We included studies that (1) examined or implemented eHealth-based self-management, (2) included liver transplant recipients aged ≥18 years, and (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on the posttransplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of eHealth or used technology solely for data collection. The quality of the selected eHealth interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist and (2) the 5 core self-management skills identified by Lorig and Holman. RESULTS: Of 1461 articles, 15 (1.03%) studies were included in the final analysis. Our findings indicate that eHealth-based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies used diverse technologies, including mobile apps, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource use skills essential for comprehensive self-management. The reviewed studies highlighted the potential of eHealth in enhancing individualized health care, but only a few included collaborative features such as 2-way communication or tailored goal setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures. CONCLUSIONS: This scoping review maps the current literature on eHealth-based self-management support for liver transplant recipients, assessing its potential and challenges. Future studies should focus on developing predictive models and personalized eHealth interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future eHealth self-management research to address the digital divide, especially with the aging liver transplant recipient population, and ensure more inclusive studies across diverse ethnicities and regions.

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol.

BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4-6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore. METHODS: The study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child's socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the "LVL UP App", a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the "HAPPY App", a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period. DISCUSSION: High rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs. TRIAL STATUS: The protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023. TRIAL REGISTRATION: ClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

[The innovation and challenge of artificial intelligence in the whole process management of fundus disease].

Artificial intelligence (AI) has demonstrated revolutionary potential and wide-ranging applications in the comprehensive management of fundus diseases, yet it faces challenges in clinical translation, data quality, algorithm interpretability, and cross-cultural adaptability. AI has proven effective in the efficient screening, accurate diagnosis, personalized treatment recommendations, and prognosis prediction for conditions such as diabetic retinopathy, age-related macular degeneration, and other fundus diseases. However, there is a significant gap between the need for large-scale, high-quality, and diverse datasets and the limitations of current research data. Additionally, the black-box nature of AI algorithms, the acceptance by clinicians and patients, and the generalizability of these algorithms pose barriers to their widespread clinical adoption. Researchers are addressing these challenges through approaches such as federated learning, standardized data collection, and prospective trials to enhance the robustness, interpretability, and practicality of AI systems. Despite these obstacles, the benefits of AI in fundus disease management are substantial. These include improved screening efficiency, support for personalized treatment, the discovery of novel disease characteristics, and the development of precise treatment strategies. Moreover, AI facilitates the advancement of telemedicine through 5G and the Internet of Things. Future research should continue to tackle existing issues, fully leverage the potential of AI in the prevention and treatment of fundus diseases, and advance intelligent, precise, and remote ophthalmic services to meet global eye health needs.

mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan.

BACKGROUND: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. OBJECTIVE: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. METHODS: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. RESULTS: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. CONCLUSIONS: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully.

Human Factors in AI-Driven Digital Solutions for Increasing Physical Activity: Scoping Review.

BACKGROUND: Artificial intelligence (AI) has the potential to enhance physical activity (PA) interventions. However, human factors (HFs) play a pivotal role in the successful integration of AI into mobile health (mHealth) solutions for promoting PA. Understanding and optimizing the interaction between individuals and AI-driven mHealth apps is essential for achieving the desired outcomes. OBJECTIVE: This study aims to review and describe the current evidence on the HFs in AI-driven digital solutions for increasing PA. METHODS: We conducted a scoping review by searching for publications containing terms related to PA, HFs, and AI in the titles and abstracts across 3 databases-PubMed, Embase, and IEEE Xplore-and Google Scholar. Studies were included if they were primary studies describing an AI-based solution aimed at increasing PA, and results from testing the solution were reported. Studies that did not meet these criteria were excluded. Additionally, we searched the references in the included articles for relevant research. The following data were extracted from included studies and incorporated into a qualitative synthesis: bibliographic information, study characteristics, population, intervention, comparison, outcomes, and AI-related information. The certainty of the evidence in the included studies was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS: A total of 15 studies published between 2015 and 2023 involving 899 participants aged approximately between 19 and 84 years, 60.7% (546/899) of whom were female participants, were included in this review. The interventions lasted between 2 and 26 weeks in the included studies. Recommender systems were the most commonly used AI technology in digital solutions for PA (10/15 studies), followed by conversational agents (4/15 studies). User acceptability and satisfaction were the HFs most frequently evaluated (5/15 studies each), followed by usability (4/15 studies). Regarding automated data collection for personalization and recommendation, most systems involved fitness trackers (5/15 studies). The certainty of the evidence analysis indicates moderate certainty of the effectiveness of AI-driven digital technologies in increasing PA (eg, number of steps, distance walked, or time spent on PA). Furthermore, AI-driven technology, particularly recommender systems, seems to positively influence changes in PA behavior, although with very low certainty evidence. CONCLUSIONS: Current research highlights the potential of AI-driven technologies to enhance PA, though the evidence remains limited. Longer-term studies are necessary to assess the sustained impact of AI-driven technologies on behavior change and habit formation. While AI-driven digital solutions for PA hold significant promise, further exploration into optimizing AI's impact on PA and effectively integrating AI and HFs is crucial for broader benefits. Thus, the implications for innovation management involve conducting long-term studies, prioritizing diversity, ensuring research quality, focusing on user experience, and understanding the evolving role of AI in PA promotion.

Patient Retention in a Substance Use Disorder Telemedicine Clinic.

OBJECTIVES: Although research has continued to show that substance use disorders (SUDs) can be treated effectively with evidence-based treatment, there continues to be gaps in access, and utilization remains low. Alternative SUD treatment methods, including telemedicine, are increasingly being explored to reach patients where traditional in-person treatment approaches are inaccessible. This cross-sectional study aimed to explore SUD treatment retention, specifically comparing telemedicine-delivered opioid use disorder (OUD) treatment with a traditional in-person treatment delivery approach. METHODS: Patients at Cahaba Medical Care, an FQHC in Birmingham, AL with a diagnosis of OUD and undergoing buprenorphine/naloxone or buprenorphine treatment were categorized into two groups: treatment and control. The dependent variable, retention to SUD treatment, was assessed at four different time periods over 12 months to determine patient SUD consultation appointment attendance. Multiple linear regression was used to examine the relationship between SUD treatment retention and delivery mode. Correlations were obtained to assess associations between frequency of urine drug screens performed and SUD treatment retention. RESULTS: As the number of the urine drug screens patients received increased by 1, the number of SUD treatment program consultations patients attended increased by 0.69 (P < 0.001). There was no significant difference in SUD treatment retention between traditional in-person and telemedicine delivered approaches, however. CONCLUSIONS: The findings of this study suggest that a telemedicine-delivered treatment program equals retention effectiveness when compared with in-person delivery. This suggests that leveraging telemedicine to treat patients with SUD could be an effective alternative for those unable to access treatment or who are less likely to attend or complete traditional in-person treatment sessions.

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms.

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Youth often lack access to evidence-based care after trauma. This study assessed the feasibility of a trauma-focused internet- and mobile-based intervention with therapist guidance.The intervention was accepted by youths, and the preliminary evaluation of participant responses suggests its efficacy.Future studies should examine strategies to improve adherence and the IMI's efficacy in a RCT.

Design of Digital Mental Health Platforms for Family Member Cocompletion: Scoping Review.

BACKGROUND: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. OBJECTIVE: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. METHODS: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. RESULTS: Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver-care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. CONCLUSIONS: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation.

A qualitative study of stakeholders' experiences with and acceptability of a technology-supported health coaching intervention (SHARE-S) delivered in coordination with cancer survivorship care.

PURPOSE: Healthy cancer survivorship involves patients' active engagement with preventative health behaviors and follow-up care. While clinicians and patients have typically held dual responsibility for activating these behaviors, transitioning some clinician effort to technology and health coaches may enhance guideline implementation. This paper reports on the acceptability of the Shared Healthcare Actions & Reflections Electronic systems in survivorship (SHARE-S) program, an entirely virtual multicomponent intervention incorporating e-referrals, remotely-delivered health coaching, and automated text messages to enhance patient self-management and promote healthy survivorship. METHODS: SHARE-S was evaluated in single group hybrid implementation-effectiveness pilot study. Patients were e-referred from the clinical team to health coaches for three health self-management coaching calls and received text messages to enhance coaching. Semi-structured qualitative interviews were conducted with 21 patient participants, 2 referring clinicians, and 2 health coaches to determine intervention acceptability (attitudes, appropriateness, suitability, convenience, and perceived effectiveness) and to identify important elements of the program and potential mechanisms of action to guide future implementation. RESULTS: SHARE-S was described as impactful and convenient. The nondirective, patient-centered health coaching and mindfulness exercises were deemed most acceptable; text messages were less acceptable. Stakeholders suggested increased flexibility in format, frequency, timing, and length of participation, and additional tailored educational materials. Patients reported tangible health behavior changes, improved mood, and increased accountability and self-efficacy. CONCLUSIONS: SHARE-S is overall an acceptable and potentially effective intervention that may enhance survivors' self-management and well-being. Alterations to tailored content, timing, and dose should be tested to determine impact on acceptability and outcomes.

Study protocol for an adaptive, multi-arm, multi-stage (MAMS) randomised controlled trial of brief remotely delivered psychosocial interventions for people with serious mental health problems who have experienced a recent suicidal crisis: Remote Approaches to Psychosocial Intervention Delivery (RAPID).

BACKGROUND: People with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behaviours and reduce avoidable psychiatric admissions. METHODS: A multi-stage, multi-arm (MAMS) randomised controlled trial (RCT) with four arms conducted over two stages to determine the clinical and cost effectiveness of three psychosocial treatments, compared to treatment as usual (TAU), for people with SMHP who have had recent suicidal crisis. Primary outcome is any psychiatric hospital admissions over a 6-month period. We will assess the impact on suicidal thoughts and behaviour, hope, recovery, anxiety and depression. The remote treatments delivered over 3 months are structured peer support (PREVAIL); a safety planning approach (SAFETEL) delivered by assistant psychologists; and a CBT-based suicide prevention app accessed via a smartphone (BrighterSide). Recruitment is at five UK sites. Stage 1 includes an internal pilot with a priori progression criteria. In stage 1, the randomisation ratio was 1:1:1:2 in favour of TAU. This has been amended to 2:2:3 in favour of TAU following an unplanned change to remove the BrighterSide arm following the release of efficacy data from an independent RCT. Randomisation is via an independent remote web-based randomisation system using randomly permuted blocks, stratified by site. An interim analysis will be performed using data from the first 385 participants from PREVAIL, SAFETEL and TAU with outcome data at 6 months. If one arm is dropped for lack of benefit in stage 2, the allocation ratio of future participants will be 1:1. The expected total sample size is 1064 participants (1118 inclusive of BrighterSide participants). DISCUSSION: There is a need for evidence-based interventions to reduce psychiatric admissions, via reduction of suicidality. Our focus on remote delivery of established brief psychosocial interventions, utilisation of different modalities of delivery that can provide sustainable and scalable solutions, which are also suitable for a pandemic or national crisis context, will significantly advance treatment options. TRIAL REGISTRATION: ISRCTN33079589. Registered on June 20, 2022.

Clinical applications of telemedicine services using a regional telemedicine platform for cancer treatment: a cross-sectional study.

BACKGROUND: Telemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine. METHODS: We collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations. RESULTS: From 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration. CONCLUSIONS: In China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital.

Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review.

BACKGROUND: Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. OBJECTIVE: With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. METHODS: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. RESULTS: Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. CONCLUSIONS: For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.

Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review.

BACKGROUND: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. OBJECTIVE: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. METHODS: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. RESULTS: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. CONCLUSIONS: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation.

Telapheresis: One institution's experience.

Telemedicine in its most common form is the use of videoconferencing to consult with a patient and telapheresis is telemedicine in the form of videotelephony applied to consult with a patient for apheresis. The article discusses how a large apheresis program in a metropolitan area provided physician coverage for apheresis in a more remote hospital using telapheresis with local physician "partners" and local nurses employed by and trained by the apheresis program that perform the procedure. Consent for the procedure was obtained, and orders were placed by the local physician after consultation with the apheresis physician, or the apheresis physician him/herself, having obtained privileges at the remote hospital. This allowed patients access to apheresis procedures nearer to their place of residence and in familiar surroundings which generally made them feel more positive about their health care experience.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Clinician commentary on addressing suicidality safety risk in students through a hospital-school-community telepartnership program.

Comments on the article by Shaidullah, et al. (see record 2024-13778-001). Shahidullah and team describe the utilization of the hospital-school-community telepartnership (HSCT), a telehealth program aimed to increase rapid crisis response and interagency care coordination for students with suicidality safety risk. The HSCT team followed both crisis mental health (SAFE-T) and telebehavioral health best practices, with a licensed teleclinician conducting virtual crisis evaluation at the student's school, often on the same day. The HSCT maximized telebehavioral health by simultaneously supporting and consulting with school staff who often serve as de facto crisis mental health with little training or supported time. This collegial cross-system approach resonates with the current author team's experience of the importance of training, including opportunities to validate the supports that school personnel have provided as well as problem solving together to support students in crisis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Digital health intervention in patients undergoing cardiac rehabilitation: systematic review and meta-analysis.

Background: Cardiovascular disease (CVD) continues to be the foremost mortality internationally. Cardiac rehabilitation has proven as an effective program in reducing CVD burden. Participation in cardiac rehabilitation programs is very low. Digital health intervention emerged as an alternative method to deliver Cardiac rehabilitation. This review aimed to investigate the impact of digital health intervention on the outcomes of interest. Methods: the following databases: PubMed, CINAHL, Scopus, and Cochrane Library have been searched to retrieve randomized controlled trials that examine the impact of digital health intervention on blood pressure, body mass index, lipid profile, blood glucose, Six-Minute Walk Test, and peak oxygen consumption. filters were set to include studies published in English between 2000-2023. Results: Nineteen studies were included in this review. Six-Minute Walk Test (MD = 16.70; 95% CI: 6.00 to 27.39, p = 0.000) and maximal oxygen consumption (SMD = 0.27; 95% CI: 0.08 to 0.45, p = 0.004) significantly improved following digital health intervention, after employing the sensitivity analysis significant improvement was observed in systolic (MD = -2.54; 95% CI: -4.98 to -0.11, p = 0.04) and diastolic blood pressure (SMD = -2.0182; 95% CI: -3.9436 to -0.0928, p = 0.04) favoring experimental groups. Subgroup analysis revealed significant improvement in quality of life after three months of follow-up (SMD = 0.18; 95% CI: 0.05 to 0.31, p = 0.00), no significant differences have been observed in body mass index, lipid profile, and blood glucose. Conclusion: The findings emphasize the significant impact of digital vs CBCR or usual care on physical capacity, blood pressure, and quality of life. Despite the non-statistically significant differences in body mass index and lipid profile, the comparable effect between the two methods suggests the superiority of digital over CBCR or usual care due to its convenient nature, accessibility, and cost-effectiveness.

Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. OBJECTIVE: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. RESULTS: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001). CONCLUSIONS: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.

Ethical dimensions in telemedicine - balancing technology, responsible care, and patient protection.

Telemedicine, defined as the practice of delivering healthcare services remotely using information and communications technologies, raises a plethora of ethical considerations. As telemedicine evolves, its ethical dimensions play an increasingly pivotal role in balancing the benefits of advanced technologies, ensuring responsible healthcare practices within telemedicine environments, and safeguarding patient rights. Healthcare providers, patients, policymakers, and technology developers involved in telemedicine encounter numerous ethical challenges that need to be addressed. Key ethical topics include prioritizing the protection of patient rights and privacy, which entails ensuring equitable access to remote healthcare services and maintaining the doctor-patient relationship in virtual settings. Additional areas of focus encompass data security concerns and the quality of healthcare delivery, underscoring the importance of upholding ethical standards in the digital realm. A critical examination of these ethical dimensions highlights the necessity of establishing binding ethical guidelines and legal regulations. These measures could assist stakeholders in formulating effective strategies and methodologies to navigate the complex telemedicine landscape, ensuring adherence to the highest ethical standards and promoting patient welfare. A balanced approach to telemedicine ethics should integrate the benefits of telemedicine with proactive measures to address emerging ethical challenges and should be grounded in a well-prepared and respected ethical framework.

How effective are digital/e-health interventions for supporting prisoners with mental ill-health? An integrative review.

PURPOSE: There has been a move towards the implementation of digital/e-health interventions for some time. Digital/e-health interventions have demonstrable efficacy in increasing individual empowerment, providing timely access to psychological interventions for those experiencing mental ill-health and improving outcomes for those using them. This study aims to determine the efficacy of digital/e-health interventions for individuals detained in prison who experience mental ill-health. DESIGN/METHODOLOGY/APPROACH: A systematic search of five academic databases - CINAHL, ASSIA, PsycINFO, Embase and Medline - was completed in December 2020 and updated in February 2022. The review was guided by the Whittemore and Knafl (2005) framework for integrative reviews. A total of 6,255 studies were returned and screened by title and abstract. A full-text screening of nine (n = 9) studies was conducted. FINDINGS: No study met the inclusion criteria for the clinical efficacy of digital/e-health interventions in a prison setting. Subsequently, a review of the literature that made it to the full-text review stage was conducted, and gaps in the literature were identified to inform policy, practice and future research. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first integrative review conducted on the efficacy of digital/e-health interventions for mental ill-health in prison settings.