Assessing Cross-Border Telemedicine Data Exchange in the European Union: A Call to Action.

Background: Telemedicine offers potential benefits for health care delivery. However, evidence of cross-border telemedicine data exchange within the European Union (EU) remains limited. The objective of this communication provides a brief outline of the regulatory framework, initiatives, and challenges associated with cross-border telemedicine data exchange in the EU, setting the stage for a comprehensive evidence assessment. Methods: We explore the current regulatory landscape (European Health Data Space), existing initiatives (the European Electronic Health Record Exchange Format), and interoperability challenges (e.g., legal, technical, semantic) facing EU cross-border telemedicine data exchange. Results: There is a need for thorough evidence assessment of cross-border telemedicine and related data movements. Conclusion: Understanding the current landscape of cross-border telemedicine is crucial. This article highlights the need for evidence assessment through a formal review to inform future research and policy initiatives in this domain.

Electrodiagnosis for mitigating false-negative non-responsiveness in electrical evoked contractions: A case series exploring probable polyneuromyopathy induced by nonuse.

INTRODUCTION: The revised international standards for neurological classification of spinal cord injury (ISNCSCI) have facilitated the documentation of non-spinal cord injury-related impairments, such as chronic peripheral nerve injuries and muscle weakness due to immobility. This advancement addresses potential biases in muscle strength examinations. Utilizing electrically evoked contractions from paralyzed muscles, enhanced by electrodiagnosis, holds promise in identifying false-negative diagnoses of non-responsiveness to neuromuscular electrical stimulation. This concept prompts the exploration of polyneuromyopathy arising from nonuse in paralyzed muscles. CASE SERIES PRESENTATION: To substantiate our hypothesis, we recruited nine participants for a case series aimed at elucidating the potential benefits of incorporating the stimulus electrodiagnostic test (SET) to mitigate non-responsiveness during preparation for functional electrical stimulation (FES)-assisted cycling. In our convenience sample (n = 5), we conducted neurological mapping based on ISNCSCI and applied SET on the quadriceps. The SET guided optimal dosimetry for evoking contractions and revealed responses similar to those observed in peripheral neuropathies, with α coefficients equal to or lower than 2.00. This observation is likely attributable to nonuse of paralyzed muscles, indicative of an ongoing polyneuropathy in individuals with chronic spinal cord injury (SCI). DISCUSSION: Among the nine initially recruited subjects, seven exhibited responsiveness to neuromuscular electrical stimulation (78% responsiveness), with two participants excluded based on exclusion criteria. In the final five reported cases, all displayed α coefficient values indicating impaired neuromuscular accommodation, and one presented no α coefficient within the normal range. The inclusion of electrodiagnosis appears effective in averting non-responsiveness, suggesting the presence of ongoing polyneuropathies in paralyzed muscles.

Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study.

Introduction: Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods: We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results: Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions: The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.

Pathophysiology-Based Management of Secondary Injuries and Insults in TBI.

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality among all ages; despite the advances, understanding pathophysiological responses after TBI is still complex, involving multiple mechanisms. Previous reviews have focused on potential targets; however, the research on potential targets has continuously grown in the last five years, bringing even more alternatives and elucidating previous mechanisms. Knowing the key and updated pathophysiology concepts is vital for adequate management and better outcomes. This article reviews the underlying molecular mechanisms, the latest updates, and future directions for pathophysiology-based TBI management.

Perfusion tomography in early follow-up of acute traumatic subdural hematoma: a case series.

Perfusion Computed Tomography (PCT) is an alternative tool to assess cerebral hemodynamics during trauma. As acute traumatic subdural hematomas (ASH) is a severe primary injury associated with poor outcomes, the aim of this study was to evaluate the cerebral hemodynamics in this context. Five adult patients with moderate and severe traumatic brain injury (TBI) and ASH were included. All individuals were indicated for surgical evacuation. Before and after surgery, PCT was performed and cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were evaluated. These parameters were associated with the outcome at 6 months post-trauma with the extended Glasgow Outcome Scale (GOSE). Mean age of population was 46 years (SD: 8.1). Mean post-resuscitation Glasgow coma scale (GCS) was 10 (SD: 3.4). Mean preoperative midline brain shift was 10.1 mm (SD: 1.8). Preoperative CBF and MTT were 23.9 ml/100 g/min (SD: 6.1) and 7.3 s (1.3) respectively. After surgery, CBF increase to 30.7 ml/100 g/min (SD: 5.1), and MTT decrease to 5.8s (SD:1.0), however, both changes don't achieve statistically significance (p = 0.06). Additionally, CBV increase after surgery, from 2.34 (SD: 0.67) to 2.63 ml/100 g (SD: 1.10), (p = 0.31). Spearman correlation test of postoperative and preoperative CBF ratio with outcome at 6 months was 0.94 (p = 0.054). One patient died with the highest preoperative MTT (9.97 s) and CBV (4.51 ml/100 g). CBF seems to increase after surgery, especially when evaluated together with the MTT values. It is suggested that the improvement in postoperative brain hemodynamics correlates to favorable outcome.

Análise de Artigos sobre o Teste de Apercepção Temática (TAT) no Brasil / Analysis of Articles on the Thematic Apperception Test (TAT) in Brazil / Análisis de Artículos en el Test de Apercepción Temática (TAT) en Brasil

Resumo: O Teste de Apercepção Temática (TAT) é um instrumento projetivo usado para avaliação da personalidade. Devido ao aumento da utilização do TAT no Brasil em diferentes contextos, percebeu-se a necessidade de realizar uma revisão narrativa. Objetiva-se analisar a produção científica de estudos empíricos em relação aos principais objetivos, características metodológicas e principais resultados. Foram recuperados 18 artigos das bases de dados SciELO, LILACS, PePSIC. Os estudos foram submetidos à análise temática considerando os objetivos principais. Os resultados indicaram uma distribuição desproporcional de publicações nos últimos 15 anos, com maior produção no sudeste do país. Notou-se maioria de estudos qualitativos do tipo exploratório, sendo prevalentes estudos realizados com participantes mulheres, e uso do TAT como instrumento único. Conclui-se a necessidade da realização de estudos empíricos nas diversas regiões do país, com diferentes idades e gêneros para ampliar o escopo do uso do teste.

Abstract: The Thematic Apperception Test (TAT) is a projective instrument used to assess individuals' personality. The increase in the use of TAT in Brazil in different contexts entailed the need for a narrative review. This study aimed to analyze the scientific production of empirical studies by evaluating its main objectives, methodological characteristics, and results. In total, 18 articles were retrieved from the SciELO, Lilacs, and PePSIC databases. The studies were subjected to thematic analysis considering their main objectives. Results indicated a disproportionate distribution of publications in the last 15 years, with higher production in the Brazilian southeast. Qualitative exploratory studies predominated, especially those with female participants and TAT as a single instrument. In conclusion, empirical studies must be carried out in different regions of the country with different ages and genders to expand the scope of the use of the test.

Resumen: El Test de Apercepción Temática (TAT) es una herramienta proyectiva utilizada en la evaluación de la personalidad. Debido al aumento en el uso de TAT en Brasil en diferentes contextos, surgió la necesidad de realizar una revisión narrativa. El objetivo de este estudio fue analizar la producción científica de los estudios empíricos con relación a los principales objetivos, características metodológicas y principales resultados. Dieciocho artículos fueron recolectados de las bases de datos SciELO, LILACS y PePSIC. Se sometieron los estudios a análisis temático considerando los objetivos principales. Los resultados muestran una distribución desproporcionada de publicaciones en los últimos quince años, con mayor producción en el Sudeste del país. Hubo una mayoría de estudios cualitativos exploratorios, con predominio de estudios realizados con participantes del sexo femenino, y la utilización del TAT como única herramienta. Se concluye que es necesario realizar estudios empíricos en diferentes regiones del país, con diferentes grupos etarios y de género, para ampliar el alcance del uso de la prueba.

Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform.

PURPOSE: Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. METHODS: The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. RESULTS: Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. CONCLUSIONS: Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

This work makes three important contributions, in which it extends existing research:Presents insights into the requirements of effective remote physiotherapy sessions;Highlights the challenges and concerns of patients and physiotherapists regarding telerehabilitation;Provides guidance for developing telerehabilitation platforms.

Fatores que dificultam o diagnóstico da hanseníase nas perspectivas dos profissionais da saúde da estratégia da saúde da família em unidades básicas de saúde em Imperatriz - MA / Factors that hinder the diagnosis of leprosy in the perspectives of health professionals of the family health strategy in basic health units in Imperatriz - MA

A hanseníase é uma doença crônica ocasionada pelo Mycobacterium leprae, gerando sintomas dermatoneurológicos. O diagnóstico é clínico, porém sua identificação é dificultada pela similaridade clínica com outras patologias cutâneas, impedindo o diagnóstico precoce e promovendo a ocorrência de incapacidades físicas. Diante disso, faz-se imprescindível conhecer os motivos dessa demora, a partir da perspectiva dos profissionais de saúde na atenção primária. Para tanto, este estudo tem como objetivo avaliar a percepção dos profissionais da estratégia da saúde da família (ESF) acerca das dificuldades no diagnóstico da hanseníase no município de Imperatriz, Maranhão. Esta pesquisa se trata de um estudo de natureza aplicada, abordagem qualitativa e com caráter exploratório, realizada com a equipe da ESF em Unidades Básicas de Saúde (UBS) de Imperatriz-MA. Para a coleta de dados, foi aplicada uma entrevista semiestruturada elaborada pelos autores, dividida em três blocos. No bloco "conhecimento sobre a doença", o nível mediano foi o mais prevalente nas falas dos participantes. No bloco "dificuldades de diagnóstico", o que ficou mais em evidência nas respostas foram "baixa adesão",. "estigmas/preconceito" e "resistência". Sendo assim, medidas foram sugeridas pelos entrevistados, as quais devem ser colocadas em prática diariamente tanto em ambiente social como profissional, visando um diagnóstico mais rápido, melhorando a qualidade de vida dos pacientes e favorecendo o controle da doença.

Leprosy is a chronic disease caused by Mycobacterium leprae, resulting in dermatoneurological symptoms. The diagnosis is clinical, but its identification is hindered by the clinical similarity to other skin pathologies, preventing early diagnosis and promoting the occurrence of physical disabilities. Therefore, it is essential to know the reasons for this delay from the perspective of primary healthcare professionals. Thus, this study aims to evaluate the perception of family health strategy (FHS) professionals about the difficulties in diagnosing leprosy in the municipality of Imperatriz-MA. This research is a study of applied nature, qualitative approach and with an exploratory character, carried out with the FHS team in Basic Health Units (UBS, in portuguese) from Imperatriz-MA. For data collection, a semi-structured interview prepared by the authors was applied, divided into three sections. In the "knowledge about the disease" section, the median level was the most prevalent in the participants' statements. In the section "diagnosis difficulties", what was more evident in the answers were "low adherence", "stigma/prejudice", and "resistance". Consequently, the interviewees suggested measures that should be implemented in daily practice, both in a social and professional environment, aiming at a faster diagnosis, improving the quality of life of patients and favoring disease control.

Maximal respiratory pressures: Measurements at functional residual capacity in individuals with different health conditions using a digital manometer.

BACKGROUND: Measuring maximal respiratory pressure is a widely used method of investigating the strength of inspiratory and expiratory muscles. OBJECTIVES: To compare inspiratory pressures obtained at functional residual capacity (FRC) with measures at residual volume (RV), and expiratory pressures obtained at FRC with measures at total lung capacity (TLC) in individuals with different health conditions: post-COVID-19, COPD, idiopathic pulmonary fibrosis (IPF), heart failure (CHF), and stroke; and to compare the mean differences between measurements at FRC and RV/TLC among the groups. METHODS: Inspiratory and expiratory pressures were obtained randomly at different lung volumes. Mixed factorial analysis of covariance with repeated measures was used to compare measurements at different lung volumes within and among groups. RESULTS: Seventy-five individuals were included in the final analyses (15 individuals with each health condition). Maximal inspiratory pressures at FRC were lower than RV [mean difference (95% CI): 11.3 (5.8, 16.8); 8.4 (2.3, 14.5); 11.1 (5.5, 16.7); 12.8 (7.1, 18.4); 8.0 (2.6, 13.4) for COVID-19, COPD, IPF, CHF, and stroke, respectively] and maximal expiratory pressures at FRC were lower than TLC [mean difference (95% CI): 51.9 (37.4, 55.5); 60.9 (44.2, 77.7); 62.9 (48.1, 77.8); 58.0 (43.9, 73.8); 57.2 (42.9, 71.6) for COVID-19, COPD, IPF, CHF, and stroke, respectively]. All mean differences were similar among groups. CONCLUSION: Although inspiratory and expiratory pressures at FRC were lower than measures obtained at RV/TLC for the five groups of health conditions, the mean differences between measurements at different lung volumes were similar among groups, which raises the discussion about the influence of the viscoelastic properties of the lungs on maximal respiratory pressure.

Evaluating the ability of an artificial-intelligence cloud-based platform designed to provide information prior to locoregional therapy for breast cancer in improving patient's satisfaction with therapy: The CINDERELLA trial.

BACKGROUND: Breast cancer therapy improved significantly, allowing for different surgical approaches for the same disease stage, therefore offering patients different aesthetic outcomes with similar locoregional control. The purpose of the CINDERELLA trial is to evaluate an artificial-intelligence (AI) cloud-based platform (CINDERELLA platform) vs the standard approach for patient education prior to therapy. METHODS: A prospective randomized international multicentre trial comparing two methods for patient education prior to therapy. After institutional ethics approval and a written informed consent, patients planned for locoregional treatment will be randomized to the intervention (CINDERELLA platform) or controls. The patients in the intervention arm will use the newly designed web-application (CINDERELLA platform, CINDERELLA APProach) to access the information related to surgery and/or radiotherapy. Using an AI system, the platform will provide the patient with a picture of her own aesthetic outcome resulting from the surgical procedure she chooses, and an objective evaluation of this aesthetic outcome (e.g., good/fair). The control group will have access to the standard approach. The primary objectives of the trial will be i) to examine the differences between the treatment arms with regards to patients' pre-treatment expectations and the final aesthetic outcomes and ii) in the experimental arm only, the agreement of the pre-treatment AI-evaluation (output) and patient's post-therapy self-evaluation. DISCUSSION: The project aims to develop an easy-to-use cost-effective AI-powered tool that improves shared decision-making processes. We assume that the CINDERELLA APProach will lead to higher satisfaction, better psychosocial status, and wellbeing of breast cancer patients, and reduce the need for additional surgeries to improve aesthetic outcome.

Chronic stroke survivors' perspective on the use of serious games to motivate upper limb rehabilitation - a qualitative study.

Upper limb paresis occurs quite commonly after stroke and may result in the affected limb's disuse or learned non-use. As a result, its cortical representation may be suppressed, further inhibiting its spontaneous utilization, resulting in motor function deterioration, increase in spasticity, joint stiffness and pain.The aim of this work was to involve stroke survivors in a qualitative study within a user centred design process to better understand the perspectives of stroke survivors on virtual reality - based serious games (SG) for upper limb rehabilitation during the chronic phase and use those insights to design a VR-based serious games which promotes activation of the affected cortical area.A qualitative research method was performed using a multi professional focus group discussion, including a representative group of stroke survivors.With the insights of this work, the authors initiated the design of a VR-based SG prototype for upper limb rehabilitation with two modes, one version to be played with any arm to pick a virtual hammer and hit targeted objects, and other version, a mirror version based on mirror therapy.

Digital vaccine passports and digital health diplomacy: an online model WHO simulation.

In the wake of Coronavirus disease 2019 (COVID-19), several nations have sought to implement digital vaccine passports (DVPs) to enable the resumption of international travel. Comprising a minimum dataset for each unique individual, DVPs have the makings of a global electronic health record, broaching key issues involved in building a global digital health ecosystem. Debate simulations offer a safe, interactive space to foster participatory policy discussions for advancing digital health diplomacy. This study used an online simulation of a Model World Health Assembly to critically analyze the sociotechnical issues associated with the global implementation of DVPs, and to generate useful insights and questions about the role of diplomacy in global digital health. The debate arguments addressed and provided insights into the technological, scientific, ethical, legal, policy, and societal aspects of DVPs. Reflecting on the simulation, we discuss its opportunities and challenges for the digitalization, decolonization, decentralization, and democratization of participatory policymaking.

Cultural Adaptation and Psychometric Evidence of the Phubbing Scale / Adaptação Cultural e Evidências Psicométricas da Escala de Phubbing / Adaptación Cultural y Evidencia Psicométrica de la Escala de Phubbing

Abstract Phubbing, the act of ignoring people during a face-to-face interaction to dedicate attention to the smartphone, is a phenomenon widely observed in today's society. Therefore, this research aimed to carry out the cross-cultural adaptation of the Phubbing Scale to Brazilian Portuguese and examine its psychometric properties. The study included 1,551 Brazilian adults, 61.7% female and 29.9% male, aged from 18 to 76 years (M = 31.6 years; SD = 9.6 years). A socio-demographic questionnaire and the Phubbing Scale were used. Exploratory Factor Analysis, Confirmatory Factor Analysis, Network Analysis and Mann-Whitney Test were performed. The results confirmed the bifactorial version of the Phubbing Scale with good fit indices (CFI = 0.99; TLI = 0.99; α = 0.83). The Phubbing Scale showed adequate psychometric properties and internal consistency for use in Brazil.

Resumo Comportamento de Phubbing, ato de ignorar as pessoas durante uma interação presencial para dedicar atenção ao smartphone, é um fenômeno amplamente observado na sociedade atual. Diante disto, o objetivo desta pesquisa foi realizar a adaptação transcultural da Escala de Phubbing para a população brasileira e examinar suas propriedades psicométricas. Participaram da pesquisa 1.551 adultos brasileiros, sendo 61,7 % do sexo feminino e 29,9% do sexo masculino, com idades entre 18 e 76 anos (M = 31,6 anos; DP = 9,6 anos). Foram utilizados o questionário sociodemográfico e a Escala de Phubbing. Foram realizadas Análise Fatorial Exploratória, Análise Fatorial Confirmatória, Análise de Rede e Teste de Mann-Whitney. Os resultados confirmaram a versão bifatorial da Escala de Phubbing com bons índices de ajustes (CFI = 0,99; TLI = 0,99; α = 0,83). A Escala de Phubbing apresentou propriedades psicométricas e consistência interna adequadas para utilização no contexto brasileiro.

Resumen El Comportamiento de Phubbing, el acto de ignorar a las personas durante una interacción cara a cara para dedicar su atención al teléfono inteligente, es un fenómeno ampliamente observado en la sociedad actual, por tanto, el objetivo de esta investigación fue realizar la adaptación transcultural de la Escala Phubbing al portugués brasileño y examinar sus propiedades psicométricas. Un total de 1551 adultos brasileños participaron en la encuesta, 61,7% mujeres y 29,9% hombres, con edades entre 18 y 76 años (M = 31,6 años; SD = 9,6 años). Se utilizó el cuestionario sociodemográfico y la Escala de Phubbing. Se realizaron Análisis Factorial Exploratorio, Análisis Factorial Confirmatorio, Análisis de Redes y Prueba de Mann-Whitney. Los resultados confirmaron la versión bifactorial de la Escala de Phubbing con buenos índices de ajuste (CFI = 0,99; TLI = 0,99; α = 0,83). La Escala de Phubbing mostró propiedades psicométricas y consistencia interna adecuadas para su uso en el contexto brasileño.

A Novel Functional Electrical Stimulation-Induced Cycling Controller Using Reinforcement Learning to Optimize Online Muscle Activation Pattern.

This study introduces a novel controller based on a Reinforcement Learning (RL) algorithm for real-time adaptation of the stimulation pattern during FES-cycling. Core to our approach is the introduction of an RL agent that interacts with the cycling environment and learns through trial and error how to modulate the electrical charge applied to the stimulated muscle groups according to a predefined policy and while tracking a reference cadence. Instead of a static stimulation pattern to be modified by a control law, we hypothesized that a non-stationary baseline set of parameters would better adjust the amount of injected electrical charge to the time-varying characteristics of the musculature. Overground FES-assisted cycling sessions were performed by a subject with spinal cord injury (SCI AIS-A, T8). For tracking a predefined pedaling cadence, two closed-loop control laws were simultaneously used to modulate the pulse intensity of the stimulation channels responsible for evoking the muscle contractions. First, a Proportional-Integral (PI) controller was used to control the current amplitude of the stimulation channels over an initial parameter setting with predefined pulse amplitude, width and fixed frequency parameters. In parallel, an RL algorithm with a decayed-epsilon-greedy strategy was implemented to randomly explore nine different variations of pulse amplitude and width parameters over the same stimulation setting, aiming to adjust the injected electrical charge according to a predefined policy. The performance of this global control strategy was evaluated in two different RL settings and explored in two different cycling scenarios. The participant was able to pedal overground for distances over 3.5 km, and the results evidenced the RL agent learned to modify the stimulation pattern according to the predefined policy and was simultaneously able to track a predefined pedaling cadence. Despite the simplicity of our approach and the existence of more sophisticated RL algorithms, our method can be used to reduce the time needed to define stimulation patterns. Our results suggest interesting research possibilities to be explored in the future to improve cycling performance since more efficient stimulation cost dynamics can be explored and implemented for the agent to learn.

Assessment of neuromuscular electrical stimulation in critically ill patients: physical therapists' knowledge and barriers to its use / Avaliação do uso da estimulação elétrica neuromuscular em pacientes críticos: conhecimento dos fisioterapeutas e barreiras à implementação / Evaluación del uso de la electroestimulación neuromuscular en pacientes críticos: conocimiento de los fisioterapeutas y barreras para su implementación

ABSTRACT Transcutaneous neuromuscular electrical stimulation (NMES) is considered an important tool to prevent muscle mass and strength loss in patients admitted to intensive care units (ICU). This study aimed to evaluate physical therapists' profile and knowledge of NMES and identify the main barriers to its use in ICUs. This observational cross-sectional study was conducted via a structured questionnaire created by the authors. It consisted of 12 objective questions to analyze physical therapists' knowledge of NMES use in critically ill patients. Physical therapists were invited to participate in this study during an international symposium on NMES. In total, 56 physical therapists, with a mean age of 33.5±7.2 years and working an average of 9.7±7 years after graduation, completed the survey. Overall, 34 respondents worked in ICUs, of which only four (12%) reported regular NMES use in their ICUs. We found a low average of correct answers to our questionnaire (25%; 3/12). The main barriers reported to using NMES in ICUs were lack of knowledge (28; 50%) and equipment (24; 43%). The number of correct answers expert and non-expert physical therapists was not statistically significant (p=0.68). Thus, we observed participants' poor knowledge of NMES use in critically ill patients. Respondents showed that NMES has been underused in their ICUs. Lack of knowledge and equipment seems to be the main barriers for the use of NMES in ICUs.

RESUMO A estimulação elétrica neuromuscular transcutânea (EENM) é considerada uma importante ferramenta para prevenir a perda de força e massa muscular em pacientes internados em unidades de terapia intensiva (UTIs). Este estudo teve como objetivo avaliar o perfil e conhecimento dos fisioterapeutas sobre a EENM e identificar as principais barreiras para sua utilização na UTI. Foi realizado um estudo observacional transversal, por meio de um questionário estruturado elaborado pelos autores. O questionário foi composto por 12 questões objetivas que visavam analisar o nível de conhecimento dos fisioterapeutas sobre o uso da EENM em pacientes críticos. Os fisioterapeutas foram convidados a participar do estudo durante um simpósio internacional sobre EENM. Cinquenta e seis fisioterapeutas completaram a pesquisa, a média de idade foi de 33,5±7,2 anos e o tempo médio de graduação de 9,7±7 anos. Trinta e quatro entrevistados trabalhavam na UTI, e destes apenas 4 (12%) relataram que a EENM era realizada rotineiramente em suas UTIs. Observou-se baixo nível de conhecimento sobre o uso da EENM em pacientes críticos no questionário, com média de 25% de acertos (3/12). Ao comparar os fisioterapeutas especialistas e não especialistas, o número de acertos não foi estatisticamente significativo (p=0,68). As principais barreiras relatadas para a utilização da técnica foram a falta de conhecimento 28 (50%) e a falta de equipamentos 24 (43%). Os entrevistados demonstraram que a EENM tem sido subutilizada em suas UTIs.

RESUMEN La electroestimulación neuromuscular transcutánea (TENS) es una herramienta importante para prevenir la pérdida de fuerza y masa muscular en pacientes ingresados en unidades de cuidados intensivos (UCI). Este estudio tuvo como objetivo evaluar el perfil y el conocimiento de los fisioterapeutas sobre la TENS, así como identificar las principales barreras para su uso en la UCI. Se llevó a cabo un estudio observacional transversal mediante un cuestionario estructurado desarrollado por los autores. El cuestionario constaba de 12 preguntas objetivas cuyo objetivo era analizar el nivel de conocimiento de los fisioterapeutas sobre el uso de la TENS en pacientes críticos. Se invitó a los fisioterapeutas a participar en el estudio durante un simposio internacional sobre TENS. Cincuenta y seis fisioterapeutas completaron la encuesta, la edad media fue de 33,5±7,2 años, y el tiempo medio desde la graduación fue de 9,7±7 años. Treinta y cuatro encuestados trabajaban en la UCI, y de estos solo 4 (12%) informaron que la TENS se realizaba de forma rutinaria en las UCI donde trabajaban. Los resultados del cuestionario mostraron un bajo nivel de conocimiento sobre el uso de la TENS en pacientes críticos, con un promedio de 25% de respuestas correctas (3/12). En la comparación entre los fisioterapeutas especialistas y los no especialistas, el número de respuestas correctas no fue estadísticamente significativo (p=0,68). Las principales barreras reportadas para el uso de esta técnica fueron la falta de conocimiento 28 (50%) y la falta de equipamiento 24 (43%). Los encuestados demostraron que esta técnica es infrautilizada en las UCI.

Clinical Applications of Artificial Intelligence-An Updated Overview.

Artificial intelligence has the potential to revolutionize modern society in all its aspects. Encouraged by the variety and vast amount of data that can be gathered from patients (e.g., medical images, text, and electronic health records), researchers have recently increased their interest in developing AI solutions for clinical care. Moreover, a diverse repertoire of methods can be chosen towards creating performant models for use in medical applications, ranging from disease prediction, diagnosis, and prognosis to opting for the most appropriate treatment for an individual patient. In this respect, the present paper aims to review the advancements reported at the convergence of AI and clinical care. Thus, this work presents AI clinical applications in a comprehensive manner, discussing the recent literature studies classified according to medical specialties. In addition, the challenges and limitations hindering AI integration in the clinical setting are further pointed out.

Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling.

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.

"Digital Health Diplomacy" in Global Digital Health? A call for critique and discourse.

Actualizing the vision of Global Digital Health is a central issue on the Global Health Diplomacy agenda. The COVID-reinforced need for accelerated digital health progress will require political structures and processes to build a foundation for Global Digital Health. Simultaneously, Global Health Diplomacy uses digital technologies in its enactment. Both phenomena have driven interest in the term "Digital Health Diplomacy." A review of the literature revealed 2 emerging but distinct definitions that have been published very recently, each with its associated discourse and practice. This multiplicity of ideas demonstrates the myriad ways in which global digital and political systems are becoming increasingly entangled. Untangling these, this paper proposes and discusses 3 dimensions of Digital Health Diplomacy: "Diplomacy for digital health," "Digital health for diplomacy," and "Digital health in diplomacy." It calls upon digital health professionals, diplomats, political and social scientists, epidemiologists, and clinicians to discuss, critique, and advance this emerging domain.

Telemedicina aplicada a los cuidados paliativos, implicaciones éticas y beneficios: una revisión sistemática / Telemedicine applied to palliative care, ethical implications and benefits: a systematic review

Introducción: La telemedicina o la telesalud son conceptos similares que definen el uso de las tecnologías de telecomunicación en la prestación de servicios médicos especializados a distancia. El entorno de los cuidados paliativos ofrece nuevas oportunidades para mejorar la comunicación y apoyar a los pacientes y sus familias al final de la vida. Sin embargo, existen implicaciones éticas en el contexto del final de la vida, principalmente asociadas a los riesgos de descuidar la privacidad y confidencialidad del paciente y a cuestiones relacionadas con la humanización/deshumanización de los cuidados.Objetivo: Identificar los beneficios y las implicaciones éticas de la telemedicina aplicada a los cuidados paliativos.Métodos: Es una revisión sistemática con síntesis narrativa. Población de interés: pacientes adultos de cuidados paliativos al final de la vida expuestos a las tecnologías y sus familias, los cuidadores informales y los profesionales implicados en el proceso de atención. Se incluyeron todos los diseños de estudio, excepto la literatura gris. Las revisiones sistemáticas solo se seleccionaron para identificar artículos relevantes y significativos para incluir en la revisión.Resultados: Se incluyeron un total de 22 artículos de los 321 encontrados. Los estudios cualitativos fueron mayoritarios y, en general, hubo una variación significativa en el tamaño de la muestra. Los cuidados paliativos a domicilio fueron la aplicación más común de las intervenciones de telemedicina, y las formas de teleconsulta constituyeron la mayoría de las intervenciones.Conclusiones: Se identificaron intervenciones de telemedicina con gran potencial para mejorar la calidad de la atención. Algunas plantean cuestiones de humanización. Sin embargo, se abordan de manera superficial y no se correlacionan con la satisfacción y la calidad de vida del paciente/cuidador. (AU)

Introduction: Telemedicine and telehealth are similar concepts that define the use of telecommunication technologies in delivering specialized medical services at a distance. The palliative care setting offers new opportunities to enhance communication and support patients and their families at the end of life. However, there are ethical implications in the end-of-life context, mainly associated with the risks of neglecting patient privacy and confidentiality, and issues related to the humanization/dehumanization of care.Objective: To identify the benefits and ethical implications of telemedicine as applied to palliative care.Methods: A systematic review with a narrative synthesis. The population of interest: adult palliative care patients at the end of life, exposed to technologies, and their families, informal caregivers and professionals involved in the care process. All study designs were included, except grey literature. Systematic reviews were only selected to identify relevant and meaningful articles to include in the review.Results: 22 articles were included out of the 321 that were found. Qualitative studies were in the majority, and overall there was significant variation in sample size. Home-based palliative care was the most common application of telemedicine interventions, and forms of teleconsultation constituted the majority of interventions.Conclusions: Telemedicine interventions with great potential to improve quality of care were identified. Some raise humanization issues. However, they are superficially addressed and do not correlate with patient/caregiver satisfaction and quality of life. The most critical ethical implications had to do with privacy and the safety of the technology used, as recognized by both patients and healthcare professionals. (AU)