The Lancet. Digital healthMahima Kalla, Noushin Nazarian, Laura Vokey, Carrie Van Rensburg, Divya Kewalramani, Sipho Dlamini, Esmita Charani, Hasan Ferdous, Leo A Celi, Chikondi Milanzi…
The need to embed decolonising methodologies in health-care practice has been recognised globally. The term decolonising health, which has become a topic of increasing public and academic discourse since 2021, refers to the dismantling of colonial systems of dominance and oppression ingrained within health systems and structures. Despite the growing recognition of the need for decolonisation in broader health research and practice, the application of a decolonial lens to the rapidly evolving field of digital health remains largely underexplored. An active commitment to decolonisation should be driven by a quest for social justice. However, a key concern for those committed to decolonisation in any field of inquiry is the continuing hegemony of western Eurocentric knowledge and knowledge systems that dominate much of the global research machinery. Hence, we suggest that decolonisation of digital health should start at the ontological level of coloniality. In this Viewpoint, we present a justice-based reimagination of digital health using the established research paradigm framing of ontology, epistemology, axiology, and methodology. We also map decolonial recommendations across the learning health system model and provide a translational reflexivity checklist to support digital health project teams in decolonising research and innovation activities.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyY V Dolzhenkova, E V Kamneva
The implementation of digital technologies in the work of both health care professionals and the industry as a whole is a key factor in improving health care efficiency. The digitization of the Russian health care is implemented in accordance with the strategy of digital transformation. The digital transformations not only condition changes in the existing organization of functioning of medical institutions but also cardinal transformations in content, nature and organization of labor of medical workers. The transformations in labor sphere of health care are related to appearance of telemedicine, digital ecosystems and application of databases, knowledge bases and AI in treatment of patients. The changes in labor sphere in conditions of digitization result in both positive outcomes (development of professional knowledge and skills, expansion of functional, labor enrichment) and negative outcomes (workers overload, resistance to innovations, professional burnout).
Sexual healthSylvester Okeke, Eliza Basheer, Rochelle Avasalu, Carolyn Slattery, Belinda Meggitt, Limin Mao
BACKGROUND: This study evaluates the perceived impact and needed enhancement of a co-designed digital sexual and reproductive health (SRH) tool ('the Hub') developed to address SRH literacy gaps among international students (IS) in New South Wales, Australia. Despite Australia's large IS population and recognition of SRH as a fundamental human right, many report limited exposure to SRH information and face barriers to navigating health systems and accessing SRH services in host countries. METHODS: A mixed-methods evaluation was conducted comprising an online survey (August-October 2024; N = 129) and a focus group discussion (FGD) with professionals working with IS (N = 11). RESULTS: Survey findings indicate high acceptability and perceived usefulness of the Hub, with over 80% of participants rating content, including on the Australian health system, as high quality and most endorsing its design, tone, and usability. Although IS knowledge of HIV prevention and STI treatment was generally strong, gaps persisted regarding asymptomatic STIs, contraceptive limitations, and health system navigation. Notably, despite high awareness and favourable peer norms toward condom use and STI testing, testing uptake remained low: fewer than one in five sexually active IS reported STI (17.8%) or HIV (19.4%) testing in the previous 12 months. Qualitative FGD findings highlighted support for broader promotion strategies, including pre-arrival and campus-based dissemination, alongside needed enhancements to service navigation and cost transparency for SRH services. CONCLUSION: Overall, the Hub demonstrates feasibility and relevance as a digital intervention, though improved promotion and stronger linkage between knowledge and service uptake are essential to maximise public health impact.
Sexual healthLawrence Chun-Wei Loy, Sandip Kapse, Alap Gandhi, Kwee Choy Koh, Iskandar Azwa
Pre-exposure prophylaxis (PrEP) uptake remains low among key populations in Malaysia despite notable improvements in PrEP awareness. This literature review aims to understand PrEP awareness, barriers and facilitators that influence PrEP utilisation. PrEP awareness ranged between 20 and 85%, whereas uptake ranged between 8 and 18.3%. Reported barriers included cost, limited accessibility, poor PrEP literacy, potential side-effects, daily pill burden, along with stigma and discrimination. Potential facilitators, such as digital health interventions, pharmacy-led PrEP services, HIV testing integration and interest in long-acting injectable formulation of PrEP, could eliminate underlying barriers Malaysian key populations experience and encourage PrEP adoption.
BMJ openZypher Jude G Regencia, Janine Phoebe Liwanag, Hannah Faye Hindang, Athena Ira De Guzman, Jason Alacapa
INTRODUCTION: The Philippines is among the most disaster-prone countries globally, with recurrent typhoons, earthquakes and volcanic eruptions significantly disrupting healthcare delivery, particularly in geographically isolated and disadvantaged areas. Despite existing disaster risk reduction frameworks, gaps persist in ensuring equitable and continuous access to healthcare during and after disasters. METHODS AND ANALYSIS: This study will employ a convergent parallel mixed-methods design to assess barriers to healthcare access and identify context-specific solutions in disaster-affected communities. The study will be conducted in three purposively selected municipalities with varying hazard profiles: Albay, Leyte and Davao del Sur. The quantitative component will involve a cross-sectional household survey of approximately 422 adult respondents using structured questionnaires. Descriptive and inferential analyses, including logistic regression, will be performed to identify key determinants of healthcare inaccessibility and utilisation of telemedicine. The qualitative component will include key informant interviews and focus group discussions with stakeholders and will be analysed using thematic analysis. A scoping review of digital health systems in the Philippines (2010-2025) will complement primary data collection. Findings from all components will be integrated through triangulation to generate policy-relevant insights. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the De La Salle University Research Ethics Review Committee (2025-369C). Findings will be disseminated through peer-reviewed publications, policy briefs and stakeholder engagement activities to inform national and local health system strengthening and disaster preparedness efforts.
Journal of medical Internet researchSarina Yaghobian, Nina Sulkowski, Gary Galambos, Linda Scarazzini, Nicolas Maloumian, Stephane Verhaeghe
BACKGROUND: Digital health increasingly depends on data exchange across institutions, technologies, and jurisdictions, creating persistent challenges for the governance of access, consent, interoperability, provenance, and accountability. Blockchain and distributed ledger technology (DLT) systems have been proposed as mechanisms for coordinating and verifying governance processes across distributed actors. However, existing research has examined individual applications or technical domains, leaving unclear how blockchain/DLT systems function as governance infrastructure across health care, and whether these systems have progressed toward real-world implementation. OBJECTIVE: This evidence gap map and scoping review aim to characterize how blockchain/DLT systems are applied to health data governance, identify the health care application domains, and governance functions addressed by these systems, and assess their evidence maturity. METHODS: We searched PubMed/MEDLINE, Embase, Scopus, and Dimensions (Digital Science), and conducted backward and forward citation searching to identify peer-reviewed studies reporting blockchain/DLT systems in health care with an implemented artifact, technical evaluation, simulation, benchmark, pilot/usability assessment, or operational deployment, published between January 1, 2010, and February 28, 2026. Conceptual or architecture-only papers were excluded. Studies were charted by application domain, governance function, and evidence maturity (proof-of-concept/prototype, simulated/benchmarked evaluation, pilot/usability-tested implementation, or operational/real-world deployment). A focused narrative synthesis was conducted for studies reporting pilot/usability-tested implementation or operational/real-world deployment. RESULTS: Of 892 included studies, the evidence base was dominated by proof-of-concept/prototype (n=418) and simulated/benchmarked evaluation (n=455) work; only 18 reported pilot/usability-tested implementation, and 1 reported operational/real-world deployment. Studies were concentrated in electronic health record management/health information exchange (n=372) and telemedicine/distributed care/Internet of Things (IoT)-enabled remote monitoring (n=250), followed by clinical decision support/smart health care (n=82), public health surveillance/certification (n=72), clinical trials/research governance (n=67), and health data marketplace/monetization (n=49). Across 3273 nonmutually exclusive governance-function codes, the most frequent functions were privacy/security, interoperability/data sharing, access control, data/model integrity, and identity/authentication. Publication activity increased over time, with the highest annual volumes in 2022 and 2025. This growth was not accompanied by a shift toward higher-maturity evidence. Privacy/security and interoperability/data sharing remained prominent across publication years, while other governance functions varied over time. Higher-maturity evidence was unevenly distributed across application domains, particularly clinical trials/research governance and electronic health record management/health information exchange. Within the 19 higher-maturity studies, evidence remained limited by small-scale evaluations, short follow-up, and a lack of sustained routine use beyond the evaluation period. CONCLUSIONS: Across digital health, blockchain/DLT systems were positioned as governance infrastructure for verifiable access, consent, provenance, identity, and audit trails, rather than as repositories for health data. Despite a growing literature, real-world implementation evidence remained limited. Whether blockchain/DLT systems improve governance outcomes over conventional architectures remains largely untested. Future research should prioritize comparative, implementation-focused evaluation of whether these systems can be integrated, sustained, and shown to provide governance benefits in real-world settings.
Journal of advanced nursingLaura-Maria Peltonen, Maxim Topaz, Martin Michalowski, Charlene Ronquillo, James Mitchell, Aleksandar Babic, Dari Alhuwail, Alain Junger, Molly K McCarthy, Nic…
AIM: Artificial intelligence (AI) is reshaping healthcare delivery. This work aims to explore how nursing expertise can be fully integrated into the development of AI-based health technologies and to assess the implications for clinical practice, education, leadership, industry, policy and research. METHODS: This qualitative expert elicitation study drew on data generated during a structured three-day international think tank hosted by the Brocher Foundation in November 2024. Interdisciplinary experts in nursing, informatics, ethics, philosophy, medicine, computer science and law participated in structured presentations, facilitated subgroup discussions, plenary synthesis activities and collaborative development of recommendations. Reflexive thematic analysis was used to analyse workshop outputs and identify cross-cutting patterns, tensions and implications. RESULTS: Six interrelated thematic findings were generated. Participants framed nursing expertise as a form of sociotechnical governance rather than simply end-user input: (1) nurses were positioned as co-developers who can shape AI problem definition, design and implementation; (2) AI education was viewed as building critical interpretive capacity, not only technical literacy; (3) structural barriers limited nurse participation in innovation; (4) legal and ethical concerns reflected a gap between accountability and authority; (5) nurses were positioned as frontline actors for identifying AI bias and inequity; and (6) competency frameworks were viewed as tools for clarifying role-specific expectations in AI-enabled care. DISCUSSION: The findings suggest that embedding nursing expertise in healthcare AI is a matter of sociotechnical governance, requiring attention to organisational structures, education, legal accountability, professional roles and mechanisms for identifying safety, equity and workflow concerns. IMPLICATIONS FOR THE PROFESSION: This study provides an expert-informed framework for strengthening nursing participation in healthcare AI development. While the recommendations require empirical validation, they indicate priority areas for action, including nurse-led innovation, competence development, cross-sector collaboration, and educational and policy frameworks that recognise nursing expertise in AI development. REPORTING METHOD: The study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.
Online journal of public health informaticsYogita Chaudhary, Lathika R, Solomon Thirumurugan, Manikandan Kumaraguru, Sharan Murali, Rizwan Suliankatchi Abdulkader
BACKGROUND: Rapid digitalization has led to the generation of vast volumes of health data across diverse sources, including public health surveillance, electronic health records from hospitals, primary care facilities, and telemedicine. However, it often remains fragmented across multiple domains and systems due to siloed data collection practices and a lack of interoperability standards, limiting its potential to generate actionable public health insights. OBJECTIVE: In this study, we examined publicly available health data portals and assessed their scope, user engagement features, and implementation of interoperability standards. METHODS: We conducted an environmental scan to profile publicly available health data portals. We identified portals through systematic web searches, expert consultation using the Delphi technique, and snowball sampling from initial sources. We assessed each portal for the type of data hosted, the scope of user engagement, and the implementation of interoperability standards (Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT]) or adopted Fast Healthcare Interoperability Resources (FHIR) as a data exchange standard. RESULTS: We identified 17 data portals in total, of which 9 (53%) hosted global data and 1 (6%) hosted regional data. Portals hosted data across diverse domains including communicable diseases and noncommunicable diseases, maternal and child health, injuries, and others. Most portals supported basic user interactions such as data querying (n=15, 88%) and downloading (n=15, 88%), but none offered in-portal analytics. While 3 (18%) portals used International Classification of Diseases (ICD) coding systems, none implemented SNOMED CT or adopted FHIR. CONCLUSIONS: Our study highlighted substantial fragmentation and a lack of interoperability across health data portals, which limits the ability to conduct integrated analysis and obtain comprehensive public health insights. Realizing the full potential of health data will require accessibility and interoperability, intelligent analytics, and seamless integration across domains.
BACKGROUND: The COVID-19 pandemic led to the rapid integration of telemedicine into health care delivery. As a result, the ability to effectively collaborate in interprofessional virtual teams became a necessity, as did the development of educational opportunities designed to equip health care students with these skills. Currently, there is a lack of dedicated tools to assess learners' ability and readiness to function as a well-coordinated virtual medical team. OBJECTIVE: The primary objective of this study was to conduct a psychometric assessment and validation of measures evaluating graduate-level health professions learners' experience and familiarity within virtual interprofessional settings. The secondary objective was to integrate these 2 validated subscales into a comprehensive survey tool for use in interprofessional education course evaluation, spanning domains including demographics, telehealth knowledge and skills, understanding interprofessional roles, communication, and teamwork. METHODS: An interprofessional expert panel reviewed an initial item pool of 126 questions compiled from adaptations of previously validated instruments and newly developed items. Five experts with experience in interprofessional education and telehealth competencies independently rated each item, and the highest-ranked items were selected for distribution to graduate health professions students at Stony Brook University. The survey was administered during mandatory in-class instruction across the School of Medicine, School of Nursing, School of Health Professions, and School of Social Welfare between November 2023 and June 2024. Participation was voluntary, and responses were anonymous. Item reduction focused on the 33 experience items and 8 familiarity items using interitem correlations, the Cronbach α, item-to-total correlations, and exploratory factor analysis (EFA); confirmatory factor analysis was not conducted. RESULTS: A total of 520 responses were obtained. After excluding records without any response to questions 9 or 10 and duplicate submissions, 393 records were included in the analysis. The final survey was reduced from 51 to 32 items, including 5 demographic items, 3 telehealth knowledge items, 17 retained experience items, and 5 retained familiarity items. For the experience domain, EFA identified 17 items loading onto 3 factors, accounting for 69.81%, 13.00%, and 9.58% of the variance. Internal consistency remained high, with the Cronbach α decreasing from 0.94 to 0.90. For the familiarity domain, EFA supported a refined 5-item structure, with the Cronbach α decreasing from 0.94 to 0.91. CONCLUSIONS: This EFA-based validation study provides preliminary psychometric support for 2 subscales assessing graduate health professions learners' experience and familiarity within virtual interprofessional settings. Additional validation work is needed before broader claims can be made regarding the full survey's ability to evaluate educational outcomes or clinical impact.
PLOS digital healthIlaria Durosini, Dario Monzani, Veronica Coppini, Maria Vittoria Ferrari, Chiara Bovolenta, Asia Grigis, Giuseppe Curigliano, Paola Zagami, Elisabetta Munzone,…
Despite advances in cancer treatment, the growing global cancer burden underscores the need for comprehensive and supportive care to address the needs of patients and their families. However, access to psycho-oncological support remains often limited across healthcare systems. This could be related to factors such as resource constraints and insufficient integration of psychological care into routine oncological pathways. Individual-level barriers also exist, including low awareness of available services, stigma, and heterogeneity in patients' perceived needs and help-seeking attitudes. Nevertheless, psychological burden can significantly influence patients' experience of the treatment pathway, influencing cognitive clarity, perceived self-efficacy, communication, risk perception, decision-making, and all areas of daily life. In this context, digital mental health solutions have emerged as promising tools to enhance accessibility, continuity of care, and personalisation of support. In this manuscript, we aim to describe the structure of the ALTHEA project ("tAckling menTal Health cancer patients and their families: digital solutions for bEtter cAre"), which focuses on the development of a novel web-based digital platform targeting cancer patients and their informal caregivers' mental health across different stages of the care pathway. ALTHEA is distinguished by the presence of screening, classification into different support profiles, and tailored interventions within a single platform, as well as by its co-creation approach involving patients and stakeholders. In this line, the ALTHEA project represents a timely opportunity to integrate digital health solutions into psycho-oncology care, improving mental health outcomes, enhancing patient empowerment, and promoting a more holistic approach to cancer care.
Journal of medical Internet researchXuxin Wang, Wen Jing, Yunxia Li, Hui Li, Jing Li, Yuanyuan Liu, Su'e Yuan
BACKGROUND: Chronic musculoskeletal pain is a major public health problem, and access to continuous, long-term care remains challenging. Digital health interventions may extend care beyond conventional settings; however, their comparative effects across delivery modalities and core therapeutic components remain uncertain. OBJECTIVE: This study aimed to synthesize evidence and compare the effects of different digital health intervention modalities on pain, functional disability, and health-related quality of life in adults with chronic musculoskeletal pain. METHODS: This systematic review and Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, CINAHL, MEDLINE, and Scopus were systematically searched from database inception to January 29, 2026. Randomized controlled trials comparing digital health interventions with control conditions in adults with chronic musculoskeletal pain were included. Interventions were classified according to digital delivery format and core therapeutic components. Standardized effect sizes (Hedges g) were used, and pairwise meta-analyses and Bayesian random-effects network meta-analyses were conducted. Subgroup analyses explored effect modification by core components. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework adapted for network meta-analysis. RESULTS: Ninety-two randomized controlled trials involving 12,595 participants were included. Pairwise meta-analyses suggested small to moderate favorable average effects of app-based, virtual reality-based, and telerehabilitation interventions on pain and functional disability, whereas estimates for wearable device and multimodal interventions were imprecise. However, the prediction intervals crossed the null, suggesting that benefits may not be consistent across settings. Component-based analyses suggested larger effects for exercise or motor function training than for interventions centered primarily on education or cognitive behavioral therapy; however, several subgroups included few studies. In the Bayesian network meta-analyses, motor function-oriented virtual reality and exercise-based telerehabilitation showed potentially favorable effects across pain and disability outcomes, while some virtual reality interventions ranked relatively highly for pain. However, these rankings remained uncertain because of heterogeneity, imprecision, and limited direct evidence for some comparisons. Network meta-regression suggested that intervention duration may be associated with functional disability outcomes, whereas the corresponding association for pain was less certain. The certainty of evidence was predominantly low or very low. CONCLUSIONS: Digital health interventions may provide small to moderate average improvements in pain and disability, but their clinical importance and comparative effects remain uncertain. Unlike previous reviews focused on individual technologies or broad delivery categories, this systematic review integrated delivery modality with core therapeutic content. This dual-dimensional framework provides a more clinically interpretable basis for comparing interventions and prioritizing future head-to-head trials. Exercise-based virtual reality and telerehabilitation appear promising but cannot be considered superior. Future research should standardize intervention content and conduct high-quality head-to-head trials to confirm long-term effects.
Health information management : journal of the Health Information Management Association of AustraliaMaria Schwarz, Elizabeth C Ward, Sarah Jeffery, Joshua Simmons, Kristy Perkins, Philip Juffs, Sara Burrett
BACKGROUND: Electronic medical records (EMRs) currently rely on standardised data fields to support secondary data use for clinical care, performance monitoring, and system-level reporting. However, utilisation of standardised data capture and reporting within allied health remains underdeveloped in practice. Greater understanding of how allied health clinicians and managers perceive the purpose, value, and impact of standardised data collection is needed to support advancement in data maturity and transformation of utilisation. OBJECTIVE: To explore the perceived benefits, challenges and future opportunities of standardised data collection within an EMR, from the allied health perspective. METHOD: A qualitative descriptive study using semi-structured interviews was conducted with 28 allied health clinicians and managers from 5 allied health disciplines: Dietetics, Occupational Therapy, Physiotherapy, Speech Pathology, and Social Work. RESULTS: Five overarching themes reflected a gap between the acknowledged value of standardised data collection and its current utilisation in allied health practice: (i) Recognised value but unrealised potential of EMR data, including its role in clinical insights, service planning, financial justification, and professional advocacy; (ii) System and workflow misalignment limits meaningful data use, including disconnect between data collection and use, workflow burden, inefficient data capture, system constraints; (iii) Standardisation as both enabler and constraint, supporting benchmarking and system alignment while limiting clinical flexibility and contextual relevance; (iv) Pathways to advancing data maturity, including training, improved data and digital literacy, and integration with emerging technologies; and the broader impact of (v) Digital workflows reshaping workforce and care delivery, with implications for team-based and person-centred care. CONCLUSION: While standardised EMR data were recognised as valuable, their potential remains limited when data collection is poorly aligned with allied health workflows. Advancing allied health data maturity requires clinically meaningful, workflow-integrated and feedback-driven approaches that improve usability while supporting high-quality data for secondary use.Implication for health information management practice:Standardisation efforts must balance data quality with clinical relevance, ensuring data collection aligns with real-world workflows and supports meaningful use.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerPatsy Yates, Wei-Hong Liu, Vanissa Ong, Sue Hegarty, Cyril Dixon, Anna Tart, Natalie Williams, Bridget Bradhurst
PURPOSE: A nationwide nurse-led telehealth case management program was established providing personalised supportive care to individuals and families experiencing ovarian cancer. The program was evaluated using the RE-AIM framework. This paper focuses on the effectiveness findings of the evaluation. METHODS: Using mixed methods design, participants completed four surveys over 12 months assessing symptom burden, psychological distress, supportive care needs, quality of life, and self-efficacy. Service experiences were further explored through interviews. RESULTS: Of the 652 individuals enrolled in the program, 112 (17%) participated in the evaluation. Predominant baseline moderate to severe symptoms were fatigue (65%); anxiety (56%); and sleep issues (50%). Key unmet needs included: uncertainty about the future (54%); fear of cancer spread (48%); and anxiety (42%). 43% reported high distress; 27% lacked confidence self-managing fatigue, 23% self-managing distress. All participants received symptom and needs assessment; 80% received information support, and one-third accessed specialised psychosocial care. Those with greater symptom burden, distress, lower quality of life and self-efficacy at baseline received more services. Over 12 months, overall wellbeing and satisfaction with information improved significantly. 30 interview participants consistently valued the program for: being seen and heard as a whole person; trusted information and advice; meaningful emotional support; and flexible and timely services. CONCLUSION: Participation in this nurse-led telehealth program was associated with improved outcomes and positive experiences among individuals with ovarian cancer who are at high risk of poorer outcomes. These findings support continued investment in person-centred tailored supportive care delivered via telehealth prioritising emotional wellbeing, symptom management, and quality of life.
BMJ openKlara Doppler, Jana Marica Hluch, Magdalena Eitenberger
OBJECTIVE: Austrian correctional facilities face persistent shortages of on-site physicians challenging the principle of equivalence of care. Consequently, the Ministry of Justice launched a telemedicine (TM) pilot to support primary care in correctional facilities without round-the-clock medical cover. The goal of this study was to evaluate TM alongside its implementation in order to investigate key stakeholders' experiences with TM and its integration into routine medical practice and to assess if and how health technologies such as TM can be used to improve quality of care in underserved facilities long-term. DESIGN: We conducted a qualitative evaluation study with semistructured interviews which were analysed using thematic analysis. SETTING AND PARTICIPANTS: Using purposive sampling across 20 correctional facilities, we interviewed a total of 48 participants (35 nurses, 3 physicians, 7 facility directors, 3 correctional officers). RESULTS: TM emerged as a tool to partially mitigate the shortage of physicians. Participants viewed TM as well suited for low-risk prescribing, follow-ups, discussion of test results and administrative tasks, while emergencies and presentations requiring physical examination remained unsuitable for TM according to interviewees' reports. Nurses emerged as central operational actors who scheduled and prepared visits, mediated communication and implemented postconsultation tasks; the resulting workload was experienced as either increased (added coordination work) or reduced (fewer external transfers), depending on context. Overall, TM was valued as a complement rather than a replacement for in-person care. Perceived quality of TM depended on technical reliability, adequate space and-critically-the remote clinician being familiar with facility routines and patients. CONCLUSIONS: Effective scaling should include clear clinical use criteria, stable remote clinician assignment, close collaboration with on-site staff and acknowledgement of nursing workload, while maintaining access to in-person assessment for complex or urgent cases, as well as personalised, in-person care.
Urologie (Heidelberg, Germany)K F Kowalewski, M E Geissler, J P Bereuter, J Ebbing, M Glienke, J Hatzl, F Heinrich, T Huber, F Joeres, Bfb Mayer, A Preukschas, M Queisner, M W Schmidt, L Sc…
BACKGROUND: Digitalization in healthcare is progressing only slowly in Germany. To counter this trend, four different consensus groups came together as part of the Digital Health Summit in Brandenburg. The aim was to assess the current situation and to formulate demands directed at policymakers and the scientific community in order to advance digitalization. OBJECTIVE: This paper presents the results of the experts' Delphi process on extended reality (XR) in surgical specialties. MATERIALS AND METHODS: As part of the Digital Health Summit Brandenburg 2024, a multistage expert consensus process was conducted with physicians and researchers. Following an initial literature review, statements on the topics of definition, status quo, translation, and utopia were developed and evaluated within a Delphi process. RESULTS: A total of 31 statements were developed across five categories, the majority of which were endorsed with very strong (41%) or strong (56%) consensus. Participants currently see XR being used primarily in education and training and in surgical planning. For clinical translation, interdisciplinary collaboration as well as the provision of resources and guidelines for clinical integration were key priorities. With regard to optimal use of the technologies, interdisciplinary development as well as mandatory provision and promotion of the technologies were cited. CONCLUSION: XR applications have already been adopted in certain areas of medicine and have demonstrated benefit in specific domains. However, the current framework conditions for developers and healthcare providers are insufficient for widespread implementation in routine clinical practice. In addition to financial and methodological support, there is a particular need to streamline regulatory barriers.
European journal of pediatricsNikolina Zdraveska, Aco Kostovski, Thilo Reich, Deborah K Hill, Lobke M Gierman, Timothy M Bahr
UNLABELLED: Previous publications have reported the accuracy of the Picterus Jaundice Pro (Picterus JP), a smartphone-based medical device app for screening neonatal jaundice prior to phototherapy. The purpose of this study was to evaluate the accuracy of the Picterus JP app before and during phototherapy. Between April 2025 and April 2026, newborns whose total serum bilirubin concentration (TSB) reached or exceeded the American Academy of Pediatrics phototherapy thresholds were enrolled in the study after written informed consent was obtained from their parent or legal guardian. A Picterus JP scan was obtained from the chest of the newborn (within 60 min of the TSB blood sample collection), a light-occlusive patch was placed on the newborn's chest, and phototherapy was initiated. Then, up to five Picterus JP scans per newborn were obtained from the newborn's chest, from the region covered by the phototherapy patch, within one hour of the blood collection for subsequent TSBs. We calculated diagnostic accuracy statistics to summarize the accuracy of Picterus JP. A total of 137 paired Picterus JP-TSB measurements were analyzed. Overall, Picterus JP correlated well with TSB (r = 0.720; bias - 38.5 µmol/L; RMSE 73.7 µmol/L). Restricted to a phototherapy course of ≤ 3 days, correlation was strong before phototherapy (n = 45 measurements; r = 0.849; bias - 46.5 µmol/L; RMSE 65.3 µmol/L) and weaker during phototherapy (n = 83 measurements; r = 0.520; bias - 40.7 µmol/L; RMSE 79.6 µmol/L), although the magnitude of bias and RMSE was similar in both periods. The relative (fractional) decline in Picterus JP during phototherapy correlated well with the relative decline in TSB (n = 97 paired change measurements; r = 0.752), and the direction of the bilirubin trend agreed between methods in 83% of assessed trajectories. A fixed offset correction reduced the bias during phototherapy from - 40.7 to + 5.8 µmol/L. CONCLUSION: Although the correlation between Picterus JP results and TSB measurements decreased during phototherapy, the direction of change in Picterus JP results almost always agreed with the direction of change in associated TSB measurements. This suggests that Picterus JP may be useful for monitoring bilirubin trends and treatment response during phototherapy, while also providing non-invasive bilirubin assessment before treatment initiation. WHAT IS KNOWN: • Total serum bilirubin (TSB) is the reference standard for guiding phototherapy but requires invasive blood draws; smartphone-based tools are validated mainly before phototherapy. WHAT IS NEW: • Picterus JP tracked bilirubin trends during phototherapy despite reduced correlation; an offset correction reduced bias, extending validation to severe hyperbilirubinemia.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes ResearchAnn-Kathrin Fischer, Axel Mühlbacher
OBJECTIVES: Digital Health Interventions (DHIs) are systematically developed digital solutions that address key healthcare challenges such as accessibility, efficiency, and quality of care. These interventions optimize healthcare processes and benefit multiple stakeholders. Despite their increasing significance, the evaluation of DHIs remains complex due to their multidimensional impacts and value contribution. This review aims to identify and synthesize value assessment frameworks (VAFs) and further evaluation approaches for DHIs, focusing on value dimensions, value criteria, and methodological diversity. METHOD: This systematic review was reported in accordance with the PRISMA 2020 statement. Literature was retrieved from PubMed, Web of Science, and Google Scholar. Eligibility criteria were defined using the PICO framework. Two independent reviewers screened and selected studies. A qualitative synthesis categorized approaches and extracted value dimensions. RESULTS: A total of 2,061 records were screened, with 97 studies meeting inclusion criteria. The review identified a diverse set of evaluation approaches, including checklists, scorecards, and multidimensional VAFs. While checklists and scorecards provided structured decision-making tools, comprehensive frameworks incorporated multiple value dimensions of DHIs. Key value dimensions included impact on subject (e.g., clinical benefit), impact on interaction (e.g., usability), impact on system (e.g., interoperability), and impact on society (e.g., public perception). CONCLUSION: The review identified key dimensions and associated value criteria across existing frameworks and approaches, providing a structured overview of how DHIs are assessed in current practice. These findings highlight the importance of multidimensional evaluation and may support the development of more structured approaches for assessing DHIs, thereby enhancing comparability and informing value-based decision-making.
Online journal of public health informaticsTianca Crocker
BACKGROUND: Telehealth use expanded rapidly during the COVID-19 pandemic, yet persistent digital inequities continue to shape who benefits from virtual and preventive health services. Although community-based digital inclusion programs aim to reduce barriers to access, less is known about how device reliability, broadband conditions, and perceptions of online health information influence health care use after access is provided. OBJECTIVE: The objective of this study was to investigate associations between digital attitudes and access and health care use, including telehealth use and preventive health care visits, among participants in a community-based laptop distribution program. METHODS: This study analyzed cross-sectional survey data from 1019 participants in a community-based laptop distribution program. Refurbished laptops were distributed between October 2020 and July 2023, after which approximately 20,000 program recipients were invited by email to complete an online survey in English or Spanish. Ordered logistic regression models assessed predictors of telehealth use and preventive health care use. Models were adjusted for sociodemographic characteristics, digital access conditions, and attitudes toward online health information. RESULTS: Among respondents, 26.95% (218/809) reported increased preventive health care visits since receiving a laptop, and 62% (502/810) reported using telehealth sometimes or often. Having a functioning program laptop was associated with higher odds of increased preventive health care use (odds ratio [OR] 2.13, 95% CI 1.07-4.27; P=.03), whereas living with a partner was associated with lower odds (OR 0.47, 95% CI 0.23-0.99; P=.048). Participants with both fast internet and affordable broadband had greater odds of increased preventive health care use (OR 8.29, 95% CI 1.03-66.50; P=.046). Participants who strongly agreed that online information helped them make better health decisions were more likely to report increased preventive health care use (OR 15.03, 95% CI 4.53-49.82; P<.001). More frequent telehealth use was associated with reporting that online health information often improved health (OR 17.77, 95% CI 6.78-46.56; P<.001) and with speaking a language other than English as a primary language (OR 5.95, 95% CI 1.73-20.41; P=.005). Respondents reporting decreased physician visits had lower odds of telehealth use (OR 0.21, 95% CI 0.10-0.46; P<.001). Race, ethnicity, gender, race-by-gender, and ethnicity-by-gender interaction terms were not substantial in adjusted models. CONCLUSIONS: Digital inclusion efforts may support engagement with preventive and virtual health services, but access alone appears insufficient. Device functionality, broadband quality and affordability, and perceptions of the value of online health information were important predictors of health care use. Digital inclusion initiatives should address both technological infrastructure and digital health engagement to promote equitable access to care.
JMIR formative researchBridget Bassilios, Katrina J Scurrah, Amy J Morgan, Leo Roberts, Maria Ftanou, Matthew J Spittal
BACKGROUND: Mental Health Online, MindSpot, and THIS WAY UP are 3 Australian Government-funded digital mental health services (DMHSs). These services are free for consumers and deliver a range of (depression and anxiety disorder) psychological assessments and interventions using the internet, with or without clinician support. OBJECTIVE: This study examines the uptake and effectiveness of these services. METHODS: We used 3 data sources to examine the performance of the three DMHSs: (1) aggregated routinely collected service data to describe uptake of the services from January 2013 to December 2021, (2) peer-reviewed and gray literature reporting treatment outcomes, and (3) treatment outcome data from one evaluation conducted by Mental Health Online. The second and third data sources were used to analyze the effectiveness of the DMHSs compared to other mental health treatment programs (Australian primary, public, and low-intensity mental health care; UK stepped psychological care). We generated pooled mental health symptom (Cohen d) effect sizes for each service's clinician-supported and self-directed treatments and compared those with effect sizes we calculated for the alternative treatment programs. RESULTS: The 3 DMHSs offered care to more than 282,000 consumers and therefore contributed to improving overall access to mental health care in Australia. Clinician-supported online treatment significantly improved the mental health of consumers who use these services (Mental Health Online, Cohen d=0.95; MindSpot, Cohen d=1.42; and THIS WAY UP, Cohen d=1.04), and self-directed treatment by Mental Health Online produced a moderate reduction (Cohen d=0.59) in anxiety disorder severity ratings. Clinician-supported treatments produced improvements in mental health symptoms that are close or equivalent to most (face-to-face, phone, and stepped or symptom severity-matched mental health care) comparison treatments examined. CONCLUSIONS: Mental Health Online, MindSpot, and THIS WAY UP are producing clinically significant improvement for consumers experiencing psychological distress and anxiety and depression symptoms. The magnitude of improvement produced by clinician-supported treatment is comparable with more resource-intensive face-to-face treatment options. Heterogeneity in the magnitude of improvements produced by the 3 DMHSs (and comparator interventions across levels of clinical need) indicates that findings should be interpreted with caution, particularly in relation to the populations for whom DMHSs may be most appropriate.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and TobaccoKinsey Pebley, Kathryn Moody, Amanda M Palmer, Alana M Rojewski
INTRODUCTION: Cigarette smoking poses unique risks for cancer survivors, but challenges remain with reach and efficacy of current interventions. The current randomized controlled pilot study created a video-based smoking cessation intervention for cancer survivors and tested acceptability/feasibility. METHODS: Participants were cancer survivors ages 21+ reporting current smoking, could read/understand English, and did not have medical/psychiatric conditions impairing ability to consent. Three videos were created and shown to survivors (N = 10) and refined based on feedback. Four additional videos were then created. Participants (N = 40) were randomized to a video (n=20, received 7 video links) or control (n=20, received link to NCI's "Clearing the Air" online booklet) group. Primary outcomes were acceptability/feasibility, assessed using the Acceptability and Feasibility of Intervention measures (scores ≥4 considered acceptable/feasible). Secondary outcomes included quit attempts, abstinence, cigarettes per day, and cessation resource use. Surveys were completed at baseline and 1-week, 1-month, and-3 months post-randomization. RESULTS: Mean acceptability scores for video and control groups were 4.2 and 3.9, respectively. Mean feasibility scores for video and control groups were 4.0 and 3.8, respectively. Video participants saw decreases in cigarettes per day that were sustained from baseline (Mean [M]=16.2) through final follow-ups (M=7.7), and had numerically higher use of all nine cessation resources assessed. More video participants reported quit attempts at 1-week (55.0%), 1-month (50.0%), and 3-months (60.0%) than the control group (40.0% at 1-week and 1-month, 52.6% at 3-months). CONCLUSION: The video intervention was acceptable/feasible among a diverse sample. Larger studies assessing intervention efficacy are needed.
PLOS global public healthSoarov Chakra Borty, Maiya G Block Ngaybe, Angela E Apeagyei, Divya Bhagianadh, Monica H Swahn, Nazmus Sakib
Dementia is a growing public health challenge in Sub-Saharan Africa (SSA), where population aging is expected to substantially increase the regional burden of dementia in the coming decades. Rapidly changing demographics, underdeveloped health infrastructure, and limited awareness of dementia symptoms and care pathways contribute to delayed diagnosis, treatment, and care. This scoping review examined literature published from 2021 to 2025 to identify gaps in dementia care across four key domains: environmental and social factors, technological capacity, community-based caregiving, and financial and economic factors. First, social and ecological factors, including low health literacy, rural residence, and weak primary care infrastructure, influence disease diagnosis and access to care. Second, technological capacity remains limited, including scarce access to neuroimaging and diagnostic tools, limited telemedicine coverage, weak electronic health information systems, and insufficient digital health solutions for early detection, management, and monitoring. Third, evidence from community-based care highlights heavy reliance on informal caregivers who often lack training and institutional support, resulting in substantial emotional, physical, and financial burden. Finally, inadequate public financing for dementia care, coupled with limited insurance coverage, further restricts access to dementia care services and support. Overall, this review highlights critical gaps in policy, evidence generation, cost-effective technology investment, caregiver support, and health systems strengthening across all levels of care. Addressing these multidimensional challenges is crucial to improving the quality of life for people living with dementia and their caregivers across SSA.
BACKGROUND: Digital health literacy (DHL) may be associated with health-related quality of life (HRQoL) in older adults with type 2 diabetes, but the behavioural and contextual correlates of this association remain unclear. This study examined that association, the indirect association through proactive health behaviours (PHB), and potential effect modification by the digital healthcare environment. METHODS: A cross-sectional survey was conducted from July to August 2025 among older adults with type 2 diabetes recruited by convenience sampling from primary healthcare chronic disease management registries in Huai'an, China. DHL, PHB and four single-item digital healthcare environment indicators were assessed using structured instruments, and HRQoL using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3L) and EuroQol Visual Analogue Scale (EQ-VAS). Adjusted indirect-association (5000 bias-corrected bootstrap resamples) and effect-modification analyses used heteroscedasticity-consistent type 3 (HC3) standard errors. RESULTS: Among 1053 participants, the mean DHL score was 21.24±10.43, the mean PHB score 76.75±9.88 and the mean EQ-5D-3L utility score 0.968±0.069. The adjusted total association between DHL and utility was significant (B=0.000569, 95% CI 0.000228 to 0.000910), whereas the direct association was not (B=0.000152; p=0.338). The indirect association through PHB was significant (B=0.000418, bias-corrected 95% CI 0.000260 to 0.000619) and accounted for 73.5% of the total. There was no robust evidence of effect modification for EQ-5D-3L utility: interactions with remote service use and online health management use reached significance only under HC3 inference and were not reproduced in sensitivity analyses. An exploratory positive PHB-by-remote-service-use interaction was observed for the supplementary EQ-VAS outcome. CONCLUSIONS: Higher digital health literacy was associated with better HRQoL among older adults with type 2 diabetes, with a significant cross-sectional indirect association observed through proactive health behaviours. No robust effect modification was identified for the primary EQ-5D-3L outcome. These findings support further longitudinal and intervention research on digital health capabilities and proactive health behaviours in this population.
JMIR human factorsEmmanuel Oluwatosin Oluokun, Festus Fatai Adedoyin, Huseyin Dogan, Nan Jiang
BACKGROUND: Digital health platforms can expand access to HIV care, but among men who have sex with men (MSM) and transgender people living with HIV and AIDS in Nigeria, adoption is shaped by structural stigma, criminalization, and fear of disclosure as much as by system functionality. Teleconsultation and medication-delivery platforms offer alternative pathways to care, but their acceptance within marginalized populations cannot be assumed and requires empirical investigation. OBJECTIVE: This study aimed to examine the factors influencing behavioral intention (BI) to adopt TechAids, a confidentiality-oriented digital health platform designed to support HIV consultation and service access among MSM and transgender individuals in Nigeria, using an extended Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS: A cross-sectional survey was conducted in Lagos, Nigeria, through HIV service delivery and outreach settings facilitated by partnering nongovernmental organizations, supplemented by online LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities) networks. The study used nonprobability convenience sampling with prespecified eligibility criteria. Data collection was conducted from January 2025 to May 2025. The sample comprised 141 platform users and 27 health care providers (N=168). An extended UTAUT model incorporated performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), trust, and perceived stigma (PS). Data were analyzed using correlation analysis and ordinary least squares (OLS) regression. Age and educational attainment were examined as potential moderating variables. Qualitative feedback was also collected to contextualize quantitative findings. RESULTS: FC emerged as the strongest predictor of BI to use the platform (β=.813; P<.001), explaining a substantial proportion of variance in adoption intention (R²=0.652). Age demonstrated a modest but statistically significant positive effect on BI (β=.105; P=.03). Contrary to theoretical expectations, PE, EE, SI, trust, and PS did not significantly predict intention to adopt the platform. Qualitative feedback highlighted practical infrastructure-related concerns, including reliable internet access, offline functionality, and availability of technical support, as more salient than psychological or feature-based considerations. CONCLUSIONS: In resource-constrained, highly stigmatized contexts, enabling infrastructure and practical support may outweigh cognitive, social, and attitudinal determinants of technology acceptance. Successful digital health interventions for marginalized populations therefore require privacy-conscious, user-centered design alongside sustained investment in the infrastructure that supports real-world use.
Journal of medical Internet researchVerena Schneider, Akish Luintel, Bethan Balch, Shivani Gangadia, Grainne Brady, Emma McGuire, Gwenan M Knight, Laura Shallcross, Steve Harris, Cecilia Vindrola…
BACKGROUND: Prior microbiology results, resistance patterns, and antimicrobial exposure are central to safe and effective antimicrobial prescribing. Digital health fragmentation refers to the dispersal of patient data across multiple electronic systems and the associated challenge of accessing complete information at the point of care. Antimicrobial prescribing for infections represents a critical use case to investigate the impact of digital health fragmentation on patient care. While interoperability has been studied in the context of patient safety, no review has described digital health fragmentation within the United Kingdom and examined its impact on antimicrobial prescribing and antimicrobial stewardship (AMS). OBJECTIVE: This study aimed to (1) characterize the extent of digital health fragmentation in the United Kingdom, (2) summarize the available evidence on its impact on AMS and prescribing practices in high-income countries, and (3) identify potential solutions. METHODS: A rapid review of the peer-reviewed literature was conducted following published guidance for rapid reviews and the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) statement. MEDLINE ALL and PsycInfo were searched on August 19, 2025, using search terms relating to digital health fragmentation or interoperability, patient safety, and antimicrobial use. Searches were limited to English-language publications from 2015 (for characterizing the recent trends or current state of digital health fragmentation in the United Kingdom) or 2010 onward (for AMS-related impacts and solutions). Screening was conducted by 4 researchers following predefined inclusion and exclusion criteria. Extracted data were synthesized narratively through framework analysis. Study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: Fourteen studies met the inclusion criteria. Ten studies described the extent and nature of digital health fragmentation in the United Kingdom. Digital health fragmentation affects a large number of patients and is linked to clinical care efficiency, quality, and safety risks, including limited access to external clinical records, missing or incomplete information, duplicate investigations, delays in decision‑making, and substantial time spent searching for data. Evidence specific to antimicrobial prescribing was limited (4 studies) but indicated that AMS relies on information spread across multiple systems, with poor interoperability disrupting workflows, hindering communication, and undermining stewardship activities. Only 1 study reported the development of a digital tool designed to address digital health fragmentation and support AMS. CONCLUSIONS: Digital health fragmentation negatively affects patient care across the United Kingdom, yet evidence on how it impacts AMS remains scarce. Given the urgency of the global antimicrobial resistance crisis, future research should therefore quantify the scale and impact of digital health fragmentation for AMS to inform investment and innovation in digital infrastructure and clinical-supportive solutions. TRIAL REGISTRATION: PROSPERO CRD420251126067; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251126067.
BMJ global healthOlufunke Fayehun, Bronwyn Harris, Titus Mashanya, Kennedy Bashan Nkhoma, Aboluwaji Daniel Ayinmoro, Ayanfeoluwa Ibrahim, Abiodun Alliu, Wendy Higman, Chinwe On…
INTRODUCTION: Remote consulting can improve healthcare access and equity. When delivered by trained health workers, it is safe, trustworthy and efficient. Alongside two independent clinical trials, we studied the implementation of a cascaded health worker training intervention (REaCH), plus airtime, on remote consulting in primary healthcare facilities in Nigeria (n=35) and Tanzania (n=21). Additionally, we assessed health service readiness for sustainable remote consulting in Ghana, Kenya, Nigeria, Malawi, Sierra Leone, Tanzania and Uganda. METHODS: We explored what worked for whom, how, and why in both health worker training in Nigeria (n=115) and Tanzania (n=136), and the implementation of remote consulting for patients with long-term conditions. We assessed REaCH training for talent, resources, alignment, implementation and nurture. We analysed system readiness with WHO's Digital Investment Guide. We undertook 82 semi-structured interviews with health workers and patients (n=40: Nigeria, n=42: Tanzania), collected text produced, engaged with stakeholders and reviewed key policies/guidelines. Data were analysed thematically. RESULTS: Health workers were already doing informal remote consulting. REaCH training helped facilities to plan and implement remote consulting. It addressed concerns about delivering a safe and ethical service. Provision of airtime was critical. Health workers used remote consulting for patient follow-up and patients sought advice, test results, prescriptions, referrals and emergency help. Patients and health workers trusted and appreciated remote consulting as it saved time. Patients felt cared for, but some received calls at inconvenient times. Health workers reported reduced stress but noted off-duty calls could be burdensome. Stakeholders were aware of informal remote consulting and were concerned about quality. None of the study countries provided airtime for remote consulting or had guidance or recording systems for remote consulting. CONCLUSION: There is an appetite for remote consulting in primary healthcare. However, health systems in seven countries of sub-Saharan Africa are not yet fully prepared for this.
JMIR research protocolsDayenne Jeneffer Souza da Silva, Vitor Leandro da Cunha, Luanna Barbara de Araújo Farias, Lara Cecília de Araújo Carlos, Candice Simões Pimenta de Medeiros, Ed…
BACKGROUND: Upper limb impairment is a common consequence of stroke, affecting independence and quality of life. Virtual reality (VR) interventions, including serious games designed for therapeutic purposes and commercial games developed primarily for entertainment, have been increasingly used for poststroke upper limb rehabilitation. Evidence comparing the effectiveness of these game types on functional outcomes remains unclear. OBJECTIVE: This systematic review protocol aims to determine whether serious and commercial VR games differentially impact upper limb function, measured by the Action Research Arm Test, in adults after stroke. Secondary outcomes will include upper limb motor function assessed using the Fugl-Meyer Assessment-Upper Extremity, Box and Block Test, Motor Activity Log, Jebsen-Taylor Hand Function Test, and Wolf Motor Function Test; functional independence assessed using the Functional Independence Measure and Barthel index; and adherence indicators, including dropout rates and session completion. Secondary objectives include evaluating pooled VR effects vs conventional therapy (CT) and exploring potential moderators, such as VR immersion level and stroke chronicity. METHODS: Parallel randomized controlled trials involving adults (aged ≥18 years) with ischemic or hemorrhagic stroke in the acute, subacute, or chronic phases will be included. Interventions using serious or commercial VR games (nonimmersive, semi-immersive, or fully immersive) delivered alone or combined with CT will be considered. Studies using nongamified VR, digital technologies without VR, or augmented reality not integrated into VR will be excluded. Eligible comparators include conventional physiotherapy, occupational therapy, usual care, educational interventions, or no therapy. This protocol was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols) guidelines. Systematic searches will be conducted in the PubMed (MEDLINE), Web of Science, Embase, Scopus, Virtual Health Library, ScienceDirect, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Brazilian Clinical Trials Registry, World Health Organization (WHO) International Clinical Trial Registry Platform, and ISRCTN Registry databases from inception to February 2026. Data extraction will be performed independently by 2 reviewers, and risk of bias will be assessed using the Cochrane risk of bias 2.0 tool. Meta-analyses will be conducted when clinical and methodological homogeneity permits. A random-effects model is planned; however, the final choice of model will be based on the level of heterogeneity observed at the time of analysis. Subgroup analyses will explore stroke phase, immersion level, intervention dosage, and concomitant therapy. RESULTS: Data collection is planned from inception to February 2026. Study screening and data extraction are ongoing, with synthesis and meta-analysis expected by November 2026 and final publication anticipated in winter 2026. CONCLUSIONS: This systematic review will clarify whether different VR game formats produce distinct effects on upper limb rehabilitation after stroke, providing evidence to inform the design and implementation of VR-based neurorehabilitation interventions. TRIAL REGISTRATION: PROSPERO CRD42024595266; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595266. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/95135.
Dental and medical problemsMagdalena Osiewicz, Alessandro Bracci, Mieszko Więckiewicz, Aleksandra Nitecka-Buchta, Daniele Manfredini
BACKGROUND: The clinical paradigm for assessing awake bruxism (AB) has evolved from retrospective self-reports toward real-time, data-driven monitoring through ecological momentary assessment (EMA). The BruxApp Cloud platform represents a significant technological advancement in this field, enabling real-time monitoring of masticatory muscle behaviors. However, the international applicability of such digital health instruments depends on rigorous linguistic validation and cultural adaptation to ensure that the ecological validity and conceptual intent of the original instrument are preserved across different linguistic and cultural populations. OBJECTIVES: The aim of the present study was to linguistically validate and culturally adapt the Polish version of the BruxApp Cloud platform in accordance with the latest international standards. MATERIAL AND METHODS: A methodological study was conducted in accordance with the 12-step international guideline for bruxism-related instruments. The protocol comprised independent forward translations performed by a specialist and a "naive" translator, followed by a back translation by 2 independent bilingual native speakers. An expert panel comprising clinicians, translators, and one of the original developers then conducted an iterative reconciliation process to resolve discrepancies and ensure conceptual equivalence between the original English version and the Polish translation. RESULTS: The finalized Polish version demonstrated full conceptual and linguistic equivalence with the original English version. The reconciliation process refined anatomical and behavioral terminology - for example, "mandible bracing" was translated as napinanie żuchwy - to balance clinical precision with clarity for lay users. Rather than relying on a single group consensus, discrepancies were resolved through iterative forwardand back-translation rounds until 100% agreement with the original English source was achieved. CONCLUSIONS: The validated Polish version of BruxApp Cloud provides a standardized tool for clinical practice and research in Poland. It enables remote, General Data Protection Regulation (GDPR)-compliant monitoring of AB behaviors and supports cognitive-behavioral re-education through biofeedback.
Nature communicationsConrad O Iyegbe, Melek Chaouch, Itunuoluwa Isewon, Lerato Majara, Olatunde Ayinde, Michaela A O'Hare, Mary Mufford, Ofure A Ubah, Amine Larnaout, Anje-Lore Gro…
Across Africa, rising mental health needs coincide with rapid advances in genomics, digital health and continental policy reform. Yet research into the genetic, environmental and social determinants of neuropsychiatric illness remains sparse and underfunded. This review argues that African leadership in neuropsychiatric genetics can strengthen discovery, guide prevention and care, and support equitable precision public health, provided that investment in cohorts, informatics, governance and workforce development is sustained and scaled. By linking the advancement of genomics to health systems, biobanking and translational innovation, Africa can define globally-relevant models of inclusive mental health research, care and sustainable development.
BACKGROUND: The COVID-19 pandemic has increased the demand for telepsychiatry in neurodevelopmental assessment; however, few studies have examined the interrater reliability of clinician-rated autism scales, such as the Childhood Autism Rating Scale, Second Edition (CARS2), when used remotely. Although the feasibility and validity of telehealth assessments have been explored previously, the consistency between remote and in person CARS2 ratings by different clinicians remains underinvestigated. OBJECTIVE: The objective of this study was to evaluate agreement between CARS2 total scores obtained by different evaluators using telepsychiatry and face-to-face assessments in children with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD). METHODS: In this randomized feasibility study, 75 children aged 6 to 17 years with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) diagnoses of ASD, ADHD, or both were enrolled at 5 medical institutions in Japan; 73 of 75 were included in the final analysis. Each participant underwent 2 independent CARS2 evaluations, one face-to-face and the other via telepsychiatry, conducted by different evaluators who were blinded to each other's ratings. Remote assessments were conducted using a secure video platform with caregiver facilitation. Agreement was assessed using intraclass correlation coefficients (ICCs) for the overall sample and subgroups defined by primary diagnosis, sex, and age. RESULTS: The overall ICC for CARS2 total scores between face-to-face and telepsychiatry assessments was 0.582 (95% CI 0.407-0.717), indicating moderate agreement. The ICC was 0.546 among participants with ASD as the primary diagnosis and 0.495 among those with ADHD as the primary diagnosis. Point estimates were higher among girls than boys (0.666 vs 0.495) and among children aged 11 years or older than among those aged 10 years or younger (0.676 vs 0.419). In a sensitivity analysis including all participants with an ASD diagnosis, the ICC was 0.580. CONCLUSIONS: CARS2 total scores obtained through telepsychiatry showed moderate agreement with scores obtained through face-to-face assessment when the assessments were conducted by different evaluators in different settings. Higher point estimates were observed among older children and girls, although these subgroup findings should be interpreted cautiously. Telepsychiatry-based CARS2 assessment may be considered a complementary approach rather than a replacement for comprehensive face-to-face evaluation. Larger studies using more standardized assessment protocols are needed.
Expert review of molecular diagnosticsCamellia Kianbakht, Maryam Ghelichli, Amir Attaran Khorasani, Jamshid Hashemi, Kioumars Maraghehmoghaddam, Nooshin Mohtasham
INTRODUCTION: Current diagnostic approaches to oral disease have limitations, highlighting the need for rapid, sensitive, and accessible technologies for routine clinical use. Biosensors can evaluate a wide range of biomarkers in oral conditions, including periodontal diseases, oral cancer, dental caries, oral infections, and peri-implant diseases. AREAS COVERED: We present a clinical perspective on salivary biosensors for oral diseases, focusing on biomarker discovery and technological advances, with particular emphasis on challenges and solutions. Integrating biosensors with artificial intelligence, smartphones, and digital health platforms holds promise for saliva-based diagnostics in modern dentistry. These technologies support continuous monitoring through teledentistry, thereby facilitating precision dentistry. Bridging the gap between laboratory innovation, clinical validation, regulatory approval, and commercialization will be essential for the broader adoption of oral biosensors. EXPERT OPINION: The use of wearable intraoral and portable POC biosensors could increase their clinical applicability in the future. Current limitations include long sensor response times, the computational demands of data processing, and reduced model performance across diverse patient populations. Future efforts should focus on efficient on-device data analysis and on developing robust systems that incorporate advances in both material and digital technologies, while ensuring manufacturability, user comfort, and sustained patient compliance.
Journal of visualized experiments : JoVEJing Wang, Jin Zhang
Accurate vertebral-level localization before percutaneous vertebroplasty (PVP) commonly requires fluoroscopic confirmation, and repeated imaging may prolong the localization workflow. This single-center randomized controlled trial evaluated a smartphone measurement application for transmitting distance data obtained from imaging to the patient's back to assess its clinical efficacy. A smartphone with a rear-facing LiDAR sensor was used as the measurement instrument. The LiDAR's principal function is to acquire high-precision three-dimensional point-cloud data of terrain, object surfaces, and the surrounding environment, thereby enabling accurate determination of object outlines and structures, measurement of distances, and detection of dynamic changes in ground objects. From October 2025 to March 2026, 43 patients with acute thoracolumbar osteoporotic vertebral compression fractures were allocated using a random-number table to smartphone measurement application (n = 21) or conventional anatomical localization with C-arm verification (n = 22). Outcomes included localization time (T0), the number of fluoroscopic images acquired during T0, initial localization accuracy, additional time required to correct a localization deviation (T1), and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores before surgery and at 3 months. Key findings: Compared with conventional localization, the smartphone measurement application resulted in a shorter T0, fewer fluoroscopic images during T0, and a shorter T1 (all P < 0.05). Initial localization accuracy was numerically higher in the smartphone measurement application group, but the between-group difference was not statistically significant (P > 0.05). VAS and ODI scores improved within both groups, with no significant between-group differences at 3 months (P > 0.05). The smartphone measurement application for smartphone measurement application improved localization efficiency without a detectable difference in initial accuracy or short-term clinical outcomes. Because radiation dose was not directly quantified, fewer fluoroscopic images should not be interpreted as proof of a proportional dose reduction.
European geriatric medicineSuzanne M Debeij, Miriam L Haaksma, Margot W M de Waal, Jolanda C M van Haastregt, Margriet C Pol, Marise J Kasteleyn, Eléonore F van Dam van Isselt
OBJECTIVE: This study explored the usability and feasibility of a sensor-based monitoring system that provides feedback on sedentary behaviour during inpatient and home-based geriatric rehabilitation from the perspectives of patients and healthcare professionals. METHODS: This mixed-methods study, which is part of the Better@Home study, included a focus group with care professionals, patient surveys, and collection of activity data (e.g. sedentary time and bout duration) via a wearable sensor monitoring system. Usability was assessed qualitatively, while feasibility was assessed using both qualitative data and quantitative adherence to the monitoring system. Focus group data were analysed using the framework method; other data were analysed descriptively. RESULTS: Twenty-six patients and nine care professionals participated. Usability was perceived as limited due to challenges on both the technology (e.g. measurement accuracy) and implementation level (e.g. tailored use and added value), which impeded integration into existing workflows. Feasibility was deemed sufficient since adherence levels were high. CONCLUSIONS: From the perspectives of patients and healthcare professionals, a sensor-based monitoring system that provides feedback on sedentary behaviour showed sufficient feasibility and limited usability. To facilitate the integration into existing workflows, measurement accuracy should be improved, and implementation should focus on tailored use that offers a clear added value, in line with patient goals.
JMIR human factorsShujie Dong, Qiushi Cai, Jingyi Ye, Yanya Chen, Rongsheng Zhao, Wai-Kit Ming
BACKGROUND: Online medical consultation (OMC) services have gained considerable attention as an integral component of telemedicine. Recently, AI has been increasingly integrated into OMC platforms, facilitating more efficient consultations and clinical decision-making. AI-driven OMC services can provide preliminary triage, medication guidance, and diagnostics for multiple medical conditions. Despite the availability and potential benefits of AI-driven OMC services, public acceptance and willingness to pay (WTP) for these services remain low. OBJECTIVE: This study aimed to identify perceived barriers, facilitators, expectations, and factors shaping public acceptance of and stated WTP for AI-driven OMC services. METHODS: We conducted semistructured qualitative interviews with patients, caregivers, and health care professionals to explore barriers, facilitators, expectations, and factors shaping public acceptance of and stated WTP for AI-driven OMC services. The study was informed by the theories of perceived risk and perceived benefit, which guided the development of the interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using NVivo (version 15; Lumivero) with deductive thematic analysis guided by these theories. Coding was conducted independently and cross-checked by 2 researchers to ensure credibility and consistency. RESULTS: Thematic analysis of 20 in-depth interviews identified 2 main themes and 11 subthemes. Perceived risks and perceived benefits emerged as 2 key perspectives influencing participants' acceptance and WTP. Psychological, governance, social, functional, health, and financial risks reduced acceptance, whereas convenience, diversity, reliability, efficiency, and educational benefits promoted it. Participants' self-reported WTP ranged from RMB 0 to RMB 200 (US $0-$27.28; RMB 1=US $0.1364 as of January 15, 2025), with participants who had prior experience with OMC generally reporting higher values than those without prior OMC experience. CONCLUSIONS: This study identified facilitators and barriers influencing public acceptance of and WTP for AI-driven OMC services using theoretical constructs. Our findings offer valuable insights into the development and refinement of AI-driven OMC services, enabling more targeted pricing strategies and tailored services that address public preferences and concerns, as well as supporting the development of standardized regulatory governance for digital medical consultation platforms.
Journal of healthcare quality researchR M Añel Rodríguez, F J García García
INTRODUCTION: Patient safety is a strategic priority for healthcare systems. In Spain, decentralisation of the National Health System (NHS) facilitates the adaptation of policies to regional characteristics, but poses challenges in terms of coordination, standardisation, and evaluation. OBJECTIVES: To compare regional patient safety strategies, assess their concordance with the 2015-2020 and 2025-2035 NHS strategies, and identify the changes and advances introduced in the new national strategy compared with its predecessor. METHODS: A retrospective descriptive study was conducted using documentary analysis of the strategies of Spain's 17 autonomous communities and the autonomous cities of Ceuta and Melilla. Their general characteristics and lines of action were analysed and classified according to their hierarchical level as primary, secondary, or absent. Concordance was assessed by directly comparing regional lines of action with conceptually equivalent lines in the 2015-2020 and 2025-2035 NHS strategies. An evolutionary content analysis was also conducted to identify changes between the two national strategies. Two researchers independently reviewed and coded all documentation, resolving discrepancies by consensus. RESULTS: Fourteen regional strategies were identified, showing considerable heterogeneity in structure, terminology, content, and evaluation systems. Eleven lines of action were present in all 14 strategies (100%), including organisation and leadership, safety culture and training, patient involvement, risk management, incident reporting, and safe practices related to healthcare-associated infections, surgery, medication, patient identification, and care. Coverage was lower for digital health and safe use of information and communication technologies (28.6%), safe healthcare environments and emergency care (35.7%), and transfusion safety, diagnostic safety, and low-value practices (42.9%). The 2025-2035 NHS strategy broadens the scope of safe clinical practices and incorporates emerging challenges related to digitalisation, continuity of care, and the reduction of low-value practices. CONCLUSIONS: Regional patient safety strategies show broad convergence around core lines of action, together with substantial heterogeneity in structure, terminology, and coverage of less established areas. Areas related to organisation and leadership, safety culture, training, incident management, and several safe clinical practices show greater coverage, whereas diagnostic safety, mental health, support for second and third victims, care transitions, remote care, emergency care, and reduction of low-value practices show more variable presence and hierarchical positioning across regions. The evolution from the 2015-2020 to the 2025-2035 NHS strategy reflects an expansion of strategic priorities, particularly in safe clinical practices, digitalisation, continuity of care, and reduction of low-value practices.
OBJECTIVE: A digital health application dedicated to polyendocrine metabolic ovarian syndrome (PMOS), the SOLENCE application, was offered to patients diagnosed with PMOS according to the Rotterdam criteria at a University Hospital. We seek to evaluate the impact of the SOLENCE application on patients' quality of life. METHODS : Questionnaires assessing the quality of life of PMOS patients, their anxiety, depression, and sexual satisfaction before and after 6 months of using the app were compared. The inclusion period was from November 2023 to December 2024. The questionnaire consisted of four validated sub-questionnaires: PCOSQOL (Polycystic Ovary Syndrome Quality of Life), HADS (Hospital Anxiety and Depression Scale), ASEX (Arizona Sexual Experience Scale), and FACT-G7 (Functional Assessment of Cancer Therapy - General - 7 Item Version). RESULTS: A total of 54 patients were included. After comparing the questionnaires before and after using the app, only the FACT-G7 questionnaire, which assesses overall quality of life in the monitoring of chronic diseases showed a statistically significant worsening. The lack of statistical power due to the small sample size may partially explain these results. In addition, the patients who logged in most frequently felt that the SOLENCE app could have a place in the medical monitoring of PMOS patients. CONCLUSION : The SOLENCE app does not appear to provide any benefit to our patients with PMOS. Further studies are needed to investigate the improvement in PMOS symptoms between users and non-users of the app, which has since been updated to offer more personalized content.
BACKGROUND: Alcohol use disorder (AUD) involves an impaired ability to stop or control alcohol use despite adverse consequences and represents a major public health problem. While AUD is most prevalent among college students, integrated evidence-based treatments for this population are lacking. OBJECTIVE: The objectives of our study were to test the feasibility and acceptability of a newly developed behavioral intervention, problem-solving therapy and Apple Watch (PST-APPLE), and to preliminarily investigate the effectiveness of PST-APPLE among college students with symptoms of AUD. METHODS: Participants were recruited through online advertising and on campus at universities in the Chicago area between May and September 2024. They were randomized in a 1:1 ratio using block randomization to the intervention group (PST-APPLE: n=12 individuals) or the control group (education-only: n=14 individuals), with the data analyst blinded to treatment assignment. Participants in the intervention group completed 12 weeks of the PST-APPLE intervention, delivered remotely via Zoom videoconferencing and interactions with the Apple Watch. Participants in the control group were asked to watch a 20-minute abstinence-motivation video and then participate in a 30-minute group discussion via Zoom. All participants completed follow-up assessments at 3 months. Outcomes included alcohol-related problems (Alcohol Use Disorders Identification Test [AUDIT] and Rutgers Alcohol Problem Index [RAPI]) and drinking motivation (Drinking Motives Questionnaire Revised [DMQR]). RESULTS: We enrolled 26 participants aged 18-25 years. The mean age was 22.5 (SD 2.20) years. We found reduced scores between preintervention and postintervention measures in the intervention group using 2-tailed paired t tests and baseline-adjusted analysis of covariance, including reduced alcohol misuse and problems (AUDIT and RAPI scores) and reduced DMQR social and coping motivation scores. Baseline-adjusted mean differences comparing the intervention with the control group showed reductions in alcohol use (AUDIT; mean difference -4.70, 95% CI -8.69 to -0.70) and in DMQR social motivation (mean difference -0.85, 95% CI -1.51 to -0.18) and enhancement motivation scores (mean difference -0.75, 95% CI -1.47 to -0.04). CONCLUSIONS: Our study findings indicate that the PST-APPLE intervention is feasible, acceptable, and hypothesis generating among college students with AUD. While findings are promising, this pilot study was not powered for definitive efficacy testing. A fully powered randomized controlled trial is needed to confirm these effects. Future studies could adapt PST-APPLE to other wrist-worn electronic devices/watches that capture physiological data (eg, Fitbit, Samsung Galaxy Watch) to increase reach and scalability, particularly among younger adults and digitally literate populations.
Journal of medical Internet researchChengji Yu, Ping Lu, Ying Zhou, Juan Zhao, Xiaodie Yang, Dayu Tang, Liying Ying
BACKGROUND: Intrinsic capacity (IC) has become a central concept in healthy aging because it emphasizes functional ability across the aging trajectory rather than disease alone. However, current IC assessment primarily relies on episodic clinical evaluations, which are insufficient for continuous monitoring and early identification of functional decline. Recent advances in AI and digital health technologies have created new opportunities for objective, continuous, and real-world assessment of IC. However, existing evidence remains fragmented across AI-enabled devices, digital biomarkers (DBs), AI techniques, and IC domains. OBJECTIVE: This scoping review aimed to systematically synthesize the current evidence on AI-based measurement tools for IC and to characterize the landscape of AI-enabled IC assessment using a 3D analytical framework integrating AI-enabled digital devices and systems, DBs, and AI techniques. METHODS: A comprehensive search of PubMed, Embase, CINAHL, PsycINFO, the Cochrane Library, SinoMed, and China National Knowledge Infrastructure (CNKI) was conducted from database inception to July 2025 and updated on May 31, 2026, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline. Studies investigating AI-based measurement tools applicable to one or more IC domains were included. RESULTS: A total of 161 studies met the inclusion criteria. Research on AI-based measurement tools for IC has expanded rapidly since 2016, with studies conducted in 28 countries, predominantly the United States and China. Most studies focused on a single IC domain, with cognition accounting for the largest proportion. Eleven categories of AI-enabled digital devices and systems were identified, among which multimodal data acquisition devices, computer vision (CV) systems, and AI-driven health platforms were the most frequently reported. Twenty-one types of DBs were extracted and classified into 3 major categories, with gait parameters, digital task performance, physical activity features, speech and language features, and facial features representing the most commonly used biomarkers. Machine learning and deep learning were the predominant AI techniques, while CV and natural language processing played central roles in multimodal data interpretation. The distribution and maturity of evidence varied substantially across domains, with cognition and locomotor capacity representing the most developed areas, whereas vitality, hearing, and multidomain IC assessment remained comparatively underrepresented. CONCLUSIONS: This scoping review provides a 3D synthesis of AI-enabled digital devices and systems, DBs, and AI techniques across the 6 World Health Organization (WHO)-defined domains of IC. Unlike previous technology-, disease-, or domain-specific reviews, it compares evidence across the broader IC framework, identifying more developed areas, key evidence gaps, and priorities for standardization, external validation, and multidomain assessment. AI-based measurement tools may complement conventional assessment in community, primary care, and home settings, although their clinical translation will require robust validation, integration into care pathways, and implementation approaches that address the needs of older adults.
Journal of medical Internet researchJessica Faiz, Caroline Gray, Allison Engstrom, Justine Seidenfeld, Anita A Vashi
BACKGROUND: Emergency departments (EDs) face persistent challenges related to overcrowding, boarding, ambulatory care access barriers, and workforce strain, contributing to compromised patient care and high rates of physician burnout. Virtual care has emerged as a potential strategy to alleviate pressure on emergency care systems. In 2020, the Veterans Health Administration (VA) launched the national Tele-Emergency Care (TEC) program, in which patients who call a call center can be connected to an emergency medicine clinician by phone or video. Although virtual care may help address ED capacity and clinician burnout, the perspectives of emergency medicine-trained clinicians remain limited. OBJECTIVE: The aim of this study is to examine the experiences of emergency medicine clinicians participating in VA's TEC program. METHODS: As part of a national mixed methods evaluation of TEC, we conducted semistructured interviews with clinicians delivering emergency care through TEC between February 2025 and June 2025. Participants (n=15) were recruited via multistage purposeful sampling from 4 of 18 regional TEC programs that varied in geography, volume, duration, and operational models. Interviews explored experiences of providing care in a virtual environment, including perceived benefits and challenges. We performed a descriptive qualitative analysis. RESULTS: We interviewed 14 physicians and 1 nurse practitioner with formal emergency medicine training. Interviewees described four primary themes: (1) clinical decision-making in a virtual environment; (2) development of the provider-patient relationship; (3) clinician job satisfaction and professional well-being; and (4) challenges. Participants reported that TEC provided perceived opportunities to avoid ED referrals, more focused patient interactions, and improved job satisfaction related to flexible virtual shifts. Reported challenges included filling primary care gaps and performing care coordination tasks. CONCLUSIONS: TEC represents an emerging model of emergency care delivery that clinicians perceive may expand access, prevent avoidable ED visits, and support clinician well-being while also introducing distinct clinical and operational challenges. Our findings can inform the implementation of similar emergency telehealth services in other health systems.
European heart journalGerhard-Paul Diller, Curt Daniels, Ariane Marelli
Over the past decades, advances in the diagnosis and treatment of congenital heart disease have reshaped its epidemiology. Congenital heart disease is now increasingly a chronic, lifelong disorder, with adult survivors outnumbering affected children in many countries. This demographic transition has shifted the focus from preventing early mortality towards optimizing long-term health and managing comorbidities. Adult congenital heart disease (ACHD) experience acquired cardiovascular and systemic complications that challenge traditional models of care. As the lifelong burden of disease in ACHD patients continues to rise globally, advanced training pathways in ACHD have spearheaded the content expertise required to deliver high quality of care. The well-established hub-and-scope model has been recommended in the last two decades to improve ACHD care by expanding the number of specialized centres that allow ACHD specialists to reach underserved regions more effectively. However, the advent of technology, digital health, and artificial intelligence-enhanced decision-making provides an opportunity to imagine a different approach, to coordinate advances in research, clinical care, and health system design, with particular emphasis on scalable models that align expertise, data, and delivery across the life course. Networked care structures, workforce redesign, and digitally enabled learning health systems offer a pathway to close persistent gaps in care access and quality. Ultimately, the future of ACHD care will depend on our ability to integrate these innovations into routine practice, ensuring that extended survival is matched by preserved function, quality of life, and equitable outcomes at the population scale.
JMIR research protocolsMichela Falcone, Francesco Giuliani, Stephen Gilbert, Oscar Freyer, Francesco Ricciardi
BACKGROUND: Remote patient monitoring (RPM) systems based on the Internet of Medical Things (IoMT) technologies are increasingly integrated into chronic disease management and telemedicine pathways. Despite their widespread adoption, cybersecurity performance, system resilience, and user behavior in real-world clinical environments remain underexplored. Existing evidence is fragmented, often limited to laboratory simulations or vendor-driven assessments, leaving a critical gap in understanding how cybersecurity risks across the full life cycle of RPM systems deployed in health care settings. OBJECTIVE: This study aims to systematically analyze the cybersecurity posture, system resilience, and user behavior across the full life cycle of IoMT-enabled RPM systems in a real-world hospital and home-care environment. The study aims to generate empirical evidence on how technical safeguards, operational workflows, and human factors influence cybersecurity risks during procurement, integration, deployment, routine use, and decommissioning of these platforms. METHODS: This observational study will analyze 2 independent RPM systems used for chronic disease monitoring in a real-world hospital setting. The assessment framework includes (1) system-log analytics to evaluate authentication events, device connectivity, update and patch management, and anomalous behaviors; (2) a controlled phishing simulation targeting health care professionals to assess susceptibility and response patterns; (3) an evaluation of update management processes and vendor-hospital interactions; (4) measurement of cybersecurity awareness and practices among patients and health care professionals using validated instruments; and (5) mapping of vulnerabilities across all life cycle phases, from procurement to decommissioning. Although the study includes cybersecurity training, preassessments/postassessments, and controlled phishing and update-management scenarios, these activities are part of the observational framework and are not designed as experimental interventions that have an impact on the clinical aspects of patient care. Quantitative data will be analyzed using descriptive and inferential statistics, while qualitative insights from operational workflows will be integrated to contextualize system performance. Ethical approval has been obtained from the institutional ethics committee. RESULTS: The CYMEDSEC (enhanced cybersecurity for networked medical devices through optimization of guidelines, standards, risk management, and security by design) project received funding from the European Union's Horizon Europe program (grant 101094218) and started on November 1, 2024. Ethical approval was obtained on December 18, 2025, and institutional authorization on January 29, 2026. Patient enrollment is scheduled to begin on April 1, 2026. At the time of paper submission, no patients were recruited. Data analysis will begin after completion of patient involvement, with results expected before the project end date in October 2027. CONCLUSIONS: This study will provide real-world evidence on the cybersecurity performance of IoMT-enabled RPM systems, capturing the interplay among technical safeguards, operational processes, and human factors. Findings are expected to support the development of security-by-design approaches, inform procurement and regulatory frameworks, and guide the safe integration of connected medical devices into routine care within the framework of the CYMEDSEC research project.