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Background: During the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs. Methods: This study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs. Results: Primary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14). Conclusions: Digital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies. [ABSTRACT FROM AUTHOR]

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

Background : The prevention of type 2 diabetes (T2DM) is recognised as a health care priority in the UK. In people living with T2DM, lifestyle changes (e.g. increasing physical activity) have been shown to slow disease progression and protect from the development of associated comorbidities. The use of digital health technologies provides a strategy to increase physical activity in patients with chronic disease. Furthermore, behaviour economics suggests that financial incentives may be a useful strategy for increasing the maintenance and effectiveness of behaviour change intervention, including physical activity intervention using digital health technologies. The Milton Keynes Activity Rewards Programme (MKARP) is a 24-month intervention which combines the use of a mobile health app, smartwatch (Fitbit or Apple watch) and financial incentives to encourage people living with T2DM to increase physical activity to improve health. Therefore, this randomised controlled trial aims to examine the long-term acceptability, health effects and cost-effectiveness of the MKARP on HbA1c in patients living with T2DM versus a waitlist usual care comparator. Methods: A two-arm, single-centre, randomised controlled trial aiming to recruit 1018 participants with follow-up at 12 and 24 months. The primary outcome is the change in HbA1c at 12 months. Secondary outcomes included changes in markers of metabolic, cardiovascular, anthropometric, and psychological health along with cost-effectiveness. Recruitment will be via annual diabetes review in general practices, retinal screening services and social media. Participants aged 18 or over, with a diagnosis of type 2 diabetes and a valid HbA1c measurement in the last 2 months are invited to take part in the trial. Participants will be individually randomised (1:1 ratio) to receive either the Milton Keynes Activity Rewards Programme or usual care. The intervention will last for 24 months with assessment for outcomes at baseline, 12 and 24 months. Discussion: This study will provide new evidence of the long-term effectiveness of an activity rewards scheme focused on increasing physical activity conducted within routine care in patients living with type 2 diabetes in Milton Keynes, UK. It will also investigate the cost-effectiveness of the intervention. Trial registration: ISRCTN 14925701. Registered on 30 October 2023. [ABSTRACT FROM AUTHOR]

This study proposes a synthetic data generation model to create a classification framework for cerebellar ataxia patients using trajectory data from the visuomotor adaptation task. The classification objectives include patients with cerebellar ataxia, age-matched normal individuals, and young healthy subjects. Synthetic data for the three classes is generated based on class conditions and random noise by leveraging a combination of conditional adversarial generative neural networks and reconstruction networks. This synthetic data, alongside real data, is utilized as training data for the patient classification model to enhance classification accuracy. The fidelity of the synthetic data is assessed visually to measure the validity and diversity of the generated data qualitatively while quantitatively evaluating distribution similarity to real data. Furthermore, the clinical efficacy of the patient classification model employing synthetic data is demonstrated by showcasing improved classification accuracy through a comparative analysis between results obtained using solely real data and those obtained when both real and synthetic data are utilized. This methodological approach holds promise in addressing data insufficiency in the digital healthcare domain, employing deep learning methodologies, and developing early disease diagnosis tools. [ABSTRACT FROM AUTHOR]

Background: There are avoidable differences (i.e., inequities) in the prevalence and distribution of chronic pain across diverse populations, as well as in access to and outcomes of pain management services. Digital pain self-reporting tools have the potential to reduce or exacerbate these inequities. This study aimed to better understand how to optimise the health equity impact of digital pain self-reporting tools on people who are experiencing (or are at risk of) digital pain inequities. Methods: This was a qualitative study, guided by the Health Equity Impact Assessment tool—digital health supplement (HEIA-DH). We conducted three scoping focus groups with multiple stakeholders to identify the potential impacts of digital pain self-reporting tools and strategies to manage these impacts. Each group focused on one priority group experiencing digital pain inequities, including older adults, ethnic minorities, and people living in socio-economically deprived areas. A fourth consensus focus group was organised to discuss and select impact management strategies. Focus groups were audio-recorded, transcribed verbatim, and analysed using a framework approach. We derived codes, grouped them under four pre-defined categories from the HEIA-DH, and illustrated them with participants' quotes. Results: A total of fifteen people living with musculoskeletal pain conditions and thirteen professionals took part. Participants described how digital pain self-reports can have a positive health equity impact by better capturing pain fluctuations and enriching patient-provider communication, which in turn can enhance clinical decisions and self-management practices. Conversely, participants identified that incorrect interpretation of pain reports, lack of knowledge of pain terminologies, and digital (e.g., no access to technology) and social (e.g., gender stereotyping) exclusions may negatively impact on people's health equity. The participants identified 32 strategies, of which 20 were selected as being likely to mitigate these negative health equity impacts. Example strategies included, e.g., option to customise self-reporting tools in line with users' personal preferences, or resources to better explain how self-reported pain data will be used to build trust. Conclusion: Linked to people's personal and social characteristics, there are equity-based considerations for developing accessible digital pain self-reporting tools, as well as resources and skills to enable the adoption and use of these tools among priority groups. Future research should focus on implementing these equity-based considerations or strategies identified by our study and monitoring their impact on the health equity of people living with chronic pain. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Therapeutic digital health applications (DiGAs) are expected to significantly enhance access to evidence-based care. Since 2020, German physicians and psychotherapists have been able to prescribe approved DiGAs, which are reimbursed by statutory health insurance. This study investigates the usage, knowledge and perception of DiGAs as well as the growing digitalization among internal medicine physicians in Germany. Methods: A web-based survey was distributed at the 2024 annual congress of the German Society for Internal Medicine. Participants could respond by scanning a QR code or directly on a tablet. Results: A total of 100 physicians completed the survey, with a mean age of 43.4 years. The majority were internal medicine physicians (85%). Of the respondents, 31% had already prescribed DiGAs, and 29% had tested one. Self-rated knowledge of DiGAs was low (median score 3.17/10). The main barriers identified were lack of knowledge about effective implementation (60%), lack of time for patient onboarding (27%), and concerns about patient adherence (21%). However, 92% believed that DiGAs could improve care, and 88% expressed interest in specific digital health training. The majority (64%) stated that digitalization had a positive impact on medical care and 39% of physicians expected their daily workload to decrease due to digitalization. In addition, 38% believed that the physician-patient relationship would improve as a result of digitalization. Conclusions: While physicians widely acknowledged the potential benefits of DiGAs, adoption and understanding remain limited. Specific training in digital health is crucial to accelerate digitalization in internal medicine. [ABSTRACT FROM AUTHOR]

Aim: Identify the skills and knowledge future nurse and midwife leaders might require in the next 6 years. Design/methodology/approach: An online questionnaire elicited health professionals' perspectives on the future requirements for nurse and midwife leaders. Qualitative data were generated in response on health care and the likely leadership skills for the future. Data were extracted and analysed using qualitative content analysis. Findings: Four generic categories were abstracted from the core category 'Nursing and Midwifery Leadership'. These were values/traits; creating positive healthcare cultures; digital capability/competence; and systems thinking. Limitations/implications. This first stage evaluation has gained a wide variety of perspectives regarding the perceived skills and knowledge future nurse and midwife leaders might need. This is important to enable those who deliver leadership development programmes to plan appropriately, ensuring their programmes are designed and adjusted in response to the needs of a shifting health and care landscape. However, over 50% of respondents were White, so the data may not be representative of the diversity of registered nurses and midwives. The findings may not have direct relevance to the global context due to geographical limitations. [ABSTRACT FROM AUTHOR]

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT). Methods/design: We will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period. Discussion: Individuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes. This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024. [ABSTRACT FROM AUTHOR]

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

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

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

Objective: Web-based platforms for delivering physical activity (PA) to people with developmental disabilities have a great potential to improve the lives of many. However, their design, including the content design, lacks sufficient investigation. This study aims to evaluate three online platforms for delivering PA to people with developmental disabilities in terms of content quality and identify relevant barriers and facilitators of PA delivery. Methods: The study used a methodological triangulation approach which involved quantitative evaluations by experts using an evaluation rubric, on-site observations and in-depth interviews with recruited participants. The participants consisted of 15 pairs of individuals, each consisting of a person with developmental disabilities and their primary caregiver. They were instructed to watch and follow five PA video content from each of the three platforms. The on-site observations and interviews were conducted in a large computer-equipped meeting room setting. Results: The quantitative and qualitative analysis identified a set of barriers and facilitators of PA delivery related to content quality. Key barriers identified include a lack of content diversity, insufficient understanding of developmental disabilities among content creators, inappropriate language usage, and resistance to engaging in physical activities in home settings. Significant facilitators were pinpointed, such as incorporating engaging elements for individuals with developmental disabilities, utilising easy-read language, and ensuring sufficient repetition for effective learning. The results from the triangulation showed that the multiple methods were complementary and converged on the same outcome. Discussion: The study findings could contribute to the development of adequately adapted PA content to distribute knowledge to populations with developmental disabilities. IMPLICATIONS FOR REHABILITATION: Content delivered via online platforms has the potential to convey knowledge about physical activity to a significant number of individuals with developmental disabilities without the limitations of time and space. The absence of prescribed content guidelines to effectively impart physical activity to individuals with developmental disabilities impedes the process of online knowledge translation. There is a requirement for varied physical activity content encompassing various individuals with developmental disabilities, considering their diverse learning contexts. It is essential that content development is evaluated with input from experts in developmental disabilities in order to provide quality physical activity information for people with developmental disabilities. [ABSTRACT FROM AUTHOR]

Recent advancements in mobile health (mHealth) technology and the ubiquity of wearable devices and smartphones have expanded a market for digital health and have emerged as innovative tools for data collection on individualized behavior. Heterogeneous levels of device usage across users and across days within a single user may result in different degrees of underestimation in passive sensing data, subsequently introducing biases if analyzed without addressing this issue. In this work, we propose an unsupervised 2-Stage Pre-processing Algorithm for Passively Sensed mHealth Data (2SpamH) algorithm that uses device usage variables to infer the quality of passive sensing data from mobile devices. This article provides a series of simulation studies to show the utility of the proposed algorithm compared to existing methods. Application to a real clinical dataset is also illustrated. [ABSTRACT FROM AUTHOR]

Wearable devices have a significant impact on society, and recent advancements in modern sensor technologies are opening up new possibilities for healthcare applications. Continuous vital sign monitoring using Internet of Things solutions can be a crucial tool for emergency management, reducing risks in rescue operations and ensuring the safety of workers. The massive amounts of data, high network traffic, and computational demands of a typical monitoring application can be challenging to manage with traditional infrastructure. Cloud computing provides a solution with its built-in resilience and elasticity capabilities. This study presents a Cloud-based monitoring architecture for remote vital sign tracking of paramedics and medical workers through the use of a mobile wearable device. The system monitors vital signs such as electrocardiograms and breathing patterns during work sessions, and it is able to manage real-time alarm events to a personnel management center. In this study, 900 paramedics and emergency workers were monitored using wearable devices over a period of 12 months. Data from these devices were collected, processed via Cloud infrastructure, and analyzed to assess the system's reliability and scalability. The results showed a significant improvement in worker safety and operational efficiency. This study demonstrates the potential of Cloud-based systems and Internet of Things devices in enhancing emergency response efforts. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about a project that aimed to support teams caring for children and young people to reflect on their experiences and the effects of the coronavirus disease 2019 (COVID-19) pandemic • To recognise the need to ensure staff are adequately prepared to manage any future surges in respiratory illness effectively • To be aware of the potential long-term effects of the COVID-19 pandemic on emotional health and well-being. The coronavirus disease 2019 (COVID-19) pandemic was a challenging experience for children and young people’s services, and the workforce. The Valuing All Staff Together programme was a one-year project hosted by the North West Paediatric Critical Care, Surgery in Children, Long Term Ventilation Operational Delivery Network to support teams caring for children and young people to reflect on their experiences of the COVID-19 pandemic. Using an online survey, focus groups and interviews, it gave staff the opportunity to explore and understand the effects of the pandemic and the subsequent surge in demand, including how these affected services and the emotional health and well-being of staff. This would enable better preparation for future surges in respiratory illness in terms of learning, training and development. This article describes the programme’s aim, method and findings, and the main recommendations for practice. [ABSTRACT FROM AUTHOR]

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

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

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

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

Background: Mild traumatic brain injury (mTBI) is becoming a more common emergency department (ED) presentation. Towards this end, many types of testing in the acute setting are being investigated. One of these is screening for convergence insufficiency (CI) symptoms. These are common problems reported by patients with mTBI, but such oculomotor testing is rarely performed in the ED. Objective: To assess the feasibility of convergence insufficiency screening in the ED and investigate whether CI is associated with adverse events such as post-concussive symptoms or hospital admission. Methods: Written informed consent was obtained from patients age 18 years or older who experienced a mild head injury from any mechanism resulting in an mTBI. Patients underwent screening for CI symptoms using a standardized instrument of 15 questions, known as the convergence insufficiency symptom survey (CISS), with responses based on the Likert scale. These data were correlated to outcomes of hospital admission, occurrence of post-concussive symptoms, and 30-day hospital re-admission. Results: A total of 116 patients were prospectively enrolled, of which 58 were male. The median age was 31 years, with a range of 18 to 95 years of age. The median CISS score was 13, with an interquartile range (IQR) of 6 to 21 and an overall range of 0 to 53. Females presented with a median CISS score of 14, which was higher compared to the male median score of 10. The higher the CISS score, the more likely the patient was to be admitted to the hospital (p = 0.0378), develop symptoms of post-concussive syndrome at 30-day follow up (p = 0.0322), and be readmitted within 30 days (p = 0.0098). Conclusions: Screening for CI symptoms using the CISS can be a solid adjunct in the evaluation of mTBI in the ED. The CISS is easy and fast to administer, and it is a useful tool to stratify patients in terms of who is at the highest risk of developing complications related to the mTBI. [ABSTRACT FROM AUTHOR]

Background/Aims: Feedback plays a pivotal role in learning, but traditional written feedback often lack engagement and specificity, hindering learners' ability to effectively apply feedback. In midwifery education, the need for innovative feedback delivery mechanisms is pronounced. The aim of this study was to evaluate the integration of digital health technologies in feedback delivery in a midwifery programme. Methods: A novel communication strategy was implemented in a midwifery programme in northwest England, where the benefits, challenges and future implications of leveraging digital health technologies for assessment feedback were assessed. Results: Preferences were mixed, with 45.1% of learners favouring written feedback. Verbal feedback was perceived as more personal and motivating, and valued for its nuance, tone and ability to clarify complex points, although written feedback provided clearer, detailed information for future reference. Less experienced markers struggled with verbal feedback, while more experienced markers appreciated the quicker, more refreshing process. All markers found feedback templates helpful for ensuring equitable feedback. Conclusions: This study scrutinised the significance of rethinking feedback delivery in midwifery education and indicates that digital health technologies present promising opportunities for reshaping the feedback landscape. Implications for practice: Developing student confidence and competence in digital literacy remains a significant challenge. Higher education institutions can collaborate with healthcare providers to offer training in digital health technologies, helping midwives adapt to modern clinical environments. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a co-designed intervention using digital resources "Vietnam Cancer Caring Coping" (V-CCC) on the health literacy, depression, and quality of life of caregivers supporting a cancer patient in oncology hospitals in Vietnam. Methods: A pre-post quantitative evaluation with adult cancer caregivers across regional Oncology hospitals in Vietnam (Ho Chi Minh City, Da Nang, Can Tho, and Hue). Participants completed baseline and follow-up measures of health literacy (HLS-SF12) depression (PHQ-9) and Health-related Quality of Life (5Q-5D-5L). Participants accessed and reviewed V-CCC for a 2-week period. Results: Two hundred and thirty-four caregivers completed pre and post-tests. Most participants were female (n = 143, 61%), married (n = 165, 70%), aged 18–44 (n = 155, 66%), lived rurally (n = 157, 67%). All health literacy scores of participants in post-intervention were significantly higher than that in pre-intervention across all domain's healthcare, disease prevention, and health promotion as well as the total score (p < 0.001). A significant reduction in the proportion of caregivers reporting PHQ-9 moderately severe/severe depression post-intervention was demonstrated (10.2 vs. 6.1%, respectively (p ≤ 0.001). No significant differences were observed pre and post-intervention across four 5Q-5D-5L health dimensions: mobility, self-care, usual activities, and pain/discomfort. Regarding anxiety/depression as measured by 5Q-5D-5L the proportion of participants who reported having moderate, severe, and extreme problems in pre- and post-intervention was statistically significant (32 vs. 24%), respectively (p = 0.0028). Conclusion: Co-designed digital resources can reduce health literacy inequities and improve psychological outcomes for cancer caregivers. [ABSTRACT FROM AUTHOR]

Little research is available to provide practical guidance to health care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs. What exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program? Sixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an a priori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM. Seven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists. A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAM Fit remote exercise program. [ABSTRACT FROM AUTHOR]

Objective: Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements, such as digital health apps. This pilot study aimed to explore the effectiveness and safety of a novel bCBT application for treating unipolar depression in adults combined with cognitive behavioral therapy (CBT) compared to CBT alone in routine care. Methods: Patients (N = 82) were randomly assigned to bCBT (n = 42) or CBT (n = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the elona therapy depression module (a bCBT application for unipolar depression) for use between sessions. Standard CBT consisted of weekly CBT sessions. Outcomes (6,12 weeks) were analyzed with linear mixed models. Results: Improvements in depressive symptoms (BDI-II, PHQ-9) were descriptively larger for the bCBT group. Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d =.50) and generalized anxiety symptoms (d = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT. Conclusion: This pilot study provided preliminary evidence that bCBT might be advantageous in comparison to CBT alone in the treatment of depression, but larger RCTs of the bCBT application are needed. [ABSTRACT FROM AUTHOR]

Cancer places a high burden on society and health-care systems. Cancer research requires high-quality data, which is resource-intensive to obtain. Using administrative datasets such as cancer registries could improve the efficiency of cancer studies if data were valid and timely. We aimed to compare the validity and timeliness of diagnostic cancer data on-site during the SYMPLIFY study to that obtained from the cancer registries of England and Wales. Cancer data were collected from 5461 participants across 44 hospital sites during a prospective observational study in England and Wales, SYMPLIFY (ISRCTN10226380). Linked cancer data were obtained from Digital Health and Care Wales (DHCW), the Welsh Cancer Intelligence and Surveillance Unit (WCISU), and the English National Cancer Registration Dataset (NCRD) and Rapid Cancer Registration Dataset (RCRD), regularly between April, 2022, and September, 2023. The primary objectives of the study were to evaluate the validity (via assessment of the proportion of completed data fields and concordance with SYMPLIFY sites), and timeliness of the data in all datasets, for all cancers diagnosed within 9 months of study enrolment. Data fields investigated were cancer site via International Classification of Disease, 10th Revision (ICD-10) code; cancer morphology via International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) morphology histology code and broad morphological grouping; overall stage; and TNM classification. For data collected between April, 2022, and September, 2023, completeness at the last data cut available for each dataset ranged from 84% to 100% for ICD-O-3 morphology, from 43% to 100% for overall stage, and from 74% to 83% for TNM stage. The concordance between SYMPLIFY data and NCRD was 96% (95% CI 92–98) for ICD-10, 60% (53–66) for ICD-O-3 morphology, 83% (78–88) for ICD-O-3 broad morphology groupings, 73% (67–78) for stage, and 51% (44–59) for TNM; and with WCISU was 89% (95% CI 81–94) for ICD-10, 63% (53–73) for ICD-O-3 morphology, 80% (70–87) for ICD-O-3 broad morphology groupings, 83% (74–90) for overall stage, and 49% (38–61) for TNM stage. Concordance between SYMPLIFY and RCRD was 95% (95% CI 92–98) for ICD-10, 67% (60–74) for ICD-O-3 morphology, 85% (79–90) for ICD-O-3 broad morphology groupings, and 73% (65–80) for overall stage; and between SYMPLIFY and DHCW was 96% (91–99) for ICD-10, 74% (64–83) for ICD-O-3 morphology, 84% (75–91) for ICD-O-3 broad morphology groupings, and 87% (74–95) for stage. The SYMPLIFY dataset reached completion at 12 months post-enrolment in November, 2022, compared with 13 months for NCRD in December, 2023. RCRD and DHCW reached completion at 13 months and 15 months post-enrolment, in December, 2022, and February, 2023, respectively. We report similar completeness of data fields, concordance, and timeliness between on-site and centrally collected cancer outcomes data. Our findings suggest that central registry data can help alleviate the resource burden in clinical trials and improve cancer research. Cancer registries might need additional resources to provide data for registry-based trials at scale. GRAIL Bio UK. [ABSTRACT FROM AUTHOR]

The editorial discusses the ValueCare project, which aims to improve health and social care for aging communities by incorporating communication perspectives and Information and Communication Technologies (ICTs). The project focuses on integrated care, value-based approaches, digital solutions, and patient involvement to support older people's self-healthcare management in seven European pilot sites. Communication plays a crucial role in coordinating collaboration among different units, facilitating shared decision-making, and designing digital solutions. The project emphasizes the importance of intercultural communication and international collaborations to address public health challenges associated with population aging. [Extracted from the article]

Background: Digital self-management tools including mobile apps and wearables can enhance personalized care in Parkinson's disease, and incorporating patient and clinician feedback into their evaluation can empower users and nurture patient-clinician relationships, necessitating a review to assess the state of the art and refine their use. Objective: This review aimed to summarize the state of the art of self-management systems used in Parkinson's disease management, detailing the application of self-management techniques and the integration of clinicians. It also aimed to provide a concise synthesis on the acceptance and usability of these systems from the clinicians' standpoint, reflecting both patient engagement and clinician experience. Methods: The review was organized following the PRISMA extension for Scoping Reviews and PICOS frameworks. Studies were retrieved from PubMed, CINAHL, Scopus, ACM Digital Library, and IEEE Xplore. Data was collected using a predefined form and then analyzed descriptively. Results: Of the 15,231 studies retrieved, 33 were included. Five technology types were identified, with systems combining technologies being the most evaluated. Common self-management strategies included educational material and symptom journals. Only 11 studies gathered data from clinicians or reported evidence of clinician integration; out of those, six studies point out the importance of raw data availability, data visualization, and integrated data summaries. Conclusions: While self-management systems for Parkinson's disease are well-received by patients, the studies underscore the urgency for more research into their usability for clinicians and integration into daily medical workflows to enhance overall care quality. Plain Language Summary: Digital tools, such as smartphone applications and wearable devices, could help people with Parkinson's disease manage their symptoms by using data and technology to provide support that is personalized to them and by supporting communication between patients and healthcare providers. This review studies current literature on these digital self-management systems for people with Parkinson's disease. Of the 33 studies included in our review, we found that many of these systems combine different types of digital technologies (for example, a mobile app and a wearable sensor). The most common strategies to help support patients with self-management included in these digital tools were providing educational health content and symptom diaries. Only a few studies have considered healthcare providers' perspectives on these systems. Those that did highlighted a need for better access to patient data, improved data presentation, and summaries of key health insights. While patients find digital self-management tools favorable, further research is needed to ensure they meet healthcare providers' professional needs and can fit easily into daily clinical routines, ultimately improving care for individuals with Parkinson's disease. [ABSTRACT FROM AUTHOR]

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

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

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

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

Background: Time-driven activity-based costing (TDABC) and activity-based costing (ABC) are methods used in the healthcare sector to assess the costs of patient care pathways. These methods help identify opportunities for optimizing and reducing activity times without compromising the quality of care. TDABC is recommended in the Value-Based Healthcare (VBHC) model to assess the outcomes of care pathways in relation to their associated costs. By focusing on the creation of value for patients, TDABC helps identify the interventions and processes that provide the most value in terms of clinical outcomes and patient satisfaction. This enables healthcare organizations to make informed decisions on improvements that will maximize value for patients. The aim of the study is to evaluate the cost of the oncology thoracic surgery care pathway prior to and following the implementation of digital health solution. Methods: We have chosen to use the TDABC and ABC methods to calculate the costs of care pathway for oncology patients undergoing thoracic surgery in two healthcare establishments prior to and following the implementation of a digital health solution. By using these methods, we were able to calculate the costs associated with each stage of the patients' care pathway. This has given us a clearer picture of the costs associated with each activity and a better understanding of the sources of expenditure. Results: The results show that implementing the digital health solution and applying the principles of the VBHC model have provided tangible benefits in terms of reviewing processes and the roles of the various players involved, eliminating unnecessary or non-value-added activities, automating administrative or repetitive tasks, and improving coordination between the two healthcare establishments and between healthcare professionals. These improvements have contributed to better patient care. Conclusions: Given the success observed in this pilot project, decision-makers chose to persistently implement this digital health solution for specific care pathways over the long term. Additionally, there is a commitment to further enhance the platform to align closely with the needs and the expectations of healthcare professionals. This proactive approach aims to ensure optimal utilization of resources, ultimately providing the best care to patients. [ABSTRACT FROM AUTHOR]

AbstractSustaining telehealth uptake hinges on people’s desire and ability to effectively engage with it. We explored trust and confidence in telehealth delivered by medical and allied health using cross-sectional survey of 1,116 Australians. Descriptive analysis presented factors that would improve trust and confidence in telehealth cross-tabulated with video consultation experience. Inferential statistics compared levels of trust in medical and allied health telehealth with user-related variables. Trust in medical telehealth was higher than in allied health, but practice with video calls, experience with high-quality telehealth, and good internet were associated with greater levels of trust in both groups. Telehealth with a known health professional and no additional costs were top-ranked factors to improve trust and confidence. Participants confident in troubleshooting trusted telehealth more. This first cross-sectional study on trust and confidence in telehealth suggests that digital upskilling and promoting quality video consultations can potentially enhance telehealth adoption. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Impact Reporting Method Patient or Public Contribution To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport‐based intervention for family caregivers of people with dementia.A descriptive qualitative design was adopted.Semi‐structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components.The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four‐tier, eight‐component conceptual framework guides the global promotion of the web‐based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support.The ‘iSupport for Dementia’ program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination.The ‘iSupport for Dementia’ program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies.Adherence to the COREQ guidelines for reporting qualitative research was maintained.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Worldwide, mild traumatic brain injury, synonymous with concussion, affects more than 30–50 million each year. The incidence of concussion in Denmark is estimated to be about 20,000 yearly. Although complete resolution normally occurs within a few weeks, up to a third develop persistent post-concussion symptoms (PPCS) beyond 3 months. Evidence for effective treatment strategies is scarce. The objective of this study is to evaluate the efficacy of the novel intervention GAIN Lite added to enhanced usual care (EUC) for adults with mild-to-moderate PPCS compared to EUC only. Methods: An open-label, parallel-group, two-arm randomised controlled superiority trial (RCT) with 1:1 allocation ratio. Potential participants will be identified through the hospital's Business Intelligence portal of the Central Denmark Region or referred by general practitioners within 2–4 months post-concussion. Participants with mild-to-moderate PPCS will be randomly assigned to either (1) EUC or (2) GAIN Lite added to EUC. GAIN Lite is characterised as a complex intervention and has been developed, feasibility-tested and process evaluated before effect evaluation in the RCT. GAIN Lite contains an initial remote interview, self-administrated e-learning videos and voluntary remote counselling with an allocated occupational- or physiotherapist. Sixty-six participants will be recruited to each group. Primary outcomes are mean changes in PPCS and limitations in daily life from baseline to 24 weeks after baseline. Discussion: GAIN Lite is a low-intensity intervention for adults with mild-to-moderate PPCS. Offering a remote intervention may improve access to rehabilitation and prevent chronification for individuals with mild-to-moderate PPCS. Moreover, GAIN Lite will facilitate access to healthcare, especially for those with transportation barriers. Overall, GAIN Lite may provide an accessible, flexible and convenient way to receive treatment based on sound theories and previous evidence of effective interventions for adults with mild-to-moderate PPCS. Trial registration: ClinicalTrials.gov NCT05233475. Registered on February 10, 2022. [ABSTRACT FROM AUTHOR]

Background: Telemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained health professionals to connect patients with physicians, which can improve access and scope of telemedicine. The study aims to describe the design, service utilisation and chronic disease outcomes following the implementation of an assisted telemedicine initiative. Methods: This is an observational implementation study. Barriers and potential solutions to the implementation of telemedicine were identified through interviews with key stakeholders. The assisted telemedicine solution using an interoperable platform integrating electronic health records, point-of-care diagnostics, and electronic clinical decision support systems was designed and piloted at three telemedicine clinics in Tamil Nadu, India. Nurses were trained in platform use and facilitation of tele-consultations. Health records of all patients from March 2021 to June 2023 were included in the analysis. Data were analysed to assess the utilisation of clinic services and improvements in health outcomes in patients with diabetes mellitus and hypertension. Results: Over 2.4 years, 11,388 patients with a mean age of 45 (± 20) years and median age of 48 years, predominantly female (59.3%), accessed the clinics. The team completed 15,437 lab investigations and 26,998 consultations. Among 5542 (48.6%) patients that reported chronic conditions, diabetes mellitus (61%) and hypertension (45%) were the most frequent. In patients with diabetes mellitus and hypertension, 43% and 75.3% were newly diagnosed, respectively. Diabetes mellitus and hypertension patients had significant reductions in fasting blood sugar (-33.0 mg/dL (95% CI (-42.4, -23.7, P < 0.001)), and systolic (-9.6 mmHg (95% CI (-12.1, -7.0), P < 0.0001)) and diastolic blood pressure (-5.5 mmHg (95% CI (-7.0, -4.08), P < 0.0001)) at nine months from first visit, respectively. Conclusions: The 'Digisahayam' model demonstrated feasibility in enhancing healthcare accessibility and quality by bridging healthcare gaps, diagnosing chronic conditions, and improving patient outcomes. The model presents a scalable and sustainable approach to revolutionising patient care and achieving digital health equity, with the potential for adaptation in similar settings worldwide. [ABSTRACT FROM AUTHOR]

Background: Internally displaced persons (IDPs) in Nigeria face a high burden of mental health disorders, with limited access to evidence-based, culturally relevant interventions. Life skills education (LSE) is a promising approach to promote mental health and psychosocial well-being in humanitarian settings. This study aims to evaluate the effectiveness and implementation of a culturally adapted LSE program delivered through in-person and mobile platforms among IDPs in Northern Nigeria. Methods: This cluster-randomized hybrid type 2 effectiveness-implementation trial will be conducted in 20 IDP camps or host communities in Maiduguri, Nigeria. Sites will be randomly assigned to receive a 12-week LSE program delivered either through in-person peer support groups or WhatsApp-facilitated mobile groups. The study will recruit 500 participants aged 13 years and older. Intervention effectiveness outcomes include the primary outcome of change in post-traumatic stress disorder (PTSD) symptoms assessed using the PCL-5 scale, and secondary outcomes of depression, anxiety, well-being, and life skills acquisition. Implementation outcomes will be assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Both sets of outcomes will be compared between the in-person and mobile delivery groups. Quantitative data will be analyzed using mixed-effects linear regression models, while qualitative data will be examined through reflexive thematic analysis. The study will be guided by the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. Discussion: The RESETTLE-IDPs study addresses key gaps in the evidence base on mental health interventions for conflict-affected populations. It focuses on underserved IDP populations, evaluates the comparative effectiveness of in-person and mobile-delivered LSE, and incorporates implementation science frameworks to assess contextual factors influencing adoption, fidelity, and sustainability. The study employs a community-based participatory approach to enhance cultural relevance, acceptability, and ownership. Findings will inform the development and scale-up of evidence-based, sustainable mental health interventions for IDPs in Nigeria and other humanitarian contexts. Trial sponsor: Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada. Trial registration: ClinicalTrials.gov, NCT06412679 Registered 15 May 2024. [ABSTRACT FROM AUTHOR]

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

Introduction: Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service. Methods: A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care. Results: There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients' expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications. Conclusion: The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care. Trial registration: NCT05069103. [ABSTRACT FROM AUTHOR]

Background: Innovative algorithms for wearable devices and garments are critical for diagnosing and monitoring disease (such as lateral epicondylitis (LE)) progression. LE affects individuals across various professions and causes daily problems. Methods: We analyzed signals from the forearm muscles of 14 healthy controls and 14 LE patients using high-density surface electromyography. We discerned significant differences between groups by employing phase–amplitude coupling (PAC) features. Our study leveraged PAC, Daubechies wavelet with four vanishing moments (db4), and state-of-the-art techniques to train a neural network for the subject's label prediction. Results: Remarkably, PAC features achieved 100% specificity and sensitivity in predicting unseen subjects, while state-of-the-art features lagged with only 35.71% sensitivity and 28.57% specificity, and db4 with 78.57% sensitivity and 85.71 specificity. PAC significantly outperformed the state-of-the-art features (adj. p-value < 0.001) with a large effect size. However, no significant difference was found between PAC and db4 (adj. p-value = 0.147). Also, the Jeffries–Matusita (JM) distance of the PAC was significantly higher than other features (adj. p-value < 0.001), with a large effect size, suggesting PAC features as robust predictors of neuromuscular diseases, offering a profound understanding of disease pathology and new avenues for interpretation. We evaluated the generalization ability of the PAC model using 99.9% confidence intervals and Bayesian credible intervals to quantify prediction uncertainty across subjects. Both methods demonstrated high reliability, with an expected accuracy of 89% in larger, more diverse populations. Conclusions: This study's implications might extend beyond LE, paving the way for enhanced diagnostic tools and deeper insights into the complexities of neuromuscular disorders. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are among the most prevalent mental health concerns affecting children and adolescents. Despite their high prevalence, statistics indicate that fewer than 25% of individuals in this demographic seek professional assistance for their condition. Consequently, there is a pressing need to develop innovative interventions aimed at improving treatment accessibility. Objectives: This study aims to assess the effectiveness of Internet-delivered Cognitive Behavioral Therapy (iCBT) for adolescents with anxiety, with a specific emphasis on involving parents in the treatment process. Methods: The study is structured as a parallel three-armed randomized controlled trial, comparing Internet-delivered Cognitive Behavioral Therapy (iCBT) with planned feedback, iCBT with on-demand feedback, and a waitlist control group, each group including 56 participants. Participants in the two iCBT conditions will undergo a 14-week treatment regimen, while those in the waitlist control group will wait for 14 weeks before starting iCBT with planned feedback. Additionally, participants in the iCBT groups will be randomly assigned to receive a booster session or not. The study design is factorial including two factors: type of therapist feedback (factor 1) and booster or no booster (factor 2). The study population comprises adolescents aged between 12 and 17 years, residing in Denmark, diagnosed with an anxiety disorder according to DSM-5 criteria. The primary outcome measures are the Youth Online Diagnostic Assessment and the Spence Children's Anxiety Scale. Assessments will occur at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups post-treatment. Discussion: The findings of this study are anticipated to contribute to improving the accessibility of evidence-based treatments for adolescents with anxiety. Trial registration: The study is registered at clinicalTrials.gov, under protocol ID 22/59602. The Initial release was the 16.10.2023, first posted due to technical problems 16.04.2024. https://clinicaltrials.gov/study/NCT06368557?locStr=Odense,%20Denmark&country=Denmark&city=Odense&page=2&rank=13. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are among the most prevalent mental health concerns affecting children and adolescents. Despite their high prevalence, statistics indicate that fewer than 25% of individuals in this demographic seek professional assistance for their condition. Consequently, there is a pressing need to develop innovative interventions aimed at improving treatment accessibility. Objectives: This study aims to assess the effectiveness of Internet-delivered Cognitive Behavioral Therapy (iCBT) for adolescents with anxiety, with a specific emphasis on involving parents in the treatment process. Methods: The study is structured as a parallel three-armed randomized controlled trial, comparing Internet-delivered Cognitive Behavioral Therapy (iCBT) with planned feedback, iCBT with on-demand feedback, and a waitlist control group, each group including 56 participants. Participants in the two iCBT conditions will undergo a 14-week treatment regimen, while those in the waitlist control group will wait for 14 weeks before starting iCBT with planned feedback. Additionally, participants in the iCBT groups will be randomly assigned to receive a booster session or not. The study design is factorial including two factors: type of therapist feedback (factor 1) and booster or no booster (factor 2). The study population comprises adolescents aged between 12 and 17 years, residing in Denmark, diagnosed with an anxiety disorder according to DSM-5 criteria. The primary outcome measures are the Youth Online Diagnostic Assessment and the Spence Children's Anxiety Scale. Assessments will occur at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups post-treatment. Discussion: The findings of this study are anticipated to contribute to improving the accessibility of evidence-based treatments for adolescents with anxiety. Trial registration: The study is registered at clinicalTrials.gov, under protocol ID 22/59602. The Initial release was the 16.10.2023, first posted due to technical problems 16.04.2024. https://clinicaltrials.gov/study/NCT06368557?locStr=Odense,%20Denmark&country=Denmark&city=Odense&page=2&rank=13. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged mental health professionals in many unexpected ways. Research completed in the years following the pandemic suggests that individuals around the globe have experienced significant mental health difficulties since the start of the pandemic, including posttraumatic stress disorder (PTSD) and complicated grief. Much of this research has examined the general population or medical personnel specifically and has neglected to turn attention to mental health professionals who have been on the frontlines of treating these mental health difficulties. This study fills this gap in the literature by examining mental health professionals' reactions during the early stages of the pandemic. Sixty-nine mental health professionals completed questionnaires examining trauma, grief, and resilience during the COVID-19 pandemic. Results indicated that 48% of participants met criteria for a provisional diagnosis of posttraumatic stress disorder (PTSD) and 7% were experiencing severe grief. Those who first began using virtual platforms during the pandemic reported less grief and fewer PTSD symptoms. Those with children reported more resilience. Further, resilience mediated the relationship between having children and grief. Resilience and PTSD symptoms independently predicted grief responses. The results suggest the COVID-19 pandemic had profound effects on mental healthcare providers during the early stages of the pandemic. [ABSTRACT FROM AUTHOR]

Digital therapeutics—web-based programs, smartphone applications, and wearable devices designed to prevent, treat, or manage clinical conditions through software-driven, evidence-based intervention—can provide accessible alternatives and/or may supplement standard care for patients with serious mental illnesses, including schizophrenia. In this article, we provide a targeted summary of the rapidly growing field of digital therapeutics for schizophrenia and related serious mental illnesses. First, we define digital therapeutics. Then, we provide a brief summary of the emerging evidence of the efficacy of digital therapeutics for improving clinical outcomes, focusing on potential mechanisms of action for addressing some of the most challenging problems, including negative symptoms of psychosis. Our focus on these promising targets for digital therapeutics, including the latest in prescription models in the commercial space, highlights future directions for research and practice in this exciting field. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are among the most prevalent mental health concerns affecting children and adolescents. Despite their high prevalence, statistics indicate that fewer than 25% of individuals in this demographic seek professional assistance for their condition. Consequently, there is a pressing need to develop innovative interventions aimed at improving treatment accessibility. Objectives: This study aims to assess the effectiveness of Internet-delivered Cognitive Behavioral Therapy (iCBT) for adolescents with anxiety, with a specific emphasis on involving parents in the treatment process. Methods: The study is structured as a parallel three-armed randomized controlled trial, comparing Internet-delivered Cognitive Behavioral Therapy (iCBT) with planned feedback, iCBT with on-demand feedback, and a waitlist control group, each group including 56 participants. Participants in the two iCBT conditions will undergo a 14-week treatment regimen, while those in the waitlist control group will wait for 14 weeks before starting iCBT with planned feedback. Additionally, participants in the iCBT groups will be randomly assigned to receive a booster session or not. The study design is factorial including two factors: type of therapist feedback (factor 1) and booster or no booster (factor 2). The study population comprises adolescents aged between 12 and 17 years, residing in Denmark, diagnosed with an anxiety disorder according to DSM-5 criteria. The primary outcome measures are the Youth Online Diagnostic Assessment and the Spence Children's Anxiety Scale. Assessments will occur at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups post-treatment. Discussion: The findings of this study are anticipated to contribute to improving the accessibility of evidence-based treatments for adolescents with anxiety. Trial registration: The study is registered at clinicalTrials.gov, under protocol ID 22/59602. The Initial release was the 16.10.2023, first posted due to technical problems 16.04.2024. https://clinicaltrials.gov/study/NCT06368557?locStr=Odense,%20Denmark&country=Denmark&city=Odense&page=2&rank=13. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Reporting Method Patient or Public Contribution The current study aimed to identify digital health literacy levels among nurses with respect to their education, role and attitude towards digital technologies.Cross‐sectional study.Through convenience sampling, all Registered Nurses, managers/leaders and nurse researchers employed in Hospitals, University Hospitals and Districts were recruited and surveyed using an online questionnaire. The data collection tool assessed: (I) demographics, (II) Digital Health Literacy (DHL) with the Health Literacy Survey19 Digital (HLS19‐DIGI) instrument including DHL dealing with digital health information (HL‐DIGI), interaction with digital resources for health (HL‐DIGI‐INT) and use of digital devices for health (HL‐DIGI‐DD); (III) attitudes on the use of digital technologies in clinical practice. The multiple correspondence analysis was applied to identify three clusters for the education/professional role (A, B, C) and three for digital technologies' use (1, 2, 3). The one‐way nonparametric analysis of variance (Kruskal–Wallis test) was applied to compare HL‐DIGI, HL‐DIGI‐INT and the HL‐DIGI‐DD scores among clusters.Among 551 participants, the median scores of the HL‐DIGI, the HL‐DIGI‐INT and the HL‐DIGI‐DD questionnaires were 70.2, 72 and 2.00, respectively. The distribution in the clusters ‘educational/professional role’ was A, (58.8%); B, (16.5%); and C, (24.7%). Nurses in a managerial or coordinator role and with a postgraduate degree used digital resources with greater frequency. The distribution in the clusters ‘use of digital technologies’ was: 1, (54.6%); 2, (12.2%); and 3, (33.2%). The HL‐DIGI‐DD and HL‐DIGI scores of clusters 1, 2 and 3 differed significantly.DHL among nurses is strongly influenced by the education level, professional role, habits and attitude towards digital technologies. Nurses with coordinator roles used digital technologies with greater frequency and had a higher level of DHL.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting.No Patient or Public Contribution.Trial Registration: Local Ethical Committee of the Polyclinic of Bari (code: DHL7454, date: 21/09/22) [ABSTRACT FROM AUTHOR]