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Background: Effective communication between primary care providers (PCPs) and specialists plays a key role in providing high-quality patient care. A high-quality referral process should involve referral letters containing all information that is necessary to support shared care between primary and specialty care. Introduction: There is no consensus on the optimal components of specialist-to-PCP communication after a face-to-face patient encounter or in the context of the emerging field of electronic consultations (eConsult). In this study, we aimed at synthesizing the evidence on key components of a traditional consultation letter and at determining whether they can be applied to eConsult replies. Methods: We conducted a systematic review by using a narrative synthesis approach. We searched Pubmed and Embase from inception to January/March 2016 (English). Included studies focused on features of specialists' responses to PCPs. We extracted components of a consultation letter that were identified to be of importance to PCPs and attempted to relate their applicability to eConsult replies. Results: The search revealed 744 potentially relevant citations, of which 65 were deemed eligible for full-text review. Forty-one papers were excluded on full-text review, resulting in 24 studies included in the final synthesis. Important components of consultation letters that were applicable to eConsults included: answering a direct question, providing a diagnosis, providing treatment options, providing education around the case, providing a prognosis, and arranging follow-up, clarity, and organization. Key differences between traditional and eConsult replies included the history and physical investigations, impression, plan, and rationale for plan/education. Conclusion: When seeking to improve the quality of specialist reply letters in both traditional and eConsult replies, one should consider differences in how information is collected and accessed, the role of each provider, and factors that impact specialist-to-PCP communication.

Background: By facilitating direct communication of primary care providers (PCPs) with specialists for advice, electronic consult (e-consult) services can reduce the need for patients to wait for and travel to face-to-face consultations with specialists. An association between avoiding face-to-face referrals using an e-consult service and specific content within each e-consult has not been rigorously explored., Materials and Methods: Cases submitted to the Champlain Building Access to Specialists through eConsultation service between April 2011 to May 2013 were evaluated. Factors analyzed include question type (e.g., diagnosis or management), formulation (if interventions or outcomes were specified), and the addressed specialty. An avoided referral was present if the PCP indicated so in a mandatory close-out survey. A discrepancy was present if the PCP made a referral when the specialist did not indicate one was necessary, or if the PCP did not request a referral despite the specialist recommending one., Results: There were 426 (40%) avoided referrals among 1,055 cases analyzed. Questions associated with the highest avoided referral rates included ones pertaining to diagnosis (44%), nonspecific requests for direction (44%), questions without specified interventions or outcomes (47%), and dermatology cases (49.5%). Specialists agreed on the need for a referral in 82% of cases, with most discrepancies due to the PCP making a referral without the specialist recommending one., Conclusions: Referral outcomes are associated with the type of question being asked, the formulation of each question, and the specialty being addressed. Discrepancies among PCPs and specialists regarding which patients require face-to-face referrals may help identify knowledge gaps and guide professional development.

IntroductionThe transactional model of e-health literacy addresses not only the skills needed for handling online health-related information but also the capacity to communicate regarding health issues on the Internet. It also emphasizes a critical component of e-health literacy: enabling appraisal and selection of information adequate to individual needs. Our study aimed to culturally adapt the instrument assessingTransactional e-Health Literacy (TeHL) and examine the association between TeHL and the use of e-health services by Polish adult Internet users.MethodsThe analysis was conducted on data from an online survey among 1,661 respondents. After cultural adaptation and piloting of the Polish version of the instrument measuring TeHL, exploratory and confirmatory factor analyses were performed on two samples obtained by random splitting of the original data set. The roles of TeHL categories in the use of several types of e-health services were assessed with multivariable logistic regression models.ResultsWe have found that the four-factor model of the Polish version of the TeHL instrument, consisting of 17 items, obtained after excluding item 13, shows the best fit to the measurement data (NFI = 0.950, RFI 0.938, TLI = 0.951, CFI = 0.960, GFI = 0.932, RMSEA = 0.066). Regression modeling revealed that Functional e-health literacy is a significant positive predictor of the use of remote physician advice, the Internet Patient Account Portal, portals providing general health-related information, and websites allowing for checking laboratory test results. Communicative eHL was significantly negatively related to the use of general health-related information portals and positively related to the use of portals offering paid medical advice. Critical e-health literacy was a significant negative predictor of the use of remote physician advice and the laboratory test results websites but a positive predictor of using portals offering paid medical advice and websites offering easy access to e-prescriptions. Finally, Translational e-health literacy was significantly positively associated with the use of the Internet Patient Account Portal, general health-related information portals, and laboratory test results websites.DiscussionPolish version of the instrument assessing TeHL is a tool of confirmed validity that can be used for e-health research in Poland. The relationships between four types of TeHL and the use of concrete e-health solutions show a complex pattern requiring further evaluation.

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems.

The use of new technologies should create new value for all stakeholders in the healthcare system. This article explores the transformative impact of new technologies in e-health, focusing on enhancing patient empowerment and healthcare delivery. It underscores how artificial intelligence (AI) and other innovative technologies may redefine service standards, expand functionalities, boost clinician knowledge and competencies, and relieve clinicians’ workload, thereby enabling broader and more specialized healthcare services. Through a comparative analysis of technology applications in various medical sectors, the study proposes a new, original classification of new e-health technologies according to benefits to the main healthcare stakeholders – patients, clinicians, and the healthcare system itself. The methodology includes bibliographic research and a study of selected cases of technology implementations, discussing both theoretical and practical implications for medical organizations. The classification of new e-health technologies that we propose herein a clear framework for understanding the various ways in which these innovations can be implemented to maximize their benefits across different sectors of the healthcare industry.

BackgroundA staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained.MethodsThis was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-post-test knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria.ResultsIn total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were “clients not interested”, “workplace not distributing” and “workplace in process of distributing”.ConclusionsOur findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process.

Abstract Introduction Public contribution in research can facilitate the design and conduct of meaningful research, resulting in feasible and sustainable solutions to healthcare challenges. However, the evidence concerning the acceptability, feasibility, and impact of public contribution in research is limited. We will embed a mixed-method examination of public contribution activities into the CHANGE trial. The overall aim of the CHANGE trial is to evaluate the efficacy and cost-effectiveness of an internet-administered, guided, low-intensity cognitive behavioral therapy-based self-help intervention (EJDeR) plus treatment as usual (TAU) versus TAU for symptoms of depression and/or Generalized Anxiety Disorder in a superiority randomized controlled trial with an internal pilot phase. In this protocol we describe how we aim to: (1) involve parents of children treated for cancer in the managing and undertaking, analysis and interpretation, and dissemination phases of the CHANGE trial; and (2) examine the acceptability, feasibility, and perceived impact of Parent Advisory Board contribution to the trial from the perspective of board members and public contribution coordinators. Methods We will recruit around six parents of children treated for cancer to the Parent Advisory Board. Board members will contribute throughout the trial during online workshops and steering group meetings. An impact log will be used during workshops to record activities and examine the perceived impact of activities according to board members and public contribution coordinators, including anticipated and unanticipated changes to the research process and potential benefits and harms. Activities will be reported using the Guidance for Reporting Involvement of Patients and the Public checklist. We will conduct semi-structured interviews with board members and public contribution coordinators 6 months after the board is established and at the end of the trial to examine the acceptability, feasibility, and perceived impact of public contribution activities. We will also conduct interviews with board members and public contribution coordinators who withdraw participation. Findings will be reported in accordance with the Standards for Reporting Qualitative Research checklist. Discussion We hope adding public contribution to the CHANGE trial will provide guidance on how to embed public contribution in research and add to the evidence base concerning the impact of public contribution.

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their “business case” and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers.

Abstract Malnutrition is a prevalent and severe issue in hospitalized patients with chronic diseases. However, malnutrition screening is often overlooked or inaccurate due to lack of awareness and experience among health care providers. This study aimed to develop and validate a novel digital smartphone‐based self‐administered tool that uses facial features, especially the ocular area, as indicators of malnutrition in inpatient patients with chronic diseases. Facial photographs and malnutrition screening scales were collected from 619 patients in four different hospitals. A machine learning model based on back propagation neural network was trained, validated, and tested using these data. The model showed a significant correlation (p

Introduction: Electronic health (e-health) initiatives grant the tools and knowledge to improve health care, beneiting not only patients but also healthcare professionals and institutions. Objectives: To empower ASHA (Accredited Social Health Activist) technically in terms of using e-health initiatives and to assess feasibility and usefulness of such initiatives; to enhance digital health literacy and to observe the effect of training and skill development of grass root level healthcare workers engaged in primary care. Method: A prospective observational cohort study, in which ASHA's were recruited in two selected villages of Rajasthan. They were trained to use a web-based application, developed for use on portable device (tablet) to screen, diagnose and provide health education on non-communicable diseases. In-depth interviews and group discussions were done with ASHAs to know their views about the tablet and application use. Results: There was 19.3%, 29.3% and 40% improvement in ASHAs' ability to measure haemoglobin, blood sugar and blood pressure, respectively and also an improvement of 86.5% in tablet and application operation was observed. This improvement in ability of ASHAs was highly signiicant for all above four parameters(p-value

Introduction. Medical information systems have become an important tool in the complex of providing medical care. They allow storing the patient's medical data, analyzing information at many levels, and using modern electronic and telemedicine technologies. The glossary of the concept of health care informatization defines a medical information system as a type of system characterized by a complex of methodological principles, technical means, management algorithms designed for the collection, storage, analysis, forecasting and transmission of medical information in health care institutions. The aim: To analyze the level of satisfaction of medical workers regarding the functioning of the electronic health care system and medical information systems in all areas of medical activity, by evaluating the data of the electronic questionnaire. Materials and methods: A group of 213 user experts from 11 regions of Ukraine and the city of Kyiv was formed to assess the overall quality of the electronic health care system. Informational, analytical-statistical, graphic, and system analysis methods were applied. Results. The information entered into the medical information systems is subsequently widely used by doctors, other medical personnel, patients, and the administration of the health care facility. However, numerous functional deficiencies, and user wishes were identified. Assessing them will contribute to the improvement of e-Health. Conclusions: Medical information systems (MIS) have become an integral attribute of the practical activity of all doctors. The development of MIS in Ukraine continues in intensive and extensive ways. The first MIS were autonomous and responded to local clinical and administrative needs. The problems of the country's health care management can be corrected through the wide and rational use of MIS, their integration into a single electronic system. This will make it possible to analyze medical data at the level of the country, region, institution and thus be able to apply the correct management decisions. Informatization of health care is a global trend, and in Ukraine it is developing at an unusually fast pace. Therefore, the assessment of convenience, efficiency, and interoperability of MIS should become a permanent tool for monitoring and prompt response by both doctors and health care managers. Medical workers are quite satisfied with the functioning of medical information systems in Ukraine, but the issues between technical solutions and practical use of the application remain unresolved.

Mobility deficits are not uncommon in persons with neuromuscular and musculoskeletal disorders. This can have a negative impact in terms of morbidity, mortality, quality of life and activities of daily living (1). Conventionally, mobility and physical activity have been measured in a clinical and laboratory setting by a qualified health professional and is thus called supervised assessment (1). It is either a qualitative or quantitative one- time snapshot evaluation of physical activity, mobility or motion and is highly influenced by factors such as the Hawthorne effect, the time of day when the measurement was taken, white coat and reverse white coat effect (1). Moreover, supervised mobility assessment may have many limitations such as limited ecological validity, lack of patient-centered focus, inability to record real-world challenges, absence of real-time feedback, lack of ability to consider patient's environment, and an omission in observing the range of performance across the day or week (1). To tackle the above mentioned limitations, recently unsupervised mobility assessment of mobility and physical activity using mobile health technology has emerged as an alternative to conventional supervised assessment (1-3). Significant differences may be observed when comparing identical mobility outcomes measured under supervised and unsupervised conditions (1, 3). A systematic review revealed significant variations of 40-180% in identical mobility measures acquired from the same participants across different settings (1). The disparities between supervised and unsupervised measurements are notably greater than the effects observed in treatment interventions. Minor to moderate treatment effects may be overshadowed by these substantial differences in measurement modes (1). Unsupervised assessment holds the potential to address the limitations of supervised assessment as it is patient-centered, ecologically valid, capable of recording fluctuating and rare events, unaffected by the white coat and Hawthorne effects, provides real-time treatment feedback, records real-world challenges, is influenced by a person's mood and fatigue, considers the environment, and reports performance across the day or week (1). Moreover, unsupervised assessment does not require the presence of a trained professional, or the patient to report to a clinic or hospital, and thus can be of great value in rural environments and in tele-medicine/rehabilitation. Not only would this be cost effective, it will also decrease the load on the health care system and the need for health care human resource. ---Continue

BackgroundMobile e-health technologies have proven to provide tailored assessment, intervention, and coaching capabilities for various usage scenarios. Thanks to their spread and adoption, smartphones are one of the most important carriers for such applications.ProblemHowever, the process of design, realization, evaluation, and implementation of these e-health solutions is wicked and challenging, requiring multiple stakeholders and expertise.MethodHere, we present a tailorable intervention and interaction e-health solution that allows rapid prototyping, development, and evaluation of e-health interventions at scale. This platform allows researchers and clinicians to develop ecological momentary assessment, just-in-time adaptive interventions, ecological momentary intervention, cohort studies, and e-coaching and personalized interventions quickly, with no-code, and in a scalable way.ResultThe Twente Intervention and Interaction Instrument (TIIM) has been used by over 320 researchers in the last decade. We present the ecosystem and synthesize the main scientific output from clinical and research studies in different fields.DiscussionThe importance of mobile e-coaching for prediction, management, and prevention of adverse health outcomes is increasing. A profound e-health development strategyand strategic, technical, and operational investments are needed to prototype, develop, implement, and evaluate e-health solutions. TIIM ecosystem has proven to support these processes. This paper ends with the main research opportunities in mobile coaching, including intervention mechanisms, fine-grained monitoring, and inclusion of objective biomarker data.

Abstract Background Global epidemiological data indicates that despite implementation of multiple interventions and significant financial investment, the HIV/AIDS epidemic remained inadequately controlled as of 2020. E-health presents a novel approach in delivering health information and health care and has gained popularity in HIV prevention worldwide. However, evidence on the effectiveness of e-health interventions on HIV prevention among diverse populations remains inadequate. Our study aims to systematically evaluate the effectiveness of varying e-health interventions on HIV prevention, with the objective of providing data support and guidance for the development of future e-health HIV intervention strategies. Methods A systematic search of electronic English databases, including MEDLINE through PubMed, Embase, Scopus, and Web of Science, along with three Chinese databases, including National Knowledge Infrastructure (CNKI), Chinese Wanfang Digital Periodicals (WANFANG), and Chinese Science and Technology Periodicals (VIP) database, will be conducted for the period of 1 January 1980 to 31 December 2022. Additionally, gray literature and unpublished trials in trial registers will be searched. Studies aimed at HIV prevention through e-health interventions, with full-text publications available in either English or Chinese, will be included. Study types will be limited to RCT, cluster RCT, and quasi-experiment study. The risk of bias in individual studies will be assessed following the guideline highlighted by the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes will cover cognitive, behavioral, psychological, management, and biological measures of individuals involved in e-health interventions. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Ultimately, a systematic review with meta-analysis will be conducted to compare the effectiveness of e-health interventions among diverse populations. Discussion This systematic review seeks to establish novel insights into the effectiveness of e-health interventions in diverse populations worldwide. It will inform the design and use of e-health interventions to optimize HIV-related strategies. Systematic review registration PROSPERO CRD42022295909.

Privacy in relation to personal information is one of the most important facets of the concept of personal privacy as it demands that information that relates to a particular person shall remain private and secured. Covid-19 is a pandemic which affected the lives of almost all people in every corner of the world. The pandemic brought new challenges to governments, health authorities, and other private and public institutions so these authorities were compelled to introduce a number of control and preventive measures, in order to curtail the devastating impacts of the virus on public health. These measures include many preventive and control measures which have an invasive impact on the personal right to privacy. Sri Lanka also was also affected by the Covid-19 pandemic and the Sri Lankan Government imposed certain restrictions and control measures. However, the problem of whether the privacy of personal information was respected during in the context of Covid-19 is a question mark in the Sri Lankan context as there were a number of incidents where the privacy of personal information was risked. Sri Lanka does not have Constitutional protection for the Right to Privacy as a Fundamental Right under the Constitution of Sri Lanka or any Legislation on the Protection of Personal Information. In this context, this Article examines whether Sri Lanka has adequately responded to the need to assure the privacy of persons in collecting, accessing, sharing, and disclosing personal information in the context of the Covid-19 pandemic.

Abstract Background Severe postoperative pain not only is a considerable burden for patients but also leads to overprescription of opioids, resulting in considerable health concerns. The remarkable development of new technologies in the health care system provides novel treatment opportunities in this area and could exploit the additional placebo effect, provide added value for patients, and at the same time support hospital staff. We aimed to test the pain- and opioid intake-reducing effects of enhanced postoperative pain management by boosting pain medication by using a technical application and/or augmented physician rounds. Methods In a four-arm, randomized clinical trial, 96 patients (24 patients per group) scheduled for a total knee replacement (TKR) were randomized into four groups for four postoperative days: an “application” group (APP) with information via an iPad-based application; a “doctor” group (DOC) with augmented physician rounds; a combination group (APP+DOC), which received both interventions; and a “treatment as usual” group (TAU) as a baseline with no additional intervention besides the standard care which consists of standardized medication, regular physician rounds, and physiotherapy. Postoperative pain and opioid requirements pre- and postoperatively until hospital discharge were recorded. Results The difference between post- and preoperative pain was significantly different between the groups (P=.02, partial η2=.10). APP+DOC experienced greater postoperative pain relief than DOC (mean: 2.3 vs. 0.7, 95% CI: 0.08–3.09; P=.04) and TAU (mean 2.3 vs. 0.1; 95% CI: 0.69–3.71; P=.005), respectively, the difference compared to APP (mean 2.3 vs. 1.7; 95% CI −1.98–1.76) was not significant. Opioid consumption differed significantly between groups (P=.01, partial η2=.12). APP+DOC (72.9 mg) and DOC (75.4 mg) consumed less oxycodone than APP (83.3 mg) and TAU (87.9 mg; 95% CI: 2.9–22.1; P=.003). APP+DOC consumed significantly less oxycodone than DOC (d=0.2–0.4). There were no significant group differences in NSAID and Morphine sulfate consumption. Patients in APP+DOC were more satisfied with their treatment than patients in TAU (P=.03, partial η 2 =.09). Conclusions The combination of an innovative digital app, which implements open drug administration and augmented physician rounds that support the doctor–patient relationship can significantly improve postoperative pain management. Trial registration The protocol was approved by the local ethics committee of the ethical commission of the German Psychological Society (Deutsche Gesellschaft für Psychologie; DGPs). The study was registered at DRKS.de (identifier: DRKS00009554).

Background: Digital mental healthcare interventions (DMHIs) have been repeatedly mentioned as a possible solution for the growing demand for accessible treatment for patients suffering from common mental health problems, i.e. depression and anxiety disorders. However, structural implementation of DMHI is sparse and results on outcome seems inconclusive. To enrich the body of evidence, this paper compares a need-driven digital mental healthcare intervention (DMHI) for patients diagnosed with depression or anxiety disorders with traditional face-to-face treatment. The digital treatment is provided using a smartphone app which provides videoconferencing, chat, calendar- and registration functions. Method: In a naturalistic retrospective cohort study patients who received DMHI are compared to patients who received traditional face-to-face treatment. Furthermore three illustrative cases were selected to demonstrate how personalization is expressed in individual treatments. Results: The first results of the DMHI compare favorably with traditional face-to-face treatment, showing comparable satisfaction rates, equal effectiveness, and a significant decrease in treatment duration in weeks. Conclusion: The DMHI has the potential to be as effective, but more efficient than traditional face-to-face treatment. Furthermore the digital treatment opens up options to fine-tune the frequency, duration, and content of care contacts to align with patients' individual situations and personal preferences.

Abstract Background During the past decade e-oral health technology has been used to address the oral health care challenges in rural and remote settings. This review systematically evaluated the literature on patient satisfaction with e-oral health care in rural and remote communities. Methods The systematic review included interventional and observational studies published between 1946 and 2021, in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Global Health. Patient satisfaction with received oral health care using self-reported measures, at any time after the intervention, was the main outcome of the review. The other primary outcomes were undesirable consequences of the health care (e-health or conventional) such as diagnostic error. The secondary outcomes considered were waiting time, number of visits, travel, and the cost of oral health care. Two independent researchers assessed the risk of bias using the ROBINS-I risk of bias assessment tool for non-randomized studies. Results Among 898 studies, 16 studies were included in the review. In most studies reporting patient satisfaction, all patients had shown willingness for teleconsultation for a dental problem and they were mostly satisfied due to saved travel time, saved working days, and prompt treatment onset. Most of the studies acknowledged teledentistry as a cost-effective and cost-saving method. Moreover, the teledentistry consultations showed diagnostic reliability and validity values comparable to conventional dental consultations. The majority of studies were considered level 4 and 3b, due to limited sample populations, analysis based on limited alternatives or costs, non-consistent sensitivity analysis, failure to appropriately control known confounders, and/or failure to carry out an appropriate follow-up of patients. Conclusion Available evidence indicates that e-oral health is associated with higher patient satisfaction and has been found to be an effective and reliable method for patients in rural and remote areas. Therefore, in these areas, the use of e-oral health should be encouraged. However, methodological inconsistencies in the current evidence suggest the need for long-term cohort studies and clinical trials, as well as cost analysis on e-oral health in rural settings. Systematic review registration The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42016039942.

YouTube is one of the most popular video-based social media sites across the globe. The role of stem cell transplant has not been deeply explored on YouTube. The current narrative review was planned to assess the viewership of content available on YouTube related to stem cells. The videos were classified based on type of content, duration, number of views, comments and number of likes. A total of 40 videos were downloaded under the search terms “stem cells in Pakistan” and “stem cells”. Of them, 6(15%) were repeat videos, and 34(85%) were unique. The findings revealed that in 10(25%) most viewed videos from Pakistan, 6(60%) contained opinions from non-expert physicians. Among the 10(25%) most viewed international videos, the information providers were science educators in 4(40%) videos and researchers in 2 (20%). Notably, no content from Pakistan was present among the top relevant international videos. ---Continue

BackgroundFamily caregivers of cancer survivors experience equal or greater levels of fear of cancer recurrence (FCR) than survivors themselves. Some interventions have demonstrated their ability to reduce FCR among cancer survivors and dyads (patient and caregivers). However, to date, no validated intervention exists to focus solely on family caregiver's FCR.ObjectivesThis study aimed to (1) adapt the evidence-based in-person Fear Of Recurrence Therapy (FORT) for family caregivers (referred here in as FC-FORT) and to a virtual delivery format and (2) test its usability when offered virtually.MethodsThe adaptation of FC-FORT was overseen by an advisory board and guided by the Information Systems Research Framework. Following this adaptation, female family caregivers and therapists were recruited for the usability study. Participants took part in 7 weekly virtual group therapy sessions, a semi-structured exit interview and completed session feedback questionnaires. Therapists were offered a virtual training and weekly supervision. Fidelity of treatment administration was assessed each session. Quantitative data were analyzed using descriptive statistics. Exit interviews were transcribed verbatim using NVivo Transcription and coded using conventional content analysis. Results were presented back to the advisory board to further refine FC-FORT.ResultsThe advisory board (n = 16) met virtually on 7 occasions to adapt FC-FORT (i.e., patient manuals, virtual format) and discuss recruitment strategies. Minor (e.g., revised text, adapted materials to virtual format) and major adaptations (e.g., added and rearranged sessions) were made to FC-FORT and subsequently approved by the advisory board. Four family caregivers and three therapists took part in the first round of the usability testing. Six family caregivers and the same three therapists took part in the second round. Overall, participants were very satisfied with FC-FORT's usability. Qualitative analysis identified 4 key themes: usability of FC-FORT, satisfaction and engagement with content, group cohesion, and impact of FC-FORT. All participants indicated that they would recommend FC-FORT to others as is.ConclusionsUsing a multidisciplinary advisory board, our team successfully adapted FC-FORT and tested its usability using videoconferencing. Results from this study indicate that the efficacy and acceptability of FC-FORT are now ready to be tested in a larger pilot study.

Background: Today, the technologies in the world are rapidly evolving, and global infrastructure of information is spreading rapidly. The health system of different countries is facing a variety of challenges in order to apply telemedicine services. The aim of this study was to determine the challenges facing the health system of different countries in the application of telemedicine. Method: The present research was conducted in 2022 as a systematized review of studies related to challenges of telemedicine. In this study, Preferred Reporting Items for Systematic Reviews (PRISMA) and Critical Appraisal Skills Program (CASP) guidelines were used to assess the articles. The keywords “telemedicine,” “telehealth,” “E-health,” and “tele care” were used in combination with the Boolean operators OR and AND. The ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley, and Google Scholar were searched. Results: In this study, based on the search strategy, databases were searched from January 2012 to January 2022, and in the final stage, analysis was performed on 27 selected identified articles. The use of telemedicine technology faced major formality and legality, required bandwidth, development of multilingual systems, economic efficiency, available patterns, payment for services, moral barriers, social status, differences and national and legal contradictions in the world, lack of insurance coverage challenges, and so on. Recognizing gaps and challenges can provide a way to fill these gaps and create opportunities for improvement. Conclusions: Utilizing telemedicine technology can be considered as an effective step in the health system. This technology has weaknesses that may challenge it. Successful application of telemedicine technology cannot be very effective without removing these barriers.

IntroductionThere is a rapid increase in using digital technology for strengthening delivery of reproductive, maternal, newborn, and child health (RMNCH) services. Although digital health has potentially many benefits, utilizing it without taking into consideration the possible risks related to the security and privacy of patients' data, and consequently their rights, would yield negative consequences for potential beneficiaries. Mitigating these risks requires effective governance, especially in humanitarian and low-resourced settings. The issue of governing digital personal data in RMNCH services has to date been inadequately considered in the context of low-and-middle-income countries (LMICs). This paper aimed to understand the ecosystem of digital technology for RMNCH services in Palestine and Jordan, the levels of maturity of them, and the implementation challenges experienced, particularly concerning data governance and human rights.MethodsA mapping exercise was conducted to identify digital RMNCH initiatives in Palestine and Jordan and mapping relevant information from identified initiatives. Information was collected from several resources, including relevant available documents and personal communications with stakeholders.ResultsA total of 11 digital health initiatives in Palestine and 9 in Jordan were identified, including: 6 health information systems, 4 registries, 4 health surveillance systems, 3 websites, and 3 mobile-based applications. Most of these initiatives were fully developed and implemented. The initiatives collect patients' personal data, which are managed and controlled by the main owner of the initiative. Privacy policy was not available for many of the initiatives.DiscussionDigital health is becoming a part of the health system in Palestine and Jordan, and there is an increasing use of digital technology in the field of RMNCH services in both countries, particularly expanding in recent years. This increase, however, is not accompanied by clear regulatory policies especially when it comes to privacy and security of personal data, and how this data is governed. Digital RMNCH initiatives have the potential to promote effective and equitable access to services, but stronger regulatory mechanisms are required to ensure the effective realization of this potential in practice.

IntroductionDigitalisation offers innovative solutions within maternity services; however, vulnerable groups risk being overlooked. University College London Hospital's (UCLH) successful implementation of a digital maternity app, MyCare, gives women access to test results, information about appointments, and enables communication with healthcare professionals (HCPs). Yet, little is known about access and engagement among vulnerable pregnant women.MethodologyResearch was conducted over a 3-month period (April–June 2022) in the Maternity Department at UCLH, UK. MyCare datasets were analysed, and anonymised surveys completed by vulnerable pregnant women and HCPs.ResultsLower rates of utilisation and engagement with MyCare were seen in vulnerable pregnant women especially among refugee/asylum seekers, those with mental health issues, and those facing domestic violence. Non-users were also more likely to be individuals from ethnic minority backgrounds, with a lower average social-deprivation-index decile, whose first language was not English, and with a significant history of non-attendance to appointments. Patient and HCP surveys highlighted various barriers to MyCare engagement, including a lack of motivation, limited language options, low e-literacy levels, and complex app interfaces.ConclusionThe use of a single digital tool, without a formulated pathway to identify and assist those not accessing or engaging with it, risks unequal care provision which may exacerbate health inequalities. This research advances the idea that digital exclusion is not necessarily a matter of access to technology, but an issue of a lack of engagement with these tools. Therefore, vulnerable women and HCPs must be integral to the implementation of digital strategies, to ensure no one is left behind.

Wstęp: Astma jest jedną z najczęściej diagnozowanych chorób przewlekłych na świecie. Do wszystkich elementów leczenia należy przede wszystkim stosować kontrolę nad chorobą oraz aktywację chorego i jego udziału w procesie leczenia. Z pomocą przychodzącą tu e-zdrowie i telemedycyna w postaci aplikacji na smartfony, tym samym samodzielne radzenie sobie z chorobami przewlekłymi. Celem badania była ilośćowa i jakościowa ocena aplikacji wspierających taki proces działalności w języku polskim. Materiał i metody: Badanie oparto na przeglądzie i sprawdzanie aplikacji korzystających z kryteriów wykorzystujących różne rodzaje urządzeń mobilnych, algorytmy przez różne systemy operacyjne. Wyszukiwanie zakwalifikowanych do analizy przeprowadzono od 14 października do 8 listopada 2022 r. na podstawie słów: astma, aplikacja, nabiał. Wyniki: przeanalizowano 4 aplikacje obsługujące astmie. Najwyższej jakości dokumenty aplikacji Mytherapy – 5,5 pkt/12 pkt – nie weryfikuje jednak tego progu dobrej jakości aplikacji – minimum 75% wykorzystania do uzyskania punktów. Wnioski zostały sprawdzone: Wnioski te nasuwają kierunek niezależnie od próby stworzenia aplikacji holistycznie ujmującej temat, jak i badaniom w tym obszarze.

Abstract Background Elderly and frail patients who are unable to call for help in case of vital distress can develop complications during their hospitalization. As a supplement to clinical monitoring by the nursing staff, these patients can also be monitored in real time, with the Sensium E-health technology. An application notifies clinical staff of any change in their vital signs (heart rate, respiratory rate, temperature) outside of normal ranges, suggestive of physiological decline. Nurses and physicians are notified of these abnormal changes by email and also via mobile application (iPhone or iPad), allowing early intervention to prevent further deterioration. Case presentation An 86-year-old Caucasian female, with chronic kidney disease, was hospitalized in our medical unit for pyelonephritis associated with a moderate deterioration of serum creatinine. Remote continuous monitoring allowed us to diagnose clinical deterioration early and adjust her treatment. The treatment improved her clinical condition and amended the secondary sepsis with circulation failure in 2 days. Conclusions The prognosis for patients with acute complicated pyelonephritis is much worse than for those with uncomplicated pyelonephritis. Remote continuous monitoring might be helpful to early diagnose urosepsis. This technology leads to improved prognosis of patients without initial vital distress, allowing early treatment and admission to intensive care unit.

Introduction.Ε-health (eH)is a basic component of current health care provision. The cornerstone of eHis the electronic health record (EHR) system.Material and methods. The purpose of this survey is to assess the Greek EHR application byGreek family doctors, taking into consideration the brief period of EHR implementation in Greece. We adopted a preexisting questionnaire, with permission, translating and standardizing it in Greek. The questionnaire focused on computer use capability, EHR usage, and efficiency in daily clinical practice, user satisfaction and global user evaluation of the application. 175 family doctors filled out the questionnaire in February 2019.Results. Low usage rates, minimal facilitation in daily practice, competency issues, and moderate user satisfaction were among our findings. Conclusions. Greek EHR has several problems and inadequacy areas. Reversing these problems and optimizing the application, then reevaluating the results after a wider peri-od of implementation is important.

IntroductionOver 25% of Dutch young people are psychologically unhealthy. Individual and societal consequences that follow from having mental health complaints at this age are substantial. Young people need care which is often unavailable. ENgage YOung people earlY (ENYOY) is a moderated digital social therapy-platform that aims to help youngsters with emerging mental health complaints. Comprehensive research is being conducted into the effects and to optimize and implement the ENYOY-platform throughout the Netherlands. The aim of this study is to explore the usability and user experience of the ENYOY-platform.MethodsA user-centered mixed-method design was chosen. 26 young people aged 16–25 with emerging mental health complaints participated. Semi-structured interviews were conducted to explore usability, user-friendliness, impact, accessibility, inclusivity, and connection (Phase 1). Phase 2 assessed usability problems using the concurrent and retrospective Think Aloud-method. User experience and perceived helpfulness were assessed using a 10-point rating scale and semi-structured interviews (Phase 3). The Health Information Technology Usability Evaluation Scale (Health-ITUES; Phase 1) and System Usability Scale (SUS; Phase 2 and 3) were administered. Qualitative data was analyzed using thematic analysis. Task completion rate and time were tracked and usability problems were categorized using the Nielsen's rating scale (Phase 2).ResultsAdequate to high usability was found (Phase 1 Health-ITUES 4.0(0.34); Phase 2 SUS 69,5(13,70); Phase 3 SUS 71,6(5,63)). Findings from Phase 1 (N = 10) indicated that users viewed ENYOY as a user-friendly, safe, accessible, and inclusive initiative which helped them reduce their mental health complaints and improve quality of life. Phase 2 (N = 10) uncovered 18 usability problems of which 5 of major severity (e.g. troubles accessing the platform). Findings from Phase 3 (N = 6) suggested that users perceived the coaching calls the most helpful [9(0.71)] followed by the therapy content [6.25(1.41)]. Users liked the social networking aspect but rated it least helpful [6(2.1)] due to inactivity.ConclusionThe ENYOY-platform has been found to have adequate to high usability and positive user experiences were reported. All findings will be transferred to the developmental team to improve the platform. Other evaluation methods and paring these with quantitative outcomes could provide additional insight in future research.

Globally, the use of e-health has accelerated dramatically during the coronavirus pandemic. Based on both quantitative and qualitative data collected in China's Hubei province (i.e. the first epicentre of COVID-19), this research explores how the pandemic influences the practices of e-health from the perspective of users. Through analysis of 1,033 surveys and 14 in-depth interviews, we find that e-health has played a crucial role in residents' healthcare during the COVID-19 pandemic. Certain external factors influence the choice of digital health, including the high risk of infection outdoors, the shutting down of transport systems, and dysfunctional healthcare facilities that neglect non-COVID-19 patients' clinical demands. Against this backdrop, we argue digital health acts as a functional equivalent to traditional medical treatment and has largely satisfied patients and users in the crisis period. Additionally, the COVID-19 pandemic has unintentionally sped up the diffusion of digital medicine over the long term as respondents expressed their willingness to continue use of e-health in the post-COVID-19 phase. However, we assert that despite the increasing use of e-health, it cannot fully substitute traditional offline treatment. Thus, we suggest a combination of online and offline healthcare will be more commonly practiced in the future. [ABSTRACT FROM AUTHOR]

BackgroundYoung adults’ drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of “Boozebuster”, a self-guided mobile application incorporating various therapeutic principles to reduce young adults’ alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition.MethodYoung adults aged 18–30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers.Results503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns.ConclusionThe intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults’ drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.

IntroductionPhysical exercise showed to be beneficial for frail older adults on haemodialysis (HD). However, there are several obstacles hindering the regular practice of exercise, such as transportation difficulties, lack of time, fatigue and comorbidities. E-health in this regard has many potential advantages and could be useful for motivating HD patients to increase their level of physical activity. The aim of this study was to evaluate the feasibility of a blended e-health intervention for elderly HD patients who individually exercise at home while under remote supervision of a physiotherapist.Material and methodsPatients over 60 years of age with sufficient cognitive and motoric resources to perform a simple physical test battery and to use a tablet-computer were recruited from four HD outpatient facilities. Following baseline assessment at home, the participants were visited by a physiotherapist (PT). The PT set an individual exercise programme and explained how to use the web-based interface. During the 12 weeks of training, the PTs remotely supervised the patients' progress. At 12 weeks follow-up a second assessment took place.ResultsTwenty-two patients were recruited to participate in the study. Seven patients dropped out of the blended programme and 15 patients concluded the programme. The average training frequency of the 15 participants concluding the study was 1.5 times a week [range 0.2–5.8]. The duration of a training session was between 20 and 40 min. The usability of the system was deemed positive. Regarding the efficacy of the intervention, no significant improvement of any measured parameter was found, and effect sizes were small to medium.ConclusionA blended e-health intervention supported by a web-based application for exercising at home under remote supervision of a PT is feasible in a HD population including older patients. However, before planning a randomized controlled trial, strategies to increase the recruitment rate and the adherence to such a blended intervention should be further developed, e.g., to improve the recruitment procedures and lower the expectable drop-out rate. Furthermore, the dosage of the blended programme should be adapted to the patients' physical performance levels in future trials.The study was registered on the website clinicaltrials.gov with ID NCT04076488.

Introduction. The COVID-19 pandemic has revealed number of problems in the global medical system. This article is targeted to show solutions based on the technical information technologies to help patients, medical professionals and institutions for using DICOM Network application in the context of special requirements during pandemic. The objective of the study was to show how to minimize contacts with the patients by using telemedicine and online consultations based on the information technologies solutions. Material and methods. The data used in this study are based on the DICOM Network informational system, that is targeted to collect medical images based on DICOM format. This system collects all type of DICOM investigations, including tomography investigations, X-Ray images, ultrasonography and others. The average flow of the data is about 10 TB per year. In this study, we used input data collected by this system from 4 medical institutions. Results. There were defined the gaps in the existing software solutions for telemedicine. Based on the existing workflow analysis and urgent requirements of the medical institutions with COVID-19 patients, it was implemented a set of new modules and functionalities for existing DICOM Network system to limit direct contacts with the patients and to reduce the costs of the imaging investigations. Conclusions. All the DICOM Network changes were done in parallel with the spreading of the pandemic “on the fly”, but all the functionalities were implemented in time and have helped, on one hand, to reduce the direct contact of physicians with the infected patients and, on the other hand, to reduce the costs for an investigation for about 2 EUR per investigations and 3000 EUR per month only for X-Ray investigations for COVID-19 patients.

Objective (s): In a threatening situation such as Covid-19 Pandemic, E-health is more effective in providing public health, including prevention, monitoring, diagnosis, prioritization, treatment and follow-up patients. Regardless of E-health potential benefits, implementation and adaptation barriers is expected. In this regarding, it is essential to study the factors influencing EHCR adoption. Therefore, this study aimed to investigate the factors affecting the adoption of E-Health. Methods: In this research, the mixt method approach and exploratory design - typology creation model have been used. After conducting semi-structured interviews and a focus discussion group among physicians, specialists, health experts and CEOs, a research model was developed and tested one a sample of 417 physicians in an online survey. Structural Equation Modeling (SEM) has also been used to analyze the data and test the research hypotheses. Results: Trust and confidentiality, waiting time, authority, health provider-patient relationship are influencing factors that affect adoption of E-health factor. Five other factors were also found that were similar to the UTAUT2 model: performance expectancy, effort expectancy or ease of use, facilities, price value, habit. All hypotheses were significant because the absolute value of the significant number obtained from the t statistic in all hypotheses was higher than 1.96, with a 0.84 effect rate. Conclusion: The findings from this study help to understand the factors influencing behavioral tendency in using E-Health. Theoretical findings, development, and validation in this dissertation provide a framework that includes the factors influencing the adoption of health technology, theoretical foundations for designing and selecting health technology in future health care before they enter the market, or solving the problems of their acceptance implementation.

Abstract Background Sexual risk, substance use, and mental ill health constitute a syndemic of co-occurring, mutually reinforcing epidemics amongst men who have sex with men (MSM). Developed since 1995, e-health interventions offer accessible, anonymous support and can be effective in addressing these outcomes, suggesting the potential value of developing e-health interventions that address these simultaneously amongst MSM. We conducted a systematic review of e-health interventions addressing one or more of these outcomes amongst MSM and in this paper describe the theories of change underpinning relevant interventions, what these offer and how they might complement each other. Methods We identified eligible reports via expert requests, reference-checking and database and Google searches. Results were screened for reports published in 1995 or later; focused on MSM; reporting on e-health interventions providing ongoing support to prevent HIV/STIs, sexual risk behaviour, substance use, anxiety or depression; and describing intervention theories of change. Reviewers assessed report quality, extracted intervention and theory of change data, and developed a novel method of synthesis using diagrammatic representations of theories of change. Results Thirty-three reports on 22 intervention theories of change were included, largely of low/medium-quality. Inductively grouping these theories according to their core constructs, we identified three distinct groupings of theorised pathways. In the largest, the ‘cognitive/skills’ grouping, interventions provide information and activities which are theorised to influence behaviour via motivation/intention and self-efficacy/perceived control. In the ‘self-monitoring’ grouping, interventions are theorised to trigger reflection, self-reward/critique and self-regulation. In the ‘cognitive therapy’ grouping, the theory of change is rooted in cognitive therapy techniques, aiming to reframe negative emotions to improve mental health. Conclusions The synthesised theories of change provide a framework for developing e-health interventions that might holistically address syndemic health problems amongst MSM. Improving reporting on theories of change in primary studies of e-health interventions would enable a better understanding of how they are intended to work and the evidence supporting this. The novel diagrammatic method of theory of change synthesis used here could be used for future reviews where interventions are driven by existing well-defined behaviour and behaviour change theories. Systematic review registration PROSPERO CRD42018110317

Background: In an underdeveloped country like India where there are varied constraints in accessing healthcare, telemedicine can prove to be instrumental in providing access to the scant medical resources and infrastructures. The irony lies in its underutilization, which is multifactorial. Objective: The present research was planned to evaluate the level of awareness, knowledge, and attitude toward telemedicine among the faculty members of tertiary-care teaching centers in Chhattisgarh, India. Methods: A questionnaire-based survey was conducted to collect appropriate data, which were utilized for analysis as well as various intergroup analyses (among different designations, age groups, sex, and worksite). The data have been presented as median and percentage, while for intergroup comparison Mann-Whitney Test was performed. Results: Among the 115 respondents, only 34% were females. The mean age was around 40.7 years, and 58% were

Introduction: This scoping review will determine how online, randomised trials with children are conducted. The objectives of the review are: (a) to determine what methods and tools have been used to create and conduct online trials with children and (b) to identify the gaps in the knowledge in this field. Over the last decade, randomised trials employing online methods have gained traction. Decentralised methods lend themselves to certain types of trials and can offer advantages over traditional trial methods, potentially increasing participant reach and diversity and decreasing research waste. However, decentralised trials that have all aspects of the trial exclusively online are not yet common, and those involving children even less so. This scoping review will describe and evaluate the methods used in these trials to understand how they may be effectively employed. Methods: Methods are informed by guidance from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. The search strategy was developed in consultation with an information specialist for the following databases: MEDLINE, CENTRAL, CINAHL, and Embase. Grey literature searches will be completed with the consultation of experts in decentralised trials and digital health using internet searches and suitable trial registries. Once identified, included full-text studies’ references will be manually searched for any trials that may have been missed. We will include randomised and quasi-randomised trials conducted exclusively online with participants under the age of 18 published in English. We will not limit by country of conduct or date of publication. Data will be collected using a data charting tool and presented in text, graphical, and tabular formats. Ethics and Dissemination: Ethical approval is not needed since all data sources used are publicly available. The review will be available as a preprint before publication in an open-access, peer-reviewed journal.

Introduction: In this modern era of technology, Information and Communication Technology (ICT) has made a very big revolution. Telemedicine is an emerging concept in healthcare services in Kerala, its implementation has not been satisfactory and successful. It is cost effective and provides easy access to healthcare services for people anywhere and especially during pandemic situations like this. A study is required in the domain of awareness and skill of doctors to facilitate its adoption and implementation. There was an urgent need to devise means for patients to consult doctors during Coronavirus Disease 2019 (COVID-19) pandemic. Aim: To assess the level of awareness and skill among doctors practicing modern medicine during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among 535 modern medicine doctors of Kerala from June 2020 to May 2021, using a structured self-administered questionnaire designed for the study. The total scores of awareness and skill calculated and categorised as poor, moderate, and good. Data was analysed by Statistical Package for the Social Sciences (SPSS) version 20.0 software by IBM. The Chi-square test/ Fisher’s-Exact test was used as test of significance. Results: Mean age of the study participants was 40.44±10.66 years, with majority 326 (60.94%) being females. Among the 535 doctors participated, 68.22% had moderate skill, 27.85% had good skill and only 3.92% had poor skill. Years of experience of doctors ranged from 1 to 48 years, with mean of 13.47±10.46 years. In majority, 431 (80.56%) of the participants, had moderate awareness and 15.89% had good awareness, about the telemedicine practice. Poor awareness was present in 19 (3.55%) doctors. About 46.54% believed that specific software training is required for practicing telemedicine. Conclusion: Even though, awareness and skill of doctors practicing modern medicine are favourable, more webinars or workshops are needed to improve their knowledge. Telemedicine is an emerging technology in the health sector in India, so it requires study to know health professional’s awareness and skills towards telemedicine.

The internet-based technology development is beneficial for all sectors, including the health sector. For example, the Primary Healthcare Center. Primary Healthcare Center, provides health services with various health programs to fulfill the community's needs. A program in which The Primary Healthcare Center uses internet-based technology is e-health. E-health is a service designed for the public which is a combination of information and communication technology applications that are connected to all functional elements that support the health sector as their knowledge base. E-health has been enforced in 63 Primary Healthcare Centers in Surabaya. This study aims to analyze the use and satisfaction of mobile e-health in 5 Primary Healthcare Centers in Surabaya base on the End User Computing Satisfaction (EUCS) Method. EUCS consists of 5 variables, which are content, accuracy, format, ease of use, and timeliness. This study was designed as an observational study in Primary Healthcare Center patients using mobile e-health as a population. The study involved 100 patients in 5 health centers in Surabaya. The sample was selected using a random sampling method. The results of the study point out that all respondents were satisfied with the e-health mobile application, however, gaps still occur in each EUCS variable. This is due to the reality does not meet the expectations. The biggest gap is in the timeliness variable, which is 0,6. Due to the gap between reality and expectations. To increase user satisfaction, evaluation is needed to be done. Such as, strengthen the mobile application’s system, to achieve the user’s expectation and minimize the gap between expectations and reality. Simplification of usage and motivation procedures for the community should be continued so that the use of e-health mobile can cover all Surabaya citizens.

Telehealth and telemedicine become a necessity in health services amid technological advancements so that health services can reach the wider community to remote places. Implementing telehealth and telemedicine must be accompanied by the readiness of health workers to adapt to it. The purpose of this study is to determine the readiness of health workers in developed and developing countries and the barriers that affect the readiness of health workers. The research method is a literature review. Articles are chosen through google scholar, SAGE, JSTOR, and Science Direct with the keyword “e-health readiness”, “telehealth readiness”, and “telemedicine readiness”. From a total of 4783 articles, there were 56 articles selected based on abstracts and measurement targets and in the end, 18 articles were taken that were full text available for review. The most common dimensions to measure the readiness of healthcare on telehealth or telemedicine are core readiness, engagement readiness, and structural readiness. The implementation in a developed country is quite good based on core readiness and engagement readiness dimensions, but it needs more improvement in the structural readiness dimension, while in developing countries, there are already some countries that run it well but most are still constrained in infrastructure and resources financial. Overall, obstacles to running telehealth or telemedicine are also affected by the lack of available technological infrastructure in a country, lack of training of health workers, and lack of capacity building for health workers so that they are less able to adapt to telehealth and telemedicine.

Abstract Background Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. Objectives To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. Methods A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. Results Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. Conclusions This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. Systematic review registration The review protocol was registered in PROSPERO (registration number: CRD42016033163 )

Abstract Background Barriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems. Objectives This review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions. Eligibility criteria Studies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants. Sources of evidence Following a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies. Charting methods Data was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice. Results A total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use. Conclusions Culturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities.

Facial palsy (FP) is a life changing condition with physical, aesthetic, functional and psychosocial consequences, which requires specialized diagnosis, rehabilitation and (surgical) management to improve facial function and reduce its negative effects. Since patients remain in follow-up during their life and often have to travel far to receive treatment, improvements can be made in the field of telemedicine. Telemedicine is a growing field of study in medical practice and several advances have been made in the field of plastic surgery. Especially during the COVID-19 pandemic, considerable experience was gained in this way of consultation. This review provides an overview of current research available in the field of E-Health and M-Health in plastic surgery and for patients with a peripheral facial palsy.

Background: Self-care applications are effective in the control and treatment of disease symptoms. Today, the mobile phone is used as one of the tools that can help us in this regard. The present study attempts to develop and evaluate a functional self-care mobile-phone application for patients with skin and hair problems using treatment protocols of herbal medicine. Materials and Methods: This study is a descriptive-applied type. At first, a questionnaire was prepared for data need assessment and also to determine the data items and required capabilities of the application. Based on the results, an application was designed using the Java programing language in the Android software environment. In the next step, the application was installed on the mobile phones of several specialists and patients, and the necessary corrections were made. Then, the final version of the application was evaluated. Results: The most critical data elements of the mobile application for skin and hair patients included the application's functionality, temperament survey, and clinical information. After considering users' feedback, the screen functionality, the application's information and idiom, and overall functionality of the application were evaluated and approved by the users. Conclusion: By and large, the developed application could help the patients to receive the best and high-priority treatment protocols based on their own temperament.

The increasing number of digital solutions developed for use in clinical health care settings is accompanied by new challenges to develop and conduct clinical studies that include eHealth technologies. Clinical study implementation plans often disregard or underestimate the necessity of additional administrative and logistic tasks required at clinical sites as well as ethical aspects to test digital solutions. Experiences made in the run-up of an observational clinical feasibility study at three international clinical sites in the framework of the MyPal project (https://mypal-project.eu/) result in recommendations to avoid delays and barriers in the planning of such prospective studies in clinical and also palliative care for increased efficiency.

AIMS OF THE STUDY An increasing number of patients are using telehealth before contacting the healthcare system. If we are to optimise future telehealth strategies and adequately respond to patient needs, we need to know more about the frequency and characteristics of telehealth use. Our objectives were (i) to investigate whether patients use telehealth before consulting the emergency department (ED), (ii) to compare patients with and without use of telehealth, and (iii) to investigate adherence, confidence and satisfaction. MATERIALS AND METHODS A survey was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. Eligible patients were questioned about their use of telehealth before current presentation, during 30 shifts from 23 October to 15 December 2019. RESULTS A total of 183 (43.9%) of 417 surveyed patients used telehealth, with the telephone being the most commonly used modality, especially among elderly patients. Patients using telehealth were more likely to be male (53.5%, p = 0.001) and were similar in age to non-users. Telehealth users tended to be better educated. Telehealth was predominantly used for semi-urgent non-traumatic diseases that did not lead to hospitalisation. All age groups expressed satisfaction with telehealth, trusted the recommendations and adhered to them. The main reason for "non-use" of telehealth was lack of knowledge. CONCLUSIONS Lack of knowledge about telehealth opportunities and barriers in specific patient groups should be addressed to include all patients, and thus to exploit telehealth’s many advantages.

People with suicidal ideation and non-suicidal self-injury (NSSI) behavior face numerous barriers to help-seeking, which worsened during the COVID-19 pandemic. Mobile health applications (MHA) are discussed as one solution to improve healthcare. However, the commercial app markets are growing unregulated and rapidly, leading to an inscrutable market. This study evaluates the quality, features, functions, and prevention strategies of MHA for people with suicidal ideation and NSSI. An automatic search engine identified MHA for suicidal behavior and NSSI in the European commercial app stores. MHA quality and general characteristics were assessed using the Mobile Application Rating Scale (MARS). MHA of high quality (top 25%) were examined in detail and checked for consistency with established suicide prevention strategies. Of 10,274 identified apps, 179 MHA met the predefined inclusion criteria. Average MHA quality was moderate (M = 3.56, SD = 0.40). Most MHA provided emergency contact, but lacked security features. High-quality MHA were broadly consistent with the best-practice guidelines. The search revealed apps containing potentially harmful and triggering content, and no randomized controlled trial of any included MHA was found. Despite a large heterogeneity in the quality of MHA, high-quality MHA for suicidal behavior and NSSI are available in European commercial app stores. However, a lack of a scientific evidence base poses potential threats to users.

Background: Accurate self-report of sexual behavior assists in identifying potential HIV exposure in HIV prevention trials. Brief mobile phone assessments, completed daily or after sexual activity, can improve the validity and reliability of self-reported sexual behavior and allow for remote survey completion outside of the clinic setting. We conducted a qualitative study to better understand participants mobile phone use and to explore their perspectives on how to improve an existing mobile application-based sexual risk assessment.Methods: Sexually active, HIV seronegative men (n = 14) and women (n = 15) aged 18–39 years were recruited through an HIV counseling and testing clinic and community outreach in Soweto, South Africa. We conducted qualitative research through four age-stratified focus group discussions (FGDs) and analyzed a brief socio-demographics and mobile phone access questionnaire. All participants completed a sexual risk assessment before the FGD. Using a framework analytic approach, data were coded with Nvivo software.Results: All participants had access to mobile phones and internet, and 27 (93.1%) were able to download applications on their personal phones. Participants preferred mobile risk assessments to be offered in a choice of South African languages, using formal language (as opposed to emojis), with straight-forward wording and limited to five to 10 questions. Most participants found it acceptable to complete the assessment once a week, on a weekday, while a few were willing to complete it after each sexual encounter. It was suggested that a message reminder to complete the assessment should be sent at least daily until it is completed. The majority agreed that a password-protected application with a discreet logo was ideal for privacy, ease of use and flexibility for completion in any setting. A concern with this format, however, was the potential data use requirement. Participants expressed privacy concerns with using SMS, WhatsApp and other social media for risk assessments. Most agreed on an airtime incentive between ZAR5-10 (USD 0.29–0.58) per survey. Participants encouraged researchers to provide feedback to them about their sexual risk.Conclusions: Completion of mobile phone sexual risk assessments can be optimized with minimal incentives by ensuring that questionnaires are simple, brief, infrequent and have trusted privacy measures.

Health-related web content is constantly increasing, and cancer survivors use it to manage their health and activities of daily living. However, the actual usage of and satisfaction with web contents among cancer survivors is unclear. Therefore, we conducted a web-based cross-sectional survey to understand the satisfaction with web content in those cancer survivors who use the Internet to cope with their anxiety/stress, sleeplessness, or cognitive difficulties. The survey questionnaire was e-mailed to 1.2 million voluntary registrants at a research company. Cancer survivors who accessed any content via the Internet and experienced anxiety/stress, sleeplessness, or cognitive difficulties were included in the study. Out of the 412 survivors who completed the survey, 357 experienced some degree of anxiety or stress, 258 experienced sleeplessness, and 161 experienced some cognitive difficulties, such as forgetfulness or lack of attention. They used web contents to record their health or (n = 205), relieve their anxiety or stress (n = 238), and devise activities of daily living (n = 232) during cancer therapy, including surgery, chemotherapy, and radiation. The web contents included “interactive contents” (users engage with the web content by responding to it in some form), “non-interactive contents” (information medium without any user engagement), “web-storage,” or “scrolling.” Multivariate logistic regression revealed greater satisfaction with “interactive contents” in cancer survivors. This reflects that the sharing of personal experiences as well as objective information should be considered to create satisfying and effective web contents.

In the context of the fourth revolution in healthcare technologies, leveraging monitoring and personalization across different domains becomes a key factor for providing useful services to maintain and promote well-being. This is even more crucial for older people, with aging being a complex multi-dimensional and multi-factorial process which can lead to frailty. The NESTORE project was recently funded by the EU Commission with the aim of supporting healthy older people to sustain their well-being and capacity to live independently. It is based on a multi-dimensional model of the healthy aging process that covers physical activity, nutrition, cognition, and social activity. NESTORE is based on the paradigm of the human-in-the-loop cyber-physical system that, exploiting the availability of Internet of Things technologies combined with analytics in the cloud, provides a virtual coaching system to support healthy aging. This work describes the design of the NESTORE methodology and its IoT architecture. We first model the end-user under several domains, then we present the NESTORE system that, analyzing relevant key-markers, provides coaching activities and personalized feedback to the user. Finally, we describe the validation strategy to assess the effectiveness of NESTORE as a coaching platform for healthy aging.