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Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Healthcare 4.0. refers to the integration of advanced technologies, such as artificial intelligence (AI) and big data analysis, into the healthcare sector. Recognizing the impact of Healthcare 4.0 technologies in laboratory medicine (LM), we seek to assess the overall awareness and implementation of Healthcare 4.0 among members of the Korean Society for Laboratory Medicine (KSLM). Methods: A web-based survey was conducted using an anonymous questionnaire. The survey comprised 36 questions covering demographic information (seven questions), big data (10 questions), and AI (19 questions). Results: In total, 182 (17.9%) of 1,017 KSLM members participated in the survey. Thirty-two percent of respondents considered AI to be the most important technology in LM in the era of Healthcare 4.0, closely followed by 31% who favored big data. Approximately 80% of respondents were familiar with big data but had not conducted research using it, and 71% were willing to participate in future big data research conducted by the KSLM. Respondents viewed AI as the most valuable tool in molecular genetics within various divisions. More than half of the respondents were open to the notion of using AI as assistance rather than a complete replacement for their roles. Conclusions: This survey highlighted KSLM members’ awareness of the potential applications and implications of big data and AI. We emphasize the complexity of AI integration in healthcare, citing technical and ethical challenges leading to diverse opinions on its impact on employment and training. This highlights the need for a holistic approach to adopting new technologies. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a common, costly, and morbid condition. Pulmonary rehabilitation, close monitoring, and early intervention during acute exacerbations of symptoms represent a comprehensive approach to improve outcomes, but the optimal means of delivering these services is uncertain. Logistical, financial, and social barriers to providing healthcare through face-to-face encounters, paired with recent developments in technology, have stimulated interest in exploring alternative models of care. The Healthy at Home study seeks to determine the feasibility of a multimodal, digitally enhanced intervention provided to participants with COPD longitudinally over 6 months. This paper details the recruitment, methods, and analysis plan for the study, which is recruiting 100 participants in its pilot phase. Participants were provided with several integrated services including a smartwatch to track physiological data, a study app to track symptoms and study instruments, access to a mobile integrated health program for acute clinical needs, and a virtual comprehensive pulmonary support service. Participants shared physiologic, demographic, and symptom reports, electronic health records, and claims data with the study team, facilitating a better understanding of their symptoms and potential care needs longitudinally. The Healthy at Home study seeks to develop a comprehensive digital phenotype of COPD by tracking and responding to multiple indices of disease behavior and facilitating early and nuanced responses to changes in participants' health status. This study is registered at Clinicaltrials.gov (NCT06000696). [ABSTRACT FROM AUTHOR]

As the healthcare sector evolves, Artificial Intelligence’s (AI’s) potential to enhance laboratory medicine is increasingly recognized. However, the adoption rates and attitudes towards AI across European laboratories have not been comprehensively analyzed. This study aims to fill this gap by surveying European laboratory professionals to assess their current use of AI, the digital infrastructure available, and their attitudes towards future implementations.We conducted a methodical survey during October 2023, distributed via EFLM mailing lists. The survey explored six key areas: general characteristics, digital equipment, access to health data, data management, AI advancements, and personal perspectives. We analyzed responses to quantify AI integration and identify barriers to its adoption.From 426 initial responses, 195 were considered after excluding incomplete and non-European entries. The findings revealed limited AI engagement, with significant gaps in necessary digital infrastructure and training. Only 25.6 % of laboratories reported ongoing AI projects. Major barriers included inadequate digital tools, restricted access to comprehensive data, and a lack of AI-related skills among personnel. Notably, a substantial interest in AI training was expressed, indicating a demand for educational initiatives.Despite the recognized potential of AI to revolutionize laboratory medicine by enhancing diagnostic accuracy and efficiency, European laboratories face substantial challenges. This survey highlights a critical need for strategic investments in educational programs and infrastructure improvements to support AI integration in laboratory medicine across Europe. Future efforts should focus on enhancing data accessibility, upgrading technological tools, and expanding AI training and literacy among professionals. In response, our working group plans to develop and make available online training materials to meet this growing educational demand. [ABSTRACT FROM AUTHOR]

Background: This study investigates the impact of transitioning from paper and pencil (P&P) methods to electronic patient records (EPR) on workflow and usability in surgical ward rounds. Methods: Surgical ward rounds were audited by two independent observers to evaluate the effects of transitioning from P&P to EPR. Key observations included the number of medical personnel and five critical workflow aspects before and after EPR implementation. Additionally, usability was assessed using the System Usability Scale (SUS) and the Post-Study System Usability Questionnaire (PSSUQ). Results: A total of 192 P&P and 160 EPR observations were analyzed. Physicians experienced increased administrative workload with EPR, while nurses adapted more easily. Ward teams typically consisted of two physicians and three or four nurses. Usability scores rated the system as "Not Acceptable" across all professional groups. Conclusions: The EPR system introduced usability challenges, particularly for physicians, despite potential benefits like improved data access. Usability flaws hindered system acceptance, highlighting the need for better workflow integration. Addressing these issues could improve efficiency and reduce administrative strain. As artificial intelligence becomes more integrated into clinical practice, healthcare professionals must critically assess AI-driven tools to ensure safe and effective patient care. [ABSTRACT FROM AUTHOR]

Summary: New sleep technologies are being developed, refined and delivered at a fast pace. However, there are serious concerns about the validation and accuracy of new sleep‐related technologies being made available, as many of them, especially consumer‐sleep technologies, have not been tested in comparison with gold‐standard methods or have been approved by health regulatory agencies. The importance of proper validation and performance evaluation of new sleep technologies has already been discussed in previous studies and some recommendations have already been published, but most of them do not employ standardized methodology and are not able to cover all aspects of new sleep technologies. The current protocol describes the methods of a Delphi consensus study to create guidelines for the development, performance evaluation and validation of new sleep devices and technologies. The resulting recommendations are not intended to be used as a quality assessment tool to evaluate individual articles, but rather to evaluate the overall procedures, studies and experiments performed to develop, evaluate performance and validate new technologies. We hope these guidelines can be helpful for researchers who work with new sleep technologies on the appraisal of their reliability and validation, for companies who are working on the development and refinement of new sleep technologies, and by regulatory agencies to evaluate new technologies that are looking for registration, approval or inclusion on health systems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic exposed the vulnerabilities of global health care systems, underscoring the need for innovative solutions to meet the demands of an aging population, workforce shortages, and rising physician burnout. In recent years, wearable technology has helped segue various medical specialties into the digital era, yet its adoption in vascular surgery remains limited. This article explores the applications of wearable devices in vascular surgery and explores their potential outlets, such as enhancing primary and secondary prevention, optimizing perioperative care, and supporting surgical training. The integration of artificial intelligence and machine learning with wearable technology further expands its applications, enabling predictive analytics, personalized care, and remote monitoring. Despite the promising prospects, challenges such as regulatory complexities, data security, and interoperability must be addressed. As the digital health movement unfolds, wearable technology could play a pivotal role in reshaping vascular surgery while offering cost-effective, accessible, and patient-centered care. [ABSTRACT FROM AUTHOR]

Abstract Chronic obstructive pulmonary disease (COPD) is a common, costly, and morbid condition. Pulmonary rehabilitation, close monitoring, and early intervention during acute exacerbations of symptoms represent a comprehensive approach to improve outcomes, but the optimal means of delivering these services is uncertain. Logistical, financial, and social barriers to providing healthcare through face-to-face encounters, paired with recent developments in technology, have stimulated interest in exploring alternative models of care. The Healthy at Home study seeks to determine the feasibility of a multimodal, digitally enhanced intervention provided to participants with COPD longitudinally over 6 months. This paper details the recruitment, methods, and analysis plan for the study, which is recruiting 100 participants in its pilot phase. Participants were provided with several integrated services including a smartwatch to track physiological data, a study app to track symptoms and study instruments, access to a mobile integrated health program for acute clinical needs, and a virtual comprehensive pulmonary support service. Participants shared physiologic, demographic, and symptom reports, electronic health records, and claims data with the study team, facilitating a better understanding of their symptoms and potential care needs longitudinally. The Healthy at Home study seeks to develop a comprehensive digital phenotype of COPD by tracking and responding to multiple indices of disease behavior and facilitating early and nuanced responses to changes in participants’ health status. This study is registered at Clinicaltrials.gov (NCT06000696).

High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.

Janosch A Priebe,1 Linda Kerkemeyer,2 Katharina K Haas,1 Katharina Achtert,2 Leida F Moreno Sanchez,1,3 Paul Stockert,1 Maximilian Spannagl,1 Julia Wendlinger,1 Reinhard Thoma,4 Siegfried Ulrich Jedamzik,3 Jan Reichmann,5 Sebastian Franke,6 Leonie Sundmacher,6 Volker E Amelung,2 Thomas R Toelle1 1Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; 2Institute for Applied Health Services Research, Inav GmbH, Berlin, Germany; 3Bayerische TelemedAllianz, Ingolstadt, Baar-Ebenhausen, Germany; 4Pain Clinic, Algesiologikum Pain Center, Munich, Germany; 5StatConsult GmbH Magdeburg, Magdeburg, Germany; 6Department of Health Economics, Faculty of Sports and Health Sciences, Technical University of Munich (TUM), Munich, GermanyCorrespondence: Thomas R Toelle, Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, Munich, 81675, Germany, Tel +49-89-4140-4613, Email thomas.toelle@tum.dePurpose: Non-specific low back pain (NLBP) exerts a profound impact on global health and economics. In the era of Web 3.0, digital therapeutics offer the potential to improve NLBP management. The Rise-uP trial introduces a digitally anchored, general practitioner (GP)-focused back pain management approach with the Kaia back pain app as the key intervention. Here, we present the 12-months evaluation of the Rise-uP trial including clinical and economic outcomes, patient satisfaction and behavioral tracking analysis.Methods: The cluster-randomized controlled study (registration number: DRKS00015048) enrolled 1237 patients, with 930 receiving treatment according to the Rise-uP approach and 307 subjected to standard of care treatment. Assessments of pain, psychological state, functional capacity, and well-being (patient-reported outcome measures; PROMs) were collected at baseline, and at 3-, 6-, and 12-months follow-up intervals. Health insurance partners AOK, DAK, and BARMER provided individual healthcare cost data. An artificial intelligence (AI)-driven behavioral tracking analysis identified distinct app usage clusters that presented all with about the same clinical outcome. Patient satisfaction (patient-reported experience measures; PREMs) was captured at the end of the trial.Results: Intention-to-treat (ITT) analysis demonstrated that the Rise-uP group experienced significantly greater pain reduction at 12 months compared to the control group (IG: − 46% vs CG: − 24%; p < 0.001) with only the Rise-uP group achieving a pain reduction that was clinically meaningful. Improvements in all other PROMs were notably superior in patients of the Rise-uP group. The AI analysis of app usage discerned four usage clusters. Short- to long-term usage, all produced about the same level of pain reduction. Cost-effectiveness analysis indicated a substantial economic benefit for Rise-uP.Conclusion: The Rise-uP approach with a medical multimodal back pain app as the central element of digital treatment demonstrates both, clinical and economic superiority compared to standard of care in the management of NLBP.Keywords: digital medicine, medical apps, non-specific low back pain, multimodal pain therapy, healthcare costs, behavioral tracking analysis

The new round of industrial and technological revolution represented by artificial intelligence have promoted rapid changes in healthcare practice and education, posing significant challenges to the digital adaptability and competency of healthcare professionals. Therefore, medical universities and colleges must enhance digital literacy education. This paper aims to explore the performance and influencing factors of digital literacy among new students in clinical medicine. Based on 728 valid samples, the overall level of digital literacy of clinical medicine freshmen was good, yet the digital content and creation literacy was the most significant weakness. Variables including gender, only child status, student cadres, types of devices with Internet access and family backgrounds including family residency location, economic conditions, parents education level have different digital literacy performances. Student cadres, family location, and types of devices enabled with Internet access are key factors affecting their digital literacy level. The results provide scientific insights for medical universities and colleges to precisely implement digital literacy education and improvement for medical students, aiming to cultivate high - level healthcare professionals in the digital intelligence healthcare era [ABSTRACT FROM AUTHOR]

Background and Aims: Telemedicine, including teledermatology, has become a central component of modern medicine. Its importance, especially during the COVID‐19 pandemic, underlines its potential to optimize access to dermatological care. The study aims to assess the potential of teledermatology, understand the importance of linking digital and physical practices, and analyze the adoption of online services based on participants' demographic and experiential factors. Methods: This cross‐sectional survey was conducted among users of the telemedicine platform from July 2022 to March 2023. The platform ("OnlineDoctor") allows users to contact dermatologists for remote dermatological consultations. The survey included questions about the participants' dermatological concerns, their reasons for using teledermatology, their satisfaction with the recommendations and their willingness to continue using telemedicine in the future. Data was collected via the RedCap online platform. Descriptive statistics and regression analyses were carried out. Results: Overall, 1141 people participated in the study (mean age 44.0 years [SD 14.6], 61.4% women). Results showed that 52.7% of participants with skin conditions had not consulted a dermatologist in the previous year. Shorter waiting times and the lack of face‐to‐face appointments were the main reasons for using the online platform. In total, 77.6% (n = 885) of participants indicated they would use teledermatology as their first choice if they had an upcoming skin condition. Age, gender, and satisfaction with previous consultations impacted the use of teledermatology as the first choice for future skin conditions. Conclusion: Teledermatology is characterized by various benefits, including reduced waiting times and improved accessibility to treatment. Nevertheless, the study underscores the importance of a hybrid care approach involving direct interaction with physicians. Teledermatology can be transformative in meeting dermatologic needs, mainly when traditional face‐to‐face consultation is limited. A deep understanding of user preferences and widespread adoption of digital services can pave the way for the successful adoption of teledermatology platforms, improving healthcare accessibility and efficiency. [ABSTRACT FROM AUTHOR]

Robotic surgery and telemedicine have revolutionized the healthcare industry, offering improved patient outcomes and access to medical knowledge. However, Pakistan lags behind in adopting these cutting-edge technologies due to several challenges, including limited infrastructure, budget constraints, and low awareness among patients and healthcare professionals. This article provides an in-depth analysis of the current state of the healthcare system in Pakistan, highlighting the need for investment and policy reforms to integrate robotic surgery and telemedicine effectively. The potential benefits, including medical tourism, enhanced facilities, and skilled workforce retention, are discussed as incentives for the government to embrace digital medicine and bridge the healthcare gap. Through increased awareness, training programs, and collaborations with other nations, Pakistan can pave the way for a digitally empowered healthcare future. [ABSTRACT FROM AUTHOR]

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Healthcare professionals' opinions, attitudes, and thoughts toward new digital healthcare are often overlooked. However, they play a crucial role in accepting new digital care strategies. This research aimed to understand the perceptions of cardiopulmonary rehabilitation professionals towards telerehabilitation by conducting a mixed-method study at various Fondazione Don Carlo Gnocchi centers in Italy. A total of 14 healthcare workers, including 7 experts in telerehabilitation, participated through surveys and semi-structured focus groups, covering 12 thematic areas derived from the Theoretical Domains Framework (knowledge; professional role; beliefs about capabilities; beliefs about consequences; optimism; reinforcement, goals; memory, attention, and decision process; environmental context and resources; social influences; emotions; ideal patient's profile). Participants (mean age = 45.00 ± 9.06; M:F = 3:11) shared diverse experiences and views on telerehabilitation. All participants had a good knowledge of telerehabilitation. While non-experts indicated technological expertise and preserved cognitive level as a prerequisite for telerehabilitation use, experts believed that no ideal patient exists and that all people can benefit from it. They converged in defining it as a new delivery path of rehabilitation with the same objective of face-to-face rehabilitation services, enhancing the patient's quality of life. Environmental, infrastructural, and institutional resources are needed to enhance accessibility. Positive attitude, optimism, and expectation were reported, but uncertainties about how to manage safety issues and increased workload were mentioned. The study showed a complex picture of staff rehabilitation beliefs about telerehabilitation. Overall, telerehabilitation was considered a great opportunity for patients who face barriers to in-person clinical interventions.

Copyright of Die Pathologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper explores key success factors for the development and implementation of a Common Data Model (CDM) for Rare Diseases (RDs) focusing on the European context. Several challenges hinder RD care and research in diagnosis, treatment, and research, including data fragmentation, lack of standardisation, and Interoperability (IOP) issues within healthcare information systems. We identify key issues and recommendations for an RD-CDM, drawing on international guidelines and existing infrastructure, to address organisational, consensus, interoperability, usage, and secondary use challenges. Based on these, we analyse the importance of balancing the scope and IOP of a CDM to cater to the unique requirements of RDs while ensuring effective data exchange and usage across systems. In conclusion, a well-designed RD-CDM can bridge gaps in RD care and research, enhance patient care and facilitate international collaborations. [ABSTRACT FROM AUTHOR]

This paper explores the critical role of Interoperability (IOP) in the integration of Artificial Intelligence (AI) for clinical applications. As AI gains prominence in medical analytics, its application in clinical practice faces challenges due to the lack of standardization in the medical sector. IOP, the ability of systems to exchange information seamlessly, emerges as a fundamental solution. Our paper discusses the indispensable nature of IOP throughout the Data Life Cycle, demonstrating how interoperable data can facilitate AI applications. The benefits of IOP encompass streamlined data entry for healthcare professionals, efficient data processing, enabling the sharing of data and algorithms for replication, and potentially increasing the significance of results obtained by medical data analytics via AI. Despite the challenges of IOP, its successful implementation promises substantial benefits for integrating AI into clinical practice, which could ultimately enhance patient outcomes and healthcare quality. [ABSTRACT FROM AUTHOR]

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to assess the feasibility of utilizing a surgical guide, designed through digital medical technology, in lateral orbital decompression surgery. In total, 18 patients with thyroid-associated ophthalmopathy (TAO), who underwent orbital balance decompression surgery at the Affiliated Eye Hospital of Nanchang University between September 2018 and August 2022, were included. Orbital CT scanning was performed on all patients with TAO, and Mimics 21.0 software was used to reconstruct a three-dimensional model of the orbit based on the CT data. The osteotomy guide plate for lateral orbital decompression surgery was designed using 3-matic 13.0 software, adhering to the criteria of surgical effectiveness and safety. The surgical positioning guide was designed using Geomagic Wrap 21.0. Once printed, the surgical guide was sterilized with low-temperature plasma and applied during surgery. Of the nine patients treated using a surgical navigation system, three cases experienced cerebrospinal fluid leakage complications during the procedure, and two exhibited inadequate bone removal along the lateral wall. In contrast, among the nine patients treated with surgical guides, no intraoperative cerebrospinal fluid leakage or evidence of insufficient lateral wall bone removal was observed, highlighting a statistically significant distinction between the two cohorts (p = 0.046). Postoperative improvements were notable in best-corrected visual acuity (BCVA) and exophthalmos for patients afflicted with extremely severe TAO. The surgical guide, designed with digital medical technology, has been shown to be an effective and secure auxiliary tool in lateral orbital decompression surgery. It not only aids in reducing the incidence of intraoperative complications, but also enhances the accuracy and safety of surgery. These improvements offer robust support for continued exploration in this field within clinical practice. [ABSTRACT FROM AUTHOR]

Digital rehabilitation and telerehabilitation are increasingly integrated into daily clinical practice, using innovative telemonitoring tools, remote therapeutic exercise devices, and systems to verify therapeutic adherence. This is crucial for patients with chronic pain, often due to delays in treatment caused by long waiting lists. Although the effectiveness of pain monitoring apps is still debated, they are well accepted by clinicians and help patients monitor their pain daily through notifications. The use of predefined alerts improves therapeutic adherence and clinical outcomes, especially in risky drug therapies. Home-based devices for physical therapies such as magnetotherapy and electrotherapy, monitored through apps, allow sessions to be scheduled and monitored, ensuring strict control of care. Patient-Reported Outcome Measures (PROMs) collect data on pain perception and effectiveness of therapies, further improving adherence. Educating patients and caregivers via apps is essential for autonomous and safe execution of home treatments. Digital Medicine thus offers significant therapeutic opportunities, complementing in-person clinical assessment and making therapies safer, simpler, and more effective. [ABSTRACT FROM AUTHOR]

The fields of precision and personalised medicine have led to promising advances in tailoring treatment to individual patients. Examples include genome/molecular alteration‑guided drug selection, single‑patient gene therapy design and synergy‑based drug combination development, and these approaches can yield substantially diverse recommendations. Therefore, it is important to define each domain and delineate their commonalities and differences in an effort to develop novel clinical trial designs, streamline workflow development, rethink regulatory considerations, create value in healthcare and economics assessments, and other factors. These and other segments are essential to recognise the diversity within these domains to accelerate their respective workflows towards practice‑changing healthcare. To emphasise these points, this article elaborates on the concept of digital health and digital medicine‑enabled N‑of‑1 medicine, which individualises combination regimen and dosing using a patient’s own data. We will conclude with recommendations for consideration when developing novel workflows based on emerging digital‑based platforms. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Telemedicine, including teledermatology, has become a central component of modern medicine. Its importance, especially during the COVID‐19 pandemic, underlines its potential to optimize access to dermatological care. The study aims to assess the potential of teledermatology, understand the importance of linking digital and physical practices, and analyze the adoption of online services based on participants' demographic and experiential factors. Methods This cross‐sectional survey was conducted among users of the telemedicine platform from July 2022 to March 2023. The platform ("OnlineDoctor") allows users to contact dermatologists for remote dermatological consultations. The survey included questions about the participants' dermatological concerns, their reasons for using teledermatology, their satisfaction with the recommendations and their willingness to continue using telemedicine in the future. Data was collected via the RedCap online platform. Descriptive statistics and regression analyses were carried out. Results Overall, 1141 people participated in the study (mean age 44.0 years [SD 14.6], 61.4% women). Results showed that 52.7% of participants with skin conditions had not consulted a dermatologist in the previous year. Shorter waiting times and the lack of face‐to‐face appointments were the main reasons for using the online platform. In total, 77.6% (n = 885) of participants indicated they would use teledermatology as their first choice if they had an upcoming skin condition. Age, gender, and satisfaction with previous consultations impacted the use of teledermatology as the first choice for future skin conditions. Conclusion Teledermatology is characterized by various benefits, including reduced waiting times and improved accessibility to treatment. Nevertheless, the study underscores the importance of a hybrid care approach involving direct interaction with physicians. Teledermatology can be transformative in meeting dermatologic needs, mainly when traditional face‐to‐face consultation is limited. A deep understanding of user preferences and widespread adoption of digital services can pave the way for the successful adoption of teledermatology platforms, improving healthcare accessibility and efficiency.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper’s conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

Abstract Background Germ Defence ( www.germdefence.org ) is an evidence-based interactive website that promotes behaviour change for infection control within households. To maximise the potential of Germ Defence to effectively reduce the spread of COVID-19, the intervention needed to be implemented at scale rapidly. Methods With NHS England approval, we conducted an efficient two-arm (1:1 ratio) cluster randomised controlled trial (RCT) to examine the effectiveness of randomising implementation of Germ Defence via general practitioner (GP) practices across England, UK, compared with usual care to disseminate Germ Defence to patients. GP practices randomised to the intervention arm (n = 3292) were emailed and asked to disseminate Germ Defence to all adult patients via mobile phone text, email or social media. Usual care arm GP practices (n = 3287) maintained standard management for the 4-month trial period and then asked to share Germ Defence with their adult patients. The primary outcome was the rate of GP presentations for respiratory tract infections (RTI) per patient. Secondary outcomes comprised rates of acute RTIs, confirmed COVID-19 diagnoses and suspected COVID-19 diagnoses, COVID-19 symptoms, gastrointestinal infection diagnoses, antibiotic usage and hospital admissions. The impact of the intervention on outcome rates was assessed using negative binomial regression modelling within the OpenSAFELY platform. The uptake of the intervention by GP practice and by patients was measured via website analytics. Results Germ Defence was used 310,731 times. The average website satisfaction score was 7.52 (0–10 not at all to very satisfied, N = 9933). There was no evidence of a difference in the rate of RTIs between intervention and control practices (rate ratio (RR) 1.01, 95% CI 0.96, 1.06, p = 0.70). This was similar to all other eight health outcomes. Patient engagement within intervention arm practices ranged from 0 to 48% of a practice list. Conclusions While the RCT did not demonstrate a difference in health outcomes, we demonstrated that rapid large-scale implementation of a digital behavioural intervention is possible and can be evaluated with a novel efficient prospective RCT methodology analysing routinely collected patient data entirely within a trusted research environment. Trial registration This trial was registered in the ISRCTN registry (14602359) on 12 August 2020.

In connection with the adoption of Federal Law No. 258-FZ of July 31, 2020 “On experimental legal regimes in the field of digital innovation in the Russian Federation,” a number of initiatives have been developed to establish experimental legal regimes in the field of telemedicine. The idea of using digital technologies in medicine is certainly relevant. On the one hand, the prospect of remotely receiving medical services is practically in demand; on the other, the level of technology development currently allows for a significant expansion of their implementation. The need to turn to the institution of an experimental legal regime is due to the fact that the current legislation contains norms that seriously complicate the process of widespread dissemination of telemedicine services.The purpose of the study is to reveal the theoretical characteristics of the concept of telemedicine and its current state, to identify legal obstacles to its development, to conduct a comparative analysis of existing draft programs of experimental regimes, to assess the problems and prospects for the development of telemedicine technologies in modern Russian practice. The study is based on domestic and foreign scientific sources of both legal and medical nature, as well as current and projected legal acts in the field of medical services, digital technologies, and personal data protection. Formal-legal, comparative-legal, statistical, and prognostic methods are used. Several problems that require a conceptual solution, including the issue of the safety of personal data and the issue of responsibility for a medical error resulting from the use of artificial intelligence technology or a technical device have been identified. Both are unlikely to be completely resolved at the current level of legal regulation and technological development. This, however, only confirms the need to introduce appropriate experimental regimes in order to use the accumulated empirical material to find solutions to existing and abstractly predictable problems.

Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine. [Display omitted] • D2C wearables offer affordable and accessible health care data that may facilitate management of cardiovascular disorders. • There are concerns about accuracy, value, unintended psychological responses, and data overload from wearable-derived data. • Wearables promise novel paradigms for disease screening, diagnosis, and management, thereby setting a foundation for personalized medicine. [ABSTRACT FROM AUTHOR]

The aim of this study was to introduce and report on a 3D-printed perforator navigator and its clinical application. Integrated imaging and 3D printing techniques were employed for the design and manufacture of a perforator navigator. Key techniques included establishing a digital image coordinate system, localizing perforator fascia piercing points, creating a reference plane for the perforator course, and projecting the perforator course onto the body surface. All cases of maxillofacial defect repaired with free fibular myocutaneous flaps, from January 2019 to January 2022, were reinvestigated. Patients treated using traditional perforator localization methods were assigned into group Ⅰ, while those who had a navigator used during treatment were allocated to group Ⅱ. Outcome measurements included perforator positioning accuracy, perforator preparation time (PT), and flap growth score. Capillary refilling time and degree of flap swelling were recorded on the 1st, 3rd, and 7th days after surgery. On the 10th day after surgery, the flap survival situation was graded. In total, 25 patients were included in the study. Perforator preparation time for group Ⅱ was significantly less (p ＝ 0.04) than for group Ⅰ (1038.6 ± 195.4 s versus 1271.4 ± 295.1 s. In group Ⅱ, the mean positioning deviation for the perforator navigator was 2.12 cm less than that for the high-frequency color Doppler (p ＝ 0.001). Group Ⅱ also had a higher score than group Ⅰ for overall flap growth evaluation (nonparametric rank sum test, p ＝ 0.04). Within the scale of the study, it seems that perforator localization and navigation using a 3D-printed navigator is technically feasible, and helps to improve the clinical outcome of free fibular flaps. The perforator navigator will play a useful role in displaying the perforator course, improving the accuracy of perforator localization, reducing surgical injury, and ultimately enhancing flap success rate. • 3D-printed navigators are convenient and reproducible. • The establishment of a visualized coordinate system enabled precise and intuitive perforator localization. • The navigator offered a clear and entire pathway map for the perforator. • There was improvement in flap success with the use of the perforator navigator. [ABSTRACT FROM AUTHOR]

Ketones are well-known biomarkers of fat oxidation produced in the liver as a result of lipolysis. These biomarkers include acetoacetic acid and β-hydroxybutyric acid in the blood/urine and acetone in our breath and skin. Monitoring ketone production in the body is essential for people who use caloric intake deficit to reduce body weight or use ketogenic diets for wellness or therapeutic treatments. Current methods to monitor ketones include urine dipsticks, capillary blood monitors, and breath analyzers. However, these existing methods have certain disadvantages that preclude them from being used more widely. In this work, we introduce a novel acetone sensor device that can detect acetone levels in breath and overcome the drawbacks of existing sensing approaches. The critical element of the device is a robust sensor with the capability to measure acetone using a complementary metal oxide semiconductor (CMOS) chip and convenient data analysis from a red, green, and blue deconvolution imaging approach. The acetone sensor device demonstrated sensitivity of detection in the micromolar-concentration range, selectivity for detection of acetone in breath, and a lifetime stability of at least one month. The sensor device utility was probed with real tests on breath samples using an established blood ketone reference method. [ABSTRACT FROM AUTHOR]

Background: Germ Defence (www.germdefence.org) is an evidence-based interactive website that promotes behaviour change for infection control within households. To maximise the potential of Germ Defence to effectively reduce the spread of COVID-19, the intervention needed to be implemented at scale rapidly. Methods: With NHS England approval, we conducted an efficient two-arm (1:1 ratio) cluster randomised controlled trial (RCT) to examine the effectiveness of randomising implementation of Germ Defence via general practitioner (GP) practices across England, UK, compared with usual care to disseminate Germ Defence to patients. GP practices randomised to the intervention arm (n = 3292) were emailed and asked to disseminate Germ Defence to all adult patients via mobile phone text, email or social media. Usual care arm GP practices (n = 3287) maintained standard management for the 4-month trial period and then asked to share Germ Defence with their adult patients. The primary outcome was the rate of GP presentations for respiratory tract infections (RTI) per patient. Secondary outcomes comprised rates of acute RTIs, confirmed COVID-19 diagnoses and suspected COVID-19 diagnoses, COVID-19 symptoms, gastrointestinal infection diagnoses, antibiotic usage and hospital admissions. The impact of the intervention on outcome rates was assessed using negative binomial regression modelling within the OpenSAFELY platform. The uptake of the intervention by GP practice and by patients was measured via website analytics. Results: Germ Defence was used 310,731 times. The average website satisfaction score was 7.52 (0–10 not at all to very satisfied, N = 9933). There was no evidence of a difference in the rate of RTIs between intervention and control practices (rate ratio (RR) 1.01, 95% CI 0.96, 1.06, p = 0.70). This was similar to all other eight health outcomes. Patient engagement within intervention arm practices ranged from 0 to 48% of a practice list. Conclusions: While the RCT did not demonstrate a difference in health outcomes, we demonstrated that rapid large-scale implementation of a digital behavioural intervention is possible and can be evaluated with a novel efficient prospective RCT methodology analysing routinely collected patient data entirely within a trusted research environment. Trial registration: This trial was registered in the ISRCTN registry (14602359) on 12 August 2020. [ABSTRACT FROM AUTHOR]

Recent advances in mathematical modeling and artificial intelligence have challenged the use of traditional regression analysis in biomedical research. This study examined artificial data sets and biomedical data sets from cancer research using binomial and multinomial logistic regression. The results were compared with those obtained with machine learning models such as random forest, support vector machine, Bayesian classifiers, k-nearest neighbors, and repeated incremental clipping (RIPPER). The alternative models often outperformed regression in accurately classifying new cases. Logistic regression had a structural problem similar to early single-layer neural networks, which limited its ability to identify variables with high statistical significance for reliable class assignments. Therefore, regression is not per se the best model for class prediction in biomedical data sets. The study emphasizes the importance of validating selected models and suggests that a "mixture of experts" approach may be a more advanced and effective strategy for analyzing biomedical data sets. [ABSTRACT FROM AUTHOR]

Background. The study discusses the key problems of organizing healthcare in the Russian Federation, as well as the prospects for their legal resolution due to the emer-gence of innovative technologies (biomedicine, genomic medicine, digital medicine). The transformation of the principle of patient autonomy is considered under the influence of such factors as increased praticipality in the organization of medical care, a change in ap-proaches in budgeting a healthcare organization, and the emergence of legal obligations in the field of protecting the health of citizens. The purpose of the study is to conduct a sys-tematic analysis of the legal regulation of medical activities. The correction of the under-standing of medical intervention as a type of service is substantiated. At the same time, it is shown that the model of allocating medical services should not be considered as a down-playing of the importance of medical care. Materials and methods. Research problems were solved through scientific analysis of a wide range of sources on the legal regime of medical activities. The method of system analysis was used, thanks to which the basic problems that arise in the process of implementing the concept of “medical service” were investigated: rejection by the medical community; inconsistency of the courts in resolving cases on the protection of consumer rights in the field of medical care; the presence of significant excep-tions (providing emergency assistance to a suicide, artificial termination of pregnancy, or-gan donation, cosmetic surgery, reproductive technologies). Results. The features of digital-ization of the healthcare system are shown. The formation of huge amounts of information creates additional difficulties, but also opens up new prospects for the development of pre-ventive medicine. Conclusions. The threats that arise due to the formation of information resources in the field of healthcare by various non-governmental non-medical organizations are highlighted. The article presents recommendations for improving legislation in the field of healthcare.

Introduction: Monitoring changes in gait during rehabilitation allows early detection of complications. Laboratory-based gait analyses proved valuable for longitudinal monitoring of lower leg fracture healing. However, continuous gait data recorded in the daily life may be superior due to a higher temporal resolution and differences in behavior. In this study, ground reaction force-based gait data of instrumented insoles from longitudinal intermittent laboratory assessments were compared to monitoring in daily life.Methods: Straight walking data of patients were collected during clinical visits and in between those visits the instrumented insoles recorded all stepping activities of the patients during daily life.Results: Out of 16 patients, due to technical and compliance issues, only six delivered sufficient datasets of about 12 weeks. Stance duration was longer (p = 0.004) and gait was more asymmetric during daily life (asymmetry of maximal force p < 0.001, loading slope p = 0.001, unloading slope p < 0.001, stance duration p < 0.001).Discussion: The differences between the laboratory assessments and the daily-life monitoring could be caused by a different and more diverse behavior during daily life. The daily life gait parameters significantly improved over time with union. One of the patients developed an infected non-union and showed worsening of force-related gait parameters, which was earlier detectable in the continuous daily life gait data compared to the lab data. Therefore, continuous gait monitoring in the daily life has potential to detect healing problems early on. Continuous monitoring with instrumented insoles has advantages once technical and compliance problems are solved.

Recent advances in mathematical modeling and artificial intelligence have challenged the use of traditional regression analysis in biomedical research. This study examined artificial data sets and biomedical data sets from cancer research using binomial and multinomial logistic regression. The results were compared with those obtained with machine learning models such as random forest, support vector machine, Bayesian classifiers, k-nearest neighbors, and repeated incremental clipping (RIPPER). The alternative models often outperformed regression in accurately classifying new cases. Logistic regression had a structural problem similar to early single-layer neural networks, which limited its ability to identify variables with high statistical significance for reliable class assignments. Therefore, regression is not per se the best model for class prediction in biomedical data sets. The study emphasizes the importance of validating selected models and suggests that a “mixture of experts” approach may be a more advanced and effective strategy for analyzing biomedical data sets.

IntroductionOut-of-office blood pressure (BP) monitoring is increasingly valuable in the diagnosis and management of hypertension. With advances in wearable BP technologies, the ability to gain insight into BP outside of traditional centers of care has expanded greatly.MethodsHere we explore the usability of a novel, wrist-worn BP cuff monitor for out-of-office data collection with participants following digital cues rather than in-person instruction. Transmitted measurements were used to evaluate BP variation with the time of day and day of week, BP variation with mood, and orthostatic measurements.ResultsFifty participants, with a mean age of 44.5 years, were enrolled and received the BP monitor. 82% of the participants transmitted data via the smartphone application, and the median wear time of the device during the 4-week study was 11 days (IQR 8-17).DiscussionThis prospective digital pilot study illustrates the usability of wearable oscillometric BP technology combined with digital cues via a smartphone application to obtain complex out-of-office BP measurements, including orthostatic vital signs and BP associated with emotion. 25 out of 32 participants who attempted orthostatic vital signs based on in-app instruction were able to do so correctly, while 24 participants transmitted BP readings associated with emotion, with a significant difference in BP noted between calm and stressed emotional states.

Objective: To review studies on digital medicine in cardiovascular diseases (CVD), discuss its development process, knowledge structure and research hotspots, and provide a perspective for researchers in this field. Methods: The relevant literature in recent 20 years (January 2004 to October 2022) were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was used to demonstrate our knowledge of keywords, co-references and speculative frontiers. VOSviewer was used to chart the contributions of authors, institutions and countries and incorporates their link strength into the table. Results: A total of 5265 English articles in set timespan were included. The number of publications increased steadily annually. The United States (US) produced the highest number of publications, followed by England. Most publications were from Harvard Medicine School, followed by Massachusetts General Hospital and Brigham Women's Hospital. The most authoritative academic journal was JMIR mHealth and uHealth. Noseworthy PA may have the highest influence in this intersected field with the highest number of citations and total link strength. The utilization of wearable mobile devices in the context of CVD, encompassing the identification of risk factors, diagnosis and prevention of diseases, as well as early intervention and remote management of diseases, has been widely acknowledged as a knowledge base and an area of current interest. To investigate the impact of various digital medicine interventions on chronic care and assess their clinical effectiveness, examine the potential of machine learning (ML) in delivering clinical care for atrial fibrillation (AF) and identifying early disease risk factors, as well as explore the development of disease prediction models using neural networks (NNs), ML and unsupervised learning in CVD prognosis, may emerge as future trends and areas of focus. Conclusion: Recently, there has been a significant surge of interest in the investigation of digital medicine in CVD. This initial bibliometric study offers a comprehensive analysis of the research landscape pertaining to digital medicine in CVD, thereby furnishing related scholars with a dependable reference to facilitate further progress in this domain.

The rise in cardiovascular diseases necessitates accurate electrocardiogram (ECG) diagnostics, making high-quality ECG recordings essential. Our CNN-LSTM model, embedded in an open-access GUI and trained on balanced datasets collected in clinical settings, excels in automating ECG quality assessment. When tested across three datasets featuring varying ratios of acceptable to unacceptable ECG signals, it achieved an F1 score ranging from 95.87% to 98.40%. Training the model on real noise sources significantly enhances its applicability in real-life scenarios, compared to simulations. Integrated into a user-friendly toolbox, the model offers practical utility in clinical environments. Furthermore, our study underscores the importance of balanced class representation during training and testing phases. We observed a notable F1 score change from 98.09% to 95.87% when the class ratio shifted from 85:15 to 50:50 in the same testing dataset with equal representation. This finding is crucial for future ECG quality assessment research, highlighting the impact of class distribution on the reliability of model training outcomes. [ABSTRACT FROM AUTHOR]

This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000–2023, we identified the United States, China, the Republic of Korea, Japan, Canada, Australia, Taiwan, and the United Kingdom as the predominant countries in patent issuance for pulse oximeter technology. Our bibliometric analysis revealed a consistent temporal trend in both the volume of publications and citations, underscoring the growing importance of pulse oximeters in digitally-enabled medical practice. Using the VOSviewer software(version 1.6.18), we discerned six primary research clusters: (1) measurement accuracy; (2) integration with the Internet of Things; (3) applicability across diverse pathologies; (4) telemedicine and mobile applications; (5) artificial intelligence and deep learning; and (6) utilization in anesthesiology, resuscitation, and intensive care departments. The findings of this study indicate the prospects for leveraging digital technologies in the use of pulse oximetry in various fields of medicine, with implications for advancing the understanding, diagnosis, prevention, and treatment of cardio-respiratory pathologies. The conducted patent and bibliometric analysis allowed the identification of technical solutions to reduce the risks associated with pulse oximetry: improving precision and validity, technically improved clinical diagnostic use, and the use of machine learning. [ABSTRACT FROM AUTHOR]

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Today, the use of digital medicine is becoming more and more common in medicine. With the use of digital medicine, health data can be shared, processed, and visualized using computer algorithms. One of the problems currently facing digital medicine is the rapid transmission of large amounts of data and their appropriate visualization, even in 3D. Advances in technology offer the possibility to use new image processing, networking, and visualization solutions for the evaluation of medical samples. Because of the resolution of the samples, it is not uncommon that it takes a long time for them to be analyzed, processed, and shared. This is no different for 3D visualization. In order to be able to display digitalized medical samples in 3D at high resolution, a computer with computing power that is not necessarily available to doctors and researchers is needed. COVID-19 has shown that everyday work must continue even when there is a physical distance between the participants. Real-time network streaming can provide a solution to this, by creating a 3D environment that can be shared between doctors/researchers in which the sample being examined can be visualized. In order for this 3D environment to be available to everyone, it must also be usable on devices that do not have high computing capacity. Our goal was to design a general-purpose solution that would allow users to visualize large amounts of medical imaging data in 3D, regardless of the computational capacity of the device they are using. With the solution presented in this paper, our goal was to create a 3D environment for physicians and researchers to collaboratively evaluate 3D medical samples in an interdisciplinary way. [ABSTRACT FROM AUTHOR]

High blood pressure is the leading cause of death and disability globally and an important treatable risk factor for cardiovascular, cerebrovascular and chronic kidney diseases. Digital technology, including mobile health solutions and digital therapy, is expanding rapidly in clinical medicine and has the potential to improve the quality of care and effectiveness of drug treatment by making medical interventions timely, tailored to hypertensive patients' needs and by improving treatment adherence. Thus, the systematic application of digital technologies could support diagnosis and awareness of hypertension and its complications, ultimately leading to improved BP control at the population level. The progressive implementation of digital medicine in the national health systems must be accompanied by the supervision and guidance of health authorities and scientific societies to ensure the correct use of these new technologies with consequent maximization of the potential benefits. The role of scientific societies in relation to the rapid adoption of digital technologies, therefore, should encompass the entire spectrum of activities pertaining to their institutional role: information, training, promotion of research, scientific collaboration and advice, evaluation and validation of technological tools, and collaboration with regulatory and health authorities. [ABSTRACT FROM AUTHOR]