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Context: To assess the reliability of a remote 2D markerless motion tracking method (Kinovea) to quantify knee and hip angles during dynamic tasks. Methods: Fourteen healthy adults performed body weight squats and lateral lunges while video recording themselves at home. Knee and hip angles were quantified in the sagittal plane for the squats and in the frontal plane for the lateral lunges. Two students each performed the video analysis procedure twice, 2 weeks apart. Intraclass correlation coefficients were used to calculate the intrarater and interrater reliability for angles at maximum depth. The intrarater and interrater agreement over the joint angle-time signals were quantified using a validation metric; an acceptable agreement threshold was set at a validation metric of 0.803 or higher. Standard error of measurement (SEM) was also calculated. Results: Reliability was good to excellent (intraclass correlation coefficients = .80-.98) for all angle comparisons at maximum depth. The agreement over the entire joint angle-time signal was acceptable for all squat variables except for the interrater hip angle comparison (validation metric = 0.797). None of the lateral lunge variables met the threshold of acceptable agreement. The mean SEM across participants for all joint angle-time signal and for maximum depth was acceptable (<5°) for all measurements (SEM = 1.2°-4.9°). Conclusions: Overall, the reliability, agreement, and SEM quantified in this study support the integration of remote methods to quantify lower-extremity kinematics into research and clinical practice. [ABSTRACT FROM AUTHOR]

Despite inequitable access to telemedicine video visits for those lacking home-based broadband and the ability of public libraries to address this gap, the adoption of telemedicine in public libraries has been slow. The purpose of this research is to describe the implementation experience of five libraries and library programs that were among the earliest adopters of telemedicine in public libraries. This research was guided by the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. A variety of models have been implemented, but the most successful models include partnership with health providers or a health system. Dissemination of early adopters' experiences can aid other libraries in learning from their example, enabling more rapid uptake of this important programming. [ABSTRACT FROM AUTHOR]

Context: Physical performance tests (PPTs) and mobility tests have been widely used in sports rehabilitation. However, the feasibility of PPTs and mobility tests via telehealth is unknown. Objectives: To verify the feasibility of PPTs and mobility tests to assess athletes via telehealth. Design: This is a feasibility study. Participants: Athletes enrolled in a sports team or club for at least 2 years and with previous enrollment in a competitive league were recruited through advertisements on social media. The athletes included in this study (mean age = 25.9 y, from different sports) performed a battery of PPTs and mobility tests for the lower-extremity or upper-extremity and trunk, according to their sport modality. Main Outcome Measure: The feasibility was assessed with recruitment, success, and dropout rates. In addition, athletes' perceptions of easiness, satisfaction, and safety during the lower-extremity or upper-extremity and trunk PPTs and mobility tests were assessed. Results: Seventy-three athletes were included, between January and April 2021: 41 were allocated to the lower-extremity and 32 to the upper-extremity and trunk PPTs and mobility test, according to their sports modality. The overall dropout rate was 20.55%; >89% of the athletes agreed that the PPTs and mobility tests via telehealth were easy to perform, >78% were satisfied, and >75% felt safe during the assessments. Conclusion: This study indicated that these 2 batteries of performance and mobility tests via telehealth are feasible to assess the lower and upper-extremities, and the trunk of athletes, considering the adherence, athletes' perception of easiness, satisfaction, and safety. [ABSTRACT FROM AUTHOR]

Context: Lower extremity physical performance tests (PPTs) have been widely used in sports rehabilitation and are commonly performed in person. However, some situations may disrupt the in-person health care delivery, such as social distancing due to the pandemic, traveling, and living in remote locations. Those situations may require adjustments in planning and applying measurement tests, and telehealth has become an alternative. Nevertheless, the reliability of lower extremity PPT tests via telehealth is still unknown. Objectives: To verify the test–retest reliability, SEM, and the minimum detectable change (MDC95) of PPTs via telehealth. Methods: Fifty asymptomatic athletes completed 2 assessment sessions 7 to 14 days apart. The assessment via telehealth consisted of warm-up exercises followed by the single-, triple-, and side-hop tests, and the long jump test, in random order. Intraclass correlation coefficient, SEM, and MDC95 were calculated for each PPT. Results: Single-hop test showed good to excellent reliability, with SEM and MDC95 ranging from 6.06 to 9.24 cm and 16.79 to 25.61 cm, respectively. The triple-hop test showed excellent reliability, with SEM and MDC95 ranging from 13.17 to 28.17 cm and 30.72 to 78.07 cm, respectively. Side-hop tests showed moderate reliability, with SEM and MDC95 ranging from 0.67 to 1.22 seconds and 2.00 to 3.39 seconds, respectively. The long jump test showed excellent reliability, with SEM and MDC95 ranging from 5.34 to 8.34 cm and 14.80 to 23.11 cm, respectively. Conclusion: The test–retest reliability of those PPTs via telehealth was acceptable. The SEM and MDC were provided to assist clinicians in interpreting those PPTs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test a partnered, self-determination theory–informed mobile health intervention called SCI Step Together, using an 8-week randomized controlled trial design. The aim of SCI Step Together is to increase the quantity and quality of physical activity (PA) among adults with spinal cord injury (SCI) who walk. The SCI Step Together program provides PA modules and PA self-monitoring tools and facilitates peer and health coach support. Process, resource, management, and scientific feasibility were assessed, and participants completed questionnaires at baseline, mid-, and postintervention to assess determinants and outcomes of PA. Interviews were conducted to evaluate acceptability. Results suggest that the program demonstrated good feasibility, acceptability, and engagement. The intervention group (n = 11) had greater fulfillment of basic psychological needs and knowledge (p =.05) than the control group (n = 9). There were no significant interaction effects for other outcomes. The SCI Step Together program is feasible and acceptable and efficacious for improving some psychosocial variables. Results may inform SCI mobile health programs. [ABSTRACT FROM AUTHOR]

In the Internet of Medical Things (IoMT)-based real-time telemedicine systems, patients can utilize a wide range of medical devices and sensors, which leads to the continuous generation of massive amounts of data. The high speed of data generation poses challenges in collecting, organizing, processing, and making decisions about patients' emergency levels. Existing methods for classifying (triaging) patients in such environments often yield inaccurate triage levels, necessitating a computational approach to enhance accuracy. This research aims to handle data from multiple heterogeneous sources in IoMT-based real-time telemedicine systems, analyze the data to accurately triage patients with the most urgent cases, and provide swift healthcare services. The proposed solution, the Data Processing with Triaging Model (DPTM), employs a hybrid approach that combines principal component analysis and decision tree algorithms. The model was tested using 55,680 patients with two chronic diseases: heart disease and hypertension. The computational results demonstrate the promising effectiveness of DPTM in accommodating and managing the requests of 55,680 patients. The proposed system achieves an impressive accuracy of 93%, surpassing four other algorithms. In conclusion, DPTM enhances medical services, reduces hospital overcrowding, and ensures accurate services for all patients, with a 93% accuracy rate. [ABSTRACT FROM AUTHOR]

In August 2016, MSI Australia (MSIA) brought to scale a direct‐to‐patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre‐ and post‐periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas. [ABSTRACT FROM AUTHOR]

Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post–acute coronary syndrome (ACS). TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group. The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. Methods: A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. Results: We included 57 participants (median age 57, interquartile range (IQR) 50 – 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 – 36), with a median weight loss of 2 pounds (IQR -2 – 6) after BRIDGE. Conclusion: The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures. [ABSTRACT FROM AUTHOR]

Design Setting Participants Intervention Main Outcome Measures Results Conclusions A multi‐methods, single‐centre pilot comprising a quasi‐experimental pre‐/post‐test design and an exploratory qualitative study.A rural Australian hospital and health service.Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months.The intervention comprised a 12‐week virtual care program delivered via teleconference by a specialist nurse, using a pre‐existing connected care platform. The program was tailored to the post‐operative recovery journey targeting post‐operative care, psychoeducation, problem‐solving and goal setting.Primary outcome: program acceptability.Secondary outcomes: quality of life; prostate cancer‐related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post‐intervention (T2); and 12 weeks post‐intervention (T3).Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3.This pilot has shown that a tailored nurse‐led virtual care program, incorporating post‐surgical follow‐up and integrated low‐intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nImplications for rehabilitationTailored self-management support is recommended as first-line treatment for neck and low back pain, for which mHealth applications could be promising. However, there is limited knowledge about factors influencing the engagement with such apps. The aim of this study was to assess barriers and facilitators for engaging with a self-management mHealth app among adults suffering from neck and/or low back pain.We carried out a qualitative descriptive study among adults with neck and/or low back pain. The artificial intelligence-based selfBACK app supports tailored self-management of neck and low back pain and was used for 6 weeks. After these 6 weeks, participants were interviewed by phone.Thirty-two adults (17 males) with neck and/or low back pain participated (mean age = 54.9 (SD = 15.8)). Our results show that the mode of delivery and the novelty of the selfBACK app were perceived most often as a barrier to use the app. The action plans of the app and health-related factors were perceived most often as facilitating factors.This study provides insight into possible strategies to improve an mHealth service. Furthermore, it shows that adults with neck and/or low back pain are willing and ready to receive blended treatment.Adults with neck and/or low back pain are willing to receive blended care (combination of face-to-face contact with healthcare professional and use of eHealth service)When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to choose an eHealth service which includes individual action plans, evidence-based content with health benefits, goal setting and rewards and incentives.When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to choose an eHealth service which can be used on someone’s own smartphone.When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to educate their patients about the importance and possible long-term benefits of self-managing their pain.Adults with neck and/or low back pain are willing to receive blended care (combination of face-to-face contact with healthcare professional and use of eHealth service)When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to choose an eHealth service which includes individual action plans, evidence-based content with health benefits, goal setting and rewards and incentives.When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to choose an eHealth service which can be used on someone’s own smartphone.When implementing eHealth services in rehabilitation treatment of adults with neck and/or low back pain, rehabilitation professionals need to educate their patients about the importance and possible long-term benefits of self-managing their pain. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Routine ambulatory care is essential for older adults with Alzheimer's disease and related dementias (ADRD) to manage their health conditions. The federal government expanded telemedicine coverage to mitigate the impact of the COVID‐19 pandemic on ambulatory services, which may provide an opportunity to improve access to care. This study aims to examine differences in telemedicine use for ambulatory services by race, ethnicity, and community‐level socioeconomic status among community‐dwelling older adults with ADRD.This retrospective cohort study used Medicare claims data between April 01, 2020 and December 31, 2021. We included community‐dwelling Medicare fee‐for‐service beneficiaries aged 65 years and older with ADRD. The outcome variable is individual's use (yes/no) of telemedicine evaluation and management (tele‐EM) visits in each quarter. The key independent variables are race, ethnicity, and community‐level socioeconomic status.The analytical sample size of the study was 2,068,937, including 9.9% Black, 82.7% White, and 7.4% Hispanic individuals. In general, we observed a decreasing trend of tele‐EM use, and the average rate of quarterly tele‐EM use was 23.0%. Tele‐EM utilization varied by individual race, ethnicity, and community‐level socioeconomic status. On average, White and Black individuals in deprived communities were 3.5 and 2.4 percentage‐points less likely to use tele‐EM compared with their counterparts in less‐deprived communities (p < 0.001). However, Hispanic individuals in deprived communities were 2.4 percentage‐points more likely to utilize tele‐EM compared with those in less‐deprived communities (p < 0.001). Additionally, we observed various racial and ethnic differences in telemedicine use in deprived communities versus less‐deprived communities.We observed various racial and ethnic differences in telemedicine use, both within and between communities by socioeconomic status. Telemedicine is a viable healthcare delivery option that may influence healthcare access for racial and ethnic minorities and for individuals in socioeconomically deprived communities. Further policies or interventions may be needed to ensure all individuals have equal access to newly available care delivery models. [ABSTRACT FROM AUTHOR]

Background: Despite ongoing efforts to integrate palliative care into the German healthcare system, challenges persist, particularly in areas where infrastructure does not fully support digital technologies (DT). The increasing importance of digital technology (DT) in palliative care delivery presents both opportunities and challenges. Objective: This study aimed to explore the perspectives and preferences of palliative care patients and their family caregivers regarding the use of DT in care delivery. Methods: An exploratory qualitative study was conducted using semi-structured interviews with palliative care patients and their family caregivers across various settings. Participants were selected through gatekeeper-supported purposive sampling. Interviews were analysed using structured qualitative content analysis. Results: Nineteen interviews were conducted.Three themes emerged: (1) Application of DTs in palliative care; (2) Potential of DTs; (3) Barriers to the use of DTs. Key findings highlighted the preference for real-time communication using DTs that participants are familiar with. Participants reported limited perceived value for digital transformation in the presence of in-person care. The study identified requirements for DT development and use in palliative care, including the need for direct and immediate functionality, efficiency in healthcare professional (HCP) work, and continuous access to services. Conclusion: The findings highlight a demonstrate the importance of familiarity with DTs and real-time access for patients and their families. While DT can enhance palliative care efficiency and accessibility, its integration must complement, not replace, in-person interaction in palliative care. As DTs continue to grow in scope and use in palliative care, maintaining continued user engagement is essential to optimise their adoption and ensure they benefit patients and their caregivers. [ABSTRACT FROM AUTHOR]

Purpose Added layers of remote management in heart failure (HF) have become available for patients with an implantable cardioverter defibrillator (ICD). The aim of this study was to investigate the impact of pharmacist-managed HF monitoring in patients with a multisensor-capable ICD. Methods This was a retrospective, data-only, single-arm study that compared primary outcome events individually in the preactivation and postactivation periods at a single center. The primary outcomes were the total number of all-cause and HF-related hospitalizations and all-cause emergency department (ED) visits and the median length of stay for all-cause and HF-related hospitalizations. The secondary outcome quantified medication utilization. Results In total, 132 patients completed the 1-year follow-up period. Overall, there was a 49% reduction in the number of patients with an all-cause hospitalization, a 77% reduction in the number of patients with an HF-related hospitalization, and a 36% reduction in the number of patients with an ED visit. More patients were hospitalized, visited the ED (P < 0.005), and had a longer median length of stay for all-cause hospitalizations in the preactivation period (P < 0.05). Overall medication utilization increased in the postactivation period. Conclusion A pharmacist-led remote monitoring program, utilizing a multisensor diagnostic, was effective at significantly reducing hospitalizations, ED visits, and length of stay. [ABSTRACT FROM AUTHOR]

The article emphasizes the necessity of establishing a networked clinical trial system that aligns with values and purpose to address health equity disparities in regional, rural, and First Nations communities. It underscores the challenges these communities face in accessing clinical trials and advocates for a decentralized approach to trial access. It discusses the cultural barriers within the healthcare system that hinder participation in clinical trials.

Introduction: Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. Objective: To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. Design: A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010–2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. Findings: Seven hundred and fifty‐four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. Discussion: The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. Conclusion: A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co‐design and production may enhance their efficacy. [ABSTRACT FROM AUTHOR]

Effective teamwork is essential in almost every job, and can even mean life, death, or disability in some jobs. Intraoperative neurophysiological monitoring (IONM) is a career in which effective teamwork and accurate communication are of utmost importance, yet it comes with a unique set of challenges in which to achieve those goals. Operating rooms can be very stressful environments, even if a surgical neurophysiologist (SNP) works in the same hospital every day. Often an SNP is required to travel from hospital to hospital and work with different teams each day. In addition, communication with the IONM oversight professional (IONM-P) can be challenging by nature of the telemedicine model which is becoming the most commonly applied IONM model in the United States. It is unfortunate that such critical skills are assumed and are rarely formally trained. In this article, we present evidence-based recommendations for establishing effective team function. We also provide several tools designed to help create effective and efficient teams. Teams cannot function at their best without outstanding communication, so improving teamwork also means improving communication. This article also provides several techniques for excellent communication, regardless of the situation or context. [ABSTRACT FROM AUTHOR]

Background Limited language fluency can impede healthcare system navigation. In Sweden, the national telehealth line (Healthcare Guide 1177) offers interpretation in Arabic and Somali. We compared calls by language to identify differences in healthcare use for immigrant populations, focusing on three contact causes: pregnancy; vomiting or nausea in children; and worry/anxiety. Methods We conducted a cross-sectional analysis of 3.9 million (n  = 18 351 Arabic, n  = 7199 Somali) telehealth calls (2014–18). Using multivariable logistic regression, we investigated associations between language of the call (Arabic, Somali, non-interpreted) and each contact cause. Potential confounders (age, region, year, and additionally for vomiting or nausea, month) and an interaction between age and language were considered. Results Compared with non-interpreted calls, interpreted calls were associated with increased odds of being for pregnancy, especially for 19 to 29-year-olds [adjusted odds ratio (aOR) (95% CI) = 4.04 (3.66–4.46) and 4.60 (4.05–5.23), for Arabic and Somali calls, respectively]. Vomiting or nausea showed similar results, with aOR increasing with age: from 0.90 (0.75–1.07) (Arabic, <1 year) to 3.79 (2.86–5.01) (Somali, 5–9 years). In contrast, in unadjusted analyses, Arabic and Somali calls were associated with decreased odds of being for worry/anxiety [OR = 0.47 (0.38–0.58) and 0.34 (0.21–0.50)], respectively, compared with non-interpreted calls. Conclusion Our results suggest callers to the interpreted lines may need additional assistance navigating the healthcare system for pregnancy and for vomiting or nausea among children. These findings can inform healthcare services planning for immigrants to Sweden and highlight a novel use of telehealth data as a way to uncover disparities in healthcare use within a multi-linguistic population. [ABSTRACT FROM AUTHOR]

Introduction: Teleneuropsychology, which includes the remote application of neuropsychological tests to patients via telephone or videoconferencing, can expand access to health services for patients who reside in distant areas or have mobility restrictions. With the emergence of the COVID-19 pandemic, there has been a significant increase in the use of teleneuropsychology in cognitive assessment. In this review, the aim was to critically review the results of studies conducted in the field of teleneuropsychology and the fundamental principles related to teleneuropsychological assessment. Additionally, the "guideline for homebased teleneuropsychology" developed for Türkiye's practices is outlined in this review. Method: A literature search was conducted using the Web of Science and PubMed databases to include all types of articles related to the subject. Results: The results of studies on in-clinic and home-based teleneuropsychological assessment indicate that tests that assess cognitive functions such as attention, memory, executive functions, and language, particularly those based on verbal administration, can be reliably applied through teleneuropsychological assessment. However, there are factors to consider when referring patients for teleneuropsychological assessment, selecting tests for assessment, and making ethical considerations. Additionally, it is important to follow recommended steps for both the clinician and the patient and/or their caregiver before and during the interview in order for the assessment to be carried out effectively. Conclusion: Although direct contact with the patient is an essential element in clinical neuropsychology practice, when necessary, teleneuropsychological assessment performed by trained experts following appropriate application procedures can be a good alternative to face-to-face evaluations. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

Traditionally, patients presenting to primary care with severe eczema would be referred to a dermatology clinic for an in‐person specialist appointment. With the rise of teledermatology, dermatologists are instead dispensing tailored written advice based on information provided in the referral. However, there is currently minimal literature assessing whether this advice translates into relevant prescriptions. This clinical audit examines GP prescribing practices and how they correlate to dermatologist recommendations with the objective of assessing whether this form of teledermatology is a viable method of providing care to paediatric eczema patients. [ABSTRACT FROM AUTHOR]

Purpose: Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these. Method: This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment. Results: Pretreatment--posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05). Conclusions: This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the perspectives of Australiabased hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. Method: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. Results: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. Conclusion: Lowconsumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. [ABSTRACT FROM AUTHOR]

Purpose: Telehealth has proven effective for service delivery to remote and rural locations and was helpful during lockdowns when patients were unable to see clinicians in person. To assure the reliability of clinical services, the aim of the present study was to evaluate a telehealth protocol to measure speech perception skills through virtual meeting applications such as Zoom. Method: A total of 20 participants with normal hearing and cognition participated in the study. Participants' speech perception performance was measured in two sessions: one over a Zoom call and one in person in the laboratory. Speech perception was measured using Quick Speech-in-Noise Test, Bamford-- Kowal--Bench Speech-in-Noise Test, and Words-in-Noise Test. Results: Statistical analysis revealed no significant differences between speech perception scores obtained over the Zoom and in-person methodologies for any of the tests. Additionally, our study found no significant difference in the scores obtained between wired and wireless headphones during Zoom calls. Conclusion: These results suggest that Zoom can be used as a reliable method to measure speech perception in young individuals with normal hearing using these three tests in situations where conventional methods cannot be utilized. [ABSTRACT FROM AUTHOR]

(1) To validate the measurement of foam-tip real-ear-to-coupler differences (wRECD) using an integrated pressure level (IPL) method and (2) to compare the reliability of this method to SPL-based measurement of the wRECD. SPL-based wRECD and the proposed IPL wRECD measurement were completed bilaterally. Test-retest reliability of IPL wRECD was determined with full re-insertion into the ear canal and compared to published SPL wRECD test-retest data. 22 adults with normal hearing and middle ear status were recruited. Differences between SPL-based wRECD and IPL wRECD measurements were within 1.51 dB on average below 5000 Hz. At and above 5000 Hz, IPL wRECD exceeded SPL wRECDs by 6.11 dB on average. The average test-retest difference for IPL wRECD across all assessed frequencies was 0.75 dB with the greatest improvements in reliability found below 750 Hz and above 3000 Hz. IPL wRECD yielded improved estimates compared to SPL wRECD in high frequencies, where standing-wave interference is present. Independence from standing wave interference resulted in increased wRECD values above 4000 Hz using the IPL measurement paradigm. IPL wRECD is more reliable than SPL wRECD, does not require precise probe-microphone placement, and provides a wider valid wRECD bandwidth than SPL-based measurement. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the effect of including synchronous remote fine-tuning and follow-up as a part of the aural rehabilitation process. A randomised controlled trial (RCT). Experienced hearing aid users who were due for renewed aural rehabilitation were randomised to either an intervention group (n = 46) or a control group (n = 49). Both groups underwent all stages of the conventional renewed aural rehabilitation process within our clinics, but the intervention group was also offered remote follow-up visits, including an opportunity for synchronous remote fine-tuning of hearing aids. The Hearing Handicap Inventory for the Elderly/Adults (HHIE/A), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the International Outcome Intervention for Hearing Aid Users (IOI-HA) were used as outcome measures. Both groups improved in self-rated hearing difficulties and hearing aid benefits measured with HHIE/A and APHAB. No significant differences were found between the intervention and the control group. Including synchronous remote follow-up and fine-tuning as a part of an aural rehabilitation process may effectively complement clinical visits. Additionally, the synchronous remote follow-up has the potential to further develop person-centred care by enabling hearing aid users to identify individual needs directly in an everyday environment. [ABSTRACT FROM AUTHOR]

A healthy lifestyle comprising regular physical activity and an adequate diet is imperative for the prevention of non‐communicable diseases such as hypertension and some cancers. Advances in information computer technology offer the opportunity to provide personalised lifestyle advice directly to the individual through devices such as smartphones or tablets. The overall aim of the PROTEIN project (Wilson‐Barnes et al., 2021) was to develop a smartphone application that could provide tailored and dynamic nutrition and physical activity advice directly to the individual in real time. However, to create this mobile health (m‐health) smartphone application, a knowledge base of reference ranges for macro‐/micronutrient intake, anthropometry, biochemical, physiological and sleep parameters was required to underpin the parameters of the recommender systems. Therefore, the principal aim of this emerging research paper is to describe the process by which experts in nutrition and physiology from the PROTEIN consortium collaborated to develop the nutritional and physical activity requirements, based upon existing recommendations, for 10 separate population groups living within the EU including, but not limited to healthy adults, adults with type 2 diabetes mellitus, cardiovascular disease, excess weight, obesity and iron deficiency anaemia. A secondary aim is to describe the development of a library of 24‐h meal plans appropriate for the same groups and also encompassing various dietary preferences and allergies. Overall, the consortium devised an extensive nutrition and physical activity knowledge base that is pertinent to 10 separate EU user groups, is available in 7 different languages and is practically implemented via a library of culturally appropriate, 24‐h meal plans. [ABSTRACT FROM AUTHOR]

Psychodynamic therapy is commonly used to treat patients with eating disorders. Patients with a diagnosed eating disorder have varying and complex treatment needs. Psychodynamic therapists transitioning their practices to telehealth during COVID-19 experienced the novelty of developing and sustaining a therapeutic connection with their patients without inhabiting a shared physical space. The aim of this qualitative phenomenological study was to gain insight into how psychodynamic therapists treating patients with eating disorders via telehealth during COVID-19 perceived their patients' experiences and personally experienced the therapeutic relationship and therapeutic processes. Twelve respondents met inclusion criteria, consented to participate, provided demographic data, and participated in a 30–45 minute semi-structured interview. Results from the data analysis included four emergent themes: (1) depth of content; (2) manifestations of patient distress; (3) therapist-patient relationship; and (4) implementation of techniques. Participants spoke about the challenges and resilience experienced by themselves and their patients. They highlighted having to rapidly transition their therapy practice to serve patients with exacerbated symptoms. They shared the complexities of navigating a global pandemic and considered the delivery of relational and dynamic therapy via telehealth. Practical implications and considerations for future research are offered with an emphasis on the treatment of patients with eating disorders. [ABSTRACT FROM AUTHOR]

In response to the nursing shortage and the emergence of telehealth opportunities, the Oncology Nursing Society used an evidence-based approach to examine current literature and trends for the two-person independent double check of high-risk medications, such as chemotherapy, when one of those two individuals is working remotely. Analysis of available evidence suggests virtual technology for two-person independent double checks is feasible and may be equal to live two-person checks; however, lack of consistency and rigor in the interventions and outcome measures makes a determination on safety or efficacy challenging. [ABSTRACT FROM AUTHOR]

Purpose: Telemedicine approaches to autism (ASD) assessment have become increasingly common, yet few validated tools exist for this purpose. This study presents results from a clinical trial investigating two approaches to tele-assessment for ASD in toddlers. Methods: 144 children (29% female) between 17 and 36 months of age (mean = 2.5 years, SD = 0.33 years) completed tele-assessment using either the TELE-ASD-PEDS (TAP) or an experimental remote administration of the Screening Tool for Autism in Toddlers (STAT). All children then completed traditional in-person assessment with a blinded clinician, using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3), and Autism Diagnostic Observation Schedule (ADOS-2). Both tele-assessment and in-person assessment included a clinical interview with caregivers. Results: Results indicated diagnostic agreement for 92% of participants. Children diagnosed with ASD following in-person assessment who were missed by tele-assessment (n = 8) had lower scores on tele- and in-person ASD assessment tools. Children inaccurately identified as having ASD by tele-assessment (n = 3) were younger than other children and had higher developmental and adaptive behavior scores than children accurately diagnosed with ASD by tele-assessment. Diagnostic certainty was highest for children correctly identified as having ASD via tele-assessment. Clinicians and caregivers reported satisfaction with tele-assessment procedures. Conclusion: This work provides additional support for the use of tele-assessment for identification of ASD in toddlers, with both clinicians and families reporting broad acceptability. Continued development and refinement of tele-assessment procedures is recommended to optimize this approach for the needs of varying clinicians, families, and circumstances. [ABSTRACT FROM AUTHOR]

The study focused on designing a portable, objective device for assessing and addressing Cervical Motor Control (CMC) impairments. This device is based on a proposed architecture that employs advanced technology to evaluate and enhance patients’ CMC. During a pilot study with 10 participants, the device’s feasibility and usability were verified, including an initial assessment using the Head Relocation Test and a 12-session intervention over 4 weeks. The architecture of the proposed system is responsible for gathering pertinent data concerning patients’ cervical motor control. It employs advanced algorithms to process this data and objectively assess CMC function. Furthermore, the system tailors the therapy to each patient’s individual needs. Preliminary results indicate that the device and the proposed architecture positively impact assessment test performance accuracy. While additional validation tests are required to confirm their effectiveness, this device emerges as a promising and valuable alternative for assessing and treating patients with CMC impairments. Its focus on advanced technology and personalized adaptation aligns with previous research in telerehabilitation and classroom physical activity promotion. [ABSTRACT FROM AUTHOR]

The recent Federal Trade Commission (FTC) and Department of Justice (DOJ) action against Monument Inc. for selling patient data, is just the tip of the iceberg. Monument Inc. positions itself as a treatment provider (the website home page says it provides "therapy" for alcoholism) but in its extensive terms of use, it says it is not a treatment provider. And in fact, since the FTC/DOJ action this spring, Monument radically changed its website, removing the offending promise of "confidentiality" which it breached, but still selling services (lowest price $15/month). [ABSTRACT FROM AUTHOR]

Human service organizations in the US are heavily dependent on volunteers and donations. The COVID-19 pandemic compromised the ability of volunteer coordinators and fundraisers to obtain and retain such vital resources. This article details the experiences of those entrusted with the acquisition and retention of time and money for human service organizations during the pandemic. Volunteer coordinators faced obstacles in reestablishing a volunteer base, and keeping volunteers engaged and supported while navigating the health risks associated with COVID-19. Fundraisers had to rapidly adjust their solicitation methods amid greater demand for accountability, transparency, and impact from donors. These challenges required innovations and ad-hoc adjustments -both of which were difficult to initiate during the COVID-19 pandemic when operations were carried out virtually. Much has been made about how executive leadership or organizations responded to the pandemic. This article is unique by providing empirical evidence of how specific units within human service organizations adapted. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance. Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators. Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction. Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality. [ABSTRACT FROM AUTHOR]

Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment. Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome. Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress. Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy – in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed. [ABSTRACT FROM AUTHOR]

Objective To investigate clients' perceptions of changes in their therapists' provision of positive regard (PR) following their transition from in-person therapy to teletherapy. Method A total of 2,118 clients, predominantly White, female, heterosexual, and in their mid-20s, who had been working with their therapist for an average of 20 months in-person and five months in teletherapy completed a Perceptions of Psychotherapy Process Scale (POPPS). This 42-item measure investigated, at a single time-point, the extent to which participants believed that specific therapist-related behaviors, statements, or attitudes changed since shifting to teletherapy. Results An exploratory factor analysis revealed, among other factors, a factor comprised of six items related to therapist-provided PR (e.g., "my therapist makes me feel cared about"). Clients' scores on this factor indicated a marginal but significant increase in therapists' provision of PR over teletherapy; these scores also significantly predicted scores on a factor reflecting clients' engagement in teletherapy. Conclusions Despite the challenges of an abrupt shift to teletherapy, clients perceive their therapists as communicating PR to the same or even slightly higher degrees as compared to in-person therapy pre-pandemic; therapists and clients have seemingly adapted to the new demands of technology to preserve important elements of the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Objective: Although teletherapy is increasingly common, very little is known about its impact on therapeutic relationships. We aimed to examine differences between therapists' experiences of teletherapy and in-person therapy post-pandemic with regard to three variables pertinent to the therapeutic relationship: working alliance, real relationship, and therapeutic presence. Methods: In a sample of 826 practicing therapists, we examined these relationship variables, as well as potential moderators of these perceived differences including professional and patient characteristics and covid-related variables. Results: Therapists reported feeling significantly less present in teletherapy and their perceptions of the real relationship were somewhat impacted, but there were no average effects on their perceived quality of the working alliance. Perceived differences in the real relationship did not persist with clinical experience controlled. The relative reduction in therapeutic presence in teletherapy was driven by the ratings of process-oriented therapists and therapists conducting mostly individual therapy. Evidence for moderation by covid-related issues was also found, with larger perceived differences in the working alliance reported by therapists who used teletherapy because it was mandated and/or not by choice. Conclusion: Our findings might have important implications for generating awareness around the therapists' lowered sense of presence in teletherapy compared to in-person teletherapy. [ABSTRACT FROM AUTHOR]

This study compared the use of delivering a single instruction (e.g., Who is it?) versus varied instructions (e.g., What's their name? Who is this? What about this one?) when teaching three children diagnosed with autism spectrum disorder (ASD) novel expressive label targets via direct telehealth. The present investigation utilized an adapted alternating treatments design nested into a multiple probe design, to teach participants to expressively label pictures of cartoon characters using either a single instruction or varied instructions. The goal of this study was to evaluate the acquisition, effectiveness, and efficiency of the two different procedures for each participant. The results demonstrated that while students learned all targets in both conditions, skill acquisition rates were slightly higher for the majority of participants using varied instructions via telehealth. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the extent to which typically developing (TD) siblings of children with autism spectrum disorder (ASD) could implement the model-lead-test (MLT) strategy through the self-monitoring checklist and telehealth-based coaching, as well as the impact of the sibling-mediated intervention on the acquisition of various skills in children with ASD. Two sibling dyads participated in this multiple-probe-across-behaviors study. The instructors coached and provided feedback to the TD siblings on using the MLT strategy and the self-monitoring checklist via telehealth. The results demonstrated that the self-monitoring checklist and the telehealth-based coaching effectively improved treatment fidelity as the TD children delivered the target strategy, which, in turn, improved a diverse range of skills in their siblings with ASD. However, difficulties in generalization to new instructional targets for TD participants and maintaining learned targets for participants with ASD were observed. [ABSTRACT FROM AUTHOR]

To synthesize common or differing perceptions of patients' and clinicians' that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions. Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients' and clinicians' influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated. Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A (n = 7), mode B (n = 8), and mode C (n = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake. Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions. Almost 70% of perceptions related to satisfaction, acceptability, usability, and effectiveness that influence the uptake of online-delivered exercise programmes for chronic musculoskeletal conditions are shared by patients and clinicians. Patient perceptions that differ from clinicians and that hinder uptake include the risk of misdiagnosis, lack of social support, and advice from their clinic and/or clinician. Clinician perceptions that differ from patients and that hinder uptake include risk of last-minute appointment cancellations, the cost to set-up, and limitations of camera angles. Implementation of online-delivered exercise programmes may be supported by targeted education for patients and clinicians that addresses misinformed perceptions. [ABSTRACT FROM AUTHOR]

The evolving virtual health care experience highlights the potential of technology to serve as a way to enhance care. Having virtual options for assessment, consultation and intervention were essential during the coronavirus (COVID-19) pandemic, especially for children with disabilities and their families. The purpose of our study was to describe the benefits and challenges of outpatient virtual care during the pandemic within pediatric rehabilitation. This qualitative study, part of a larger mixed methods project, involved in-depth interviews with 17 participants (10 parents, 2 youth, 5 clinicians) from a Canadian pediatric rehabilitation hospital. We analyzed the data using a thematic approach. Our findings demonstrated three main themes: (1) benefits of virtual care (e.g., continuity of care, convenience, stress reduction and flexibility, and comfort within the home environment and enhanced rapport); (2) challenges related to virtual care (e.g., technical difficulties and lack of technology, environmental distractions and constraints, communication difficulty, and health impacts); and (3) advice for the future of virtual care (i.e., offering choice to families, enhanced communication and addressing health equity issues). Clinicians and hospital leaders should consider addressing the modifiable barriers in accessing and delivering virtual care to optimize its effectiveness. Families are invested in access to virtual care appointments and can benefit from clear communication about choices regarding appointment options and supports in how to access and use technology for equitable access to care. Hospitals should aim to provide clinicians with an appropriate workspace (i.e., private, quiet with adequate room to demonstrate what they need to do), equipment and technology to have virtual care appointments. Current understanding of virtual care delivery suggests a tailored approach, with some types of appointments, such as follow-ups or check-ins, more suited to this modality than other more hands-on therapy. [ABSTRACT FROM AUTHOR]

To determine needs, expectations, facilitators, and barriers of insurance physicians (IPs) for using eHealth in their work. Also, we investigated differences between age groups. All insurance physicians employed at the Dutch Social Security Institute (SSI) received an online anonymous survey in July 2020. Three hundred and fifteen IPs (31%) responded. According to these IPs, the most important need for using eHealth was to collect medical information more effectively and efficiently (71%). Main facilitators were that eHealth could make IPs' work more effectively and efficiently (61%) and more future-proof (60%). Main barriers were losing human interaction (54%) and security issues (51%). Younger IPs saw more options for using eHealth, compared to older IPs. The majority of IPs (in particular younger IPs) had a positive view towards using eHealth in their daily work. Nevertheless, differences in needs, expectations, facilitators and barriers between the age groups should be taken into account for the successful development and implementation of interventions using eHealth in insurance medicine. For the successful development and implementation of eHealth interventions in insurance medicine and rehabilitation, the needs, expectations, facilitators, and barriers that physicians indicate should be taken into account. Insurance physicians support the use of eHealth interventions to collect medical information more effectively and efficiently, to contribute to and maintain the quality of care, in the perspective of managing expected shortages in insurance physicians. When concretizing eHealth interventions for rehabilitation professionals, one should take the importance of face to face interaction with patients into account. Extra education and training for older insurance physicians may improve the implementation of eHealth interventions, because they are less inclined to see its value and feel less competent to use it. [ABSTRACT FROM AUTHOR]

Repeated visits to clinical trial sites inflict hardships on study participants, especially pregnant women. A newer trend is community-based follow-up for measurements, dosage, or monitoring, through technology or physical visits. We conducted a methodological experiment of performing "community-based physical follow-up" of participants of a trial, receiving facility-based diagnosis and pathogen-specific antibiotics for asymptomatic bacteriuria, guided by an optical-sensor-based rapid point-of-care test. We were able to retain 95.8% participants in the study. Here we describe challenges faced and socio-economic and gender issues encountered in this approach in a low-resource Indian scenario, to guide researchers world-wide for designing mother-friendly clinical trials. [ABSTRACT FROM AUTHOR]

Background: The recent coronavirus pandemic accelerated the need to deliver pharmacy-related services remotely. Objective: To describe experiences with providing comprehensive medication management (CMM) and other clinical services via telehealth by pharmacy type, before and during the COVID-19 pandemic. Methods: An online survey of pharmacists, representing 27 pharmacies, was conducted to capture telehealth usage in three pharmacy types: independently owned, integrated into a clinical setting, and retail chain. A sub-analysis was performed to assess if providing CMM services via telehealth helped, resulted in no change, or worsened the care of different patient groups (e.g., those with diabetes, were low-income, aged 65+ years). Results: During the pandemic, telehealth usage among independently owned pharmacies and those integrated into a clinical setting increased, but no change occurred among retail chain pharmacies. This usage increase in the first two pharmacy types occurred despite limited investments in connectivity-related resources to support telehealth services. Pharmacists from both independently owned pharmacies (63%) and those integrated into a clinical setting (89%) reported CMM via telehealth reached patients they would not otherwise have been able to reach during the pandemic. Most pharmacists/pharmacies found telehealth to be a feasible and acceptable method of delivering CMM. Conclusion: Pharmacists and pharmacies are now experienced with and have interest in continuing CMM via telehealth, even as the pandemic recedes. However, investments in telecommunications resources, training support, technical assistance, and continued telehealth reimbursement from health plans are needed to sustain this service delivery model. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the effect of the therapeutic alliance on both change in social recovery outcomes and usage of a moderated online social therapy platform for first‐episode psychosis (FEP), Horyzons. Design: Secondary analysis of a single group pilot trial. Methods: Clients completed an alliance measure adapted for guided digital interventions at mid‐treatment. A series of multi‐level models evaluated change in outcomes by mid‐ and post‐treatment assessments (relative to baseline) as a function of the overall alliance. Quasi‐Poisson models evaluated the effect of the overall alliance on aggregated counts of platform usage. Exploratory analyses repeated these models in terms of the bond (human–human) or the task/goal (human–program) alliance. Results: Stronger overall alliance at mid‐treatment predicted lower loneliness at mid‐treatment and lower social anxiety at mid‐ and post‐treatment. It was also associated with higher completion of therapy activities and authoring of comments and reactions. A strong bond with an online therapist was associated with lower loneliness and higher perceived social support at mid‐treatment, lower social anxiety at post‐treatment as well as a higher number of reactions made on the social network. Stronger alliance with the platform's tasks and goals facilitated lower social anxiety at both follow‐up assessments and was further associated with higher completion of therapy activities and reactions in the social network. Conclusions: The alliance may impact aspects of social recovery and usage in digital interventions for FEP. Specific aspects of the alliance (human–human and human–program relationships) should be considered in future research. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of diagnostic and monitoring tools in ophthalmology is significantly influenced by patient engagement levels. This presents a notable challenge, especially in the context of developing tools designed for telemedicine applications. Ensuring consistent patient engagement is therefore crucial for the accurate and reliable utilization of these technologies. This study assesses patient perceptions and experiences after using a purpose-built web application, called PocDoc. Methods: A cross-sectional questionnaire-based survey was conducted among 440 patients recruited from general and specialist eye clinics between March 2022 and October 2023, both before and after using the PocDoc app. Results: Pre-test findings revealed that 86.8% of patients thought that a remote eye monitoring application would have use, while 70.9% anticipated frequent usage. Only 16.4% found it overly complex, and 55.2% perceived it as easy to use. Additionally, 34.5% foresaw the need for technical support, while 72.5% believed they would quickly grasp its use. In the post-test questionnaire, 63.3% of patients still expressed intent for frequent PocDoc usage. The perception of complexity decreased to 20.4%, with 79.3% finding it easy to use. The belief in the need for technical support decreased to 36.5%, while 89.9% felt confident in mastering the application quickly. Moreover, 77.3% found the application's functions well-integrated, and 64.6% were very confident using PocDoc. Conclusions: Results suggest patient receptivity to web-based applications, confirming their viability for specific patient groups. Overall, our study contributes to the growing body of evidence indicating that greater exposure to digital health tools can significantly influence patient acceptance and perceived ease of use, an insight that has important implications for the implementation and design of these technologies in clinical settings. [ABSTRACT FROM AUTHOR]

There are a number of challenges in recruiting people living with dementia for research purposes, and consequently, studies may be underpowered or fail. This commentary describes barriers experienced by a research study in recruiting people with early-stage dementia living in the community, for a focus group about their perceptions of using a technology-enabled pain assessment tool to detect and quantify pain. Four potentially important groups of barriers encountered during the recruitment phase are discussed, namely dementia, pain, mobile health application (mHealth) technology and COVID-19. The strategies used in an attempt to overcome these barriers are also discussed. Despite a comprehensive approach to recruitment, the required participant number was not achieved. It is recommended careful consideration be given to recruitment including flexibility in recruitment strategies tailored to the unique contexts of a study. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) is a complex chronic condition that requires ongoing self‐management. Diabetes health coaching interventions provide personalized healthcare programming to address physical and psychosocial aspects of diabetes self‐management. Aims: This scoping review aims to explore the contexts and settings of diabetes health coaching interventions for adults with T2D, using the RE‐AIM framework. Methods: A search was completed in MEDLINE, PsycINFO, Emcare, Embase and Cochrane. Included citations described adults with exclusively T2D who had received a health coaching intervention. Citations were excluded if they focused on any other types of diabetes or diabetes prevention. Results: A total of 3418 records were identified through database and manual searches, with 29 citations selected for data extraction. Most health coaching interventions were delivered by health professionals, many employed lay health workers and a few included peer coaches. While many health coaching interventions were delivered remotely, in‐person intervention settings were distributed among primary care, community health settings and non‐healthcare sites. Conclusion: The findings of this review suggest that diabetes health coaching may be implemented by a variety of providers in different settings. Further research is required to standardize training and implementation of health coaching and evaluate its long‐term effectiveness. [ABSTRACT FROM AUTHOR]