Search Results (141)

Volumetric video streaming holds transformative potential for telemedicine, enabling immersive remote consultations, surgical training, and real-time collaborative diagnostics. However, transmitting sensitive patient data (e.g., 3D medical scans, surgeon head/gaze movements) raises critical privacy risks, including exposure of biometric identifiers and protected health information (PHI). To address the above concerns, we propose SecureTeleMed, a dual-track encryption scheme tailored for volumetric video based telemedicine. SecureTeleMed combines viewport obfuscation and region of interest (ROI)-aware frame encryption to protect both patient data and clinician interactions while complying with healthcare privacy regulations (e.g., HIPAA, GDPR). Evaluations show SecureTeleMed reduces privacy leakage by 89% compared to baseline encryption methods, with sub-50 ms latency suitable for real-time telemedicine applications. Full article

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes services unequal for residents in the city. To achieve fair and rapid access to medical services, healthcare accessibility and equity have become key concerns. The introduction of tele-health, i.e., online visits or digital health, can help balance the distribution of medical resources to improve accessibility and equity, particularly for elderly patients with chronic diseases. Methods: To quantitatively assess the spatial accessibility of healthcare facilities, an improved two-step floating catchment area method with tele-health (i2SFCA-TH) is proposed to study the demand–supply ratio by considering traveling time, chronic diseases, and online visits based on services provided by community and tertiary hospitals. An optimization model using mixed-integer programming to maximize average accessibility under resource constraints could help improve overall accessibility and reduce differences in access among all residential divisions to achieve better equity in the region. Results: By applying the method in a metropolitan city in China, it is observed that the overall spatial accessibility of residential divisions in the city is 0.72, but the gap between the highest and the lowest reaches 2.36; i.e., significant differences exhibit due to uneven allocation of medical resources. By introducing tele-health, the gaps of access among different divisions can be decreased, with the largest gap reduced to 1.49, and the accessibility in divisions with poor medical resource allocation can be increased. Finally, the mean healthcare accessibility and equity in the study region can be improved to 0.75. In addition, it is shown that proper management of medical resources and patients’ willingness to accept online visits could help improve accessibility and equity, which can provide insights for hospital management and urban planning. Conclusions: An integrated framework to quantitatively assess and optimally improve healthcare accessibility and equity of medical resource allocation through tele-health is presented in this paper. An i2SFCA-TH method and an optimization model are used in the framework, which provides hospital management and urban planners a quantitative tool to improve accessibility and equity in metropolitan cities in China and other countries. Full article

Background: Despite strong guideline recommendations, participation in cardiac rehabilitation (CR) among patients with chronic heart failure (CHF) remains low due to logistical, geographical, and psychosocial barriers. Telerehabilitation may help overcome these limitations by offering remote, structured exercise programs supported by digital technologies. Objective: The TELEREHAB-HF study aims to evaluate the efficacy of an 8-week, home-based cardiac telerehabilitation program compared to standard in-person rehabilitation in patients with CHF. Methods: This is a prospective, controlled cohort study involving 220 adult patients with CHF (NYHA class I–III) clinically stable and on optimized therapy. Participants are assigned to either a telerehabilitation group (remote CR via a digital platform with wearable sensors and real-time physiotherapist supervision) or a standard in-person rehabilitation group. The primary outcome is the change in peak oxygen uptake (VO₂max) at 8 weeks. Secondary outcomes include quality of life, functional performance, biochemical and echocardiographic parameters, and cognitive function, assessed at baseline and at 4, 8, 16, and 24 weeks. Expected Results: We hypothesize that telerehabilitation will be non-inferior to standard CR in improving functional capacity and secondary outcomes, with additional benefits in accessibility and adherence. Data from remote monitoring may also support a translational “rehabilomics” approach to exploring exercise-induced biomarker changes. Conclusions: This study seeks to assess the clinical effectiveness, safety, and feasibility of a home-based telerehabilitation model for CHF, with the goal of informing future strategies for broader implementation and personalized rehabilitation. Trial Registration: ClinicalTrials.gov Identifier: NCT07023536 Full article

Introduction: Stroke is a leading cause of long-term disability and substantially affects the quality of life (QoL) of both survivors and their caregivers. The transition from hospital to home is a vulnerable period characterized by discontinuity of care and insufficient caregiver support. Dyadic interventions—targeting both the survivor and caregiver—have shown promise in improving recovery outcomes. This protocol outlines a mixed-methods study to evaluate the impact of a video-based training intervention on the stroke survivor–caregiver dyad during the first year post-discharge. Methods: A mixed-methods design based on the TIDieR checklist will be implemented. Stroke survivors and their caregivers will be recruited from stroke units and rehabilitation hospitals across Italy prior to discharge. Approximately 150 dyads will receive a video training intervention followed by nurse-led transitional care support. Assessments will occur at baseline (T0) and at 1 (T1), 3 (T2), 6 (T3), and 12 months (T4) post-discharge. Outcomes will include physical functioning, disability, anxiety, depression, caregiver preparedness, burden, social support, sleep quality, and both generic and stroke-specific QoL. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, July 2024. Conclusions: Integrating caregivers into transitional care through structured training and support is essential for improving dyadic outcomes after stroke. Strengthening knowledge and preparedness in both survivors and caregivers enhances recovery, reduces caregiver burden, and may alleviate healthcare system costs associated with poor post-discharge outcomes. Full article

Telemedicine has transformed obstetrics and gynecology (OB/GYN), accelerated by the COVID-19 pandemic. This study aims to synthesize evidence on the adoption, effectiveness, barriers, and technological innovations of telemedicine in OB/GYN across diverse healthcare settings. This scoping review synthesized 63 peer-reviewed studies (2010–2023) using PRISMA-ScR guidelines to map global applications, outcomes, and challenges. Key modalities included synchronous consultations, remote monitoring, AI-assisted triage, tele-supervision, and asynchronous communication. Results demonstrated improved access to routine care and mental health support, with outcomes for low-risk pregnancies comparable to in-person services. Adoption surged >500% during pandemic peaks, stabilizing at 9–12% of services in high-income countries. However, significant disparities persisted: 43% of rural Sub-Saharan clinics lacked stable internet, while socioeconomic, linguistic, and cultural barriers disproportionately affected vulnerable populations (e.g., non-English-speaking, transgender, and refugee patients). Providers reported utility but also screen fatigue (41–68%) and diagnostic uncertainty. Critical barriers included fragmented policies, reimbursement variability, data privacy concerns, and limited evidence from conflict-affected regions. Sustainable integration requires equity-centered design, robust policy frameworks, rigorous longitudinal evaluation, and ethically validated AI to address clinical complexity and systemic gaps. Full article

Background: Hearing impairment is a significant public health issue globally, yet national data for Saudi Arabia remain sparse. Methods: Using data from the 2017 Disability Survey, we analysed 12 hearing-related indicators across 13 administrative regions. Descriptive statistics, logistic regression, cluster analysis, and residual mapping were applied to identify socio-demographic disparities and service gaps. Findings: Among 20,408,362 Saudi nationals, about 1,445,723 (7.1%) reported at least one functional difficulty. Of these, 289,355 individuals (1.4%) had hearing impairment, either alone or with other difficulties—229,541 (1.1%) had hearing impairment combined with other disabilities, while 59,814 (0.3%) had only hearing impairment. Females and males were equally affected. Notably, educational attainment and marital status significantly influenced device uptake; less-educated and divorced individuals were particularly underserved. Regionally, southern provinces (Al-Baha, Jazan, and Najran) demonstrated the highest unmet need due to geographic barriers, limited audiological resources, and socioeconomic constraints, reflecting compounded risks from consanguinity and rural isolation. Cluster analyses identified provinces requiring urgent attention, recommending mobile audiology units, tele-audiology services, and means-tested vouchers to enhance coverage. Conclusions: Despite Saudi Arabia’s existing public audiology services and a National Newborn Hearing Screening programme achieving 96% coverage, substantial gaps remain in follow-up care and specialist distribution, underscoring the necessity for systematic workforce tracking and enhanced rural incentives. International evidence from India and Brazil underscores the feasibility and cost-effectiveness (approximately USD 5200/QALY) of these recommended interventions. Implementing targeted provincial strategies, integrating audiological screening into routine healthcare visits, and aligning resource allocation with the WHO and Vision 2030 benchmarks will significantly mitigate hearing impairment’s health, social, and economic impacts, enhancing the quality of life and societal inclusion for affected individuals. Full article

Background/Objectives: Older adults (65+) are the fastest growing age group in Canada, comprising 18.8% of the country’s population. During the COVID-19 pandemic, use of virtual care, including telehealth and tele-medicine, increased dramatically among older adults in Canada who often face higher health risks, mobility limitations, and many barriers to accessing healthcare. Despite the rapid expansion in virtual care, no systematic review has focused specifically on virtual care among older adults in Canada. This review aims to explore the factors influencing virtual care adoption and the experiences of older Canadians during the pandemic through a systematic review. Methods: Conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the review involved a comprehensive search of PubMed, Scopus, ESCBOHost, and Web of Science on 2 May 2025, yielding 281 unique citations. After screening and applying eligibility criteria, 15 studies employing quantitative, qualitative, or mixed-methods designs, with sample sizes ranging from 15 to 2,282,798, were included and appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The review identified three domains of factors and the ways in which each factor shapes older adults’ virtual care experiences: (1) personal factors influencing virtual care use and demand (e.g., age, education, language, income, immigration status, community sizes), (2) resource factors impacting virtual care adoption (e.g., technology access, support), and (3) varying virtual care experiences among older adults (e.g., in assessment and communication efficacy, privacy, care quality, convenience, safety, and costs). Conclusions: This review highlights the complexities of virtual care engagement among older adults and underscores the need for inclusive, tailored strategies to improve the accessibility and effectiveness of virtual care delivery in both pandemic and post-pandemic contexts. Full article

Background: Spinal cord injury is a multisystem disease which compromises independence and quality of life; remote care models represent an opportunity for long-term management of complications. The aim of this study was to explore remote care models for chronic spinal cord injury patients. Methods: A systematic review of the literature was carried out. Five databases (PubMed, CINAHL, Web of Science, Cochrane Library, Google Scholar) were systematically explored with a time limit of five years. Included studies were assessed using Jadad Score and PEDro Scale. Results: Four RCTs were included in this systematic review. In all studies, multidisciplinary home care supported by technology were compared with in-person models. Remote care models were effective in managing pressure injury, infection, and muscle atrophy and improve quality of life. Conclusions: Remote care models can be a key tool for improving self-efficacy, decreasing hospitalizations and preventing long-term mortality. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

Background: Tele-practice, as an evidence-based practice, has gained momentum over the last two decades. However, routine clinical adoption is not spontaneous. Implementation science facilitates stakeholder engagement and the assessment of needs and plans. The study aims to assess the needs related to audiology and speech–language pathology services for children under six years of age and readiness for a tele-practice-based model of care for diagnostic and rehabilitation services among parents within the public sector in Tamil Nadu. Methods: A cross-sectional study design was used. The qualitative methods of focus group discussions and semi-structured interviews were conducted for parents of children with disabilities. A quantitative community survey was conducted on parents of children with no known disabilities. A deductive-inductive method of analysis was used. Results: Community survey responses were analyzed using percentage analysis. The results were classified based on the constructs of Bowen’s feasibility framework: demand/need for tele-practice, acceptability of tele-practice, and integration and practicality of tele-practice. Parents considered the existing services to be inadequate. Parents perceived tele-practice as beneficial, yet they felt a hybrid method would be more suitable, with sufficiently interspersed in-person visits. Parents believed that training and community awareness were necessary before implementing a technology-based model of services. Conclusions: The study’s findings guided the fine-tuning of the proposed comprehensive tele-practice model for hearing and speech–language services for children in this rural district. Full article

Nutritional health is essential for older people with dementia. Their feeding is a challenge for which caregivers are not always ready, and an intervention that supports them may have a significant social impact. The aim of this project is to design and evaluate the impact of systematic nursing intervention with formal caregivers to promote nutritional health for older people with dementia. This is a “Nursing Methodology Research” study conducted with formal caregivers of older people with dementia in four Colombian nursing homes. It includes three consecutive phases: (1) systematic intervention design under Whittemore and Grey’s parameters, (2) intervention validation with seven international experts, and (3) measurement of intervention impact, which included a quasi-experimental pre-test–post-test design. The “Nurturing Neurons—Formal Caregivers” intervention met the criteria of systematic health interventions. In response to the work and personal requirements of formal caregivers, the intervention used a tele-support modality. Its content validity ratio (CVR) ranged from 0.88 to 0.92; its content validity index (CVI) was 0.90. The experience was positive for the participant caregivers (94.9%) and professional providers (92.5%). The overall caregivers’ caring competence changed from the medium, 78.1, to the high category, 91.5 (p < 0.001). Their perceived burden of care changed from 70.4 to 63.6 (p < 0.001). In conclusion, “Nurturing Neurons—Formal Caregivers” achieved a positive impact, with changes in the structure, processes, and outputs to promote the nutritional health of older people with dementia. It led to a significant improvement in formal caregivers’ caring competence and decreased their perceived care burden. Its cost–benefit was favorable; it generated health equity for a vulnerable population and achieved unexpected benefits in the context. Full article

Background: The Standards for the Psychosocial Care of Children with Cancer and their Families provide a framework for the delivery of psychosocial care to families experiencing pediatric cancer. Similarly, the Pediatric Psychosocial Preventative Health Model (PPPHM) guides intervention approaches by identifying three tiers of psychosocial support based on a family’s level of risk. Employing both the Standards and the PPPHM, we developed a comprehensive three-tiered approach to support the psychosocial needs of families in a pediatric oncology setting. Methods: After publication of the Standards, our institution merged existing psychosocial disciplines into one unified Psychosocial Services department. The new department worked to clearly define the role and scope of each discipline’s practice to ensure the psychosocial needs of patients and families were being comprehensively met. Interprofessional workgroups were established to evaluate and enhance the psychosocial services offered to patients, siblings, and caregivers using a three-tiered model of support. Membership included representation from patients and parent/caregiver advisors to ensure their perspectives were included in program development. Results: Over ten new programs have been developed to enhance the support of families facing pediatric cancer. At the Universal tier, new programs available to all families include caregiver and sibling support groups, a caregiver podcast, and a relationship health toolkit and workshop. At the Targeted tier, psychosocial interventions and parent mentor supports were implemented. At the Clinical/Intervention tier, a partnership was developed with an external tele-mental health company to provide mental health services to caregivers with significant needs or preexisting mental health disorders. Conclusions: Given the complex needs of families facing pediatric cancer, use of an interdisciplinary approach is paramount to successful support throughout the treatment trajectory. By leveraging the expertise and strengths of diverse disciplines with the perspectives of patients and families, new psychosocial programs can comprehensively address the unique challenges of patients and families impacted by illness. Full article

Background: COVID-19 presented many challenges for our health system, one being a suspected change in the epidemiology of severe hand trauma modalities. These complex injuries are traditionally treated at specialized hand trauma centers, but COVID-19 has in many ways disturbed these established pathways and presented new challenges. Methods: We retrospectively analyzed finger amputation injuries treated at the University Hospital of St. Poelten between 2018 and 2022 to examine differences in the management of micro amputation injuries before and during the COVID-19 pandemic. Further challenges in the treatment of hand trauma patients were analyzed and solutions were developed. Results: Overall, the number of occupational finger amputation injuries in Lower Austria declined during the COVID-19 pandemic. Contrarily, more private accidents were treated in the same period, suggesting a lockdown specific change in injury characteristics. Throughout the entire examined period, a total of 130 injured fingers, including 29 thumbs, were treated. In 67 cases, a reconstruction attempt was feasible and successful in 59 cases. Specific challenges were fewer active hand trauma centers, subsequent long transport times, specific COVID-19 prevention measures, and limited postoperative rehabilitation resources. Conclusions: Despite many challenges overall affecting the time to revascularization, good results were achieved by small but meaningful modifications. These included well-established principles such as back table preparation and strengthening novel concepts such as tele-medicine for patient selection. Overall, the reconstruction of severe hand injuries is often challenging, especially during a world-wide health crisis, but with adequate solutions, good results can be readily achieved. Full article

(1) Background: American Indian and Alaska Native (AI/AN) communities faced disproportionate COVID-19 infection rates and a higher prevalence of substance use disorders (SUDs). Telehealth emerged as a key strategy to address these health disparities. (2) Objective: In response to a call to action from an urban Indian organization (UIO), our multidisciplinary team conducted a community-based participatory study to (1) examine the integration of Native practices in SUD treatment during COVID-19, and (2) develop provider training modules based on these findings. (3) Methods: Using a mixed methods approach, we conducted semi-structured interviews with six community SUD providers, surveyed 91 clients, and analyzed 278 de-identified health records from the UIO Native-serving facility in the Southwest U.S. from May 2020 to May 2021. (4) Results: As of October 2024, analysis of Aim 1 is ongoing. With UIO engagement, findings from Aim 1 are being translated into training modules for Aim 2. (5) Conclusion: This community-driven study lays the foundation for future research on Indigenous mental well-being, centering strength, resilience, and cultural knowledge in substance use treatment. Findings will be disseminated through presentations and publications with Native and non-Native communities, treatment centers, educators, and leaders. Future studies will assess the effectiveness of the training modules among clinicians. Full article

Background: Healthy cognitive functioning is a primary component of well-being, independence, and successful aging. Cognitive deficits can arise from various conditions, such as brain injury, mental illness, and neurological disorders. Rehabilitation is a highly specialized service limited to patients who have access to institutional settings. In response to this unmet need, telehealth solutions are ideal for triggering the migration of care from clinics to patients’ homes. Objectives: The aim of EARLY-COGN^3 will be threefold: (1) to test the efficacy of a digital health at-home intervention (tele@cognitive protocol) as compared to an unstructured cognitive at-home rehabilitation in a cohort of patients with Chronic Neurological Diseases (CNDs); (2) to investigate its effects on the biomolecular and neurophysiological marker hypothesizing that people with CNDs enrolled in this telerehabilitation program will develop changes in biological markers and cortical and subcortical patterns of connectivity; (3) to analyze potential cognitive, neurobiological, and neurophysiological predictors of response to the tele@cognitive treatment. Method: In this single-blind, randomized, and controlled pilot study, we will assess the short- and long-term efficacy of cognitive telerehabilitation protocol (tele@cognitive) as compared to an unstructured cognitive at-home rehabilitation (Active Control Group—ACG) in a cohort of 60 people with Mild Cognitive Impairment (MCI), Subjective Cognitive Complaints (SCCs), or Parkinson’s Disease (PD). All participants will undergo a clinical, functional, neurocognitive, and quality of life assessment at the baseline (T0), post-treatment (5 weeks, T1), and at the 3-month (T2) follow-up. Neurophysiological markers and biomolecular data will be collected at T0 and T1. Conclusions: EARLY-COGN^3 project could lead to a complete paradigm shift from the traditional therapeutic approach, forcing a reassessment on how CNDs could take advantage of a digital solution. (clinicaltrials.gov database, ID: NCT06657274) Full article