mHealth applications for managing pain in the physical therapy (PT) setting are growing in popularity. However, multiple knowledge gaps persist regarding the utility of these tools, including the types of mHealth delivery modalities tested and the amount of therapy delivered. This scoping review sought to characterize existing literature examining use of mHealth applications in adults (18+) with chronic pain eligible for PT. We searched multiple databases to identify English-language articles using pre-defined inclusion/exclusion criteria and extracted key data (e.g., study design, intervention elements). Forty-two studies met eligibility criteria and were analyzed. Average participant age was 51.8 years and a substantial majority of studies (85.7%) did not report on participants' race/ethnicity status. The mHealth interventions included stand alone apps, wearables for performance measurement (including activity trackers), and web-based content in combination with other components. Most mHealth tools delivered exercise and/or education. Most studies examined outcomes immediately or up to 3 months after completion of the intervention. The intervention results were mixed, potentially due to heterogeneity of interventions and study designs. Using the NIH Stage Model for Behavioral Intervention Development to gauge the stage of research, 64.2% of studies were classified as early-stage investigations. This scoping review identified key knowledge gaps that can guide future research, including the need to better characterize study populations, conduct future research evaluating the impact of mHealth in older populations, conduct real world effectiveness studies, and assess both adherence to the prescribed mHealth intervention and targeted behaviors.
Integration of social media (SM) with mobile health (mHealth) platforms presents significant potential to address the persistent challenge of disengagement in digital health interventions among young people. However, empirical evidence supporting this combined approach remains limited, as SM and mHealth are often examined in isolation. This systematic review aimed to identify and synthesise the determinants influencing the participation in SM and mHealth interventions for behaviour change among young people aged 14 to 35 years. A systematic search of Scopus, Web of Science, PubMed, and the ACM Digital Library was conducted to identify peer-reviewed empirical studies published between 2019 and 2024. The review followed the PRISMA framework. Eligible studies examined health behaviour interventions that employ mobile or web-based platforms accessible via smartphones or wearables. Thematic synthesis drew on constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT) and the Expectation-Confirmation Model (ECM) to interpret determinants of engagement. Twenty studies met the inclusion criteria, representing diverse geographical contexts, with 35% from the USA and 15% each from South Africa and Australia, while other regions contributed 10% and 5% each. Sexual and reproductive health (55%) was the most common intervention focus above other health domains. Determinants of sustained engagement were identified at three levels: (i) user-level (ii) intervention-level and (iii) contextual-level factors. Engagement was highest when interventions aligned with behavioural readiness, provided peer-reinforced support, and offered user-centred adaptive design. Conversely, digital inequities, privacy concerns, and commercial algorithmic bias constrained participation in low-resource settings. Sustained engagement depends on user motivation, health awareness, cultural and gender sensitivity, and equitable digital access. While integration improves behavioural adherence through social reinforcement and personalisation, risks linked to data privacy, misinformation, and commercial exploitation necessitate robust ethical governance. Context-responsive, rights-based, and gender-inclusive digital health strategies are essential to ensure equitable participation and sustained behavioural outcomes among young people.
Despite ample evidence of the benefits of cardiac rehabilitation (CR), few transcatheter aortic valve replacement (TAVR) patients participate. Commercially available mobile health offers an opportunity to deliver activity-promotion content to populations that are challenged to participate in CR. This study aims to test the efficacy of clinically controlled, commercially available fitness programming for improving physical activity and cardiovascular health outcomes designed to be initiated while patients are on waitlists for traditional CR. The Cardio Heart Connect study is a hybrid type I effectiveness-implementation trial aiming to enroll N=200 patients who have been placed on a cardiac rehab waitlist following a TAVR procedure from the University of Colorado Hospital Heart and Vascular Center. Participants will be randomized 1:1 to the Cardio Heart Connect intervention with commercially available fitness or attention control, designed to control for technology access. At baseline, post-intervention (8 weeks), and follow-up (12 months), we will assess the primary outcome of participants' daily steps as measured by smartwatch accelerometer and secondary outcomes of interest including functional capacity (Duke Activity Status Index; VO2max), quality of life (Kansas City Cardiomyopathy Questionnaire), and cardiovascular health status (Life Essential 8). In addition, we will use mixed methodologies to evaluate the implementation of intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Commercially available fitness programs have the potential to provide more accessible opportunities for patients recovering from TAVR to engage in physical activity and may be preferred due to their customizability, convenience, and ease of scheduling. Overall, this study will provide insight into the use of commercial mHealth to promote activity following TAVR.
Mental health challenges are common among college students, highlighting the need for scalable approaches that aim to reduce distress and support well-being. mHealth tools may complement campus services, though sustained engagement may be difficult. This study sought to discover how a blended intervention combining an mHealth positive psychology intervention (PPI) app with optional wellness coaching might impact student well-being. In this single-arm pilot study, 28 students at a public university were given access to a PPI app (Roadmap 2.0) with mood tracking, a Fitbit® wearable device, and optional wellness coaching. Data sources included PROMIS® surveys at baseline and monthly follow-ups, daily mood ratings, app engagement logs, wearable-derived activity metrics, coaching attendance, and optional exit interviews. Analyses were descriptive and exploratory. From baseline to exit, participants showed descriptive increases in PROMIS® global mental health and positive affect and decreases in depression, anxiety, fatigue, and anger. App engagement declined over time. In exploratory models, app engagement was lower among participants reporting greater psychosocial resources or support. Mood ratings were higher in the days following PPI activity completion, and PPI activity users were observed to have higher mood ratings over time. Interviews supported perceived app-coaching synergy and identified barriers to sustained engagement. A blended PPI mHealth app plus wellness coaching appears feasible in a real-world college setting and was associated with favorable descriptive trends in mental health and well-being outcomes. Controlled studies are needed to evaluate efficacy and assess app versus coaching contributions.
We evaluated whether offering access to a multicomponent mHealth app improves quality of life (QoL) and psychosocial outcomes among breast cancer survivors under pragmatic, nonprescriptive conditions. In this single-center, randomized, controlled trial at Hospital Clínic de Barcelona, women age ≥18 years, disease-free after breast cancer treatment, were recruited (December 2020-December 2021) and randomly assigned 1:1 to usual follow-up plus app access or usual follow-up alone. The app provided CTCAE v4.03-aligned symptom tracking with self-care guidance, educational content, an events calendar, and gamified smartphone-based step counting; no protocolized clinician monitoring or feedback was provided. Outcomes were assessed at baseline and 3, 6, 9, and 12 months using European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ)-C30/BR23, Hospital Anxiety and Depression Scale (HADS), and Three-Item Loneliness Scale (TILS). The primary end point was the difference in QLQ-C30 Global Health Status/QoL at 3 months. Analyses followed intention-to-treat using mixed models for repeated measures adjusted for baseline values. Of 124 women assessed, 121 were randomized (intervention n = 60; control n = 61). Patient-reported outcome measures were available for 106 of 121 (87.6%) at 3 months and 95 of 121 (78.5%) at 12 months. At 3 months, there was no significant difference in Global Health Status/QoL (adjusted mean difference [Intervention-Control], -2.24 [95% CI, -9.29 to 4.81]; P = .53); estimates at later time points were similarly imprecise. No significant between-group difference were observed for QLQ-BR23 domains, HADS anxiety/depression, or TILS. Exploratory subgroup analyses suggested possible heterogeneity in TILS by hormonal-treatment category; this was descriptive and hypothesis-generating only. App engagement was the highest in months 0-3 (48/60 [80.0%] with any use) and declined thereafter; 12 of 60 (20.0%) never used the app. In a pragmatic, nonprescriptive survivorship trial, offering access to a multicomponent mHealth app without closed-loop clinical integration did not show a statistically significant between-group differences in QoL or psychosocial outcomes; confidence intervals were compatible with meaningful harm and did not exclude small benefit depending on the threshold used to define clinical relevance.
Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers' communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings.
Wearable human activity recognition has become an important component of intelligent fitness tracking, but deploying accurate recognition models on resource-constrained edge devices remains challenging. Existing deep learning methods often rely on recurrent structures, attention mechanisms, or complex hybrid architectures, which increase computational cost and limit real-time deployment. This study proposes DeM-FCN, a lightweight and purely convolutional framework for smart dumbbell-based resistance-training activity recognition. The model integrates a physics-aware input representation, Gaussian noise regularization, stacked one-dimensional convolutional blocks, Global Max Pooling, and a cost-sensitive focal loss to improve subject-independent recognition. The input representation extends raw inertial measurements by introducing trigonometric encoding of Euler angles and acceleration and gyroscope magnitude features, allowing the model to capture both orientation-related motion patterns and orientation-insensitive motion intensity. The proposed model was evaluated using Leave-One-Subject-Out cross-validation on a custom smart dumbbell dataset containing four resistance-training exercises collected from 15 subjects. DeM-FCN achieved an accuracy of 0.966, macro F1-score of 0.916, and macro AUC of 0.982, while maintaining only 73.7 K parameters, 14.84 M FLOPs, and a model size of 0.29 MB. Additional evaluations on PAMAP2 and MHEALTH suggested that the convolutional backbone retained useful class-ranking ability on public IMU-based HAR datasets, while the reduced macro F1-scores indicated that hard-label daily activity recognition remains more challenging than constrained resistance-training recognition due to broader activity diversity, sensor-domain differences, and missing modality information. A refined ablation study confirmed that trigonometric encoding and magnitude features provide complementary benefits, with magnitude features contributing more strongly to cross-subject robustness. The results suggest that DeM-FCN provides a favorable accuracy-efficiency trade-off for wearable resistance-training recognition and offers a practical foundation for edge-oriented fitness monitoring.
Cancer care is becoming increasingly complex globally, with rising cases and challenges for conventional systems. Technology aids in managing this complexity, but it does not replace clinical expertise. The integration of digital tools, artificial intelligence (AI) in imaging and diagnostics, and machine learning in treatment planning marks a shift in oncology. However, successful implementation requires careful evaluation, particularly in nursing practice, where AI assists in symptom tracking and care coordination. Challenges include digital literacy among older patients and ethical issues such as data protection and algorithmic transparency. Rapid adoption without adequate understanding may contribute to long-term negative outcomes. The narrative review explores the present and future applications of modern technology, such as artificial intelligence, robotics, machine learning, telemedicine (including remote patient monitoring), the internet of medical things (such as wearable devices), genomic technologies, and nanotechnology in medicine, among others, in the management of cancer.
Maternal health in Lebanon is severely impacted by the country's ongoing socioeconomic crisis, disproportionately affectivng disadvantaged Lebanese and refugee women due to limited healthcare access. Digital prompting interventions have improved antenatal and postnatal care utilization, particularly when the husband of the pregnant woman is also engaged. This study aims to assess the influence of digital prompting and husband engagement on the satisfaction of disadvantaged pregnant women in Lebanon with their reproductive health journeys, using the artificial intelligence (AI)-based gamified mHealth intervention titled "Gamification and Artificial Intelligence and mHealth Network for Maternal Health Improvement" (GAIN MHI). This study was conducted across seven primary healthcare centers in Lebanon, targeting pregnant women up to 16 weeks of gestation with mobile phone access. The intervention included digital messages for both pregnant women and their husbands, alongside the GAIN MHI App for healthcare providers. Over 11 months, data was collected to assess maternal satisfaction, antenatal care (ANC) attendance, and the role of husband engagement in supporting maternal wellbeing. A total of 1028 pregnant women participated. Husband involvement significantly improved support for ANC visit, reminder's frequency, and psychological support. Women receiving mobile health support were more likely to report better physical health (odds ratio (OR) = 2.16; p = 0.03) and mental health (OR = 2.12; p = 0.03). Increased ANC visits were associated with higher likelihood of satisfaction with baby health (OR = 1.35; p = 0.05) and with service quality (OR = 2.68; p = 0.01). Husband support for ANC visits improved satisfaction both predelivery (OR = 2.15; p < 0.01) and postdelivery (OR = 2.05; p < 0.01). The combined effect of all support factors significantly boosted satisfaction with self-care predelivery (OR = 2.07; p < 0.01) and postdelivery (OR = 3.82; p < 0.01). The findings emphasize the importance of hybrid digital health models integrating mobile-based education, spousal support, and healthcare provider engagement to enhance maternal satisfaction and health outcomes. Future programs should adopt this approach to ensure comprehensive maternal care.
Digital services allow patients to efficiently access healthcare. These services work more effectively than traditional paper-based systems by delivering better patient outcomes, helping address global health challenges, and promoting the universal adoption of health technology. This study examined the impact of digital healthcare adoption and service quality on patient satisfaction in Pakistan's public healthcare sector and the moderating effect of telehealth services on this relationship. This study adopted the technology acceptance model to understand technology sophistication and how electronic medical records, digital patient systems, and technology impact healthcare through efficiency and communication. Simultaneously, the study examined the role of doctor services, nurse services, pharmacy services, and laboratory services in the patient experience. Random sampling techniques were employed, and questionnaires were distributed to 573 respondents across five central districts of Punjab, Pakistan. The hypotheses were tested using IBM SPSS Statistics, Amos, and structural equation modeling. These findings show that digital healthcare adoption and service quality significantly improve patient satisfaction, whereas telehealth services reinforce these relationships by overcoming geographical and logistical hurdles. The conclusions of this study offer pragmatic guidance to policymakers and healthcare administrators for devising digital healthcare strategies to improve patient outcomes.
This study examined the association between attitudes toward digital technology and intentions to use digital mental health solutions, with perceptions of mental health apps and online therapy as potential mediators. A cross-sectional survey was conducted with 360 undergraduate students at Sultan Qaboos University (SQU) (July 2025). The mean age was 21.24 (SD = 3.12), with 50.3% of female respondents and 49.7% male. Using a validated questionnaire, we included assessments of attitudes and beliefs about digital technology, perceptions of mental health apps and online therapy, and intention to use digital mental health solutions. Mediation analysis was performed using structural equation modeling. Attitudes toward digital technology were significantly associated with intention (β = 0.358, p < 0.001). Perceptions of mental health apps significantly mediated this relationship (indirect effect = 0.065, p = 0.006), while perceptions of online therapy did not (indirect effect = 0.030, p = 0.109). The total indirect effect through both mediators was significant (0.095, p = 0.002), with a strong total effect on intention (0.454, p < 0.001). These findings suggest that improving students' perceptions of mental health apps may help them use digital mental health services. Implementation strategies in similar university settings should target service-specific perceptions to drive adoption of these tools.
Chronic pain affects one in five Americans, yet rural patients face significant barriers to evidence-based interventions like biofeedback due to geographic isolation and provider shortages. This pilot study evaluates the feasibility, acceptability, and preliminary effectiveness of Mind Meter, a virtual neuroscience-based biofeedback group intervention, for rural adults with chronic pain. Twenty-nine rural-dwelling adults (mean age 44.9, SD 11.8) with chronic pain (≥3 months) were recruited from a pain management program and twenty-one participants completed a single-session virtual Mind Meter group, integrating pain neuroscience education and biofeedback via affordable equipment (pulse oximeters, skin thermometers). Feasibility was assessed by enrollment (target ≥50%), adherence (≥80%), and completion rates (≥75%); acceptability via a 10-item questionnaire (target ≥80% rating ≥4/5); and preliminary effectiveness via pre-post changes in heart rate, temperature, pain, and anxiety, analyzed with paired t-tests (adjusted P < 0.05). Enrollment was 22% (29/132 eligible), below target, while adherence reached 100%, exceeding goals. Acceptability was high, with 90.5% rating the intervention ≥4/5 (mean 4.3, SD 0.9), particularly for clarity of directions (95.2% ≥ 4). Statistically significant pre-post improvements occurred in anxiety (mean change -2.2, SD 2.4, P < 0.001, Hedge's g = -0.886) and temperature (mean increase 4.6°F, SD 6.1, P = 0.003, g = 0.726); pain decreased (mean -0.8, SD 1.5, P = 0.025) but lost statistical significance after correction for multiple comparisons. Heart rate showed no change (P = 0.615). Virtual Mind Meter is feasible and highly acceptable for rural patients with chronic pain, with promising reductions in anxiety and temperature. Lower than hypothesized enrollment warrants recruitment strategy-adjustments, while preliminary outcomes support further development.
Survivors of critical illness commonly experience post-intensive care syndrome (PICS), including cognitive, mental health, physical, quality-of-life, and social impairments after discharge. Telemedicine may improve access to post-ICU recovery clinic care, but its feasibility and effect on recovery outcomes remain unclear. We evaluated the feasibility of a multidisciplinary telemedicine post-ICU recovery clinic and collecting 6-month outcome data. We conducted a two-site pilot feasibility randomized controlled trial at an academic medical center and regional community medical center in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or acute respiratory distress syndrome were randomized 1:1 to telemedicine ICU recovery clinic visits or standard care. The intervention included two multidisciplinary visits at 3 weeks and 3 months after hospital discharge; participants accessed visits via a secure web-based personal health portal, where they videoconferenced simultaneously with an ICU clinician, pharmacist, and psychologist. Participants in the standard of care group received usual post-discharge care. Feasibility outcomes included enrollment, retention, attendance, clinician fidelity, and participant ratings of acceptability, appropriateness, and feasibility. Exploratory outcomes included cognitive, mental health (i.e., depression, anxiety, PTSD), and physical health (i.e., activities of daily living, independent activities of daily living) composite scores measured at 1 week and 6 months after hospital discharge. Of 1,108 screened patients, 91 were randomized (telemedicine, n = 46; standard care, n = 45). Among 83 participants completing the 1-week assessment, median age was 56 years, 51% were male, and 91% were White. In the telemedicine arm, 23 participants (57.5%) attended at least one visit; attendance was 55% at 3 weeks and 42.5% at 3 months among eligible participants. Primary 6-month outcome assessment was completed by 31 participants in each group (67%). Clinician participation fidelity was high, and telemedicine attendees reported favorable acceptability, appropriateness, and feasibility ratings. Exploratory analyses of PICS composite outcomes did not differ significantly between groups. A multidisciplinary telemedicine post-ICU recovery clinic and associated trial procedures were feasible, with high clinician fidelity and favorable participant ratings. Larger trials are needed to explore engagement strategies and evaluate effectiveness on long-term recovery outcomes, prioritizing inclusion of more diverse and historically underrepresented populations. NCT03926533 (posted 4/24/2019).
Background: Many patients with heart failure with reduced ejection fraction (HFrEF) remain undertreated in routine practice. Delayed treatment intensification, poor adherence, and fragmented follow-up are common barriers. Low-cost digital support may help reduce this implementation gap. Objective: This study evaluated whether a simple digital support pathway was associated with better 6-month treatment adherence and guideline-directed medical therapy (GDMT) optimization in ambulatory patients with stable HFrEF. Methods: This single-center matched cohort study compared a prospective digital-support cohort with a historical usual-care cohort. The intervention combined smartphone-based telemanagement, home blood pressure and heart-rate reporting, daily weight surveillance, and scheduled video consultations. The co-primary endpoints were treatment adherence at 6 months and GDMT optimization, assessed by change in foundational HFrEF drug classes and by a prespecified exploratory GDMT optimization score. Results: After 1:1 propensity-score matching, 200 patients were included, with 100 patients in each cohort. Treatment adherence at 6 months was higher in the digital-support cohort than in usual care (82.0% vs. 64.0%, p = 0.004). The intervention cohort also had more frequent class addition, more dose escalation, a greater increase in foundational drug classes, and a larger improvement in GDMT optimization score (all p < 0.001). Heart failure hospitalization and the composite of heart failure hospitalization or all-cause death were less frequent in the digital-support cohort, but these clinical outcomes were exploratory. Conclusions: A pragmatic low-cost digital support pathway was associated with better adherence and more complete GDMT optimization in ambulatory patients with HFrEF. The findings support further prospective multicenter evaluation.
To evaluate the feasibility and clinical impact of an IoT-based teleassistance system for remote monitoring of preterm neonates receiving home oxygen therapy. A historically controlled cohort study was conducted in Manizales, Colombia, with three phases: (1) baseline data collection from neonates receiving traditional follow-up (n=32), (2) development of an Internet of Things (IoT)-based teleassistance system integrating physiological monitoring, cloud storage, and mobile applications, and (3) pilot testing in a prospective intervention cohort (n=25). The primary outcome was the duration of home oxygen therapy. Median duration of home oxygen therapy was reduced from 34 days (IQR 25-46) in the control group to 10 days (IQR 7-17) in the intervention group (p<0.001). Reliable communication was achieved through 4G and Wi-Fi, while LoRa performance was limited by geographic constraints. IoT-based teleassistance was associated with a reduction in the duration of home oxygen therapy in preterm neonates and demonstrated feasibility for remote monitoring in resource-limited settings.
Introduction: Obstructive sleep apnoea usually co-occurs with hypertension and is managed using various therapeutic modalities. Continuous positive airway pressure (CPAP) appears to be one of the promising interventions. This review aims to narratively assess its effectiveness by comparing its effect with usual and standard care. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were consulted to enhance transparency in reporting the search and selection process; however, this review does not meet the full criteria for a systematic review because screening, data extraction, and synthesis were not conducted according to full systematic review methodology. Five electronic databases (APA PsycINFO, Web of Science, Embase, AMED, and Medline) were searched. Only randomised controlled trials were considered eligible and were assessed for risk of bias using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated using an online tool developed by the Campbell Collaboration, George Mason University, version 27 November 2023. They were interpreted as trivial (<0.1), small (0.1-0.3), moderate (0.3-0.5), or large (>0.5) effects, respectively. Results: This study includes 2944 subjects, 63.3% of whom were male. Their ages range from 23 to 69.7 years. The effect sizes for systolic blood pressure ranged from small to large (d = -0.2, 95% CI -0.69 to 0.28, to d = 0.7, 95% CI -0.15 to 1.55), and for diastolic blood pressure from d = 0.1, 95% CI -0.3 to 0.57, to d = 1.4, 95% CI -0.97 to 2.08 magnitude of effects was observed for both systolic and diastolic blood pressure at different times of the day. Standard care, such as medication and telemedicine, does not confer superior effects over usual care. This intervention showed evidence of sustained effects; however, further evidence is required. Conclusions: CPAP may be effective for both systolic and diastolic blood pressure in patients with obstructive sleep apnoea at different times of day. Its effect may be sustained. The effective dose of CPAP on hypertension remains unclear. Future studies should consider using a more robust design, such as a systematic review and meta-analysis, to obtain pooled estimates rather than individual effect sizes.
Individuals with type 2 diabetes mellitus (T2D) are at increased cardiovascular risk. Although exercise is an important strategy for reducing cardiometabolic risk, accessible and scalable intervention delivery strategies, such as synchronous telehealth programs, remain underexplored. This randomized clinical trial (RED Study; NCT05362071) investigated the effects of a 12-week synchronous telehealth exercise program on clinical, functional, and psychosocial outcomes in adults with T2D. Thirty-three participants (55.8 ± 10.1 years) were randomized to an intervention group (INT; n = 17), which performed supervised combined aerobic and resistance exercise via video calls (2-3 sessions/week), or a control group (CON; n = 16). Glycated hemoglobin (HbA1c) was the primary outcome. Secondary outcomes included capillary blood glucose, blood pressure, functional performance, and psychosocial parameters. Assessments were conducted at baseline and post-intervention by blinded evaluators, and analyses were conducted using linear mixed-effects models in an intention-to-treat analysis. No significant interaction effect was observed for HbA1c (p > 0.05). However, significant group × time interactions favored the INT for functional performance outcomes, including the 30 s Chair Stand (p = 0.02), Arm Curl (p < 0.001), Timed Up and Go (p = 0.01), and 2-Minute Step Test (p = 0.01), as well as sleep quality (p < 0.001). Depressive symptoms decreased over time (p = 0.03) in both groups. Additionally, the INT showed reductions in post-session capillary blood glucose across mesocycles 1, 2, and 4 (p = 0.03). The synchronous telehealth exercise program was not superior to the control condition in reducing HbA1c; however, it improved functional performance, enhanced sleep quality, and promoted acute reductions in glycemic levels in individuals with T2D.
Digital health is emerging as a powerful tool in rheumatology, yet routine implementation remains limited. This study aimed to assess the needs and preferences of patients with immune-mediated inflammatory diseases and rheumatology healthcare professionals regarding the implementation of digital health. We conducted 2 parallel online cross-sectional surveys, 1 targeting adults with immune-mediated inflammatory diseases and another rheumatology professionals, featuring questions rated on a scale of 1 to 10 (1 = lowest and 10 = highest level of agreement) covering domains on contacting rheumatologists, app use, teleconsultations, digital health experience, digital assessment, app features, and impediments to digital health. We analysed responses from 135 patients (86.7% women, mean age 48.6 ± 12.5 years) and 53 professionals (88.7% rheumatologists, 9.4% nurses). Overall, 24.7% of patients reported difficulties contacting their rheumatologist during flares, and disease-related app use was low (3.3 ± 2.6/10). More than half had limited digital health experience, and improving communication with professionals was the highest rated item regarding digital evaluation (8.1 ± 2.8/10). Among professionals, 75% considered digital health beneficial, but only 26.9% reported substantial training (≥7/10), and 53.9% reported minimal use of digital health tools (≤2/10). Treatment adherence showed the greatest agreement for remote monitoring (7.6 ± 2.2/10). Key barriers were poor integration of digital tools with electronic health records (EHR) (8.5 ± 2.1/10) and increased workload (7.7 ± 2.8/10), whereas lack of interest was the least relevant (5.1 ± 2.6/10). Patients and professionals show a high perceived value of digital health in rheumatology, but limited real-world adoption. Improving training, user-centred app design, and EHR integration may help bridge the gap between perceived usefulness and routine implementation.
As a pioneering development in modern gynecology, telerobotic laparoscopic surgery overcomes geographical barriers and optimizes resource allocation. However, its inherent "de-presence" has also raised significant ethical challenges and philosophical questions. Based on the practical application of remote technologies in gynecological surgery, this study first examines how network latency affects the safety of delicate pelvic anatomical dissections, considering the "ethicization" of technical parameters. Next, it analyzes the reconstruction of the responsibility chain - including the lead surgeon, on-site assistants, equipment manufacturers, and telecommunication providers - while clarifying the boundaries of legal liability among these stakeholders. Additionally, from the perspectives of both clinicians and patients, this paper discusses the heightened professional responsibility and cognitive anxiety under the "technological halo," as well as patients' expectations and concerns about their bodies being mediated by technology. To address these challenges, the study proposes establishing a "Techno-Humanistic Dual-Gate" ethical review system and emphasizes the importance of upholding the spirit of medical humanities. These measures aim to ensure that telerobotic surgery develops in a healthy manner by integrating technological precision with humanistic care.
Patient safety has undergone significant evolution over the past two decades, driven by a shift towards systemsbased approaches, the adoption of technological solutions, and a growing global commitment to improving healthcare outcomes. Early milestones (2000- 2010) saw the establishment of key safety protocols, including the "To Err is Human" report and the World Health Organisation's global initiatives. The following decade (2011-2020) marked the widespread integration of electronic health records and simulation-based training. The coronavirus disease-2019 pandemic presented unique challenges, including healthcare resource shortages and increased errors, but also accelerated innovations, such as telehealth and clinical decision-support tools. More recently, artificial intelligence has emerged as a powerful tool for enhancing patient safety, offering predictive capabilities and personalised care. However, barriers such as organisational resistance, resource constraints and inconsistent data-collection remain. Looking ahead, fostering a culture of safety, collaboration and continuous innovation is essential to address systemic gaps, and to ensure safer healthcare practices globally.