搜索结果：Journal of telemedicine and telecare

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020-2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition.

Previous investigations of work-related musculoskeletal disorders (WMSDs) and proper ergonomics in physicians have largely focused on interventionalists and surgeons, given the nature of their jobs. However, with the societal shift toward increased desk work and the widespread adoption of telemedicine, it is essential to examine the ergonomic challenges associated with remote care. Understanding and addressing these factors is critical to prevent musculoskeletal (MSK) strain among physicians and to ensure they can continue delivering high-quality patient care in the long run. Therefore, the goal of this review is to summarize recent interventions targeting ergonomic workspace improvements to mitigate WMSD in physicians practicing telemedicine. A database search was conducted in August 2024 using PubMed, Embase, CINAHL, and Scopus. Studies published in the last 15 years were included if they examined adults in interventional designs measuring musculoskeletal outcomes or sitting time. A total of 47 studies met the inclusion criteria, exploring various ergonomic interventions including: ergonomic training, active workstations, exercise programs, standing desks, backrests, ergonomic chairs, forearm supports, head-alignment devices, and biofeedback devices. Most studies had a positive impact on WMSD. This review highlights the importance of integrating movement, posture optimization, and personalized workspace adjustments to alleviate MSK discomfort and enhance workplace health for physicians. Since the COVID-19 pandemic, many physicians have increased the use of telemedicine and video visits. This change means more time spent sitting and working at a computer, similar to other office and remote workers. Unfortunately, this prolonged sedentary time and screen time often leads to pain and discomfort in the muscles and joints. These issues are known as work-related musculoskeletal disorders (WMSDs), and they commonly affect the back, neck, shoulders, and wrists. This review looked at recent research on how to improve workspaces for physicians practicing telemedicine, both at home and in clinics, to reduce their risk of WMSD. We reviewed 47 studies published over the past 15 years that looked at different ways to improve the workspaces of remote and office workers. The studies included a variety of solutions, including standing desks, ergonomic chairs, monitor and keyboard adjustments, biofeedback tools to improve posture, and scheduled movement or exercise breaks. Many of these strategies helped reduce pain, improve posture, and make workers feel more comfortable during long workdays. While the studies looked at remote workers in general, these same suggestions can be applied to physicians practicing telemedicine. One key takeaway is that combining different strategies—such as taking regular breaks, adjusting one's computer setup, and providing education on healthy workspace adjustments—is most effective. More research is needed to better understand how to support physicians practicing telemedicine, especially since many may not have access to ergonomic equipment at home. Helping physicians stay healthy at their workstations is important not just for their comfort, but also for their ability to care for patients effectively in the long run.

Proactive telecare offers services designed to reduce the occurrence of emergency situations by delivering proactive outbound calls and follow-ups and providing information and advice. By engaging regularly with users, proactive telecare may foster social connections with older adults and enable the detection of changes in needs. Telecare systems that promote active participation among older adults may also foster feelings of autonomy and self-management. This study aimed to (1) explore the acceptability and feasibility of delivering and evaluating a proactive telecare intervention to community-dwelling older adults prior to a potential effectiveness trial and (2) evaluate the proposed eligibility criteria and estimate the potential effect size of the impact of the intervention on health and well-being outcomes to inform sample size calculations for a future trial. An 8-week randomized pre-post feasibility study was conducted. Using a mixed methods approach, questionnaires and semistructured interviews were used to explore the feasibility and acceptability of the study. The proactive telecare system encouraged users to press an OK button once a day to confirm their well-being. If they did not respond, participants received a well-being check, and emergency contacts were notified if required. Outcomes associated with independence, health, and well-being were measured using standardized questionnaires, including health-related quality of life, mental health, and loneliness. Thirty older adults were recruited, with 13 randomized into the intervention group and 17 into the control group. The mean (SD) age of the participants was 75.4 (5.2) years; 66.7% (20/30) of the participants recruited had more than one health condition. This study achieved high retention rates (30/33, 90.9%); however, the expression of interest rate was low (52/295, 17.6%), indicating that changes to recruitment strategies are required. Effect sizes for all quantitative outcomes were small (approximately 0.2). Participants demonstrated high acceptance of the intervention, with the primary benefit cited as providing reassurance and promoting autonomy. Proactive engagement encouraged self-regulation and allowed users to control the level of support received. Those who were socially isolated reported feeling less lonely because of having additional social contact. Most participants felt the intervention would be particularly beneficial if they were experiencing poor health that significantly affected their daily activities, suggesting it may be more suited to those with limited independence. Some participants expressed anxiety about using the technology, primarily due to a lack of understanding and uncertainty in their perceived need for the device. This proactive telecare system is feasible to deliver within a cohort of older adults living in the community. However, changes to recruitment approaches and implementation are needed to ensure acceptability and target numbers are achieved in a future effectiveness trial.

IntroductionTelemedicine involves the use of electronic communication systems to exchange medical information between health professionals or with patients. With the increasing demand for telemedicine delivery, catalyzed by the COVID-19 pandemic, it is important to investigate the use of telemedicine within the field of hand surgery. The aim of this study is to present the current state of telemedicine use in hand trauma, with a particular focus on accuracy of diagnosis, cost effectiveness, and access to care.MethodsAn online systematic review of MEDLINE, EMBASE, Pubmed and The Cochrane Library from inception to 16 May 2025 was completed. Data extracted included telemedicine medium used, accuracy of diagnosis, cost, impact on patient transfer volume, and timeline for assessment. Study quality was assessed using the MINORS scale.ResultsOf the 15 included studies, eight assessed diagnostic accuracy, four evaluated cost savings, four examined patient transfers, five reported on efficiency, and three investigated access to care. All studies assessing accuracy found telemedicine to be an accurate method of triaging and diagnosing patients. All studies assessing cost-effectiveness found telemedicine to be an effective cost-savings instrument. Telemedicine was also demonstrated to improve healthcare efficiency by decreasing the number of unnecessary patient transfers, reducing extra visits and unnecessary consultations and improve access to specialist care for patients in rural communities.ConclusionsThe current literature suggests that the application of telemedicine in initial hand trauma consultation was found appears satisfactory diagnostic accuracy, cost savings, reduced patient transfers, increased efficiency, and improved access to care when compared to traditional face-to-face triaging and diagnosis of hand traumas although evidence is largely observational.

Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers' emotional and informational needs. Telecare-the remote delivery of health and social care via digital technologies-offers a promising approach to provide accessible, personalized, and timely support. This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy (t=1.98; P=.04) and lower depression (t=-2.24; P=.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. This study provides novel evidence that a digitally delivered, nurse-led telecare program-integrating health and social services-can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems.

Tele-ophthalmology is transforming eye care delivery, particularly in remote and underserved areas, where specialist shortages and geographic barriers prevent millions from receiving timely diagnosis and treatment for preventable blindness. Tele-ophthalmology has emerged as a critical solution to bridge these care gaps, with applications ranging from remote screening, diagnosis, and monitoring of conditions like diabetic retinopathy and glaucoma. Despite rapid technological advances and growing implementation, the research landscape lacks literature providing an overview of global trends, collaborative patterns, and emerging innovations in this field, hindering strategic research planning and evidence-based policy development for expanding digital eye care services. This study aims to analyse global trends and emerging themes in tele-ophthalmology research to fill this knowledge void and provide strategic insights for researchers, clinicians, and policymakers. A comprehensive online literature search was conducted using the Scopus database, retrieving English-language publications related to tele-ophthalmology up to 31st December 2024. Data were extracted and analysed using Biblioshiny in R Studio and VOSviewer. The study assessed annual publication trends, top journals' contributions, authors' contributions, authors' collaboration, keyword co-occurrence, and thematic evolution. A total of 5,498 publications were identified, with an annual growth rate of 9.55%, and nearly 800 articles published in 2023 alone. The United States led in publication output and international collaborations. Dr. Michael F. Chiang published the highest number of articles, with the highest total link strength (174), followed by Dr. R.V. Paul Chan and Dr. J. Peter Campbell (122). Telemedicine and E-Health was the leading journal, followed by the Journal of Telemedicine and Telecare and the Indian Journal of Ophthalmology. Common keywords included "telemedicine," "diabetic retinopathy," "artificial intelligence," and "COVID-19," reflecting major research themes. Thematic analysis showed a shift toward AI integration and digital health solutions in ophthalmology. The field of teleophthalmology has experienced significant and rapid growth in research activity. Recent trends indicate growing integration of artificial intelligence and digital health tools. This bibliometric study provides a comprehensive overview that can inform future research and policy efforts to enhance digital eye care delivery.

IntroductionThe use of digital solutions including patient-reported outcomes is limited to follow-up of patients with established diagnoses but is rarely used as first step of the diagnostic process substituting a personal contact with a health professional. We report on the diagnostic validity and cost per patient implications based on a feasibility study of a new virtual diagnostic service (VDS) for common neurological sleep disorders that, as a first step, involves the collection and automated analysis of self-reported digital patient data.MethodsThe VDS was established at the Odense University Hospital, Denmark. Assessment of diagnostic validity of the underlying algorithm was conducted independently and blinded. Estimation of effects on cost per patient was based on administrative hospital cost data comparing similar periods before and after the introduction of VDS and estimates for travel and time consumption to assess the patients' economic benefits.ResultsA questionnaire-based algorithm was developed leveraging the diagnostic criteria of the American Academy of Sleep Medicine; comprehensibility was secured and improved by initial patient involvement. Parallel use of both the questionnaire and assessment by a senior sleep specialist of the first 20 patients revealed no discernible safety concerns and resulted in additional linguistic adaptions. The final questionnaire was completed by 123 of 157 patients (78.3%) identified as suitable for VDS. The questionnaire-based algorithm resulted in correct use of additional diagnostic procedures in 84 out of 95 patients with final diagnosis at data closure (88.4%, Cohen's kappa: 0.84). The algorithm proposed a specific diagnosis in 55 patients that was correct in 49.1% of cases (Cohen's kappa: 0.39). The economic analysis revealed a 46.7% reduction of the time from referral to diagnosis of the patient (226.5 days to 120.7 days). The average number of contacts with health professionals decreased from 2.15 to 1.26, the average direct costs per patients were reduced by 39.6% from 1811 Danish Kroner (DKK) to 1093 DKK. We estimated a 40.6% reduction of the total costs per patients from 3904 DKK to 2320 DKK including time consumption and travel costs.DiscussionThis first feasibility study indicates that use of digital diagnostic solutions as first step of the diagnostic process of neurological sleep disorders combined with an essentially complete virtual work flow has high accuracy and may be associated with reduced time for diagnostics and cost reductions for health providers and patients.

BackgroundThe growing incorporation of telenursing into the conventional healthcare system has raised urgent ethical and legal questions concerning the scope and standards of nursing practice. As nursing expands beyond traditional in-person care into digitally mediated environments, the lack of a legal framework in South Korea presents challenges to protecting patient rights and ensuring professional accountability.AimThis study aims to support the development of a regulatory framework for telecare nursing by identifying and prioritizing key legislative challenges affecting professional autonomy and ethical care delivery.Research designA two-round Delphi technique was employed.Participants and research contextA panel of twelve experts in nursing, health law, and digital health, each with over ten years of professional experience, participated. An initial set of 16 legislative items was developed through content analysis of legal documents and guidelines and reviewed by two subject-matter experts. Through iterative expert consultation, the item pool was refined and expanded to 24 statements for use in the Delphi process.Ethical considerationsThe study was approved by the institutional review board. Informed consent was obtained, and confidentiality was maintained throughout.ResultsEight items met all consensus criteria (necessity and feasibility ≥4.0; ≥80% agreement), including data security, documentation standards, identity verification, nurse certification, and informed consent. Seven ethically significant items such as scope of practice, liability, and reimbursement lacked feasibility consensus, suggesting major implementation barriers. Nine items were considered lower priority. The panel also highlighted three preparatory tasks: building public consensus, forming a multistakeholder steering committee, and legally recognizing nursing roles in telecare.ConclusionsLegislative priorities for ethical telecare were identified, though feasibility gaps indicate challenges to implementation. Legal frameworks should uphold ethical principles while supporting information governance, patient-centeredness, and professional empowerment. These findings offer timely guidance for integrating telecare into nursing practice and enhancing patient trust.

IntroductionTelemedicine has evolved into an integral component of neurosurgical care, especially in expanding access to specialized services in remote or resource-limited areas. This systematic review summarizes worldwide evidence on the implementation, outcomes, and barriers of tele-neurosurgery in emergency and outpatient settings.MethodsFollowing PRISMA guidelines, a comprehensive PubMed/MEDLINE search (2000-2025) identified English-language studies on telemedicine applications in neurosurgery. Eligible studies included emergency cases (trauma, stroke, intracerebral hemorrhage) and outpatient settings. Data on design, interventions, outcomes, and limitations were extracted and analyzed qualitatively.ResultsThirty-six studies met inclusion criteria, covering programs within high-, middle-, and low-income regions. Emergency networks using teleradiology and teleconsultation achieved significant reductions in time-to-specialist evaluation-from about 160 to 38 min-and prevented up to 44% of potential patient transfers, with low failure rates among locally managed cases. Outpatient programs reported patient satisfaction above 80%, surgical decision agreement comparable to in-person visits, and notable travel and cost savings, especially in pediatric teleclinics. Across various settings, telemedicine improved access, workflow efficiency, and cost-effectiveness, though challenges remained regarding connectivity, imaging interoperability, licensure differences, and digital inequality.ConclusionTele-neurosurgery is a safe, effective, and cost-efficient addition to traditional neurosurgical care. It enhances response times, improves triage, and maintains high patient satisfaction across various health systems. Overcoming infrastructural and regulatory barriers through standardized digital networks and equitable access programs will be essential for consolidating telemedicine as a core element of global neurosurgical practice.

IntroductionTelehealth may offer a valuable resource for family caregivers' physical and psychological well-being; however, understanding its effectiveness is crucial to determining its true potential. Thus, this systematic review and meta-analysis aims to examine the effectiveness of telehealth interventions focused on family caregivers' physical and psychological well-being, along with other factors during the care of older adults with various diseases (such as neurocognitive disorders, chronic conditions, and musculoskeletal diseases).MethodsPubMed, Web of Science, Scopus, and Cochrane Library databases were searched. Studies that investigated the effects of telehealth on family caregivers of older adults with any disease and a comparison group receiving any type of intervention were selected. Two independent reviewers carried out the study selection and data extraction. We conducted a meta-analysis using standardized mean differences (SMDs) to pool the continuous outcomes included. Heterogeneity (I&#xb2; and Tau&#xb2;), publication bias (Egger's test and funnel plots), risk of bias (Joanna Briggs Institute tool), potential mediators (meta-regressions), and robustness (leave-one-out method) were also assessed.ResultsTwenty-six studies were selected (23 randomized controlled trial and 3 quasi-experimental studies), including a total of 2932 family caregivers. Telehealth was more effective than usual care in improving psychological well-being (SMD&#x2009;=&#x2009;0.21; p&#x2009;=&#x2009;0.006), caregiving competence (SMD, 0.73; p&#x2009;=&#x2009;0.007), and reducing caregiver burden (SMD&#x2009;=&#x2009;-0.26; p&#x2009;=&#x2009;0.01) in a follow-up shorter than 4 months. It was not effective in reducing anxiety or depression (SMD&#x2009;=&#x2009;-0.18 and -0.40; p&#x2009;=&#x2009;0.08 and 0.20, respectively), nor in improving physical fitness (SMD&#x2009;=&#x2009;-0.16; p&#x2009;=&#x2009;0.460). Considering a follow-up period of 4-12 months, the only outcome in favor of telehealth was the improvement in managing patients' problematic behaviors (SMD&#x2009;=&#x2009;-1.27; p&#x2009;<&#x2009;0.0001). It was not effective for psychological well-being, anxiety, depression, or caregiver burden (SMD&#x2009;=&#x2009;0.15, 0.22, 0.08, and -0.33; p&#x2009;=&#x2009;0.290, 0.260, 0.550, and 0.550, respectively).ConclusionTelehealth may be a valuable option for supporting family caregivers of older adults in improving psychological well-being, caregiving competence, and reducing burden, but the benefits may not last long term.

BackgroundMaxillofacial trauma requires timely recognition of urgent conditions, yet specialized expertise is often limited in rural settings. Hub-and-spoke trauma networks supported by telemedicine may optimize triage, reduce unnecessary transfers, and integrate advanced workflows. Evidence for maxillofacial trauma teleconsultation, however, remains sparse.MethodsA retrospective study of all teleconsultations for maxillofacial trauma between January 2023 and August 2025 within the major trauma network of South-Eastern Vast Area of Tuscany (AV-TSE) (population &#x223c;809,000) was conducted. Thirteen spokes hospitals from 13 peripheral Azienda Unit&#xe0; Sanitaria Locale Toscana Sud-Est (AUSL-TSE) are connected to the tertiary hub in Siena, for example, the Azienda ospedaliero-universitaria Senese (AOUS). Teleconsultations used a secure platform provided by Ente di supporto tecnico amministrativo regionale (ESTAR) enabling safe exchange of clinical data, photographs/videos, and radiological images. Patients were triaged as emergency (immediate transfer), urgency (hub evaluation within 72&#x2005;h), or elective (spoke follow-up). Primary outcomes were: avoided transfers, efficiency, and equity of access. Multivariable logistic regression assessed predictors of avoided transfer and loss to follow-up (LTFU).ResultsA total of 670 patients were analyzed (mean age = 64.4 years; 43.9% female). Zygomaticomaxillary complex (29.1%), orbital (19.4%), and maxillary fractures (15.1%) predominated. Overall, 174 patients (26.0%) were managed locally, avoiding &#x223c;4520&#x2005;km and 75&#x2005;h of travel. Conservative outpatient care was most frequent (57.6%), while 13.7% required surgery under general anesthesia. Older age independently predicted both avoided transfer (OR = 1.03/year, 95% CI = 1.02-1.04) and LTFU (OR = 1.023, 95% CI = 1.010-1.035). No duplicate CT scans were required. Virtual surgical planning by computer-aided design (CAD) and computer-aided manufacturing (CAM) enabled preoperative workflows to begin before transfer, reducing delays.ConclusionsIn the experience of AV-TSE, a pragmatic telemedicine teleconsultation pathway between AOUS and AUSL-TSE decentralized one-quarter of cases, reducing transfers while ensuring safety. Integration with CAD/CAM planning enhanced surgical readiness. Improving follow-up reliability, especially in older patients, remains a priority for future network optimization.

BackgroundPost-stroke cognitive impairment is characterized by cognitive dysfunction occurring within 6 months post-stroke. Telemedicine uses communication technologies to deliver healthcare remotely and has shown efficacy in improving cognitive impairment. However, a systematic review specifically evaluating telemedicine's effects on cognitive outcomes in post-stroke cognitive impairment is lacking.ObjectivesThis systematic review aimed to examine the effectiveness of telemedicine interventions for cognitive function in post-stroke cognitive impairment.MethodsA comprehensive search was performed across 10 electronic databases, including PubMed, Web of Science, CINAHL, EMBASE, Cochran library, Scopus, and ProQuest Dissertations and three Chinese-language databases (CNKI, Wan Fang, and Vip) from their respective inception dates to May 2025. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Meta-analysis was performed by the use of Review Manager 5.3 and Stata 15.ResultsThe initial search yielded 10,365 articles, with 19 studies included in the systematic review. The results showed that telemedicine interventions had a significant moderate effect on global cognition (standardized mean difference (SMD&#x2009;=&#x2009;0.69, Z&#x2009;=&#x2009;4.23, P&#x2009;<&#x2009;0.01) and significantly improved visuospatial function (SMD&#x2009;=&#x2009;0.57, Z&#x2009;=&#x2009;2.76, P&#x2009;<&#x2009;0.05) and language (SMD&#x2009;=&#x2009;0.62, Z&#x2009;=&#x2009;2.59, P&#x2009;<&#x2009;0.05). Sub-group analyses showed significant effects for both online tools or computer software and mobile apps, though high heterogeneity was noted. Additionally, telemedicine interventions had a significant effect on activities of daily living (SMD&#x2009;=&#x2009;0.64, Z&#x2009;=&#x2009;5.16, P&#x2009;<&#x2009;0.01).ConclusionConsidering the obstacles and limitations of traditional face-to-face rehabilitation, telemedicine is an effective approach for treating post-stroke cognitive impairment that can significantly improve cognitive function. Future studies should address heterogeneity through rigorous designs, long-term follow-ups, neuroimaging, and biomarker integration to elucidate underlying mechanisms.The protocol was registered on PROSPERO (CRD42024502185).

IntroductionDementia prevalence is rising, imposing significant burdens on patients and caregivers. Telemedicine, encompassing devices, software, and videos, shows potential to address these challenges, but evidence on its effectiveness across dementia severities and intervention types remains unclear. This study aimed to systematically evaluate the effects of different telemedicine types on health outcomes in older adults with dementia using randomized controlled trials (RCTs).MethodsSix databases were searched through February 2026 for RCTs involving adults &#x2265;60 years with dementia. Twelve studies (21500 participants) were included, assessing telemedicine interventions (video, device, software) versus usual care. Outcomes included cognitive function, activities of daily living (ADLs), depression, and caregiver burden. Risk of bias was evaluated via Cochrane RoB 2.0, and meta-analyses used RevMan 5.4.FindingsTelemedicine significantly improved ADLs (Z&#x2009;=&#x2009;2.63, P&#x2009;<&#x2009;0.05, I2=1%) but showed no effects on cognitive function, depression, caregiver burden, or transfer rates. High heterogeneity was noted in cognitive (I2=81.6%) and depression (I2=87%) analyses. Subgroup differences between video and device interventions were nonsignificant.ConclusionsTelemedicine modestly enhances ADLs in dementia but lacks broad efficacy across other outcomes. Variations in intervention content, population severity, and technological accessibility may influence results. Future research should stratify by dementia severity, tailor interventions to cognitive levels, and integrate caregiver-focused approaches to optimize telemedicine impact.

IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM's potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.

BackgroundTelecare is increasingly important in managing patients with chronic diseases, including patients with inflammatory bowel disease (IBD). This study evaluates the impact of telecare on patient retention and access to tertiary care for patients with IBD.MethodsWe analyzed patient data from a tertiary care IBD center, comparing patterns pre-COVID (January 2018 to March 2020) and post-COVID (August 2020 to January 2023) as only post-COVID patients had availability of telecare for return visits. Patients were classified based on their visit types and drive times to the clinic. Statistical analyses were conducted using Pearson Chi Square analysis for categorical variables as well as Mann-Whitney U and Kruskal-Wallis statistical tests with Bonferroni correction for multiple tests.ResultsA total of 7040 patients were included. In the post-COVID period, 62% of return visit patients chose telecare, leading to increased retention rates (nonreturning patients decreased from 14% to 8%). Returning patient retention increased for 2 to 3 hours and more than 3&#x2005;hours of drive time (+10% and +14%). Telecare return patients had significantly longer drive times (median 56.1 minutes) than nonreturn (median 45.7 minutes, p&#x2009;=&#x2009;0.007) and in-person return prior to telecare availability (median 38.8, p&#x2009;<&#x2009;0.001) patients. Patient satisfaction scores were high for both telecare and in-person visits. Telecare patients had lower rates of emergency department visits and hospital admissions.ConclusionTelecare significantly enhances patient retention and access to tertiary IBD care, particularly for patients living at greater distances. The study demonstrates that telecare is an effective strategy for maintaining multidisciplinary IBD care without compromising patient satisfaction or outcomes.

To conduct a scoping review on the fundamental aspects, application effectiveness, and existing problems of telemedicine in home-based palliative care (HBPC) patients, with the aim of providing evidence-based insights for future practice and research, particularly for healthcare systems such as China's that are in the developmental stages of HBPC. Relevant studies were systematically retrieved from databases including PubMed, Web of Science, Cochrane Library, Embase, ScienceDirect, CNKI, Wanfang Data, VIP, and CBM from their inception to February 2, 2026.using a comprehensive set of keywords related to telemedicine, home-based care, and palliative care. Included studies were summarized and analyzed. A total of 18 studies were included. Telemedicine applications in HBPC are diverse, encompassing forms such as applications and video conferencing. Their core content covers six key elements, including symptom management and psychological support. Telemedicine demonstrated positive effects in improving patients' symptom burden, quality of life, and optimizing healthcare resource utilization. Telemedicine, as a feasible, effective, and cost-efficient supplementary model for HBPC, shows great potential. For contexts like China, Future efforts should focus on conducting high-quality research, improving policy support and talent cultivation, and enhancing cultural adaptability to promote its standardized development and large-scale application.

IntroductionTelemedicine has implemented the regional networks between 24/7 catheterization laboratories of "Hub" hospitals and the Territorial Emergency Medical Service (TEMS) to reduce time to diagnosis and treatment of ST segment elevation myocardial infarction (STEMI). Telemedicine has been conversely hypothesized to carry an excess of false-positive diagnoses; however, comparisons with a traditional diagnostic process at non-percutaneous coronary intervention capable ("Spoke") hospitals are lacking.MethodsThis multicenter case-control study retrospectively included 1001 consecutive patients with an initial diagnosis of STEMI or very high risk (VHR) non-ST elevation acute coronary syndrome who were referred from January 2018 to December 2021 to the Apulian STEMI network after an "in-presence" clinical evaluation at a Spoke center or a remote telemedicine-supported assessment. The comparative performance of both approaches has been evaluated by comparing the running diagnosis with the discharge diagnosis.ResultsTEMS and Spoke groups included 470 and 531 patients, respectively. False-positive diagnoses occurred in 21.3% and 35.8% of the TEMS and Spoke patients, respectively (p&#x2009;<&#x2009;0.001). Spoke group showed a higher number of discharge diagnoses of non-ST elevation myocardial infarction without VHR features (p&#x2009;<&#x2009;0.001), myocardial infarction with no obstruction of coronary arteries (p&#x2009;=&#x2009;0.033), and myocarditis (p&#x2009;=&#x2009;0.007). Overall, the main predictors of false-positive diagnoses were the referral from Spoke center, chronic kidney disease, and ongoing oral anticoagulation.ConclusionsTelemedicine showed lower false-positive rate compared with an on-site clinical cardiological assessment. This apparently paradoxical result questions the hypothesis of overdiagnosis as the main limitation of telemedicine which conversely reduces time-to-diagnosis and healthcare costs.

BackgroundTele-assessments are becoming increasingly important to increase access to healthcare services and facilitate patient follow-up. Whether they can provide results with similar accuracy to face-to-face assessments remains relevant.ObjectiveThe aim of this study was to compare the face-to-face and tele-assessment scores of the International Cooperative Ataxia Rating Scale (ICARS) and Assessment and Rating of Ataxia (SARA) in ataxic MS patients and to examine their suitability for tele-assessment.MethodsThe participants were assessed both online and face-to-face. Randomization determined which method would be used first to assess the participants. ICARS and SARA were used in the assessments. Face-to-face assessments were conducted as part of routine clinical practice by one researcher, while teleassessments were performed via real-time video by two different researchers. The video was recorded and reassessed one week later. The agreement and correlation between face-to-face and teleassessments were analyzed using intra-class correlation coefficients (ICC), Bland-Altman Plots, and Pearson's/Spearman's correlation coefficients.ResultsThis study included 20 patients with ataxic MS with an EDSS score of 3.6&#x2009;&#xb1;&#x2009;0.66. The inter-rater reliability of tele-assessments (ICCICARS&#x2009;=&#x2009;0.97; ICCSARA&#x2009;=&#x2009;0.97) achieved excellent reliability. Intra-rater reliability of the tele-assessment was excellent (ICCICARS&#x2009;=&#x2009;0.99; ICCSARA&#x2009;=&#x2009;0.99). High correlations were observed in ICARS and SARA scores between face-to-face and tele-assessment methods according to assessors (r&#x2009;>&#x2009;.80 for all).ConclusionICARS and SARA are reliable and agreed-upon tests that can be used with tele-assessments, offering similar data to face-to-face methods.

BackgroundDigital health literacy (DHL) is essential for ensuring effective, safe, and equitable healthcare delivery. Understanding the DHL levels of healthcare professionals and the factors shaping them is critical for guiding workforce development and managing digital transformation processes. This study aimed to identify determinants of DHL among healthcare professionals and examine their implications from a managerial perspective.MethodsA systematic review was conducted following PRISMA guidelines on August 13 to 14, 2024. Web of Science, Scopus, PubMed, MEDLINE, and CINAHL were searched without time restrictions using terms such as "digital health literacy," "e-health literacy," and terms related to healthcare professions, yielding 2702 records. Peer-reviewed full-text studies in English involving healthcare professionals were included, while non-research articles and studies on non-healthcare populations were excluded. Screening and selection were performed independently by two reviewers.ResultsEleven studies published between 2022 and 2024 were included. Content analysis identified several determinants of DHL, including education level, professional experience, access to digital infrastructure, and technological competence. Younger professionals tended to report higher DHL, while more experienced staff demonstrated strong adaptability when required by evolving clinical processes. Some studies noted that digital health tools could create time pressures and affect communication with patients, potentially hindering effective DHL use.ConclusionsStrengthening DHL among healthcare professionals is essential for optimising healthcare quality, safety, and operational efficiency. Integrating digital health competencies in undergraduate curricula, providing role-specific training, and implementing organisational strategies that support digital adoption are key priorities. Although this review is based on a limited number of heterogeneous studies, it provides important insights and highlights the need for more robust and standardised research on DHL in healthcare settings.