As telehealth grows in ubiquity, it is important to understand the barriers and facilitators to telehealth utilization in historically marginalized populations. This study utilizes the Theory of Planned Behavior (TPB) to assess correlates of the intention to utilize video consultations among low-income Hispanic patients.

This cross-sectional observational study included participants (N = 138) recruited from a federally qualified health center affiliated with a large university health system. Components of the TPB were assessed using an in-person survey. Participant survey responses were analyzed using multiple logistic regression to identify correlates of participants' intention to utilize video consultations.

Multiple logistic regression revealed subjective norms (adjusted odds ratio (aOR [95% CI]) = 3.29 [1.66, 6.52], P = .001) as the only significant correlate of participants' intention to utilize video consultations. Attitudes toward video consultations (aOR [95% CI] = 1.32 [0.60, 2.89], P = .49) and perceived behavioral control (1.72 [0.89, 3.32], P = .11) did not independently correlate with behavioral intention.

Ratings of subjective norms were independently correlated with intention to utilize video consultations among low-income, predominantly Spanish-speaking Hispanic adults. These results suggest a potentially central role of relational influences in determining telehealth engagement in this population.

The spread of the coronavirus disease (COVID-19) has accelerated the provision of medical services using video conferencing systems. Hence, educational institutions are required to develop human resources that can utilize Internet communication technology in clinical settings.

This study aimed to create a learning program incorporating an online video conferencing environment into medication counseling clinical preparatory education for pharmacy students and measure its educational effectiveness. Specifically, we compared pharmacy students' medication instruction abilities using an online video conferencing system and the characteristics of face-to-face and online medication instruction before and after the program.

Fourth-year students of the School of Pharmacy at Shujitsu University in Okayama Japan for the academic year 2023-2024.

To evaluate the program, we compared changes in learners' abilities and the characteristics of face-to-face and online medication instruction as recognized by the learners.

Participants' abilities improved after completing the program. A characteristic of online medication counseling using a videoconferencing system is that, as in the real world, it is more difficult to maintain a patient's concentration than in face-to-face counseling. However, sharing clinical test results and checking the medication status may be more useful online than during face-to-face counseling.

Our clinical preparatory education program for medication instruction, which incorporates an online context into learning strategies, has been shown to closely mimic real-life online medication instruction.

Background: Telemedicine (TM) is a crucial component of modern health care, yet its adoption in nursing remains suboptimal. Effective integration requires structured training, institutional support, and digital infrastructure. Purpose: This study investigates TM utilization among nurses in the United Arab Emirates (UAE), focusing on its integration into practice, the training received, and the resources available to support its implementation. Methods: A cross-sectional survey was conducted among 434 nurses across hospitals and clinics in Dubai Health, UAE. The survey assessed demographic and professional details, TM experience, training availability, infrastructure, and institutional support. Data were analyzed using descriptive statistics and logistic regression. Results: While 70% of nurses reported TM availability, only 27% actively used it. Usage frequency varied, with 18% utilizing TM daily, 8% weekly, and 10% monthly. Adoption was highest in pediatric and geriatric care (50%) and lowest in intensive care units (11%). Remote patient monitoring and health education (47%) were the most common applications, whereas specialty consultations had the lowest use (17%). Logistic regression identified TM availability (OR = 2.1) and prior training (OR = 3.0) as key predictors of utilization (p < 0.001). However, only 14% of participating nurses had received formal TM training, though 90% expressed willingness to participate in future programs. Nurses' demographics, job titles, years of experience, and health sector did not significantly predict TM utilization (p > 0.05). Conclusion: TM has the potential to transform nursing practice, but its integration requires enhanced training programs, infrastructure investment, and institutional support. Addressing these gaps will optimize TM utilization and improve health care delivery.

In recent times, the telemedicine landscape has changed dramatically; it serves as a bridge, connecting health care providers and patients, especially during challenges such as the recent COVID-19 pandemic.

This study seeks to explore the Swedish telemedicine landscape in terms of primary patient symptoms for teleconsultation and the patterns of telemedicine use in the periods before COVID-19, during COVID-19, and after COVID-19, including the primary care use dynamics with respect to the teleconsultations done.

Secondary data was used in this observational retrospective study. The study population consisted of Swedish residents who had online telemedicine consultations. Telemedicine consultations were divided by text and video delivery; the period of analysis ranged from November 2018 to June 2023. The statistical methods used for the data analysis were descriptive analysis, 2-way cross tabulation, and a generalized linear model.

During the pandemic, the number of teleconsultations concerning general, unspecified symptoms increased in comparison to the other analyzed symptoms, signaling a change in care-seeking behavior under epidemiological pressure. General health-related issues were the most pronounced symptom across all periods: 186.9 of 1000 consultations before COVID-19, 1264.6 of 1000 consultations during COVID-19, and 319.2 of 1000 consultations after COVID-19. There was no significant main effect of COVID-19 period on the number of telemedicine consultation meetings (F2=1.653; P=.38). The interaction effect between delivery type and period was statistically significant (F2=14.723; P<.001).

The findings are in favor of the COVID-19 pandemic having had a considerable effect on telemedicine use. Telemedicine could subsequently be used more often for general health consultations and acute conditions. Video consultations were more prominent because of the importance of bidirectional communication. The study suggests that there was a transformation of patterns of demand for health care; there is a necessity for health care systems to respond to these changes.

Depression, a prevalent mental health disorder with severe health and economic consequences, can be costly and difficult to detect. To alleviate this burden, recent research has been exploring the depression screening capabilities of deep learning (DL) models trained on videos of clinical interviews conducted by a virtual agent. Such DL models need to consider the challenges of modality representation, alignment, and fusion as well as small sample sizes. To address them, we propose WavFace, a multimodal deep learning model that inputs audio and temporal facial features. WavFace adds an encoder-transformer layer over pre-trained models to improve the unimodal representation. It also applies an explicit alignment method for both modalities and then uses sequential and spatial self-attention over the alignment. Finally, WavFace fuses the sequential and spatial self-attentions among the two modality embeddings, inspired by how mental health professionals simultaneously observe visual and vocal presentation during clinical interviews. By leveraging sequential and spatial self-attention, WavFace outperforms pre-trained unimodal and multimodal models from the literature. With a single interview question, WaveFace screened for depression with a balanced accuracy of 0.81. This presents a valuable modeling approach for audio-visual mental health screening.

Background: The increasing demand for elective surgery makes optimizing preoperative assessment a priority. Value-based healthcare aims to provide the highest value for patients at the lowest possible cost through various mechanisms, including reorganizing care into integrated practice units (IPUs). However, few studies have analyzed the effectiveness of implementing virtually led IPUs for preoperative assessment. Methods: We performed a retrospective observational cohort study including patients undergoing elective surgery at a teaching hospital in Madrid, Spain from 1 January 2018 to 31 December 2023, analyzing changes in surgical complications, efficiency, and patient satisfaction between the pre-implementation (2018-2019) and post-implementation (2020-2023) periods. Anesthesiologists' satisfaction with the virtual assessments was described. During the post-implementation period, preoperative assessment was reorganized as a virtually led IPU. At the IPU appointment, preoperative testing and physical (including airway) examinations were performed by a nurse anesthesiologist. The results were uploaded to the electronic health records, and asynchronous virtual anesthesiologist assessment using a store-and-forward approach was performed. Digital patient education was carried out over the Patient Portal mobile application. Results: A total of 40,233 surgical procedures were included, of which 31,259 were from the post-intervention period. During the post-intervention period, no increase in surgical complications was observed, while same-day cancellations decreased from 4.3% to 2.8% of the total procedures (p < 0.001). The overall process time did not increase, despite the rising number of surgical procedures per year. Patient satisfaction improved. The median time to complete anesthesiologist assessment was significantly lower for virtual assessment (4.5 versus 10 min (p < 0.001), signifying estimated time savings of 716 person-hours per year. Anesthesiologists agreed that virtual assessment was more efficient than in-person evaluation, and half of the participants agreed that virtual preoperative care improved their work-life balance and reduced burnout. Conclusions: A digitally enhanced value-based model of preoperative care can improve efficiency and satisfaction metrics, reducing unnecessary costs and potentially improving the quality of care.

While Internet hospitals have rapidly developed as China's dominant digital healthcare model, critical evidence gaps persist regarding operational status and challenges of their core online consultation services. This study aimed to evaluate the current status and challenges of online consultation in Internet hospitals services through large-scale multi-center business data analysis.

Retrospective analysis of 594,695 online consultations (2020-2021) from 30 Internet hospitals across 11 Chinese provinces. Descriptive analyses were conducted on counselee demographics, consultant qualifications, and order informations. A novel five-category consultation classification was applied. Multivariate logistic regression identified the inflencing factors for order, while locally weighted regression (LOESS) modeled workload-response relationships.

There were 244,678 counselees (median age 29) and 5,781 providers (91.89% doctors) involved. Service are concentrated in pediatrics, obstetrics and gynecology (48.25%). Senior-title providers handled 43.79% consultations but showed reduced completion probability (OR = 0.77). The main types of consultations were re-visit (44.89%) and first visit (34.57%). Temporal patterns revealed peak consultation hours at 10:00 (8.11%) and 16:00 (7.29%), with provider response peaks at 12:00 (5.38%), 16:00 (6.61%), and 21:00 (6.63%), averaging 3.64-hour response delays. Provided medical history (OR = 2.13) could independently increase the response probability, whereas senior title (OR = 0.77) could reduce such probability. Workload-response efficiency transitioned from positive (< 78 orders) to negative correlation (> 1,700 orders), with 27.69% uncompleted orders attributed to consultant factors (75.87%).

Even with the increased momentum, the online consultation service still faces many challenges mainly including the relative absence of elderly patients with chronic diseases, personnel qualification issues, the imbalance of service supply and demand, the unfitness of order contents with official regulations, and the insufficient quality control of response rate and timeliness. Comprehensive measures should be carried out to promote the effectiveness of online consultation for better disease prevention and control.

The COVID-19 pandemic resulted in a dramatic increase in the use of telemedicine, with heightened rates of use persisting postpandemic. This change in use created a need for a valid and reliable scale to assess telemedicine use and facilitators impacting its uptake. The current study developed and validated the Telemedicine Facilitators Scale (TFS), a novel measure for assessing facilitators of telemedicine uptake. A sample of 228 physicians completed 13 items for the TFS along with an index of telemedicine use for convergent validity. We conducted two confirmatory factor analysis (CFA) models testing a four-factor structure (Positive Attitudes, Facilitating Infrastructure, Organizational Support, and External Policies) and a bifactor model in which all items loaded onto to a single telemedicine facilitators factor and the previous four factors. Both the four-factor CFA and bifactor models demonstrated acceptable fit for χ2/degrees of freedom, comparative fit index, and incremental fit index. The correlations among subscales showed that each subscale, while related, measured independent constructs. Both the general telemedicine facilitators factor and all four subfactors were positively correlated with telemedicine use, evidencing good convergent validity. Results suggest that the TFS may be used as a four-factor scale, a unidimensional scale, or a scale composed of both an overarching construct and four subconstructs. The TFS represents a useful tool for researchers, clinicians, and healthcare administrators who wish to study, use, or facilitate the use and evolution of telemedicine.

Obtaining valid consent is an ethical and legal requirement in clinical practice, ensuring patients are adequately informed about their treatments. Recent updates in consent policies, including General Medical Council guidance, the Patterson Inquiry report, and key legal rulings like Montgomery, emphasize a shift towards patient-centred care and the importance of a comprehensive patient-clinician dialogue. Budget constraints and increasing National Health Service demand have led to the adoption of digital solutions and streamlined pathways, such as teledermatology and direct booking to surgery, potentially compromising the consent process. This review examines the current state of informed consent in UK dermatology, particularly in light of the Montgomery ruling, which requires clinicians to ensure patients are aware of all material risks and alternatives associated with their treatments. The two-stage consent process, involving consent at two distinct points, is advocated to allow patients adequate time for reflection and decision making. However, challenges remain in pathways like one-stop clinics and direct booking for surgery, where limited face-to-face interaction and time constraints can undermine the quality of informed consent. To mitigate these issues, integrating multimedia tools and standardized procedure-specific consent forms can enhance patient comprehension and satisfaction. These tools ensure consistent and clear communication of risks, benefits and alternatives, maintaining robust informed consent amid evolving healthcare delivery models. Sustaining a thorough and individualized dialogue throughout the patient care journey is essential for upholding patient autonomy and shared decision making in dermatological surgery.

Self-injectable contraceptives, namely subcutaneous depot medroxyprogesterone acetate 104 mg micronised formulation delivered via uniject system, reduce the need to travel to a facility for contraceptive access, but the initial, in-person, training may be a barrier to starting this method. This article reports on a small, exploratory pilot in Kenya to test the feasibility and acceptability of digital self-injection training.

Participants (n=11) who were currently using injectable contraceptives, intramuscular depot medroxyprogesterone acetate 150 mg injected by a healthcare worker, received digital self-injection training from a trained clinician via a WhatsApp video call. Participants administered a simulated self-injection on a model and an actual self-injection (under supervision) on themselves. The participants' self-injection proficiency, a measure of the feasibility of remote training, was documented using a checklist, and participants were administered a questionnaire about their training experience. The training was observed, and content analysis was used to understand the functionality of training.

All participants were proficient when performing the self-injection on themselves after receiving the remote training and reported that the training was acceptable. A barrier to training via a video call was lack of access to quality digital devices. Eight training 'lessons learnt' emerged from the training observations.

Training participants to administer self-injectable contraceptives via WhatsApp video call was feasible and acceptable. Training lessons learnt offer pragmatic adaptations for communicating about a practical skill via a digital channel. Further research is needed to ascertain the efficacy of digital training for self-injection and feasibility and acceptability for wider groups.

The COVID-19 pandemic facilitated the rapid uptake of telehealth Australia wide. To date, no studies have analysed patient perceptions of a regional urological telehealth service before and after the pandemic. With over 10 years of experience delivering telehealth to Southwest Victoria, we aim to highlight the benefits, limitations and progress of a regional urological telehealth service.

Regional patients living within Western Victoria who participated in our 2017 survey and continued their urological telehealth consultations throughout 2021-2023 were invited to participate in our 2023 survey. Questions were both short answer and multiple choice. Seventy-eight patients met inclusion criteria, and 42 responses were returned. Data analysis utilized a mixed methods approach.

Overall patient perceptions were favourable in 2017 and improved throughout the Pandemic. The greatest improvements were seen within the performance areas: overall satisfaction, technological aspects, comprehension and financial benefits. Following the pandemic, the distance patients were prepared to travel for face-to-face reviews decreased and preferences for telehealth compared to face-to-face consultations increased by almost 20%. However thematic analysis revealed loss of personalized care, technological faults, fixed beliefs and unsuitable appointments as limitations of this model of care.

Patients' perspectives of a regional urological telehealth service were overwhelmingly positive highlighting the vital place of urological telehealth in the delivery of equitable urological healthcare to a regional population. Overall, post COVID-19 there were improved patient perceptions of a telehealth service and its role in providing regional patients with the provision of timely, supportive and high-quality urological care.

The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists' hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists' control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software.

This study aims to investigate whether introducing technical features might improve clinicians' control over their video sessions. Additionally, it seeks to understand the role of the video in therapists' VCP experience from a technical and relationship point of view.

A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) "challenges in providing VCP," (2) "features to enhance the therapeutic relationship," and (3) "enhancing control." Path analysis was used to observe the relationship between factors on their own and with adjustment to participants' areas of expertise and year in practice.

This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between "challenges in VCP" and "features to enhance the therapeutic relationship" (adjusted beta [Adjβ]=-0.54, 95% CI 0.29-0.79; P<.001) and "features to enhance TR" and "enhancing control" (Adjβ=0.25, 95% CI 0.15-0.35; P<.001). Additionally, a significant positive relationship was found between "features to enhance the therapeutic relationship" and "enhancing control" (Adjβ=0.25, 95% CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of "challenges in providing VCP" on "enhancing control" (Adjβ=0.13, 95% CI 0.05-0.22; P=.001) mediated by "features to enhance TR." The analysis identified the factor "features to enhance TR" (effect size=0.25) as key for improving clinicians' performance and control.

This study demonstrates that technology may help improve therapists' VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists' control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients' reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP.

The increasing digitalization of the healthcare system makes it possible to provide medical services using digital technologies without direct patient-provider contact. This study aimed to investigate 1) the use and acceptance of video consultation and 2) factors associated with the use of video consultation.

A cross-sectional online survey was conducted in February 2023. Overall, 20,000 adults insured at a statutory health insurance company in Germany (10,000 users and 10,000 non-users of video consultation) were invited by email to an online survey with 31 items. The items addressed use and acceptance of digital health services with a focus on video consultation, digital health literacy, and sociodemographic characteristics. Data were analyzed using descriptive statistics and factors associated with video consultation use were assessed using binary logistic regression.

Among the 1,657 participants, 686 were users and 971 were non-users of video consultation. The participants were aged between 18 and 80 years (M ± SD: 44 ± 13 years), 55% were female, 59% reported a medium subjective socioeconomic status and 69% a good to very good health status. Video consultation was predominantly used following physician recommendations (71%) as part of general medical care (50%). The main reasons for using video consultation were time saving (93%) and flexibility in terms of location (87%). Most video consultation users felt well cared-for during video consulting (93%), would use it again (95%), and would recommend it to others (93%). Factors associated with video consultation use were age from 30 to 49 years, high subjective socioeconomic status, high digital health litercay, and very poor to moderate health status.

The acceptance of video consultations in this study was high. Advantages and barriers to offering video consultations from a physician perspective should be investigated to incorporate video consultations in everyday medical practice.

Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers.

The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines.

We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus.

This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support.

This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education.

Sustained engagement and promotion by healthcare professionals are essential for the advancement of telemedicine. Post coronavirus disease 2019 (COVID-19) pandemic, the preference for in-person care highlights the need for research on healthcare professionals' sustained telemedicine attitudes. This study assessed healthcare professionals' continued willingness to participate in and recommend telemedicine post-pandemic and identified factors influencing their decisions. From September to October 2023, a cross-sectional study was conducted among 560 healthcare professionals, with samples recruited from 230 hospitals across 11 provinces in China using a multi-stage sampling method. Overall, 518 (92.5%) of 560 respondents expressed their willingness to continue participating in telemedicine, and nearly all respondents (93.5%) displayed a willingness to recommend telemedicine to those in need. The results showed that perceived usefulness, subjective norms, patient coverage, and satisfaction were positively associated with healthcare professionals' willingness to continue participating in and recommend telemedicine. Satisfaction and subjective norms play a partial mediating role in the effect of usefulness on willingness to continue participating in and recommend telemedicine. Patient coverage partially mediates relationship between usefulness and willingness to recommend telemedicine. Chinese healthcare professionals exhibited a generally high level of willingness to continue participating in and to recommend telemedicine. To further enhance this willingness, it is essential to improve their perceptions of telemedicine's usefulness, increase their satisfaction with the technology, and emphasize the roles of subjective norms. Moreover, broadening patient access to telemedicine services will be crucial in promoting healthcare professionals' recommendations.

As information and communication technology continues to shape the healthcare landscape, future medical practitioners need to be equipped with skills and competencies that ensure safe, high-quality, and person-centred healthcare in a digitised healthcare system. This study investigated undergraduate medical students' and medical educators' opinions of teleconsultation practice in general and their opinions of teleconsultation education.

This study used a cross-sectional, mixed-methods approach, utilising the additional coverage design to sequence and integrate qualitative and quantitative data. An online questionnaire was sent out to all medical schools in the UK, inviting undergraduate medical students and medical educators to participate. Questionnaire participants were given the opportunity to take part in a qualitative semi-structured interview. Descriptive and correlation analyses and a thematic analysis were conducted.

A total of 248 participants completed the questionnaire and 23 interviews were conducted. Saving time and the reduced risks of transmitting infectious diseases were identified as common advantages of using teleconsultation. However, concerns about confidentiality and accessibility to services were expressed by students and educators. Eight themes were identified from the thematic analysis. The themes relevant to teleconsultation practice were (1) The benefit of teleconsultations, (2) A second-best option, (3) Patient choice, (4) Teleconsultations differ from in-person interactions, and (5) Impact on the healthcare system. The themes relevant to teleconsultation education were (6) Considerations and reflections on required skills, (7) Learning and teaching content, and (8) The future of teleconsultation education.

The results of this study have implications for both medical practice and education. Patient confidentiality, safety, respecting patients' preferences, and accessibility are important considerations for implementing teleconsultations in practice. Education should focus on assessing the appropriateness of teleconsultations, offering accessible and equal care, and developing skills for effective communication and clinical reasoning. High-quality teleconsultation education can influence teleconsultation practice.

Patient-centred care (PCC) is essential to quality medical consultation. PCC communication refers to how PCC principles are reflected in doctor-patient interactions. Research has shown that a doctor's ability to communicate in a patient-centred manner is positively linked to patient satisfaction and improved health outcomes. However, previous studies have focused mainly on face-to-face communication and less is known about patient perceptions of PCC when medical interactions are not face-to-face such as online medical consultations (OMCs). This pilot study aims to explore patients' perceptions and experiences of OMCs.

Participants were recent university graduates from mainland China. Sixty-three participants completed an online questionnaire designed to gauge PCC communication, which included four validated communication measures: (I) patient health willingness to communicate (HWTC); (II) doctors' consultation and relational empathy (CARE); (III) patient perceptions of participation in health consultation (PPP); and (IV) doctors' communication assessment tool (CAST). Participants provided their modality preference when using OMCs. To gain a deeper understanding of quantitative data, two supplementary open-ended questions were included where participants provided feedback on their preferences for using OMCs and discussed the advantages and disadvantages of OMCs.

Correlational analysis indicated that participants' perceptions of doctors' interpersonal and communication skills significantly correlated with perceived CARE (r=0.813, P<0.01) and with patient participation in health consultations (r=0.632, P<0.01). Supporting the quantitative results, the qualitative findings revealed that while participants appreciated the convenience of OMCs, they also felt that emotional care from doctors was lacking in the online format. Specifically, participants noted that nonverbal cues, rapport building, and other relational aspects were missing, which aligns with the quantitative data linking perceived doctor communication and empathy to patient satisfaction.

The findings suggest that more emphasis should be placed on training doctors to practice PCC communication in OMCs especially when the interactions are text-based. The results highlight that consideration must also be given to the interpersonal and emotional aspects of care that contribute to patient satisfaction with OMCs. Overall, this pilot study reinforces that PCC communication remains integral to quality medical interactions, regardless of whether they occur face-to-face or through an online format.

Digital health technology in swallowing rehabilitation offers personalized exercises, remote monitoring, and real-time feedback, enhancing accessibility and effectiveness of therapy. This scoping review was conducted to summarize what types and features of digital technology-based dysphagia rehabilitation interventions exist, how they are applied in patients with dysphagia, and what the effectiveness and facilitators and barriers to intervention application are.

We searched Medline Complete, Embase, CINAHL, Scopus, and gray literature for articles published between January 2000 and June 2023. We used subheadings and terms related to digital health, dysphagia, and rehabilitation to search for articles. The included studies were mapped according to the types and features, effectiveness, enablers, barriers, and future improvements of swallowing rehabilitation using digital technologies.

Twenty-five studies met the inclusion criteria. Three types of digital swallowing rehabilitation interventions were identified: home-based rehabilitation using the mHealth app, synchronous telepractice and monitoring, as well as game-based biofeedback and tracking. The included studies reported positive results regarding physiological changes in swallowing function, swallowing performance, and quality of life. Digital unfamiliarity, resources for digital access, and technical issues related to the failure of the mobile device operating system were identified as barriers to the use of digital swallowing rehabilitation technology and future improvements.

Digital technology has potential value in dysphagia rehabilitation. In the future, developing various interventions utilizing the advantages of digital technology and conducting additional research to validate their effectiveness is necessary. Additionally, improved digital familiarity, better accessibility, better technology, and management practices will be needed.

Telepsychiatry saw wide acceptance during the COVID-19 pandemic, when traditional healthcare facilities were inaccessible. Post-pandemic, however, user preferences for the service remain uncertain. This study explores user perceptions of telepsychiatry, particularly focusing on those who discontinued its use, to identify factors influencing service satisfaction and barriers to continued use.

A mixed methods study was conducted on interviews with 165 patients who had utilised telepsychiatry services at a tertiary care teaching hospital in north India. Quantitative data were collected on telepsychiatry dropout rates, and bivariate analyses identified differences between continuing users and discontinuers. Qualitative data were gathered via semi-structured interviews, thematically analysed, and coded to examine personal, illness-related, and socio-environmental determinants of service choice.

Analysis revealed a telepsychiatry dropout rate of 56.4 %, once physical OPDs became operational. Eight major themes - convenience, cost & time, therapeutic relationship, technological difficulty, service limitation, treatment outcome and privacy, affected telepsychiatry usage. Patients valued telepsychiatry for its convenience and time savings, while challenges such as brief consultations, frequent changes in doctors, and lack of privacy at home or work, prevented continued use. Technological barriers, especially for elderly and rural patients, and higher medication costs at local pharmacies were significant deterrents.

Telepsychiatry service use is dependent on a dynamic interplay between clinical condition, resource availability with user, service quality and available alternatives. Addressing these challenges remain crucial for integrating telepsychiatry into primary healthcare and ensuring its long-term sustainability.

The metaverse is emerging as a transformative force in healthcare communication, integrating virtual reality (VR), augmented reality (AR), artificial intelligence (AI), and extended reality to enhance doctor-patient interactions, interprofessional collaboration, medical education, and surgical planning. By providing immersive, interactive, and data-driven environments, the metaverse could facilitate real-time consultations, remote surgical assistance, and simulation-based training, overcoming traditional geographical and logistical barriers. Despite these advancements, skepticism persists regarding the metaverse's true benefit in fostering meaningful human interaction. Some critics argue that virtual interfaces risk alienating communication, eroding the depth of doctor-patient relationships rather than strengthening them. The concern remains that digital mediation might replace rather than enhance human presence, diminishing the nuances of empathy and trust inherent in face-to-face interactions. Economic constraints, technological disparities, and the potential reduction in direct human interaction can complicate widespread adoption. Some perspectives suggest that, if strategically implemented, the metaverse could foster a more human, authentic, and profound doctor-patient relationship by reducing administrative burdens and allowing physicians to focus more on patient care. While the metaverse holds promise for revolutionizing digital healthcare, its long-term success depends on responsible implementation, equitable access, and strategic integration into existing healthcare frameworks. In this paper, we aim to critically evaluate both sides of this debate, synthesizing existing evidence to clarify the role of the metaverse in future healthcare communication.

The objectives were to analyze the association between the cognitive performance of older adults/caregivers, adherence to a telehealth program and investigate reasons for dropouts, retention and adherence. A mixed-methods study was conducted involving 41 older adults diagnosed with dementia who participated in a 12-week telehealth program that offered physical exercises for the older adults and psychoeducation for the caregivers. Cognitive performance, adherence rates, benefits and reasons for withdrawal, retention and adherence were determined with the aid of questionnaires, field records, and focus groups. No significant association was found between the adherence rate and cognitive performance. The main reason for dropouts was the occurrence of illness during the intervention. The reasons for adherence were the convenience of the online program and the fact that the program was free of cost. The benefits were improvements in the wellbeing, mood of the older adults and the mitigation of progressive symptoms of dementia.

eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users.

This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth.

We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase.

Three types of user personas could be identified, including "high-level self-managers" (254/572, 44.4%), "medium-level self-managers" (283/572, 49.5%), and "low-level self-managers" (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost ("free of charge").

The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites.

Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity).

A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models.

In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12).

VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context .

We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding.

All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it.

These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings.

Virtually-delivered obesity care has the potential to increase access to weight loss interventions at scale. While there is ample literature assessing various weight loss interventions, studies specifically demonstrating outcomes of commercial programs offering antiobesity medications in virtual care settings are lacking.

This retrospective cohort study assessed the weight loss outcomes of 66,094 participants in a virtual weight care program that prescribes antiobesity medications alongside a digital behavior change program. Outcomes included the primary endpoint of percent weight loss at 12 months, as well as absolute change in body weight, change in body mass index (BMI), categorical weight loss at three, six, and 12 months, and stratifications by program engagement and medication type (first vs. second generation antiobesity medications).

At program enrollment, members were on average 42.6 years old and 91.5% female, with a BMI of 36.0 kg/m2. At 12 months, the mean percent weight loss was 8.0%, with weight loss increasing over time from 2.9 kg (SD = 3.7, Cohen's d = 0.8) at 3 months, to 5.8 kg (SD = 6.1, Cohen's d = 0.9) at 6 months, to 8.0 kg (SD = 8.7, Cohen's d = 0.9) at 12 months (p < 0.001 for all time points). At 12 months, 64.2% had achieved ≥ 5% weight loss. Weight loss outcomes increased with program engagement. At 12 months, those engaging at least once weekly lost 10.0% of body weight, while those logging weight at least weekly lost 12.0%.

This study provides real-world evidence that users of a virtual commercial weight care clinic who were prescribed antiobesity medications achieved clinically significant weight loss at six and 12 months. These findings support the value of virtual platforms in efficiently scaling access to high-quality weight care.

Solid organ transplant (SOT) recipients now have widespread access to telehealth, but the factors influencing their satisfaction still need to be understood. This cross-sectional study explored potential contributors to telehealth satisfaction among SOT recipients, including liver, kidney, and simultaneous liver-kidney recipients. A total of 136 adult SOT recipients completed an online survey. The survey assessed telehealth satisfaction, previous telehealth experiences, including confidence levels and the need for assistance from others, electronic health literacy (eHealth literacy), perceived physical and mental health status, and cognitive function, along with demographic and clinical characteristics. The multivariate regression backward selection method was used to identify potential factors contributing to telehealth satisfaction. Participants had a mean age of 60.1 years (standard deviation [SD] = 10.5) and were, on average, 92 months post-transplant (SD = 99.9). The mean telehealth satisfaction score was 5.3 out of 7 (SD = 1.2), indicating positive satisfaction with telehealth. However, lower telehealth satisfaction was associated with poor confidence in communicating with providers via telehealth, lower eHealth literacy, better perceived cognitive function, and a prolonged time since SOT (adjusted R2 = 0.49). SOT recipients who perceive vulnerability in online technology, report better perceived cognitive function, and are farther out from their SOT may exhibit lower satisfaction with telehealth. When considering telehealth for transplant care, clinicians should prioritize addressing the specific concerns and challenges of SOT recipients who may perceive telehealth unfavorably.

Objective: As digital natives appear to be the most suitable target group for technological innovations, we tested this notion by analyzing their attitude toward the implementation of telemedicine in Poland. Methods: An online survey was conducted from April to October 2021, yielding responses from 475 university students on their experience with teleconsultations, which are an essential part of telemedicine. Satisfaction-related questions were used to perform cluster analysis, and subsequently, clusters were compared based on significant differences in responses including sociodemographic and utilization patterns. Open-ended questions were analyzed to further gauge the rationale behind the demonstrated attitude. Results: The responses were polarized. In the cluster analysis, on one side were the "Skeptics" and "Enemies," who shared negative opinions on professionalism and convenience, differing only in their assessment of intangible skills. On the other side were the "Enthusiasts," who were satisfied in all categories; the "Indifferent," who lacked strong opinions; and the "Time-pressed," who, while openly admitting its drawbacks, were highly likely to continue using it due to its time-saving potential. Recurring concerns in open-ended questions focused on unreliable diagnoses and uncooperative administrative personnel. Conclusions: The reception was polarized. The split in answers suggests that administrative problems were limited to some providers, indicating they should be possible to overcome. There is a clear pattern that telemedicine is seen as an incomplete service. However, many would happily continue to use it due to its convenience and time-saving benefits.

 Tele-intervention gained popularity, during the coronavirus disease 2019 (COVID-19) pandemic, prompting healthcare providers to adapt to remote service delivery. Research about stuttering treatment via tele-intervention in South Africa is limited. Speech-language therapists (SLTs) require further insights to deliver a well-supported approach for treatment of stuttering using tele-intervention, despite limitations such as technological disruptions, including loadshedding, that impact service reliability.

 The study aims to explore clients' experiences with tele-intervention for stuttering therapy, and to provide recommendations to improve service delivery.

 Semi-structured interviews were conducted with 11 persons who stutter (PWS) recruited through purposive sampling. Written informed consent was obtained from all participants with experience in both tele-intervention and in-person treatment. Inductive thematic analysis supplemented by descriptive statistics was used to identify patterns and trends.

 Four main themes emerged: (1) User experiences and factors shaping perceptions of tele-intervention; (2) technical infrastructure: barriers and facilitators; (3) financial and access considerations and (4) in-person treatment experience compared to tele-intervention user experience. Likert scale ratings indicated no considerable difference in preferences between tele-intervention and in-person treatment.

 Participants' diverse experiences highlighted tele-intervention's benefits and challenges for stuttering therapy. While limitations exist, findings inform service enhancement in South Africa, emphasising the importance of users' perspectives in tele-intervention design.Contribution: Insights from PWS can be used in informing clinical practice, aiding SLTs in meeting the needs of PWS and guiding best practice. Tele-intervention should be integrated into a hybrid intervention model that PWS prefer.

Telemedicine is transforming health care by enabling remote diagnosis, consultation, and treatment. Despite rapid adoption during the COVID-19 pandemic, telemedicine uptake among health care professionals (HCPs) remains inconsistent due to perceived risks and lack of tailored policies. Existing studies focus on patient perspectives or general adoption factors, neglecting the complex interplay of contextual variables and trust constructs influencing HCPs' telemedicine adoption. This gap highlights the need for a framework integrating risks, benefits, and trust in telemedicine adoption, while addressing health care's unique dynamics.

This study aimed to adapt and extend the extended valence framework (EVF) to telemedicine, deconstructing factors driving adoption from an HCP perspective. Specifically, it investigated the nuanced roles of perceived risks, benefits, and trust referents (eg, technology, treatment, technology provider, and patient) in shaping behavioral intentions, while integrating contextual factors.

We used a qualitative research design involving semistructured interviews with 14 HCPs experienced in offering video consultations. The interview data were analyzed with deductive and inductive coding based on the EVF. Two coders conducted the coding process independently, achieving an intercoder reliability of 86.14%. The qualitative content analysis aimed to uncover the nuanced perspectives of HCPs, identifying key risk and benefit dimensions and trust referents relevant to telemedicine adoption.

The study reveals the complex considerations HCPs have when adopting telemedicine. Perceived risks were multidimensional, including performance risks such as treatment limitations (mentioned by 7/14, 50% of the participants) and reliance on technical proficiency of patients (5/14, 36%), privacy risks related to data security (10/14, 71%), and time and financial risks associated with training (7/14, 50%) and equipment costs (4/14, 29%). Perceived benefits encompassed convenience through reduced travel time (5/14, 36%), improved care quality due to higher accessibility (8/14, 57%), and operational efficiency (7/14, 50%). Trust referents played a pivotal role; trust in technology was linked to functionality (6/14, 43%) and reliability (5/14, 36%), while trust in treatment depended on effective collaboration (9/14, 64%). Transparency emerged as a critical antecedent of trust across different referents, comprising disclosure, clarity, and accuracy. In addition, the study highlighted the importance of context-specific variables such as symptom characteristics (10/14, 71%) and prior professional experience with telemedicine (11/14, 79%).

This study expands the EVF for telemedicine, providing a framework integrating multidimensional risks, benefits, trust, and contextual factors. It advances theory by decomposing trust referents and transparency into actionable subdimensions and emphasizing context-specific variables. Practically, the findings guide stakeholders: policy makers should prioritize transparent regulations and data security, health care organizations should provide training and support for HCPs, and technology developers must design telemedicine solutions aligning with trust and usability needs. This understanding equips health care to address barriers, optimize adoption, and leverage telemedicine's potential for sustainable clinical integration.

To test the impact of virtual care usage on quality metrics used for performance measurement.

Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use.

This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021. Eligible patients had at least one primary care contact. Eligible physicians had 10 or more patient contacts. The quartile of virtual visits per physician per month is calculated as the percentage of total visits conducted by phone or video (Q1 is the lowest). Six metrics used for value-based reimbursement were chosen for modeling with generalized linear mixed models.

The data included 200,090 patients of 683 physicians in 42 clinics over 24 months. Virtual care usage peaked in April 2020 at 78% and then stabilized at 18%. The blood pressure metric was met in 66% (95% CI: 63%-69%) of physician months in Q1 and 65% (95% CI: 63%-68%) in Q4 ( P = 0.003). The hemoglobin A1c metric was met in 73% (95% CI: 70%-76%) of physician months in Q1 and 72% (95% CI: 69%-75%) in Q4, not a significant difference. Breast cancer screening completion and colon cancer screening completion did not differ across virtual care quartiles. Medicare annual wellness visits were completed in 55% (95% CI: 50%-60%) of Q1 physician months and 54% in each of Q2, Q3, and Q4 ( P < 0.0001).

Some quality metrics were modestly impacted by high virtual primary care usage; the absolute differences in rates were small. This may provide reassurance to physicians and their health systems that telemedicine use may not adversely impact quality metrics.

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

Objectives: We aimed to review the effect of lifestyle interventions in women with a history of gestational diabetes mellitus (GDM) based on the participants and intervention characteristics. Methods: We systematically searched seven databases for RCTs of lifestyle interventions published up to 24 July 2024. We included 30 studies that reported the incidence of type 2 diabetes mellitus (T2DM) or body weight. A random effects model was used to calculate the relative risk and mean difference with a 95% confidence interval. Subgroup analyses were conducted for participants' characteristics (age, body mass index (BMI)) and intervention characteristics according to the Template for Intervention Description and Replication (TIDieR). Results: A greater T2DM risk reduction was seen in trials that started within one year postpartum, in participants with a mean baseline BMI of 30 kg/m2 or more, or based on behavioral change theory. For body weight reduction, studies on participants with a mean baseline BMI of 25 kg/m2 or more or ones that included electronic/mobile delivery (text message, web, phone call) were more effective. Conclusions: Diabetes prevention trials in women with a history of GDM are more effective when commencing within one year postpartum, underpinned by behavior change theory, and in participants with overweight or obesity.

Guided by communication accommodation theory, we studied 27 physician reports of patient-physician advanced cancer communication during the COVID-19 pandemic. Advanced cancer communication requires recognizing patients' psychosocial states and collaboratively engaging patients empathetically to develop the shared understanding necessary to guide decision-making. However, physicians found their communication underaccommodated, stemming from personal protection equipment, social distancing, and telemedicine. Based on provider perspectives, our study identified that during advanced cancer communication, emotional expression was critical for reflecting care and concern to patients, and discourse management was central to showing interest and engagement to patients by their providers. The failure to convey emotional expression to patients meant rapport-building cues were missing, impeding discourse management when navigating difficult conversations about prognosis and end-of-life care. Despite efforts to adjust emotional expression and discourse management during the pandemic to address the needs of their patients, providers were dissatisfied with their communication outcomes. Physicians struggled to relay verbal and nonverbal emotional expressions effectively, supportively, and compassionately to patients when breaking bad news during advanced cancer communication, resulting in a profound source of moral and emotional distress.

The rapid adoption of telehealth services has been significantly accelerated by the need for accessible healthcare solutions, especially among older adults. However, the utilization of telehealth remains limited in many regions, including Saudi Arabia. This study aims to identify the barriers and facilitators influencing telehealth adoption among older adults in Riyadh.

A qualitative phenomenological approach was employed, involving semi-structured interviews with 25 participants aged 60 and above. Thematic analysis was utilized to analyze the data, allowing for the identification of key themes related to participants' experiences with telehealth services.

Four main themes emerged from the analysis: access to technology and connectivity, attitudes toward telehealth, support systems, and institutional and policy factors. Participants reported challenges such as low digital literacy and unreliable Internet access, along with the need for trust in healthcare providers. Family support and the desire for training resources were highlighted as important facilitators of telehealth utilization.

The findings indicate that addressing barriers such as digital literacy and connectivity is crucial for enhancing telehealth utilization among older adults. Implementing strategies that promote education, strengthen support systems, and improve policy frameworks is essential for facilitating greater engagement with telehealth services in this demographic.

Resistance exercise (RE) has been demonstrated to result in a myriad of benefits for individuals treated for cancer, including improvements in muscle mass, strength, physical function, and quality of life. Though this has resulted in the development of recommendations for RE in cancer management from various international governing bodies, there is also increasing recognition of the need to improve the design of RE interventions in oncology. The design and execution of RE trials are notoriously complex, attempting to account for numerous cancer/treatment related symptoms/side effects. Further, the design of exercise trials in oncology also present numerous logistical challenges, particularly those that are scaled for effectiveness, where multi-site trials with numerous exercise facilities are almost a necessity. As such, this review paper highlights these considerations, and takes evidence from relevant areas (RE trials/recommendations in oncology, older adults, and other clinical populations), and provide a practical framework for consideration in the design and delivery of RE trials. Ultimately, the purpose of this framework is to provide suggestions for researchers on how to design/conduct RE trials for individuals with cancer, rather than synthesizing evidence for guidelines/recommendations on the optimal RE dose/program.

Background: Telemedicine has become a global tool for enhancing health care accessibility. However, its widespread adoption is still limited by technological illiteracy, lack of appropriate devices, slow internet services, and privacy concerns. In the Middle East and North Africa, including the United Arab Emirates (UAE), there is a dearth of telemedicine research. This study aimed to understand the perceptions and satisfaction levels of the UAE population regarding telemedicine. Methods: Between June and September 2023, a cross-sectional study was undertaken, using an online questionnaire distributed among UAE citizens and residents aged 18 years and above. The survey aimed to gauge the perceptions, usability, and satisfaction levels of telemedicine users, alongside identifying barriers hindering its acceptance. Data analysis was performed using Python 3, using Matplotlib v3.3.4 and Pandas v1.2. Results: The data analysis encompassed 1,013 participants, among whom 66.9% (678/1,013) were familiar with telemedicine. From this group, 29.8% (202/678) had previously utilized it. Of these users, 92.3% (186/202) found it to be useful or highly useful, whereas 83.1% (168/202) expressed overall satisfaction with their telemedicine experience. Among those who had not used telemedicine (47%, 476/1,013), the predominant concerns were a preference for in-person health care consultations for better care (77%, 367/476) and uncertainty about the quality of care offered through telemedicine (62%, 296/476). Conclusions: Despite high awareness of telemedicine in the UAE, its actual usage remains limited, highlighting the necessity for increased promotional efforts. Nevertheless, positive feedback suggests considerable potential for broad adoption. Future studies should address participants' concerns to enhance telemedicine utilization in the region.

The shift toward virtualized care introduces challenges in assessing the motor severity of Parkinson's disease (PD). The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, the most used rating scale in PD, lacks validation for synchronous remote administration.

Our goal was to validate the usability of a patient guide to allow an accurate video-based MDS-UDPRS part III remote examination.

We conducted a multi-stage mixed methods study that included a team consensus for the concept of the guide, cognitive pretesting, and usability (system usability scale, [SUS]) testing in five sites (total n = 25 participants) with distinct linguistic and cultural contexts.

A multi-language (English, Portuguese, Spanish, and traditional Chinese) largely pictograph guide of the MDS-UPDRS part III remote examination reached benchmark for usability (SUS score ≥68) in 25 participants who completed the synchronous remote assessment.

The MDS-UDPRS part III remote examination guide can be used remotely accurately, and facilitate clinical practice and research in a paradigm of telemedicine.

Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool.

A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality.

This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.

Telemedicine use in healthcare is rising. However, infrastructural barriers may impede implementation in lower- and middle-income country settings. Patient perspectives regarding teleconsultation need to be explored. This study assesses the feasibility of teleconsultation among patients with cancer, patient satisfaction with its use, determinants of satisfaction, and its economic benefits.

A cross-sectional telephonic interview-based study was conducted between February and September 2021 in a tertiary care cancer center in India. Adult patients with cancer or their caregivers who had availed of teleconsultation during the 6 months preceding the interview date were included. Teleconsultation was administered through email and telephone conversation. The research team developed an interview guide to elicit demographic details, satisfaction with teleconsultation, and the underlying reasons. Cost savings through teleconsultation were also recorded. Factors predicting subject satisfaction were identified by multivariable logistic regression.

During the study period, 195 subjects, including 84 patients (43.1%) and 111 caregivers (56.9%), were interviewed. The median patient age at diagnosis was 31 years. In our study, 147 (75.4%) patients/caregivers reported satisfaction with teleconsultations. The benefits cited included better access and follow-up (n = 173, 88.7%) and saving time and money (n = 164, 84.1%). In multivariable analysis, a higher patient age (more than 30 years) was the only factor predictive of less satisfaction with teleconsultation. The median cost savings were not a predictor of satisfaction.

Teleconsultation is feasible and acceptable to most patients availing treatment in a tertiary oncology care setting in India. Patient and physician training for better communication may further improve the utility of this modality.

Telemedicine is a vital tool for improving healthcare delivery in Ethiopia, where geographic, economic, and infrastructural challenges limit access to care, particularly in rural areas. With a shortage of healthcare professionals and limited medical services, telemedicine offers a solution by enabling remote consultations and continuous monitoring, extending healthcare to underserved populations. However, the successful adoption of telemedicine depends largely on the attitudes of healthcare professionals, whose acceptance and use of the technology are crucial for its integration. This study reviews the factors influencing Ethiopian health professionals' attitudes toward telemedicine to provide insights that can support its adoption and improve healthcare delivery in the country.

Following the PRISMA guidelines, we conducted a systematic review of studies on telemedicine attitudes, initially identifying 15,900 articles. After screening, 5 full-text articles were selected for inclusion. The data were analyzed using STATA version 11, where heterogeneity was assessed using the I² test, and publication bias was evaluated through funnel plots and Egger's regression. The pooled effect size was calculated using a random-effects model, with a 95% confidence interval to ensure the robustness and precision of the findings.

The finding that 53.42% (95% CI: 42.02-64.83) of Ethiopian health professionals hold positive attitudes towards telemedicine suggests a moderate level of acceptance. Factors associated with these positive attitudes included receiving computer training in telemedicine (AOR 4.47, 95% CI: 1.94-10.26), possessing advanced digital literacy (AOR 4.08, 95% CI: 1.30-12.81), comprehensive knowledge of telemedicine technology (AOR 3.28, 95% CI: 1.73-6.23), access to reliable internet (AOR 3.04, 95% CI: 1.67-5.53), and availability of electronic devices in healthcare settings (AOR 2.59, 95% CI: 1.73-3.87).

This meta-analysis reveals that 53.42% of Ethiopian health professionals hold positive attitudes towards telemedicine, influenced by specialized training, digital literacy, and resource access. To enhance adoption, initiatives should focus on targeted training, reliable internet connectivity, availability of devices in healthcare settings, and promoting broader awareness about telemedicine benefits and applications among healthcare professionals.

Obesity is a unique chronic disease, with China having the largest number of people living with overweight and obesity in the world. There has been little research from the demand perspective for online medical consultation (OMC) by individuals living with obesity. With the growing demand for obesity OMC, especially due to the emergence of new pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, individuals living with obesity are seeking both advice on obesity management and the prescription of obesity drugs. Therefore, our demand scenarios defined 2 OMC motivations to manage obesity: "For-Drugs" use and "For-Advice" use.

This study aims to assess and compare the preferences for For-Drugs and For-Advice OMC among individuals living with obesity in China.

Following the International Society for Pharmacoeconomics and Outcomes Research's checklist and comprising 400 participants assigned to the For-Drugs scenario and 400 to the For-Advice scenario, the For-Drugs and For-Advice preferences were estimated through discrete choice experiments. The groups in the 2 scenarios followed a similar distribution, and the 2 different demand scenarios shared the same discrete choice experiment design, comprising 16 choice sets with 6 representative attributes. Mixed logit modeling was used to estimate the willingness to pay and relative importance scores.

Doctors with well-known and general expert titles, versus ordinary doctors; doctors from high-level, provincial, tertiary, and municipal hospitals, versus lower-level county hospitals; less waiting time; and lower OMC fees were preferred in both the For-Drugs and For-Advice scenarios. The differences between the 2 scenarios lay in the consultation format, consultation duration, and the relative importance of consultation duration versus waiting time. The For-Advice group preferred telephone consultations, while the For-Drugs group did not; the For-Drugs group preferred longer consultation duration (β=.029), while the For-Advice group preferred shorter consultation duration (β=-.030); and the For-Drugs group rated consultation duration higher than waiting time, while the For-Advice group rated the waiting time as more important than consultation duration. Combined with our qualitative research, the differences can be explained by the different consultation needs in the 2 scenarios, where longer patient consultations were preferred by the For-Drugs patients who sought detailed advice on drug side effects, while quick and direct responses were preferred by the For-Advice participants.

By revealing user preferences on costs, doctors' titles and hospital level, wait time, and consultation duration and format, our research informs OMC platforms, OMC regulators, and doctors on market segmentation and service differentiation strategies.

Telehealth, including video consultation (VC), has become prevalent during the COVID-19 pandemic. However, the experience and concern of women using VC for postpartum care has yet to be adequately studied but is crucial for their adoption. The study aimed to assess the experience and attitude of postpartum mothers (PPM) towards using VC as a novel model of care delivery and the factors that could potentially affect their adoption.

Data were gathered from PPM participating in VC using Zoom platform for postpartum care using mixed method. In-depth interviews (IDI) of twenty-five PPM were audio-recorded, transcribed verbatim and audited for accuracy. Thematic analysis was conducted to identify themes relating to perceived threat, usefulness, ease of use, and attitudes toward using VC in postpartum care. The themes are reported based on the "Health Information Technology Acceptance Model" framework. Preliminary quantitative data on the acceptability of VC were collected using structured surveys.

PPMs valued convenience, accessibility, and personalised care VC offered to address their immediate postpartum concerns. They perceived VC as suitable for seeking medical opinions, improving confidence in parent crafting, and providing better care access. They recognised the lack of physical examination as a major limitation in VC and proposed a hybrid postpartum care model, combining VC and in-person consultation to cater to individual needs and preferences. PPMs alluded to trust in the care providers, flexibility in VC appointment timings and enhanced interface of remote platforms as enablers for VC adoption. Preliminary quantitative data shows that PPMs found VC saved time (100%), energy (98%), and money (90%) and was appropriate (94%), easy to use (96%), acceptable (96%) for postpartum care.

PPMs favoured combining VC and in-person consultation to mitigate their concerns and personalise their care needs.

In Japan, telepharmacy is becoming increasingly popular due to deregulation triggered by the outbreak of COVID-19. The purpose of this study was to gain an understanding of the actual state of telepharmacy in Japan by interviewing pharmacists who have experience with telepharmacy and describing its advantages and disadvantages, as well as their outlook for its use going forward. The interviews were conducted online using Zoom. Each interview lasted approximately 30 min. Eleven people were interviewed. The advantages mentioned by the pharmacists were classified into three main categories: "Better communication", "Time savings", and "Improved safety". The disadvantages were classified into the following nine categories: "Drug delivery problems", "Communication failures", "Ease of use for patients", "Emotional reactions", "Pharmacy system", "Communication issues", "Healthcare system issues", "App system issues", and "Cost". Many of these factors correspond to the Unified Theory of Acceptance and Use of Technology (UTAUT) constructs presented by Venkatesh, et al. Many of the pharmacists mentioned that the use of telepharmacy is likely to expand further in the future, but that this will require further development of communication technology and the widespread use of systems such as electronic prescriptions.