Adherence in people with insulin-treated type 2 diabetes (T2D) is not well understood despite it being a prerequisite for preventing complications. This study used insulin injection data from connected insulin pens to examine adherence and characteristics of people with insulin-treated T2D in telemonitoring.

Data from 165 participants were included. We applied a three-step methodology to assess overall adherence, adherence distribution, and dose deviation, using injection data recorded by a connected insulin pen. Additionally, statistical tests were performed to evaluate differences in characteristics between adherent and non-adherent participants.

Weekly averaged overall adherence levels ranged between 70.6 % and 79.3 %. Deviation from the recommended dose occurred in 98.8 % of participants, primarily as increased or reduced doses. Non-adherent participants had higher HbA1c (OR = 0.96, 95 % CI = 0.93, 0.99), and total daily insulin dose (OR = 0.99, 95 % CI = 0.98, 0.99), and a lower level of physical activity (OR = 2.55, 95 % CI = 1.23, 5.28) compared to adherent participants.

Utilizing insulin injection data our results provide detailed insights into basal insulin adherence behavior, including irregularities and daily dose adjustments. Our findings are necessary for supporting healthcare providers' preventable efforts and optimizing diabetes care.

To explore the application of telemedicine in patients with an ostomy and assess the current research status.

The authors searched PubMed, EMBASE, Web of Science, Ovid, CINAHL (Cumulative Index to Nursing and Allied Health Literature), China Biology Medicine, China National Knowledge Infrastructure, WanFang, and VIP (Chinese Scientific Journals Database) databases from the inception of each database to March 2024.

A total of 41 articles comparing telemedicine and standard care in ostomy patients were included.

Information was extracted from full-text articles, including author(s), year, country, study design, ostomy type, sample characteristics, intervention type, duration, and outcomes.

In the 41 studies, telemedicine intervention tools encompass social and conference software, mobile healthcare apps, and remote devices. Intervention durations ranged from 4 weeks to 3 years. The intervention content can be categorized into seven key aspects: health guidance, health counseling, psychological care, peer support, medical appointment scheduling, information statistics, and remote visits. Evaluation of these interventions involves measuring outcomes in 10 areas, including quality of life, ostomy knowledge, self-efficacy, self-care ability, stoma complications, participant satisfaction, psychology, coping and adaptation, burden, and health condition.

The implementation of telemedicine for patients with an ostomy has had a profound impact. As internet technology evolves, optimization of platforms and longer interventions are needed. Healthcare professionals should enhance their training in online communication. In addition, researchers should design specific, specialized measurement scales based on the characteristics of patients with stomas.

Multiple sclerosis (MS) is a chronic disease that presents individuals with various caregiving challenges, making their empowerment based on their real needs essential. The aim of this study was to determine the impact of a patient-centered empowerment program through telenursing on the self-management of people with multiple sclerosis (PwMS).

The present study was a double-blinded, randomized clinical trial conducted on 90 PwMS attending MS Society using a convenience sampling method with random block allocation. The inclusion criteria were a definite diagnosis of MS for at least 6 months, age range of 18 to 60 years, ability to use a telephone and smartphone, no other physical or mental illnesses, and no cognitive or psychological disorders based on self-report and patient records. Additionally, the participants who were not able to continue the intervention due to reasons such as fatigue, unwillingness, or hospitalization could not follow the study. The tools used included a demographic questionnaire and the Multiple Sclerosis Self-Management Scale (Healthcare Provider Relationship and Communication, Treatment Adherence/Barriers, Social/Family Support, MS Knowledge and Information, and Health Maintenance Behavior). The research intervention involved providing an empowerment program through 5 telenursing sessions over 4 weeks, with the number of sessions varying based on each person's needs. Data analysis was performed using SPSS software version 26.

In this study, data from 90 individuals with MS were analyzed. Findings indicated that the majority of the study participants were female (62.2%) and married (55.6%). The results indicated no significant differences in the mean scores of self-management and its relevant subscales, between the two groups before the intervention (P > 0.05). However, after the intervention, the mean scores showed a significant difference in the intervention group compared to the control group in terms of self-management index (91.62 ± 11.14 vs. 88.51 ± 11.27), and subscales of MS Knowledge and Information (15.82 ± 1.28 vs. 14.89 ± 2.4) and Health Maintenance Behavior (15.27 ± 2.87 vs. 14.84 ± 3.37) (P < 0.05). The calculated effect size indicates a medium effect (Cohen's d = 0.56).

Empowering PwMS, focusing on their unique needs and delivering it through telenursing, can be an effective method in enhancing their self-management capabilities. Therefore, it is recommended that healthcare providers in chronic diseases prioritize patient empowerment based on individual needs.

This research was registered (13-09-2021) in the https://irct.behdasht.gov.ir with registration number: IRCT20210824052281N1.

Liver cancer poses significant health challenges worldwide, particularly for ethnic minority populations, who often face barriers such as cultural differences, limited health literacy, and inadequate access to healthcare, contributing to poorer self-management and treatment outcomes. Existing self-management tools do not adequately address the unique needs of ethnic minority liver cancer patients, necessitating the development of a culturally tailored assessment scale.

Grounded in the Health Belief Model, this study developed a self-management behavior assessment scale specifically for ethnic minority liver cancer patients. The scale was constructed using a comprehensive literature review, semi-structured qualitative interviews with 11 ethnic minority liver cancer patients, and two rounds of expert consultation via the Delphi method. The initial item pool was refined through expert input to ensure relevance and cultural sensitivity.

Through literature review and semi-structured qualitative interviews with 11 ethnic minority liver cancer patients, four key dimensions were identified: health behavior management, disease perception and cognition, psychological and emotional regulation, and information acquisition and decision-making participation. These dimensions and items were further refined through two rounds of expert consultation using the Delphi method, ensuring the scale's cultural relevance and content validity. As a result, a self-management behavior assessment scale was developed, consisting of four dimensions and 31 items tailored to the specific needs of ethnic minority liver cancer patients.

This newly developed scale provides a culturally sensitive tool to assess self-management behaviors in ethnic minority liver cancer patients. It has the potential to enhance patient care by identifying culturally specific barriers to effective self-management. Further research is needed to validate the scale's reliability and applicability in broader patient populations.

Self-management positivity is important for patients to improve treatment outcomes, reduce healthcare costs, and provide an intrinsic motivation to gain hope and self-confidence in coping with their illness. In clinical practice, it has been found that head and neck cancer (HNC) patients have a lower level of self-management positivity.

To investigate the degree of self-management positivity among patients with HNC and analyze its influencing factors.

A cross-sectional survey of 215 patients in the radiotherapy department was conducted using the Patient Activation Measure 13 (PAM13), Health Literacy Management Scale, Acceptance of Illness Scale, Cancer Loneliness Scale, and General Self-efficacy Scale.

The PAM13 score of patients with HNC was 63.48 ± 14.7 at level 3. Multiple linear regression analysis showed that widowhood (β = -.127; P < .05), monthly family income per capita (β = .234; P < .01), disease duration (β = .154; P < .01), health literacy (β = .215; P < .01), loneliness (β = -.128; P < .05), disease acceptance (β = .144; P < .05), and self-efficacy (β = .152; P < .01) were the influencing factors of self-management positivity, which accounted for 37.9% of the total variance.

Patients' self-management positivity still needs to be improved. Medical staff should attach great importance to patients' psychological dynamics and actively popularize health knowledge in order to effectively enhance self-management enthusiasm.

It is imperative that we give adequate attention to the self-management positivity of HNC patients. In addition, our country can try to incorporate PAM13 into the healthcare system, using the scale to identify patients who lack self-management awareness, knowledge, and ability and are at risk of readmission upon admission or discharge.

Patients with non-English language preference (NELP) participate in video visits considerably less often than their English-speaking counterparts. Understanding the capability, opportunities, and motivation of patients with NELP to use video visits is key to determining how this technology may benefit their care.

To investigate the perceptions of patients with NELP regarding the facilitators and barriers to usage of video visits.

This qualitative analysis of semistructured interviews of patients with NELP from an ambulatory clinic network of a large, urban, academic health system in California serving a linguistically diverse population was conducted from November 2022 to September 2023. Electronic health data were used to identify Spanish- and Cantonese-speaking patients with at least 1 clinic visit but no video visits in the prior 12 months. Data were analyzed from September 2023 to February 2024.

One-on-one semistructured interviews were conducted by telephone to capture perceptions on facilitators and barriers to video visit use. Interviews were audio-recorded until reaching thematic saturation, deidentified, transcribed and translated, and analyzed using rapid qualitative analysis. Common themes were identified and matched to relevant domains of the capability, opportunities, and motivation model.

Of the 31 patients successfully contacted by telephone, 27 participants (mean [SD] age, 66 [15] years; 18 women [67%]), including 16 Spanish-speaking and 11 Cantonese-speaking participants, were interviewed. Four major themes emerged, including (1) video visits creating additional communication challenges and potentially exacerbating communication difficulties for patients who face language barriers; (2) video visits perceived as having some drawbacks for medical evaluations as well as some appealing benefits; (3) limited digital literacy, device and data access, and non-user-friendly video visit processes as important barriers; and (4) in-person teaching, simpler technologic processes, opportunities to repetitively practice video use, troubleshooting support, and language-concordant instructions, clinicians, and clinic staff as facilitators of video visits. For some, the disadvantages were sufficient to deter use of video visits, while for others, they were counterbalanced by the ease of access provided by video visits.

In this qualitative study, participants with NELP perceived multiple barriers to video visits, including greater communication difficulties, lower medical evaluation quality, and technical issues. These findings suggest that addressable technical challenges associated with language barriers hamper access to video visits and decrease motivation for use and that interventions are needed to increase telehealth equity.

This systematic review and meta-analysis evaluated the cost-effectiveness of telerehabilitation compared to traditional in-person rehabilitation. A comprehensive search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid databases identified 14 eligible studies. The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, assessing economic outcomes using incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Findings indicate that telerehabilitation was cost-effective in three out of 14 studies included in the cost-effectiveness analysis. The mean ICER for telerehabilitation compared to traditional rehabilitation varied, with a probability of cost-effectiveness reaching 90% at a willingness-to-pay (WTP) threshold of $30,000 per QALY. However, at a WTP threshold of $0, the probability of cost-effectiveness remained low, suggesting that telerehabilitation does not always dominate in cost-effectiveness analyses. The study highlights the potential of telerehabilitation to provide similar or improved health outcomes compared to traditional rehabilitation while reducing travel costs and enhancing patient access. Increased patient satisfaction, reduced hospital readmissions, and improved adherence to rehabilitation protocols contributed to the economic benefits observed. However, methodological heterogeneity across studies remains a limitation. Given the growing adoption of digital health technologies, telerehabilitation presents a viable and economically efficient alternative to in-person rehabilitation. Policymakers should consider integrating telerehabilitation into routine healthcare services, particularly in resource-constrained settings, to optimize cost-effectiveness and enhance accessibility. Further research should focus on standardizing cost-effectiveness evaluation methods to strengthen evidence for large-scale implementation.

The positive impact of Internet use on enhancing physical activity among older adults is an important response to the aging problem in the new era. However, while previous studies have explored the important impact of Internet use on physical activity among older adults, the specific mechanisms of this impact have not been much analyzed. In an attempt to answer this question, we further focus on the mediating role of social support in the relationship between Internet use and physical activity among older adults.

This study utilizes data from the 2021 China General Social Survey (CGSS) to categorize social support into three dimensions: support from relatives, friends, and neighbors. A nested multiple OLS regression model is employed to analyze the impact of internet use on physical exercise among the old adults. Additionally, the SPSS macro PROCESS is used to test the mediation effect, examining the mediating role of social support in this relationship.

Our research findings indicate the following: (1) Internet use significantly and positively predicts physical exercise among the old adults; (2) Social support exerts a positive influence on physical exercise in this population; and (3) Social support partially mediates the relationship between internet use and physical exercise among the old adults.

The study concludes that increasing Internet penetration among the old adults is of great practical significance in expanding their social support network and promoting physical activity. The results of the study provide new perspectives on the layout of work on ageing and policies for healthy ageing in the new era, as well as lessons for other developing countries on the issue of ageing.

Chronic obstructive pulmonary disease (COPD) primarily originates from exposure to tobacco smoke, although factors, such as air pollution and exposure to chemicals, also play a role. One of the primary treatments for COPD is oxygen therapy, which helps manage dyspnea and improve survival rates. Mobile health (mHealth) technologies have demonstrated significant potential in monitoring patients with chronic diseases, offering new avenues for enhancing patient care and disease management.

The purpose of this study was to evaluate the efficacy and acceptability of a mobile app designed for the clinical monitoring of patients with COPD and home oxygen (HO) therapy, compared with conventional monitoring in real-world community settings.

A parallel-group, nonblinded, multicenter randomized controlled trial was conducted with 45 participants; the intervention group (IG), which used the mobile app in addition to conventional monitoring (n=23) and the control group, which received only conventional monitoring (n=22), administered by therapists over a duration of 3 months. The primary outcomes included the chronic obstructive pulmonary disease assessment test (CAT) score, the level of dyspnea measured by the Borg scale, and oxygen saturation percentage, assessed at both the beginning and end of the trial. Secondary outcomes included the frequency of app use, the number of hospitalizations, and survival rates. In addition, a satisfaction survey and an interview were conducted with the IG.

The median use of the mobile app was 21 (IQR 16-28) days. At the end of the follow-up, the Borg dyspnea scale was significantly lower in patients who used the mobile app for HO therapy monitoring (mean 0.6, SD 0.8 vs mean 4.1, SD 1.4; P=.001). Regarding the impact of COPD on quality of life, as measured by the CAT, no differences were found in the scores between baseline and end-of-follow-up within the control group. However, a significant decrease was observed in the IG (baseline median CAT 27, IQR 23-31 vs final median CAT 22, IQR 14-28; P<.001). In addition, the CAT score was significantly higher in patients receiving conventional monitoring compared with those monitored with the mobile app (median 30, IQR 23-32 vs median 22, IQR 14-28; P=.02).

The use of the mobile app, AppO2 (SINCO), designed for the clinical monitoring of patients with COPD and HO therapy, is associated with improved quality of life. In addition, the app is highly accepted by users, promotes self-care, and fosters patient confidence in managing their own condition.

ClinicalTrials NCT04820790; https://clinicaltrials.gov/study/NCT04820790.

RR2-https://doi.org/10.1186/s12875-021-01450-8.

Chronic obstructive pulmonary disease (COPD) is a complex health problem, with important repercussions for patients and their families. Interventions need to be improved to prevent exacerbations and reduce high readmission and mortality rates. Evidence suggests that including a telephone follow-up (TFU) call in discharge plans could improve outcomes in patients with a chronic disease.

This project aimed to improve how primary care nurses in Gran Canaria, Spain, followed up COPD patients after hospital discharge.

This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) method. The JBI approach uses audit, feedback, and re-audit to promote evidence-based health care.

A baseline audit was conducted to compare current practices against best practices. Five barriers to best practices were identified and improvement strategies were developed. The follow-up audit revealed 100% compliance for Criteria 1 and 2, which related to COPD patients having a discharge plan and that plan including TFU. There was a 4.88% improvement for both Criteria 3 and 4, which involved the TFU being prompt and using a validated clinical questionnaire. Following project implementation, the 30-day readmission rate increased from 2.78% to 4.88% but the 30-day emergency room presentation rate decreased from 25% to 9.76%.

The practice changes were partly achieved, but further strategies are needed to achieve full compliance. Educational programs are necessary when conducting improvement projects. Chances of success increase when decisions about hospital discharge involve both the hospital and the primary care service.

http://links.lww.com/IJEBH/A296.

Acute remote home monitoring of acutely ill patients with COVID-19 holds potential for early detection of deterioration and thus subsequentearly intervention that may prevent or mitigate progression to severe illness and need for respiratory support. Our aim was to describe common features of acute remote home monitoring programs for acutely ill patients with COVID-19 in the Netherlands.

We performed literature searches (both grey and academic) between 1st March 2020 and 1st March 2023 to identify Dutch acute remote home monitoring initiatives, excluding studies on early hospital discharge. From the available protocols, we extracted relevant information on patient eligibility, organization of acute remote home monitoring and home management.

We identified and approached ten acute remote home monitoring initiatives for information regarding their used protocols. Seven out of ten protocols were retrieved and assessed. All initiatives focused on adult patients with COVID-19 who where at risk of developing severe COVID-19, and all initiatives provided close follow-up through remote home monitoring using medically certified pulse oximeters. Daily measurements included peripheral oxygen saturation (all initiatives, n = 7), body temperature (n = 6), heart frequency per minute (n = 4) and breathing rate per minute (n = 4). For follow-up and review of measured values, in most initiatives (n = 6) the physician (general practitioner or hospital physician) in charge was supported by a dedicated monitoring center. In 5 out of 7 initiatives, the general practitioner (GP) was responsible for supervising the patients and monitoring staff.

The acute remote home monitoring initiatives that emerged in the Netherlands during the first wave of the COVID-19 pandemic were similarly organized. Common building blocks for home monitoring include daily check of peripheral oxygen saturation, monitoring through a dedicated remote monitoring center alongside healthcare personnel and a supervising physician.

This study aimed to co-design and develop a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for adults with musculoskeletal disorders.

A three-step system development cycle was employed. Step 1 involved creating intervention features and content, with two focus groups reviewing prioritised eHealth intervention elements based on earlier research. Step 2 involved heuristic testing using Nielsen's 10 heuristic principles. Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale.

Republic of Ireland.

Step 1 included adults with musculoskeletal disorders (n = 12). Step 2 involved five reviewers. Step 3 included people with musculoskeletal disorders (n = 5) and musculoskeletal physiotherapists (n = 5).

Participants in step 1 approved four main intervention components, which map to recognised theoretical frameworks, and suggested increased use of visual and interactive elements. Heuristic testing in step 2 identified design and navigation issues. In Step 3, usability testing, additional navigation, content and design recommendations were identified. The overall median system usability score (interquartile range) was 75 (0) out of 100 for adults with musculoskeletal disorders and 77.5 (2.5) out of 100 for musculoskeletal physiotherapists, indicating good usability.

A theory-based, user-centred eHealth-mediated follow-up self-management support prototype has been developed for people with musculoskeletal disorders, with the next steps focusing on feasibility testing in clinical practice, with a more diverse population.

Patients living with long-term chronic illnesses often need ongoing medical attention, lifestyle adjustments, and psychosocial support beyond the initial diagnosis and treatment phases. Many experience illness deterioration and subsequently require hospitalisation, especially in the transition period after hospital discharge. A promising strategy for managing long-term conditions is promoting self-management. eHealth interventions involving remote patient monitoring have the potential to promote self-management and offer a more seamless bridge between the hospital and the patient´s home environment. However, such interventions can only significantly impact health and health care if they are effective, accepted and adopted by users, normalised into routine practice and everyday life, and able to be widely implemented. Feasibility studies are used to determine whether an intervention is suitable for the target population and effective in achieving its intended goal. They may also provide critical information about an intervention´s acceptability and usability.

We aimed to evaluate the acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illnesses by use of the core constructs of normalisation process theory.

A descriptive and explanatory qualitative approach was used, with patients observed during training and semi-structured interviews conducted with patients and nurses after study completion.

Participants were recruited from two university hospitals in Norway between December 2021 and February 2023.

Ten patients were observed during training, and 27 patients and eight nurses were interviewed after study completion.

Structured and overt observations were made while the patients received training to operate the remote patient monitoring service, guided by an observation guide. Semi-structured interviews were conducted with patients and nurse navigators about their experiences of remote follow-up care, guided by open ended questions. Data analysis followed a stepwise deductive inductive method.

`Achieving acceptance and usability through digital social interaction´ emerged as a unifying theme that bridged the experiences of patients with long-term illnesses and the nurse navigators. This overarching theme was illustrated by four sub-themes, which all reflected the usability and acceptability of the nurse-assisted remote patient monitoring service in various ways.

Acceptability and usability are critical factors to consider when evaluating remote patient monitoring interventions. In this study, the most important feature for promoting acceptability and usability was the interaction between patients and nurse navigators. Therefore, the intervention´s feasibility and implementation potential rested upon the relationship between its deliverer and receiver.

Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients' access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated.

This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas.

A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions.

The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor's degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P≥.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth.

This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted.

To assess whether post-discharge telemonitoring reduces hospital readmission in patients participating in the diabetes care program.

This retrospective cohort study was conducted from June 2021 to December 2022 and included patients who were enrolled in the Diabetes Program under a hyperglycemia treatment protocol and eligible for post-discharge telemonitoring. The variables included age, sex, diagnosis, hospital stay, LACE Score, and readmission rate.

Among 165 patients who underwent telemonitoring, significant differences emerged in hospital readmission rates between those with and without telemonitoring (p=0.015), with a 15.4% lower readmission rate in the telemonitoring group (95%CI= 3.0-27.9%). Subgroup analyses revealed higher readmission rates in men without telemonitoring (15.2% difference; 95%CI= 0.4-30.0%; p=0.045), and in age groups ≤60 and ≥75 years without telemonitoring (24.2% difference; 95%CI= 4.5-43.9%; p=0.016 for ≤60 years; 37.1% difference; 95%CI= 9.9% to 64.2%; p=0.007 for ≥75 years). Additionally, patients with prolonged hospital stays (>7 days) without telemonitoring had higher readmission rates (19.5% difference; 95%CI= 4.5%-34.5%; p=0.011).

This study suggests that post-discharge telemonitoring can effectively lower hospital readmission rates in diabetes management programs, potentially offering improved health outcomes, cost savings, and enhanced healthcare delivery to patients.

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete.

This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization.

We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission.

In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84).

Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

To explore the impact of digitally-enabled peer support interventions on diabetes distress and depression for individuals living with Type 1 Diabetes (T1D).

We synthesized the results of nine key studies from a review of 3,623 English-language articles published between January 2012 and January 2024. Three studies demonstrated significant reductions in diabetes distress, and two studies reported reductions in depression. Data were analyzed using a narrative approach, including thematic synthesis. This process was structured around the Behavior Change Wheel framework Effective interventions shared several common features such as (1) involved participatory development approaches, (2) included diabetes education, (3) lasted over a longer time, (4) designed with a psychological framework, and (5) utilized peer mentors. Studies showed that digitally-enabled peer support has the potential to improve diabetes distress and depression among people living with T1D despite heterogeneity in intervention approaches. Moreover, designing interventions with certain features may enhance key psychosocial outcomes.

Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.

The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders' perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device.

This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored.

Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method.

HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB.

HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD.

To explore the relationships among benefit finding (BF), self-management, and quality of life (QOL) among patients with COPD.

A total of 205 patients with COPD were selected via a convenient sampling method. BF refers to the ability to find meaning or benefit from difficult situations. The Benefit Finding Scale (BFS), self-management scale, and 36-item Short-Form Health Survey (MOS SF-36) were used to investigate BF, self-management and QOL (including a physical component summary (PCS) and a psychological component summary (MCS)). Structural equation modeling was used to examine the relationships among BF, self-management and QOL in patients with COPD and to analyze the effects of BF and self-management on QOL.

The total QOL score of patients with COPD was 61.38±21.15, and the PCS and MCS scores were 57.67±23.60 and 65.09±21.24, respectively. BF and self-management had positive predictive effects on both the PCS (βBF = 0.519, PBF = 0.012; βself-management = 0.473, Pself-management = 0.012) and MCS (βBF = 0.425, PBF = 0.013; βself-management = 0.535, Pself-management = 0.016) of patients with COPD, and self-management mediated the relationships of BF with the PCS (β = 0.144, P = 0.008) and MCS (β = 0.162, P = 0.007).

The QOL of patients with COPD needs to be improved, especially in terms of physical aspects. Helping COPD patients obtain better BF not only helps them improve their PCS and MCS directly but also indirectly through enhancing self-management to improve their PCS and MCS.

In 2020, three crises coalesced to transform the clinical care landscape of addiction medicine in the United States (US). The opioid overdose crisis (crisis #1), which had been contributing to excess US mortality for over two decades, worsened during the COVID-19 pandemic (crisis #2). The racial reckoning (crisis #3) spurred by the murder of George Floyd at the hands of police impacted clinical care, especially in safety net clinical settings where the majority of people targeted by police violence, and other forms of structural violence, receive healthcare to mend both physical and psychological wounds. Collectively, the three crises changed how providers and patients viewed their experiences of clinical surveillance and altered their relationships to the violence of US healthcare. Drawing from two different research studies conducted during the years preceding and during the COVID-19 pandemic (2017-2022) with low income, safety net patients at risk for opioid overdose and their care providers, I analyze the relationship between surveillance and violence in light of changes wrought by these three intersecting health and social crises. I suggest that shifting perceptions about surveillance and violence contributed to clinical care innovations that offer greater patient autonomy and transform critical components of addiction medicine care practice.

Green exercise, defined as physical activity in natural settings, shows promise for enhancing exercise participation and improving health. This systematic review aimed to assess the effectiveness of green exercise in people with chronic conditions. Seven electronic databases were searched and of the 7801 screened articles, 14 trials met the inclusion criteria. Green exercise was a safe and well-tolerated intervention, with low drop-out levels. It was found to positively affect participants' quality of life in three studies and mental health in four studies. Compared to non-exercise groups, green exercise significantly improved physical and mental health in patients with breast cancer, COPD, cardiovascular disease risk, chronic low back pain, obesity, and diabetes. However, it had no impact on the physical health of stroke patients or the cognitive performance of those with ADHD. Green exercise appears to be a safe intervention that can improve various chronic health issues.

To compare the effects a Mediterranean diet (MedDiet) versus the Irish Healthy Eating Guidelines (HEG) on physical function and quality of life in adults with rheumatoid arthritis (RA) in Ireland.

Forty-four adults with RA were randomised (1:1) to the MedDiet or HEG for 12 weeks. The intervention included three video teleconsultations and two follow-up telephone calls facilitated by a Registered Dietitian (RD). Changes in physical function by Health Assessment Questionnaire- Disability Index (HAQ-DI) and quality of life by Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) were the primary outcomes measured. Secondary outcomes included changes in dietary adherence, physical activity by Yale Physical Activity survey (YPAS), patient-perceived pain and general health, and anthropometric measures. All measurements were administered at baseline and repeated at 6 and 12 weeks.

Forty participants completed the study. Participants were primarily females (87.5%), mean age was 47.5 ± 10.9 years. At the end of the intervention, participants in the MedDiet group reported significantly better physical function (p = 0.006) and quality of life (p = 0.037) compared to HEG group. From baseline to 12 weeks, physical function significantly improved in both diet groups, MedDiet (0.9 ± 0.5 to 0.5 ± 0.4 units, p < 0.001) and HEG (1.4 ± 0.7 to 1.0 ± 0.6 units, p < 0.001). Quality of life also significantly improved in the MedDiet (10.1 ± 7.5 to 4.0 ± 4.7 units, p < 0.001) and HEG group (11.25 ± 7.2 to 7.9 ± 6.4 units, p = 0.048). Physical activity improved significantly in the MedDiet (56.7 ± 28.6 to 70.6 ± 33.5 points, p = 0.01) but not within the HEG group despite similar recommendations.

Adhering to the MedDiet and Irish Healthy Eating Guidelines resulted in improvements in RA patient-reported outcomes. The changes observed in both diet groups are likely due to the improvement in overall diet quality irrespective of dietary prescription.

NCT04262505.

to map available evidence on telenursing use in the postoperative period and its impact on patient outcomes.

a scoping review, conducted according to the JBI model and the PRISMA-ScR checklist. The search was carried out in the CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus and Cochrane Library databases.

twelve studies were included, published between 2011 and 2023, 66.6% of which were in developed countries. Of the positive outcomes, we highlight improved levels of disability, autonomy and quality of life, lower rates of post-operative complications, pain and reduced costs. Telephone monitoring was the most widely used modality, but there were few studies in the pediatric context and in Brazil.

of the studies, 11 (91.6%) identified at least one positive outcome in telenursing use and none showed negative aspects in the postoperative period. The role of nurses in digital health needs further study.

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

ClinicalTrials.gov: NCT04955600.

Hybrid models that integrate both in-person and remote health services are increasingly recognized as a promising approach. Nevertheless, research that defines and characterizes these models in children and young people is scarce and essential for establishing guidelines for implementation of hybrid allied health services. This scoping review evaluates four key aspects of hybrid allied health services in children and young people: 1. definitions, 2. service characteristics, 3. outcome measures, and 4. results of hybrid allied health services.

Six databases were searched: Medline (Ovid), Embase, CINHAL, Psycinfo, Cochrane CENTRAL, and Web of Science. Of the 9,868 studies potentially meeting the inclusion criteria, 49 studies focused on children and young people. Following full-text review, n = 21 studies were included.

Terminology used for hybrid allied health services varied across studies which targeted diverse clinical populations and varied in study design, type and frequency of remote and in-person treatments. Over 75% of cases used custom-written software, limiting scalability. All interventions started in-person, possibly to establish a therapeutic alliance and solve technological issues. Most hybrid allied health services (67%) were in mental health, while only a minority involved physical, occupational or speech therapy. The most common outcomes were feasibility and satisfaction, but tools used to measure them were inconsistent. Although 57% of studies demonstrated effectiveness of hybrid allied health services, none measured cost-effectiveness.

Despite the potential of hybrid allied health services for children and young people, the literature remains at a preliminary stage. Standardization of definitions and outcome measures, and clearer reporting of service characteristics and results would likely promote consolidation of hybrid allied health services in children and young people into clinical practice.

This study evaluated the effectiveness of electronic self-management support interventions in reducing all-cause mortality, cardiovascular mortality, readmission rates, and HF-related readmission in heart failure patients.

Following the PRISMA-P guidelines and PRISMS taxonomy, we searched Pubmed, Cochrane Library, and Embase for RCTs and trials of electronic health technologies for heart failure interventions. Develop support programs in advance for education, monitoring, reminders, or a combination of these to screen and categorize studies. The Cochrane ROB2 tool was used to assess the risk of bias.

The monitoring interventions may improve all-cause mortality (OR 0.77, 95% CI 0.63 to 0.93) and cardiovascular mortality (OR 0.75, 95% CI 0.61 to 0.93) compared to usual care. Reminder interventions were associated with significantly reducing readmission rates (OR 0.07, 95% CI 0.00 to 0.94). Mixed interventions were most effective in reducing HF-related readmission rates (OR 0.75, 95% CI 0.56 to 0.99).

Electronic self-management interventions, particularly monitoring and reminders, can potentially improve outcomes of heart failure patients, including reducing all-cause mortality, cardiovascular mortality, and readmission rates.

The eHealth model and the combination of self-management are significant for long-term intervention in patients with HF to improve their quality of life and prognosis.

People with vestibular dysfunction encounter many obstacles when seeking vestibular rehabilitation treatment. Remote delivery of vestibular rehabilitation may offer a promising avenue for overcoming these barriers, ensuring uninterrupted and cost-effective care.

To evaluate clinical trials studying telerehabilitation and virtual reality devices as therapeutic interventions for individuals with vestibular dysfunction.

A PRISMA systematic review of PubMed, EMBASE, Cochrane, Web of Science, and SCOPUS was conducted for randomized controlled trials describing the use of remote care delivery for vestibular rehabilitation. Bias of studies was assessed with the revised Cochrane risk-of-bias tool (RoB2).

The search identified 1,358 unique articles and 14 articles matched the search criteria. Study samples size ranged from 20 to 337, with mean ages ranging from 29.3 to 77.7 years. Interventions included telephone and online communication, exergaming devices, web-based applications, and head-mounted devices to deliver vestibular rehabilitation. Outcomes included validated questionnaires, objective clinical tests, and physical examinations.

The studies reviewed in this article reported greater or equivalent outcomes when incorporating remote care options as supplements or alternatives to standard care for patients with vestibular dysfunction. Further research is required to address limitations in these studies such as heterogeneity of control groups and cost-effectiveness of these interventions.

Evidence is shown for the benefits of physical activity, for patients with lung cancer, at different times through the course of the disease. Telerehabilitation can overcome some of barriers often met by patients to practice physical activity. The objective of this systematic review is to assess feasibility and safety of telerehabilitation for patients with lung cancer, its effects on physical capacity, quality of life, symptoms severity, depression and anxiety, survival, lung function, post-operative outcomes, dyspnoea and body composition. Secondary aim was to distinguish the telerehabilitation efficacy between the different phases of the disease.

Pubmed, PEDro, Scopus, ScienceDirect, randomized controlled trials and non-randomized controlled trials, written in French or English, of telerehabilitation among patients with lung cancer.

Eight studies were included. Telerehabilitation is safe but was characterized by a low recruitment and attendance rate (<70%). It enhances quality of life, muscle mass, depression and anxiety but it does not improve physical capacity (except in preoperative period), symptoms severity, survival, lung function or dyspnoea. After surgery, it ameliorates quality of life, depression and anxiety. During systemic treatments of lung cancer, it improves quality of life, symptoms severity and muscle mass.

Telerehabilitation could be proposed in patients with lung cancer as a complementary intervention of hospital-based programme to increase physical activity volume, compliance and self-efficacy. In case the classic programmes are not possible, it could also be an alternative approach for patients unable to participate to a hospital or community-based training programme.

Diabetes is considered one of the fastest growing diseases worldwide. Especially in the treatment of type 2 diabetes, lifestyle interventions have proven to be effective. However, long-term studies in real-world contexts are rare, which is why further research is needed. The aim of the present study is to investigate whether effects achieved in the context of a long-term lifestyle intervention can be sustained by patients in the long term.

In a two-arm randomized trial we compared diabetes care as usual to a lifestyle intervention combining telemedically support and individual needs-based telephone coaching. The study included 151 patients with type 2 diabetes randomized to either the intervention or control group. Intervention Group (IG; N = 86, 80.2% male, mean age: 59.7) received telemedical devices and telephone coaching over a period of 12 months, Control Group (CG; N = 65, 83.1% male, mean age: 58,8) received care as usual. The primary outcome was chance in HbA1c. A follow-up survey was conducted after 24 months.

The intervention group showed significantly better HbA1c- values compared to the control group at both 12 and 24 months (12 M: - 0.52 (-0.73; - 0.32), p < .000; 24 M: - 0.38 (-0.61; - 0.15), p = .001). The strongest change was seen in the first three months, with the best value obtained at 6 months and stable thereafter.

Combined telephone coaching with telemedicine support could lead to better long-term glycemic control in people with type 2 diabetes. In the future, more long-term studies should be conducted in real-world settings and lifestyle interventions should be offered more widely.

This review meticulously evaluates the integration of behavioral change theories into pulmonary rehabilitation programs for chronic obstructive pulmonary disease (COPD) management, addressing the critical need for enhanced patient compliance and improved therapeutic outcomes. With COPD posing significant global health challenges, characterized by high morbidity and mortality rates, the manuscript underscores the potential of Self-Determination Theory, Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, and the Theory of Planned Behavior to foster meaningful health behavior changes among patients. Through a comprehensive literature analysis, it reveals how each model contributes to understanding patient behaviors in pulmonary rehabilitation contexts, advocating for their systematic application to craft more effective, patient-centered interventions. Despite the proven efficacy of these theories in various health domains, their current underutilization in pulmonary rehabilitation underscores a gap between theoretical knowledge and clinical practice. The review calls for an interdisciplinary approach that bridges this gap, highlighting the urgency of developing actionable, theory-based behavioral intervention plans. By doing so, it aims to advance COPD management strategies, ultimately improving the quality of life for individuals living with this debilitating disease.

Maintaining optimal glycemic control in type 2 diabetes (T2D) is difficult. Telemedicine has the potential to support people with poorly regulated T2D in the achievement of glycemic control, especially if the telemedicine solution includes a telemonitoring component. However, the ideal telemonitoring design for people with T2D remains unclear. Therefore, the aim of this feasibility study is to evaluate the feasibility of two telemonitoring designs for people with non-insulin-dependent T2D with a goal of identifying the optimal telemonitoring intervention for a planned future large-scale randomized controlled trial.

This 3-month randomized feasibility study will be conducted in four municipalities in North Denmark starting in January 2024. There will be 15 participants from each municipality. Two different telemonitoring intervention designs will be tested. One intervention will include self-monitoring of blood glucose (SMBG) combined with sleep and mental health monitoring. The second intervention will include an identical setup but with the addition of blood pressure and activity monitoring. Two municipalities will be allocated to one intervention design, whereas the other two municipalities will be allocated to the second intervention design. Qualitative interviews with participants and clinicians will be conducted to gain insight into their experiences with and acceptance of the intervention designs and trial procedures (e.g., blood sampling and questionnaires). In addition, sources of differences in direct intervention costs between the two alternative interventions will be investigated.

Telemonitoring has the potential to support people with diabetes in achieving glycemic control, but the existing evidence is inconsistent, and thus, the optimal design of interventions remains unclear. The results of this feasibility study are expected to produce relevant information about telemonitoring designs for people with T2D and help guide the design of future studies. A well-tested telemonitoring design is essential to ensure the quality of telemedicine initiatives, with goals of user acceptance and improved patient outcomes.

ClinicalTrials.gov, ID: NCT06134934 . Registered November 1, 2023. The feasibility trial has been approved (N-20230026) by the North Denmark Region Committee on Health Research Ethics (June 5, 2023).

Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.

To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group-based self-management education with a digital website.

A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self-experience of COPD as a special competence, were involved as research partners at the design of this study.

Eleven individual and two group interviews with five participants in each group were conducted.

Group-based self-management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self-reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in-depth reflection that support learning over time.

Chronic diseases disproportionately affect patients in low-income minority groups who traditionally use in-person healthcare services. COVID-19 disrupted their routines and limited options for people to receive care; this could exacerbate health inequities. The study examined telehealth chronic disease management among low-income minority groups. We used Florida Medicaid claims data from March to December 2020 and the American Consumer Survey to examine the study objectives. Data were analyzed using Linear and Logistic Regression. We retrieved claim records of 52,904 unique patients; 31,999 were female and 49% of the sample had at least one telehealth visit. Medicaid patients were 8% less likely to use telehealth and 21% more likely to have audio visits when compared to Medicare patients. The analyses suggest that Non-Hispanic Black patients and individuals with a lack of education experience significant health inequities. People with chronic obstructive pulmonary disease (5%) and heart failure (14%) were less likely to use telehealth than patients with diabetes. Telehealth will continue to be a health delivery option; thus we recommend that strategies are enacted to educate, and resources are provided to promote equity among Non-Hispanic Black patients. Without priority attention to people among low-income minority populations, health inequities will continue to plague this community.

Telehealth is a promising tool for delivering lifestyle interventions for the management of health conditions. However, limited evidence exists regarding the cost-effectiveness of these interventions. This systematic review aimed to evaluate the current literature reporting on the cost-effectiveness of telehealth-delivered diet and/or exercise interventions.

Four electronic databases (PubMed, CENTRAL, CINAHL and Embase) were searched for published literature from database inception to November 2020. This review adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the ISPOR Criteria for Cost-Effectiveness Review Outcomes Checklist. The quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to telehealth modality, organised into tables and reported narratively.

Twenty-four studies of controlled trials (11 combined diet and exercise, 9 exercise-only and 4 diet-only telehealth-delivered interventions) were included for data extraction and quality assessment. Interventions were reported as cost-effective in 12 studies (50%), five studies (21%) reported inconclusive results, and seven studies (29%) reported that the interventions were not cost-effective. Telephone interventions were applied in eight studies (33%), seven studies (29%) used internet interventions, six studies (25%) used a combination of internet and telephone interventions, and three studies (13%) evaluated mHealth interventions. Quality of study reporting varied with between 54% and 92% of Consolidated Health Economic Evaluation Reporting Standards items reported.

This review suggests that telehealth-delivered lifestyle interventions can be cost-effective compared to traditional care. There is a need for further investigations that employ rigorous methodology and economic reporting, including appropriate decision analytical models and longer timeframes.

Periodontitis, one of the most common oral diseases, is a chronic inflammatory condition occur in response to bacterial plaque biofilms. Plaque control and oral hygiene instructions are the most widely used and effective nonsurgical treatment for periodontitis, which is based on a partnership between patient and clinician and requires a life-long commitment. The objective of this study was to analyze the effectiveness of internet-based nursing interventions for the treatment of patients with periodontitis. The findings from this study may help to enhance the therapeutic outcomes for patients with periodontitis.

A total of 80 patients with periodontitis treated in Zhejiang Province Stomatology hospital from December 2021 to January 2023 were randomly selected and divided into control group and intervention group with 40 cases each. The control group was given routine oral health guidance and the intervention group received internet based nursing intervention. The periodontal pocket depth, percentage of periodontal pocket depth (PD) ≥ 4 mm, bleeding on probing (BOP)%, and self-efficacy scale for oral health care (SESS) were assessed and compared at four time points: initial visit, 6-8-weeks follow-up, 3-months follow-up, and 6-months follow-up.

There was no significant difference between the two groups in terms of age, gender, initial visit PD, initial visit PD ≥ 4 mm (%), initial visit BOP (%), and initial visit SESS (P > 0.05). The intervention group showed a significantly decreased percentage of PD ≥ 4 mm at 6-8 weeks and 6-months follow-up compared to the control group (P < 0.05). The PD, BOP%, and SESS scores of the intervention group were significantly better than those of the control group at 6-months follow-up (P < 0.05). There was no statistically significant difference in patient satisfaction between the two groups.

This study confirmed that the internet-based nursing intervention in conjunction with periodontal treatment was able to improve the periodontal pocket depth, gingival bleeding and the level of self-efficacy of patients, suggesting that it is necessary to carry out the extended oral hygiene instructions via internet-based platforms for the patients in clinical practice.

Among people with COPD, smartphone and wearable technology may provide an effective method to improve care at home by supporting, encouraging, and sustaining self-management. The current study was conducted to determine if patients with COPD will use a dedicated smartphone and smartwatch app to help manage their COPD and to determine the effects on their self-management.

We developed a COPD self-management application for smartphones and smartwatches. Participants were provided with the app on a smartphone and a smartwatch, as well as a cellular data plan and followed for 6 months. We measured usage of the different smartphone app functions. For the primary outcome, we examined the change in self-management from baseline to the end of follow up. Secondary outcomes include changes in self-efficacy, quality of life, and COPD disease control.

Thirty-four patients were enrolled and followed. Mean age was 69.8 years, and half of the participants were women. The most used functions were recording steps through the smartwatch, entering a daily symptom questionnaire, checking oxygen saturation, and performing breathing exercises. There was no significant difference in the primary outcome of change in self-management after use of the app or in overall total scores of health-related quality of life, disease control or self-efficacy.

We found older patients with COPD would engage with a COPD smartphone and smartwatch application, but this did not result in improved self-management. More research is needed to determine if a smartphone and smartwatch application can improve self-management in people with COPD.

ClinicalTrials.Gov NCT03857061, First Posted February 27, 2019.

Telemedicine use was common during the COVID-19 pandemic, expanding many patients' approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations.

To assess patient characteristics associated with telemedicine use and telemedicine mode and describe telemedicine visit experiences by telemedicine mode.

This cross-sectional study included data from the 2022 Health Information National Trends Survey and included US adults with a health care visit. Data were analyzed from May to September 2023.

Patient characteristics.

Any telemedicine visits vs in-person visits only; telemedicine mode (video vs audio-only). Multivariable logistic models assessed patient characteristics associated with telemedicine visits and mode. Bivariate analyses compared telemedicine experiences by mode.

The study included 5437 adult patients (mean [SE] age, 49.4 [0.23] years; 3136 females [53.4%]; 1928 males [46.6%]). In 2022, 2384 patients (43%) had a telemedicine visit; 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. In multivariable models, older age (≥75 years: adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.94), no internet use (aOR, 0.62; 95% CI, 0.48-0.81), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70) were negatively associated with having telemedicine visits. Female sex (aOR, 1.43; 95% CI, 1.12-1.83), having chronic conditions (aOR, 2.13; 95% CI, 1.66-2.73), and multiple health care visits (2-4 visits: aOR, 1.77; 95% CI, 1.23-2.54; ≥5 visits: aOR, 3.29; 95% CI, 2.20-4.92) were positively associated. Among individuals who used telemedicine, older age (65-74 years: aOR, 2.13; 95% CI, 1.09-4.14; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00), no health insurance (aOR, 2.84; 95% CI, 1.42-5.67), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78) were positively associated with having audio-only visits. We observed no significant differences in telemedicine use or mode by education, race and ethnicity, or income. Patients' experiences using telemedicine were generally similar for video and audio-only except more individuals who used audio-only had privacy concerns (20% vs 12%, P = .02).

In this cross-sectional study of adults with health care visits, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.

The knowledge, attitude, and practice (KAP) toward post-percutaneous coronary intervention (PCI) self-management among Chinese patients remains unknown. This study investigated the KAP toward postoperative self-management among patients after PCI.

Patients exhibit poor knowledge, attitudes, and practices regarding post-PCI self-management, requiring enhanced education strategies.

This cross-sectional study recruited patients after PCI at Jishuitan Hospital, Beijing, between November 2022 and May 2023. Inclusion criteria comprised patients 1-3 months post-PCI, those capable of self-care, and those willingly participating. The questionnaire (49 items) was designed with reference to current guidelines (the Cronbach α = .829). The final questionnaire included four dimensions with 49 items. The Pearson correlation analysis and structural equation modeling (SEM) were used to determine the relationship among knowledge, attitude, and practice.

A total of 476 valid questionnaires were included. The knowledge, attitude, and practice scores were 8.24 ± 2.78 (possible range: 0-12), 21.61 ± 3.15 (possible range: 9-45), and 32.62 ± 3.75 (possible range: 10-50). The Pearson correlation analysis showed only knowledge scores were correlated with the attitude scores (r = .446, p < .001). The SEM showed that knowledge directly affects attitude (β = .616, p < .001) but had no influence on practice (β = .119, p = .155); attitude had no influence on practice (β = .015, p = .809).

This study indicated that patients had poor knowledge, unfavorable attitudes, and unsatisfied practice toward post-PCI self-management. Strengthening patient health education through diverse approaches is imperative.

This article summarises some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2023 European Respiratory Society International Congress. Two sessions from each Assembly group are outlined, covering the following topics: Group 9.01 focuses on respiratory physiology techniques, specifically on predicted values and reference equations, device development and novel applications of cardiopulmonary exercise tests; Group 9.02 presents an overview of the talks given at the mini-symposium on exercise training, physical activity and self-management at home and outlines some of the best abstracts in respiratory physiotherapy; Group 9.03 highlights the nursing role in global respiratory health and presents nursing interventions and outcomes; and Group 9.04 provides an overview of the best abstracts and recent advances in behavioural science and health psychology. This Highlights article provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.

Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.