J Pediatr Surg. 2026 Feb 3:162976. doi: 10.1016/j.jpedsurg.2026.162976. Online ahead of print.

ABSTRACT

BACKGROUND: Telemedicine has transitioned from emergency pandemic response to routine postoperative pediatric surgical care, yet evidence regarding parental satisfaction with sustained implementation remains limited, particularly using validated instruments across different modalities.

OBJECTIVE: To evaluate parental satisfaction with telemedicine follow-up after pediatric surgery and identify key factors associated with satisfaction during the post-COVID-19 adoption period.

METHODS: Cross-sectional survey of 327 parents whose children received telemedicine follow-up (video or phone) between January 2021 and December 2024. Satisfaction was measured using an adapted Telehealth Usability Questionnaire (TUQ). Multivariable logistic regression identified independent predictors of high satisfaction.

RESULTS: Mean satisfaction score was 4.28/5 (SD 0.51), with 82.0% reporting high satisfaction (TUQ ≥4.0). Video consultations (adjusted OR 1.78, 95% CI 1.10-2.89, p=0.018) and absence of technical problems (adjusted OR 3.14, 95% CI 1.63-6.05, p=0.001) independently predicted satisfaction. Safety outcomes were reassuring: 7.0% required unscheduled in-person visits and 4.6% presented to emergency departments within 14 days, with no significant differences between modalities. Nearly 72% of parents preferred telemedicine for future follow-up appointments.

CONCLUSIONS: Telemedicine demonstrates high parental satisfaction with acceptable safety outcomes in routine postoperative pediatric surgical care. Video capability and technical reliability are critical satisfaction drivers. These findings support integration of telemedicine into standard care pathways with attention to infrastructure quality and family-centered flexibility.

PMID:41643768 | DOI:10.1016/j.jpedsurg.2026.162976

Harm Reduct J. 2026 Feb 5. doi: 10.1186/s12954-026-01408-y. Online ahead of print.

ABSTRACT

BACKGROUND: The rate of hepatitis C virus (HCV) treatment initiation and cure is suboptimal among people experiencing homelessness. A recent randomized controlled trial conducted by our study team compared peer-assisted telemedicine for HCV (TeleHCV) to peer-assisted referral to local providers (enhanced usual care [EUC]) in a rural population in Oregon. We hypothesized that the TeleHCV treatment model is more effective than EUC among those with unstable housing.

METHODS: In this secondary analysis of the Oregon TeleHCV randomized controlled trial in adults with HCV and injection drug use (n = 203), we explored the role of unstable housing as an effect modifier of the TeleHCV intervention using a Poisson regression analysis. Randomized arm, frequency of peer contacts, and medication lockers were exposures of interest. HCV cure, defined as undetectable HCV RNA 12 weeks after treatment initiation, is the primary outcome.

RESULTS: Overall, attaining HCV cure was less likely for those with unstable housing (RR = 0.68, 0.49-0.96, p = 0.026). However, unstably housed participants assigned to the TeleHCV arm were more than 6 times more likely to achieve HCV cure compared to unstably housed EUC participants (RR = 6.47, 3.12-13.43, p < 0.001) with a statistically significant interaction between treatment assignment and housing status (p = 0.022). The impact of TeleHCV on HCV cure was also identified among stably housed participants, but with a smaller effect size (RR = 2.15, 1.19-3.89, p = 0.012). Among participants with unstable housing, greater peer engagement was associated with an increased likelihood of both treatment initiation (RR = 1.24, p < 0.001) and HCV cure (RR 1.26; p < 0.001).

CONCLUSIONS: The peer-assisted TeleHCV intervention was substantially more effective for achieving HCV cure among participants with unstable housing at baseline compared to those unstably housed who received EUC. The treatment model should be broadly disseminated to target populations with HCV and high rates of homelessness to achieve HCV elimination goals.

CLINICAL TRIALS REGISTRATION: NCT04798521.

PMID:41645194 | DOI:10.1186/s12954-026-01408-y

BMC Health Serv Res. 2026 Feb 5. doi: 10.1186/s12913-026-14147-4. Online ahead of print.

ABSTRACT

BACKGROUND: The economic crisis in the Kurdistan Region of Iraq has severely affected public sector salaries and healthcare infrastructure. These disruptions have increased pressures on the healthcare workforce and exposed gaps in the region's institutional and workforce resilience. This study explored physicians' experiences and adaptive responses to the prolonged financial instability and its consequences for healthcare delivery.

METHODS: A qualitative design was adopted using semi-structured interviews with 25 physicians from various specialties working in both public and private sectors across the Kurdistan Region. The study was conducted from March to August 2024 during a period of heightened financial instability. Data were analyzed thematically using a structured six-step qualitative analysis, using an inductive qualitative thematic analysis approach.

RESULTS: Ten interrelated but analytically distinct themes emerged: workload-related operational stress, salary instability, psychological stress, burnout and hopelessness, coping mechanisms, institutional inaction, clinical decisions under constraints, proposed reforms, need for support, emerging innovations, and impact on patient care. Physicians described increased workloads, delayed or reduced salaries, emotional exhaustion, and a deep sense of hopelessness. Institutional inaction compounded these challenges, forcing doctors to ration care and delay procedures. Despite adversity, participants demonstrated moral resilience through volunteering, free care, and semi-private models. Limited innovations-such as telemedicine and community outreach-were also noted. Collectively, these findings reveal a fragile health system sustained primarily by physicians' ethical commitment rather than institutional stability.

CONCLUSION: The Kurdistan healthcare system endures economic hardship through the moral endurance and adaptability of its physicians. Sustaining healthcare quality requires transforming this individual resilience into institutional resilience through salary stabilization, leadership accountability, and structured psychosocial and professional support. Framing these findings through a resilience lens highlights the urgent need to strengthen both workforce resilience and system-level resilience to sustain healthcare delivery during prolonged crises.

PMID:41645193 | DOI:10.1186/s12913-026-14147-4

JMIR Mhealth Uhealth. 2026 Feb 5;14:e67514. doi: 10.2196/67514.

ABSTRACT

BACKGROUND: Integrating electronic patient-reported outcomes (ePROs) into electronic health records (EHRs) can enhance the quality of patient care. However, collecting longitudinal ePRO data throughout treatment and posttreatment surveillance remains challenging in patients with breast cancer. To address this, we implemented an automated system that enables ePRO acquisition and seamless integration into the EHR. The system delivers questionnaire weblinks via a mobile messaging app, allowing patients to complete ePROs before clinic visits, with responses automatically transferred to the EHR.

OBJECTIVE: This study aimed to assess patient response rates to the ePRO system and identify key factors influencing the response rate among patients with breast cancer who received radiotherapy and postradiotherapy follow-up.

METHODS: We conducted a retrospective analysis of prospectively collected ePRO data by using the BREAST-Q questionnaire, a validated patient-reported outcome measure for breast surgery, from patients who received adjuvant radiotherapy at our institution between May 2023 and April 2024. At a preradiotherapy or postradiotherapy visit, each patient was asked to complete the questionnaire via a weblink sent to their mobile messaging app, KakaoTalk. The questionnaire was dispatched from minutes to several days before each visit. The response rate was calculated as the percentage of patients whose responses were successfully recorded in the EHR among those who were requested to respond. A complete response (CR) was defined as completion of all required questionnaire items. CR rates were analyzed according to clinical factors using univariate and multivariate logistic regression.

RESULTS: Data from 1488 patients were analyzed, encompassing 2431 encounters (median 1, IQR 1-2 per patient). The median age of the patients was 51 (range 23-83) years, with 65.1% (n=968) patients aged 40 to 59 years. Comorbidities were present in 15% (223/1488) of the patients. The CR rate for the first, second, and third ePRO encounters was 89.9% (1338/1488), 98.3% (735/748), and 97.3% (180/185), respectively. Among first-time respondents, younger patients had a significantly higher CR rate (patients aged <60 years: 100/1104, 90.9%; patients aged ≥60 years: 334/384, 87%; P=.03). The timing of the questionnaire dispatch also affected the CR rate (P<.001). The CR rate was the highest when questionnaires were sent more than 1 hour before the visit (547/583, 93.3%) or in the afternoon of the previous day (505/545, 92.7%) and the lowest when sent 2 or more days before (100/130, 76.9%) or within 1 hour before the appointment (92/112, 81.7%). Both age (P=.006) and timing (P<.001) remained significant in the multivariate analysis.

CONCLUSIONS: This study demonstrates the feasibility of integrating ePRO into EHR through a mobile messaging app-based system, with high patient adherence. Response rates were significantly influenced by patient age and the timing of questionnaire dispatch. These findings provide practical insight for optimizing ePRO implementation in routine oncology care.

PMID:41643191 | DOI:10.2196/67514

JMIR Mhealth Uhealth. 2026 Feb 5;14:e76862. doi: 10.2196/76862.

ABSTRACT

BACKGROUND: The use of mobile health (mHealth) apps can assist with the management of gestational diabetes (GDM). Although a number of studies have demonstrated their efficacy in improving maternal-fetal outcomes, opinions differ regarding their usability and overall quality. Poorly designed apps, with ill-conceived features or inappropriate content, may pose a threat to patient safety. Nevertheless, very few studies provide in-depth evaluations of app design quality, and the diversity of features and techniques used remains insufficiently explored.

OBJECTIVE: We aimed to evaluate the quality and multifunctionality of commercially available mHealth apps for GDM.

METHODS: This is a systematic app review guided by the TECH (target user, evaluation focus, connectedness, and health domain) framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist. Searches were conducted on the Apple App Store and Google Play. Apps were screened by name, description, and full navigation to identify inclusions. The quality of the apps was evaluated using the Mobile App Rating Scale and IMS Institute for Healthcare Informatics Functionality Score. Multifunctionality of the apps was evaluated using the GDM-adapted features and techniques list developed from the App Behavior Change Scale, NICE (National Institute for Health and Care Excellence) 2015 guidelines, and previous studies. The general features list, which contains instruction, data security, customization, and technical issues, was derived from previous studies.

RESULTS: The search (June 2024) identified 23 commercially available apps from UK app stores. The overall app quality was evaluated to be satisfactory (Mobile App Rating Scale: mean 4.0, SD 0.36; IMS Institute for Healthcare Informatics Functionality Score: mean 5.83, SD 3.03). The multifunctionality evaluation found that the apps had a mean of 17.95 and SD of 7.31 across all 45 items. Overall, our findings suggested that mHealth apps for GDM achieved a certain level of multifunctionality. However, their feature types and supporting digital techniques are relatively basic. The apps focused on education and managing blood glucose control rather than integrating other self-monitoring data and pregnancy-relevant management into their design. The digital techniques used to achieve these features included text and manual operation, rather than other automated features.

CONCLUSIONS: This is the first app review to consider the relationship between app features and usability for women with GDM. Future app development should integrate a wide range of pregnancy-relevant information and more automated features and use advanced digital techniques to enable a holistic digital solution for women with GDM.

PMID:41643159 | DOI:10.2196/76862

Technol Health Care. 2026 Feb 5:9287329251414326. doi: 10.1177/09287329251414326. Online ahead of print.

ABSTRACT

BackgroundThe Parkinson's Image Self (PIS) Report app was developed to complement standard clinician-rated assessments, such as the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), by enabling patients to digitally self-report Parkinson's disease (PD) symptoms, including pain, tremor, rigidity, and emotional states.ObjectiveTo evaluate PIS Report validity and digital health utility by comparing patient-reported outcomes with clinician-rated MDS-UPDRS assessments.MethodsSeventy-eight PD participants completed baseline assessments; 70 provided week-8 follow-up data. PIS outcomes were compared with MDS-UPDRS items using ANOVA, correlation analysis, chi-square tests, and Cohen's kappa statistics.ResultsPIS-derived pain scores differed significantly across MDS-UPDRS pain strata (Item 1.9; F = 4.48, p < 0.01). Head/neck and upper limb pain correlated with perceived OFF periods (r = 0.46-0.48, p < 0.001), while head/neck and lower limb pain correlated negatively with happiness (r = -0.35 to -0.41, p < 0.001). Tremor reports showed fair agreement with clinician ratings (χ² = 18.54, p < 0.001; κ = 0.36), whereas rigidity showed negligible agreement (χ² = 0.00, p = 1.000; κ = 0.01).ConclusionThe PIS Report provides a structured digital tool enhancing patient-clinician communication and remote monitoring by capturing pain, OFF states, and emotional symptoms. Integration with wearables and telemedicine may advance patient-centered PD care.Trial RegistrationCRIS (KCT0006646); ClinicalTrials.gov (NCT05621772).

PMID:41641966 | DOI:10.1177/09287329251414326

J Rural Health. 2026 Jan;42(1):e70124. doi: 10.1111/jrh.70124.

ABSTRACT

PURPOSE: Rural older Veterans have limited access to specialty care. In the Veterans Health Administration (VHA), tele-geriatric mental health (tele-GMH) services provide mental health care to older Veterans through regional telehealth hubs. However, older Veterans may still face gaps in access to geriatric medicine and specialty services, exacerbating unmet needs at the intersection of mental and physical health. We assessed unmet needs for geriatric medicine and related specialty services for rural older Veterans served by tele-GMH.

METHODS: We surveyed 32 clinicians in 6 VHA geographic regions who referred Veterans to tele-GMH services in fiscal year 2023, 25 of whom served rural Veterans. We also conducted semi-structured interviews with 11 tele-GMH clinicians. Survey data were summarized using descriptive statistics, and interviews were analyzed utilizing rapid qualitative analysis. We also described workflows of tele-GMH clinicians as they align with the "4Ms" of age-friendly care (Mentation, Medications, Mobility, What Matters).

FINDINGS: Referring clinicians serving rural Veterans reported lower access to geriatricians than those serving both rural and nonrural Veterans (14.3% vs 36.4%, respectively). Reported access to additional specialty services, as well as local aging services, was also limited. Based on interviews, facilitators for connecting Veterans to services included tele-GMH clinicians' knowledge of local resources. Tele-GMH clinicians reported barriers including high demand, geography, and frequent staff turnover. Tele-GMH clinicians highlighted the utility of the 4Ms to enhance quality of care.

CONCLUSIONS: Integrating geriatric medicine into tele-GMH programs supports the delivery of high-quality, age-friendly health care, optimizing VHA workforce capacity and improving care coordination within VHA and non-VHA systems.

PMID:41641930 | DOI:10.1111/jrh.70124

Telemed J E Health. 2026 Feb 5:15305627261419371. doi: 10.1177/15305627261419371. Online ahead of print.

ABSTRACT

INTRODUCTION: This meta-analysis aims to systematically review and synthesize the available evidence comparing telehealth and in-person follow-up after gynecological surgeries, focusing on clinical outcomes related to safety, patient satisfaction, and healthcare utilization.

METHODS: A systematic search across PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, covering publications from their inception up to October 2025. Studies were selected if they reported outcomes including patient satisfaction measured by the Patient Satisfaction Questionnaire (PSQ-18), incidence of urinary tract infection (UTI), unplanned healthcare visits, and hospitalizations. Seven randomized controlled trials were included, resulting in a total of 692 patients. Data were assessed using Cochrane's RoB 2 tool and GRADE, with random-effects models applied for statistical analyses.

RESULTS: The analysis revealed higher scores for telehealth in interpersonal manner (MD = 0.19) and time spent with providers (MD = 0.26), while other PSQ-18 domains showed no significant differences. Postoperative complications, including UTI unplanned visits, phone calls, hospitalizations, and emergency care access, were similar between telehealth and in-person follow-up. Sensitivity analysis and quality assessment (using RoB 2 and GRADE) indicated a critical risk of bias and low certainty of evidence.

CONCLUSION: Telehealth follow-up after gynecological surgery is as safe as in-person care, with similar complication rates and unplanned healthcare utilization. It also improves patient satisfaction, adherence, and cost efficiency, making it a viable, resource-effective alternative for postoperative care.

PMID:41641710 | DOI:10.1177/15305627261419371

Discov Appl Sci. 2026;8(2):177. doi: 10.1007/s42452-025-08154-z. Epub 2026 Jan 2.

ABSTRACT

This paper proposes an innovative light-fidelity (Li-Fi) system for high-speed communication in hospital environments that operates at a green wavelength of 500 nm with Directly Modulated Laser (DML). The proposed system shows an excellent performance and achieves a Q factor of 18.84, a bit error rate (BER) of 1.6e-79, and a signal-to noise ratio (SNR) of 74.94 dB, which is significantly better than the previous research. It also has a range of up to 25 m line-of-sight (LOS) and can transfer data at speeds in excess of 1 Gbps, making it significantly faster than previous work conducted with much lower LOS ranges while being robust against interference. New applications of DML combined with optical splitters contribute to providing signal stability and system scalability, overcoming problems such as low range. This design ensures safe, reliable, and non-intrusive communication, ideal for applications that require high data reliability, such as real-time imaging and telemedicine in hospitals. This new Li-Fi system is found to be compatible with modern hospital power requirements, and it also provides a solid foundation for future 6G communication networks.

PMID:41641093 | PMC:PMC12864248 | DOI:10.1007/s42452-025-08154-z

Ocul Oncol Pathol. 2026 Jan 6. doi: 10.1159/000550302. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with treated uveal melanoma or suspicious choroidal naevi require a long period of follow-up to detect and treat malignant change in a timely manner. Ocular oncology patients are often managed in highly specialized services and such follow-up can create a significant burden on a service.

SUMMARY: The availability of high-quality imaging has increased acceptability of virtual clinics in other subspecialist areas of ophthalmology. Multi-modal imaging is an important tool for monitoring choroidal lesions and review of imaging by consultant ocular oncologist has been found to be highly sensitive and specific for detecting change of choroidal lesions. Virtual clinics can improve patient access to care, reducing barriers such as time, travel and financial costs. Our experience of virtual oncology clinics in the Scottish Ocular Oncology Service (SOOS) found a high level of patient satisfaction provided results are communicated to patients in a timely manner.

KEY MESSAGES: There is a need for increased capacity in both triaging and monitoring of choroidal naevomelanocytic lesions and virtual clinics provide an efficacious solution to this. Change in practice is challenging, however, with increased accessibility to high-quality imaging modalities, standardized assessment protocols, and focus on patient communication the role of virtual services in ocular oncology is promising.

PMID:41640694 | PMC:PMC12867511 | DOI:10.1159/000550302