J Atheroscler Thromb. 2025 May 9. doi: 10.5551/jat.RV22036. Online ahead of print.

ABSTRACT

Digital health innovations (DHI) in medicine have led to remarkable progress in stroke prevention and management worldwide. For example, education regarding the knowledge and awareness of stroke, risk scores for stroke incidence, and wearable devices have been used for primary prevention. Automatic telemedicine and diagnostic imaging have been introduced for the treatment of acute stroke. Rehabilitation using robot-assisted training, virtual reality systems, and other applications has been attempted. Information sharing using the DHI may be expected in secondary prevention. Although these DHI technologies likely assist in stroke prevention and management, their usage remains insufficient, partly because of insufficient evidence. Here, we report the current status and problems associated with the effective and widespread use of DHI in Japan.

PMID:40350320 | DOI:10.5551/jat.RV22036

Adv Med Sci. 2025 May 9:S1896-1126(25)00025-2. doi: 10.1016/j.advms.2025.05.001. Online ahead of print.

ABSTRACT

PURPOSE: Ferritin amounts that accumulate in the meconium may provide new postnatal insights into intrauterine iron homeostasis and neonatal preparedness for the postnatal period. The most dynamic increases in fetal iron stores and fetal growth occur during the third trimester.

MATERIALS AND METHODS: This study involved 122 neonates born between 36 and 41 weeks of gestation, with birth weights from 2,650 g to 4,960 g and birth lengths ranging from 50 cm to 60 cm. Ferritin amounts per gram of meconium were determined via ELISA in the first meconium passed after birth.

RESULTS: A significant week-by-week increase in the birth weight and length (p<0.05) was accompanied by decreasing meconium ferritin amounts (p=0.021) across the gestational age range of 36-41 weeks. There were negative correlations (p<0.05) between the systematic decrease in meconium ferritin amounts and the gestational age across the same range (r = -0.18) and between ferritin amounts and the birth weight and length of newborns (r= -0.20 and r= -0.31). Neonates born at 36-37 weeks of gestation had lower birth weight and length, while their meconium ferritin amounts were nearly twice as high as in neonates born at 38-39 weeks or 40-41 weeks (p<0.05).

CONCLUSIONS: Systematic decreases in meconium ferritin amounts from 36 to 41 weeks of gestation may suggest a gradual and gestational age-appropriate maturation of the mechanisms responsible for adaptation of the fetus to postnatal life. Determining a cut-off value for meconium ferritin amounts could aid in optimal management of newborns after birth.

PMID:40349924 | DOI:10.1016/j.advms.2025.05.001

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2025 May 8;33(2):1591. doi: 10.32687/0869-866X-2025-33-2-176-181.

ABSTRACT

The relevance of humanitarian analysis of digitization of medicine is conditioned by the fact that digitization track is a general component of transformation of entire health care system, including relationships between subjects of medicine, changes in content of professional competencies of physician. The necessity of discussion and multilateral reflection of digitization processes unites developers, physicians, management staff of industry, representatives of social and humanitarian sciences.

PMID:40349228 | DOI:10.32687/0869-866X-2025-33-2-176-181

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2025 May 8;33(2):1590. doi: 10.32687/0869-866X-2025-33-2-171-175.

ABSTRACT

The article presents results of analysis of current trends, challenges and prospects of health care digitization. The key directions of digital transformation are considered: telemedicine, implementation of e-medical records, application of AI, Big Data analysis, patient remote monitoring. The statistical data confirming growth of digitization of health care at the international and national levels, including national experience of Russia, are presented. The special attention is paid to challenges of digitization, including cybersecurity issues, insufficient digital literacy of medical personnel and complexity of normative legal regulation. In conclusion, importance of integrated approach, of interaction of the state, medical institutions and IT companies for effective implementation of digital technologies is emphasized. It is concluded that digitization of health care is both a challenge and a unique opportunity to modernize medicine.

PMID:40349227 | DOI:10.32687/0869-866X-2025-33-2-171-175

BMC Pediatr. 2025 May 10;25(1):372. doi: 10.1186/s12887-025-05656-y.

ABSTRACT

BACKGROUND: Parents of children with a health condition experience high levels of distress which can have long-term impact on the child and parent. Dyadic interventions have the potential to decrease this distress, however several barriers to access including time constraints have been reported. Mobile health (mHealth) interventions can address several of these barriers.

GOAL: The goal of this systematic review was to review and synthesize the literature examining the effects of parent-oriented mHealth interventions and their content and design.

METHODS: We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central databases from January 2013 to 2023 using a search strategy based on telemedicine and parents/caregivers. Included studies were randomized controlled trials assessing the effect of parent-oriented mHealth interventions on child and parent health. The Cochrane risk-of-bias tool was used to assess for bias in studies. Trial details and design and content features of interventions were extracted. Outcomes were organized using the Van Houtven's Framework for Informal Caregiver Interventions. Results are presented narratively.

RESULTS: Fifty papers pertaining to 49 unique studies met our inclusion criteria. More than half of the studies scored high-risk for bias. Interventions targeted a wide range of pediatric conditions. Intervention type included texting (n = 17) and investigator-developed mobile applications (n = 16). Interventions significantly improved parent psychological health and child health outcomes. Key intervention features and design included the use/application of codesign and a theory-driven intervention.

CONCLUSION: Parent-oriented mHealth interventions identified in this review significantly improved both parent and child health outcomes. Therefore, these interventions have the potential to support parents outside of a clinical setting.

PMID:40349017 | DOI:10.1186/s12887-025-05656-y

Transfusion. 2025 May 10. doi: 10.1111/trf.18279. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhage is a leading cause of preventable deaths in combat settings, requiring rapid blood transfusion to improve survival. While the feasibility of drone-assisted medical logistics has been explored, its practical application in battlefield transfusion remains unreported.

STUDY DESIGN AND METHODS: This case report describes the first documented massive transfusion in a combat environment using an autonomous unmanned aerial vehicle (UAV). A 27-year-old soldier sustained severe lower limb injuries from an improvised explosive device explosion and developed hemorrhagic shock in a remote battlefield location where adverse weather conditions prevented immediate evacuation. In response, 6 units of whole blood and 2 units of fresh frozen plasma were transported via UAV, enabling prehospital transfusion under telemedicine supervision.

RESULTS: The UAV successfully delivered blood products on two consecutive flights, ensuring early resuscitation and stabilization despite delayed evacuation. The casualty's vital signs improved post-transfusion, and surgical interventions were successfully performed following hospital admission. This case demonstrates the feasibility of drone-assisted blood product transport in prolonged field care scenarios.

DISCUSSION: To our knowledge, this is the first reported case of a combat casualty receiving a UAV-facilitated massive transfusion in an operational setting. While UAV-based medical logistics offers a rapid and reliable alternative for remote trauma care, challenges remain in regulatory implementation, blood product stability, and integration into standardized protocols. Further controlled studies are needed to optimize UAV-assisted transfusion strategies and their potential expansion into civilian and disaster response settings.

PMID:40346889 | DOI:10.1111/trf.18279

Arch Public Health. 2025 May 9;83(1):129. doi: 10.1186/s13690-025-01590-8.

ABSTRACT

BACKGROUND: The COVID- 19 pandemic has significantly impacted global health, underscoring the crucial role of digital health solutions. The World Health Organization's Classification of Digital Interventions, Services, and Applications in Health (CDISAH) provides a framework for categorizing these technologies. This study aims to analyze the adoption and trends of digital health interventions during the COVID- 19 pandemic, mapping them to the CDISAH framework to identify the most and least utilized interventions and technologies.

METHODS: This overview-of-reviews study was conducted from 1 st January 2020 to 30 th December 2023, focusing on systematic reviews and meta-analyses retrieved from the Cochrane Database of Systematic Reviews, PubMed, Scopus, Web of Science, IEEE Xplore, and ProQuest. Additionally, gray literature was identified through searches on the Google Scholar platform and reviewing the citations and reference lists of the included studies. The findings were qualitatively mapped to the CDISAH framework.

RESULTS: A total of 64 review articles were analyzed. A content analysis of the included studies identified 292 codes related to healthcare providers, 257 codes related to data services, 88 codes related to individuals, and 43 codes related to health management and support personnel. The results revealed that the most frequent interventions were associated with telemedicine and data management subcategories, while gaps were identified in areas such as individual-based data reporting during the pandemic, highlighting the need for individuals to take a more active role in managing their own health in preparation for future crises.

CONCLUSIONS: This study identifies both the strengths and weaknesses of the current digital health landscape. It emphasizes the transformative impact of digital health technologies during the COVID- 19 pandemic and provides a roadmap for future improvements in digital health interventions. By providing a comprehensive overview of digital health during this period, the study underscores the importance of implementing robust digital health strategies within the healthcare system to address existing gaps, leverage strengths, and enhance preparedness and resilience in future public health crises.

PMID:40346715 | DOI:10.1186/s13690-025-01590-8

BMJ Open. 2025 May 8;15(5):e099728. doi: 10.1136/bmjopen-2025-099728.

ABSTRACT

INTRODUCTION: Telerehabilitation (also known as virtual rehabilitation) refers to the use of telecommunication technologies to deliver remote rehabilitation services synchronously or asynchronously to patients. Systematic reviews seem to validate the efficacy and efficiency of telerehabilitation services for diverse patient conditions while offering in addition potential cost savings in healthcare. However, integrating telerehabilitation into clinical settings raises several ethical issues, including the risk of exacerbating existing health inequities in the provision of care. Despite the apparent scarcity of the literature addressing ethical issues related to telerehabilitation, some of these fundamental concerns have already been discussed in health ethics publications. The main objectives of this study are therefore to first scrutinise what has been published to date and second to critically examine the way in which these dimensions have been conceptualised, especially the philosophical and ethical conceptions on which they are based.

METHODS AND ANALYSIS: To meet these objectives, we will conduct a Critical Interpretive Synthesis (CIS). By using an iterative and interactive process, a CIS aims to critically examine the literature and develop a theoretical understanding grounded in review studies. As per the steps described by Dixon-Woods, we will start by conducting a systematic search of the literature within five selected databases: CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. The search strategy will be based on two main concepts: (1) telerehabilitation and (2) ethics. This systematic search will be completed by other research strategies: searching the list of references of selected articles and contacting experts within and outside our team's expertise. Search results will be imported within the Covidence software to be assessed for relevance. We will include all empirical and non-empirical articles that specifically investigate or discuss the ethical dimensions of telerehabilitation. Only studies published in English and French will be included. The search and selection of the articles will be carried out interactively and inductively throughout the stages of extraction and development of a theoretical understanding of the data to fill emerging conceptual gaps. The analysis and critical synthesis will be led by the first author but carried out by our multidisciplinary research team. This study, through its critical dimension, has the potential to provide a more comprehensive overview of the many ethical issues surrounding telerehabilitation.

ETHICS AND DISSEMINATION: This review does not require ethical approval. We aim to publish the results in a peer-reviewed journal and do presentations at local, national and/or international research meetings and workshops for all stakeholders.

PMID:40345696 | DOI:10.1136/bmjopen-2025-099728

Heart Lung. 2025 May 8;73:90-94. doi: 10.1016/j.hrtlng.2025.04.032. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines require physician confirmation for smartwatch-diagnosed atrial fibrillation (AF), increasing telemedicine workloads. The newest ChatGPT-4o (GPT-4o) incorporates advanced image input capabilities.

OBJECTIVE: To assess GPT-4o's performance in identifying AF from smartwatch recordings.

METHODS: Consecutive 120 patients with AF and 60 controls with sinus rhythm (SR), confirmed by conventional 12-lead ECG, recorded single-lead ECGs using an Apple Watch (AW) Series 6®. Two blinded cardiologists independently classified the smartwatch recordings as AF, SR, or undetermined. GPT-4o was subsequently prompted to analyze all smartwatch ECGs.

RESULTS: Six AF cases were excluded due to undetermined AW-ECG recordings, leaving 114 AF patients (mean age: 73.4 ± 10.4 years) and 60 controls. The AW algorithm achieved 97.3 % and 100 % accuracy for AF and SR, respectively, while GPT-4o correctly analyzed 47.3 % of AF and 71.6 % of SR tracings. None of the AF characteristics-chronicity, heart rate, QRS width, fibrillatory wave amplitude, or R-wave amplitude and polarity-were predictive of GPT-4o's diagnostic accuracy.

CONCLUSION: The current capabilities of GPT-4o are insufficient to make a reliable diagnosis of AF from smartwatch ECGs. Despite the theoretical appeal of leveraging this innovative technology for such purpose, the findings highlight that human expertise remains indispensable. Consumers must remain aware of the current limitations of this technology.

PMID:40345017 | DOI:10.1016/j.hrtlng.2025.04.032

BMC Health Serv Res. 2025 May 9;25(1):671. doi: 10.1186/s12913-025-12839-x.

ABSTRACT

BACKGROUND: Access to healthcare services is at the center of every health system. Research to understand access to healthcare services for the Fulani in Ghana is limited. Efforts have mainly focused on the confrontations between the Fulani herders and the communities. The study aimed to explore what access barriers exist among the Fulani vulnerable population in Ghana; this will contribute to the understanding of access to healthcare services for a vulnerable population, who are also prone to possible transmission of diseases from human-animal connections, and requiring global health interventions.

METHODS: This is an explorative study using qualitative methods to investigate how the Fulani population access healthcare services in the Sissala East Municipality, Ghana. From 17 to 30 September 2022, interviews were conducted using an interview guide among 11 individuals sampled purposively based on the criteria that, the individual is a Fulani or healthcare professional, resides in and around the study area, and is 18 years or older. Thematic content analysis was used for the analysis.

RESULTS: Contrary to the widely held view of the Fulani population being typically conservative, they displayed positive healthcare-seeking behavior and acceptance of modern healthcare services. And despite their nomadic lifestyle, physical accessibility of healthcare services has not been a challenge given that they can even reach a health facility via mobile phones (mHealth) as well as via other means of transport (e.g., motor bike). However, access barriers to healthcare are influenced mainly by financial constraints and gender roles. They rely on health insurance for healthcare coverage, but co-payments and difficulties in enrollment pose serious healthcare affordability challenges. They require access to health information to improve their knowledge on health-related issues as well.

CONCLUSION: This study reveals that the main barrier to healthcare access among the Fulani is affordability and gender-specific roles. However, they are also utilizing innovative mobile technologies to assist in seeking healthcare against the potential barrier of their nomadic lifestyle. Community engagement and policy measures to improve the coverage of the national health insurance scheme are required to improve healthcare access among the Fulani vulnerable population.

PMID:40346645 | DOI:10.1186/s12913-025-12839-x