Rev Infirm. 2025 Dec;74(316):37-40. doi: 10.1016/j.revinf.2025.10.030. Epub 2025 Nov 24.

ABSTRACT

Chronic wounds are a major public health issue. As they are mainly treated in urban areas, it is essential to consider the resources available and accessible to private nurses. There are many resources available, but are they being used effectively and deployed sufficiently? The coordination of care pathways is the subject of numerous measures and is intended to be a central part of patient care, a "bridge between the hospital and the community," but what about training and, above all, the patient's place in the process?

PMID:41371816 | DOI:10.1016/j.revinf.2025.10.030

JMIR Form Res. 2025 Dec 10;9:e77319. doi: 10.2196/77319.

ABSTRACT

BACKGROUND: While digital health solutions are becoming increasingly sophisticated, simple forms of everyday digital support may offer underexplored opportunities to promote health among older adults. However, evidence remains scarce on whether such teleassistance-based approaches can effectively enhance health literacy and daily self-care, particularly among populations facing socioeconomic and educational disparities.

OBJECTIVE: This study examined whether a 14-week mobile teleassistance intervention could support daily health promotion and improve health literacy and quality of life among older adults, and whether different levels of user engagement were associated with differences in outcomes.

METHODS: This randomized digital pilot study involved 21 older adults (aged ≥60 years) from Ribeirão Preto, Brazil. All participants were assigned to the intervention arm and subsequently categorized into high-engagement (n=11) and low-engagement (n=10) subgroups according to platform-use metrics. The intervention combined weekly teleconsultations, gamified educational quizzes, and guided health-related activities delivered through a mobile app. Outcomes included health literacy (Health Literacy Questionnaire), quality of life (36-Item Short-Form Health Survey), physical activity, and sedentary behavior, assessed at baseline and postintervention. Analyses appropriate for small samples were applied, including frequentist and Bayesian models.

RESULTS: Participants in the high-engagement subgroup showed greater improvements in health literacy compared with those in the low-engagement subgroup (mean change +9.5 vs +9.1 points; time × group: P<.001; Bayes Factors [BF₁₀]=15). Significant interactions also favored higher engagement for selected quality-of-life domains: vitality (P≤.001), functional capacity (P=.02), and general health (P=.02). A group effect was observed for the mental component (P<.001). Physical activity (F2,38=0.95; P=.39; BF_incl=0.68) and sedentary behavior (F1,19=1.12; P=.32; BF_incl=0.53) did not differ significantly between subgroups. Engagement analytics confirmed higher overall platform use in the high-engagement subgroup (mean 6483.8, SD 807.0 vs mean 3345.3, SD 742.7; t19=6.238; P<.001; d=2.73) and more weekly health-activity minutes (mean 5124.3, SD 757.9 vs mean 3120.7, SD 704.3; t19=6.256; P<.001; d=2.73).

CONCLUSIONS: This 14-week randomized digital pilot trial suggests that everyday digital teleassistance may enhance health literacy and specific quality-of-life domains among older adults when engagement is high. However, such support alone appears insufficient to modify physical activity or sedentary behavior in the short term. Larger and longer trials are needed to assess sustainability, scalability, and strategies to address structural inequalities in digital health adoption.

PMID:41370788 | DOI:10.2196/77319

Rev Bras Enferm. 2025 Dec 8;78(5):e20250032. doi: 10.1590/0034-7167-2025-0032. eCollection 2025.

ABSTRACT

OBJECTIVES: to report the experience of telehealth in monitoring healthcare in the context of supplementary health.

METHODS: an experience report developed in telehealth service in supplementary health for the years 2022 to 2024.

RESULTS: Information and Communication Technologies have expanded the provision of care, access to health through telehealth, patients seeking care provided by nurses, and professionals' job satisfaction. The use of care protocols and digital technologies has enabled the construction of indicators and dashboards for care management. Challenges encountered were connection problems, lack of skills with digital technologies, lack of training and literacy in digital health, and lack of understanding of the role of nurses by patients, other services, and professionals.

FINAL CONSIDERATIONS: telehealth contributes to healthcare qualification, highlighting digital health as a powerful field of action for nurses.

PMID:41370458 | DOI:10.1590/0034-7167-2025-0032

JBRA Assist Reprod. 2025 Dec 10;29(4):562-564. doi: 10.5935/1518-0557.20250172.

ABSTRACT

The prevalence of infertility is rising rapidly, affecting approximately one in every six individuals worldwide and impacting nearly 200 million people. Access to assisted reproductive technologies (ART) remains limited, as most countries fail to provide adequate ART services to those in need. Economic barriers are among the most significant obstacles to ART access. However, treatment costs rarely account for additional expenses such as transportation, accommodation, or lost work hours required for clinic visits, including consultations, monitoring exams, and procedures. These overlooked costs further increase the financial burden on patients. To mitigate geographical barriers, telehealth and remote monitoring technologies have emerged as promising solutions. Studies indicate that telehealth, when combined with remote ultrasound monitoring performed by local gynecologists, yields clinical outcomes comparable to traditional in-clinic monitoring, with high patient satisfaction. The development of remote ultrasound devices aims to enhance ART accessibility for patients facing logistical constraints. Research has demonstrated that these devices are non-inferior to conventional monitoring, providing similar oocyte and embryo outcomes while offering additional benefits such as increased patient autonomy, discretion, reduced stress, and lower costs. A survey of 146 Brazilian infertility patients assessed their acceptance of the remote ultrasound device, revealing that 88.3% were willing to conduct ultrasounds at home, provided that the image quality and diagnostic accuracy were comparable to those of clinic-based examinations. While infertility patients appear receptive to remote fertility care, concerns persist regarding the efficiency and reliability of remote monitoring. Therefore, identifying the most suitable patient profile for this approach is essential, with those already familiar with ART processes potentially being the most appropriate candidates.

PMID:41370413 | DOI:10.5935/1518-0557.20250172

J Telemed Telecare. 2025 Dec 10:1357633X251389690. doi: 10.1177/1357633X251389690. Online ahead of print.

ABSTRACT

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

PMID:41370063 | DOI:10.1177/1357633X251389690

Aging Clin Exp Res. 2025 Dec 10. doi: 10.1007/s40520-025-03279-y. Online ahead of print.

ABSTRACT

The progressive aging of the Italian population and the increasing prevalence of multimorbidity and frailty call for a reorganization of health and social care services. In this paper we aim to critically examine Ministerial Decree 77/2022, within Mission 6 of the National Recovery and Resilience Plan, which establishes new models and standards for community-based care and offers an unique opportunity to deliver care that is closer to people's homes, fostering a holistic approach that combines clinical expertise, social support, and technological innovation. The reform places Community Houses and Health Districts at the core of integration between hospitals, general practitioners, and social services. The care of frail older adults relies on population stratification through validated tools, such as the Primary Care Frailty Index (PC-FI), and on the development of individualized care plans that integrate multidisciplinary interventions. Although general practitioners remain central in the health care system, geriatricians may play a pivotal role in multidimensional assessment, pharmacological management, health promotion, and the coordination of care teams. Telemedicine and digital tools support continuity of care and ensure traceability of clinical processes. Indicators of accessibility, equity, appropriateness, acceptability, and effectiveness are proposed, including the use of Patient-Reported Outcome and Experience Measures proposed for the evaluation of its impact. The reform's success will depend on overcoming methodological and operational barriers, reducing regional disparities, and ensuring that clinical expertise, social support, and technological innovation deliver measurable benefits for frail older adults.

PMID:41369843 | DOI:10.1007/s40520-025-03279-y

HIV Res Clin Pract. 2025 Dec 31;26(1):2588009. doi: 10.1080/25787489.2025.2588009. Epub 2025 Dec 9.

ABSTRACT

INTRODUCTION: Despite youth representing a large proportion of incident human immunodeficiency virus (HIV) infections in the United States, uptake and retention of youth on pre-exposure prophylaxis (PrEP) remain low. This study evaluated the feasibility and effectiveness of a telehealth model for youth PrEP (TelePrEP) among individuals assigned male at birth at risk for HIV in Colorado.

METHODS: A mixed-methods pilot feasibility trial of telehealth-delivered PrEP services was conducted between January 2023 and December 2024. Youths 14-24 years of age eligible for PrEP using oral tenofovir alafenamide and emtricitabine (F/TAF) were enrolled in a prospective type 1 hybrid effectiveness implementation study. The primary effectiveness outcome was retention, defined as having either a PrEP visit or a PrEP prescription refill 12 months after study enrollment (+/- three months). Additional youth 18-24 years and PrEP providers were recruited for interviews or focus groups to explore implementation determinants such as youth PrEP and service model preferences, facilitators, and barriers. Rapid qualitative analysis was employed to summarize qualitative findings.

RESULTS: Among 44 eligible survey respondents, 21 enrolled in the study, with a median age of 22 years (interquartile range (IQR) 21-24). Eleven (52.4%) of the 21 participants initiated PrEP, and five (23.8%, 95% confidence interval 19.5%-43.3%) were retained per the study definition at 12 months. PrEP persistence (time to first discontinuation) was a median of 33 weeks (IQR 21-57). TelePrEP usage, assessed by the percentage of participants having at least 2 telehealth visits, was ten (47.6%) out of 21 enrolled participants and ten (90.1%) out of 11 participants who initiated PrEP. Qualitative findings among youth were favorable to the study recruitment approaches, including social media use, primary care providers referrals and youth-serving organizations, and community events. Both youth and PrEP providers support a TelePrEP care model.

CONCLUSIONS: PrEP uptake and retention remain challenging for youth at risk for HIV. Further tailoring of PrEP models of care is needed to achieve risk reduction goals for youth.

PMID:41368725 | DOI:10.1080/25787489.2025.2588009

J Multidiscip Healthc. 2025 Dec 2;18:7797-7810. doi: 10.2147/JMDH.S548884. eCollection 2025.

ABSTRACT

BACKGROUND: The global opioid crisis has prompted healthcare systems to implement opioid stewardship programs (OSPs) aimed at optimizing prescribing practices and mitigating harm. Multidisciplinary teams (MDTs) are increasingly recognized as central to the success of these programs, yet their roles, structures, and implementation across clinical contexts remain poorly defined.

OBJECTIVE: This scoping review explores the composition, functions, and contextual application of MDTs within OSPs. It aims to map the professional roles, describe the interventions deployed, examine reported outcomes, and identify implementation barriers and facilitators across healthcare settings.

METHODS: Following the Joanna Briggs Institute framework and PRISMA-ScR guidelines, a systematic search of PubMed was conducted to identify studies involving MDT-led opioid stewardship interventions. Studies were eligible if they described multidisciplinary collaboration in opioid prescribing, pain management, or harm-reduction efforts. Data were extracted on team composition, interventions, outcomes, and contextual factors, and synthesized narratively.

RESULTS: Thirteen studies published between 2017 and 2023 were included. Most were U.S.-based and employed descriptive or observational designs across varied settings, including hospitals, primary care, rural clinics, and telemedicine platforms. Core MDT members included physicians, pharmacists, and nurses, with frequent contributions from addiction specialists, psychologists, and social workers. Common interventions included opioid-sparing protocols, individualized tapering plans, naloxone co-prescribing, and interprofessional education. Reported outcomes included reductions in opioid prescribing, improved adherence to safety protocols, and enhanced provider confidence. Implementation challenges included limited staffing, fragmented communication, and patient resistance, while facilitators included standardized workflows, institutional support, and integrated electronic health systems.

CONCLUSION: MDTs play a critical role in operationalizing opioid stewardship across diverse clinical environments. Their effectiveness depends not only on professional composition but also on systemic support for collaboration, training, and workflow integration. Future research should evaluate the comparative impact of MDT configurations using standardized outcome measures and expand to non-US and resource-limited settings.

PMID:41368440 | PMC:PMC12682565 | DOI:10.2147/JMDH.S548884

Transl Androl Urol. 2025 Nov 30;14(11):3653-3663. doi: 10.21037/tau-2025-497. Epub 2025 Nov 24.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic created a paradigm shift in healthcare delivery with rapid utilization of telehealth in urology. Despite cessation of pandemic policies, urologists continue to utilize telehealth at a high rate. While these visits can improve access and convenience for many, the degree to which they translate to in person encounters remains underexplored. This study aimed to evaluate features associated with in-person encounters following a virtual visit within our urology department.

METHODS: Telehealth visits in our department with a new or consult billing code between January 2022 and December 2023 were retrospectively identified. The primary outcome was follow-up for an in-person appointment within 90 days. Secondary outcome was the number of surgical procedures. Multivariable logistic regression was used to model associations between patient features and subsequent in-person care, using benign prostatic hyperplasia (BPH) as the referent category for visit diagnosis.

RESULTS: We identified 1,079 video visits, of whom 598 (55%) sought in-person care within 90 days. Following multivariable adjustment, patients living over 150 miles away [adjusted odds ratio (adjOR) 0.56, 95% confidence interval (CI): 0.41-0.78] and prostate cancer visits (adjOR 0.40, 95% CI: 0.30-0.65) were less likely to follow-up in-person. Among returning patients, 413 (69%) underwent urological surgery within 90 days. After multivariable adjustment, kidney cancer (adjOR 0.41, 95% CI: 0.23-0.72), elevated prostate-specific antigen (PSA) (adjOR 0.36, 95% CI: 0.23-0.56), and prostate cancer (adjOR 0.32, 95% CI: 0.22-0.47) were significantly less likely to pursue surgery than BPH visits.

CONCLUSIONS: Patients with a shorter travel distance and those being seen for a vasectomy were more likely to pursue in-person care within 90 days after a telehealth visit than those seen for oncologic indications. These findings may be useful to other urology departments seeking to efficiently integrate virtual visits in resource-constrained environments.

PMID:41368244 | PMC:PMC12683433 | DOI:10.21037/tau-2025-497

BMC Health Serv Res. 2025 Dec 10. doi: 10.1186/s12913-025-13874-4. Online ahead of print.

NO ABSTRACT

PMID:41366671 | DOI:10.1186/s12913-025-13874-4