Artif Intell Med. 2025 Nov 11;171:103303. doi: 10.1016/j.artmed.2025.103303. Online ahead of print.

ABSTRACT

Electrohysterography (EHG) represents a promising computational approach for non-invasive monitoring of uterine activity during pregnancy and labor. This review summarizes the advancements in signal processing techniques and machine learning algorithms that have been applied to enhance the utility of EHG. Key topics include the extraction and analysis of uterine electrical signals, classification of contractions, and prediction of obstetric outcomes such as preterm and labor/non-labor states. The review emphasizes computational methodologies for signal processing and extraction, including empirical mode decomposition or wavelet transform, and for data classification, such as neural networks or support vector machine, highlighting their performance and limitations. Despite significant progress, challenges persist, such as the lack of standardized protocols, limited datasets, and inconsistent evaluation and annotation metrics, which hinder broader clinical adoption. The integration of additional clinical markers, simultaneous monitoring of maternal and fetal health, and the development of wearable systems for telemedicine present exciting opportunities for future research.

PMID:41240468 | DOI:10.1016/j.artmed.2025.103303

BMC Health Serv Res. 2025 Nov 14;25(1):1469. doi: 10.1186/s12913-025-13583-y.

ABSTRACT

BACKGROUND: Cancer incidence and mortality in Canada have improved greatly over recent decades, but these improvements have not been equally distributed across all populations. This environmental scan synthesizes evidence from the real-world implementation of three interventions identified to improve access to cancer care for underserved populations-patient navigation, eHealth, and education and counselling-targeting healthcare access disparities in Alberta. It aims to inform local improvements in cancer care access and healthcare access more broadly, while offering insights for other regions in Canada and internationally with similar health equity challenges.

METHODS: A comprehensive electronic database search was conducted to identify academic and grey literature from January 2013 to March 2024. Data on initiatives (context, setting, target population, modality, and lessons learned) were extracted, coded thematically, and, where relevant, mapped to the Consolidated Framework for Implementation Research to support synthesis.

RESULTS: Twenty-one initiatives involving patient navigation, 17 utilizing eHealth, and 7 inclusive of education and counselling were identified. Multimodal approaches were commonly used across interventions, enhancing flexibility and accessibility. Most initiatives were urban based, suggesting a gap in rural access. Virtual programming has recently expanded, potentially enhancing reach, while education and counselling initiatives remain limited.

CONCLUSIONS: Three key lessons applicable to initiatives which aim to address disparities in cancer care were identified. These lessons emphasize the importance of simplifying implementation, securing leadership and stakeholders' support, and fostering partnerships and collaboration for program success.

PMID:41239470 | DOI:10.1186/s12913-025-13583-y

Neurol Res Pract. 2025 Nov 14;7(1):89. doi: 10.1186/s42466-025-00448-2.

ABSTRACT

BACKGROUND AND AIMS: Stroke remains a leading cause of mortality and disability in many low- and middle-income countries, where access to diagnostic and treatment resources is often severely constrained. This pilot study investigated the feasibility of telemedicine-based training to integrate carotid artery ultrasound and Holter monitoring into routine diagnostic practices at the stroke unit of the University Teaching Hospital (UTH) in Lusaka, Zambia.

METHODS: Five neurology residents at the University Teaching Hospital in Zambia, without prior clinical experience in carotid artery ultrasound, received remote online training sessions. Subsequently, they were divided into two groups: the first conducted practical examination sessions under on-site supervision of a stroke neurologist, while the second was remotely supervised via screen sharing by a stroke neurologist from Krankenhaus Nordwest in Frankfurt (KHNW), Germany. Handheld portable ultrasound probes (Butterfly IQ+) were used for the examinations. Following the training, each group of residents performed 50 extracranial ultrasound examinations in acute ischemic stroke patients at the UTH stroke unit. Each examined patient was re-examined in a separate session by an experienced stroke neurologist, who was blinded to the results of the residents' examination. The agreement between raters in the assessment of carotid stenosis was assessed using Cohen's kappa (κ), a statistical measure that evaluates interrater reliability for categorical items. Similarly, 26 stroke nurses at UTH were trained in Holter monitoring exclusively through video tutorials, without hands-on practice. They recorded 30 Holter examinations on subsequent acute ischemic stroke patients. The quality of the recordings was subsequently compared to 30 Holter recordings from consecutive patients at the stroke unit of KHNW. A cardiologist, blinded to the origin of the recordings, evaluated their quality on a scale of 1 to 10, and the results were analyzed using Welch's t-test. All participants completed multiple-choice assessments to evaluate their theoretical knowledge, along with a feedback survey on the training program.

RESULTS: 50 patients underwent bilateral carotid artery ultrasound examination, split evenly between the direct and remotely supervised groups. Both groups achieved a high rate of concordance with an experienced stroke neurologist. The directly supervised group achieved 86% concordance for ICA stenosis and 88% for plaque detection, while the remotely supervised group achieved 80% and 84%, respectively. Holter recordings from UTH demonstrated higher quality than those from the stroke unit at KHNW (p < 0.01). Most participants reported enhanced confidence and knowledge, though over 60% preferred face-to-face training formats.

CONCLUSION: Innovative telemedical training approaches offer a transformative solution for addressing diagnostic and infrastructure challenges in stroke care, particularly in resource-constrained healthcare settings. Comprehensive research is crucial to optimize these programs and enhance medical capabilities across diverse healthcare environments.

PMID:41239430 | DOI:10.1186/s42466-025-00448-2

BMC Public Health. 2025 Nov 14;25(1):3954. doi: 10.1186/s12889-025-25241-3.

ABSTRACT

BACKGROUND: Immigrant populations face numerous barriers to accessing evidence-based diabetes interventions. Mobile health (mHealth) interventions are increasingly being used to support individuals in managing diabetes. This review aims to synthesize the available evidence on mHealth interventions specifically designed for immigrant populations with diabetes.

METHODS: An integrative review was conducted following Whittemore and Knafl's methodology. Studies from the inception of PubMed, Web of Science, Cochrane Library, CINAHL Ultimate, Embase, and APA PsycInfo up to July 2024 were searched. The Mixed Methods Appraisal Tool was used to assess the quality of the included studies. A constant comparison strategy was employed for data analysis.

RESULTS: A total of seven studies met the inclusion criteria for this review, including five randomized controlled trials (RCTs: two fully powered RCTs and three pilot RCTs) and two pre-post single-arm pilot studies. All studies were conducted in the United States. The mHealth interventions were tailored to Korean, Chinese, Marshallese, Latinx, and South Asian immigrants. The sample sizes varied from 17 to 250. Evidence from the included studies is primarily limited by statistical power due to their pilot designs and small sample sizes. Despite this limitation, all studies demonstrated high feasibility and acceptability of mHealth interventions for diabetes management among these immigrant groups. Participants also reported high levels of satisfaction with mHealth interventions. The included studies consistently reported significant improvements in a range of health, psychosocial, and behavioral outcomes within the intervention groups, including hemoglobin A1C levels, body weight, blood glucose, total cholesterol, triglycerides, low-/high-density lipoprotein levels, and blood pressure; and self-efficacy, mental health status, diabetes knowledge, and quality of life; as well as physical activity, self-management, and dietary behaviors. However, when compared to control groups, the reported effectiveness of mHealth interventions on these outcomes was inconsistent.

CONCLUSIONS: This review demonstrates the feasibility and acceptability of mHealth interventions for diabetes management among within immigrant populations. The findings suggest that these interventions may serve as a viable strategy to improve health, psychosocial, and behavioral outcomes. Future RCTs with larger sample sizes are needed to provide more robust evidence of the effectiveness of mHealth interventions. Importantly, this review highlights the scarcity of mHealth-related studies focused on immigrant populations with diabetes and calls for more research to examine how to best support this underserved group.

PMID:41239283 | DOI:10.1186/s12889-025-25241-3

Support Care Cancer. 2025 Nov 14;33(12):1062. doi: 10.1007/s00520-025-10113-8.

ABSTRACT

PURPOSE: The aim of this prospective cohort study was to compare the identification of complications through telehealth versus face-to-face appointments following breast cancer surgery. Client satisfaction and acceptance of each appointment mode were also examined.

METHODS: Fifty-three participants with a diagnosis of breast cancer were recruited from a breast surgery pre-admission clinic and attended two modes of assessment: video telehealth and face-to-face. The assessments were 2-7 days apart, 16-34 days post-surgery. Complications related to an increased risk of lymphoedema were assessed by a lymphoedema physiotherapist or occupational therapist as present or not: wound healing and infection, shoulder range of motion, cording, upper limb or breast swelling, and pain. Participants completed an online satisfaction survey after each appointment. Observed agreement and Gwet's AC1 coefficients were used to examine the agreement in complication identification between assessment modes. An a priori agreement coefficient of ≥ 80% was deemed clinically acceptable.

RESULTS: Agreement between telehealth and face-to-face appointments met the criteria for acceptability for wound healing, infection, and shoulder range of motion. However, swelling (AC1 coefficient 0.59, 95%CI 0.36-0.82), cording (0.71, 95%CI 0.51-0.90), and pain (0.79, 95%CI 0.63-0.95) did not meet the criteria. Eighty-nine percent (n = 39/44) of participants agreed they would use telehealth again, while 67% (n = 34/51) of participants preferred the face-to-face appointment over the telehealth appointment.

CONCLUSION: Agreement levels for identifying swelling, cording, and pain via telehealth were deemed not acceptable. Improved questioning and screening practices are required to improve the detection of complications during telehealth appointments. This will ensure the accessibility of effective post-operative complication screening for all people post breast cancer surgery.

PMID:41239022 | DOI:10.1007/s00520-025-10113-8

Sci Rep. 2025 Nov 14;15(1):40008. doi: 10.1038/s41598-025-23582-y.

ABSTRACT

Efficient compression of medical images is vital for telemedicine and cloud-based healthcare, where bandwidth and storage constraints pose significant challenges. Conventional lossless approaches provide limited compression, whereas lossy techniques risk compromising diagnostic accuracy. To address these limitations, we introduce a novel hybrid compression framework that combines Discrete Wavelet Transform (DWT) with a deep Cross-Attention Learning (CAL) module to preserve clinically relevant details while reducing redundant information. The proposed pipeline first decomposes input images into multi-resolution sub-bands via DWT, followed by a CAL-driven encoder that emphasizes high-information regions through dynamic feature weighting. A lightweight Variational Autoencoder (VAE) refines feature representation prior to entropy coding for final compression. Extensive experiments on benchmark datasets, including LIDC-IDRI, LUNA16, and MosMed, demonstrate that our approach achieves superior performance in terms of PSNR, SSIM, and MSE compared to state-of-the-art codecs such as JPEG2000 and BPG. These results highlight the method's potential for real-time medical image transmission and long-term storage without sacrificing diagnostic integrity.

PMID:41238565 | DOI:10.1038/s41598-025-23582-y

BJGP Open. 2025 Nov 14:BJGPO.2025.0075. doi: 10.3399/BJGPO.2025.0075. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic necessitated significant adaptations for General Practitioner (GP) practices, affecting healthcare services and workload. The mixed-methods study VeCo-Praxis was designed to investigate these changes, focusing on non-COVID-related services in three German regions. This article is based on a qualitative interview study with GPs and Medical Practice Assistants (MPAs).

AIM: To explore the perspectives of GPs and MPAs regarding their work and role during the pandemic and what conclusions they draw for GP care in the aftermath of the pandemic.

DESIGN & SETTING: A qualitative study with 15 GPs and 15 MPAs from three federal German states (August 2022 - September 2023).

METHOD: We conducted semi-structured telephone interviews and performed thematic analysis by Braun and Clarke.

RESULTS: In this article, we focus on three key aspects: 1) the evolving role of GPs and MPAs as central healthcare coordinators, 2) frustrations stemming from inadequate collaboration with specialists, health authorities, and hospitals, and 3) conclusions and outlook for the aftermath of the pandemic. GPs reported an increased sense of responsibility but also greater exhaustion, while MPAs felt undervalued, particularly in comparison to hospital nurses. While telemedicine was helpful, both groups criticised the administrative workload, the lack of timely communication from authorities and the lack of support with pandemic-related tasks to ensure general patient care.

CONCLUSION: As lessons learnt from the pandemic, GPs and MPAs must be adequately supported in their roles, interdisciplinary collaboration must be improved, and information flows and administrative processes must be more efficient to assure better pandemic-preparedness.

PMID:41238379 | DOI:10.3399/BJGPO.2025.0075

Otol Neurotol. 2025 Nov 13. doi: 10.1097/MAO.0000000000004720. Online ahead of print.

ABSTRACT

OBJECTIVE: The Complete Cochlear Implant Care (CCIC) model is a highly coordinated care delivery model reducing and condensing in-person visits for cochlear implant (CI) patients, leveraging telehealth and remote programming. Clinical, quality-of-life, implementation, patient experience, and financial outcomes of the clinical trial are reported.

STUDY DESIGN: Prospective, nonrandomized, 2-arm clinical trial.

SETTING: Tertiary referral CI center.

PATIENTS: Adult CI candidates.

INTERVENTIONS: Cochlear implantation.

MAIN OUTCOME MEASURES: Speech perception, quality of life, implementation, patient experience, and financial outcomes for both CCIC and traditional care delivery models.

RESULTS: Patients participating in the traditional and CCIC delivery models demonstrated 12-month postoperative speech perception scores comparable to nationally reported outcomes (CNC 61% and 72% and AzBio in quiet 75% and 87% for traditional and CCIC cohorts, respectively). Quality-of-life evaluation using the CIQOL-10 demonstrated similar 12-month postoperative scores between groups (52 and 54 for traditional and CCIC cohorts, respectively). The CI Patient Experience Survey demonstrated high satisfaction outcomes in ease of communication, preparedness for surgery, and overall care in both cohorts. Implementation analysis of the CCIC model revealed perceived benefits from staff and clinicians; however, support for expansion of the program was contingent upon the availability of app-based or web-based remote programming technology. Finally, financial analysis revealed decreased out-of-pocket costs for CCIC patients.

CONCLUSION: The CCIC model has the potential to dramatically streamline hearing health care delivery and reduce out-of-pocket costs for CI recipients. Clinical outcomes between cohorts were comparable in this feasibility study; however, a sufficiently powered trial is required to definitively comment on clinical outcomes with the new care delivery model.

PMID:41236091 | DOI:10.1097/MAO.0000000000004720

J Am Geriatr Soc. 2025 Nov 14. doi: 10.1111/jgs.70203. Online ahead of print.

ABSTRACT

BACKGROUND: As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.

METHODS: We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.

RESULTS: In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (-24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.

CONCLUSIONS: Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.

PMID:41236038 | DOI:10.1111/jgs.70203

J Am Acad Dermatol. 2025 Oct 24:S0190-9622(25)03065-8. doi: 10.1016/j.jaad.2025.10.070. Online ahead of print.

NO ABSTRACT

PMID:41235987 | DOI:10.1016/j.jaad.2025.10.070