Urol Pract. 2025 Jul 10:101097UPJ0000000000000872. doi: 10.1097/UPJ.0000000000000872. Online ahead of print.

ABSTRACT

INTRODUCTION: Adherence to clinical practice guidelines. for non-muscle invasive bladder cancer (NMIBC) remains suboptimal We aimed to develop an electronic health record (EHR)-integrated intervention to improve compliance with clinical guidelines for the management of NMIBC.

METHODS: We designed an EHR-integrated intervention within the Epic EHR (Epic Systems, Verona, WI) based on the American Urological Association's (AUA) NMIBC pathways. Our multidisciplinary group created four pathways for the clinical management of NMIBC: Evaluation and Staging, Low and Intermediate Risk, High and Very High Risk, and Persistent or Recurrent Disease. Adoption was encouraged through a communication strategy including newsletters, site visits, and CME-accredited meetings.

RESULTS: From October 2021 to May 2024, the Care Pathway was used 412 times across various encounter types, including procedural, office-based, and telemedicine visits, involving 253 patients (mean age: 70 years). Self-pay (84; 33.2%) and Medicare (66; 26.1%) were the most common payer type. Sixty-eight providers used the pathway, most commonly by MDs (38; 55.9%) and RNs (14; 20.6%). The pathway was used primarily in the urology specialty (28; 41.8%), but utilization also occurred in the primary care setting. The initial staging and treatment of low and intermediate risk pathway was the most used CarePathway (150; 36.4%).

CONCLUSIONS: The EHR-integrated intervention was designed to improve adherence to AUA NMIBC guidelines across diverse clinical scenarios and was adopted by providers with varying expertise. This pathway could improve standardized care delivery and reduce practice variability in NMIBC management. Further evaluation of its long-term impact on clinical outcomes is warranted.

PMID:40637707 | DOI:10.1097/UPJ.0000000000000872

JACC Cardiovasc Imaging. 2025 Jun 26:S1936-878X(25)00263-3. doi: 10.1016/j.jcmg.2025.03.016. Online ahead of print.

ABSTRACT

BACKGROUND: Limited contemporary evidence exists on risk prediction by stress imaging and exercise electrocardiography (ECG) among patients with chronic coronary syndromes (CCS). Objectives From the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) study, prognosis was examined by core laboratory-defined stress imaging and exercise ECG findings in CCS patients.

METHODS: A total of 5,179 patients (qualifying by stress nuclear imaging [n = 2,567], echocardiography [n = 1,085], cardiac magnetic resonance [CMR] [n = 257], and ECG [n = 1,270]) were randomized. Cox models assessed associations between trial endpoints and the number of scarred and ischemic segments, rest/stress left ventricular ejection fraction (LVEF), and ST-segment depression. HRs and 95% CIs were calculated per millimeter, segment, or 5% of LVEF. We examined prognostic models for the following trial endpoints: 1) the trial's primary endpoint of cardiovascular (CV) death, myocardial infarction (MI), resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure; 2) CV death; 3) spontaneous MI; 4) procedural MI; and 5) type 2 MI.

RESULTS: The number of scarred segments (HR: 1.07 [95% CI: 1.02-1.13]; P = 0.0209), rest LVEF (HR: 0.88 [95% CI: 0.83-0.93]; P < 0.001), and stress LVEF (HR: 0.87 [95% CI: 0.83-0.91]; P < 0.001) predicted the trial's primary endpoint of CV death, MI, resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure. The extent of scar and rest/stress LVEF on echocardiography and nuclear imaging predicted several trial endpoints. The number of ischemic segments predicted spontaneous (HR: 1.08 [95% CI: 1.03-1.14]; P = 0.0104) and procedural MI (HR: 1.14 [95% CI: 1.03-1.25]; P = 0.0015) but was of borderline significance for the trial's primary endpoint (P = 0.0746). Ischemia extent by CMR predicted the trial's primary endpoint (P = 0.0068) and spontaneous MI (P = 0.0042).

CONCLUSIONS: ISCHEMIA trial findings from 320 worldwide centers revealed that stress imaging and exercise ECG measures exhibited a variable association with key trial endpoints delineating risk patterns for ischemia and infarction. Stress CMR ischemia predicted several trial endpoints, supporting an expanded role in the evaluation of patients with CCS (ISCHEMIA [International Study of Comparative Health Effectiveness With Medical and Invasive Approaches]; NCT01471522).

PMID:40637654 | DOI:10.1016/j.jcmg.2025.03.016

Telemed J E Health. 2025 Jul 10. doi: 10.1089/tmj.2025.0078. Online ahead of print.

ABSTRACT

Introduction: Telemedicine research in France remains relatively underexplored, with a notable absence of comprehensive literature reviews or bibliometric analyses guiding research prioritization and funding allocation for public health interests. The objective of this study is to provide a comprehensive overview of telehealth research in France, elucidating its current trends and primary funding sources. Methods: A bibliometric analysis was conducted spanning a 20-year period from January 1, 2004, to December 31, 2023, using six open-access databases, including the Ministry of Health of France (public research funding), Health Data Hub (research protocols from France), Clinicaltrials.gov (global repository of research protocols), PubMed (scientific publications), Theses.fr (PhD database in France), and DUMAS (master's and doctorate theses database in France). Results: The French Ministry of Health funded 41 telehealth research projects between 2009 and 2022, amounting to €15 million, which constituted 1.1% of all projects funded during this period. 279 study protocols were identified on ClinicalTrials.gov, peaking in 2021 with 58 protocols (20.8%), representing 5.8% of worldwide protocols. Public hospitals provided most of the funding (66%), with 18% coming from the industry. A total of 1,254 publications related to telehealth were identified in PubMed, representing 2.5% of worldwide telehealth publications. Discussions: This is the first study in France and Europe to describe the trends in telehealth research over a 20-year period. Telehealth research in France started in the early 2000s, had a linear growth between 2011 and 2021, peaked during the COVID-19 pandemic, and decreased in 2022 and 2023. All types of telehealth interactions were covered, and funding came mostly from public sources. Funding for telehealth research was however limited and should be increased in France.

PMID:40637602 | DOI:10.1089/tmj.2025.0078

Laryngoscope. 2025 Jul 10. doi: 10.1002/lary.32425. Online ahead of print.

ABSTRACT

This case report describes "tele-flexible laryngoscopy," a novel telemedicine approach for rural emergency departments (EDs) without otolaryngology coverage. A 60-year-old male with progressive voice changes and dyspnea underwent flexible laryngoscopy by an emergency physician, with video captured via smartphone and reviewed asynchronously by an otolaryngologist. This method eliminated the need for patient transfer, demonstrating its potential to improve rural access to specialty care and highlighting the need for further research on training and standardization.

PMID:40637487 | DOI:10.1002/lary.32425

Cochrane Database Syst Rev. 2025 Jul 10;7:CD015968. doi: 10.1002/14651858.CD015968.

ABSTRACT

BACKGROUND: Childhood obesity is a worldwide public health problem that increases the risk of chronic diseases. In 2016, more than 340 million children and adolescents aged 5 to 19 years were living with overweight or obesity.

OBJECTIVES: To assess the effects and safety of interventions using digital technology - that is, interventions applied to achieve health objectives implemented within any digital application, communication, or system - for the integrated management of obesity in children and adolescents. Specifically, to assess the effects of digital interventions in the management of obesity in children and adolescents when used: - in combination with conventional care compared to conventional care alone; and - alone compared to conventional care alone.

SEARCH METHODS: We searched CENTRAL, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and two major trials registers to identify the studies included in this review. The date of the last search was 14 April 2025. We did not apply any language restrictions.

SELECTION CRITERIA: We included randomized controlled trials conducted in children (0 to 9 years old) and adolescents (10 to 19 years old) living with obesity, as defined by World Health Organization (WHO) Growth References. We included trials using the following digital health interventions for managing obesity: 'wearable' or implantable devices, web-based interventions, text messages, mobile phone or tablet applications, 'exergaming' or active video gaming, and telehealth. Participants in the comparison groups received conventional care or an intervention without a digital/technological component.

DATA COLLECTION AND ANALYSIS: Working independently, two review authors extracted data, assessed the studies' risk of bias using Cochrane's original risk of bias tool, and evaluated the certainty of the evidence using GRADE criteria. The following outcomes were extracted: anthropometry (body mass index [BMI], weight, skinfolds, waist-to-hip ratio, waist circumference), adiposity, physical activity, physical and mental well-being, quality of life, blood pressure, adverse events associated with the interventions, presence of obesity co-existing complications, obesity-associated disability, hyperinsulinemia, insulin resistance, glycemia, lipid metabolism or adipogenesis, lipid hormones, alterations in hunger or satiety, reduced disability in any of the functionality domains, mortality, prevalence of obesity in adulthood, and access to health services.

MAIN RESULTS: We included 15 studies involving 911 participants, conducted in the USA (five studies), Sweden (three studies), and one each in Canada, China, Ireland, Italy, South Korea, Switzerland, and Thailand. All studies involved participants aged 10 to 19 years old, with 10 exclusively focusing on this age group. Five studies also included younger children (0 to 9 years). Eight studies included both diet and physical activity components, four studies included only a physical activity component, and three included only a diet component. We classified nine studies as short duration (< six months) and six as long duration (six or more months). Nine trials did not specify the theoretical basis of their intervention. We grouped the studies into two comparisons: (1) digital health technology plus conventional care versus conventional care alone; and (2) digital technology alone versus conventional care alone. Digital interventions combined with conventional care versus conventional care alone (8 studies) Digital interventions led to a slightly lower, but clinically meaningful, fat mass at the end of the study (mean difference -2.63%, 95% confidence interval -4.47 to -0.78; 3 studies, 203 participants; moderate-certainty evidence). The effect of digital interventions plus conventional care on other important outcomes reported was unclear. No studies reported adverse event data. Digital interventions alone compared to conventional care alone (7 studies) The effect of digital interventions alone on any of the outcomes reported was unclear. No studies reported adverse event data.

AUTHORS' CONCLUSIONS: Digital interventions plus conventional care may have a small, short-term beneficial effect on fat mass in children and adolescents compared to conventional care alone. The effect on other outcome measures is unclear. The long-term clinical benefit in children and adolescents is difficult to assess due to the limited number of studies with relatively small sample sizes included in this review. Future studies should: report their results by age, gender, and race/ethnicity; report full data to better enable data extraction and analysis; assess other important outcomes, particularly adverse events; control for both diet and physical activity in their analyses; and report the behavioral theory informing their intervention.

PMID:40637164 | DOI:10.1002/14651858.CD015968

Clin Exp Dermatol. 2025 Jul 10:llaf300. doi: 10.1093/ced/llaf300. Online ahead of print.

ABSTRACT

BACKGROUND: Postgraduate medical education is vital for addressing global health disparities, particularly in low- and middle-income countries (LMICs). Dermatology residency training programmes in Ethiopia commenced in 2006 to address a critical shortage of specialists and improve access to care for skin-related conditions, including neglected tropical diseases (NTDs). This study explores the progress, achievements, and challenges of Ethiopia's dermatology residency programs.

OBJECTIVES: To evaluate the development, outcomes, and lessons learned from dermatology residency training in Ethiopia, offering insights for scaling specialist training programs in (LMICs.

METHODS: A mixed-methods approach was employed, combining quantitative analysis of training outputs and regional distribution of dermatologists with qualitative key informant interviews. Data were collected through an online survey involving members from the Ethiopian Dermatovenerology Society. Semi-structured Interviews were conducted with senior dermatologists involved in program development initiation. Thematic content analysis was performed to identify barriers, facilitators, and recommendations for program sustainability.

RESULTS: Between 2008 and 2023, Ethiopia trained 194 dermatologists across five institutions. The annual output increased 600% from six to 31 specialists trained each year. 71% of dermatologists in the country work full time in public sector and 45.5% are involved in academic institutions. However, 60% of dermatologists remain concentrated in the urban areas. Key facilitators included the Addis Ababa University commitment in expanding postgraduate education, partnerships with All Africa Leprosy Rehabilitation and Training Center (ALERT) Hospital and full government sponsorship. Challenges included limited infrastructure, shortages in subspecialty training, and an urban-centric workforce distribution. Interviewees highlighted the importance of thorough nationally coordinated planning and commitment to address these barriers.

CONCLUSIONS: Ethiopia's dermatology training programs have significantly strengthened the specialist workforce, but inequities in service distribution and gaps in training capacity remain. Strategies to enhance rural service incentives, expand subspecialty training, and integrate telemedicine are critical for improving healthcare equity. Lessons from Ethiopia's experience underscore the value of Ministry of Health local leadership and ownership in post graduate program expansion.

PMID:40635122 | DOI:10.1093/ced/llaf300

Biopsychosoc Med. 2025 Jul 9;19(1):11. doi: 10.1186/s13030-025-00333-z.

ABSTRACT

BACKGROUND: The prolonged COVID-19 pandemic has significantly affected the clinical care and the mental health of patients in psychosomatic medicine. Between late 2021 and early 2022, the Japanese Society of Psychosomatic Medicine (JSPM) and the Japanese Society of Psychosomatic Internal Medicine (JSPIM) conducted a nationwide physician survey to assess these effects. The survey identified difficulties in outpatient and inpatient care, increased use of telemedicine, and rises in patient numbers and symptom severity. Due to inconsistent findings in prior studies on long-term mental health effects of the pandemic, a follow-up survey was needed.

METHODS: This study is the one-year follow-up survey conducted by JSPM and JSPIM. A cross-sectional, web-based survey was conducted among physicians of the two societies from December 21, 2022, to February 14, 2023. The questionnaire examined trends in outpatient and inpatient care, telemedicine use, and changes in the mental health of patients with psychosomatic disorders, eating disorders, adjustment disorders, mood disorders, and anxiety disorders. Descriptive statistical analyses were performed.

RESULTS: A total of 251 physicians responded. While outpatient numbers showed partial recovery, 28% of the respondents reported persistent declines compared to pre-pandemic levels. Telemedicine remained in use at 62% of their institutions, but 70% of the respondents reported difficulties in symptom assessment. Compared to the previous year, more respondents reported an increase in the number of patients across all surveyed disorders. Regarding the psychosocial factors that affected patients, fear of infection was the predominant factor for anxiety disorders, as in the previous survey, whereas restrictions on daily and social activities were the most influential for psychosomatic disorders, mood disorders, and adjustment disorders.

CONCLUSIONS: The COVID-19 pandemic has had a lasting effect on patients receiving psychosomatic treatment. Outpatient numbers are gradually recovering, and telemedicine has contributed to the continuity of care. However, concerns about patient assessment in telemedicine persist. The impact of the prolonged pandemic on mental health appears to have evolved, with shifts in the psychosocial factors that influence different aspects of mental health deterioration. Future studies that incorporate clinical data will provide valuable insights into the long-term consequences of the pandemic and help guide future clinical practice.

PMID:40635104 | DOI:10.1186/s13030-025-00333-z

BMC Health Serv Res. 2025 Jul 9;25(1):944. doi: 10.1186/s12913-025-12977-2.

ABSTRACT

BACKGROUND: The future of digital health holds enormous potential to improve communication with patients and optimize the delivery of care. The current study aims to answer the central question of which knowledge, skills, and competencies in the use of Information and Communication Technologies (ICT), health professionals should develop to promote efficient remote communication processes with patients.

METHODS: A mixed-method approach was used for data collection, combining an online survey with semi-structured interviews. The study was structured into four key phases/question groups: professional context, practices related to the use of ICT in patient communication, training needs, and other relevant information. Qualitative data from open-ended responses were analysed using thematic analysis and triangulated with quantitative findings where applicable. The target population consisted of nursing professionals with patient care experience. The survey was distributed electronically, with 194 nurses fully or partially completing the questionnaire. Additionally, 24 interviews were conducted.

RESULTS: The data shows that around 25.85% of professionals do not establish distance communication and 95.4% do not use telehealth. Telephone and cellular contact are the most used means of communication with patients (62.60%). Despite the predominance of face-to-face care, 62.5% stated that they do not experience difficulties or concerns, recognizing ICT as an increasingly integrated and advantageous tool for remote communication. Most professionals (80.1%) believe that there should be more training and courses in digital communication with patients and the use of ICT in healthcare, to address gaps in academic training. The growth of telemedicine and the digitalization of healthcare services reinforce the need for continuous professional training in this area.

CONCLUSIONS: Most professionals have a positive perception of the opportunities created by emerging technologies, but they also express concerns about the ethical, social, safety and technical challenges that need to be addressed. The introduction of mandatory ICT courses in academic education and the implementation of continuous training are essential to prepare professionals for the challenges of telehealth and digital communication in healthcare. They emphasize the need for a well-structured digital transition, ensuring that technologies complement healthcare rather than replace human care.

PMID:40634957 | DOI:10.1186/s12913-025-12977-2

J Gen Intern Med. 2025 Jul 9. doi: 10.1007/s11606-025-09708-y. Online ahead of print.

ABSTRACT

IMPORTANCE: Unhealthy alcohol use is commonly identified in primary care, yet most patients do not receive any treatment services. Pharmacists can complement the work of primary care physicians (PCPs), but it is unknown whether they increase patient access to services for alcohol use problems.

OBJECTIVE: To examine implementation outcomes of a primary care-based, pharmacist-delivered service for patients with unhealthy alcohol use.

DESIGN: A pragmatic, cluster-randomized trial conducted in a large healthcare system between 9/1/2021 and 8/31/2023.

SETTING: Primary care clinics block-randomized by facility to an intervention arm (N = 8) or Usual Care (N = 8).

PARTICIPANTS: Primary care providers (204 intervention arm, 132 Usual Care arm) from study clinics.

INTERVENTION: Alcohol Telemedicine Consultation (ATC), involving telephone contact, assessment, motivational enhancement, and specialty referral facilitation.

MAIN OUTCOMES AND MEASURES: Prescriptions for an FDA-approved alcohol use disorder (AUD) medication and referrals to specialty treatment for individuals (age 18 +) who screened positive for unhealthy alcohol use or received an AUD diagnosis between 9/1/2021 and 8/31/2023 summarized by arm.

RESULTS: Bivariate: Collectively, ATC arm providers made 161 referrals to ATC in year 1 and 126 referrals in year 2. Usual Care arm providers made more referrals to specialty treatment (mean (SE) 3.14 (0.28) vs. 2.34 (0.20) in year 1 and 3.24 (0.27) vs.2.43 (0.21) in year 2). Multivariable: Multivariable analyses using zero-inflated Poisson models adjusting for provider characteristics showed that ATC-arm providers prescribed 66% more AUD medications (RR = 1.66, p = 0.001) and made 15% more referrals to specialty treatment (RR = 1.15, p = 0.049) in year 2 compared to Usual Care.

CONCLUSIONS AND RELEVANCE: Referral to ATC may offer an effective approach for improving treatment utilization by increasing pharmacotherapy in primary care, but providers may need training boosters over time.

TRIAL REGISTRATION: ClinicalTrials.gov # 1564446.

PMID:40634649 | DOI:10.1007/s11606-025-09708-y

JMIR Form Res. 2025 Jul 9;9:e73807. doi: 10.2196/73807.

ABSTRACT

BACKGROUND: Unhealthy lifestyle behaviors have been identified as a major cause of numerous health issues, with a steady global increase in their prevalence. Addressing this challenge requires comprehensive behavioral changes to promote the adoption of a sustainable healthier lifestyle. However, despite the prevalent need, cost-effective and successful digital coaching for health-related behavior change remains scarce.

OBJECTIVE: This study aimed to present a holistic framework for designing, modeling, and executing behavior change strategies through a multiagent reasoning system that selected optimal digital coaching techniques based on individual assessments and integrated data-driven decision-making.

METHODS: Behavioral change theories have been explored to design a multiagent system aimed at achieving sustainable lifestyle changes. This system selected behavior change techniques based on individual user assessments, prioritizing those with the strongest impact on key behavioral components. The framework incorporated evidence-based practices stemming from behavioral change science and integrated them into Healthentia's behavioral change coaching scheme. Healthentia, a certified software as a medical device, implemented this framework in its non-medical modules that aim for lifestyle behavioral change and wellbeing specifically for chronic disease management, serving as an eHealth solution that advances decentralized care by enabling remote monitoring, data-driven content selection, and personalized digital coaching that adjusts to patient progress and engagement patterns.

RESULTS: This study explored the application of the Healthentia behavioral change coaching scheme in patients with type 2 diabetes. Behavioral attributes have been evaluated in 9 patients, yielding notable results in terms of fasting glucose dropping by an average of -17.3 mg/dL (Cohen d=1.5; P=.002), further underscored by a narrow 95% CI (-26.1 to -8.43), and in terms of weight and BMI, with mean reductions of -2.89 kg and -1.05 kg/m², respectively. These changes yielded large effect sizes (Cohen d approximately 1.05) and were statistically significant (P=.01). The positive outcomes were at least partly attributed to the personalized delivery of content, 71.66% (1125/1570) of which was well received by the patients.

CONCLUSIONS: Our study of this multiagent system, which was tested through simulated patient behavior and preliminary, limited behavior observations of patients with type 2 diabetes, promises improved health outcomes using personalized digital coaching strategies. Future directions include optimizing the multiagent selection process; further exploring the type 2 diabetes program; conducting an in-depth evaluation of its results, including glycated hemoglobin measurements; and expanding its applications to other chronic conditions.

PMID:40633923 | DOI:10.2196/73807