Search Results (696)

The rapid proliferation of Internet of Things (IoT) technologies has transformed the modern home into a complex cyber–physical ecosystem encompassing hundreds of millions of connected devices globally. Smart homes support automation, energy management, and healthcare monitoring, but they also introduce a broad and evolving range of security and privacy challenges. This review examines 233 sources published between 2018 and May 2025, selected through a PRISMA-informed process covering five major academic databases and relevant standards and technical reports. It discusses communication protocols, including Matter, develops a Threat-Layer-Defense synthesis matrix covering ten attack categories; examines the practical limitations of AI-based anomaly detection and blockchain-based trust management; and derives recommendations for manufacturers, platform providers, users, and regulators. Privacy challenges, regulatory frameworks, and user behavior are considered alongside technical threats. The findings suggest that scalable smart home security requires coordinated progress in protocol standardization, enforceable device update lifecycles, gateway-level anomaly detection, and privacy-preserving local analytics rather than reliance on a single technical solution. Full article

Background/Objectives: Nutritional impairment is common across the cancer care continuum and may negatively affect treatment tolerance, functional status, quality of life, and caregiver burden. Digital tools may offer new opportunities to extend nutritional care beyond conventional clinical encounters, but their application in oncology remains heterogeneous and poorly defined. This narrative review aims to describe the current landscape of digital nutritional care in oncology, focusing on quality of life and patient perspectives while also considering the emerging role of caregivers. Methods: We conducted a narrative review of the available evidence on digital nutritional and lifestyle interventions in cancer care, including mobile applications, web-based platforms, teleconsultations, SMS- or email-based communication, remote monitoring systems, and hybrid models. Results: Digital nutritional and lifestyle interventions have been evaluated across active treatment, postoperative recovery, and survivorship. Available studies indicate that these interventions are generally feasible and may improve nutritional status, dietary behaviors, and physical activity levels. However, quality-of-life outcomes remain heterogeneous and have not been consistently assessed across studies. Some interventions combining digital tools with personalization, professional feedback, behavioral support, or clinically actionable monitoring reported favorable patient-centered outcomes. However, heterogeneity across studies limits the interpretation of these findings and the identification of specific intervention features associated with effectiveness. Patient and caregiver perspectives further highlight the importance of usability, trust, access to reliable information, communication with healthcare professionals, and practical support in the home setting. Conclusions: Digital nutritional care has the potential to extend and strengthen the delivery of nutritional care. Rather than replacing conventional interventions, it should be implemented through hybrid, supervised, equitable, and clinically integrated models. Future studies should consistently assess quality of life and other patient-reported outcomes while also addressing caregiver needs, digital burden, psychological safety, and inequalities in access. Full article

Background: Lung transplantation (LTx) is the final therapeutic option for patients with end-stage irreversible respiratory failure. Chronic lung allograft dysfunction (CLAD) remains a major determinant of long-term outcomes, but early detection of functional decline may enable timely intervention and partial reversibility. Therefore, systematic monitoring of graft function is essential, and telemedicine-based spirometry may facilitate early identification of clinically relevant decreases in lung function. Objective: The aim of our study was to evaluate the feasibility of spirometry telemonitoring (TM) and its association with healthcare utilisation in lung transplant patients. Methods: This retrospective study compared lung transplant recipients: the first group underwent spirometry TM (n = 21), the second group was monitored with standard home spirometry (HS) (n = 23), and the control group underwent routine follow-ups only at the transplant centre (n = 32). Results: In the TM spirometry group, mean adherence was 62.7%, with 4957 examinations performed over a mean monitoring period of 252 days; 59.7% of FEV1 and 58.9% of FVC measurements were technically acceptable. Compared with routine care (RC), TM spirometry was associated with a shorter mean duration of both combined planned and urgent admissions (5.8 vs. 10.0 days, p < 0.001) and urgent admissions analysed separately (14.7 vs. 26.2 days, p < 0.001). Conclusions: TM spirometry was feasible and associated with lower healthcare utilisation in lung transplant recipients, supporting its potential value for post-transplant surveillance. Larger prospective randomised studies are needed to confirm these preliminary findings. Full article

Background: Postoperative complications after staging surgery for endometrial cancer often occur after discharge, and 30-day unplanned readmission is an important post-discharge outcome. Existing models lack same-day usability at discharge and sufficient validation, limiting discharge-time risk stratification and transitional care planning. This study aimed to develop and validate a discharge-time risk prediction model based on administrative data for 30-day unplanned hospital readmission among patients undergoing staging surgery for endometrial cancer. Methods: This retrospective cohort study was conducted in accordance with the TRIPOD reporting guidelines. We constructed a nationally representative adult cohort using the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD) from 2016 to 2022, including index hospitalizations discharged between January and November to ensure complete 30-day follow-up. Variables available at discharge (demographics, payer/income, presentation, inpatient course, discharge disposition, hospital characteristics, Elixhauser index) were included; age and length of stay were modeled with restricted cubic splines. Complex survey-weighted multivariable logistic regression was used for model development with 1000 bootstrap internal validations. Temporal validation within the NRD was performed using 2020–2021 and 2022 data. Decision curve analysis, subgroup, and sensitivity analyses were conducted. Results: A total of 89,627 hospitalizations were included; development and validation cohorts had balanced baselines. Internal validation showed moderate discrimination (AUC 0.719) and good calibration (Brier 0.045; intercept 0.014; slope 0.955). Discharge to home health or institutional care, non-elective or emergency admission, and a higher Elixhauser readmission index (a measure of comorbidity burden) were associated with increased risk. Age and length of stay showed nonlinear associations. Temporal validation yielded a similar performance (AUC 0.708–0.713; Brier 0.043–0.046), and decision curves indicated positive net clinical benefit. Conclusions: The model demonstrated stable discrimination and maintained good calibration after temporal validation and recalibration. It represents a candidate discharge-time decision-support tool, based on administrative data, for identifying patients at higher risk of 30-day unplanned readmission, and may support nurse-led transitional care planning. External validation and local recalibration are required before application in other healthcare settings. Full article

Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) has long been established as a safe and cost-effective alternative to inpatient care in Western healthcare systems. In contrast, its implementation across Asia has historically been fragmented and unstructured. A landmark multinational survey in 2017 identified OPAT in Asia as a “missed opportunity,” citing the lack of systematic oversight, standardized protocols, and outcome monitoring systems. Methods: This narrative review examines the evolution of OPAT in Asia over the past decade, synthesizing evidence from regional studies, national policies, and implementation models. Results: The findings demonstrate a clear shift from ad hoc infusion practices toward structured, multidisciplinary OPAT programs in several healthcare systems. These systems increasingly integrate antimicrobial stewardship principles, dedicated care teams, and reimbursement mechanisms. In parallel, innovative models, including hospital-at-home services and elastomeric pump–based continuous infusion, have expanded treatment feasibility while enabling the use of narrower-spectrum antibiotics. Despite these advances, substantial heterogeneity persists. Key barriers include the absence of unified national guidelines, limited monitoring infrastructure, workforce constraints, and regulatory restrictions in certain settings. Resource-limited regions continue to face challenges related to financing, laboratory capacity, and digital health integration. Conclusions: Overall, OPAT in Asia is transitioning from an underrecognized and inconsistently delivered service to an increasingly structured component of infectious disease care. Future priorities include standardized governance, integration with antimicrobial stewardship programs, sustainable reimbursement, digital outcome monitoring, and region-specific evidence on antimicrobial stability and safety. Full article

Background/Objectives: Clinical documentation places a significant time burden on healthcare professionals, including in the context of home care. Large language models (LLMs) offer potential for automated note generation, but current approaches rely on static prompt templates that fail to generalize across care settings, languages, and documentation formats. This study proposes and evaluates an adaptive retrieval-augmented generation (RAG) framework that uses retrieval as a format adaptation mechanism, enabling the generation of structured clinical notes from patient–provider transcripts across various documentation formats without model fine-tuning. Methods: The proposed framework retrieves dialogue–note pairs that demonstrate the structure of specific sections, allowing the transfer of formatting knowledge during inference. Experiments were conducted on three datasets covering two languages and various documentation formats: the Japanese Visiting Nurse corpus (JP-VN), MTS-Dialog, and ACI-BENCH. Six controlled conditions were evaluated: zero-shot prompting (C1), static few-shot prompting (C2), dense retrieval (C3), random retrieval (C4), sparse BM25 retrieval (C5), and hybrid retrieval using reciprocal rank fusion (RRF) (C6). Performance metrics include structural adherence to required section headings, content quality (ROUGE-1, BLEU, BERTScore), and the number of hallucinated clinical entities per generated record. Results: Structure compliance increased from 0–37% under static conditions (C1/C2) to 91–100% under all adaptive RAG conditions (C3–C6) across all datasets. On MTS-Dialog, dense retrieval achieved the highest content quality (ROUGE-1: 0.519 vs. 0.446–0.492 for C4–C6; $p<0.001$). Hallucinated entities in JP-VN decreased from 2.73–3.58 per note (C1/C2) to 1.15–1.30 (C3–C6), an approximately 55–56% reduction. Conclusions: Adaptive RAG can improve structure compliance and reduce hallucinations in multilingual clinical note generation without dataset-specific prompt engineering or model fine-tuning. These findings support retrieval-based format adaptation as a generalizable mechanism for diverse clinical documentation contexts. Full article

Background: Teach-Back is a structured communication strategy increasingly used in patient education to enhance understanding and self-management, particularly among people with complex chronic conditions such as cardiovascular disease. Aim: To explore and map how Teach-Back has been applied in adults with cardiovascular disease and to describe outcomes assessed in the literature. Methods: A scoping review was conducted following the JBI Manual for Evidence Synthesis and the PRISMA-ScR checklist. MEDLINE/PubMed, CINAHL, Embase, and Scopus databases were searched up to January 2026. Studies involving adult patients with cardiovascular disease receiving Teach-Back–based interventions were included. Data were charted and synthesized descriptively, focusing on intervention characteristics, delivery contexts, and reported outcomes. Results: Eighteen studies were included, with heart failure being the most frequently investigated condition. Teach-Back was delivered across hospital, outpatient, and home-care settings, often as part of multicomponent educational or transitional-care interventions. Outcomes were grouped into five domains: knowledge and understanding, self-care and adherence, clinical outcomes, healthcare utilization, and patient-reported outcomes. Improvements were most consistently reported for knowledge, understanding, self-care, and adherence, whereas findings on readmissions and other clinical outcomes were less homogenous. Conclusions: Teach-Back appears particularly relevant for cardiovascular nursing practice at points of high-risk communication, including discharge, early post-discharge follow-up, and self-management reinforcement. As a low-resource strategy, it may support nurses in verifying patient understanding and reducing misinterpretation during care transitions. Future studies should standardize delivery, training, fidelity monitoring, documentation, and outcome measurement. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

Background/Objectives: A multivariable prediction model was developed and externally validated to estimate an individual’s current need to visit a dentist among young to middle-aged adults. The objective was to provide an accessible, non-invasive screening tool for independent home self-assessment or integration within routine healthcare workflows. Methods: A cross-sectional study utilised data from two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014). Logistic regression was applied to develop the prediction model among 1870 dentate adults aged 30–50, a critical onset period for oral diseases. The primary outcome was derived from objective oral examinations conducted by licensed dentists. The resulting questionnaire-based tool provides two recommendations: a visit to a dentist or continuation of routine oral care. Results: External validation using the independent NHANES 2013–2014 cohort (n = 2024) demonstrated robust and clinically relevant predictive capacity, with an AUC of 0.822 (95% CI 0.803–0.842). The model exhibited acceptable calibration (slope 0.85; intercept 0.04) and stable operation. Decision-curve analysis showed net benefit across thresholds; at Pt = 0.33, 14/100 unnecessary screenings were avoided compared with treat-all. Internal validation using a 10% hold-out partition (n = 184) supported these findings, indicating similarly strong discrimination (AUC 0.817, 95% CI 0.751–0.884). Conclusions: Early midlife is a consistent and informative period for oral health intervention. A scalable 14-predictor architecture using accessible indicators established high clinical utility, supporting integration into digital health and primary care. This approach enables efficient population-level prevention. Large-scale, nationally representative NHANES data allowed for the investigation of less-studied factors, including intermittent smoking, metabolic dysregulation, and elevated cholesterol levels. Full article

Background: Preterm infants remain vulnerable after discharge from the neonatal intensive care unit (NICU), yet the key components of effective hospital-to-home transitional care remain unclear. Objectives: This systematic review synthesized evidence on hospital-to-home transitional care models for preterm infants and identified intervention characteristics associated with post-discharge infant and parental outcomes. Methods: This PRISMA 2020-guided systematic review was registered in PROSPERO (CRD420251011887). The protocol was amended to remove the planned meta-analysis because of substantial heterogeneity. Searches were conducted in EBSCO-MEDLINE, Scopus, PubMed, and the Cochrane Library in March 2025 and updated in March 2026. Quantitative and mixed-method studies evaluating hospital-to-home transitional care for preterm infants were included. Findings were synthesized narratively using a SWiM-based approach. Results: Twenty-one studies were included, comprising 4142 study units across infants, parents/caregivers, or infant–parent dyads. Interventions were initiated during NICU admission, at discharge, or after discharge and commonly included discharge preparation, parental education, telehealth support, and care coordination. Several studies reported favorable outcomes related to infant growth, feeding, length of stay, readmission, healthcare utilization, and parental readiness or caregiving competence, although findings varied across intervention types, study designs, and outcome measures. Three non-comparative studies provided additional evidence on feasibility and acceptability. Conclusions: Hospital-to-home transitional care may benefit preterm infants and their families when delivered as a multicomponent, family-centered pathway extending beyond discharge. However, the evidence remains heterogeneous, and practice implications should be interpreted cautiously. Larger comparative studies using standardized infant-centered outcomes are needed, particularly in low- and middle-income settings. Full article

Background: Virtual reality (VR) is a promising technology for the relief of physical and psychosocial burdens. We found that individualised VR videos were well tolerated and accepted and seemed to have a stronger effect on well-being and emotional connection than standardised VR in cancer inpatients under palliative care. For implementation, it is important to actively involve patients, as their input helps to ensure that the VR intervention meets their needs, thus making it more likely to be accepted and effective in practice, while balancing the needs of healthcare professionals. Aim: Exploration of patients’ and healthcare professionals’ perspectives on best practice VR intervention implementation. Design: Workshop-based 360° focus group using a strengths–weaknesses–opportunities–threats (SWOT) model and deductive/inductive qualitative analysis with a ‘framework’ approach. Setting/participants: The focus group took place at the National Centre for Tumour Therapy of a German university hospital. Participants were a local doctor (1) and nurses (3) with VR experience, the cooperating patient advisory board of the study (2), and members of a regional self-help group (3). Results: Eighteen subthemes were identified in the SWOT model. While there was agreement on the ‘strength of distraction’ and ‘opportunities of individualised VR’, concerns remained regarding data protection when using private VR content. There was an argument about gatekeeping by relatives worried about mental distress in patients immersing in home or family VR scenes. In contrast, many ideas were discussed regarding how to overcome rejectionist staff attitudes. However, the high organisational time and staff deployment were addressed as major weaknesses. Conclusions: Involving patient stakeholders and healthcare professionals in the planning of the implementation strategy revealed several issues that require attention. In particular, information needs to be provided not only to patients but also to relatives and hospital staff, alongside ensuring data protection and adequate staffing. Trial registration: Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11 July 2023. Full article

Background: Long-term care facility (LTCF) residents are highly susceptible to healthcare-associated infections, and prevention is challenging given frailty, dementia, communal living, and resource constraints. Environmental surface and air contamination contribute to transmission. Novel no-touch automated disinfection technologies have been studied in hospitals, but evidence specific to LTCFs is scarce. This scoping review summarizes recent LTCF-focused interventions, their effectiveness, and implementation considerations. Methods: This scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched PubMed, Medline, Embase, CINAHL, and Scopus for observational or experimental studies evaluating environmental disinfection in LTCFs/nursing homes, excluding body decolonization, non-LTCF settings, and reviews/protocols. Two reviewers independently screened and extracted data via Covidence. This review has been registered on OSF (Open Science Framework). Results: Of 1491 records, 7 studies met the inclusion criteria (6 from the USA, 1 from Australia): one cluster randomized trial, one interrupted time series studies, three prospective observational studies, and two pre–post designs. Interventions included physical methods (HVAC-integrated UV/UVGI, continuous UVGI) and chemical approaches (dry hydrogen peroxide, room fogging plus chlorine dioxide wipes, hydrogen peroxide wipes). Outcomes were heterogeneous (surface SARS-CoV-2 RNA, COVID-19 attack/case rates, airborne/surface microbial loads, and one clinical endpoint—acute respiratory illness). Several studies reported reductions in environmental or airborne bioburden; however, UV-based studies did not demonstrate statistically significant reductions in clinical infections. Certainty was limited by small numbers, non-randomized designs, and diverse outcome measures. Conclusions: No-touch automated disinfection methods appear promising as supplements to standard infection prevention control bundles for reducing environmental contamination in LTCFs. Nevertheless, consistent clinical benefits are unproven. Rigorous, LTCF-tailored, adequately powered trials with standardized clinical and environmental outcomes, plus implementation and cost-effectiveness evaluations, are needed. Full article

Background/Objectives: Chronic diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) remain a major source of morbidity, healthcare utilization, and limb loss, despite adherence to established standards of care protocols and the widespread availability of advanced wound technologies. Many advanced modalities only target isolated aspects of wound healing and fail to address the complex, interdependent pathophysiology of chronic wounds, particularly tissue hypoxia, edema, impaired microcirculation, and persistent inflammation. Cyclical Pressurized Topical Wound Oxygen (TWO₂) therapy is a home-based, multimodal intervention that combines humidified topical oxygen delivery with cyclical non-contact compression to address these core drivers simultaneously. Methods: This review synthesizes mechanistic rationale and evidence from randomized controlled trials, long-term venous ulcer studies, and real-world comparative effectiveness analyses. Emphasis is placed on the large cohort study by Yellin et al., which directly compared TWO₂ with other advanced modalities including negative pressure wound therapy (NPWT), skin substitutes, and growth factor therapies. Results: Across these studies, TWO₂ therapy is consistently associated with improved healing durability, reduced recurrence, and substantial reductions in hospitalization and amputation rates compared with both standard care and advanced wound therapies. Conclusions: The convergence of randomized and real-world evidence supports TWO₂ therapy as a clinically meaningful and mechanism-driven adjunctive treatment option for patients with chronic, high-risk lower-extremity wounds. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article

Objectives: For patients with multiple myeloma (MM), an increasing proportion of treatment is now delivered at home. While this shift offers convenience and supports continuity of care, it also demands new ways to ensure patient safety outside the hospital. Although patients receiving home-based treatment are generally clinically stable, each administration still requires a pre-treatment safety assessment, traditionally performed by telephone. We aimed to evaluate whether digital patient-reported outcomes (PROs) could replace these calls to determine treatment readiness. Methods: This feasibility study included 30 patients (median age 76 years, 60% male). Prior to each scheduled treatment, patients completed a digital symptom questionnaire. An algorithm stratified patients according to treatment readiness. In total, 233 questionnaires were distributed and 179 completed (completion rate 77%). Healthcare professionals were blinded to PRO data during the study, and PRO-based assessments were compared with standard nurse-led telephone evaluations after study completion. Results: Digital PRO data reliably identified patients ready for treatment. The algorithm achieved a positive predictive value of 100%, indicating concordance between PRO-based readiness classification and clinical decisions. The negative predictive value was 19%, reflecting that most patients reporting symptoms were ultimately eligible for treatment. Overall, nearly 80% of routine pre-treatment telephone calls could safely be omitted without compromising patient safety. Conclusions: This study suggests that digital PRO-based symptom reporting may support a reduction in routine pre-treatment telephone assessments for selected patients with MM receiving daratumumab. The approach showed potential for streamlining clinical workflows while maintaining patient safety, although confirmatory studies are needed before implementation. Full article