Search Results (74)

Background/Objectives: The rapid expansion of telemedicine has reshaped healthcare delivery, positioning telenursing as essential for continuity of care and patient management. This scoping review maps current evidence on telecare nursing practices, examining organizational models, professional roles, and key clinical and organizational outcomes. Methods: The review was conducted across five international databases, following the methodological framework proposed by Arksey and O’Malley, the interpretive extension by Levac et al., and the Joanna Briggs Institute guidelines, with reporting aligned to PRISMA-ScR recommendations. The search identified 1760 records, of which 1219 remained after duplicate removal. After title and abstract screening and full-text evaluation, 25 studies met the inclusion criteria. Results: Telenursing was implemented across diverse clinical contexts, particularly in chronic disease management, oncology, postoperative care, and emergency settings. Evidence indicates improvements in symptom management, therapeutic adherence, quality of life, and complication reduction, suggesting positive clinical and organizational impacts. The literature highlights the need for advanced digital, communication, and relational competencies, emphasizing the importance of targeted professional training. Cross-cutting trends include enhanced continuity of care, greater patient autonomy, improved integration between hospital and community services, and reduced healthcare costs. Conclusions: This review provides an updated overview of telenursing applications, highlighting their adaptability across clinical settings and the expanding strategic role of nurses in digital care. The findings indicate a rapidly evolving field and emphasize the need for further research to strengthen organizational frameworks, define advanced competencies, and support the sustainable integration of telenursing into healthcare systems. Full article

Background: Home-based digital healthcare interventions are increasingly used to support people living with dementia (PLWD) and their family caregivers. However, evidence regarding their effectiveness across patient and caregiver outcomes remains heterogeneous. Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261302166). Six databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Scopus) were searched from January 2000 to October 2025. Randomized and quasi-experimental quantitative studies evaluating home-based or remotely delivered digital interventions for PLWD and/or informal caregivers were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively. Results: Fourteen studies met the inclusion criteria. Interventions included web-based psychoeducation, telecoaching, digital cognitive training, assistive technologies, and multicomponent programs. Caregiver outcomes demonstrated the most consistent benefits, including reduced burden and stress, improved self-efficacy, and improved sleep efficiency in technology-supported trials. For PLWD, small-to-moderate improvements were observed in global cognition and selected neuropsychiatric symptoms, particularly in interactive and personalized programs. Multicomponent interventions combining caregiver education with patient activation and professional feedback showed more durable effects. Conclusions: Home-based digital interventions appear feasible and beneficial, particularly for caregiver outcomes. Future large-scale trials with longer follow-up and standardized outcome measures are needed to confirm durability, equity, and cost-effectiveness. Full article

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice. Full article

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020–2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition. Full article

The COVID-19 pandemic has profoundly amplified burnout and moral injury among nurses, exposing structural vulnerabilities in healthcare systems and accelerating workforce attrition. Beyond the acute crisis, nurses continue to face chronic staff shortages, overwhelming workloads, and unresolved ethical tensions that compromise both well-being and quality of care. Synthesis of recent meta-analyses in this review indicates that nurse burnout during the pandemic ranged between 30% and 50%, illustrating the magnitude of the problem. Particular attention is given to innovative organizational strategies that foster resilience, including workload redistribution, enhanced professional autonomy, supportive leadership, and the integration of digital technologies such as telecare. Comparative perspectives across healthcare systems illustrate how policy reforms, staffing models, and ethical frameworks can mitigate psychological distress and strengthen organizational resilience. By reframing burnout and moral injury not only as individual challenges but as systemic phenomena requiring structural solutions, this review emphasizes the imperative of multilevel interventions. Building resilient nursing workforces through innovation, leadership, and evidence-based policies is essential for sustaining high-quality patient care in the post-pandemic era. Full article

This study presents an algorithm for non-invasive blood pressure (BP) estimation in neonates using photoplethysmography (PPG), suitable for resource-constrained neonatal telecare platforms. Using the Windkessel model, the algorithm processes PPG signals from a MAX 30102 sensor, (Analog Devices (formerly Maxim Integrated), based in San Jose, CA, USA) filtering motion noise and extracting cardiac cycle time and systolic time (ST). These parameters inform a derived blood flow signal, the input for the Windkessel model. Calibration utilizes average parameters based on the newborn’s post-conceptional age, weight, and gestational age. Performance was validated against readings from a standard non-invasive BP cuff at SES Hospital Universitario de Caldas. Two parameter estimation methods were evaluated. The first yielded root mean square errors (RMSEs) of 24.14 mmHg for systolic and 19.13 mmHg for diastolic BP. The second method significantly improved accuracy, achieving RMSEs of 2.31 mmHg and 5.13 mmHg, respectively. The successful adaptation of the Windkessel model to single PPG signals allows for BP calculation alongside other physiological variables within the telecare program. A device analysis was conducted to determine the appropriate device based on computational capacity, availability of programming tools, and ease of integration within an Internet of Things environment. This study paves the way for future research that focuses on parameter variations due to cardiovascular changes in newborns during their first month of life. Full article

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

As populations age globally, governments face mounting challenges in reconfiguring healthcare and housing systems to support aging-in-place. This study offers a comparative analysis of South Korea and the United Kingdom, examining how each country integrates digital technologies, such as Artificial Intelligence (AI), telecare, and smart housing systems, into their aging strategies. South Korea employs a centralized, technology-driven approach that prioritizes the national rollout of AI-enabled smart homes and digital health infrastructure. In contrast, the UK advances a decentralized, community-based model emphasizing social housing, localized care delivery, and telecare integration. Despite these differing trajectories, both nations face shared limitations, including high implementation costs, digital literacy barriers, and concerns about data privacy. Critically, the study finds that the success of aging-in-place efforts is shaped not only by technological capacity but also by governance dynamics, political continuity, and institutional coordination. In response, the paper proposes policy recommendations alongside an ethical framework grounded in transparency, autonomy, informed consent, and equity. Sustainable aging-in-place strategies require not only innovative technologies, but also inclusive governance and ethically robust design to ensure accessibility, trust, and long-term impact. Full article

Background: People with cerebral palsy (CP) present with limitations in gait and functionality, with a great impact on participation. Physiotherapy interventions based on goal-directed training (GDT), treadmill gait training (TGT), and action observation treatment (AOT) showed to be effective for improving functionality, gait and balance in children and adolescents with CP. On the other hand, since COVID-19 lockdown, telecare has an increased role in physiotherapy interventions. The aim of this randomized controlled trial (RTC) is to analyze the effectiveness of a multimodal intervention that combines face-to-face PT sessions of GDT and TGT and online PT sessions of a family-centered education program, which includes AOT activities and is effective to improve participation, gross motor function, gait and balance in children and adolescents with CP. Methods: A single-blinded RCT is proposed for 48 children and adolescents with CP (6–17 years old) who will be randomly allocated into two groups: the experimental group will receive six weeks of a multimodal PT intervention with 12 face-to-face sessions (GDT and TGT) and 6 online sessions of a family-centered telecare EP, which includes AOT activities. Participants in the control group will carry on with their regular PT treatment plus the EP as the experimental group. The outcome variables of participation (CAPE); gait speed and endurance (10 mm/6 mm); gross motor function (GMFM-88-SP); and dynamic and static balance (PBS) will be collected at baseline, after group interventions and 12 weeks from baseline and will be compared following standard principles for RCTs. Conclusions: The implementation of a multimodal PT intervention that combines face-to-face sessions of GDT and TGT and online sessions of a family-centered EP, which includes AOT activities, may be effective to improve participation, gross motor function, gait and balance in children and adolescents with CP. Trial registration: ClinicalTrials.gov with ID: NCT04778930. Full article

(1) Left ventricular assist device (LVAD) implantation is increasingly used as a treatment option for patients with advanced heart failure (HF). There is a need to provide patients with LVAD with long-term care, preferably at home. The implementation of home-based telerehabilitation (HTR) and telecare offers new opportunities in this field. Purpose: The purpose of this study was to assess the feasibility and safety of HTR and telecare in HF patients with implanted LVAD and evaluate patients’ acceptance of and adherence to HTR. (2) The study enrolled 30 HF patients with recently implanted LVAD (21 Heart Mate III, 9 Heart Ware) (29 males, mean 59 years) who underwent a 12-week telecare and HTR program based on walking, respiratory, and resistance training, five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recordings and to transmit data via a mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise. The influence on physical capacity was assessed by comparing changes in peak oxygen consumption (pVO₂; [mL/kg/min]) and workload duration (t; [s]) during the cardiopulmonary exercise test. (3) HTR resulted in a significant physical capacity improvement in pVO₂ 12.5 ± 2.9 vs. 15.1 ± 3.0 (p < 0.001), and workload duration t 628 ± 204 vs. 728 ± 222 (p < 0.001) during the cardiopulmonary exercise test. There were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the medical team. All patients completed HTR. (4) HTR is a feasible and safe form of rehabilitation that is well-accepted by patients. The adherence to HTCR was high. Full article

Background/Objectives: Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery. Methods: A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m² or a BMI ≥ 35 kg/m² with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions. Results and Conclusions: The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients. Full article

With the rapid development of information technology from one side and the experience of the COVID-19 pandemic from the other side, people presently prefer to access healthcare services remotely. Telecare Medical Information System (TMIS) provides more flexible, faster, and more convenient e-healthcare services available to all people, particularly those who lack access to physicians due to their geographical restrictions. However, due to the sensitivity of medical information, preventing unauthorized access to patient data and preserving patient privacy is crucial. In this paper, we propose an authenticated key agreement scheme for TMIS to preserve the privacy of the patient’s identity from all internal (even the health server and the physician) and external entities. Moreover, the physician’s identity is kept secret from all external entities. Formal and informal security analysis of the proposed scheme indicates that it is secure against all attacks in the context. Full article

Over the past few years, life expectancy has increased significantly. However, elderly individuals living independently often require assistance due to mobility issues, symptoms of dementia, or other health-related challenges. In these situations, high-quality elderly care systems for the aging population require innovative approaches to guarantee Quality of Service (QoS) and Quality of Experience (QoE). Traditional remote elderly care methods face several challenges, including high latency and poor service quality, which affect their transparency and stability. This paper proposes an Edge Computational Intelligence (ECI)-based haptic-driven ECI-TeleCaring system for the remote caring and monitoring of elderly people. It utilizes a Software-Defined Network (SDN) and Mobile Edge Computing (MEC) to reduce latency and enhance responsiveness. Dual Long Short-Term Memory (LSTM) models are deployed at the edge to enable real-time location-aware activity prediction to ensure QoS and QoE. The results from the simulation demonstrate that the proposed system is proficient in managing the transmission of data in real time without and with an activity recognition and location-aware model by communication latency under 2.5 ms (more than 60%) and from 11∼12 ms (60∼95%) for 10 to 1000 data packets, respectively. The results also show that the proposed system ensures a trade-off between the transparency and stability of the system from the QoS and QoE perspectives. Moreover, the proposed system serves as a testbed for implementing, investigating, and managing elder telecaring services for QoS/QoE provisioning. It facilitates real-time monitoring of the deployed technological parameters along with network delay and packet loss, and it oversees data exchange between the master domain (human operator) and slave domain (telerobot). Full article

This article reviews technological advances and global trends in the diagnosis, treatment, and monitoring of cardiovascular diseases. A bibliometric analysis was conducted using the SCOPUS database, following PRISMA-ScR guidelines, to identify relevant publications on technologies applied in the diagnosis and treatment of cardiovascular diseases. An increase in scientific output since 2018 was observed, reflecting a growing interest in the technologies available for the treatment of cardiovascular diseases, with terms such as “telemedicine”, “artificial intelligence”, “image analysis”, and “cardiovascular disease” standing out as some of the most commonly used terms in reference to CVDs. Significant trends were identified, such as the use of artificial intelligence in precision medicine and machine learning algorithms to analyse data and predict cardiovascular risk, as well as advances in image analysis and 3D printing. Highlighting the role of artificial intelligence in the diagnosis and continuous monitoring of cardiovascular diseases, showing its potential to improve prognosis and reduce the incidence of acute cardiovascular events, this study presents the integration of traditional cardiology methods with digital health technologies—through a transdisciplinary approach—as a new direction in cardiovascular health, emphasising individualised care and improved clinical outcomes. These advances have great potential to impact healthcare, and as this field expands, it is crucial to understand the current research landscape and direction in order to take advantage of each technological advancement for improving the diagnosis, treatment, and quality of life of cardiovascular patients. It is concluded that the integration of these technologies into clinical practice has important implications for public health. Early detection and personalised treatment of cardiovascular diseases (CVDs) can significantly reduce the morbidity and mortality associated with these diseases. In addition, the optimisation of public health resources through telemedicine and telecare can improve access to quality care. The implementation of these technologies can be a crucial step towards reducing the global burden of cardiovascular diseases. Full article

In the context of the detection and evolutionary control of Alzheimer’s disease from voice recordings and their automatic processing, this work aims to objectively determine the discriminatory capacity of a set of voice features linked to the emotional load of speech. We use descriptive statistics derived from the concept of emotional temperature as quantifiable characteristics of the voice. We apply a series of parametric and nonparametric analyses to the set of features, both individually and collectively, and explore their potential in relation to the use of different methods of unsupervised classification. With the aim of comparing how the type of interviewer used in the sample collection (i.e., voice recordings) influences the discrimination of AD through emotional speech analysis, we used the CSAP-19 database, which includes voice samples obtained through human interviewer (spontaneous speech samples) and automatic interviewer (induced speech samples) for the three defined populations (HC, mild AD, and moderate AD). In this regard, a comparative analysis is also conducted on the potential of emotional temperature features defined according to the sample collection process (manual or automatic interview process). Full article