Search Results (126)

Background and Objectives: Telemedicine has become an essential component of chronic Inflammatory Bowel Disease (IBD) care, yet the factors that shape patient satisfaction with remote consultations remain only partially understood. This study aimed to assess satisfaction with institutional telemedicine services among Italian patients with ulcerative colitis (UC) and Crohn’s disease (CD), and to identify sociodemographic, clinical and organisational predictors to inform more person-centred telehealth models. Materials and Methods: We conducted a prospective, multi-centre, cross-sectional study in three IBD units in northern, central and southern Italy between June and October 2024. Consecutive adult patients who had completed a scheduled, non-emergency telemedicine visit were invited within 24–48 h to complete an online questionnaire including the Italian Telemedicine Satisfaction Questionnaire (I-TSQ), sociodemographic items, IBD-related variables, and telemedicine process indicators (accessibility, technology usability, technical support, time saved). Data were analysed descriptively and with multivariable linear regression to determine independent predictors of satisfaction, adjusting for recruiting centre. Results: A total of 705 patients participated (54.9% UC; 55.3% disease duration > 10 years). Overall, telemedicine satisfaction was high (mean I-TSQ total 57.5 ± 4.9; range 35–70), and all respondents reported reduced indirect costs compared with in-person visits. Greater ease of technology use, more frequent contact with the care team, male sex, older age, and employment were independently associated with higher satisfaction scores. Conversely, first-ever teleconsultations, CD, subcutaneous therapies, more difficult platform access, and the need for technical support were linked to lower satisfaction. Model fit was modest (R² up to 0.20), suggesting the presence of additional unmeasured relational and contextual factors. Conclusions: Telemedicine for IBD is widely accepted in Italy, but satisfaction is strongly conditioned by digital usability, previous experience, and clinical complexity. Tailored telehealth pathways that incorporate user-friendly platforms, proactive technical support, and attention to vulnerable subgroups are needed to translate high satisfaction into sustained, equitable remote care. Full article

Background/Objectives: Teledermatology has transformed access to dermatologic care, yet its association with melanoma prognostic parameters and diagnostic pathways in tertiary settings remains incompletely characterized. To compare the clinicopathologic profile of melanomas diagnosed under face-to-face consultation (2019) versus teledermatology-based referral (teleconsultation) (2022). Methods: A retrospective observational study comparing two patient cohorts: those diagnosed with melanoma via in-person consultation in 2019, and those diagnosed through teleconsultation in 2022. These years were selected to reflect the structural shift in care delivery models before and after the COVID-19 pandemic, during which teledermatology was formally implemented. Sociodemographic, clinical, and histopathological variables were collected. A multivariable logistic regression model assessed variables associated with being diagnosed in the 2022 teledermatology cohort versus the 2019 face-to-face cohort. Statistical analyses were performed using R (v. 4.4.3). Results: A total of 151 patients were included (89 in-person in 2019, 62 via teleconsultation in 2022). Multivariable analysis identified three variables independently associated with being diagnosed via teleconsultation. Increasing Breslow thickness was inversely associated with teleconsultation diagnosis (OR 0.60 per 1 mm increase; 95% CI 0.40–0.91; p= 0.017). Similarly, the presence of histologic regression (OR 0.28; 95% CI 0.09–0.90; p = 0.032) and immunosuppression (OR 0.08; 95% CI 0.008–0.86; p = 0.037) were inversely associated with teleconsultation diagnosis. No significant associations were found for sex, age, tumor location, ulceration, mitosis, or clinical stage. Conclusions: In this retrospective single-center comparison of two care models, melanomas diagnosed through teleconsultation in 2022 were associated with a more favorable clinicopathologic profile at diagnosis than those diagnosed via face-to-face consultation in 2019. These findings support the role of teledermatology-based referral pathways in facilitating timely melanoma assessment, although causal inference is limited by the observational design. Full article

Background: The management of hard-to-heal wounds poses a major clinical challenge due to heterogeneous etiology and significant global healthcare costs (estimated at USD 148.64 billion in 2022). Large Language Models (LLMs), such as ChatGPT and Gemini, are emerging as potential decision-support tools. This study aimed to rigorously assess the accuracy and reliability of ChatGPT and Gemini in the visual description and initial therapeutic management of complex wounds based solely on clinical images. Methods: Twenty clinical images of complex wounds from diverse etiologies were independently analyzed by ChatGPT (version dated 15 October 2025) and Gemini (version dated 15 October 2025). The models were queried using two standardized, concise prompts. The AI responses were compared against a clinical gold standard established by the unanimous consensus of an expert panel of three plastic surgeons. Results: Statistical analysis showed no significant difference in overall performance between the two models and the expert consensus. Gemini achieved a slightly higher percentage of perfect agreement in management recommendations (75.0% vs. 60.0% for ChatGPT). Both LLMs demonstrated high proficiency in identifying the etiology of vascular lesions and recognizing critical “red flags,” such as signs of ischemia requiring urgent vascular assessment. Noted divergences included Gemini’s greater suspicion of potential neoplastic etiology and the models’ shared error in suggesting Negative Pressure Wound Therapy (NPWT) in a case potentially contraindicated by severe infection. Conclusions: LLMs, particularly ChatGPT and Gemini, demonstrate significant potential as decision-support systems and educational tools in wound care, offering rapid diagnosis and standardized initial management, especially in non-specialist settings. Instances of divergence in systemic treatments or in atypical presentations highlight the limitations of relying on image-based reasoning alone. Ultimately, LLMs serve as powerful, scalable assets that, under professional supervision, can enhance diagnostic speed and improve care pathways. Full article

Using advanced communication and information technologies, teleconsultation can provide high-quality healthcare services to remote areas. To enhance service efficiency, this study develops a two-level dynamic scheduling model for teleconsultation, which prioritizes optimizing service frequency and incorporates downstream room utilization and overtime risk as considerations. The first-level model is a data-driven framework that optimizes the frequency by adjusting service start times. Based on the solutions of the first-level model, a second-level model is built to assign teleconsultation rooms to departments with demands and reduce the total overtime risk and and room opening cost. For solving, an integer programming (IP) solver is embedded in a deep reinforcement learning (DRL) approach. A presorting mechanism of interval constraints is proposed to improve the quality of solutions. For verification, actual teleconsultation data are used as samples. The experimental results demonstrate the effectiveness of the proposed two-level model, the embedded solving algorithm, and the interval constraint presorting mechanism. Compared with real schedules, the two-level model can reduce four service scheduling performance criteria, including demand average waiting time, number of services, risk of overtime, and number of rooms used. As a result, the efficiency of teleconsultation is improved to promote its development. Full article

Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, compelling rapid adaptation of clinical workflows and accelerating the integration of telemedicine. Objective: This study evaluates the implementation of telemedicine in neurosurgical outpatient care at a tertiary referral hospital in Madrid during the first epidemic wave (March–May 2020) and explores its long-term significance five years later. Methods: A retrospective observational analysis including 5175 neurosurgical outpatient consultations was conducted, comparing the first epidemic wave of COVID-19 (2070 teleconsultations) with the equivalent period in 2019 (3105 in-person visits). Demographic, clinical, and procedural data were analyzed, including six-month follow-up outcomes. Univariate and multivariate analyses were performed to identify factors associated with teleconsultation use and follow-up delay. Results: The total number of consultations decreased by 33% compared to the pre-pandemic year. In May 2020, teleconsultations represented more than 70% of all visits. Continuity of care was preserved (follow-up adherence >80%), and missed appointments declined to zero. Cranial and oncological pathologies were prioritized, while degenerative and benign cases were largely deferred. Teleconsultation independently predicted delayed six-month follow-up (aOR 1.9, 95% CI 1.3–2.8, p = 0.002) and a lower likelihood of surgical indication (aOR 0.4, 95% CI 0.2–0.7, p = 0.004). Despite these differences, remote care ensured accessibility, safety, and clinical continuity under extreme healthcare system strain. Five years perspective: In addition to these early outcomes, the study describes the sustained integration of telemedicine during the subsequent five years, illustrating how this model became permanently embedded in routine neurosurgical practice in this center. Conclusions: This study represents one of the earliest structured telemedicine experiences in Spanish neurosurgery. The rapid adaptation of the Hospital General Universitario Gregorio Marañón ensured care continuity during the pandemic and catalyzed the lasting adoption of hybrid models that enhance accessibility, safety, efficiency, and healthcare system resilience. Full article

Background: Chronic Brain Injury (CBI) is a lifelong condition requiring continuous adaptation by patients, families, and healthcare professionals. Transitioning rehabilitation toward patient-centered and self-management approaches is essential, yet remains limited in Spain. Methods: We conducted a two-phase consensus study in collaboration with the Spanish Society of Physical Medicine and Rehabilitation (SERMEF) and the Spanish Federation of Brain Injury (FEDACE). In Phase 1, surveys were distributed to patients (214 invited; 95 complete responses, 44.4%) and physiatrists (256 invited; 106 valid responses, 41.4%) to capture perceptions of current rehabilitation practices, including tele-rehabilitation. Differences and convergences between groups were analyzed using a Synthetic Factor (F). In Phase 2, a panel of 21 experts applied a real-time eDelphi process (SmartDelphi) to assess the feasibility of proposed innovations, rated on a six-point Likert scale. Results: Patients and professionals showed both alignment and divergence in their views. Patients reported lower involvement of rehabilitation teams and expressed more reluctance toward replacing in-person care with telemedicine. However, both groups endorsed hybrid models and emphasized the importance of improved communication tools. Expert consensus prioritized feasible interventions such as online orthopedic renewal services, hybrid care models, and educational video resources, while less feasible options included informal communication platforms (e.g., WhatsApp) and bidirectional teleconsultations. Recommendations were consolidated into five domains: (R1) systemic involvement of rehabilitation teams in chronic care, (R2) patient and caregiver education, (R3) self-management support, (R4) communication tools, and (R5) socialization strategies. Conclusions: This study demonstrates the value of combining patient and professional perspectives through digital Delphi methods to co-design innovation strategies in CBI rehabilitation. Findings highlight the need to strengthen communication, provide structured education, and implement hybrid care models to advance patient-centered rehabilitation. The methodology itself fostered engagement and consensus, underscoring its potential as a tool for participatory healthcare planning. Full article

Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods: Between April and June 2025, a multicenter cross-sectional survey was conducted in four primary healthcare centers in Slovenia. The sample included 214 people who had used both patient portals and phone consultations within the previous 12 months. Data collected covered socio-demographic and clinical profile, digital communication skills, quality of life, and annual use of digital tools. Acceptability was assessed using the Theoretical Framework of Acceptability (TFA) tool. Univariate and multivariable linear regression analyses were performed to identify factors associated with acceptability. Results: Among the 214 participants (mean age 42.9 ± 14.1 years; 61.2% female), both patient portals and phone consultations were generally acceptable, with similar overall TFA scores (3.9/5). Patient portals were considered as significantly less time-consuming and better for communication, whereas phone consultations were preferred for accessibility and reliability. Multivariable analyses showed that higher digital communication skills and better quality of life predicted greater acceptability for both methods, whereas lower education level and more frequent use were associated with higher acceptability of phone consultations. Conclusions: Acceptability of patient portals and phone consultations varies by education, digital communication skills, and quality of life. This highlights the need for personalized hybrid care solutions. Healthcare providers should offer flexible digital options, invest in digital literacy programs, and develop interoperable eHealth infrastructure to enable safe and sustainable integration of advanced tools such as video consultations. Full article

Background: he surge in the use of Pre-hospital Emergency Medical Systems (EMS) and Emergency Departments (ED) has become a pressing issue worldwide after the COVID-19 pandemic. To address this challenge, we developed an experimental and innovative care pathway supported by telemedicine. The aim of this study is to describe the activity of the Integrated Medical Center (CMI): a new telemedicine-based care model for patients referring to the Emergency Medical System. Methods: A prospective observational study was conducted from January 2022 to December 2022. The CMI was established to manage patients referring to the Emergency Medical System. Results: From January to December 2022, a total of 8680 calls were managed by CMI, with an average of 24 calls per day. 6243 patients (71.9%) were managed without ED access of whom 4884 patients (78.2%) were managed through telemedicine evaluation only, and 1359 (21.8%) with telemedicine evaluation and dispatch of the Home Rapid Response Team (HRRT). The population treated by the HRRT exhibited a higher age. The mean satisfaction score was 9.1/10. Conclusions: Telemedicine evaluation allowed for remote assessments, treatment prescriptions, and teleconsultation for HRRT and was associated with high patient satisfaction. This model could be useful in future pandemics for managing patients with non-urgent illnesses at home, preventing hospital admissions for potentially infectious patients, and thereby reducing in-hospital transmission. Full article

Introduction: African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare. Objective: The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers’ mental health in an Angolan healthcare network and develop a telemedicine model tailored to this context. Methodology: This mixed-method study collected quantitative data from a questionnaire applied to healthcare workers (n = 275), which were analyzed using descriptive statistics and logistic regressions. Qualitative data were obtained through structured interviews (n = 5) with psychologists and psychiatrists, and analyzed using thematic analysis in MAXQDA (Version 2022, VERBI Software, Germany), to identify recurring patterns and themes. The data were triangulated to ensure the rigor and consistency of the findings. Participation was anonymous and voluntary, and informed consent was obtained from all participants. Results: Previous experiences with mental health consultations, perceptions of teleconsultations, and doctor–patient relationship were significant in influencing telemedicine adoption by workers. The thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. The key adoption factors for providers included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards. Conclusions: The adoption of telemedicine for occupational mental health requires culturally adapted interventions and compliance with technological and data protection standards. Hospital management must address infrastructure challenges and mental health perceptions, and implement sustainable strategies that promote occupational well-being within the organization. Full article

Background/Objectives: Telemedicine has emerged as a transformative solution to healthcare access challenges in Sub-Saharan Africa, where many populations remain underserved. This systematic review focuses on the adoption, implementation, and technological prospects of telemedicine in South Africa, Kenya, and Nigeria, three countries leading the region in healthcare innovations. Methods: A systematic search of PubMed, Scopus, and Web of Science, guided by PRISMA protocols, identified 567 studies published between 2014 and 2024, of which 53 met the inclusion criteria with a focus on telemedicine adoption, implementation, and technological prospects in the selected countries. A structured critical appraisal was used to assess potential biases in the included studies’ design, selection criteria, and reporting, while findings were thematically analysed to provide actionable and comparative insights. Results: The findings reveal that South Africa has the highest adoption rate, focusing on specialist teleconsultations, chronic disease management, and mental health services. Kenya demonstrates strong mHealth integration and advanced mobile applications, particularly in maternal health, HIV care, and sexual and reproductive health. While facing infrastructural and regulatory constraints, Nigeria is advancing innovations for remote diagnosis and teleconsultation. Conclusions: By synthesising evidence from peer-reviewed literature, the review identifies adoption trends, enabling factors, and opportunities for scaling telemedicine in these contexts. Despite these advancements, challenges persist, including regulatory gaps, digital literacy limitations, and infrastructure constraints. Addressing these barriers requires targeted investments in broadband expansion, policy harmonisation, and healthcare workforce training to optimise telemedicine’s impact and ensure its sustainability as a healthcare delivery model in Sub-Saharan Africa. Full article

Amidst the rapid proliferation of mHealth applications, questions persist regarding their efficacy, usability, and integration into oral health practice. This review aims to inform practitioners and stakeholders in the field of oral health about the potential of digital technologies to transform healthcare delivery and promote healthy behaviors. Key terms included “dental”, “dentistry”, “oral health”, “dental treatment”, and “tooth care”. The Google Play Store search identified 130 applications, out of which 18 met our study objectives. Most apps (n = 13) focused on providing dental appointments, oral health education, and promotion. The Mobile Application Rating Scale (MARS) quality rating revealed that only 50% of these apps were of high quality. Engagement and information were the lowest scored subscales. This review highlights the many benefits that these digital tools provide, including online appointments, teleconsultations, and access to oral health educational resources. Nevertheless, despite their potential, the current state of dental health applications left substantial room for development, especially in the areas of user involvement and information quality. The lack of reliable and accurate information in many apps may be harmful to users’ health. To fully realize the potential of these digital technologies and to enhance oral health outcomes on a larger scale, coordinated actions involving stakeholders from the technology and dentistry sectors are imperative. Full article

Background/Objectives: Poisoning represents a significant global public health challenge, particularly with its complex manifestations in adult populations. Understanding regional epidemiology through digital health systems is crucial for developing evidence-based prevention and management strategies. This nationwide study analyzes hospital-based toxicology teleconsultation data from the Toxicology Consultation Service-Saudi Medical Appointments and Referrals Center (TCS-SMARC) platform to characterize the epidemiological patterns, clinical features, and outcomes of adult poisoning cases across Saudi regions. Methods: We conducted a retrospective cross-sectional analysis of 6427 adult poisoning cases where hospitals sought teleconsultation from the Saudi Toxicology Consultation Service (TCS) from January to December 2023. Descriptive statistics were used to analyze poisoning rates by demographic characteristics, agents responsible for the poisoning, clinical presentations, and management decisions. Population-adjusted rates were calculated using the national census data. Associations between variables were analyzed using cross-tabulations and chi-square tests. Results: Young adults aged 18–35 years constituted most cases (58.67%), with the highest population-adjusted rates observed among those aged 18–24 (5.15 per 10,000). Medicine-related poisonings were the most common across all regions (50.04%), followed by bites and stings (15.31%). Regional analysis indicated relatively uniform poisoning rates across Business Units (BUs) (2.02–2.74 per 10,000). Most cases (87.44%) were asymptomatic, with 91.71% exhibiting normal Glasgow Coma Scale scores, although substance abuse cases had higher rate of severe manifestations (24.34%). Significant seasonal variations were observed (p < 0.001), with peak incidents occurring in the summer (29.25%). Management decisions primarily involved hospital observation (40.27%) and admission (30.34%), with agent-specific variations in care requirements (p < 0.001). Conclusions: This comprehensive analysis demonstrates the effectiveness of Saudi Arabia’s digital health infrastructure in capturing and managing nationwide poisoning data. The integrated digital platform enables real-time surveillance, standardized triage, enhanced access to specialized toxicology services, and coordinated management across diverse geographical contexts. Our findings inform evidence-based recommendations for targeted prevention strategies, particularly for young adults and medicine-related poisonings, while establishing a scalable model for digital health-enabled poisoning management. Full article

Background/Objectives: Access to healthcare in medically underserved areas remains a significant challenge in South Korea due to the concentration of healthcare resources in metropolitan regions. Telemedicine offers a promising approach to mitigating this issue, yet its cost-effectiveness in these settings remains underexplored. This study aims to conduct a cost-minimization analysis comparing teleconsultation and in-person care for chronic diseases, dementia, and rehabilitation in medically underserved areas. Methods: In accordance with CHEERS 2022 guidelines, this study evaluates both direct and indirect costs from a societal perspective, while accounting for costs borne by various societal stakeholders. It provides evidence to guide policy decisions in regions with significant healthcare access disparities. Results: Using data from South Korea’s 2018 teleconsultation pilot program involving 1232 patients, the analysis revealed that teleconsultation reduced societal costs per consultation by USD 7.92 for chronic diseases, USD 27.30 for dementia care, and USD 9.61 for rehabilitation. These savings were primarily attributed to reductions in productivity losses and transportation expenses. Furthermore, the analysis identified a shift in financial burden from patients and caregivers to government and public expenditures. Conclusions: The findings highlight teleconsultation’s effectiveness in reducing healthcare costs while consistently benefiting diverse patient groups, underscoring the necessity of integrating telemedicine into mainstream healthcare systems to improve access and alleviate financial strain on patients and their families. Full article

Background: This paper presents TheraSense, a system developed within the Supporting Mental Health in Young People: Integrated Methodology for cLinical dEcisions and evidence (Smile) and Sensor Enabled Affective Computing for Enhancing Medical Care (SenseCare) projects. TheraSense is designed to enhance teleconsultation services by leveraging deep learning for real-time emotion recognition through facial expressions. It integrates with the Knowledge Management-Ecosystem Portal (SenseCare KM-EP) platform to provide mental health practitioners with valuable emotional insights during remote consultations. Method: We describe the conceptual design of TheraSense, including its use case contexts, architectural structure, and user interface layout. The system’s interoperability is discussed in detail, highlighting its seamless integration within the teleconsultation workflow. The evaluation methods include both quantitative assessments of the video-based emotion recognition system’s performance and qualitative feedback through heuristic evaluation and survey analysis. Results: The performance evaluation shows that TheraSense effectively recognizes emotions in video streams, with positive user feedback on its usability and integration. The system’s real-time emotion detection capabilities provide valuable support for mental health practitioners during remote sessions. Conclusions: TheraSense demonstrates its potential as an innovative tool for enhancing teleconsultation services. By providing real-time emotional insights, it supports better-informed decision-making in mental health care, making it an effective addition to remote telehealth platforms. Full article

Objective. Telecontrol approaches for rheumatoid arthritis (RA) management aim to enhance patient outcomes. This pilot study assessed whether the Rheumatoid Arthritis Impact of Disease (RAID) approach could be used during teleconsultations to monitor RA disease activity through a web-based platform called iARPlus (Innovative Approach in Rheumatology). Methods. Forty RA patients participated in two in-person visits (baseline and 12 months) and seven teleconsultations over 12 months, collected via the iARPlus portal and accessible through an internet browser. Disease activity, at baseline and follow-up, was measured using the Clinical Disease Activity Index (CDAI) and self-reported RAID scores throughout the study. The RAID approach, developed by the European Alliance of Associations for Rheumatology (EULAR), combines key patient-reported outcomes (PROs). Results. Nineteen patients (mean age: 49.3 years) were treated with Janus kinase inhibitors (JAKis), and 21 patients (mean age: 48.1 years) received adalimumab. All patients had active disease (mean CDAI 27.9 ± 4.8). Strong correlations were found between CDAI and RAID scores at baseline (ρ = 0.809, p < 0.0001) and at follow-up (ρ = 0.789, p < 0.0001). JAKi-treated patients showed greater reductions in RAID scores, pain relief, and higher rates of disease remission compared to adalimumab-treated patients. Conclusions. RAID scores were effective in teleconsultations for assessing RA disease activity. JAKi treatment resulted in better pain control and disease activity improvement compared to adalimumab. Further studies are needed to confirm the clinical and economic benefits of telecontrol for RA management. Full article