Editorial

11 pages, 401 KiB

Open AccessEditorial

Joint Expedition: Exploring Telehealth and the Digital Healthcare Landscape as a Team Integration

by Daniele Giansanti

Healthcare 2024, 12(5), 585; https://doi.org/10.3390/healthcare12050585 - 04 Mar 2024

Viewed by 797

The TeleHealth and digital healthcare domains have witnessed remarkable advancements in recent years (Contribution 1), propelled by the evolution of digitization processes, both in mobile [...] Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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6 pages, 234 KiB

Open AccessEditorial

Ten Years of TeleHealth and Digital Healthcare: Where Are We?

by Daniele Giansanti

Healthcare 2023, 11(6), 875; https://doi.org/10.3390/healthcare11060875 - 17 Mar 2023

Cited by 5 | Viewed by 2425

Abstract

Due to the development of the technological innovation of devices, availability of increasingly performing networks, improvement of the digitization processes, and the push to greater diffusion determined by the COVID-19 pandemic, Digital Healthcare (DH), also referred to as Digital Health [...] Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

Research

Jump to: Editorial, Review, Other

19 pages, 1643 KiB

Open AccessArticle

Acceptability of Telerehabilitation: Experiences and Perceptions by Individuals with Stroke and Caregivers in an Early Supported Discharge Program

by Fatimata Ouédraogo, Louis-Pierre Auger, Emmanuelle Moreau, Odile Côté, Rosalba Guerrera, Annie Rochette and Dahlia Kairy

Healthcare 2024, 12(3), 365; https://doi.org/10.3390/healthcare12030365 - 31 Jan 2024

Viewed by 1494

Abstract

Introduction: Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. Objective: The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. Methods: A [...] Read more.

Introduction: Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. Objective: The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. Methods: A qualitative descriptive approach was used. Six individuals with stroke and three caregivers participated in individual online interviews. An abductive thematic analysis was employed to analyze the qualitative data, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) model. Results: Participants reported positive experiences with TR, resulting in improvements in functional abilities, such as manual dexterity, balance, and positive interactions with therapists. They found the technology easy to learn and use, facilitating engagement in TR. Participants’ prior experiences with technology, along with support from caregivers and therapists, facilitated acceptance and the use of TR. The COVID-19 pandemic also motivated participants to accept TR. However, technical issues, unstable internet connections, and lack of feedback were barriers to the use of TR. Conclusion: Despite existing obstacles, TR can be used to provide rehabilitation services for individuals with stroke. Addressing these barriers is necessary to promote the widespread and effective use of TR in the context of stroke recovery. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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14 pages, 423 KiB

Open AccessArticle

Evaluation of Telephone Visits in Primary Care: Satisfaction of Pediatricians and Family Physicians and Their Perceptions of Quality of Care and Safety

by Tamar Shalom, Osnat Bashkin, Alexander Gamus, Yoram Blachar, Shlomit Yaron, Doron Netzer, Ayelet Nevet and Gil Lavie

Healthcare 2024, 12(2), 212; https://doi.org/10.3390/healthcare12020212 - 15 Jan 2024

Viewed by 690

Abstract

Telehealth has accelerated since the outbreak of the COVID-19 virus. As telephone visits become more common, it is important to examine the challenges involved in using this modality of care. In this study, we examined family physicians’ and pediatricians’ perceptions regarding three aspects [...] Read more.

Telehealth has accelerated since the outbreak of the COVID-19 virus. As telephone visits become more common, it is important to examine the challenges involved in using this modality of care. In this study, we examined family physicians’ and pediatricians’ perceptions regarding three aspects of the use of telephone visits: quality of care, safety of care, and physicians’ satisfaction. A total of 342 family physicians and pediatricians responded to an online survey. Respondents were asked to rate their degree of agreement with 17 statements inquiring about quality, safety, and satisfaction with telephone visits on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This was followed by in-depth interviews between January and April 2023 with 26 physicians. Participants expressed satisfaction (3.66 ± 0.80) with the use of telephone visits and lower assessments of safety (3.03 ± 0.76) and quality (2.27 ± 0.76) of care using the telephone modality. Eighty percent of the respondents think combining a face-to-face visit with a telephone visit is recommended, and 51% noted that the inability to examine patients closely affects and impedes a physician’s decision making. Most interviewees indicated that telephone visits are safe only with former patients they had already seen in the clinic. The findings shed light on the perceptions of family physicians and pediatricians regarding telephone visits. The lower assessments of quality and safety compared to the assessment of satisfaction underscore the need for careful use of telephone visits in healthcare. A proper and balanced selection of patients, implementing technological upgrades to the modality, and performing patient education practices are recommended. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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15 pages, 2018 KiB

Open AccessArticle

The Impact of a Multicomponent Platform Intervention on the Daily Lives of Older Adults

by Vera Stara, Margherita Rampioni, Adrian Alexandru Moșoi, Dominic M. Kristaly, Sorin-Aurel Moraru, Lucia Paciaroni, Susy Paolini, Alessandra Raccichini, Elisa Felici, Giacomo Cucchieri, Luca Antognoli, Alessandra Millevolte, Marina Antici and Mirko di Rosa

Healthcare 2023, 11(24), 3102; https://doi.org/10.3390/healthcare11243102 - 05 Dec 2023

Viewed by 836

Abstract

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and [...] Read more.

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and improve their quality of life. This study aims to assess the impact of a multicomponent platform, consisting of an ambient sensor, wearable devices, and a cloud application, as an intervention in terms of usability and acceptance as primary outcomes and well-being, quality of life, and self-efficacy as secondary outcomes in a sample of 25 older adults aged over 65 after 21 days of non-supervised usage at home. This research involved the use of a mixed-methods approach, in which both qualitative and quantitative data were collected in three different measurements. Overall, the participants shared good engagement with the integrated platform. The system achieved positive results in terms of both usability and acceptance, especially the smartwatch. The state of complete well-being slightly improved over the period, whereas self-efficacy remained stable. This study demonstrates the ability of target users to use technology independently in their home environment: it strengthens the idea that this technology is ready for mainstream use and offers food for thought for developers who create products for the aging population. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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13 pages, 957 KiB

Open AccessArticle

Beyond Hypoglossal Hype: Social Media Perspectives on the Inspire Upper Airway Stimulation System

by Nicholas A. Rossi, Bridget A. Vories, Samuel E. Razmi, Nishat A. Momin, Zachary S. Burgess, Harold S. Pine, Sepehr Shabani, Rizwana Sultana and Brian J. McKinnon

Healthcare 2023, 11(23), 3082; https://doi.org/10.3390/healthcare11233082 - 01 Dec 2023

Viewed by 960

Abstract

In the landscape of sleep surgery, the Inspire^® Upper Airway Stimulation (UAS) device has gained prominence as an increasingly popular treatment option for obstructive sleep apnea, prompting significant discourse across social media platforms. This study explores the social media narrative of the [...] Read more.

In the landscape of sleep surgery, the Inspire^® Upper Airway Stimulation (UAS) device has gained prominence as an increasingly popular treatment option for obstructive sleep apnea, prompting significant discourse across social media platforms. This study explores the social media narrative of the UAS device, particularly the nature of multimedia content, author demographics, and audience engagement on Instagram, Facebook, and TikTok. Our analysis encompassed 423 public posts, revealing images (67.4%) and videos (28.1%) as the dominant content types, with over a third of posts authored by physicians. A notable 40% of posts were advertisements, whereas patient experiences comprised 34.5%. TikTok, although presenting a smaller sample size, showed a substantially higher engagement rate, with posts averaging 152.9 likes, compared with Instagram and Facebook at 32.7 and 41.2 likes, respectively. The findings underscore the need for otolaryngologists and healthcare professionals to provide clear, evidence-based information on digital platforms. Given social media’s expanding role in healthcare, medical professionals must foster digital literacy and safeguard the accuracy of health information online. In this study, we concluded that maintaining an evidence-based, transparent digital dialogue for medical innovations such as the UAS device necessitates collaborative efforts among physicians, health institutions, and technology companies. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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24 pages, 4285 KiB

Open AccessArticle

Patent and Bibliometric Analysis of the Scientific Landscape of the Use of Pulse Oximeters and Their Prospects in the Field of Digital Medicine

by Olena Litvinova, Fabian Peter Hammerle, Jivko Stoyanov, Natalia Ksepka, Maima Matin, Michał Ławiński, Atanas G. Atanasov and Harald Willschke

Healthcare 2023, 11(22), 3003; https://doi.org/10.3390/healthcare11223003 - 20 Nov 2023

Viewed by 1190

Abstract

This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000–2023, we identified [...] Read more.

This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000–2023, we identified the United States, China, the Republic of Korea, Japan, Canada, Australia, Taiwan, and the United Kingdom as the predominant countries in patent issuance for pulse oximeter technology. Our bibliometric analysis revealed a consistent temporal trend in both the volume of publications and citations, underscoring the growing importance of pulse oximeters in digitally-enabled medical practice. Using the VOSviewer software(version 1.6.18), we discerned six primary research clusters: (1) measurement accuracy; (2) integration with the Internet of Things; (3) applicability across diverse pathologies; (4) telemedicine and mobile applications; (5) artificial intelligence and deep learning; and (6) utilization in anesthesiology, resuscitation, and intensive care departments. The findings of this study indicate the prospects for leveraging digital technologies in the use of pulse oximetry in various fields of medicine, with implications for advancing the understanding, diagnosis, prevention, and treatment of cardio-respiratory pathologies. The conducted patent and bibliometric analysis allowed the identification of technical solutions to reduce the risks associated with pulse oximetry: improving precision and validity, technically improved clinical diagnostic use, and the use of machine learning. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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21 pages, 755 KiB

Open AccessArticle

The RODI mHealth app Insight: Machine-Learning-Driven Identification of Digital Indicators for Neurodegenerative Disorder Detection

by Panagiota Giannopoulou, Aristidis G. Vrahatis, Mary-Angela Papalaskari and Panagiotis Vlamos

Healthcare 2023, 11(22), 2985; https://doi.org/10.3390/healthcare11222985 - 19 Nov 2023

Viewed by 904

Abstract

Neurocognitive Disorders (NCDs) pose a significant global health concern, and early detection is crucial for optimizing therapeutic outcomes. In parallel, mobile health apps (mHealth apps) have emerged as a promising avenue for assisting individuals with cognitive deficits. Under this perspective, we pioneered the [...] Read more.

Neurocognitive Disorders (NCDs) pose a significant global health concern, and early detection is crucial for optimizing therapeutic outcomes. In parallel, mobile health apps (mHealth apps) have emerged as a promising avenue for assisting individuals with cognitive deficits. Under this perspective, we pioneered the development of the RODI mHealth app, a unique method for detecting aligned with the criteria for NCDs using a series of brief tasks. Utilizing the RODI app, we conducted a study from July to October 2022 involving 182 individuals with NCDs and healthy participants. The study aimed to assess performance differences between healthy older adults and NCD patients, identify significant performance disparities during the initial administration of the RODI app, and determine critical features for outcome prediction. Subsequently, the results underwent machine learning processes to unveil underlying patterns associated with NCDs. We prioritize the tasks within RODI based on their alignment with the criteria for NCDs, thus acting as key digital indicators for the disorder. We achieve this by employing an ensemble strategy that leverages the feature importance mechanism from three contemporary classification algorithms. Our analysis revealed that tasks related to visual working memory were the most significant in distinguishing between healthy individuals and those with an NCD. On the other hand, processes involving mental calculations, executive working memory, and recall were less influential in the detection process. Our study serves as a blueprint for future mHealth apps, offering a guide for enhancing the detection of digital indicators for disorders and related conditions. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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29 pages, 10038 KiB

Open AccessArticle

Machine Learning Applications in Sarcopenia Detection and Management: A Comprehensive Survey

by Dilmurod Turimov Mustapoevich and Wooseong Kim

Healthcare 2023, 11(18), 2483; https://doi.org/10.3390/healthcare11182483 - 07 Sep 2023

Cited by 3 | Viewed by 1502

Abstract

This extensive review examines sarcopenia, a condition characterized by a loss of muscle mass, stamina, and physical performance, with a particular emphasis on its detection and management using contemporary technologies. It highlights the lack of global agreement or standardization regarding the definition of [...] Read more.

This extensive review examines sarcopenia, a condition characterized by a loss of muscle mass, stamina, and physical performance, with a particular emphasis on its detection and management using contemporary technologies. It highlights the lack of global agreement or standardization regarding the definition of sarcopenia and the various techniques used to measure muscle mass, stamina, and physical performance. The distinctive criteria employed by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGSOP) for diagnosing sarcopenia are examined, emphasizing potential obstacles in comparing research results across studies. The paper delves into the use of machine learning techniques in sarcopenia detection and diagnosis, noting challenges such as data accessibility, data imbalance, and feature selection. It suggests that wearable devices, like activity trackers and smartwatches, could offer valuable insights into sarcopenia progression and aid individuals in monitoring and managing their condition. Additionally, the paper investigates the potential of blockchain technology and edge computing in healthcare data storage, discussing models and systems that leverage these technologies to secure patient data privacy and enhance personal health information management. However, it acknowledges the limitations of these models and systems, including inefficiencies in handling large volumes of medical data and the lack of dynamic selection capability. In conclusion, the paper provides a comprehensive summary of current sarcopenia research, emphasizing the potential of modern technologies in enhancing the detection and management of the condition while also highlighting the need for further research to address challenges in standardization, data management, and effective technology use. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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11 pages, 273 KiB

Open AccessArticle

Introducing Telemedicine in Italy: Citizens’ Awareness of a New Healthcare Resource

by Francesca Gallè, Stefania Oliva, Edoardo Covelli, Antonio Del Casale, Giovanna Da Molin, Giorgio Liguori, Giovanni Battista Orsi and Christian Napoli

Healthcare 2023, 11(15), 2157; https://doi.org/10.3390/healthcare11152157 - 28 Jul 2023

Cited by 1 | Viewed by 863

Abstract

In recent years, especially during the COVID-19 pandemic, new technologies have emerged as useful resources in healthcare. Telemedicine services may decrease opportunities for contagion by limiting direct medical contacts; they can lead to greater access to and better quality of care, especially for [...] Read more.

In recent years, especially during the COVID-19 pandemic, new technologies have emerged as useful resources in healthcare. Telemedicine services may decrease opportunities for contagion by limiting direct medical contacts; they can lead to greater access to and better quality of care, especially for the elderly and chronically ill patients. However, there are still some difficulties in their widespread use, such as lack of knowledge about the effectiveness and safety of telemedicine; lack of awareness of its existence; privacy issues; and lack of computer literacy. The aim of this study is to assess the awareness of and attitude toward telemedicine in the Italian adult population, considering sociodemographic characteristics and territorial differences in telemedicine service implementation. A questionnaire was administered to Italian citizens from October 2022 to February 2023 using communication and social media in order to collect sociodemographic and health characteristics and data on awareness and use of telemedicine services. Less than half of the respondents (n = 1002) were aware of telemedicine services in their region; most of them did not use the available services due to a preference for in-person visits or lack of need. More than 90% of participants who used these services were satisfied with them. A negative attitude toward telemedicine was found in a higher proportion of older adults. This study demonstrated that, although telemedicine services are active in Italy, a large part of the population ignores its availability. Therefore, further efforts should be made to increase citizens’ awareness and the use of telemedicine in our country. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

17 pages, 1633 KiB

Open AccessCommunication

Primary Care of the (Near) Future: Exploring the Contribution of Digitalization and Remote Care Technologies through a Case Study

by Federico Pennestrì and Giuseppe Banfi

Healthcare 2023, 11(15), 2147; https://doi.org/10.3390/healthcare11152147 - 27 Jul 2023

Cited by 1 | Viewed by 1320

Abstract

The Italian Government planned to invest €15 billion of European funds on National Health Service digitalization and primary care enhancement. The critical burden brought by the pandemic upon hospital care mean these investments could no longer be delayed, considering the extraordinary backlogs of [...] Read more.

The Italian Government planned to invest €15 billion of European funds on National Health Service digitalization and primary care enhancement. The critical burden brought by the pandemic upon hospital care mean these investments could no longer be delayed, considering the extraordinary backlogs of many treatments and the ordinary gaps of fragmented long-term care, in Italy and abroad. National guidelines have been published to standardize interventions across the Italian regions, and telemedicine is frequently mentioned as a key innovation to achieve both goals. The professional resources needed to run the facilities introduced in primary care are defined with great precision, but no details are given on how digitalization and remote care technologies must be implemented in this context. Building on this policy case, this paper focuses on what contribution digitalization and telemedicine can offer to specific primary care innovations, drawing from implemented technology-driven policies which may support the effective stratification, prevention and management of chronic patient needs, including anticipatory healthcare, population health management, adjusted clinical groups, chronic care management, quality and outcomes frameworks, patient-reported outcomes and patient-reported experience. All these policies can benefit significantly from digitalization and remote care technology, provided that some risks and limitations are considered by design. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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11 pages, 231 KiB

Open AccessArticle

Scratch Where It Itches: Electronic Sharing of Health Information and Costs

by Na-Eun Cho and KiHoon Hong

Healthcare 2023, 11(14), 2023; https://doi.org/10.3390/healthcare11142023 - 14 Jul 2023

Viewed by 809

Abstract

The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved hospital performance. However, despite the benefits, hospitals often encounter significant challenges when it comes to sharing information with external parties. Our [...] Read more.

The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved hospital performance. However, despite the benefits, hospitals often encounter significant challenges when it comes to sharing information with external parties. Our study aimed to identify the circumstances under which sharing information with external parties can result in changes in overall hospital costs, with a particular emphasis on various obstacles that hospitals may encounter, including lack of incentives or capabilities essential to facilitate effective information exchange. To achieve this goal, we obtain data from multiple sources, including the American Hospital Association (AHA) annual and IT surveys, the Center for Medicare and Medicaid Services (CMS) hospital compare dataset, and the Census Bureau’s small-area income and poverty estimates. Consistent with previous research, we observed a significant reduction in hospital costs when information was shared internally but not externally. However, our findings also revealed that the sharing of health information can lead to cost savings for hospitals when they encounter challenges such as the absence of incentives and capabilities regardless of whether the information is shared internally or externally. The implication of our study is simple but strong: perseverance and effort yield positive outcomes. Only when hospitals push through challenges related to sharing information can they achieve the anticipated advantages of information sharing. Based on our results, we suggest that policymakers should strategically target hospitals and providers that face challenges in sharing health information rather than focusing on those without obstacles. This targeted approach can significantly increase policy efficiency, and we emphasize the need for policymakers to address the specific areas where hospitals and providers encounter difficulties. By doing so, they can effectively “scratch where it itches” and address the core issues hindering the successful exchange of health information. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

11 pages, 2242 KiB

Open AccessArticle

The Effect of Kinesio Taping Combined with Virtual-Reality-Based Upper Extremity Training on Upper Extremity Function and Self-Esteem in Stroke Patients

by Seo-Won Yang, Sung-Ryong Ma and Jong-Bae Choi

Healthcare 2023, 11(13), 1813; https://doi.org/10.3390/healthcare11131813 - 21 Jun 2023

Viewed by 1347

Abstract

(1) Background: The purpose of this study is to investigate the effect of virtual-reality-based hand motion training (VRT) in parallel with the Kinesio Taping (KT) technique on upper extremity function in stroke patients and to present a more effective therapeutic basis for virtual [...] Read more.

(1) Background: The purpose of this study is to investigate the effect of virtual-reality-based hand motion training (VRT) in parallel with the Kinesio Taping (KT) technique on upper extremity function in stroke patients and to present a more effective therapeutic basis for virtual reality training intervention. (2) Methods: First, 43 stroke patients were randomly assigned to two groups: 21 experimental subjects and 22 controls. The experimental group performed Kinesio Taping (KT) on the dorsal part of the hand along with virtual-reality-based hand motion training, and the control group performed only virtual-reality-based hand motion training. The intervention was conducted for a total of 30 sessions over 6 weeks. To evaluate changes in upper extremity function, the Fugl–Meyer Assessment of the Upper Extremity (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL) (including amount of use (AOU) and quality of movement (QOM)) were evaluated. In addition, the Self-Efficacy Scale (SEF) was evaluated to examine the change in the self-esteem of the study subjects. (3) Results: The experimental group who participated in the virtual reality training in parallel with the KT technique showed statistically significant improvement (** p < 0.01) in the FMA-UE, WMFT, and MAL evaluations that investigate changes in upper extremity function. SEF evaluation also showed a statistically significant improvement (** p < 0.01). A statistically significant difference between the two groups was observed in the evaluation of FMA-UE, WMFT, MAL-QOM, and SEF (^† p < 0.05), showing that that combined intervention was more effective at improving upper extremity function than the existing VRT intervention. There was no statistical difference between the two groups in the MAL-AOU item, which is an evaluation of upper extremity function (p > 0.05). There was a statistically significant difference between the two groups in the amount of change in upper limb function (^†† p < 0.01). (4) Conclusions: It was confirmed that virtual-reality-based hand motion training performed in parallel with the KT technique had a positive effect on the recovery of upper extremity function of stroke patients. The fact that the KT technique provided stability to the wrist by assisting the wrist extensor muscles appears to have improved the upper extremity function more effectively than VRT alone. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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15 pages, 303 KiB

Open AccessArticle

Use of Digital Healthcare Communication to Improve Urologists’ Surveillance of Lithiasis Patients Treated with Internal Urinary Drainage Pre- and Post-COVID-19 Period

by Mihai Vintilă, Dan Mischianu, Octavia-Sorina Honțaru, Mihai Dobra and Alin Gabriel Sterian

Healthcare 2023, 11(12), 1776; https://doi.org/10.3390/healthcare11121776 - 16 Jun 2023

Viewed by 829

Abstract

The COVID-19 pandemic has greatly affected lithiasis patients, which has led to an increase in the number of internal stents that have been installed. In this paper, two studies were carried out, a clinical study and a quantitative study. The aim of the [...] Read more.

The COVID-19 pandemic has greatly affected lithiasis patients, which has led to an increase in the number of internal stents that have been installed. In this paper, two studies were carried out, a clinical study and a quantitative study. The aim of the first study was to evaluate the incidence and the prevalence of bacterial urinary colonization in patients with obstructive urolithiasis who needed internal stents implanted. In the second study, a multiple linear regression was created to identify the opinion of urologists regarding the importance of using digital technologies to improve the communication process. The result of the clinical study illustrates that the prevalence of urinary colonization in patients with internal stents carried out for obstructive urolithiasis was 35%, with this value being influenced by co-infection with COVID-19. The results of the quantitative study illustrated the fact that urologists are open to using new online technologies to facilitate communication with patients. The results have high importance for both doctors and patients, illustrating the main factors that have the ability to influence the communication process. The hospital managers should take into account the results obtained in this study when they choose to use certain online communication technologies with patients. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

12 pages, 2769 KiB

Open AccessArticle

Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care

by José Luis Gatica, Diego Aragón-Caqueo, Gabriel Aedo, Héctor Fuenzalida, Rodrigo Loubies, Sócrates Aedo, María Francisca Carrasco, Vezna Sabando, Carolina Cunill and María José Letelier

Healthcare 2023, 11(11), 1626; https://doi.org/10.3390/healthcare11111626 - 02 Jun 2023

Viewed by 1080

Abstract

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment [...] Read more.

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient’s destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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15 pages, 463 KiB

Open AccessArticle

Challenges of Integrating New Technologies for Orthopedic Doctors to Face up to Difficulties during the Pandemic Era

by Marius Niculescu, Octavia-Sorina Honțaru, George Popescu, Alin Gabriel Sterian and Mihai Dobra

Healthcare 2023, 11(11), 1524; https://doi.org/10.3390/healthcare11111524 - 23 May 2023

Cited by 2 | Viewed by 1483

Abstract

In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the [...] Read more.

In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the intention of orthopedic doctors to integrate new medical technologies. The survey was based on a questionnaire that was used for data collection. The quantitative study registered a sample of 145 orthopedic doctors. The data analysis was performed based on the IBM SPSS program. A multiple linear regression model was applied, which analyzed how the independent variables can influence the dependent variables. After analyzing the data, it was observed that the intention of orthopedic doctors to use new medical technologies is influenced by the advantages and disadvantages perceived by them, the perceived risks, the quality of the medical technologies, the experience of physicians in their use, and their receptivity to other digital tools. The obtained results are highly important both for hospital managers and authorities, illustrating the main factors that influence doctors to use emergent technologies in their clinical work. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

12 pages, 1442 KiB

Open AccessArticle

The Usage of Digital Health Mobile-Based Applications among Saudi Population

by Naif AlAli, Yasser AlKhudairy, Khalid AlSafadi, Bandar Abduljabbar, Nawfal Aljerian, Abdulrahman M. Albeshry and Najim Z. Alshahrani

Healthcare 2023, 11(10), 1413; https://doi.org/10.3390/healthcare11101413 - 12 May 2023

Viewed by 1582

Abstract

This study aimed at assessing the extent to which the general Saudi population has embraced digital health medical applications to meet their health-related needs so that the Saudi Ministry of Health and government can appropriately be guided on scaling up digital health across [...] Read more.

This study aimed at assessing the extent to which the general Saudi population has embraced digital health medical applications to meet their health-related needs so that the Saudi Ministry of Health and government can appropriately be guided on scaling up digital health across the country. As such, this study was guided by the question of to what extent the Saudi people use digital health mobile-based applications. This was a cross-sectional study utilizing snowballing sampling approach. Frequencies, Chi-square, and Spearman rank correlation statistics were used to offer descriptive and inferential analysis of the variables. The majority of the participants were economically able to afford smart devices that have medical apps, had at least an app on such devices, and highly regarded the benefits of the apps. Unfortunately, their understanding of how to use such apps was limited, and this posed a barrier to embracing digital health alongside difficulty downloading apps and medical ethical concerns. Although there is a willingness, extra effort is needed from the Saudi Ministry of Health and the government to promote the uptake of digital health in Saudi Arabia. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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12 pages, 345 KiB

Open AccessArticle

Effect of Mobile Health Interventions on Lifestyle and Anthropometric Characteristics of Uncontrolled Hypertensive Participants: Secondary Analyses of a Randomized Controlled Trial

by Caroline Nespolo David, Cirano Iochpe, Erno Harzheim, Guilhermo Prates Sesin, Marcelo Rodrigues Gonçalves, Leila Beltrami Moreira, Flavio Danni Fuchs and Sandra Costa Fuchs

Healthcare 2023, 11(8), 1069; https://doi.org/10.3390/healthcare11081069 - 08 Apr 2023

Cited by 2 | Viewed by 1552

Abstract

Our objective was to evaluate the effect of a mobile health (mHealth) intervention on lifestyle adherence and anthropometric characteristics among individuals with uncontrolled hypertension. We performed a randomized controlled trial (ClinicalTrials.gov NCT03005470) where all participants received lifestyle counseling at baseline and were randomly [...] Read more.

Our objective was to evaluate the effect of a mobile health (mHealth) intervention on lifestyle adherence and anthropometric characteristics among individuals with uncontrolled hypertension. We performed a randomized controlled trial (ClinicalTrials.gov NCT03005470) where all participants received lifestyle counseling at baseline and were randomly allocated to receive (1) an automatic oscillometric device to measure and register blood pressure (BP) via a mobile application, (2) personalized text messages to stimulate lifestyle changes, (3) both mHealth interventions, or (4) usual clinical treatment (UCT) without technology (control). The outcomes were achieved for at least four of five lifestyle goals (weight loss, not smoking, physical activity, moderate or stopping alcohol consumption, and improving diet quality) and improved anthropometric characteristics at six months. mHealth groups were pooled for the analysis. Among 231 randomized participants (187 in the mHealth group and 45 in the control group), the mean age was 55.4 ± 9.5 years, and 51.9% were men. At six months, achieving at least four of five lifestyle goals was 2.51 times more likely (95% CI: 1.26; 5.00, p = 0.009) to be achieved among participants receiving mHealth interventions. The between-group difference reached clinically relevant, but marginally significant, reduction in body fat (−4.05 kg 95% CI: −8.14; 0.03, p = 0.052), segmental trunk fat (−1.69 kg 95% CI: −3.50; 0.12, p = 0.067), and WC (−4.36 cm 95% CI: −8.81; 0.082, p = 0.054), favoring the intervention group. In conclusion, a six-month lifestyle intervention supported by application-based BP monitoring and text messages significantly improves adherence to lifestyle goals and is likely to reduce some anthropometric characteristics in comparison with the control without technology support. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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Review

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17 pages, 4131 KiB

Open AccessReview

Mobile Apps for COVID-19: A Systematic Review of Reviews

by Felix Holl, Johannes Schobel and Walter J. Swoboda

Healthcare 2024, 12(2), 139; https://doi.org/10.3390/healthcare12020139 - 08 Jan 2024

Viewed by 877

Abstract

Background: One measure national governments took to react to the acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic was mobile applications (apps). This study aims to provide a high-level overview of published reviews of mobile apps used in association with coronavirus disease 19 [...] Read more.

Background: One measure national governments took to react to the acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic was mobile applications (apps). This study aims to provide a high-level overview of published reviews of mobile apps used in association with coronavirus disease 19 (COVID-19), examine factors that contributed to the success of these apps, and provide data for further research into this topic. Methods: We conducted a systematic review of reviews (also referred to as an umbrella review) and searched two databases, Medline and Embase, for peer-reviewed reviews of COVID-19 mobile apps that were written in English and published between January 1st 2020 and April 25th 2022. Results: Out of the initial 17,611 studies, 24 studies were eligible for the analysis. Publication dates ranged from May 2020 to January 2022. In total, 54% (n = 13) of the studies were published in 2021, and 33% (n = 8) were published in 2020. Most reviews included in our review of reviews analyzed apps from the USA, the UK, and India. Apps from most of the African and Middle and South American countries were not analyzed in the reviews included in our study. Categorization resulted in four clusters (app overview, privacy and security, MARS rating, and miscellaneous). Conclusions: Our study provides a high-level overview of 24 reviews of apps for COVID-19, identifies factors that contributed to the success of these apps, and identifies a gap in the current literature. The study provides data for further analyses and further research. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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17 pages, 1664 KiB

Open AccessReview

Content, Mechanism, and Outcome of Effective Telehealth Solutions for Management of Chronic Obstructive Pulmonary Diseases: A Narrative Review

by Saeed Mardy Alghamdi

Healthcare 2023, 11(24), 3164; https://doi.org/10.3390/healthcare11243164 - 14 Dec 2023

Viewed by 1078

Abstract

Telehealth (TH) solutions for Chronic Obstructive Pulmonary Disease (COPD) are promising behavioral therapeutic interventions and can help individuals living with COPD to improve their health status. The linking content, mechanism, and outcome of TH interventions reported in the literature related to COPD care [...] Read more.

Telehealth (TH) solutions for Chronic Obstructive Pulmonary Disease (COPD) are promising behavioral therapeutic interventions and can help individuals living with COPD to improve their health status. The linking content, mechanism, and outcome of TH interventions reported in the literature related to COPD care are unknown. This paper aims to summarize the existing literature about structured TH solutions in COPD care. We conducted an electronic search of the literature related to TH solutions for COPD management up to October 2023. Thirty papers presented TH solutions as an innovative treatment to manage COPD. TH and digital health solutions are used interchangeably in the literature, but both have the potential to improve care, accessibility, and quality of life. To date, current TH solutions in COPD care have a variety of content, mechanisms, and outcomes. TH solutions can enhance education as well as provide remote monitoring. The content of TH solutions can be summarized as symptom management, prompt physical activity, and psychological support. The mechanism of TH solutions is manipulated by factors such as content, mode of delivery, strategy, and intensity. The most common outcome measures with TH solutions were adherence to treatment, health status, and quality of life. Implementing effective TH with a COPD care bundle must consider important determinants such as patient’s needs, familiarity with the technology, healthcare professional support, and data privacy. The development of effective TH solutions for COPD management also must consider patient engagement as a positive approach to optimizing implementation and effectiveness. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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20 pages, 1319 KiB

Open AccessReview

Promoting Universal Equitable Accessibility: An Overview on the Impact of Assistive Technology in the UN, UNICEF, and WHO Web Portals

by Rossella Simeoni, Antonia Pirrera, Paola Meli and Daniele Giansanti

Healthcare 2023, 11(21), 2904; https://doi.org/10.3390/healthcare11212904 - 05 Nov 2023

Viewed by 1030

Abstract

The number of people with disabilities and frailties who need support and assistance is increasing. Assistive technologies (ATs) are increasingly playing a central role in supporting people with disabilities and frailties. The study investigated the impact of the ATs on the websites of [...] Read more.

The number of people with disabilities and frailties who need support and assistance is increasing. Assistive technologies (ATs) are increasingly playing a central role in supporting people with disabilities and frailties. The study investigated the impact of the ATs on the websites of the UN, UNICEF, and WHO in terms of proposed activities and actions. The methodology proposed was based on two points of view: (1) A formal process to directly select elements in the institutional webs of the UN, UNICEF, and WHO. (2) A formal process for a complementary literature narrative review based on an umbrella review of Pubmed and Scopus. A standard checklist and a qualification process were applied. The outcome reported 35 documents from the direct search on the web and 19 systematic reviews for the complimentary literature overview. The direct search returned documents related to initiatives focused on the following: The tailoring of the ATs to a person based on international guidelines and specific monitoring initiatives of the AT introduction/access based on surveys both at the population and system/government level with the publication of the data/metadata in an observatory. Dissemination initiatives of both the culture of ATs (e.g., catalog, guidelines, reports, congresses) and of recommendations. The literature overview contributed more specifically to the use and effectiveness of categories of ATs. Both direct research and the literature overview have shown a consistent growth in interest in ATs. The initiatives of the UN, UNICEF, and WHO have been consistent with the institutional role and aimed at improving the diffusion of ATs through capillary monitoring, which is not free from obstacles, and a diffusion of the culture and rational use of ATs. The narrative review shows also the important role of research in monitoring the development, use, and effectiveness of devices, strategies, and support of international institutional initiatives. Important initiatives have been launched internationally on AT in terms of monitoring, dissemination, and improvement in access. However, it is necessary to consider and face the obstacles that limit these initiatives. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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17 pages, 751 KiB

Open AccessReview

Leveraging Motor Imagery Rehabilitation for Individuals with Disabilities: A Review

by Maram Fahaad Almufareh, Sumaira Kausar, Mamoona Humayun and Samabia Tehsin

Healthcare 2023, 11(19), 2653; https://doi.org/10.3390/healthcare11192653 - 29 Sep 2023

Cited by 2 | Viewed by 1109

Abstract

Motor imagery, an intricate cognitive procedure encompassing the mental simulation of motor actions, has surfaced as a potent strategy within the neuro-rehabilitation domain. It presents a non-invasive, economically viable method for facilitating individuals with disabilities in enhancing their motor functionality and regaining self-sufficiency. [...] Read more.

Motor imagery, an intricate cognitive procedure encompassing the mental simulation of motor actions, has surfaced as a potent strategy within the neuro-rehabilitation domain. It presents a non-invasive, economically viable method for facilitating individuals with disabilities in enhancing their motor functionality and regaining self-sufficiency. This manuscript delivers an exhaustive analysis of the significance of motor imagery in augmenting functional rehabilitation for individuals afflicted with physical impairments. It investigates the fundamental mechanisms governing motor imagery, its applications across diverse disability conditions, and the prospective advantages it renders. Moreover, this document addresses the prevailing obstacles and prospective trajectories in this sector, accentuating the necessity for continued investigation and the invention of cutting-edge technologies that optimize the potentiality of motor imagery in aiding disabled persons. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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17 pages, 1854 KiB

Open AccessReview

Artificial Intelligence Models in Health Information Exchange: A Systematic Review of Clinical Implications

by Sahar Borna, Michael J. Maniaci, Clifton R. Haider, Karla C. Maita, Ricardo A. Torres-Guzman, Francisco R. Avila, Julianne J. Lunde, Jordan D. Coffey, Bart M. Demaerschalk and Antonio J. Forte

Healthcare 2023, 11(18), 2584; https://doi.org/10.3390/healthcare11182584 - 19 Sep 2023

Cited by 1 | Viewed by 1645

Abstract

Electronic health record (EHR) systems collate patient data, and the integration and standardization of documents through Health Information Exchange (HIE) play a pivotal role in refining patient management. Although the clinical implications of AI in EHR systems have been extensively analyzed, its application [...] Read more.

Electronic health record (EHR) systems collate patient data, and the integration and standardization of documents through Health Information Exchange (HIE) play a pivotal role in refining patient management. Although the clinical implications of AI in EHR systems have been extensively analyzed, its application in HIE as a crucial source of patient data is less explored. Addressing this gap, our systematic review delves into utilizing AI models in HIE, gauging their predictive prowess and potential limitations. Employing databases such as Scopus, CINAHL, Google Scholar, PubMed/Medline, and Web of Science and adhering to the PRISMA guidelines, we unearthed 1021 publications. Of these, 11 were shortlisted for the final analysis. A noticeable preference for machine learning models in prognosticating clinical results, notably in oncology and cardiac failures, was evident. The metrics displayed AUC values ranging between 61% and 99.91%. Sensitivity metrics spanned from 12% to 96.50%, specificity from 76.30% to 98.80%, positive predictive values varied from 83.70% to 94.10%, and negative predictive values between 94.10% and 99.10%. Despite variations in specific metrics, AI models drawing on HIE data unfailingly showcased commendable predictive proficiency in clinical verdicts, emphasizing the transformative potential of melding AI with HIE. However, variations in sensitivity highlight underlying challenges. As healthcare’s path becomes more enmeshed with AI, a well-rounded, enlightened approach is pivotal to guarantee the delivery of trustworthy and effective AI-augmented healthcare solutions. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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15 pages, 315 KiB

Open AccessReview

Development and Use of Assistive Technologies in Spinal Cord Injury: A Narrative Review of Reviews on the Evolution, Opportunities, and Bottlenecks of Their Integration in the Health Domain

by Giovanni Morone, Antonia Pirrera, Antonio Iannone and Daniele Giansanti

Healthcare 2023, 11(11), 1646; https://doi.org/10.3390/healthcare11111646 - 04 Jun 2023

Cited by 3 | Viewed by 1465

Abstract

Assistive technologies are increasingly taking a leading role in supporting people with spinal cord injury (SCI). This narrative review of reviews intends to contribute by making a map point investigating the integration of ATs in SCI. The methodology of the review was based [...] Read more.

Assistive technologies are increasingly taking a leading role in supporting people with spinal cord injury (SCI). This narrative review of reviews intends to contribute by making a map point investigating the integration of ATs in SCI. The methodology of the review was based on: (I) a search of PubMed and Scopus and (II) an eligibility assessment using specific parameters. The outcome highlighted the following: -The evolution of ATs considered in the context of SCI, considering ATs as both products and/or services in standalone and/or networked devices, and as processes of delivery. -Innovative technologies could play an important role in improving the quality of life and in minimizing costs in healthcare. -The international scientific community has identified ATs as one of the six strategic development areas in SCI. The overview also allowed the detection of some problems: (I) The ethical and regulatory aspects have been addressed in a weak way and only in specific and limited cases. (II) There is a lack of studies on the use and applications of ATs in SCI with a focus in multiple domains (e.g., costs, acceptance, dissemination, problems, regulatory aspects, ethical aspects, and other issues important for integration into the health domain). This review highlights the need for further studies and activities focused on integrating consensus in multiple domains, including ethics and regulations, to aid researchers and decision-makers in the field. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

Other

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15 pages, 270 KiB

Open AccessPerspective

Telehealth Competencies: Training Physicians for a New Reality?

by Ilian Cruz-Panesso, Issam Tanoubi and Pierre Drolet

Healthcare 2024, 12(1), 93; https://doi.org/10.3390/healthcare12010093 - 31 Dec 2023

Viewed by 1338

Abstract

In North America, telehealth increased by 40% between 2019 and 2020 and stabilized at 40% in 2021. As telehealth becomes more common, it is essential to ensure that healthcare providers have the required skills to overcome the challenges and barriers of this new [...] Read more.

In North America, telehealth increased by 40% between 2019 and 2020 and stabilized at 40% in 2021. As telehealth becomes more common, it is essential to ensure that healthcare providers have the required skills to overcome the challenges and barriers of this new modality of care. While the COVID-19 pandemic has accelerated the design and implementation of telehealth curricula in healthcare education programs, its general adoption is still a major gap and an important barrier to ensuring scaling up and sustainability of the telesshealth practice. Lack of experienced faculty and limited curricular time are two of the most common barriers to expanding telehealth education. Overcoming the barriers of telehealth curricula implementation may require moving away from the classic expert model of learning in which novices learn from experts. As the adoption of telehealth curricula is still in its early stages, institutions may need to plan for faculty development and trainee education at the same time. Questions regarding the timing and content of telehealth education, the interprofessional development of curricula, and the identification of optimal pedagogical methods remain open and crucial. This article reflects on these questions and presents telesimulation as an ideal instructional method for the training of telehealth competencies. Telesimulation can provide opportunities for practical training across a range of telehealth competencies, fostering not only technical proficiency but also communication skills and interprofessional collaboration. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

20 pages, 3665 KiB

Open AccessSystematic Review

Efficacy and Safety of Respiratory Telerehabilitation in Patients with Long COVID-19: A Systematic Review and Meta-Analysis

by Andrés Calvache-Mateo, Alejandro Heredia-Ciuró, Javier Martín-Núñez, Sofía Hernández-Hernández, Gregory Reychler, Laura López-López and Marie Carmen Valenza

Healthcare 2023, 11(18), 2519; https://doi.org/10.3390/healthcare11182519 - 12 Sep 2023

Cited by 1 | Viewed by 1271

Abstract

The aim of this review was to identify, map, and synthesize the extent and nature of research activity on the use of telerehabilitation to support Long COVID-19 rehabilitation and examine the efficacy and safety of respiratory telerehabilitation in patients with Long COVID-19. A [...] Read more.

The aim of this review was to identify, map, and synthesize the extent and nature of research activity on the use of telerehabilitation to support Long COVID-19 rehabilitation and examine the efficacy and safety of respiratory telerehabilitation in patients with Long COVID-19. A systematic review and meta-analysis of randomized controlled trials were performed. We included controlled trials that tested the effect of respiratory telerehabilitation interventions in patients with Long COVID-19 versus no intervention, usual care, placebo, or face-to-face intervention. The data were pooled, and a meta-analysis was completed for quality of life, dyspnea, lung function, anxiety and depression, respiratory muscle strength, functional capacity, and lower limb strength. Finally, 10 studies were included. The meta-analysis results show significant differences in favor of respiratory telerehabilitation in quality of life (p = 0.02), dyspnea (p < 0.00001), respiratory muscle strength (p < 0.001), functional capacity (p < 0.0001), and lower limb strength (p = 0.01) but not in lung function (p = 0.28) and anxiety and depression (p = 0.55). In addition, there were no statistically significant differences in adverse effects (p = 0.06) between the telerehabilitation and comparator groups. The results suggest that these interventions can improve quality of life, reduce dyspnea, and increase respiratory and lower extremity muscle strength as well as functional capacity in patients with Long COVID-19. Full article

(This article belongs to the Special Issue The 10th Anniversary of Healthcare—TeleHealth and Digital Healthcare)

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