Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background/Objectives: Neck pain is a complex biopsychosocial condition that affects a significant proportion of the global population. Projections indicate that over the next 30 years, cervical pain will impact approximately 269 million individuals, positioning it as one of the primary drivers of healthcare expenditure and system burden worldwide. While exercise is a key approach for neck pain, the effectiveness and cost-effectiveness of treatments delivered remotely remain underexplored. The aim of this study is to analyse the cost-effectiveness and cost-utility of the treatment of non-specific neck pain through a telerehabilitation programme based on cervical exercise and analgesic electrotherapy. Methods: This is a study protocol for an economic evaluation based on a randomised controlled trial (RCT) with a sample size of 210 participants (N = 210). The sample will be evenly divided into two groups to perform the same cervical exercise programme combined with electroanalgesia: one group will receive the intervention via telerehabilitation, and the other will receive the intervention face-to-face. Three sessions will be held per week for eight weeks for a total of 24 sessions. Demographic and clinical data of the participants, healthcare resource utilisation, and associated costs will be collected. Assessments will be carried out throughout the study: before the first session (baseline), at 8 weeks (postintervention), and 6 months after completion of the treatment (follow-up). Discussion: This study will make a significant contribution to reducing costs and improving the treatment of patients with non-specific chronic neck pain. The social perspective associated with economic evaluation will enable the investigation of indirect costs such as work absenteeism or expenses borne by the patient, providing useful data to optimise planning and decisionmaking in the healthcare sector....
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....
Background: Medicare annual wellness visits (AWVs) are vital for older adults' preventive care, which was transitioned to telehealth modalities during COVID- 19. This study examined primary care providers' perceptions of telehealth- delivered AWVs and explored the factors influencing telehealth implementation using the Practical Robust Implementation and Sustainability Model (PRISM). Participants and Setting: Twenty- five primary care providers from eight clinics within an integrated health system in the Midwestern United States were interviewed. Eligibility required having conducted at least one telehealth AWV for patients aged 65 or older between March 2023 and October 2023. Methods: Semi- structured interviews lasting 30–45 min were conducted using purposeful sampling. Topics aligned with PRISM domains were addressed: program (telehealth utilization), recipient (organizational characteristics), external environment, and implementation infrastructure. Data were analyzed using NVivo software, using inductive and deductive thematic coding. Results: Providers described telehealth AWV as flexible, convenient, and efficient. Benefits included shorter visit durations and the ability to observe patients' home environments. Challenges included difficulty conducting cognitive and mobility assessments, limitations in physical exams, and managing patients with hearing or visual impairments without caregiver support. Most providers did not perceive language as a major barrier, particularly for Spanish- speaking patients (Program domain). Providers noted that limited internet, device access, and lack of community technology support, especially in underserved areas, hindered telehealth use. They also emphasized the importance of maintaining reimbursement parity between telehealth and in- person visits (External Environment). Providers reported minimal formal training and inconsistent access to telehealth- equipped rooms, though support from colleagues and workflow adaptations helped address these limitations (Implementation Infrastructure). Staff support, particularly through pre- visit coordination, technical troubleshooting, and patient preparation, was crucial in implementing telehealth (Recipient). Conclusion: This study provided valuable insights into the implementation of telehealth AWVs and underscored the importance of organizational support for sustainable telehealth practices in primary care settings....
Background/Objectives: Early melanoma management depends on rapid triage and definitive treatment. Image-enabled teledermatology, particularly teledermoscopy, may accelerate pathways without compromising safety. This review evaluated effects on timeliness, diagnostic performance, and initial prognostic severity at diagnosis. Methods: Following a preregistered PRISMA-2020 protocol, PubMed/MEDLINE, Embase, and Scopus were searched from inception to 1 September 2025. Comparative clinical studies and service evaluations reporting melanoma-specific outcomes were eligible. Dual screening, duplicate data extraction, and risk-of-bias appraisal were performed; substantial clinical and methodological heterogeneity precluded quantitative meta-analysis, so findings were synthesized narratively. Results: Twelve studies met criteria. Front-end intervals consistently shortened: time to expert advice was ≈1 day and median time to first clinic was reduced by ~10 days versus conventional referral. Downstream milestones showed mixed translation, with time to excision and histology in several programs remaining ≈45–67 days, indicating capacity constraints beyond triage. Diagnostic safety was high where quantified: melanoma triage sensitivity approached ~99% with a false-negative rate near ~1.1%, and positive predictive value for suspected-melanoma referrals was ~45–50% in mature services. Selected observational comparisons suggested a ≈0.6 mm lower mean Breslow thickness and ~13-percentage-point higher in situ/T1 proportion in one TD network, although these findings are susceptible to selection and lead-time bias and are not consistent across all settings. Overall, teledermoscopy functioned as a “front-door accelerator,” with pathway gains being largest before surgical and pathology steps. Conclusions: Teledermatology/ teledermoscopy reliably compresses referral-to-decision intervals and maintains high triage safety, with indications of stage migration toward thinner tumors at diagnosis. Integrating surgical and pathology capacity is essential to convert early advice into earlier definitive treatment....
Background: Dementia is a growing concern in Sub‐Saharan Africa (SSA), particularly Nigeria, where care is hindered by weak infrastructure, stigma, and limited culturally responsive services. Telemedicine offers promise but faces adoption challenges in low‐resource settings. Objective: To evaluate digital interventions for dementia care in SSA and examine how culturally tailored telemedicine is shaped by stakeholder input, it may reduce caregiver burden and improve care delivery. Methods: Following PRISMA guidelines, 1650 records were screened: across PubMed, Scopus, PsycINFO, and Google Scholar; 20 studies met inclusion criteria. Thematic analysis identified trends across intervention types, populations, and barriers. Results: Five core themes emerged: barriers to care (30%), telemedicine opportunities (25%), stakeholder involvement (23%), cultural influences (20%) and technological feasibility (17%). Mobile health tools showed potential when culturally adapted. However, poor infrastructure, digital literacy and traditional beliefs constrained adoption. Engaging caregivers, clinicians and community leaders improved solution relevance and uptake. Conclusions: Culturally informed, co‐designed telemedicine models can strengthen dementia care delivery in SSA, stakeholder‐driven digital models may serve as a scalable blueprint for other low‐resource contexts. Patient or Public Contribution: This review incorporated studies that engaged patients, informal caregivers, clinicians, policymakers and community leaders in the codesign and implementation of digital dementia care tools. Their lived experiences and cultural insights informed the development of interventions that are not only technologically feasible but also socially and “culturally appropriate”....
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