Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 5 Articles
Background and Objectives: Artificial intelligence (AI) and extended reality (XR) are increasingly being integrated into telemedicine, yet clinician adoption depends not only on perceived utility but also on digital preparedness and technology-related burden. This study compared clinician acceptance of AI-only, XR-only, and combined AI+XR telemedicine scenarios and examined whether AI literacy, health literacy, technostress, age, and sex explained variability in acceptance. Materials and Methods: We conducted a cross-sectional, anonymous online vignette survey among 117 resident physicians and nurses from a tertiary-care hospital and affiliated outpatient clinics in Western Romania. Participants evaluated three randomized telemedicine scenarios (AI-only, XR-only, and AI+XR) using a 3-item Acceptance Index scored from 1 to 4. Additional measures included a studydeveloped AI literacy quiz, the Romanian-validated HLS-EU-Q16, an adapted brief technostress scale, prior AI/XR exposure, perceived accessibility, perceived value, privacy concern, and demographic variables. Results: Acceptance was highest for the combined AI+XR scenario (3.74 ± 0.49), followed by AI-only (3.64 ± 0.56) and XR-only (3.49 ± 0.64). AI+XR acceptance was significantly higher than AI-only and XR-only acceptance (both p < 0.001), although the absolute between-scenario differences were modest. Residents reported consistently higher acceptance than nurses across all scenarios, whereas sex differences were small and non-significant; younger age showed only weak inverse associations with acceptance. AI+XR acceptance correlated positively with AI literacy (ρ = 0.60) and health literacy (ρ = 0.23), and negatively with technostress (ρ = −0.47). In multivariable analysis, higher AI literacy (β = 0.603, p < 0.001) and health literacy (β = 0.241, p < 0.001) independently predicted higher AI+XR acceptance, whereas technostress was inversely associated (β = −0.212, p < 0.001). Conclusions: In this sample, clinicians rated the integrated AI+XR vignette most favorably, but the observed differences between scenarios should be interpreted cautiously and as hypothesis-generating rather than definitive evidence of superiority. Acceptance appeared to depend more on digital readiness and technostress than on age or sex, supporting implementation strategies focused on literacy-building, workflow fit, and burden reduction....
Background/Objectives: Digital twin technology has attracted growing attention in orthopedics for its potential to support patient-specific modeling, simulation, and data-driven clinical decision-making. However, despite the rapid growth in the literature, clinical adoption remains limited, and the term “digital twin” is often applied inconsistently to fundamentally different technological approaches. To establish a clear, function-oriented definition and taxonomy of digital twins in orthopedics, to map current applications across subspecialties, and to critically assess the level of clinical evidence supporting their use. Methods: A structured narrative review was conducted using targeted searches of major bibliographic databases (PubMed,Web of Science, Scopus), publisher platforms, and complementary semantic search tools. The retrieved literature was interpreted using a functional analytical framework focusing on patient specificity, data integration, intended clinical role, and degree of clinical validation. Rather than conducting a formal, systematic appraisal, the aim was to provide a concept-driven synthesis of the field and identify patterns of use, maturity, and translational limitations. Results: Most reported orthopedic digital twin implementations appear to represent static patient-specific simulations supported primarily by preclinical or feasibility-level evidence. Monitoring-oriented digital twins have been more commonly reported in spine care, rehabilitation, and sports medicine, enabling longitudinal assessments but offering limited predictive or decision-support value. Decision-oriented digital twins are uncommon, yet they seem to be the most clinically mature type described in the current literature; so far, only one randomized controlled trial has demonstrated improved decision quality in arthroplasty care. Fully integrated hybrid or closed-loop digital twins remain largely experimental. Conclusions: Digital twin technology in orthopedics is characterized by substantial conceptual heterogeneity and limited clinical validation. Near-term clinical impact is most likely to arise from narrowly focused, decision-oriented, and monitoring-based digital twins, although this projection remains dependent on further clinical validation. Greater definitional clarity, functional transparency, and rigorous clinical evaluation are essential to support meaningful translation into routine orthopedic practice....
Smartphone-based portable slit lamp microscopes are increasingly used as low-cost tools for anterior segment imaging in teleophthalmology, yet the literature combines heterogeneous study designs, comparator standards, and deployment contexts. Because the evidence base spans engineering reports, basic science, clinical validation studies, implementation research, and case-based telemedicine, we structured a narrative review rather than a pooled meta-analysis. We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, Cochrane Library, ScienceDirect, and DOAJ for literature available on or before 28 February 2026, supplemented by manual reference list screening and targeted retrieval of relevant technical standards. Peer-reviewed English original studies formed the core evidence base; contextual non-English and gray literature sources were retained only when explicitly labeled as non-core. To improve interpretability, the results were grouped by synthesis domain, clinical task, comparator standard, telemedicine scenario, and artificial intelligence (AI) dataset/validation characteristics. The highest-confidence evidence concerned nuclear cataract grading, tear film breakup time and corneal staining assessment, anterior chamber depth screening, tear meniscus height measurement, allergic conjunctival grading, and selected corneal disorders. Agreement with conventional slit lamp examination or anterior segment optical coherence tomography was generally moderate to high within task-specific comparisons, and telemedicine deployment was feasible for screening, follow-up, remote consultation, emergency triage, house visits, and outreach. However, illumination reporting remains inconsistent, explicit ISO-aligned dosimetry is sparse, and most AI studies remain retrospective, single-center, and device family-specific. Current evidence, therefore, supports smartphone-based portable slit lamp microscopes primarily as adjunctive teleophthalmology tools rather than replacements for comprehensive in-clinic microscopy. The synthesis clarifies where conclusions are supported by comparative validation data, where they remain exploratory, and which methodological gaps should be prioritized in future multicenter studies....
Background/Objectives: Teledermoscopy may improve melanoma triage by accelerating specialist review and compressing the time to definitive treatment, but its clinical relevance depends on whether faster access is accompanied by detection at a less advanced stage. This study compared teledermoscopy-assisted and conventional referral pathways for cutaneous melanoma as a pathway-level service evaluation. Methods: In this singlecenter observational cohort, 87 patients with histologically confirmed primary cutaneous melanoma were analyzed, including 43 managed through teledermoscopy-assisted referral and 44 through a conventional pathway. Primary outcomes were time from referral to dermatology consultation, biopsy, and definitive excision. Secondary outcomes included Breslow thickness, mitotic rate, ulceration, stage distribution, early-stage disease, and selected pathway-quality indicators. Results: Teledermoscopy-assisted referral was associated with shorter median times to consultation (9.0 vs. 18.7 days), biopsy (16.6 vs. 30.3 days), and excision (26.9 vs. 43.2 days), all p < 0.001. Patients in the teledermoscopy group had lower Breslow thickness (0.7 vs. 1.5 mm, p < 0.001), lower mitotic rate (1.2 vs. 2.9 mitoses/mm2, p < 0.001), a higher proportion of stage 0/I melanoma (79.1% vs. 40.9%; risk ratio 1.93, 95% CI 1.31–2.85), and fewer lesions with Breslow > 2.0 mm (9.3% vs. 36.4%; risk ratio 0.26, 95% CI 0.09–0.70). Conclusions: In this non-randomized cohort, teledermoscopy-assisted referral was associated with faster melanoma care and a more favorable stage profile at excision. Because pathway assignment was not randomized and lesion-level referral urgency was incompletely measured, these findings should be interpreted as associations that support further prospective evaluation rather than as proof of causal stage migration....
Background: Arterial hypertension is one of the most prevalent chronic non-communicable diseases and a leading cause of cardiovascular morbidity and mortality worldwide. Its burden remains particularly high in rural and resource-limited settings, where access to healthcare is often constrained by shortages of healthcare professionals, geographical barriers, and underdeveloped infrastructure. These factors may contribute to delayed diagnosis, suboptimal disease control, and increased risk of complications. In this context, telemedicine has emerged as a useful approach to supporting hypertension management and improving access to care in rural populations. Methods: This study presents a narrative review of the literature focusing on the application of telemedicine in the management of arterial hypertension in rural populations. A structured literature search of PubMed, Scopus, and Web of Science databases was conducted for studies published between 2015 and 2025. The review included randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating telemedicine interventions, including remote blood pressure monitoring, mobile health applications, and teleconsultations. Study selection was guided by relevance to the research objective, with particular attention to rural and resource-limited contexts. Results: Telemedicine interventions have been associated with improvements in blood pressure control, treatment adherence, and access to healthcare services. Evidence from randomized controlled trials and meta-analyses suggests modest reductions in systolic and diastolic blood pressure compared with standard care. However, a substantial proportion of the available evidence originates from studies conducted in general or mixed populations rather than exclusively rural settings. Therefore, the applicability of these findings to rural contexts remains limited and should be interpreted with caution. The effectiveness of telemedicine may vary depending on differences in healthcare infrastructure, resource availability, digital accessibility, and organizational models across healthcare systems. Integrated care approaches involving primary healthcare providers and specialist support may contribute to improved continuity of care, although their impact appears to be context-dependent. Key barriers include limited telecommunication infrastructure, digital literacy challenges, and difficulties in integrating telemedicine into routine clinical practice. Conclusions: Telemedicine may represent a useful approach to supporting hypertension management in rural populations. However, its implementation requires careful consideration of local healthcare systems, patient characteristics, and organizational context. Telemedicine should be viewed as a context-dependent strategy rather than a uniform solution. Further context-specific research is needed to evaluate the long-term clinical, organizational, and economic impact of telemedicine interventions in rural hypertension management....
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