In Japan, Emergency Life-Saving Technicians (ELSTs) cannot independently perform diagnostic ultrasound under the current legal framework. If ELST-performed focused assessment with sonography for trauma (FAST) is to be introduced in the prehospital setting, technical feasibility during ambulance motion and the viability of remote physician observation must be established.

The study aimed to evaluate the feasibility of ELST-performed FAST in moving ambulances in a controlled manikin setting and to descriptively assess an integrated monitoring system for remote observation.

A prospective observational pilot study was conducted at the Okayama City Fire Department Training Center in Okayama Prefecture, Japan on March 3, 2025. Twenty ELSTs completed structured e-learning and a hands-on workshop using standardized FAST/ER FAN manikins. Participants performed FAST under three fixed-order conditions: stationary (STOP), 15km/hour, and 30km/hour on a 250-m circular course. The primary outcome was the total Task-Specific Checklist (TSC) score (0-24 points). Secondary outcomes were examination time, site-specific TSC subscores, inter-rater agreement, and a descriptive assessment of transmitted image quality by two specialist physicians.

All 20 ELSTs completed the study. Mean total TSC scores were 23.4 (SD = 0.8) in the STOP condition, 23.4 (SD = 0.9) at 15km/hour, and 23.7 (SD = 0.6) at 30km/hour. Compared with the STOP condition, the mean difference in total TSC score was 0.08 points (95% CI, −0.24 to 0.39; P for noninferiority < 0.001) at 15km/hour and 0.33 points (95% CI, −0.04 to 0.69; P for noninferiority < 0.001) at 30km/hour. Both moving conditions met the pre-specified noninferiority criterion relative to the STOP condition. Mean examination times were 36.7 (SD = 14.4) seconds in the STOP condition, 30.3 (SD = 9.8) seconds at 15km/hour, and 31.9 (SD = 14.8) seconds at 30km/hour. Inter-rater agreement for TSC scoring was moderate (weighted kappa, 0.56). Descriptive ratings suggested that transmitted image quality was generally favorable for remote review in this controlled setting.

In this controlled manikin-based pilot study, ELST-performed FAST was technically feasible during moderate ambulance motion, and remote physician observation was feasible. These findings may help inform staged prehospital ultrasound training and future clinical validation under legal and operational constraints.

Hybrid care is increasingly used for chronic disease management, yet how patients are allocated to these modalities in routine practice remains poorly understood.

To characterize baseline factors associated with physician-driven allocation to hybrid versus in-person care and examine three-year clinical outcomes.

This retrospective observational cohort included adults with hypertension, type 2 diabetes, and/or dyslipidemia enrolled in a programme in Alma Mater Hospital of Antioquia, Medellín, Colombia (2019–2025). Care modality was determined by treating physicians. Associations between baseline clinical, functional–behavioural, and psychosocial characteristics, care allocation, and follow-up outcomes were examined using logistic regression and interpreted as associational rather than causal.

Among 638 participants (319 hybrid; 319 in-person), higher baseline glycated haemoglobin (HbA1c) (adjusted odds ratio [aOR] 2.68 per 1% increase; 95% CI 2.17–3.31) and inadequate medication adherence (aOR 1.96; 95% CI 1.17–3.28) were associated with hybrid care allocation, whereas higher educational attainment was inversely associated (middle vs low: aOR 0.43; 95% CI 0.25–0.72; high vs low: aOR 0.19; 95% CI 0.10–0.33). A strong gradient was observed in the secondary complexity analysis. Hybrid care was associated with higher three-year therapeutic goal attainment (OR 7.34; 95% CI 4.96–10.86) and lower chronic disease-related emergency department utilization (OR 0.53; 95% CI 0.36–0.79).

Hybrid care allocation was systematically associated with baseline clinical and contextual characteristics. Outcome differences should be interpreted cautiously given clinician-driven allocation and baseline differences.

Advanced Parkinson disease (APD) is often under-recognized, which may delay treatment optimization and referral for device-aided therapy assessment. Machine learning-enabled remote monitoring systems (ML-RMS) may support earlier recognition of progression, but their value depends on whether alerts lead to clinical action and patient benefit.

We developed a Markov model comparing standard care with ML-RMS-supported care from the Finnish health care perspective. The model simulated persons with Parkinson disease at risk of APD over 16 years. The base case assumed ML-RMS sensitivity and specificity of 88 percent and 62 percent. Costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios, and incremental net monetary benefit were estimated. Scenario and probabilistic sensitivity analyses explored diagnostic accuracy, monitoring costs, direct quality-of-life effects, deep brain stimulation (DBS) costs, pathway timing, and delayed nursing home admission.

In the base case, ML-RMS generated 0.0044 additional QALYs at an additional cost of €761 per patient, resulting in an incremental cost-effectiveness ratio of €172,023 per QALY gained. At a willingness-to-pay threshold of €35,000 per QALY, the incremental net monetary benefit was negative. Scenario analyses indicated that ML-RMS could become cost-effective if active monitoring produced direct quality-of-life gains or delayed nursing home admission.

ML-RMS is unlikely to be economically favorable if limited to earlier APD recognition and timely DBS treatment in a small eligible subgroup. Its value depends on whether monitoring changes care pathways, improves patient outcomes, or reduces long-term care needs. Future studies should prioritize clinical utility, quality-of-life effects, treatment decisions, and institutional care.

Telestroke allows rapid assessment of acute stroke patients for intravenous thrombolysis and endovascular thrombectomy (EVT). While its safety and efficacy for thrombolysis are well established, evidence regarding EVT decision-making via telestroke is scarce.

We analysed data from Optimising Patient Treatment In Major Ischaemic Stroke with EVT (OPTIMISE), an EVT registry of Canadian comprehensive stroke centres. We compared unadjusted time metrics and procedural outcomes between patients treated with EVT evaluated via telestroke and those evaluated without telestroke. A primary analysis included all EVT cases, and a sub-analysis focused on patients transferred from another centre. Mixed-effects logistic regression, adjusted for relevant clinical and radiological confounders, was used to assess symptomatic intracerebral haemorrhage (sICH), good functional outcome and all-cause mortality.

Between 2018 and 2021, a total of 6803 patients received EVT across 20 centres. Patients receiving telestroke consultation had longer onset-to-EVT centre door time and onset-to-groin puncture time. In unadjusted analyses, telestroke patients had higher sICH proportions (6.5% vs. 3.1%), lower proportions of good functional outcomes (35.6% vs. 40.6%) and higher all-cause mortality (39.9% vs. 27.5%) compared to those not receiving telestroke consultation. These differences did not persist in adjusted analyses. The sub-analysis with multivariate adjustment restricted to transferred patients also revealed no differences in outcomes between the two groups.

Patients evaluated with telestroke prior to EVT had longer treatment times than those not evaluated with telestroke. The higher risk for unfavourable outcomes did not persist after adjustment for confounders. There remains a strong need to optimise the delivery of EVT for patients evaluated at telestroke centres.

Digital testing is being regularly used in neuropsychological research. However, critical questions remain regarding its psychometric robustness, availability, and usability, potentially limiting its clinical impact.

This systematic review focused on the characteristics of digital tools for assessing attention and executive functions (EFs), two cognitive domains particularly suitable for being digitally tested. A systematic search was performed across three electronic databases (PubMed, Scopus, Embase). We only included studies performed on adults with validated tools.

Of 2,583 identified records, 236 studies met the inclusion criteria. From those, we extracted information about 107 distinct digital tools, ranging from computerized versions of traditional paper-and-pencil tests to emerging technologies such as virtual reality and eye-tracking hybrid systems. Most tools were administered in person (85%), while only 12% involved remote unsupervised assessment. Information on licensing, normative data, or source code availability was reported for approximately one-third of tools (34.9%). Most operated under paid licensing models, and only 6.5% were freely accessible. Only one had also source code available.

Several tools are available for assessing attention and EFs; however, most are not widely used. We discuss an imbalance between accessibility and validity whereby standardized batteries are often commercial and not necessarily more validated than less commonly adopted free-access tools. The limited validation of emerging technologies currently prevents their broader implementation. Overall, distinct digital tools offer complementary strengths rather than a single optimal solution. More standardized validation approaches and broader adoption of Open Science practices might support their integration into routine clinical practice.

Bystander cardiopulmonary resuscitation (CPR) has been shown to be associated with increased rates of survival from non-traumatic out-of-hospital cardiac arrest (OHCA). GoodSAM is a platform integrated into the computer-assisted dispatch system. The software allows the telecommunicator to send a link to the caller’s smart phone. Once activated, the telecommunicator can see and hear the patient, and obtain breathing and heart rates using the camera and microphone on the caller’s phone. The telecommunicator can use the platform to identify cardiac arrest and provide real-time compression feedback. It was hypothesized that telecommunicator use of video telecommunication would be associated with increased rates of pre-arrival CPR.

This was a retrospective review of all cardiac arrest resuscitations performed from July 2021 through February 2022 in the San Antonio Fire Department (SAFD) Emergency Medical Services (EMS) system – the seventh largest city in the United States. Data source was the Office of the EMS Medical Director (OMD) Cardiac Arrest Registry. Inclusion criteria included cardiac arrests for which resuscitation was attempted. Exclusion criteria were cardiac arrest was witnessed by EMS personnel, or missing data. Dataset included: location of arrest, presumed etiology of the arrest, if dispatch CPR instructions were given; caller compliance; type of CPR performed; who witnessed the arrest; and who performed the CPR prior to EMS. Patients were dichotomized as to whether video telecommunication was used by the paramedic telecommunicator. A case was recorded as having received pre-arrival CPR if the initial CPR was performed by anyone other than the responding unit.

A total of 779 cases were included in the study. Primary outcome, in the cases where video telecommunication was utilized, 46/74 (62%) received pre-arrival CPR, versus 324/705 (46%) without the use of video telecommunication, with an overall difference of 16.2% (95% CI, 4.6% to 27.9%; P = .008). When using video telecommunication, a larger proportion of the persons performing pre-arrival CPR were family members when compared to the cases where video telecommunication was not used (35% versus 17%).

Using video telecommunication to perform paramedic clinical dispatch telemedicine was associated with an increased rate of pre-arrival CPR. Further research will be required to show outcome-related results to determine if dispatch video and audio telemedicine can be used to increase survival in patients suffering OHCA.

Access to quality healthcare is often limited in rural and underserved areas, leading to higher rates of preventable diseases, avoidable hospitalizations, and mortality. Virtual health clinics, utilizing telehealth and telemedicine technologies, offer a promising solution to bridge these gaps. This scoping review aimed to systematically identify and analyze the benefits, outcomes, and service range of virtual clinics in remote and underserved settings.

This scoping review was conducted following Arksey and O’Malley’s six-stage framework. Relevant literature was searched in PubMed, Web of Science, Scopus, Google, and Google Scholar. Data were extracted using a standardized charting form and thematically analyzed using Braun and Clarke’s method with MAXQDA software.

A total of 38 benefits of virtual clinics were identified, primarily related to improved access to health services, reduced costs, and decreased patient travel. In the domain of governance and leadership, enhanced governmental support and optimal resource allocation were reported. For human resources, improved communication and training were emphasized. Moreover, the use of local technologies, remote medication ordering, and digital record-keeping demonstrated a significant impact, particularly in middle- and high-income countries.

Virtual clinics can effectively enhance the quality and accessibility of health services in underserved areas and play an important role in reducing health inequities.

To evaluate the impact of telemedicine on the workload of primary care physicians (PCPs).

Telemedicine, including video visits, telephone visits, and digital correspondence, is increasingly offered by physicians, particularly since the COVID-19 pandemic. It is still unclear whether increasing the variety of services creates an increase in demand and therefore causes an increase in the workload of PCPs. In this study.

A population-based descriptive study, conducted during the 2020–2021 period, on a cohort of 464,119 patients, all members of Leumit Health Services and without a diagnosis of COVID-19. The patients were stratified into three distinct groups based on the nature of their healthcare visits: Patients who used only face-to-face (FTF) visits; Patients who used asynchronous visits with or without FTF visits but did not use synchronous telemedicine visit; and patients who used synchronous telemedicine visits with or without other types of visits. We performed a comparative analysis on Accumulated Annual Duration of Time (AADT) as an index for workload, across the different periods, using standard descriptive statistics methods.

Telemedicine use was higher in older persons, females, those of higher socioeconomic status, and patients with comorbidities. The greater the number of telemedicine visits, the greater the time the PCP spent on visits during the year. The largest increase in AADT (56.1%) was observed in patients who had only FTF meetings in 2020 but in 2021 made all types of visits. Overall, there was an increase of 2.5% in time invested in 2021 and a 5.8% increase in the number of patients making digital visits.

Policymakers encouraging telemedicine should consider the additional load on PCPs associated with telemedicine use and plan resources accordingly.

Test educational interventions to increase the quality of care in telemedicine.

Telemedicine (TM) has become an essential tool to practise medicine around the world. However, education to address clinical skills in TM remains an area of need globally across the health professions. We aim to evaluate the impact of a pilot online learning platform (OLP) and standardized coaching programme on the quality of medical student TM clinical skills.

A randomized pilot study was conducted with fourth-year medical students (n = 12). All participants engaged in video-recorded standardized patient (SP) simulated encounters to assess TM clinical skills before and after the intervention. Participants were randomized to either the OLP or OLP + Virtual Coaching Institute (VCI) intervention cohort. Quantitative and qualitative data were collected to address self-reported skills, attitudes, and self-efficacy before the 1st SP encounter and after the 2nd SP encounter. SP encounter recordings were scored by two blinded non-investigator raters based on a standardized rubric to measure the change in TM care delivered pre- and post-intervention. Statistical analysis of quantitative data included descriptive statistics and mixed effects ANOVA.

Recruitment and retention of participants exceeded expectations, pointing to significant enthusiasm for this educational opportunity. Self-reported skills and scored simulation skills demonstrated significant improvements for all participants receiving the interventions. Both OLP and VCI interventions were well received, feasible, and demonstrated statistically significant efficacy in improving TM clinical skills. Participants who received coaching described more improvements in self-efficacy, confidence, and overall virtual clinical skills. This study provides evidence that virtualized clinical learning environments can positively impact the development of TM clinical skills among medical students. As TM continues to evolve, the implementation of innovative training approaches will be crucial in preparing the next generation of healthcare professionals for the demands of modern healthcare delivery.