BACKGROUND: The evaluation of digital tools for measuring self-reported symptoms in children and adolescents undergoing cancer treatment is a critical area of research with significant implications for clinical practice and patient outcomes.
OBJECTIVE: This study aims to identify, evaluate, and summarize evidence on digital tools that enable self-reported symptom assessment and management for pediatric oncology patients.
METHODS: Seven academic databases, including PubMed, Cochrane Library, Scopus, Web of Science, CINAHL, and Medline (OVID), were searched systematically from inception until February 28, 2024. Inclusion criteria were the following: (a) study subjects were pediatric oncology patients and young adults, (b) using digital tools, (c) self-report symptom assessment and management, (d) employed either qualitative or quantitative study design, (e) written in English (f) published in peer-reviewed journals. This is a systematic review, and its protocol was registered in PROSPERO (ID: CRD42024528285). The study was conducted following the PRISMA statement.
RESULTS: Twenty-seven studies were included in this systematic review. All included studies were conducted to develop digital tools for assessing and managing the symptoms. Eight of these studies focused only on the pain; three were only for nausea and vomiting, one for nausea, and the other 15 for all symptoms. The studies\' quality ranged from low to high, with overall scores ranging between 4 and 24 out of 28.
CONCLUSIONS: It shows that studies have generally focused on developing digital tools to address pain, nausea, vomiting, and other symptoms commonly experienced by pediatric oncology patients. While the quality of the included studies ranged from low to high, the overall findings show promise for the effectiveness and usability of these digital tools for symptom assessment and management in pediatric oncology care.

As technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings, and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalizing existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with the reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice, and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility, and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use, and lack of organizational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomized controlled trials are warranted to provide objective evidence of tool efficacy.

Rare neurological diseases as a whole share peculiar features as motor and/or cognitive impairment, an elevated disability burden, a frequently chronic course and, in present times, scarcity of therapeutic options. The rarity of those conditions hampers both the identification of significant prognostic outcome measures, and the development of novel therapeutic approaches and clinical trials. Collection of objective clinical data through digital devices can support diagnosis, care, and therapeutic research. We provide an overview on recent developments in the field of digital tools applied to rare neurological diseases, both in the care setting and as providers of outcome measures in clinical trials in a representative subgroup of conditions, including ataxias, hereditary spastic paraplegias, motoneuron diseases and myopathies.

This is a scoping review on mapping the use of digital tools to assess food consumption in Brazil. Searches were carried out in nine electronic databases (Medline, Lilacs, Scopus, Embase, Web of Science, Science Direct, Ovid, Free Medical Journal and Crossref) to select studies published from October 2020 to December 2023. This review identified forty-eight digital tools in the 94 publications analyzed, the most frequent being web-based technologies (60%) and mobile devices (40%). Among these studies, 55% (n = 52) adopted a population-based approach, while 45% (n = 42) focused on specific regions. The predominant study design observed was cross-sectional (n = 63). A notable trend observed was the increasing frequency of validation studies in recent years. Although the use of digital tools in the assessment of food consumption in Brazil has grown in recent years, studies did not describe the process of creating and validating the tools, which would contribute to the improvement of data quality. Investments that allow the expansion of the use of the internet and mobile devices; the improvement of digital literacy; and the development of open-access tools, especially in the North and Northeast regions, are challenges that require a concerted effort towards providing equal opportunities, fostering encouragement, and delving deeper into the potential of digital tools within studies pertaining to food consumption in Brazil.

BACKGROUND: Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents\' SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents.
OBJECTIVE: We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally.
METHODS: This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews.
RESULTS: Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization).
CONCLUSIONS: This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents\' SRH and will incorporate a range of published sources.
UNASSIGNED: DERR1-10.2196/55081.

Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence-across all conditions and technology types-on DHT measurement of patient outcomes in the real world.
We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data.
We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines.
The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time.
This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry.
Open Science Framework 5TMKY; https://osf.io/5tmky/.

Effectiveness of health professionals\' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of polysomnography, the gold standard.
This study aimed to identify, gather, and analyze the most accurate digital tools and smartphone-based health platforms used for OSA screening or diagnosis in the adult population.
We performed a comprehensive literature search of PubMed, Scopus, and Web of Science databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies. The sensitivity, specificity, and area under the curve (AUC) were used as discrimination measures.
We retrieved 1714 articles, 41 (2.39%) of which were included in the study. From these 41 articles, we found 7 (17%) smartphone-based tools, 10 (24%) wearables, 11 (27%) bed or mattress sensors, 5 (12%) nasal airflow devices, and 8 (20%) other sensors that did not fit the previous categories. Only 8 (20%) of the 41 studies performed external validation of the developed tool. Of these, the highest reported values for AUC, sensitivity, and specificity were 0.99, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI)≥30. These values correspond to a noncontact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the studies that only internally validated their models, the work that reported the highest accuracy measures showed AUC, sensitivity, and specificity values of 1.00, 100%, and 96%, respectively, for a clinical cutoff AHI≥30. It uses the Sonomat-a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and uses it to classify OSA events.
These clinical tools presented promising results with high discrimination measures (best results reached AUC>0.99). However, there is still a need for quality studies comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in clinical settings.
PROSPERO CRD42023387748; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387748.

BACKGROUND: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive.
OBJECTIVE: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases.
METHODS: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute\'s criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review.
RESULTS: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis.
CONCLUSIONS: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon.

UNASSIGNED: Although digital decision aids (DAs) have been developed to improve shared decision-making (SDM), also in the cardiovascular realm, its implementation seems challenging. This study aims to systematically review the predictors of successful implementation of digital DAs for cardiovascular diseases.
UNASSIGNED: Searches were conducted in MEDLINE, Embase, PsycInfo, CINAHL, and the Cochrane Library from inception to November 2021. Two reviewers independently assessed study eligibility and risk of bias. Data were extracted by using a predefined list of variables. Five good-quality studies were included, involving data of 215 patients and 235 clinicians. Studies focused on DAs for coronary artery disease, atrial fibrillation, and end-stage heart failure patients. Clinicians reported DA content, its effectivity, and a lack of knowledge on SDM and DA use as implementation barriers. Patients reported preference for another format, the way clinicians used the DA and anxiety for the upcoming intervention as barriers. In addition, barriers were related to the timing and Information and Communication Technology (ICT) integration of the DA, the limited duration of a consultation, a lack of communication among the team members, and maintaining the hospital\'s number of treatments. Clinicians\' positive attitude towards preference elicitation and implementation of DAs in existing structures were reported as facilitators.
UNASSIGNED: To improve digital DA use in cardiovascular diseases, the optimum timing of the DA, training healthcare professionals in SDM and DA usage, and integrating DAs into existing ICT structures need special effort. Current evidence, albeit limited, already offers advice on how to improve DA implementation in cardiovascular medicine.