UNASSIGNED: An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance.
UNASSIGNED: This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals.
UNASSIGNED: Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69).
UNASSIGNED: The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

BACKGROUND: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD.
OBJECTIVE: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care.
METHODS: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses.
RESULTS: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non-study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as \"good\" or \"very good\" across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score).
CONCLUSIONS: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode.
BACKGROUND: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747.

UNASSIGNED: The COVID pandemic prompted an increase in the use of digital clinical consultations (telephone or video calls) within midwifery and nursing care. This paper reports on a realist review project related to maternity care that seeks to illuminate for whom such consultations can safely and acceptably be used, how, for what purposes and in what contexts.
UNASSIGNED: This paper addresses the first phase of a realist enquiry - initial programme theory development - focusing particularly on the role of stakeholder involvement (including digital transformation leaders, midwives, obstetricians, service users and community organisations).
UNASSIGNED: Three sub-stages of initial programme theory development are described highlighting the contribution of stakeholder groups to each stage: (i) consultation to focus the review question, (ii) focused searching and (iii) further consultation.
UNASSIGNED: Realist literature searching strategies yielded limited theory-rich evidence on digital consultations. Stakeholders provided essential additional contributions resulting in the development of 13 initial programme theories and a conceptual framework.
UNASSIGNED: More research on the implementation of virtual midwifery/nursing consultations is needed. Nursing/midwifery digital researchers should involve stakeholders to help shape research priorities, deepen contextual understanding and sense-check emerging findings.

UNASSIGNED: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood.
UNASSIGNED: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff\'s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery.
UNASSIGNED: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework.
UNASSIGNED: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families.
UNASSIGNED: In this qualitative study exploring health care staff\'s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.

BACKGROUND: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome.
OBJECTIVE: In this study, we aimed to understand the experience of the telehealth SICP from the clinician\'s perspective.
METHODS: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience.
RESULTS: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients\' values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience.
CONCLUSIONS: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships.
BACKGROUND: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676.

Falls are the leading cause of injury-related deaths among older adults and affect women at disproportionate rates. Dance has been used to improve postural stability, balance confidence and strength of older adults, but in-person classes are often inaccessible. This quasi-experimental pre-mid-post design study investigates whether 12 weeks of online dance classes can improve postural stability, dynamic balance and strength of women aged 65 plus. 16 participants (median=74 years, IQR=6) recruited via convenience sampling completed 12 weeks of twice weekly 75-minute online dance classes. In-person pre, mid and post assessments used 30-second trials of quiet standing, Star Excursion Balance Test, 30-second Sitto-Stand and Calf-Raise-Senior. Significance was evaluated using Friedman\'s test with Wilcoxon Signed-Rank test post-hoc (p≤.05). Participants demonstrated a high attendance rate (median=87.5, IQR=4.2%). Decreased mediolateral sway was observed pre-mid in eyes closed (p=.003, r=.76) and foam (p=.02, r=.60) conditions, where the latter also produced decreased sway area (p=.015, r=.63). Greater dynamic balance was demonstrated when reaching laterally (pre-mid p=.008, r=.68; pre-post p=.008, r=.69) and posterior-laterally (pre-post p=.009, r=.75). Participants significantly improved their number of repetitions on the Calf-Raise Senior (mid-post p=.02, r=.60; prepost p=.015, r=.63). Online dance classes are engaging, accessible and effective in decreasing older women\'s risk of falls and maintaining their independence.

Introduction: Post-COVID-19 is an increasing chronic disease for which potential treatment options require further development and examination. A well-established approach to symptom management in post-COVID-19 patients could be e-Health interventions. To enhance the implementation and utilization of e-Health interventions, the needs and demands of patients should be taken into consideration. The aim of this study was to investigate needs and demands of post-COVID-19 patients concerning e-Health symptom management interventions. Methods: A total of 556 patients participated in this cross-sectional online survey study. Recruitment was performed from January 19 to May 24, 2022. Data related to the needs and demands for e-Health interventions were analyzed, along with medical and sociodemographic information. Results: The majority of the patients preferred interventions accessible on smartphones (95.3%). The favored content formats were applications (82.7%), interactive training (69.3%), or audio and video materials (61.1%). Furthermore, the preferred session length was about 10-20 min. The most desired topics included \"quality of life,\" \"information about how intensively I may exert myself or do sports,\" \"adjustment to new life situation,\" and \"handling physical changes.\" Conclusions: This study provides a detailed framework for the content and design of e-Health interventions to support patients managing their post-COVID-19 symptoms. The findings could significantly influence the further development of tailored e-Health interventions to address this pressing global health concern.

BACKGROUND: Heart failure and type 2 diabetes are prevalent public health issues in Europe. These complex chronic conditions require extensive pharmacological management, ongoing self-care, and behavioral changes. Despite the known benefits of lifestyle changes, such as regular exercise and better control of blood sugar levels, patients may need help implementing the recommended changes. This study aims to assess the effectiveness of a telemedicine program for managing heart failure and type 2 diabetes at home. The program focuses on promoting lifestyle changes.
METHODS: During scheduled outpatient cardiology evaluations, eligible patients are recruited and randomly assigned to either an intervention or control group in a 1:1 ratio. The intervention group receives support from a nursing case manager through a structured home-based teleassistance program and a trainer for daily physical activity stimulation. They also have access to teleconsultations with cardiologists and diabetes specialists as needed, telemonitoring of vital signs, and daily step tracking. An app records and monitors daily drug treatment, glycemia, blood pressure, heart rate, and other clinical parameters. Patients can also self-report symptoms and communicate via a chat and videoconference system with a Nurse Case Manager. The control group receives routine care. Data collection occurs before intervention and 6 months after baseline during a new outpatient cardiology evaluation. The primary outcome is to measure the difference in the distance walked during a 6-min walk test between baseline and after 6 months. The key secondary outcomes include improving the disease status and physical activity profile. Data will be analyzed according to the intention-to-treat principles.
CONCLUSIONS: This study will provide evidence on the efficacy of a telemedicine home-based management model to maintain correct lifestyles in patients with both heart failure and type 2 diabetes, improving self-management, their empowerment on the diseases, and increasing their knowledge and ability to recognize symptoms early.
BACKGROUND: ClinicalTrials.gov NCT05633784. Registered on November 30, 2022.

BACKGROUND: Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution.
OBJECTIVE: This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes.
RESULTS: Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise.
CONCLUSIONS: Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

UNASSIGNED: To develop and evaluate Cochlear™ Remote Assist (RA), a smartphone-based cochlear implant (CI) teleaudiology solution. The development phase aimed to identify the minimum features needed to remotely address most issues typically experienced by CI recipients. The clinical evaluation phase assessed ease of use, call clarity, system latency, and CI recipient feedback.
UNASSIGNED: The development phase involved mixed methods research with experienced CI clinicians. The clinical evaluation phase involved a prospective single-site clinical study and real-world use across 16 clinics.
UNASSIGNED: CI clinicians (N = 23), CI recipients in a clinical study (N = 15 adults) and real-world data (N = 57 CI recipients).
UNASSIGNED: The minimum feature set required for remote programming in RA, combined with sending replacements by post, should enable the clinician to address 80% of the issues typically seen in CI follow-up sessions. Most recipients completed the RA primary tasks without prior training and gave positive ratings for usefulness, ease of use, effectiveness, reliability, and satisfaction on the Telehealth Usability Questionnaire. System latency was reported to be acceptable.
UNASSIGNED: RA is designed to help clinicians address a significant proportion of issues typically encountered by CI recipients. Clinical study and real-world evaluation confirm RA\'s ease of use, call quality, and responsiveness.