BACKGROUND AND OBJECTIVES: Enhanced Recovery After Surgery (ERAS) guidelines for Radical Cystectomy (RC) were published over ten years ago. Aim of this systematic review is to update ERAS recommendations for patients undergoing RC and to give an expert opinion on the relevance of each single ERAS item. METHODS: A systematic review was performed to identify the impact of each single ERAS item on RC outcomes. Embase and Medline (through Pubmed) were searched systematically. Relevant articles were selected and graded. For each ERAS item, a level of evidence was determined. An e-Delphi consensus was then performed amongst an international panel with renowned experience in RC to provide recommendations based on expert opinion. KEY FINDINGS AND LIMITATIONS: Preoperative medical optimization and avoiding bowel preparation are highly recommended. Robotic-assisted RC with intracorporeal urinary diversion is moderately recommended and can help in applying other ERAS items, such as early mobilization. Medical thromboprophylaxis should be administered and nasogastric tube should be removed at the end of surgery. Perioperative fluid restriction as well as opioid-sparing anesthesia protocols should be implemented. Generally, consensus was reached on most ERAS items, with the exception of epidural anesthesia (no consensus), resection site drainage (consensus against), and type of urinary drainage. Limitations include the lack of a multidisciplinary approach to the present consensus, giving however a highly specialized surgical opinion on ERAS. CONCLUSIONS: and clinical implications: The current study updates ERAS recommendations for patients undergoing RC and suggests application of ERAS by a panel of experts in the field.
- MeSH
- Early Ambulation MeSH
- Surgeons MeSH
- Cystectomy * methods MeSH
- Urinary Diversion methods MeSH
- Humans MeSH
- Urinary Bladder Neoplasms surgery MeSH
- Robotic Surgical Procedures MeSH
- Practice Guidelines as Topic MeSH
- Enhanced Recovery After Surgery * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Systematic Review MeSH
PURPOSE OF REVIEW: A critical evaluation of contemporary literature regarding the role of big data, artificial intelligence, and digital technologies in precision cardio-oncology care and survivorship, emphasizing innovative and groundbreaking endeavors. RECENT FINDINGS: Artificial intelligence (AI) algorithm models can automate the risk assessment process and augment current subjective clinical decision tools. AI, particularly machine learning (ML), can identify medically significant patterns in large data sets. Machine learning in cardio-oncology care has great potential in screening, diagnosis, monitoring, and managing cancer therapy-related cardiovascular complications. To this end, large-scale imaging data and clinical information are being leveraged in training efficient AI algorithms that may lead to effective clinical tools for caring for this vulnerable population. Telemedicine may benefit cardio-oncology patients by enhancing healthcare delivery through lowering costs, improving quality, and personalizing care. Similarly, the utilization of wearable biosensors and mobile health technology for remote monitoring holds the potential to improve cardio-oncology outcomes through early intervention and deeper clinical insight. Investigations are ongoing regarding the application of digital health tools such as telemedicine and remote monitoring devices in enhancing the functional status and recovery of cancer patients, particularly those with limited access to centralized services, by increasing physical activity levels and providing access to rehabilitation services. SUMMARY: In recent years, advances in cancer survival have increased the prevalence of patients experiencing cancer therapy-related cardiovascular complications. Traditional cardio-oncology risk categorization largely relies on basic clinical features and physician assessment, necessitating advancements in machine learning to create objective prediction models using diverse data sources. Healthcare disparities may be perpetuated through AI algorithms in digital health technologies. In turn, this may have a detrimental effect on minority populations by limiting resource allocation. Several AI-powered innovative health tools could be leveraged to bridge the digital divide and improve access to equitable care.
- Publication type
- Journal Article MeSH
Obezita je chronické, relabující a progredující onemocnění s rostoucí prevalencí, které významně ovlivňuje zdraví a kvalitu života i u dětí. Je spojena se zvýšeným rizikem metabolických a kardiovaskulárních onemocnění, jako je inzulinová rezistence, diabetes mellitus 2. typu, hypertenze, dyslipidémie a metabolicky asociovaná steatóza jater. Obezita dále může vést k rozvoji syndromu spánkové apnoe, ortopedickým a psychickým komplikacím. Základem terapie je edukace zdravého životního stylu celé rodiny, která však často naráží na překážky, jako jsou časová náročnost, omezená dostupnost specialistů a nízká dlouhodobá adherence rodin. Telemedicína nabízí inovativní přístup ke zlepšení léčby obezity dětí prostřednictvím digitálních nástrojů, online konzultací, chytrých aplikací a nositelných technologií. Umožňuje efektivnější monitorování stravovacích a pohybových návyků, podporu psychického zdraví i snížení časové a finanční zátěže pro rodiny. Výsledky studií ukazují, že kombinace prezenční a distanční podpory a aktivní zapojení rodinných příslušníků vede k vyšší úspěšnosti v redukci tělesné hmotnosti a udržení zdravého životního stylu. Článek se zaměřuje na využití telemedicíny v léčbě obezity u dětí, přehled metod, které byly v této oblasti aplikovány, a jejich účinnost v kontextu současných vědeckých poznatků.
Obesity is a chronic, relapsing, and progressive disease with increasing prevalence, that significantly impacts health and quality of life, even in children. It is associated with an increased risk of metabolic and cardiovascular diseases such as insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease. Additionally, obesity can lead to the development of sleep apnea syndrome, orthopedic issues, and psychological complications. The cornerstone of the care is educating the whole family about a healthy lifestyle; however, this may often be challenging due to obstacles such as time constraints, limited access to specialists, and low long-term adherence of families. Telemedicine offers an innovative approach to improving obesity treatment in children through digital tools, online consultations, smart applications, and wearable technologies. It enables more effective monitoring of dietary and physical activity habits, supports mental health, and reduces time and financial burdens for families. Studies indicate that combining in-person and remote support, along with active involvement of family members, leads to higher success rates in weight reduction and a healthy lifestyle maintenance. This article focuses on the use of telemedicine in the treatment of obesity in children, providing an overview of the methods applied in this field and their effectiveness in the context of current scientific knowledge.
- MeSH
- Child MeSH
- Humans MeSH
- Pediatric Obesity * therapy MeSH
- Motor Activity MeSH
- Psychosocial Intervention methods MeSH
- Preventive Health Services methods MeSH
- Feeding Behavior psychology MeSH
- Telemedicine * MeSH
- Life Style MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
BACKGROUND: Type 2 diabetes and prediabetes represent significant global health challenges, with physical activity (PA) being essential for disease management and prevention. Despite the well-documented benefits, many individuals with (pre)diabetes remain insufficiently active. General practitioners (GP) provide an accessible platform for delivering interventions; however, integrating PA interventions into routine care is hindered by resource constraints. OBJECTIVES: The ENERGISED trial aims to address these barriers through an innovative GP-initiated mHealth intervention combining wearable technology and just-in-time adaptive interventions. METHODS: The ENERGISED trial is a pragmatic, 12-month, multicentre, randomised controlled trial, assessing a GP-initiated mHealth intervention to increase PA and reduce sedentary behaviour in patients with type 2 diabetes and prediabetes. The primary outcome is daily step count, assessed via wrist-worn accelerometry. The primary analysis follows the intention-to-treat principle, using mixed models for repeated measures. Missing data will be handled under the missing-at-random assumption, with sensitivity analyses exploring robustness through reference-based multiple imputation. The trial incorporates the estimand framework to provide transparent and structured treatment effect estimation. DISCUSSION: This statistical analysis plan outlines a robust approach to addressing participant non-adherence, protocol violations, and missing data. By adopting the estimand framework and pre-specified sensitivity analyses, the plan ensures methodological rigour while enhancing the interpretability and applicability of results. CONCLUSIONS: The ENERGISED trial leverages innovative mHealth strategies within primary care to promote PA in individuals with (pre)diabetes. The pre-specified statistical framework provides a comprehensive guide for analysing trial data and contributes to advancing best practices in behavioural intervention trials for public health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05351359 . Registered on April 28, 2022.
- MeSH
- Accelerometry MeSH
- Exercise * MeSH
- Diabetes Mellitus, Type 2 * therapy psychology diagnosis MeSH
- Fitness Trackers MeSH
- Humans MeSH
- Multicenter Studies as Topic MeSH
- Wearable Electronic Devices MeSH
- Pragmatic Clinical Trials as Topic MeSH
- General Practice * methods MeSH
- Prediabetic State * therapy psychology diagnosis MeSH
- Sedentary Behavior * MeSH
- Telemedicine * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial Protocol MeSH
BACKGROUND: Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes. OBJECTIVE: This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management. METHODS: In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden. RESULTS: Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03). CONCLUSIONS: This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management. TRIAL REGISTRATION: German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.
- MeSH
- Diabetes Mellitus, Type 2 * blood therapy MeSH
- Adult MeSH
- Glycated Hemoglobin analysis MeSH
- Middle Aged MeSH
- Humans MeSH
- Mobile Applications * MeSH
- Self Care MeSH
- Self-Management MeSH
- Aged MeSH
- Telemedicine MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
Telemedicína již dávno nepředstavuje revoluční přístup k poskytování zdravotní péče, naopak se v posledních letech stále více integruje do různých medicínských oborů, včetně pediatrie. Rychlý technologický pokrok a rostoucí potřeba efektivní a dostupné zdravotní péče vedou k rozšíření telemedicínských řešení, jež umožňují lékařům a pacientům komunikovat a spolupracovat na dálku. V oblasti pediatrie přináší telemedicína nejen nové možnosti diagnostiky a sledování dětí, ale také usnadňuje přístup ke specializované péči, což je obzvláště významné v odlehlých regionech nebo v případě centralizovaných specializovaných pracovišť. Tento článek se zaměřuje na přehled aktuálních možností využití telemedicíny v pediatrii, její přínosy, omezení a výzvy spojené s implementací do každodenní klinické praxe.
Telemedicine is no longer considered a revolutionary approach to delivering healthcare; rather, it has increasingly integrated into various medical fields, including pediatrics, in recent years. Rapid technological advancements and the growing demand for efficient and accessible healthcare have driven the expansion of telemedicine solutions, enabling physicians and patients to communicate and collaborate remotely. In pediatrics, telemedicine not only introduces new possibilities for diagnosis and monitoring but also facilitates access to specialized care, which is particularly important in remote regions or for centralized specialized facilities. This article provides an overview of the current applications of telemedicine in pediatrics, highlighting its benefits, limitations, and the challenges associated with its implementation in everyday clinical practice.
- MeSH
- Chronic Disease MeSH
- Child Psychiatry methods organization & administration MeSH
- Child MeSH
- Health Services Accessibility organization & administration MeSH
- Humans MeSH
- Pediatrics * instrumentation MeSH
- Telemedicine * MeSH
- Pediatric Dentistry organization & administration MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
- Geographicals
- Czech Republic MeSH
Klimatické změny vedou v posledních letech k prodloužení pylové sezóny, respektive k jejímu časnějšímu začátku. Mobilní aplikace umožnují dnes pacientům monitorovat aktuální pylovou situaci, zaznamenávat vlastní klinické obtíže a lépe dodržovat compliance k léčbě. Klinické projevy pylové alergie zahrnují nejčastěji alergickou rhinokonjunktivitidu. V příspěvku zmiňuji zásady symptomatické farmakoterapie alergické rýmy a kauzální léčbu - specifickou alergenovou imunoterapii.
Pollen season lasts longer because of its earlier start due to recent climate changes. Mobile apps enable pollen monitoring, help patients describe their clinical symptoms, and improve compliance with therapy. Allergic rhinoconjunctivitis is the most frequent clinical symptom. This paper provides info about symptomatic pharmacotherapy as well as about causal treatment- about specific allergen immunotherapy.
- MeSH
- Allergens adverse effects therapeutic use MeSH
- Hypersensitivity * etiology drug therapy MeSH
- Histamine H1 Antagonists therapeutic use MeSH
- Administration, Intranasal MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Immunotherapy methods MeSH
- Consumer Health Informatics methods MeSH
- Internet MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Mobile Applications MeSH
- Pollen adverse effects MeSH
- Rhinitis, Allergic, Seasonal * etiology drug therapy MeSH
- Check Tag
- Humans MeSH
BACKGROUND: Mobile health (mHealth) is increasingly being used in contemporary health care provision owing to its portability, accessibility, ability to facilitate communication, improved interprofessional collaboration, and benefits for health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, especially as care settings extend beyond traditional center-based technology usage to home-based care. OBJECTIVE: This study aimed to explore health care professionals' perspectives on the safety aspects of mHealth integration in real-world service provision, focusing on Hong Kong Special Administrative Region (SAR) and Wuhan city in mainland China. In Hong Kong SAR, real-world mHealth care provision is largely managed by the Hospital Authority, which has released various mobile apps for home-based care, such as Stoma Care, Hip Fracture, and HA Go. In contrast, mHealth care provision in Wuhan is institutionally directed, with individual hospitals or departments using consultation apps, WeChat mini-programs, and the WeChat Official Accounts Platform (a subapp within the WeChat ecosystem). METHODS: A multicenter qualitative study design was used. A total of 27 participants, including 22 nurses and 5 physicians, from 2 different health care systems were interviewed individually. Thematic analysis was used to analyze the data. RESULTS: The mean age of the participants was 32.19 (SD 3.74) years, and the mean working experience was 8.04 (SD 4.05) years. Most participants were female (20/27, 74%). Nearly half of the participants had a bachelor's degree (13/27, 48%), some had a master's degree (9/27, 33%), and few had a diploma degree (3/27, 11%) or a doctoral degree (2/27, 7%). Four themes emerged from the data analysis. Considering the current uncertainties surrounding mHealth implementation, participants emphasized "liability" concerns when discussing patient safety. They emphasized the need for "change management," which includes appropriate referral processes, adequate resources and funding, informed mHealth usage, and efficient working processes. They cautioned about the risks in providing mHealth information without ensuring understanding, appreciated the current regulations available, and identified additional regulations that should be considered to ensure information security. CONCLUSIONS: As health care systems increasingly adopt mHealth solutions globally to enhance both patient care and operational efficiency, it becomes crucial to understand the implications for patient safety in these new care models. Health care professionals recognized the importance of patient safety in making mHealth usage reliable and sustainable. The promotion of mHealth should be accompanied by the standardization of mHealth services with institutional, health care system, and policy-level support. This includes fostering mHealth acceptance among health care professionals to encourage appropriate referrals, accommodate changes, ensure patient comprehension, and proactively identify and address threats to information security.
- MeSH
- Patient Safety * MeSH
- Adult MeSH
- Qualitative Research MeSH
- Humans MeSH
- Mobile Applications MeSH
- Telemedicine * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- China MeSH
- Hong Kong MeSH
Capillary and microchip electrophoresis plays an important role in the analysis of the chemical composition of plants and nutrient soils, which finds applications in plant physiology, agrochemistry, medicine, toxicology and food science. Electrophoretic methods are used to determine minerals such as nutrients, heavy metal ions, primary and secondary metabolites, herbicides, phytohormones, peptides, proteins and extracellular vesicles. Progress is particularly evident in the following topics: i) development of mobile electrophoretic analysers for field-based monitoring of soil mineral supply, ii) direct analysis of xylem sap without sample treatment, iii) coupling of capillary and microchip electrophoresis with mass spectrometry for comprehensive metabolome and proteome characterization, iv) determination of secondary metabolites as biologically active compounds with a range of therapeutic and toxicological effects, v) monitoring of herbicides and their degradation dynamics, vi) research on plant exudates, extracellular vesicles and specific protein interactions.
- MeSH
- Electrophoresis, Capillary methods MeSH
- Herbicides analysis MeSH
- Mass Spectrometry MeSH
- Plants * chemistry metabolism MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
