Corinne H. Miller

Background: Patient-reported outcomes (PROs) are collected in some multiple sclerosis (MS) care settings, yet their uses in MS clinical care are unclear. Objectives: To determine how PROs are used in MS clinical care and gain insights into instruments, purposes, facilitators/barriers, and impact. Methods: Scoping review of studies reporting PRO use in MS clinical practice (January 2012–June 2025) across seven electronic databases. Results: Of 6797 records screened, 21 articles (10 countries; 43 instruments) met review criteria. Frequently assessed domains were health-related quality of life (48%), depression (43%), and fatigue (29%). Electronic collection predominated (57%), yet only 38% integrated PROs with electronic health records (EHRs). Purposes included program evaluation (33%), secondary analysis (24%), collection methods (19%), and quality improvement (14%). While 48% reported process or system-level changes, only 29% documented clinical actions triggered by PRO data. Facilitators included brief measures, delegation to non-physician staff, and EHR integration. Barriers included low physician review, lack of response protocols, and absent auditing. Conclusions: Articles on PROs in MS care are sparse. No consistent uses and purposes were found. Advancing meaningful PRO use requires response protocols, actionable thresholds, clinician accountability, and routine auditing of PRO-guided decisions.

Background: Digital health tools are increasingly vital in rural health care due to widespread hospital closures and the rapid adoption of telehealth during the COVID-19 pandemic. Rural older adults, a uniquely vulnerable population, face barriers to accessing these tools due to rurality and usability challenges. Although a growing body of literature examines the acceptability and usability of digital tools among rural older adults, no study has synthesized this research to establish best practices. Objective: This study aims to review existing literature on digital health tools for rural older adults, highlighting key lessons learned about their acceptability and identifying strategies to improve usability for this population. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, this study reviewed literature that investigated the role of digital health tools on the health outcomes of rural older adults (ie, at least 60 years old). The literature was retrieved from 5 electronic databases through June 2023. This study and all reviewed literature were conducted in the United States. Guided by a systematic process, 2 reviewers assessed relevant articles for eligibility, analyzed data, and extracted relevant content. The extracted findings were organized according to the evidence-based technology acceptance model, which assesses the acceptability of a technology by its usefulness, ease of use, and intention to use. Results: The preliminary title review produced 7728 results, and 38 eligible manuscripts were included in the final review. Studies included both rural older adults and providers of rural older adults as participants. Digital health tools included, but were not limited to, videoconferencing, phone calls, telehealth monitoring, telemedicine appointments, and computer-based interventions. Findings on the usefulness of digital health tools by rural older adults were mixed. While digital health tools were useful for overcoming barriers to accessing care, these tools were less useful for rural older adults with limited digital literacy. Additionally, some studies described that the technology was easy but difficult to use when faced with environmental barriers, equipment issues, and discomfort with the technology. Rural older adults often reported an intention to use the technology after the study. Yet, on a few occasions, participants who preferred in-person care visits or did not have buy-in on the technology reported no intention to use the technology again. Conclusions: Our review highlights that rural older adults and their providers generally view digital health tools as acceptable for delivering care and, in some cases, as a viable alternative to in-person clinic visits. While certain barriers impacted the acceptance of these tools among rural older adults, many of these challenges were not directly linked to their age or rural location; thus, they are potentially applicable to urban older adults. Trial Registration: PROSPERO CRD42021287924; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021287924

Background: Digital health interventions (DHIs) offer major potential for improving cardiovascular disease (CVD) primary and secondary prevention, but their adoption by healthcare providers (HCPs) remains inconsistent. Objective: To identify barriers and facilitators to DHI uptake in CVD primary and secondary prevention from HCPs’ perspectives. Methods: We conducted a systematic review of studies published between 2020 and 2024 that investigated HCPs’ perceptions of DHI implementation for CVD primary and secondary prevention. We appraised individual study quality using a validated tool. We performed a qualitative synthesis of reported barriers and facilitators, categorized according to country income level and according to the World Heart Federation Roadmap domains: HCPs, patients, technology, and health systems. Results: We included 125 primary studies (101 qualitative, 15 quantitative, 9 mixed methods). The most frequently cited barrier was excessive workload, both from existing responsibilities and additional tasks introduced by DHIs. The leading facilitator was the perceived positive clinical impact of DHIs—such as improved adherence, reduced hospital readmissions, and better outcomes. HCP motivation, adequate training, and system integration also facilitated adoption. Many factors—like effects on HCP-patient relationships and workflow—functioned as either barriers or facilitators, depending on the setting. Patient-related barriers included limited digital access and literacy; facilitators included perceived gains in patient-centered care. Health system factors such as organizational structure, financing, and policy support were commonly mentioned, with mixed views. Technology-related facilitators included usability, adaptability, and integration with electronic records; instability was a key barrier. Conclusions: This is the first systematic review to synthesize post-COVID-19 literature on HCPs’ perceptions of DHIs in CVD primary and secondary prevention. While offering a rich, global overview, limitations include a predominance of qualitative studies and lack of data from low-income countries. Effective implementation must address workload, align with workflows, and build trust through training and leadership. LAY SUMMARY This research analyzed 125 studies from 33 countries to understand the factors that influence healthcare professionals’ uptake of digital health tools, such as apps and wearable devices, for preventing cardiovascular disease. The leading facilitator for adoption is the perceived positive clinical impact; doctors and nurses are highly motivated to use digital tools when they help patients follow treatments better, reduce hospital readmission rates, and improve overall heart health. The most significant barrier is the perceived excessive workload. While some digital health tools can be time-saving, many providers feel that they add burdensome technical tasks to their already busy schedules, which undermines their acceptance. Uptake is also influenced by patient-related factors, such as digital literacy and internet access, as well as technological factors like how easily a tool integrates into existing hospital computer systems. To improve the future of cardiovascular care, digital tools should be co-designed with clinicians to ensure they fit seamlessly into daily work routines and are supported by proper training and strong institutional leadership.

Objective This scoping review aims to identify change ideas and implementation strategies that support CPAP use for eligible newborns (Introduction Continuous Positive Airway Pressure (CPAP) is a well-established and effective treatment for neonates with respiratory distress syndrome (RDS), widely used to prevent respiratory failure in small and sick infants across different settings. Yet, its timely and appropriate use remains inconsistent due to persisting obstacles to access and implementation, particularly in sub-Saharan Africa. Gaps in CPAP coverage related to challenges in device availability, functionality and delivery continue to hinder the provision of optimal care to vulnerable newborns. While the barriers have been widely documented, few literature reviews have systematically explored tangible strategies aimed at overcoming these barriers. Inclusion criteria This review includes articles involving preterm and term neonates (Methods This scoping review follows the Joanna Briggs Institute methodology and uses the Population–Concept–Context framework to guide inclusion criteria. This protocol is published a priori in alignment with PROSPERO guidelines. Searches were conducted in MEDLINE (via PubMed), Embase (via Elsevier), and CINAHL (via EBSCOhost) in August 2025, with no date limits and English-language restriction. The search strategy was peer-reviewed using the PRESS 2015 guideline. Reference lists of included studies will be screened for additional sources. Article selection will be performed independently by two reviewers using Rayyan, with discrepancies resolved by consensus or a third reviewer. Full-text screening will apply predefined inclusion criteria, and reasons for exclusion will be documented. Data extraction will be conducted using a piloted form developed by the review team, capturing facility and participant characteristics, implementation strategies/change ideas, context, and CPAP-related use outcomes. No critical appraisal will be performed, consistent with JBI guidance on scoping reviews. Results will be presented narratively and in tabular format, with a PRISMA-ScR flow diagram summarizing the selection process.

BACKGROUND Digital health tools are increasingly vital in rural health care due to widespread hospital closures and the rapid adoption of telehealth during the COVID-19 pandemic. Rural older adults, a uniquely vulnerable population, face barriers to accessing these tools due to rurality and usability challenges. Although a growing body of literature examines the acceptability and usability of digital tools among rural older adults, no study has synthesized this research to establish best practices. OBJECTIVE This study aims to review existing literature on digital health tools for rural older adults, highlighting key lessons learned about their acceptability and identifying strategies to improve usability for this population. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, this study reviewed literature that investigated the role of digital health tools on the health outcomes of rural older adults (ie, at least 60 years old). The literature was retrieved from 5 electronic databases through June 2023. This study and all reviewed literature were conducted in the United States. Guided by a systematic process, 2 reviewers assessed relevant articles for eligibility, analyzed data, and extracted relevant content. The extracted findings were organized according to the evidence-based technology acceptance model, which assesses the acceptability of a technology by its usefulness, ease of use, and intention to use. RESULTS The preliminary title review produced 7728 results, and 38 eligible manuscripts were included in the final review. Studies included both rural older adults and providers of rural older adults as participants. Digital health tools included, but were not limited to, videoconferencing, phone calls, telehealth monitoring, telemedicine appointments, and computer-based interventions. Findings on the usefulness of digital health tools by rural older adults were mixed. While digital health tools were useful for overcoming barriers to accessing care, these tools were less useful for rural older adults with limited digital literacy. Additionally, some studies described that the technology was easy but difficult to use when faced with environmental barriers, equipment issues, and discomfort with the technology. Rural older adults often reported an intention to use the technology after the study. Yet, on a few occasions, participants who preferred in-person care visits or did not have buy-in on the technology reported no intention to use the technology again. CONCLUSIONS Our review highlights that rural older adults and their providers generally view digital health tools as acceptable for delivering care and, in some cases, as a viable alternative to in-person clinic visits. While certain barriers impacted the acceptance of these tools among rural older adults, many of these challenges were not directly linked to their age or rural location; thus, they are potentially applicable to urban older adults. CLINICALTRIAL PROSPERO CRD42021287924; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021287924

Introduction Deficits in decision-making (DM) can lead to adverse outcomes across multiple domains such as financial management and medical care. By hindering such DM abilities, cognitive impairment (CI) often affects quality of life. Routine screening for CI, however, does not include systematic and comprehensive assessment of DM ability. While there are many DM measures, there is considerable heterogeneity in what constructs are measured and the populations in which they have been validated. This scoping review protocol details the proposed comprehensive examination of published literature on DM measures used in adults aged 45 years and older. Methods and analysis Arksey and O’Malley’s (2005) scoping review methodology framework will guide the current scoping review. We will systematically search Embase (Elsevier), MEDLINE (Ovid), PsycINFO (Ebsco), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) to identify the studies meeting our eligibility criteria. We will review literature published between January 2018 and November 2023. Following best practice recommendations, a two-stage study selection process will be applied. First, titles and abstracts will be independently reviewed by two reviewers based on our eligibility criteria. Second, full texts will be screened and data will be extracted only from the articles included after the full review. The results of the current scoping review will be reported in adherence to PRISMA-Scr guidelines. Ethics and dissemination This study does not require ethics approval as the scoping review methodology involves reviewing results from publicly available published materials. Results of the scoping review will be submitted for publication in a peer-reviewed journal. Trial registration number NIA grant number 1U24AG082022-01.

Objective: To synthesize the methodologies of studies that evaluate the impacts of heat exposure on morbidity and mortality. Methods: Embase, MEDLINE, Web of Science, and Scopus were searched from date of inception until 1 March 2023 for English language literature on heat exposure and health outcomes. Records were collated, deduplicated and screened, and full texts were reviewed for inclusion and data abstraction. Eligibility for inclusion was determined as any article with climate‐related heat exposure and an associated morbidity/mortality outcome. Results: Of 13,136 records initially identified, 237 articles were selected for analysis. The scope of research represented 43 countries, with most studies conducted in China (62), the USA (44), and Australia (16). Across all studies, there were 141 unique climate data sources, no standard threshold for extreme heat, and 200 unique health outcome data sources. The distributed lag non‐linear model (DLNM) was the most common analytic method (48.1% of studies) and had high usage rates in China (68.9%) and the USA (31.8%); Australia frequently used conditional logistic regression (50%). Conditional logistic regression was most prevalent in case‐control studies (5 of 8 studies, 62.5%) and in case‐crossover studies (29 of 70, 41.4%). DLNMs were most common in time series studies (64 of 111, 57.7%) and ecological studies (13 of 20, 65.0%). Conclusions: This review underscores the heterogeneity of methods in heat impact studies across diverse settings and provides a resource for future researchers. Underrepresentation of certain countries, health outcomes, and limited data access were identified as potential barriers.