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Postoperative rehabilitation after knee surgery is crucial for functional recovery, but traditional in-person methods can impose burdens on patients, particularly those with mobility limitations or living remotely. Telerehabilitation, leveraging digital platforms, offers a potential alternative, yet its comparative efficacy and acceptability remain debated, especially across surgery types. This study aims to evaluate whether telerehabilitation improves postoperative rehabilitation satisfaction and efficacy compared to traditional methods for patients undergoing knee joint surgery. Six databases (Web of Science, PubMed, MEDLINE, ScienceDirect, Embase, and Cochrane Library) were searched from inception to September 27, 2025. Eligibility criteria included randomized controlled trials (RCTs) comparing telerehabilitation with traditional rehabilitation in adult patients undergoing postoperative knee surgery, reporting patient satisfaction and/or efficacy outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 1 tool (developed by the Cochrane Collaboration). Data were synthesized using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method for CIs, reporting standardized mean differences or mean difference, τ2 (between-study variance), τ (between-study SD), and prediction intervals (PIs) where applicable. Heterogeneity was assessed with τ2, τ, and PIs. Certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. In total, 19 randomized controlled trials were included. Overall, patient satisfaction showed no significant difference between telerehabilitation and traditional rehabilitation (standardized mean difference [SMD] 0.15, 95% CI -0.48 to 0.78; P=.48; τ2=0.30; τ=0.55; PI=-1.17 to 1.47). Subgroup analysis revealed lower satisfaction with synchronous telerehabilitation (k=4 included studies; SMD -0.52, 95% CI -1.02 to -0.02; P=.04; τ2=0.17; τ=0.41) and higher with asynchronous (k=6 included studies; SMD 0.56, 95% CI 0.08-1.03; P=.02; τ2=0.30; τ=0.55). Telerehabilitation showed significant improvements on total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; k=4; SMD -0.76, 95% CI -1.38 to -0.14; P=.02; τ2=0.08; τ=0.29; PI=-1.85 to 0.33), Knee Injury and Osteoarthritis Outcome Score (KOOS; k=5; SMD 0.58, 95% CI 0.47-0.70; P=.01; τ2=0; τ=0; PI=0.36-0.80), timed-up-and-go (TUG) test (k=4; mean difference [MD]=-2.73 seconds, 95% CI -4.50 to -0.96; P=.04; τ2=1.14; τ=1.07; PI=-7.17 to 1.72) and knee extension range (k=3; MD=9.64°, 95% CI 6.89-12.39; P=.049; τ2=2.45; τ=1.56; PI=0.60-18.68). The pooled average effects suggest that telerehabilitation is noninferior to traditional care for patient satisfaction on average and may improve pain and function and some objective measures. However, bootstrapped PIs and between-study variability indicate that effects vary by context, so implementation should therefore be individualized with attention to modality, patient digital literacy, and technical support. Targeted trials with standardized measures are recommended to increase certainty and narrow the expected distribution of effects.

Patients with tracheal diseases often require long-term follow-up after tracheal device placement, with a risk of adverse events that may lead to emergency care and unplanned interventions. Telemedicine has been proposed as an alternative to in-person follow-up to improve access and continuity of care. The primary objective was to compare the need for emergency department visits between telemedicine and in-person groups. Secondary objectives included comparing hospital readmissions, 30-day hospital readmissions, and unplanned interventions between groups. This retrospective, single-institution study included adult patients with tracheal devices who underwent telemedicine and in-person outpatient clinic visits between 2020 and 2024. To balance the groups, we used 1:1 propensity score matching. We collected demographic and clinical data and evaluated the need for emergency department visits, hospital readmissions, 30-day hospital readmissions, and unplanned interventions. Kaplan-Meier estimation of time to first emergency department visit was performed to assess outcomes after outpatient visits. A total of 483 patients (277 telemedicine and 206 in-person) underwent 2487 visits (1258 telemedicine and 1229 in-person). After propensity score matching, 336 patients remained (168 in each group). There were no significant differences in the need for emergency department visits, hospital readmissions, or unplanned interventions. Telemedicine group had significantly fewer 30-day hospital readmissions (OR = 0.38; 95% CI = 0.16-0.87; p = 0.021). Kaplan-Meier analysis indicated no statistically significant difference in emergency department-free visits. Telemedicine follow-up was associated with outcomes comparable to those of in-person follow-up in this cohort of adult patients with tracheal devices, with no evidence of an increased need for emergency department visits. In the matched analysis, telemedicine was associated with lower odds of 30-day hospital readmission.

Postoperative anxiety following voluntary medical male circumcision (VMMC) poses a significant health challenge, with limited telemedicine access and inadequate communication compromising recovery and adherence. Narrative-based interventions have shown promise in reducing psychological distress in other contexts, and large language models may enable automated follow-up, but their role in VMMC care remains underexplored. We evaluated the effect of a narrative-enhanced tool (NET) on anxiety, sleep quality, quality of life, and pain management and identified risk factors for postoperative anxiety. We also assessed the feasibility of an artificial intelligence-assisted consultation (AAC) system in improving follow-up efficiency. From October 1, 2023, to April 29, 2024, patients aged ≥15 years undergoing VMMC were recruited and randomized 1:1 to a standardized risk tool (SRT) or NET group. In addition to the routine postoperative communication, the NET group received a narrative video highlighting positive recovery experiences. Both groups accessed an AAC chatbot for automated follow-ups. Primary outcomes were anxiety levels measured by the 7-item Generalized Anxiety Disorder scale (GAD-7), sleep quality measured by Pittsburgh Sleep Quality Index, quality of life measured by 3-level EuroQoL 5D questionnaire, and pain levels measured by Numerical Rating Scale. Secondary outcomes included analgesic use, satisfaction, and health care worker efficiency. Repeated measures ANOVA assessed trends and regression identified risk factors for anxiety. Between October 1, 2023, and April 29, 2024, 671 eligible participants were enrolled, with 388 completing the 30-day follow-up (SRT group: n=189, mean age 26.21, SD 3.69 years; NET group: n=199, mean age 26.41, SD 3.56 years; P=.60). Both groups exhibited increased anxiety levels, diminished quality of life, and poorer sleep quality during the 30-day postoperative period. However, compared to SRT, the NET group demonstrated lower GAD-7 scores (7.06, SD 2.73 vs. 9.95, SD 3.50; P<.001), improved sleep quality (12.29, SD 3.57 vs 13.20, SD 3.54; P=.01), higher quality of life scores (0.87, SD 0.07 vs 0.84, SD 0.09; P<.001), more regular analgesic use (154/173, 89.02% vs 100/169, 59.17%; P<.001), reduced opioid consumption (5/173, 2.89% vs 25/169, 14.79%; P<.001), and higher pain medication satisfaction (4.21, SD 0.69 vs 3.76, SD 0.97; P<.001). Multivariate analysis identified SRT assignment, inability to recall opioid risk levels, hematoma, swelling, and pain as independent risk factors for elevated GAD-7 scores. Implementation of the AAC substantially reduced health care worker follow-up time (2.34, SD 1.95 min vs 7.85, SD 2.65 min; P<.001). The study demonstrates that narrative is effective in reducing anxiety, improving quality of life, and improving pain management post-VMMC. The integration of artificial intelligence into clinical follow-up protocols has the potential to enhance health care worker efficiency without compromising patient satisfaction.

Postoperative complications remain a major challenge in health care systems, with more than 70% of postoperative in-hospital mortality occurring in general wards. Current practice relies on intermittent spot-check monitoring of vital signs guided by track-and-trigger thresholds such as early warning scores. Evidence shows that, up to 4 hours before an adverse event, abnormal vital signs can be detected in up to 60% of patients. Continuous vital sign monitoring in general wards offers the potential to detect clinical deterioration earlier. However, prospective evaluations of continuous monitoring in general wards remain limited. This study aims to prospectively evaluate the impact of continuous vital sign monitoring in adult postoperative patients in general wards. The primary objective is to determine whether continuous vital sign monitoring reduces the time from device-defined physiological deterioration to the first objective escalation event (acknowledgment or clinical action) by the health care team. Secondary objectives are to evaluate clinical outcomes, operational impact, and both staff and patient experiences. We conducted a single-center, open-label randomized controlled trial of 200 general surgical patients, receiving continuous vital signs monitoring alongside standard care. Participants were randomized 1:1 to alerting or nonalerting groups, either real-time data and alerts visible or blinded to clinicians, respectively. The primary outcome is the time from the first device-defined physiological deterioration episode to the first objective escalation event (acknowledgment or clinical action). Exploratory outcomes evaluate time to treatment initiation, rapid response team activation, escalation of care, length of stay, mortality, alarm performance, and patient and staff experience. The Ward Alerting and Ambulatory Monitoring Study (WARD-AMS) trial received ethical approval in April 2024; recruitment commenced in October 2024 and was completed by December 2025 with 200 patients enrolled. Data analysis is ongoing, with results to be submitted for publication by mid-2026. The WARD-AMS study is among the first prospective, randomized evaluations of continuous vital sign monitoring in real-world ward settings looking at clinical outcomes and user experience. By integrating clinical outcomes, alarm analytics, and stakeholder experiences, it aims to provide a comprehensive understanding of the benefits, limitations, and implementation challenges of continuous monitoring. Findings from this study will inform strategies to optimize response to early clinical deterioration, reducing alarm fatigue and embedding new technologies into existing routine ward practice.

Open appendectomy is commonly performed under either general or spinal anesthesia. Postoperative quality of recovery, a multidimensional patient-centered measure of outcomes after surgery, is affected by the choice of anesthesia technique. The objective of our study was to compare the effects of general and spinal anesthesia on the immediate postoperative quality of recovery in adults undergoing open appendectomy. In this prospective cohort study, 74 patients were assigned to either the general (n=37) or the spinal anesthesia (n=37) groups. The primary outcome was the total Quality of Recovery-15 score measured 24 hours postoperatively. Secondary outcomes included postoperative pain scores, analgesic consumption, incidence of postoperative nausea and vomiting, time to first oral intake, time to first ambulation, and length of hospital stay. Intergroup comparisons were performed using the chi-square test, Fisher exact test, independent t test, or Mann-Whitney U test, as appropriate. Patients in the spinal anesthesia group had significantly higher Quality of Recovery-15 scores than those in the general anesthesia group (P=.001). They also exhibited lower pain scores at 1, 2, 6, and 12 hours postoperatively (P<.001), reduced consumption of diclofenac and tramadol, and a decreased incidence of postoperative nausea and vomiting (P<.001). The time to first mobilization, time to first oral intake, and length of hospital stay were also significantly lower in the spinal anesthesia group (P<.001). Spinal anesthesia is the preferred anesthesia technique for patients undergoing open appendectomy. It may provide improved postoperative recovery, with lower pain scores and improved analgesia. It may also reduce the need for additional analgesics, decrease the incidence of nausea and vomiting, and improve intrahospital patient recovery trajectories.

Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has demonstrated many patient and health care system benefits. Consequently, the use of RM technology for patients with CIEDs is the standard of care as highlighted by international guidelines. However, RM has not yet been integrated into universal, routine clinical practice. We aimed to establish key stakeholder perspectives on the barriers and enablers of CIED RM implementation and to apply the theoretical domain framework to highlight the most effective approaches to facilitate routine adoption of CIED RM. This was a qualitative study, using semistructured interviews to explore the barriers and enablers encountered when incorporating RM into CIED management. Participants included cardiologists, cardiac clinicians or physiologists, nurses, and patients. Interviews were transcribed verbatim and analyzed through inductive thematic analysis and deductive approaches using the NVivo (version 14; QRS International Pty Ltd) software. The theoretical domains framework was used to understand barriers and enablers. In the inductive phase, we did not assess trustworthiness, as our thematic analysis approach views data as interpretations rather than objective truths. In the deductive phase, we conferred to ensure consistency in theme alignment with existing frameworks. Interviews were conducted among 35 participants (16 patients, 10 cardiologists, and 9 cardiac physiologists and nurses). We identified 5 main themes and their associated subthemes, with 1 representing an enabler and 4 representing barriers. They were: (1) patient benefits from RM, such as improved CIED and cardiovascular management, and improved patient-centered care; (2) insufficient allocation of CIED RM resources, which included insufficient RM clinic funding and staffing, insufficient RM service reimbursement, and RM infrastructure and access inequity; (3) suboptimal management of data, which includes inconsistent RM alert interpretation and management, lack of guidance for clinic staff on RM data management, and an increased alert burden for clinics; (4) insufficient patient education post-CIED implant, this was attributed to limited health care worker availability and resulted in inadequate patient CIED and RM knowledge postimplant and patient anxiety associated with RM; and (5) patient engagement with CIED management, which included the need for increased patient interaction with RM alerts and the ability to share data with patients. These subthemes were mapped to 6 specific domains of the theoretical domains framework: \"Beliefs About Capabilities,\" \"Environmental Context and Resources,\" \"Beliefs About Consequences,\" \"Knowledge,\" \"Emotions,\" and \"Goals.\" Patient engagement was identified in 3 of the 5 themes describing barriers and enablers to RM. These highlight the importance of addressing patient engagement with RM to better implement and integrate the use of RM into routine clinical practice. Barriers and enablers extend across multiple domains and suggest that a multipronged approach is required to translate the gold standard care of RM to routine clinical practice.

Digital health data and infrastructure facilitate rapid analysis to provide actionable data, thereby fulfilling the principles of a learning health system. In response to a report from the UK Medicines and Healthcare Products Regulatory Agency (MHRA), a rapid service evaluation was carried out to identify patterns of modified-release (MR) opioid use after elective surgery. We aimed to describe the prescribing patterns of MR opioids, methods to repurpose existing infrastructure, and the experience of collaboration between clinical and research teams using shared data pipelines. A retrospective case-control study was conducted at a tertiary care organization across multiple hospital sites in London, United Kingdom. Prescription and administration data for adult patients undergoing elective surgery between March 31, 2019, and June 20, 2025, were extracted from a standardized research data pipeline within 4 weeks of the publication of the MHRA report. Patients were screened for MR opioid prescriptions in the postoperative period and at hospital discharge. Counts and proportions of encounters in which MR opioids were administered or prescribed were evaluated across the study period. Reflections on the application of the infrastructure for this purpose were also documented. Of 126,882 elective surgeries screened, 102,879 (81.1%) met the eligibility criteria. Over the study period, patients received a new MR opioid prescription after 7525 (7.3%) of the 102,879 eligible encounters, with 2438 (2.4%) encounters receiving a new MR opioid prescription at hospital discharge. Postoperative administration of MR opioids and prescribing at discharge have declined since 2020. As a result of this study, a new context-aware alert system was developed to monitor and reduce MR opioid prescribing in this surgical cohort. Reflections on the implementation experience demonstrated how collaboration between clinical and research teams in conjunction with integrated and seamless research pipelines allowed rapid knowledge generation. Key issues raised were the difficulty of validation between parallel data extraction systems and how the two different teams compared nonequitable data points and results. Mature digital and analytical infrastructure within health care institutions can enable swift evaluation of local practices in the context of national medication safety alerts. This can shorten action response times and improve patient care but requires close collaboration between clinicians and research teams. Shared infrastructure between teams across the learning health system improves data quality and provides easy access to the key users. Further work is needed to understand the benefits and challenges of infrastructure built for other use cases and the effectiveness of the intervention.