Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 15 appraisals
PloS one
Development of a scale for measuring the perception of artificial intelligence among mental health consumers
BACKGROUND: Artificial Intelligence (AI) has emerged as a transformative force revolutionizing various sectors, including healthcare, particularly the mental health field. However, the acceptance and integration of AI technologies in different healthcare systems can be influenced by various factors, including cultural, social, and individual aspects. Nevertheless, there is a need for a valid and reliable tool for assessing AI's perception among healthcare consumers. AIM: To develop and validate a tool for the perception of AI among healthcare consumers and apply the tool to assess AI's perception among mental health consumers in the Jordanian healthcare system. METHOD: A cross-sectional descriptive correlational design was utilized in the study. Data was collected from a convenience sample of 431 mental health consumers visiting mental health clinics of the International Medical Corps and university hospitals in Jordan. Structured interviews were conducted using an AI Perception (AIP) questionnaire developed by the authors. The questionnaire's content validity was assessed by an expert panel. Using Principal Component Analysis (PCA), the construct validity of the tool was evaluated, and its internal consistency was examined using Cronbach's alpha. Descriptive statistics were used to assess the levels of AI perception among participants. RESULTS: The final AIP tool consisted of 20 items across 4 domains and has demonstrated strong internal consistency across its four domains: AI acceptance and readiness (α = 0.92), AI perceived importance (α = 0.92), AI perceived risk (α = 0.9), and AI perceived challenges (α = 0.85). The construct validity of the four-domain structure of the tool was supported by PCA. Additionally, the mean scores for each domain indicated the average level of agreement with AI perception items among participants. Specifically, the mean score for AI acceptance and readiness was [Formula: see text]). AI perceived importance was (2.18 [Formula: see text]0.83), AI perceived risk was (2.58[Formula: see text]0.92), and AI perceived challenge was (2.78 [Formula: see text] 0.87). CONCLUSION: The findings of this study resulted in developing a valid and reliable 20-item tool to assess AI's perception among mental health consumers. The tool can be used to assess the predictors of AI's readiness among mental health consumers. Therefore, aiding policymakers and other stakeholders in understanding the AI adoption barriers from the perspective of end-users. In addition, this study developed the AIP tool that can be validated and used among other populations in future research.
31 July 2026
Read appraisal →Journal of medical Internet research
Shadow AI in Swedish Health Care: Qualitative Analysis of Physicians' Free-Text Answers
BACKGROUND: The rapid emergence of artificial intelligence (AI) has outpaced its formal adoption in health care organizations, contributing to the emergence of Shadow AI, defined here as the use of unauthorized AI tools by medical professionals. Under the European Union Medical Device Regulation, AI tools used for clinical purposes must undergo conformity assessment before use; general-purpose tools such as ChatGPT have not done so, rendering their clinical application unauthorized at the regulatory level. While Shadow AI offers potential efficiency gains and higher performance, it poses significant risks to data privacy, clinical safety, and regulatory compliance. Despite its growing prevalence, empirical research on the purposes for which physicians use Shadow AI remains scarce. OBJECTIVE: This study explores the purposes for which physicians describe using Shadow AI in their work. METHODS: We conducted a cross-sectional survey of physicians employed in Swedish health care organizations (N=357; response rate~64%). Data were collected between December 2023 and January 2024 via a verified online panel. We conducted a qualitative content analysis of free-text responses on the use of unauthorized AI tools. We applied theoretical lenses from the sociology of professions and paradox theory to interpret the empirical findings. RESULTS: Physicians use Shadow AI for several purposes, which we grouped into 4 categories: clinical work and decision-making, administrative work, research and professional development, and technological interest and curiosity. More specifically, Shadow AI is used as a colleague and second opinion for clinical decision support (eg, differential diagnoses and rare cases), administrative tasks such as patient communication and documentation, and research aimed at staying up to date and exploring developments in generative AI. Physicians described using these tools compensated for perceived gaps in institutional systems, reducing workload, and accessing knowledge considered difficult to obtain through conventional channels. The findings reveal a tension between physicians' drive to improve their practice and the regulatory and organizational constraints that render such use unauthorized. CONCLUSIONS: Shadow AI used by physicians presents both opportunities and risks for health care professionals and organizations. Shadow AI indicates gaps where formal hospital systems may fail to meet health care professionals' needs and signals a way for physicians to strengthen their experience-based knowledge. It represents a renegotiation of professional boundaries, as physicians bypass institutional constraints to maintain professional efficacy. The findings highlight a paradox in which the same tools that pose regulatory and safety risks also address real gaps in clinical and administrative support, suggesting that governance approaches must account for this tension rather than relying on prohibition alone.
30 July 2026
Read appraisal →PloS one
Analysis of swimming teaching programs, aquatic competencies and specific skills in school settings from early childhood to secondary education: A systematic review.
The teaching of swimming in school contexts has become increasingly important due to the benefits in the integral development of students and the prevention of aquatic accidents.This study analyses, by means of a systematic review, the aquatic teaching programmes and Competencies implemented in school settings over the last 25 years, from infant to secondary education. The Methodological approach was based on the PRISMA guidelines, with searches in scientific databases (PubMed, Scopus, Sport Discus and Web of Science) and secondary sources. Sixteen studies were selected according to the PICOS model, assessed with the STROBE and TREND tools. The results show a predominance of technical-utilitarian approaches focused on specific swimming skills, with little curricular integration and limited involvement of PE teachers. Most of the studies focused on infant and primary school, being scarce in secondary school. A high variability in duration, frequency, Contents and Assessment instruments was evidenced. The studies highlight the need for greater inclusion of swimming in school curricula, with more comprehensive pedagogical approaches adapted to each stage. It is concluded that although progress has been made, systematic implementation is still limited, requiring greater institutional support, teacher training and methodological coherence.
25 July 2026
Read appraisal →Science (New York, N.Y.)
AI in scientific publishing: Slower, worse, and more expensive.
There's a saying in the management world, popularized by NASA administrator Daniel Goldin in the 1990s, that the goal of technological improvements is to make products faster, better, and cheaper. Although this strategy had some success in the aerospace industry, the zealots of artificial intelligence (AI) have been making the same argument regarding how it will transform work, claiming that so little human effort will be required that humanity will enter an era of radical abundance, free from disease, drudgery, and danger, among other benefits, leaving society with more time for creative pursuits. But history tells a different story. When machines began to increase productivity during the second industrial revolution, American engineer Frederick Winslow Taylor's The Principles of Scientific Management encouraged corporations to use surveillance to get employees to work harder and longer, an approach that exhausted and discouraged workers and led to the transfer of knowledge and any decision-making from workers to management, while enriching the profits for only those at the top. Yet, it remains foundational to the American economic enterprise. Indeed, scientific publishing is starting to experience some Taylorism with the insertion of AI. Rigorous human checking of AI-generated research papers is creating bottlenecks as publishers strive to maintain the integrity of the scientific record. The challenge is requiring even more human effort, making the whole endeavor slower and more expensive.
17 July 2026
Read appraisal →Journal of medical Internet research
Evolution of Regional Information Infrastructures Integrating Health and Social Care in Scotland: Qualitative Study
BACKGROUND: Expectations of integrating health and social care providers have driven the development of digital solutions aimed at overcoming interoperability challenges and ensuring access to information needed for integrated care across fragmented services. However, challenges persist in aligning diverse coding practices, heterogeneous data-sharing mechanisms, and stakeholder needs. OBJECTIVE: We examine how expectations of interoperability and integrated care have shaped the growth of regional information infrastructures in Scotland, using the Key Information Summary (KIS), a summary record that shares key patient information from general practitioner records with out-of-hour services, ambulance services, hospitals, social workers, and caregivers across multiple care settings, as a case study. METHODS: This qualitative study examined the development, implementation, and adoption of KIS in Lothian, Scotland, across health and care settings, where it has been in use for 13 years. Multisited ethnography was used to understand how technology design, implementation, and adoption were shaped by social, organizational, cultural, and political factors. Data were collected through interviews with users, vendors, and implementers; observations of technology use and multidisciplinary team meetings; and documentary analysis of policies, user guides, and internal reports. A hybrid analytical approach was applied: the Technology, People, Organization, and Macroenvironment framework guided initial coding, while the sociology of expectations and information infrastructure theory were used inductively to trace evolving visions of integration, and the long-term development of regional information infrastructure. RESULTS: Data included 54 qualitative interviews, 20 hours of observation, and 59 documents collected between April 2024 and March 2025. Findings illustrate how information infrastructures for integrating health and care providers evolved through successive concerted efforts, conceptualized as waves. Three waves were identified, each characterized by attempts to interlink disparate information systems used by various health and care providers. The first wave focused on linking health care providers by developing networks and architectures required for sharing clinical information, which later supported the development and sharing of KIS. Subsequent waves sought to interlink information systems used by health care providers with those used by local authorities and social care providers. In the absence of shared data standards across these sectors, interoperability was achieved by extending the existing health care-centric infrastructure to different social care settings through workarounds such as providing proxy access to hospital systems and secure emailing networks. CONCLUSIONS: This work illustrates how regional information infrastructures for integrated care evolve through orchestrated waves of change. Some expectations for change required coordinated, system-level action, such as setting up standards, networks, and architecture, while others were realized through local adaptations. Integrating health and care providers through digitalization is a long-term process requiring sustained coordination, with progress often occurring through incremental, local extensions. Policies must support adaptive, long-term coordination, balancing system-level initiatives with local adaptations to achieve meaningful integration.
12 July 2026
Read appraisal →International journal of qualitative studies on health and well-being
Between duty and constraint: a qualitative systematic review of healthcare providers' ethical challenges and moral stressors in caring for undocumented migrants
PURPOSE: Healthcare providers play a critical role in delivering care to undocumented migrants, who face systemic barriers to healthcare access. While research has documented undocumented migrants' legal and policy barriers, less is known about the ethical challenges and moral stressors experienced by providers. This systematic review synthesizes qualitative studies on providers' experiences when delivering care to undocumented migrants. METHODS: The review followed PRISMA guidelines. PubMed, Embase, CINAHL, and the Cochrane Library were searched for relevant qualitative studies. Studies were screened by title, abstract, and full text using predefined inclusion and exclusion criteria. Quality assessment was conducted using the CASP checklist. Data were synthesized using the Qualitative Analysis Guide of Leuven (QUAGOL), integrating Graneheim and Lundman's approach to qualitative content analysis. RESULTS: The systematic search identified 37 qualitative studies. Analysis revealed 58 themes and subthemes, organized under five key concepts: experiences, perceptions, attitudes, practices and coping mechanisms, and ethical challenges. Providers reported moral distress, emotional exhaustion, and professional dilemmas arising from legal constraints, resource limitations, and conflicting obligations. Ethical tensions centered on beneficence vs. non-maleficence, professional duty vs. legal compliance, and the moral dilemma of deservingness. Across these findings, the synthesis identifies ethical burden-shifting as a central analytical contribution: restrictive systems transfer the moral and practical consequences of exclusionary arrangements onto providers and undocumented migrants at the point of care. CONCLUSION: This review shows that providers' ethical challenges are not only individual clinical dilemmas but structurally generated moral stressors. Addressing these challenges requires structural interventions, including policy reforms that reconcile professional ethics with legal constraints and institutional support to mitigate moral distress.
10 July 2026
Read appraisal →International health
Antimicrobial stewardship interventions currently implemented at primary healthcare settings across low- and lower-middle-income countries (LLMICs)
BACKGROUND: Antimicrobial resistance (AMR) is a top global public health and development threat. Antimicrobial stewardship programs (AMSPs) are one of the most cost-effective interventions to optimize the use of antimicrobials. This study reviews AMSPs that have been implemented in low- and lower middle-income countries. METHODS: A systematic search was conducted on electronic databases including MEDLINE, PubMed, Embase, OVID, Web of Science and Cochrane Library on 18 July 2024 for published papers from 2014 to 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Relevant published literature was then selected based on the established inclusion/exclusion criteria. Each article was screened by two independent reviewers. Data were extracted and synthesized in the review. RESULTS: Of the 425 articles screened, only 13 were eligible for review and included in this study. Two studies were multinationals. Five studies were randomized controlled trials. Among the three key focuses of AMSPs, most of the interventions focused on optimizing antibiotic use (n=8), followed by improving diagnostics and monitoring (n=3) and education and training (n=2). The most commonly reported barriers to implementing AMSPs was a lack of resources (n=9). Facilitators reported included knowledge of AMS (n=8), availability of educational and training resources (n=8), adequate funding (n=6), accountable and transparent procedures (n=5) and positive communication within healthcare facilities (n=4). CONCLUSIONS: All included studies show improvement in AMS through innovative programs. However, only a few have been adopted nationwide and influence policy formulation in the country. We recommend adoption of effective AMSPs into the national strategic planning and implementation across primary health settings.
5 July 2026
Read appraisal →The Journal of international medical research
Examining the state of telehealth for mental health and substance use care after the coronavirus disease 2019 pandemic: An integrative review.
ObjectiveThe objective of this integrative review was to synthesize literature and provide implications for clinical practice on telehealth use among patients with serious mental illness and substance use disorders following the coronavirus disease 2019 pandemic.MethodsAn integrative review guided by Socio-Technical Systems Theory was applied. The PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Academic Search Complete, and Gale Health and Wellness databases were searched for publications from 1 January 2019 to 1 December 2024. Articles selected according to the established inclusion and exclusion criteria were evaluated using a rapid critical appraisal checklist developed by Fineout-Overholt and Melnyk.ResultsAmong the 172 articles reviewed, 16 peer-reviewed and 2 government publications were included. Four themes were identified: (a) treatment adherence; (b) satisfaction reported by patients and providers; (c) telehealth policy developments; and (d) access to services. Telehealth supported continuity of care, improved satisfaction, and improved access. Technological and financial barriers restricted equitable access. Policy changes enabled broader adoption; however, regulatory approaches varied across jurisdictions.ConclusionTelehealth remains an integral method for delivering mental health and substance use care following the coronavirus disease 2019 pandemic. Greater focus is needed on long-term effectiveness and limitations of telehealth.
3 July 2026
Read appraisal →BMJ open
Effectiveness and safety of pharmacist prescribing: a systematic review
OBJECTIVE: To examine the effectiveness and safety of pharmacist prescribing across multiple healthcare settings. DESIGN: A systematic review of quantitative studies. ELIGIBILITY CRITERIA FOR THE SELECTION OF STUDIES: Quantitative studies assessing the effectiveness and safety of pharmacist prescribing compared with non-pharmacist prescribing in any healthcare setting and for any healthcare population. A clear statement of pharmacists' prescriptive authority was required for inclusion in this systematic review. DATA SOURCES: A systematic search was conducted using six electronic databases: Embase (Ovid), MEDLINE (EBSCO), SCiELO, Dimensions AI, Cochrane Library and Epistemonikos. Database searches were conducted from database inception to 29 January 2025. Additional grey literature searches were conducted using Google and DuckDuckGo. Both backward and forward citation chasing were conducted for all included studies. DATA EXTRACTION AND SYNTHESIS: Data were extracted using standardised bespoke data extraction forms. The revised Cochrane Risk of Bias 2 tool for randomised controlled trials and the Risk of Bias in Non-Randomised Studies of Interventions tool were used to assess risk of bias. A narrative synthesis approach was applied following the Synthesis Without Meta-analysis guideline. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the level of certainty of the evidence. RESULTS: Of the 39 included studies, 32 studies reported on effectiveness and 20 studies reported on safety across 15 health conditions. Healthcare settings included outpatient (n=14), primary care (n=10), community pharmacy (n=6), inpatient (n=5), emergency department (n=1) and long-term care (n=3). These studies were based in the USA (n=26), Canada (n=5), the UK (n=4), Australia (n=2) and Singapore (n=2). In total, there were 153 outcomes related to safety and effectiveness. For 74 outcomes, no significant difference was reported between pharmacist prescribing and non-pharmacist prescribing, while 46 outcomes were significantly improved with pharmacist prescribing. Four outcomes reported in favour of non-pharmacist prescribing. Inferential statistics were not reported for 29 outcomes, meaning we cannot comment on their statistical significance. The certainty of evidence was low or very low for all outcomes. CONCLUSIONS: The consistency of effectiveness and safety findings across studies, showing either no significant difference (indicating equivalence of care and outcomes) or significant improvement in pharmacist prescribing groups, suggests it is a potential policy option. Future research on implementation, public and patient preferences and cost-effectiveness would provide valuable insights into the potential benefits of pharmacist prescribing at a health system level.
28 June 2026
Read appraisal →JMIR mental health
Coproduction Without Youth? Closing the Participation Gap in Digital Mental Health Research
Young people are among the most intensive users of digital and generative artificial intelligence (GenAI)-enabled mental health tools, yet they remain underrepresented in the research and design processes that shape these technologies. Although participatory approaches such as co-design and patient and public involvement are widely endorsed as best practices, youth involvement in digital youth mental health (DYMH) research is often inconsistent, superficial, or limited to late-stage consultation. This participation gap risks producing interventions that are misaligned with young people's lived experiences, priorities, and vulnerabilities, particularly in the context of rapidly evolving and scalable GenAI systems. This Viewpoint aims to reexamine the underlying drivers of the participation gap in DYMH research; clarify how participation is conceptualized and implemented across disciplines; and propose concrete, actionable recommendations to support more meaningful and consistent youth involvement across the research life cycle. We draw on interdisciplinary literature from digital mental health, human-computer interaction, child-computer interaction, and health research policy. Our Viewpoint integrates conceptual frameworks (eg, Lundy's model of participation), existing reviews of co-design practices, and emerging evidence on GenAI in mental health. We adopt a life cycle-oriented perspective to examine how youth participation is distributed across stages of research and development, including problem formulation, design, implementation, and evaluation. We identify 3 interrelated drivers of the participation gap. First, conceptual and linguistic fragmentation obscures what participation entails in practice, with terms such as co-design, participatory design, user-centered design, and patient and public involvement used inconsistently across disciplines. Second, youth involvement is uneven across the research life cycle, with participation often concentrated in early ideation or usability testing but largely absent from upstream decision-making and downstream evaluation. Third, institutional barriers-including ethics review processes, consent requirements, funding constraints, and adult-centric research norms-systematically limit meaningful youth partnership. These challenges are amplified in the context of GenAI, where opaque "black box" systems, simulated therapeutic interactions, and rapid deployment cycles introduce distinct risks if youth perspectives are not integrated. We propose a set of minimum expectations to address these gaps, including explicit specification of participatory models, life cycle mapping of youth involvement, reporting of youth influence on decisions, dedicated funding for participation, proportional ethics frameworks, and mechanisms for youth-informed governance of GenAI systems. Closing the participation gap in DYMH research is both an ethical imperative and a practical necessity. Moving beyond aspirational commitments requires embedding youth participation as a standard, resourced, and accountable component of research, design, and governance. In the context of rapidly evolving digital and GenAI technologies, failure to do so risks producing interventions that are scalable but not safe, credible, or responsive to the needs of young people.
27 June 2026
Read appraisal →JMIR medical education
Exploring the Role of Early Career Medical Professionals From a Digital-Oriented University in Germany in Promoting Digital Health in Professional Settings: Qualitative Interview Study
BACKGROUND: To address care delivery gaps, the health care system must embrace innovative digital solutions. Additionally, the rising integration of digitalization as a topic into medical education is providing students with broader opportunities to engage with digitalization overall. As digital health becomes an increasingly integral component of medical education and health care practice, digitally affine early career medical professionals constitute a vital resource for advancing digitalization within the health care sector. OBJECTIVE: This study examines how early career medical professionals from Witten/Herdecke University in Germany, with various courses focusing on digitalization, acquire digital knowledge, apply it across diverse practical contexts-ranging from start-ups and corporate environments to traditional clinical settings-and how they contribute to the advancement of digitalization within the entire health care sector. METHODS: Using a qualitative approach, 19 interviews were conducted with early career medical professionals who graduated in the last 15 years at Witten/Herdecke University. Subsequently, the interviews were transcribed and analyzed using a deductive-inductive approach. RESULTS: The findings reveal that medical graduates often acquire digital skills through intensive self-study and learning on the job, integrating them in various ways into their professional lives. Moreover, while graduates recognize their high potential to make their own contribution to the advancement of digitalization, they also face significant barriers such as knowledge gaps, limited resources, and complex regulations, which hinder their ability to contribute to digitalization in a variety of professional settings. Medical graduates report that they face a pressing need for enhanced knowledge access, improved institutional frameworks, and supportive policy measures to maximize their potential in advancing digitalization initiatives. CONCLUSIONS: Recent medical graduates represent an underused resource for health care digitalization. Unlocking this potential requires coordinated action across medical education, health care institutions, and policymaking to create appropriate conditions for graduates to actively drive digitalization.
26 June 2026
Read appraisal →Journal of medical Internet research
You Can't Launch This: Trust as Infrastructure in Digital Behavioral Health
Digital behavioral health interventions frequently fail to scale, even when evidence-based and technically and operationally sound. In this News and Perspectives article, researcher, digital behavioral health platform founder, and JMIR Correspondent Trevor van Mierlo concludes a four-part series examining why this occurs, reporting on the foundational role of trust.
25 June 2026
Read appraisal →Reviews on environmental health
Air quality and public health co-benefits of national transport policies
INTRODUCTION: Transport is a major contributor to urban air pollution and premature mortality worldwide. This systematic review evaluates the air-quality and public health co-benefits of national and regional transport policies aimed at reducing population exposure to air pollution. CONTENT: Following PRISMA 2020 guidelines, this review synthesized evidence published between 2011 and 2024 on the health and environmental impacts of national or regional transport policies. Ten eligible studies were reviewed, covering diesel vehicle phase-outs, inspection and maintenance programs, electric vehicle incentives, fuel taxation, and promotion of public or active transport. SUMMARY: Across multiple settings, these policies were associated with reductions in PM2.5 concentrations and with avoided premature mortality, respiratory and cardiovascular hospitalizations, and healthcare costs. The largest and most consistent health benefits were observed for integrated policy packages, particularly those combining regulatory and technological measures such as fuel quality improvements, vehicle electrification and diesel phase-out, complemented by behavioral or fiscal instruments. Most available evidence originates from high-income countries, while studies from low- and middle-income regions remain scarce. The limited number of eligible studies and their concentration in specific regions and modeling approaches constrain generalizability, especially to settings with different transport systems, resource availability, and air-quality profiles. OUTLOOK: Embedding health-impact assessment within transport planning and expanding long-term evaluations in low- and middle-income countries are essential to ensure equitable and sustained air-quality and health improvements. Future policy frameworks should prioritize source-oriented regulatory and technological measures such as vehicle electrification, fuel-quality regulation, and diesel phase-out implemented within integrated policy packages to maximize public-health co-benefits.
25 June 2026
Read appraisal →Journal of medical Internet research
Policy Considerations for National Virtual Hospitals: Global Evidence and the Seha Virtual Hospital Model
Health systems worldwide face growing pressure from population aging, multimorbidity, and rising emergency admissions, prompting reconsideration of traditional inpatient care models. In response, digitally enabled models such as tele-intensive care unit (tele-ICU) programs, hospital-at-home services, virtual wards, and other remote specialist pathways have expanded, particularly after the COVID-19 pandemic accelerated telemedicine adoption and cross-site virtual staffing. However, nationally coordinated, multispecialty virtual hospitals remain uncommon worldwide, and robust evidence on their system-level effects is still limited. As a result, policy discussions about national virtual hospitals must often draw on evidence from related virtual-care models rather than from mature national implementations. This viewpoint synthesizes representative international evidence from tele-ICU systems, hospital-at-home programs, virtual wards, telestroke networks, and other condition-specific virtual-care pathways, and examines Saudi Arabia's Seha Virtual Hospital (SVH) as a national case study to identify policy lessons relevant to the design, governance, and evaluation of national virtual hospitals. Across settings, these models suggest that remote and digitally supported care can achieve outcomes comparable to in-person hospital care when patient selection is appropriate, escalation and transfer pathways are explicit, monitoring intensity matches clinical risk, and multidisciplinary teams are integrated into local workflows. Tele-ICU programs have reported reductions in intensive care mortality and length of stay under well-structured organizational models, while hospital-at-home and virtual-ward programs have shown comparable safety, reduced hospital usage, and improved patient experience among selected patient groups. Telestroke networks likewise demonstrate outcomes comparable to specialist in-person care in acute stroke pathways. Nevertheless, the evidence base remains heterogeneous and strongly context-dependent. Much of the literature is short-term, with limited consistent evidence on long-term outcomes, caregiver burden, cost-effectiveness, workforce implications, and digital equity. SVH illustrates the emerging implementation of a centralized national virtual hospital model. Launched in 2022 under Saudi Arabia's Vision 2030 Health Sector Transformation Program, SVH operates as a national telehealth hub embedded within the country's broader digital-health ecosystem and links hospitals across the Kingdom to specialized clinical expertise. Its service portfolio includes urgent and critical care consultations, specialized virtual clinics, multidisciplinary case discussions, and supportive diagnostic services. Early reports indicate rapid operational expansion, broad institutional participation, and national-scale feasibility. However, independent comparative evidence evaluating SVH's effects on mortality, readmissions, length of stay, cost-effectiveness, equity, and workforce sustainability remains limited. National virtual hospitals should therefore be understood as evidence-generating health-system innovations rather than fully validated care models. Sustainable scale-up requires embedding rigorous prospective evaluation within implementation, aligning financing mechanisms with substitution of inpatient care, establishing clear governance and regulatory frameworks, and addressing digital inclusion and workforce sustainability. These considerations can help guide policymakers and health-system leaders in the accountable, equitable, and evidence-informed development of national virtual hospital programs.
25 June 2026
Read appraisal →Journal of robotic surgery
Rethinking health technology assessment in robotic surgery: an EFISDS-TROGSS position paper. Official position paper of the European Federation - International Society for Digestive Surgery (EFISDS) and The Robotic Global Surgical Society (TROGSS).
Robotic-assisted surgery (RAS) has evolved from a procedural innovation into an increasingly integrated component of contemporary digital surgical ecosystems. Nevertheless, most current Health Technology Assessment (HTA) frameworks continue to evaluate robotic systems primarily through comparator-based models focused on isolated perioperative and oncological outcomes. In this EFISDS-TROGSS position paper, we critically examine the methodological limitations of conventional HTA paradigms when applied to robotic surgical platforms, using the recent Italian AGENAS appraisal as a representative case study. While the AGENAS document represents one of the most comprehensive national evaluations of RAS performed to date, its heterogeneous recommendations across procedures highlight unresolved tensions regarding perioperative benefit, real-world implementation, learning curves, organizational impact, and long-term healthcare value. We argue that RAS should increasingly be interpreted not simply as a surgical device, but as a platform technology interacting with simulation-based training, digital infrastructure, surgical data science, artificial intelligence, telecommunication systems, and institutional organization. Rather than a surgical device alone, RAS should be interpreted and regarded as a combination of technological advances and approaches that integrate various degrees of artificial intelligence autonomy, image navigation, telesurgery, and other benefits to empower the surgical team. Conventional HTA models, originally developed for relatively discrete therapeutic interventions, may incompletely capture the multidimensional interaction between robotic technologies and modern healthcare systems. Particular attention is dedicated to real-world evidence, implementation maturity, reimbursement limitations, and the growing mismatch between current Diagnosis-Related Group (DRG) structures and technologically integrated surgical care. Finally, we propose more flexible and multidimensional assessment frameworks integrating procedural outcomes with organizational sustainability, digital interoperability, workforce implications, and longitudinal healthcare value.
20 June 2026
Read appraisal →