Background: This research paper provides a systematic literature review (SLR) on the current status of augmented-reality head-mounted devices (AR-HMDs) that guide and navigate spine surgeries and pedicle screw placement. Methods: Embase, Scopus, PubMed, Cochrane Library and IEEE Xplore databases were screened for the systematic literature search to collect and statistically analyze live patient clinical, procedural and user experience data. Multi-level Poisson and binominal models were used for analysis. Results: In vivo patient data, only the clinically widely used Gertzbein–Robbins Scale, were published as an outcome in the recent heterogeneous literature. The statistical analysis supports the hypothesis that using AR-HMDs has the same clinical outcomes as using more expensive robot-assisted surgical (RAS) systems. Conclusions: AR-HMD-guided pedicle screw insertion is reaching its technology readiness, providing similar benefits to RAS. Further meta-analysis is expected in the future from higher case-numbered and standardized randomized clinical trials.

University rankings are gaining importance worldwide. While the top-ranked universities are the subject of numerous academic publications, very little literature is available on universities in the lower two-thirds of the ranking list. In this study, we analysed the sensitivity of year to year changes in position in the Times Higher Education World University Rankings (THE) of universities from the Czech Republic, Hungary, Poland, and Slovakia using hypothetical scenarios of potential changes in their research outputs. A regression model was developed that quantifies the effect of the inclusion of institutions that are new to ranking as well as dropouts on the ranking list. We also developed a method to allow customized sensitivity analysis of the subsequent year's rank from an institution's projected research output, given its current rank and research output, assuming that other ranking indicators remain unchanged over 1–2 years. It should be noted that most universities in the region have ranked below 800, and while research output has been increasing, it was observed that ranks worsened for most universities from these four countries. The Field-Weighted Citation Impact and the total volume of publications had the highest effect on rankings, while the proportion of Scimago Q1 publications did not have a consistent effect on the projected next year's ranks. In most universities, the growth in research performance indicators were below the level that would be required to offset the rank changes due to the inclusion of new entrants in ranking. The findings of this research suggest that universities have to consider complex strategies to improve their ranking focusing on other activities than research such as reputation, internationalization, or industry income. With due caution, our results might be generalized to most of the universities below 800 in the THE. The rank prediction tool presented in this article is available online at https://hecon.uni-obuda.hu/en/rank-calculator/.

Background: The aim of this study was to assess social preferences for two different advanced digital health technologies and investigate the contextual dependency of the preferences. Methods: A cross-sectional online survey was performed among the general population of Hungary aged 40 years and over. Participants were asked to imagine that they needed a total hip replacement surgery and to indicate whether they would prefer a traditional or a robot-assisted (RA) hip surgery. To better understand preferences for the chosen method, the willingness to pay (WTP) method was used. The same assessment was conducted for preferences between a radiologist’s and AI-based image analysis in establishing the radiological diagnosis of a suspected tumour. Respondents’ electronic health literacy was assessed with the eHEALS questionnaire. Descriptive methods were used to assess sample characteristics and differences between subgroups. Associations were investigated with correlation analysis and multiple linear regressions. Results: Altogether, 1400 individuals (53.7% female) with a mean age of 58.3 (SD = 11.1) years filled in the survey. RA hip surgery was chosen by 762 (54.4%) respondents, but only 470 (33.6%) chose AI-based medical image evaluation. Those who opted for the digital technology had significantly higher educational levels and electronic health literacy (eHEALS). The majority of respondents were willing to pay to secure their preferred surgical (surgeon 67.2%, robot-assisted: 68.8%) and image assessment (radiologist: 70.9%; AI: 77.4%) methods, reporting similar average amounts in the first (p = 0.677), and a significantly higher average amount for radiologist vs. AI in the second task (p = 0.001). The regression showed a significant association between WTP and income, and in the hip surgery task, it also revealed an association with the type of intervention chosen. Conclusions: Individuals with higher education levels seem to accept the advanced digital medical technologies more. However, the greater openness for RA surgery than for AI image assessment highlights that social preferences may depend considerably on the medical situation and the type of advanced digital technology. WTP results suggest rather firm preferences in the great majority of the cases. Determinants of preferences and real-world choices of affected patients should be further investigated in future studies.

Background: Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents’ skills to deal with electronic health information sources. Objective: We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children’s outcomes. Methods: A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents’ electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children’s treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. Results: Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents’ average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children’s treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=−0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children’s HbA1c (r=−0.143; P=.08), PedsQL Diab (r=−0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=−0.13; P=.12). Regression analysis revealed significant associations of the child’s HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=−0.66; P=.03; pump + sensor: β=−0.93; P=.007), and parents’ self-efficacy (PSESDM; β=−0.08; P=.001). Conclusions: Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents’ diabetes management attitude but not with the child’s glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.

Background: Implantable medical devices (IMDs) are medical instruments embedded inside the body. Well-informed and empowered patients living with IMDs are key players of improving IMD-related patient safety and health outcomes. However, little is known about IMD patients’ epidemiology, characteristics, and current awareness levels. Our primary aim was to investigate the point and lifetime prevalence of patients living with IMDs. Patients’ IMD-related knowledge and determinants of IMDs’ impact on their life were also explored. Methods: An online cross-sectional survey was conducted. Respondents’ IMD history, whether they received instructions for use and IMD’s overall impact on life were recorded by self-reports. Patients’ knowledge about living with IMDs was assessed on visual analogue scales (VAS, 0–10). Shared decision-making was analyzed by the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Descriptive statistics and subgroup comparisons between IMD wearers were performed for statistical differences. Significant determinants of IMD’s overall impact on life were examined in linear regression analysis. Results: In the total sample (N = 1400, mean age 58.1 ±11.1; female 53.7%), nearly one third of respondents were living with IMD (30.9%; 433/1400). Among them, the most frequent IMDs were tooth implants (30.9%) and intraocular lens (26.8%). Mean knowledge VAS scores were similar (range: 5.5 ±3.8–6.5 ±3.2) but differences by IMD types were observed. Patients who received instructions for use or reported better impact on life indicated higher self-reported knowledge. Regression confirmed that patients’ knowledge was significant predictor of IMD’s impact on life, but this effect was overwritten by the SDM-Q-9. Conclusions: This first comprehensive epidemiological study on IMDs provides basic data for public health strategy planning alongside the implementation of MDR. Improved self-perceived outcomes were associated with higher knowledge hence education of patients receiving IMD deserves consideration. We suggest to investigate further the role of shared decision-making on IMD’s overall impact on patients’ life in future prospective studies.

Background: The Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ) measures symptom severity and health-related quality of life (HRQoL) of people with musculoskeletal (MSK) conditions. We aimed to test the psychometric properties of the MSK-HQ among the general adult population and identify the determinants of MSK-HQ states. In addition, we aimed to explore the relationship between MSK-HQ and standard well-being measurement tools. Methods: The translation proccess of the MSK-HQ into Hungarian followed the standard methods provided by the developer. A cross-sectional online survey was performed in Hungary involving a population normative sample (N = 2004, women: 53.1%; mean age: 48.3, SD = 16.6 years). Socio-demographic characteristics and self-reported MSK disorders were recorded. Alongside the MSK-HQ, standard measures of HRQoL (EQ-5D-5L), physical functioning (HAQ-DI) and well-being (ICECAP-A/O, WHO-5, Happiness VAS) were applied. Clinical and convergent validity were assessed by subgroup comparisons (Mann–Whitney-U and Kruskal–Wallis tests) and Spearman’s rank correlations. Internal consistency was assessed by Cronbach’s alpha. Test–retest reliability (N = 50) was evaluated by intraclass correlation coefficient (ICC). Predictors of MSK-HQ were analysed by ordinary least square multiple regressions. Results: The mean MSK-HQ index score was 44.1 (SD = 9.9). MSK-HQ scores were significantly lower in subgroups with self-reported MSK disorders. Correlations were strong between MSK-HQ and EQ-5D-5L (0.788), EQ VAS (0.644) and HAQ-DI (-0.698) and moderate with the well-being measures (p < 0.05). Cronbach’s alpha was 0.924 and ICC was 0.936 (p < 0.05). Being a man, living in the capital, having higher income and education were positively associated with MSK-HQ scores. Conclusions: This is the first study to prove the validity and reliability of the MSK-HQ among the general public. The impact of socio-demographic characteristics on MSK-HQ scores deserves consideration in clinical studies.