Physical activity monitors can be successfully implemented to assess perioperative activity in urologic surgery

Same-day Catheter Removal and Hospital Discharge After Holmium Laser Enucleation of the Prostate: A Prospective Study

OBJECTIVE

To assess the feasibility, safety, and predictive factors for the success of holmium laser enucleation of the prostate (HoLEP) with catheter removal and hospital discharge on the same day of the procedure.

METHODS

This prospective study included 34 patients who underwent HoLEP using a 60-W holmium laser device and the Wolf Piranha morcellation system. Surgeries began at 10:30 am and the patients were expected to be discharged by 5 pm on the same day. The patients underwent a voiding trial to remove the urinary catheter before hospital discharge. Functional outcomes were assessed 90 days after the procedure.

RESULTS

Mean (range) age, prostate-specific antigen value, and prostate weight were as follows: 63.4 (50-80) years, 4.81 (0.19-14) ng/mL, and 89.3 (33-258) g, respectively. The mean (range) enucleation and morcellation times were 56.2 (29-91) minutes and 14.67 (3-45) minutes, respectively. Thirty-one patients (91.1%) were discharged on the same day of the procedure after urinary catheter removal.

CONCLUSION

The performance of HoLEP is safe on an outpatient basis. Same-day catheter removal is feasible and does not affect hospital discharge.

Applications of wearable activity monitors for prostate cancer survivors: A systematic scoping review

BACKGROUND

Wearable technology is used to monitor and motivate physical activity (PA) and provides continuous, objective PA and sleep data outside the clinical setting. We reviewed the literature to understand how wearables are integrated into prostate cancer (PC) investigations in order to identify current practices, gaps, and research opportunities.

METHODS

We conducted a literature search for articles using wearables, among PC survivors published between 2012 and 2022. We extracted study details, interventions and outcomes, participant baseline characteristics, and device characteristics and grouped them by study type: randomized control trials (RCTs) and non-randomized studies.

RESULTS

Of 354 articles screened, 44 met eligibility criteria (23 RCTs, and 21 non-randomized). 89% used wearables to monitor PA metrics, 11%, sleep metrics, and 6.8%, both. Most studies involved exercise (70% RCTs, 9% non-randomized studies) or lifestyle interventions (30% RCTs, 9% non-randomized studies). Intervention delivery methods included personalized computer-based (48%), in-person (e.g., trainer) (20%), and education web or print-based (20%). Interventions occurred at the participant's home (48%) or at a gym (20%). 57% of the studies evaluated the feasibility and acceptability of the wearable as an activity-measuring device or as part of a remotely delivered computer-based intervention. Studies used wearables to monitor adherence to PA interventions, motivate behavior change, to assess patient outcomes (e.g., patient function, quality of life, mood), or as data collection tools.

CONCLUSIONS

Wearables are primarily being used to assess daily activity and monitor adherence to exercise interventions in clinical studies involving PC survivors. Findings suggest that they are feasible for use in this population. More research is needed to understand how to integrate wearables into routine clinical care, expand their use to predict clinical outcomes, or to deliver tailored interventions for PC survivors.

Wearable mobile health device for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery: A prospective comparison study

BACKGROUND

This study aimed to evaluate the feasibility of using mHealth devices for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery (MIS).

METHODS

Patients with colorectal cancer undergoing MIS were prospectively recruited to wear mHealth devices for recording postoperative ambulation between October 2018 and January 2021. The primary outcome was the compliance by evaluating the weekly submission rate of step counts. The secondary outcome was the association of weekly step counts and postoperative length of stay.

RESULTS

Of 107 eligible patients, 53 patients wore mHealth devices, whereas 54 patients did not. The average weekly submission rate was 72.6% for the first month after surgery. The total step counts <4000 or >10 000 in the postoperative week one were negatively associated with postoperative length of stay (β = -2.874, p = 0.038).

CONCLUSIONS

mHealth devices provide an objective assessment of postoperative ambulation among patients with colorectal cancer undergoing MIS.

CLINICAL TRIAL REGISTRATION

NCT03277235.

Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature

PURPOSE OF REVIEW

There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges.

RECENT FINDINGS

There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality.

SUMMARY

Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.

Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis

An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

The Impact of Wearable Technologies in Health Research: Scoping Review

Background

Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research.

Objective

In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research.

Methods

We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing.

Results

We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations—wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%).

Conclusions

Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.

Mobile devices and wearable technology for measuring patient outcomes after surgery: a systematic review

Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.

The role of technology in the perioperative management of bladder cancer patients

Consumer technology in the form of personal computers, mobile devices, and wearable technology, despite current underutilization, has the potential to greatly enhance the practice of urologic oncology and the surgical care of bladder cancer patients, particularly through the dissemination of educational videos, telemedicine, and the use of wearable technology for patient monitoring. A comprehensive healthcare application can unite all of these features, providing curated educational videos at different timepoints in surgical care, facilitating communication between the patient and the care team, and interfacing with wearable technology and other peripherals to allow for nonintrusive patient monitoring to help facilitate early identification of complications and to follow post-operative patient progress. Here we seek to review the available literature on this topic, discuss our institutional experience, and provide future perspectives in the perioperative management of bladder cancer patients.

Wearable devices for patient monitoring in the early postoperative period: a literature review

The early postoperative period is a crucial stage in a patient's recovery as they are susceptible to a range of complications, with detection and management the key to avoiding long term consequences. Wearable devices are an innovative way of monitoring patient's post-intervention and may translate into improved patient outcomes, and reduced strain on healthcare resources, as they may facilitate safer and earlier discharge from the hospital setting. Several recent studies have investigated the use of wearable devices in postoperative monitoring. This review outlines the current literature including the range of wearable devices used for postoperative monitoring, the variety of surgeries investigated, and the outcomes assessed. A search of five electronic databases was performed. Data on the range of wearable devices, outcomes and surgeries investigated were extracted and synoptically analysed. Twenty-four articles were retrieved. Data on several different types of surgery were available and discussed. Most studies used wrist-mounted wearable devices and accelerometers or pedometers to assess physical activity metrics, including step counts and physical activity intensity (PAI), as markers of recovery. Wearable devices can provide objective data capture in the early postoperative phase to remotely monitor patients using various metrics including temperature, cardiac monitoring and physical activity. The majority of current research is focussed on wrist-mounted accelerometers and pedometers used to assess physical activity as a marker of postoperative function. Further research is required to demonstrate improved safety and cost-effectiveness of this technology.

[Digital innovation in medicine: the COVID-19 pandemic as an accelerator of "digital health"]

The COVID-19 pandemic has triggered a wave of digitalization in medicine. In the coming years, the use of state-of-the-art technologies will revolutionize routine diagnostic and treatment approaches, as well as have a positive effect on the physician-patient relationship. The application of AI (artificial intelligence) and Big Data, combined with the development of mHealth (mobile health), represents the most significant milestone in the creation of a digital and intelligent health system!

Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

Objective

To determine if same day catheter removal is feasible in a select population after holmium laser enucleation of the prostate (HoLEP).

Methods

We performed an analysis of patients undergoing HoLEP at our institution who underwent same-day catheter removal after HoLEP. All HoLEPs were performed with Moses 2.0 Optimized for BPH. Patients were dismissed from postoperative recovery unit to the clinic for catheter removal and voiding trial.

Results

To date, 30 patients have undergone same day catheter removal. Median age is 68.6 years (interquartile range [IQR] 61.8-73.3) and preoperative prostate volume 81 mL (IQR 53-114.8). Median enucleation time was 39.5 minutes (IQR 30.5-53), morcellation time was 5 minutes (IQR 4-12 minutes), and enucleated specimen weight was 52.5 g (IQR 33-81). Twenty-seven (90%) patients successfully voided on the same day without requiring catheter replacement. All patients were catheter free by POD1. For patients who successfully passed their voiding trial, the median time from the end of the procedure to hospital discharge was 2.6 hours (IQR [2.1-2.9]) and from the end of the HoLEP to catheter removal was 4.9 hours (IQR [3.5-6.0]).

Conclusion

We present for the first time that same day catheter removal is a feasible option in a select population of patients undergoing HoLEP. With more study, this has the potential for transforming the management of BPH, especially larger glands.

Evaluation of a Commercial Activity Monitor for Determining Step Counts in Horses

Monitoring activity level has become popular in people and animals. In the horse, these monitors may be helpful for the detection of disease, monitor limb loading after surgery, and assist in rehabilitation. The objective of this study was to evaluate the accuracy of a commercial activity monitor (AM) (FitBit Zip) in horses. In Part 1, four stalled horses had five AMs placed (head, chest, withers, and left forelimb and hindlimbs) with stride length setting of 60.96 cm and were monitored for 24 hours with AM and video. In Part 2, four stalled horses had two AMs placed (left forelimb and hindlimbs) with stride length setting of 30.48 cm and were monitored for 24 hours with AM and video. In Part 3, three horses with two AMs (left forelimb and hindlimbs) had step data collected at the walk and trot in hand by AM and video. AM and video data were compared using Pearson's correlation coefficients and by calculating AM to video step count ratios. In Part 1, there was considerable movement of AMs at the chest and withers, but head and limb mounted AMs were more secure. In Part 2, video and AM activity counts were moderate to high for forelimb and hindlimbs with R² values of 0.82 and 0.74, respectively. From Part 3, AMs mounted on either forelimb or hindlimbs approximately doubled the step counts compared to the video. While this AM did not accurately count steps, it may be able to provide general information on activity level in the stalled horses.

Enhanced Recovery After Surgery

Purpose of Review

To provide a brief summary of the progress of enhanced recovery over the last 5 to 10 years and set out what the future might hold for such programmes.

Recent Findings

There has been significant progress in the adoption of enhanced recovery programmes across multiple surgical specialities. However there is still difficulty in sustaining a target of > 80% compliance, which has been identified through research as the optimal level to observe best patient results. With increasing interest in perioperative medicine and prehabilitation, more focus is being put into enhanced recovery programmes.

Summary

The evidence continues to support the use of enhanced recovery programmes to reduce patient mortality, morbidity and length of stay and therefore saving cost and resource. However more progress needs to be made in adoption and compliance to these programmes. In the future, advances in technology may aid programme implementation and data collection.

Smartphone technology and its applications in urology: a review of the literature

PURPOSE

Smartphone technology has propelled the evolution of health-related mobile technology, referred to as mobile health (mHealth). With the rise of smartphone ownership and the growing popularity of health-related smartphone usage, mHealth offers potential benefits for both patients and health care providers. The objective of this review is to assess the current state of smartphone technology in urology.

METHODS

A literature search of PubMed database was conducted to identify articles reporting on smartphone technology in urology. Publications were included if they focused on smartphone mHealth technology pertinent to the field of urology or included an evaluation of urological applications in digital stores.

RESULTS

We identified 50 publications focused on the use of smartphones in urology. Studies were then grouped into the following categories: smartphones employing the built-in camera and light source, applications specific to prostate cancer, urolithiasis, pediatric urology, and as educational tools for urologists. In 23/50 (46%) studies, smartphone technology/intervention was compared to a control group or to standard of care. In this regard, smartphone technology did not demonstrate benefit over standard of care in 13 studies. In contrast, in 10 studies, smartphone interventions were proven beneficial over current practice.

CONCLUSIONS

Smartphone technology is constantly evolving and has the potential to improve urological care and education. Of concern to consumer and urologist alike is that these downloadable programs are limited due to the accuracy of their content, risk of confidentiality breach, and the lack of central regulation and professional involvement in their development.

Current use of telehealth in urology: a review

PURPOSE

Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation.

METHODS

A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation.

RESULTS

Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction.

CONCLUSIONS

Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.

Sleep tracking: A systematic review of the research using commercially available technology

PURPOSE OF REVIEW

To systematically review the available research studies that characterize the benefits, uncertainty, or weaknesses of commercially-available sleep tracking technology.

RECENT FINDINGS

Sleep is a vital component of health and well-being. Research shows that tracking sleep using commercially available sleep tracking technology (e.g., wearable or smartphone-based) is increasingly popular in the general population.

METHODS

Systematic literature searches were conducted using PubMed/Medline, Embase (Ovid) the Cochrane Library, PsycINFO (Ovid), CINAHL, and Web of Science Plus (which included results from Biosis Citation Index, INSPEC, and Food, Science & Technology Abstracts) (n=842).

STUDY INCLUSION AND EXCLUSION CRITERIA

Three independent reviewers reviewed eligible articles that administered a commercially-available sleep tracker to participants and reported on sleep parameters as captured by the tracker, including either sleep duration or quality. Eligible articles had to include sleep data from users for >=4 nights.