Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp’s role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner’s understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

Feasibility of implementing patient-reported outcome measures into routine breast cancer care delivery using a novel collection and reporting platform

Objectives

imPROVE is a new Health Information Technology platform that enables systematic patient-reported outcome measure (PROM) collection through a mobile phone application. The purpose of this study is to describe our initial experience and approach to implementing imPROVE among breast cancer patients treated in breast and plastic surgery clinics.

Materials and Methods

We describe our initial implementation in 4 phases between June 2021 and February 2022: preimplementation, followed by 3 consecutive implementation periods (P1, P2, P3). The Standards for Reporting Implementation Studies statement guided this study. Iterative Plan-Do-Study-Act (PDSA) cycles supported implementation, and success was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

Results

Qualitative interviews conducted during the preimplementation phase elicited 4 perceived implementation barriers. Further feedback collected during each phase of implementation resulted in the development of brochures, posters in clinic spaces, and scripts for clinic staff to streamline discussions with patients, and the resolution of technical issues concerning patient login capabilities, such as compatibility with cell phone software and barriers to downloading imPROVE. Feedback also generated ideas for facilitating provider interpretation of PROM results. By the end of P3, 2961 patients were eligible, 1375 (46.4%) downloaded imPROVE, and 1070 (36.1% of those eligible, 78% of those who downloaded) completed at least 1 PROM.

Discussion and Conclusion

Implementation efforts across 2 surgical departments at 2 academic teaching hospitals enabled collaboration across clinical specialties and longitudinal PROM reporting for patients receiving breast cancer care; the implementation effort also highlighted patient difficulties with mobile app-based PROM collection, particularly around initial engagement.

Information needs and preferences of patients with an ankle fracture: User involvement study creating an mHealth solution

OBJECTIVE

The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after surgical or non-surgical treatment for an ankle fracture.

METHODS

Patients with an ankle fracture and health care professionals along the treatment pathway in both the hospital and municipality participated in four workshops (WS).

RESULTS

We found that patients with an ankle fracture need information on topics such as "a typical course," "bandages and assistive devices," "what can I feel," "what may I do," "what to usually worry about," "medicine," "tips and tricks," and "contact information." Moreover, patients requested diverse modes of dissemination, preferably a combination of text, timelines, pictures, animations, and videos. Alpha and beta testing of the digital platform was conducted, and content-related improvements were made. A readability analysis showed reading ease of 40.1 of 100, meaning that it should be easily understood by 15-16 year-olds.

CONCLUSION

Involving representatives of future users in creating this mHealth solution using PD demonstrates the benefits of creating a solution that aligns with users' needs.

PRACTICE IMPLICATIONS

The mHealth solution is now ready for implementation and large-scale evaluation in phase three of the overall PD study. An mHealth usability questionnaire will be employed to assess usability by future patients with surgically or non-surgically treated ankle fractures.

Apps in Clinical Practice: Usage Behaviour of Trauma Surgeons and Radiologists in Northern Germany

Introduction

Apps, in general, are an integral part of our daily lives. To investigate the current usage behaviour of trauma surgeons and radiologists regarding medical apps in clinical practice and to find out if and how the current range of medical apps can be improved, we surveyed trauma surgeons and radiologists in northern Germany. Material and Methods. An online questionnaire was sent to 100 trauma surgeons and 100 radiologists in northern Germany. Participants were asked about the frequency of their use of medical apps in clinical practice, which apps were used most often, how useful participants thought apps were, and in which area they would like to see improvements. The most frequently mentioned apps were finally analyzed.

Results

The survey study showed that 87.4% of the trauma surgeons and 67.4% of the radiologists use medical apps on a regular basis at work. It also revealed that trauma surgeons used medical apps much more often than radiologists and that young doctors were more likely to rely on medical apps than chief physicians. 80.0% of the participants would pay at least 5 euros for a medical app. Trauma surgeons see the greatest need for support in their daily work from medical apps in the area of treatment, while radiologists seek more support in the area of classification.

Conclusion

The study underscored the broad acceptance of medical apps in everyday clinical practice. As the physicians are willing to spend money and stated a general interest and need for further developments, there is high potential for the future. This trial is registered with DRKS00026766.

APP-guided assessment of acetabular defects in hip revision arthroplasty: a structured approach to a complex situation

INTRODUCTION

Acetabular defect recognition and classification remains a challenging field of practice for orthopedic surgeons. Recently, the Acetabular Defect Classification (ADC) has been introduced to provide a reliable, reproducible and intuitive classification system. In order to improve ease of use and efficiency of the ADC, a browser-based application has been created. We hypothesized that the ADC application can improve rating performance of non-specialists (medical students) to achieve good inter- and intra-rater agreement and will compare favorable to the results of specialists (experienced surgeons) without the help of the application.

MATERIALS AND METHODS

The ADC is based on the integrity of the acetabular rim and the supporting structures. It consists of four main types of defects ascending in severity. These defects are further subdivided in A-C, narrowing down defect location. 80 randomized radiographs were graded according to ADC by three non-specialists (medical students) with help of the ADC application and by three specialists (orthopedic surgeons) without help of the application to evaluate the difference in inter-rater agreement between groups. To account for intra-rater agreement, the rating process was repeated after a reasonable wash-out period.

RESULTS

Inter-rater and intra-rater agreement within the non-specialist group rated lower when compared to the specialist group while still falling into the good agreement range. The student group presented with k values of 0.61 for inter-rater agreement and 0.68 for intra-rater agreement, while the surgeon group displayed k values of 0.72 for inter-rater agreement and 0.83 for intra-rater agreement.

CONCLUSION

The app-guided assessment of acetabular defects offers a promising innovative approach to simplify complex situations. It makes the challenging field of acetabular revision arthroplasty more approachable especially for less experienced surgeons and offers insight and guidance in the planning stage as well as intra-operative setting.

Smartphone Use and Security Challenges in Hospitals: A Survey among Resident Physicians in Germany

Although mobile devices support physicians in a variety of ways in everyday clinical practice, the use of (personal) mobile devices poses potential risks for information security, data protection, and patient safety in hospitals. We used a cross-sectional survey-based study design to assess the current state of smartphone use among resident physicians in hospitals and to investigate the relationships between working conditions, current smartphone usage patterns, and security-related behavior. In total, data from 343 participating physicians could be analyzed. A large majority (98.3%) used their smartphones during clinical practice. Of the respondents who used a smartphone during clinical practice, only 4.5% were provided with a smartphone by their employer. Approximately three-quarters of the respondents who used their smartphones for professional communication never/almost never used dedicated GDPR-compliant messenger services. Using a hierarchical regression model, we found a significant effect of the organizational resources Social Support (Supervisor) and Information Security-related Communication on security-related behavior during the selection of medical apps (App Selection). Smartphones are an important part of digital support for physicians in everyday clinical practice. To minimize the risks of use, technical and organizational measures should be taken by the hospital management, resulting, for example, in a Bring-Your-Own-Device (BYOD) initiative.

Can apps be used to formulate fluid therapy plans in veterinary medicine?

BACKGROUND

Formulating sophisticated fluid therapy plans can be complicated and time consuming. Consequently, veterinarians in the field who lack experience, time, or confidence may formulate suboptimal fluid therapy plans.

OBJECTIVES

Compare conventional and app-guided fluid therapy plans for simulated cases of neonatal calf diarrhea.

PARTICIPANTS

Third and fourth year veterinary students (n = 55) from The University of Sydney.

METHODS

We developed a web app to assist fluid therapy formulation (http://calfaid.com) that was evaluated in a randomized case simulation trial. Participants were instructed to perform fluid therapy calculations and formulate an integrated fluid therapy plan for case scenarios using conventional methods and using the fluid therapy app. Responses were scored by a blinded study investigator using an a priori scoring guide and groups (conventional vs. app-guided) were compared using linear mixed models.

RESULTS

On average, total scores for app-guided fluid therapy calculations were 20.6% points higher (95% confidence interval [CI], 14.1-27.1) than calculations completed using the conventional method (88.2% vs. 67.5%, respectively). On average, total scores for app-guided integrated fluid therapy plans were 14.2% points higher (95% CI, 6.3-22.2; 65.8% vs. 51.2%). Eighty percent of respondents indicated they would prefer to use the app-guided method over the conventional method.

CONCLUSION AND CLINICAL IMPORTANCE

Our findings suggest that fluid therapy plans can be improved using apps.

Effect of phone call distraction on the performance of medical students in an OSCE

BACKGROUND

The usage of smartphones in the daily clinical routine is an essential aspect however it seems that they also present an important distractor that needs to be evaluated. The aim of this prospective study was the evaluation of the influence of phone calls as distractors on the performance levels of medical students during an objective structured clinical examination (OSCE), simulating the normal clinical practice.

METHODS

As the goal of an OSCE presents the examination of clinical skills of medical students in a realistic setting, more than 100 students recruited from the university hospital of Cologne participated in either OSCE I or II. During the OSCE I intravenous cannulation was simulated while OSCE II simulated an acute abdominal pain station. Participants had to perform each of these stations under two circumstances: a normal simulated OSCE and an OSCE station with phone call distraction. Their performance during both simulations was then evaluated.

RESULTS

In OSCE I students achieved significantly more points in the intravenous cannulation station if they were not distracted by phone calls (M=6.44 vs M=5.95). In OSCE II students achieved significantly more points in the acute abdominal pain station if they were not distracted by phone calls (M=7.59 vs M=6.84). While comparing only those students that completed both stations in OSCE I/II participating students achieved significantly more points in both OSCE I and II if they were not distracted by phone calls.

CONCLUSION

The presented data shows that phone call distraction decreases the performance level of medical students during an OSCE station. Therefore, it is an indicator that distraction especially for younger doctors should be held to a minimum. On a second note distraction should be integrated in the medical education system as it plays an important role in clinical routine.

The Use of Mobile Applications for the Diagnosis and Treatment of Tumors in Orthopaedic Oncology - a Systematic Review

The use of smartphone apps is an essential part of everyday life. Mobile applications offer enormous opportunities for dealing with challenges in public health, and their number increases every day. This paper aims to review the existing literature on mobile applications in orthopaedic oncology and to summarize the current mobile applications for musculoskeletal tumors. A systematic literature review was conducted regarding articles on mobile applications in orthopaedic and trauma surgery. The focus was on identifying mobile applications that can be used in the treatment of patients with musculoskeletal tumors. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality. In addition, the Apple App Store and Google Play Store were searched for suitable mobile applications. Ninety-one articles describing a mobile application in orthopaedic and trauma surgery were identified. Three articles focused on a mobile application for musculoskeletal tumors. Additionally, seven mobile applications were available in the App/Play Stores dealing with bone or soft tissue tumors in orthopaedic oncology without corresponding scientific articles. Increasing numbers of mobile applications are being developed in orthopaedic and trauma surgery. Currently, only three scientific articles on mobile applications in orthopaedic oncology are present, yet several more applications are available without scientific medical evaluation. Since mobile applications can facilitate the everyday life of orthopaedic and trauma surgeons, it is worthwhile to be aware of new developments in this field. A regular scientific evaluation of the subject is important in order to classify the significance of these applications.

Smartphone application alerts for early trauma team activation: Millennial technology in healthcare

BACKGROUND

Data access through smartphone applications (apps) has reframed procedure and policy in healthcare, but its impact in trauma remains unclear. Citizen is a free app that provides real-time alerts curated from 911 dispatch data. Our primary objective was to determine whether app alerts occurred earlier than recorded times for trauma team activation and emergency department arrival.

METHODS

Trauma registry entries were extracted from a level one urban trauma center from January 1, 2018 to June 30, 2019 and compared with app metadata from the center catchment area. We matched entries to metadata according to description, date, time, and location then compared metadata timestamps to trauma team activation and emergency department arrival times. We computed percentage of time the app reported traumatic events earlier than trauma team activation or emergency department arrival along with exact binomial 95% confidence interval; median differences between times were presented along with interquartile ranges.

RESULTS

Of 3,684 trauma registry entries, 209 (5.7%) matched app metadata. App alerts were earlier for 96.1% and 96.2% of trauma team activation and emergency department arrival times, respectively, with events reported median 36 (24-53, IQR) minutes earlier than trauma team activation and 32 (25-42, IQR) minutes earlier than emergency department arrival. Registry entries for younger males, motor vehicle-related injuries and penetrating traumas were more likely to match alerts (P < .0001).

CONCLUSION

Apps like Citizen may provide earlier notification of traumatic events and therefore earlier mobilization of trauma service resources. Earlier notification may translate into improved patient outcomes. Additional studies into the benefit of apps for trauma care are warranted.

Acceptance, Barriers, and Future Preferences of Mobile Health Among Patients Receiving Trauma and Orthopedic Surgical Care: Paper-Based Survey in a Prospective Multicenter Study

Background

Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown.

Objective

The aim of this study was to define target groups, evaluate patient requirements, and the potential and pitfalls regarding medical apps specific for patients receiving orthopedic and trauma surgical care.

Methods

A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression were performed.

Results

A total of 1055 questionnaires were included in our statistical analysis. Approximately 89.57% (945/1055) of the patients in this study owned a smartphone. Smartphone ownership probability decreased with every decade of life and increased with higher levels of education. Medical information was obtained via mobile web access by 62.65% (661/1055) of the patients; this correlated with smartphone ownership in regard to age and educational level. Only 11.18% (118/1055) of the patients reported previous medical app usage, and 3.50% (37/1055) of the patients received an app recommendation from a physician. More than half (594/1055, 56.30%) of the patients were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines, and medical record archival. An improved treatment experience was reported through the suggested app features by 71.18% (751/1055) of the patients.

Conclusions

Mobile devices are a widely used source of information for medical content, but only a minority of the population reported previous medical app usage. The main target group for medical apps among patients receiving orthopedic and trauma surgical care tends to be the younger population, which results in a danger of excluding fringe groups, especially the older adults. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps primarily focusing on an optimized patient education and flow of information seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group–oriented app developments, further evidence on the clinical application, feasibility, and acceptance of app usage are necessary in order to avoid patient endangerment and to limit socioeconomic costs.