1
|
Tripathy S, Shetty AP, Hansda U, P NK, Sahoo AK, V M, Mahapatra S, Mitra JK, Rao PB, Sanyal K, Panda I, N G, Sahoo J, Eborral H, Lone N, Haniffa R, Beane A. AIIMS ICU Rehabilitation (AIR): development and description of intervention for home rehabilitation of chronically ill tracheostomized patients. Wellcome Open Res 2024; 8:285. [PMID: 39280064 PMCID: PMC11399758 DOI: 10.12688/wellcomeopenres.19340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Background The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients. Methods The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders' experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention. Results The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future. Conclusions Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.
Collapse
Affiliation(s)
- Swagata Tripathy
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Asha P Shetty
- College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Upendra Hansda
- Trauma and Emergency, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Nanda Kumar P
- College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Alok Kumar Sahoo
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Mahalingam V
- College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Sujata Mahapatra
- College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Jayanta Kumar Mitra
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - P Bhaskar Rao
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Kasturi Sanyal
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Itimayee Panda
- Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Guruprasad N
- Neurosurgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Jagannath Sahoo
- Physical medicine and Rehabilitation, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Helen Eborral
- Critical Public Health, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Nazir Lone
- Critical Public Health, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Rashan Haniffa
- Critical Care, Oxford University C S Lewis Society, Oxford, England, UK
- Critical Care, MORU Thailand, THailand, Thailand
- NICST, Colombo, Sri Lanka
| | - Abi Beane
- Critical Public Health, The University of Edinburgh, Edinburgh, Scotland, UK
- Critical Care, MORU Thailand, THailand, Thailand
- NICST, Colombo, Sri Lanka
| |
Collapse
|
2
|
Saini R, Jeyaraman M, Jeyaraman N, Jain VK, Ramasubramanian S, Iyengar KP. Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions. World J Orthop 2024; 15:529-538. [PMID: 38947267 PMCID: PMC11212534 DOI: 10.5312/wjo.v15.i6.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Ravi Saini
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai 600002, Tamil Nadu, India
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospitals, Mersey and West Lancashire Teaching NHS Trust, Southport PR8 6PN, United Kingdom
| |
Collapse
|
3
|
Newmarch T, Betsch M, Michalik R, Dwyer T, Whelan D, Chahal J, Theodoropoulos J. How Important are Psychological Measures to Determine Readiness to Return to Sports after Reconstruction of the Anterior Cruciate Ligament? An Online Survey Study. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:185-192. [PMID: 36265494 DOI: 10.1055/a-1938-8359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent studies have suggested that psychological factors are important components of a successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians with respect to their criteria used to determine readiness to RTS after ACLR and to understand the significance of psychological factors on RTS. METHODS A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR, consisting of 25 questions divided into 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North American organizations for orthopedic sports medicine. RESULTS The total number of respondents was 113. Of the respondents, 95% considered psychological tests at least "somewhat important" (33% "important", 23% selected "very important"). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS. CONCLUSION This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications, and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.
Collapse
Affiliation(s)
- Tate Newmarch
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Marcel Betsch
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany
| | - Tim Dwyer
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Daniel Whelan
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Jaskarndip Chahal
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - John Theodoropoulos
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| |
Collapse
|
4
|
Leyendecker J, Prasse T, Bieler E, Yap N, Eysel P, Bredow J, Hofstetter CP. Smartphone applications for remote patient monitoring reduces clinic utilization after full-endoscopic spine surgery. J Telemed Telecare 2024:1357633X241229466. [PMID: 38321874 DOI: 10.1177/1357633x241229466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The rising number of outpatient spine surgeries creates challenges in postoperative management and care. Telemedicine offers a unique opportunity to reduce in-person clinic visits and improve resource allocation. We aimed to investigate the impact of a validated smartphone application on clinic utilization following full-endoscopic spine surgery (FESS). METHODS We evaluated patients undergoing FESS from 2020 to 2022 and a pre-COVID control group (CG) from 2018 to 2019. Subsequently, we divided the patients into three groups: one using the application (intervention group, IG), and two CGs (2020-2022, CG and 2018-2019, historical control group (HG)). We analyzed the post-surgical hospitalization rate, all follow-ups, and virtually transmitted patient-reported outcomes. RESULTS A total of 115 patients were included in the IG. The CG consisted of 137 and the HG of 202 patients (CG and HG in the following). Group homogeneity was satisfactory regarding patient age (p = 0.9), sex (p = 0.88), and body mass index (p = 0.99). IG patients were treated as outpatients significantly more often [14.78% vs. 29.2% vs. 37.62% (p < 0.001)]. Additionally, IG patients showed significantly higher follow-up compliance [74.78% vs. 40.14% vs. 37.13% (p < 0.001)] 3-month post-surgery and fewer in-patient follow-up visits [(0.5 ± 0.85 vs. 1.32 ± 0.8 vs. 1.33 ± 0.7 (p < 0.001)]. CONCLUSION Our results underline the feasibility, efficacy, and safety of remote patient monitoring following FESS. Furthermore, they highlight the opportunity to implement a virtual wound checkup, and to substantially improve postoperative follow-up compliance via telemedicine.
Collapse
Affiliation(s)
- Jannik Leyendecker
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eliana Bieler
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Natalie Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | | |
Collapse
|
5
|
Bertoni S, M M K Magema JP, Van Geluwe B, Abbes Orabi N, Bislenghi G, D'Hoore A, Wolthuis A. Digital postoperative follow-up after colorectal resection: a multi-center preliminary qualitative study on a patient reporting and monitoring application. Updates Surg 2024; 76:139-146. [PMID: 37943493 DOI: 10.1007/s13304-023-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023]
Abstract
The development of minimally invasive colorectal surgery in the last decades led to a decrease in length of hospital stay. However, readmission and postoperative complications were still observed. Several studies have shown that close postoperative follow-up is required to decrease postoperative morbidity through patient education and by detecting early signs of complications. To help in this task, multiple monitoring programs have been set up to follow patients at home, allowing detection of several complications at an early stage. To evaluate acceptance, satisfaction, usability, compliance and safety of a mobile application following postoperative colorectal patients during the first 15 days post-discharge from hospital. A mobile application enabling the communication between the patient and medical staff during the recovery phase was developed and tested in four hospitals. Patients who underwent a colorectal resection were included in this prospective qualitative study. Questionnaires to assess satisfaction and usability were handed out to patients at the end of the test period. Overall, 118 patients (52% females, median age 52.5 years) were included. Median adherence-rate during 15 days was 89.6%. Satisfaction-rate for the application was 76% and usability was high. Overall, 1220 notifications were collected, of which 722 were orange, 466 red and 32 purple, colours used to rate the severeness of complaints. We analyzed the most common notifications, showing trends in different subgroups of the study with higher risks of complications (pain (409 notifications), abnormal stools (196 notifications), and wound problems (118 notifications)). A mobile application could be used to follow patients at home after colorectal resection. Future studies should evaluate whether these applications can detect complications and prevent readmission.
Collapse
Affiliation(s)
- Sébastien Bertoni
- General and Digestive Surgery Unit, CHU-UCL Namur, Site Dinant, 5500, Dinant, Belgium
| | | | - Bart Van Geluwe
- Abdominal Surgery Unit, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Nora Abbes Orabi
- General and Digestive Surgery Unit, CHR Mons-Hainaut, 7022, Mons, Belgium
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, UZ Leuven Campus Gasthuisberg, Herestraat 49, 3000, Louvain, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, UZ Leuven Campus Gasthuisberg, Herestraat 49, 3000, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, UZ Leuven Campus Gasthuisberg, Herestraat 49, 3000, Louvain, Belgium.
| |
Collapse
|
6
|
Dalcól C, Tanner J, de Brito Poveda V. Digital tools for post-discharge surveillance of surgical site infection. J Adv Nurs 2024; 80:96-109. [PMID: 37593933 DOI: 10.1111/jan.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
AIMS Conduct a scoping review on the development and use of digital tools for post-discharge surgical site infection surveillance. DESIGN Scoping review. DATA SOURCES Science Direct, PubMed, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde and Cumulative Index to Nursing and Allied Health Literature were searched from 2013 to May 2022. Six intellectual property registries were reviewed from 2013 to 2022. REVIEW METHODS The review followed the Joanna Briggs Institute model, and included intellectual property records (applications, prototypes and software) and scientific articles published in any language on the development and/or testing of digital tools for post-discharge surveillance of surgical site infection among surgical patients aged 18 and over. RESULTS One intellectual property record and 13 scientific articles were identified, covering 10 digital tools. The intellectual property record was developed and registered by a China educational institution in 2018. The majority of manuscripts were prospective cohort studies and randomized clinical trials, published between 2016 and 2022, and more than half were conducted in the United States. The population included adult patients undergoing cardiac, thoracic, vascular, abdominal, arthroplasty and caesarean surgery. The main functionalities of the digital tools were the previously prepared questionnaire, the attachment of a wound image, the integrated Web system and the evaluation of data by the health team, with post-discharge surgical site infection surveillance time between 14 and 30 days after surgery. CONCLUSION Digital tools show promise for the surveillance of surgical site infection, collaborating with the early detection of wound infection. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Mobile technology was favourable for detecting surgical site infections, reducing unnecessary visits to the health service, and increasing patient satisfaction. IMPACT Technological advances in the health area open new perspectives for post-discharge surveillance of surgical site infection. WHAT IS ALREADY KNOWN?: There is underreporting of surgical site infections due to difficulties related to traditional methods of post-discharge surveillance. The use of digital tools within surgical site infection surveillance is increasing. Benefits of using digital tools within surgical site infection surveillance have been reported. WHAT HAS THIS STUDY ADDED TO OUR KNOWLEDGE?: This scoping review is one of the first to analyse the development and use of digital tools for post-discharge surveillance of surgical site infection in different countries. The main functionalities of digital tools are: structured questionnaires; attachment of wound images; integrated web systems; and evaluation of data by professionals. The use of mobile technology is favourable for detecting surgical site infections with a reduction in costs from face-to-face consultations and increased patient satisfaction. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Healthcare providers can successfully use digital tools for surgical site infection post-discharge surveillance. Remote monitoring can reduce unnecessary patient visits to healthcare facilities. Policy makers can study how to implement digital platforms for remote patient monitoring. REPORTING METHOD PRISMA statement for Scoping Reviews (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. TRIAL AND PROTOCOL REGISTRATION The study protocol was registered in the OSF (https://doi.org/10.17605/OSF.IO/BA8D6).
Collapse
Affiliation(s)
- Camila Dalcól
- University of São Paulo School of Nursing, São Paulo, Brazil
| | | | | |
Collapse
|
7
|
Monárrez R, Mohamadi A, Drew JM, Abdeen A. Mobile Application's Effect on Patient Satisfaction and Compliance in Total Joint Arthroplasty: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00005. [PMID: 37678829 PMCID: PMC10484373 DOI: 10.5435/jaaosglobal-d-22-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 09/09/2023]
Abstract
Use of mobile applications to improve patient engagement is particularly promising in total joint arthroplasty (TJA) whereby successful outcomes are predicated by patient engagement. In accordance with published guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, studies were searched, screened, and appraised for quality on various search engines. Hedges' g or odds ratios of patient adherence were reported. Twelve studies met the inclusion criteria, and the average age of 9,521 patients included was 60 years. Six studies concluded that mobile applications improved patients' satisfaction, with Hedges' g revealing an effect size of 1.64 (95% confidence interval [CI] 0.90 to 2.37), P < 0.001, in favor of mobile applications increasing patient satisfaction. Six studies reported improvements in compliance demonstrating an odds ratio for improved adherence of 4.57 (95% CI, 1.66 to 12.62), P < 0.001. Two studies reported a reduction in unscheduled office or emergency department visits. With evolving reimbursement policies linked to outcomes paired with the exponentially increasing volume of TJA performed, innovative ways to efficiently deliver high-quality care are in demand. Our systematic review is limited by a dearth of research on the nascent technology, but the available data suggest that mobile applications may enhance patient satisfaction, improve compliance, and reduce unscheduled visits after TJA.
Collapse
Affiliation(s)
- Rubén Monárrez
- From the Department of Orthopaedic Surgery (Dr. Mohamadi, Dr. Drew), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Monárrez, Dr. Mohamadi, Dr. Drew, and Dr. Abdeen); the Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD (Monárrez); and the Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA (Abdeen)
| | | | | | | |
Collapse
|
8
|
Little AK, Patmon DL, Sandhu H, Armstrong S, Anderson D, Sommers M. Inpatient versus Outpatient Immediate Alloplastic Breast Reconstruction: Recent Trends, Outcomes, and Safety. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5135. [PMID: 37744774 PMCID: PMC10513287 DOI: 10.1097/gox.0000000000005135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/06/2023] [Indexed: 09/26/2023]
Abstract
Background Immediate alloplastic breast reconstruction was traditionally performed as an inpatient procedure. Despite several reports in the literature demonstrating comparable safety outcomes, there remains hesitancy to accept breast reconstruction performed as an outpatient procedure. Methods A retrospective review of National Surgical Quality Improvement Program data from 2014 to 2018 was utilized to evaluate recent trends and 30-day postoperative complication rates for inpatient versus outpatient immediate prosthetic-based breast reconstruction. Propensity score matching was used to obtain comparable groups. Results During the study period, 33,587 patients underwent immediate alloplastic breast reconstruction. Of those, 67.5% of patients were discharged within 24 hours, and 32.4% of patients had a hospital stay of more than 24 hours. Immediate alloplastic reconstruction had an overall growth rate of 16.9% from 2014 to 2018. After propensity score matching, intraoperative variables that correlated with significantly increased inpatient status included increased work relative value units (16.3 ± 2.3 versus 16.2 ± 2.6; P < 0.001), longer operative times (228 ± 86 versus 206 ± 77; P < 0.001), and bilateral procedure (44.0% versus 43.5%; P < 0.001). There were higher rates of pulmonary embolism, wound dehiscence, urinary tract infection, transfusions, sepsis, readmissions, and reoperations in the group with the longer hospital stay. Conclusion Based on increased complication rates and costs in the inpatient setting, we propose outpatient reconstructive surgery as a safe and cost-effective alternative for immediate alloplastic breast reconstruction.
Collapse
Affiliation(s)
- Andrea K. Little
- From the Division of Plastic and Reconstructive Surgery, Spectrum Health Michigan State University Plastic Surgery Residency, Grand Rapids, Mich
| | - Darin L. Patmon
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Harminder Sandhu
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | | | - Daniella Anderson
- From the Division of Plastic and Reconstructive Surgery, Spectrum Health Michigan State University Plastic Surgery Residency, Grand Rapids, Mich
| | - Megan Sommers
- From the Division of Plastic and Reconstructive Surgery, Spectrum Health Michigan State University Plastic Surgery Residency, Grand Rapids, Mich
| |
Collapse
|
9
|
Liu Y, Qiu Y, Fu Y, Liu J. Evaluation of postoperative recovery: past, present and future. Postgrad Med J 2023; 99:808-814. [PMID: 37490361 DOI: 10.1136/postgradmedj-2022-141652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023]
Abstract
Postoperative recovery, as a window to observe perioperative treatment effect and patient prognosis, is a common outcome indicator in clinical research and has attracted more and more attention of surgeons and anaesthesiologists. Postoperative recovery is a subjective, multidimensional, long-term, complex process, so it is unreasonable to only use objective indicators to explain it. Currently, with the widespread use of patient-reported outcomes, various scales become the primary tools for assessing postoperative recovery. Through systematic search, we found 14 universal recovery scales, which have different structures, contents and measurement properties, as well as their own strengths and weaknesses. We also found that it is urgently necessary to perform further researches and develop a scale that can serve as the gold universal standard to evaluate postoperative recovery. In addition, with the rapid development of intelligent equipment, the establishment and validation of electronic scales is also an interesting direction.
Collapse
Affiliation(s)
- Yijun Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhua Qiu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Fu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
10
|
Temple-Oberle C, Yakaback S, Webb C, Assadzadeh GE, Nelson G. Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery: A Randomized Clinical Trial. JAMA Surg 2023; 158:693-699. [PMID: 37043216 PMCID: PMC10099099 DOI: 10.1001/jamasurg.2023.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/26/2022] [Indexed: 04/13/2023]
Abstract
Importance There has been an increase in health care-focused smartphone apps, including those for encouraging healthy behaviors and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored. Objective To compare quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app-assisted follow-up for patients following Enhanced Recovery After Surgery Society (ERAS) protocols. Design, Setting, and Participants This randomized clinical trial, conducted from June 2019 to April 2021, included women older than 18 years undergoing oncologic breast reconstruction or major gynecologic oncology surgery following ERAS protocols with the care of 2 surgeons at an academic tertiary care center. Interventions Patients were randomized 1:1 to receive smartphone app-assisted follow-up or conventional in-person follow-up. The smartphone group used a surgeon-monitored app to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer-selected adverse events, drain outputs, and surgical site photographs over 6 weeks. Patient satisfaction scores were assessed using validated Patient Satisfaction Questionnaire III (PSQ-III) subscales at 2 and 6 weeks postoperatively. The conventional follow-up group also completed the QoR15 and PSQ-III questionnaires at these intervals. Main Outcomes and Measures The primary outcomes were quality of recovery and patient satisfaction, as measured by the QoR15 and PSQ-III, respectively. Secondary outcomes were costs of follow-up; the number of contacts with the medical system, complications, and surgeons' contacts with patients; and surgeons' perceptions of app-assisted care. Results Of 72 patients included in the trial, 36 underwent breast reconstruction (mean [SD] age, 45.30 [9.13] years) and 36 underwent gynecologic oncology surgery (mean [SD] age, 54.90 [11.18] years). Three patients dropped out (2 who underwent breast reconstruction [1 in the app group, 1 in the control group], 1 who underwent gynecologic oncology surgery [control group]). The app group had significantly higher mean (SD) QoR15 scores than the control group (2 weeks: 127.58 [22.03] vs 117.68 [17.52], P = .02; 6 weeks: 136.64 [17.53] vs 129.76 [16.42], P = .03). Patients were equally satisfied between groups in all subsets of the PSQ-III at these intervals. The mean (SD) number of complications was similar in both groups, and a similar number of surgeon contacts per patient occurred (1.6 [1.2] vs 2.1 [2.0], P = .16). Surgeons appreciated early identification of complications with the app. Conclusions and Relevance In this randomized clinical trial, postoperative follow-up for patients undergoing breast reconstruction and gynecologic oncology surgery using smartphone app-assisted monitoring led to improved quality of recovery and equal satisfaction with care compared with conventional in-person follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT03456167.
Collapse
Affiliation(s)
- Claire Temple-Oberle
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Spencer Yakaback
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Webb
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Gregg Nelson
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
11
|
Baniasadi T, Hassaniazad M, Rostam Niakan Kalhori S, Shahi M, Ghazisaeedi M. Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care. BMC Med Inform Decis Mak 2023; 23:103. [PMID: 37268995 DOI: 10.1186/s12911-023-02199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries. MATERIAL AND METHODS This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians. RESULTS The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system. CONCLUSION Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.
Collapse
Affiliation(s)
- Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Hassaniazad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Mehraban Shahi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
12
|
McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
13
|
Mavragani A, Baniasadi T, Shirkhoda M, Rostam Niakan Kalhori S, Mohammadzadeh N, Roudini K, Ghalehtaki R, Memari F, Jalaeefar A. Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things-Based Device: Development and Usability Study. JMIR Cancer 2023; 9:e42250. [PMID: 36790851 PMCID: PMC9978953 DOI: 10.2196/42250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. OBJECTIVE This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. METHODS This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles. RESULTS A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. CONCLUSIONS Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations.
Collapse
Affiliation(s)
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Shirkhoda
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Peter L. Reichertz Institute for Medical Informatics (PLRI), Technical University of Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Roudini
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghalehtaki
- Department of Radiation Oncology, Cancer Institute, Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoon Memari
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohsen Jalaeefar
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Macefield RC, Blazeby JM, Reeves BC, King A, Rees J, Pullyblank A, Avery K. Remote assessment of surgical site infection (SSI) using patient-taken wound images: Development and evaluation of a method for research and routine practice. J Tissue Viability 2023; 32:94-101. [PMID: 36681617 DOI: 10.1016/j.jtv.2023.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIM Clinical assessment of wounds for surgical site infection (SSI) after hospital discharge is challenging and resource intensive. Remote assessment using digital images may be feasible and expedite SSI diagnosis. Acceptable and accurate methods for this process are needed. This study developed and evaluated the feasibility, acceptability and usability of a method for patients to capture standardised wound images for remote wound assessment to detect SSI. MATERIALS AND METHODS The work was conducted in two phases. Phase I involved: i) a review of literature to identify key components of photography relevant to taking wound images, ii) development of wound photography instructions for patients and a secure process for transmission of images using electronic survey software and iii) pre-testing of the photography instructions and processing method with a sample of 16 patients using cognitive interviews and observations. Phase II involved a prospective cohort study of 89 patients to evaluate the feasibility, acceptability and usability of the remote method following discharge from hospital after surgery. Quality of the images was assessed by three independent clinical reviewers. RESULTS Some 21 key components for photographing wounds were identified from 11 documents. Of these, 16 were relevant to include in instructions for patients to photograph their wounds. Pre-testing and subsequent iterations improved understanding and ease of use of the instructions and the process for transmitting images. Fifty-two of 89 (58.4%) patients testing the method remotely took an image of their wound(s) and 46/52 (88.5%) successfully transmitted images. When it was possible to ascertain a reason for not taking/transmitting images, this was primarily health problems (n = 7) or lack of time/poor engagement with the study (n = 4) rather than problems relating to technology/competency (n = 2) or practical issues relating to the wound itself (n = 2). Eighty-seven (85.3%) of the 102 images received were evaluated to be of high quality and sufficient to remotely assess SSI by at least two independent reviewers. CONCLUSION A simple, standardised and acceptable method for patients to take and transmit wound images suitable for remote assessment of SSI has been developed and tested and is now available for use in routine clinical care and research.
Collapse
Affiliation(s)
- Rhiannon C Macefield
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK.
| | - Jane M Blazeby
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, UK
| | - Anni King
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Jonathan Rees
- Hepatobiliary Surgery, University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, UK
| | | | - Kerry Avery
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| |
Collapse
|
15
|
Lu F, Wang X, Huang X. Counseling for Health: How Psychological Distance Influences Continuance Intention towards Mobile Medical Consultation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031718. [PMID: 36767084 PMCID: PMC9914346 DOI: 10.3390/ijerph20031718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 01/15/2023] [Indexed: 05/27/2023]
Abstract
As mobile healthcare services entered the public sight with high frequency during the COVID-19 pandemic, patients are increasingly recognizing the effectiveness of mobile medical consultation (MMC). Earlier studies have investigated what influences continuance intention (CI) towards MMC, but few studies have scrutinized it from the perspective of patients' psychological distance. We formulated a framework to examine the psychological factors influencing CI towards MMC by integrating the information systems continuance model and psychological distance theory. The framework was validated using the partial least squares structural equation modeling (PLS-SEM) approach and data from 475 MMC users in China. The empirical results revealed that immediacy, telepresence, intimacy, and substitutability were significant predictors of CI, while satisfaction mediated these pathways. Pandemic-induced anxiety positively moderated the effect of immediacy on satisfaction and the effect of satisfaction on CI. Practical implementations for MMC healthcare practitioners, designers, and marketers are drawn.
Collapse
Affiliation(s)
- Fuyong Lu
- Institute of Education and Economy Research, University of International Business and Economics, No. 10, Huixindongjie, Chaoyang District, Beijing 100029, China
| | - Xintao Wang
- School of Business, Renmin University of China, No. 59, Zhongguancundajie, Haidian District, Beijing 100872, China
| | - Xian Huang
- School of Business, Renmin University of China, No. 59, Zhongguancundajie, Haidian District, Beijing 100872, China
| |
Collapse
|
16
|
Faessen JL, van Vugt R, Veldhuizen R, Stoot JHMB. Using an E-Health Application for Post-operative Monitoring After Inguinal Hernia Repair: A Feasibility Study. World J Surg 2023; 47:182-189. [PMID: 35604449 PMCID: PMC9125961 DOI: 10.1007/s00268-022-06590-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND E-Health care is already well established in some (non-) surgical specialties and is considered as a means of improving patient-centred care. Considering the demand of remote health care changes, especially in the COVID-19 pandemic, it is essential to investigate the feasibility of e-Health care within one of the most performed surgery procedures: inguinal hernia repair. METHODS A total of 60 patients used the e-Health application in this study compliant. Primary objectives were to investigate the accuracy of the "deviating post-operative course" alerting by the e-Health application. Secondary objectives included patient perspective and e-Health costs analysis. RESULTS Forty-four patients reported no deviation in the post-operative course using the e-Health application of which 93.2% (n = 41) was in concordance with the findings during standard follow-up. Within 16 patients reporting a deviating post-operative course, a true complication was found in 25% (n = 4). Based on in-hospital costs, a hypothetical e-Health follow-up scenario was more expensive (€59.5 per patient) than current standard follow-up care (€28.2 per patient). Usage of the e-Health application showed a high perceived overall patient satisfaction: 4.2 (on a Likert-scale of 1-5). CONCLUSION An e-Health application is a promising tool for identifying patients who require in-person or phone follow-up assessment. Patients' perspectives surveys revealed high potential and willingness of using this application. A hypothetical e-Health follow-up scenario showed to be more expensive compared to current standard follow-up. If the identified (dis)advantages can be improved, e-Health follow-up care appears to be promising in terms of safety and feasibility. Future studies can leverage on this study and further investigate the use of e-Health within the field of general surgery.
Collapse
Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands.
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - R Veldhuizen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| |
Collapse
|
17
|
Beauharnais CC, Hill SS, Sturrock PR, Davids JS, Alavi K, Maykel JA. Efficacy and satisfaction of asynchronous TeleHealth care compared to in-person visits following colorectal surgical resection. Surg Endosc 2022; 36:9106-9112. [PMID: 35713720 PMCID: PMC9205288 DOI: 10.1007/s00464-022-09383-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The feasibility of remote visits following abdominal colorectal surgery has not been studied in relation to efficacy, patient satisfaction, and surgeon satisfaction. This study aims to assess reliability and satisfaction with a web-based questionnaire for post-operative visits following abdominal colorectal surgery. METHODS This was a prospective single-arm cohort study at single-tertiary care center during admission for abdominal colorectal surgery. Using a web-based patient portal, patients completed a questionnaire 48 h prior to their scheduled in-person follow-up visits and submitted photographs of their incisions. Surgeons reviewed patient-entered data and responded within 24 h. Following the subsequent in-person visit, surgeons completed questionnaires to compare the accuracy of the web-based vs. in-person evaluations. Lastly, patients and surgeons completed separate satisfaction surveys after the in-person visits. RESULTS A total of 33 patients were enrolled, of which 30 (90.9%) successfully completed the web questionnaire. Providers reported the online questionnaire to be concordant with the in-person visit in 90% of cases. Of the patients who completed the study, only half found the survey alone to be acceptable for follow-up. Patients spent significantly less time completing the online questionnaire (≤ 10 min) than in-person visits, including travel time (75 min, IQR 50-100). Only 12 patients (40%) uploaded photographs of their incisions. During in-person visits, management changes were employed in four patients (13.3%), of which 3 required treatment of superficial surgical site infections (10%). CONCLUSION This asynchronous web-based visit format was acceptable to colorectal surgeons but was only embraced by half of patients, despite considerable time savings. While patients preferred in-person visits, there may be opportunities to expand TeleHealth acceptance that focus on patient selection and education. CLINICALTRIALS gov: NCT05084131.
Collapse
Affiliation(s)
- Catherine C Beauharnais
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Division of Colorectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA.
| | - Susanna S Hill
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Paul R Sturrock
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Karim Alavi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Justin A Maykel
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| |
Collapse
|
18
|
Robin F, Roy M, Kuftedjian A, Perret L, Lavoie F, Castonguay A, Pomey MP, Zaouter C, Pare G. A Medico-Economic Evaluation of a Telehealth platform for elective Outpatient Surgeries: Protocol for a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2022; 12:e44006. [PMID: 37093634 PMCID: PMC10167590 DOI: 10.2196/44006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The number of elective outpatient surgeries in Canada has increased markedly in the last 10 years. However, unanticipated cancellations on the day of surgery and adverse postoperative events are frequent. Modern technologies have been shown to be of great help in the medical field in improving patient care. Thus, it is likely that dedicated technologies could also significantly improve surgical outpatients' pathways. Therefore, the department of anesthesiology at the University of Montreal Medical Center, in collaboration with LeoMed, a telemedicine platform, has developed a telehealth solution to offer more efficient perioperative support and follow-up for patients undergoing ambulatory surgery. OBJECTIVE The objective is to evaluate the medicoeconomic benefit of a dedicated perioperative telehealth platform for patients undergoing day surgery. Our hypothesis is that this dedicated telecare solution will allow more efficient patient care, which will reduce all types of medical costs related to day surgery pathways. METHODS This study is a single-center, single-blinded, 2-group randomized controlled trial. One thousand patients aged over 18 years with internet access who are scheduled to undergo ambulatory surgery will be enrolled and randomized either to follow a perioperative path that includes a patient-tailored perioperative digital app via the LeoMed telecare platform for 1 month or to follow the standard of care, which does not offer personalized digital support. The primary outcome will be to evaluate the cost-effectiveness of the telecare platform, assessing direct costs from factors such as unanticipated cancellations on the day of surgery due to preoperative instructions not being followed, calls to the local health information line, calls to the provincial health information line, emergency department consultations, unplanned readmissions, or medical visits for problems related to the surgical procedure within the first 30 days after the intervention. The secondary outcome will be to evaluate cost utility using a questionnaire assessing quality-adjusted life years. A blinded independent research team will analyze outcomes. All data will be analyzed according to the intention-to-treat principle. A sample size of 500 subjects in each group was calculated to detect a 21% reduction in postoperative complications with a power of 90%. This study has been approved by the ethics board of Centre hospitalier de l'Université de Montréal (University of Montreal Health Centre). No employee of LeoMed was involved in the study conception, and none will be involved in either data collection or analysis. RESULTS Results of this trial will be useful to determine the economic benefit of a telecare platform specifically developed for surgical outpatient pathways. CONCLUSIONS We believe that the deployment of a dedicated perioperative telehealth app will lead to better patient care and fewer postoperative complications, which will lower all types of costs related to surgical outpatient care. TRIAL REGISTRATION ClinicalTrials.gov NCT04948632; https://ClinicalTrials.gov/ct2/show/NCT04948632. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44006.
Collapse
Affiliation(s)
- Florian Robin
- Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Maxim Roy
- Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Alexandre Kuftedjian
- Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Laurelie Perret
- Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada
| | - Frédéric Lavoie
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Marie-Pascale Pomey
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- School of Public Health, University of Montreal, Montréal, QC, Canada
| | - Cedrick Zaouter
- Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Guy Pare
- École des Hautes Études Commerciales, Montréal, QC, Canada
| |
Collapse
|
19
|
Dany Mouarbes, Thomas P, Reina N, Cavaignac M, Berard E, Cavaignac E. How can augmented care experience (ACE) improve ACLR patient's participation to web questionnaires. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
20
|
Shi Y, Yan J, Wang S, Li Y, Deng X. Efficacy of a new day surgery management mode based on WeChat: a study protocol for randomised controlled trials. BMJ Open 2022; 12:e058204. [PMID: 35926989 PMCID: PMC9358948 DOI: 10.1136/bmjopen-2021-058204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is an enormous imbalance between the rapid development of day surgery and the current conventional medical services. Hence, an effective day surgery management mode should be developed that can be used to constantly follow up on patients both preoperatively and postoperatively. In this study, WeChat was chosen as the platform. This study aimed to investigate the feasibility and effectiveness of a new day surgery management mode. METHODS AND ANALYSIS This randomised controlled study investigated the efficacy of a new day surgery management mode based on WeChat. The target number of participants was 1000 per group. The application (app) will send personalised information based on the medical history of the patient and the type of surgery at different time points preoperatively and postoperatively. The healthcare worker can follow up the patient and acquire clinical data by simply signing into the app. The patient and the healthcare worker can also engage in video or voice chats using the app when necessary. Multiple departments, including anaesthesiology, internal medicine, surgery, nursing and psychology, will participate in this new mode. ETHICS AND DISSEMINATION Ethical approval was obtained from the West China Hospital of Sichuan University Biomedical Research Ethics Committee. Results of this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100050793.
Collapse
Affiliation(s)
- Yun Shi
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Junyu Yan
- Department of Anesthesiology, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay, Xinjiang Uyghur, China
| | - Shuangwen Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yifan Li
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqian Deng
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| |
Collapse
|
21
|
Nkurunziza T, Williams W, Kateera F, Riviello R, Niyigena A, Miranda E, Bikorimana L, Nkurunziza J, Velin L, Goodman AS, Matousek A, Klug SJ, Gaju E, Hedt-Gauthier BL. mHealth-community health worker telemedicine intervention for surgical site infection diagnosis: a prospective study among women delivering via caesarean section in rural Rwanda. BMJ Glob Health 2022; 7:bmjgh-2022-009365. [PMID: 35902205 PMCID: PMC9341172 DOI: 10.1136/bmjgh-2022-009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Surgical site infections (SSIs) cause a significant global public health burden in low and middle-income countries. Most SSIs develop after patient discharge and may go undetected. We assessed the feasibility and diagnostic accuracy of an mHealth-community health worker (CHW) home-based telemedicine intervention to diagnose SSIs in women who delivered via caesarean section in rural Rwanda. Methods This prospective cohort study included women who underwent a caesarean section at Kirehe District Hospital between September 2019 and March 2020. At postoperative day 10 (±3 days), a trained CHW visited the woman at home, provided wound care and transmitted a photo of the wound to a remote general practitioner (GP) via WhatsApp. The GP reviewed the photo and made an SSI diagnosis. The next day, the woman returned to the hospital for physical examination by an independent GP, whose SSI diagnosis was considered the gold standard for our analysis. We describe the intervention process indicators and report the sensitivity and specificity of the telemedicine-based diagnosis. Results Of 787 women included in the study, 91.4% (n=719) were located at their home by the CHW and all of them (n=719, 100%) accepted the intervention. The full intervention was completed, including receipt of GP telemedicine diagnosis within 1 hour, for 79.0% (n=623). The GPs diagnosed 30 SSIs (4.2%) through telemedicine and 38 SSIs (5.4%) through physical examination. The telemedicine sensitivity was 36.8% and specificity was 97.6%. The negative predictive value was 96.4%. Conclusions Implementation of an mHealth-CHW home-based intervention in rural Rwanda and similar settings is feasible. Patients’ acceptance of the intervention was key to its success. The telemedicine-based SSI diagnosis had a high negative predictive value but a low sensitivity. Further studies must explore strategies to improve accuracy, such as accompanying wound images with clinical data or developing algorithms using machine learning.
Collapse
Affiliation(s)
- Theoneste Nkurunziza
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda .,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Niyigena
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Vascular Surgery, University of Southern California, Los Angeles, California, USA
| | - Laban Bikorimana
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Lotta Velin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Andrea S Goodman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Matousek
- Northwest Heart and Lung Surgical Associates, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Erick Gaju
- eHealth Unit, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Bethany L Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Sybil D, Krishna M, Shrivastava PK, Singh S, Khan I. Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study. JMIR Perioper Med 2022; 5:e35997. [PMID: 35763332 PMCID: PMC9277528 DOI: 10.2196/35997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups—verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)—based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83%) and 28 (93%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice.
Collapse
Affiliation(s)
- Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | | | | | - Shradha Singh
- Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | - Imran Khan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| |
Collapse
|
23
|
Jaensson M, Nilsson U, Dahlberg K. Postoperative recovery: how and when is it assessed: a scoping review. Br J Anaesth 2022; 129:92-103. [PMID: 35623904 DOI: 10.1016/j.bja.2022.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments. METHODS A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified. RESULTS A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery. CONCLUSIONS Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
Collapse
Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| |
Collapse
|
24
|
Are patients who return for 10-year follow-up after AIS surgery different from those who do not? Spine Deform 2022; 10:527-535. [PMID: 35067897 DOI: 10.1007/s43390-021-00458-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the impact of patients lost to follow-up on outcomes of surgery for adolescent idiopathic scoliosis (AIS) at 10-year postoperative. METHODS Preoperative, 2-year, and 5-year postoperative demographic, radiographic, and SRS-22 data from a prospective multi-center registry were compared between patients with a 10-year follow-up visit versus those without. A second analysis utilized variables that were different between the groups, along with SRS scores, in a cohort of patients with preoperative, 2-, 5-, and 10-year postoperative SRS scores (complete cohort) to impute missing 10-year data (imputed cohort) utilizing Markov chain Monte Carlo simulation. RESULTS 250 patients had 10-year follow-up (21%). Those with 10-year follow-up had a greater percentage of patients who underwent anterior procedures (p < 0.05). Radiographically, the groups were similar at all three time points. SRS-22 scores demonstrated slightly worse pain and function preoperatively and at 2 year in those lost to follow-up (effect size eta = 0.11-0.12), with no differences at 5 year. Imputed data analysis demonstrated similar trends over time in SRS-22 scores compared to the complete cohort for total score and all domains except pain. There was no significant difference in imputed versus complete 10-year SRS-22 scores (p > 0.05). CONCLUSION This study identified early differences between patients with 10-year follow-up and those without, though effect sizes were small and non-existent at 5 years. SRS-22 scores at 10 year between the complete and imputed data sets did not differ. Clinically relevant outcomes of the subset who followed-up at 10 year are likely generalizable to the entire eligible AIS population.
Collapse
|
25
|
Cost-benefit analysis of a patient engagement technology (PET) in cardiac, thoracic, and colorectal surgery. Am J Surg 2022; 224:979-986. [DOI: 10.1016/j.amjsurg.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
|
26
|
Encouraging Digital Patient Portal Use in Ambulatory Surgery: A Mixed Method Research of Patients and Health Care Professionals Experiences and Perceptions. J Perianesth Nurs 2022; 37:691-698. [DOI: 10.1016/j.jopan.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
|
27
|
Determining the impact of postoperative complications in neurosurgery based on simulated longitudinal smartphone app-based assessment. Acta Neurochir (Wien) 2022; 164:207-217. [PMID: 34420108 PMCID: PMC8761146 DOI: 10.1007/s00701-021-04967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
Background Complications after neurosurgical operations can have severe impact on patient well-being, which is poorly reflected by current grading systems. The objective of this work was to develop and conduct a feasibility study of a new smartphone application that allows for the longitudinal assessment of postoperative well-being and complications. Methods We developed a smartphone application “Post OP Tracker” according to requirements from clinical experience and tested it on simulated patients. Participants received regular notifications through the app, inquiring them about their well-being and complications that had to be answered according to their assigned scenarios. After a 12-week period, subjects answered a questionnaire about the app’s functionality, user-friendliness, and acceptability. Results A total of 13 participants (mean age 34.8, range 24–68 years, 4 (30.8%) female) volunteered in this feasibility study. Most of them had a professional background in either health care or software development. All participants downloaded, installed, and applied the app for an average of 12.9 weeks. On a scale of 1 (worst) to 4 (best), the app was rated on average 3.6 in overall satisfaction and 3.8 in acceptance. The design achieved a somewhat favorable score of 3.1. One participant (7.7%) reported major technical issues. The gathered patient data can be used to graphically display the simulated outcome and assess the impact of postoperative complications. Conclusions This study suggests the feasibility to longitudinally gather postoperative data on subjective well-being through a smartphone application. Among potential patients, our application indicated to be functional, user-friendly, and well accepted. Using this app-based approach, further studies will enable us to classify postoperative complications according to their impact on the patient’s well-being. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04967-0.
Collapse
|
28
|
Sajnani J, Swan K, Wolff S, Drummond K. Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study. JMIR Perioper Med 2021; 4:e22681. [PMID: 34904957 PMCID: PMC8715356 DOI: 10.2196/22681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. OBJECTIVE This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. METHODS We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. RESULTS A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ≥9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ≥9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ≥9). CONCLUSIONS Postoperative text messages increased patients' perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate.
Collapse
Affiliation(s)
- Jocelyn Sajnani
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.,Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kimberly Swan
- Department of Obstetrics and Gynecology, Overland Park Regional Medical Center, Overland Park, KS, United States
| | - Sharon Wolff
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kelsi Drummond
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
29
|
Ben-Ali W, Lamarche Y, Carrier M, Demers P, Bouchard D, El-Hamamsy I, Cartier R, Pellerin M, Perrault LP. Use of Mobile-Based Application for Collection of Patient-Reported Outcomes in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:536-544. [PMID: 34882492 DOI: 10.1177/15569845211045677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Application-based (app) technology has been studied for patient engagement and collecting patient-reported outcomes (PROs) in several surgical specialties with limited research in cardiac surgery. The aim of study was to determine the effectiveness of app-based technology for collecting PROs, improving the patient experience, and reducing health services utilization in a cardiac surgery center. METHODS Patients accessed an interactive app via smartphones. Patients were guided from 4 weeks preoperative to 4 weeks postoperative via reminders, tasks, PRO surveys, and evidence-based education. In the postoperative period, patients were engaged with daily health surveys to track warning signs and recovery milestones. Based on the patient's signs and symptoms, the app escalated lower risk issues to self-care education or higher risk issues to the care team (e.g., phone call to a nurse). RESULTS Sixty-six percent of patients (730 of 1,108) activated their app account. Two hundred seventy-seven patients completed an end-of-program feedback survey, with 94% of patients recommending the app and 98% of patients finding the app was helpful in recovery. Patients also reported using the app to avoid unnecessary health services utilization, with 45% of patients using the app to avoid at least 1 phone call and 28% of patients using the app to avoid at least 1 hospital visit. CONCLUSIONS App-based technology for patient engagement is an effective modality to enhance the patient experience, better understand the trajectory of recovery, and reduce unnecessary health services utilization in cardiac surgery.
Collapse
Affiliation(s)
- Walid Ben-Ali
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Ismail El-Hamamsy
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| |
Collapse
|
30
|
Allenson K, Turner K, Gonzalez BD, Gurd E, Zhu S, Misner N, Chin A, Adams M, Cooper L, Nguyen D, Naffouje S, Castillo DL, Kocab M, James B, Denbo J, Pimiento JM, Malafa M, Powers BD, Fleming JB, Anaya DA, Hodul PJ. Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery. BMC Nutr 2021; 7:82. [PMID: 34886909 PMCID: PMC8656101 DOI: 10.1186/s40795-021-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Patients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery. Methods Participants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes. Results All 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7). Conclusions This intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial. Trial registration Clinicaltrials.gov. Registered 16 September 2019, https://clinicaltrials.gov/ct2/show/NCT04091165.
Collapse
Affiliation(s)
- Kelvin Allenson
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA. .,University of South Florida Morsani College of Medicine, Tampa, Fl, USA.
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, Fl, USA
| | - Erin Gurd
- Department of Nutrition Therapy, Moffitt Cancer Center, Tampa, Fl, USA
| | - Sarah Zhu
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Nicole Misner
- Department of Nutrition Therapy, Moffitt Cancer Center, Tampa, Fl, USA
| | - Alicia Chin
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Melissa Adams
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Laura Cooper
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Diana Nguyen
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Samer Naffouje
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Diana L Castillo
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Maria Kocab
- University of South Florida Morsani College of Medicine, Tampa, Fl, USA
| | - Brian James
- University of South Florida Morsani College of Medicine, Tampa, Fl, USA
| | - Jason Denbo
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Benjamin D Powers
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA.,Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jason B Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Daniel A Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Pamela J Hodul
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| |
Collapse
|
31
|
Coppens M, Van Caelenberg E, De Regge M. Postoperative innovative technology for ambulatory anesthesia and surgery. Curr Opin Anaesthesiol 2021; 34:709-713. [PMID: 34269739 DOI: 10.1097/aco.0000000000001036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the impact of different forms of telehealth that are currently used in ambulatory anesthesia and surgery. Telehealth is applicable during the early recovery and intermediate recovery period (e.g. monitoring of quality of recovery), and as a tool for postoperative check-up during the late recovery phase. RECENT FINDINGS Postoperative follow-up after ambulatory surgery is still crucial to maintain quality of care as pain and postoperative nausea and vomiting remain common adverse events. There is a surge of telehealth applications from procedure-specific commercial smartphone apps (mHealth) to complete digital patient platforms instituted by the government. However, patient and healthcare provider engagement is not universal. Usability of these applications is mandatory as well as identifying and overcoming the barriers to its use. SUMMARY Telehealth gives many opportunities for postoperative follow-up of ambulatory surgery patients. Clear evidence on the benefits of telehealth in ambulatory surgery is however still sparse. Future research should focus on telehealth for improving quality and safety of postoperative recovery, convincing policymakers for reimbursement encouraging healthcare providers and patients to engage in telehealth.
Collapse
Affiliation(s)
- Marc Coppens
- Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, Ghent University
| | - Els Van Caelenberg
- University Hospital Ghent, Department of Anesthesia and Perioperative Medicine, Ambulatory Surgery Unit
| | - Melissa De Regge
- Faculty of Economics and Business Administration, Department of Marketing, Innovation and Organinsation, Ghent University and Strategic Policy Cel, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
32
|
Knight SR, Ng N, Tsanas A, Mclean K, Pagliari C, Harrison EM. Mobile devices and wearable technology for measuring patient outcomes after surgery: a systematic review. NPJ Digit Med 2021; 4:157. [PMID: 34773071 PMCID: PMC8590052 DOI: 10.1038/s41746-021-00525-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Stephen R Knight
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Nathan Ng
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Kenneth Mclean
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Claudia Pagliari
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ewen M Harrison
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
33
|
Dawes AJ, Lin AY, Varghese C, Russell MM, Lin AY. Mobile health technology for remote home monitoring after surgery: a meta-analysis. Br J Surg 2021; 108:1304-1314. [PMID: 34661649 DOI: 10.1093/bjs/znab323] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mobile health (mHealth) technology has been proposed as a method of improving post-discharge surveillance. Little is known about how mHealth has been used to track patients after surgery and whether its use is associated with differences in postoperative recovery. METHODS Three databases (PubMed, MEDLINE and the Cochrane Central Registry of Controlled Trials) were searched to identify studies published between January 1999 and February 2021. Mobile health was defined as any smartphone or tablet computer capable of electronically capturing health-related patient information and transmitting these data to the clinical team. Comparable outcomes were pooled via meta-analysis with additional studies compiled via narrative review. The quality of each study was assessed based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Forty-five articles met inclusion criteria. While the majority of devices were designed to capture general health information, others were specifically adapted to the expected outcomes or potential complications of the index procedure. Exposure to mHealth was associated with fewer emergency department visits (odds ratio 0.42, 95 per cent c.i. 0.23 to 0.79) and readmissions (odds ratio 0.47, 95 per cent c.i. 0.29 to 0.77) as well as accelerated improvements in quality of life after surgery. There were limited data on other postoperative outcomes. CONCLUSION Remote home monitoring via mHealth is feasible, adaptable, and may even promote more effective postoperative care. Given the rapid expansion of mHealth, physicians and policymakers need to understand these technologies better so that they can be integrated into high-quality clinical care.
Collapse
Affiliation(s)
- A J Dawes
- Section of Colon and Rectal Surgery, Division of General Surgery, Stanford University School of Medicine, Stanford, California, USA.,Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - A Y Lin
- Department of Surgery, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia (Wellington), University of Otago, New Zealand
| | - C Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - M M Russell
- Section of Colon and Rectal Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - A Y Lin
- Section of Colon and Rectal Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
34
|
Jildeh TR, Castle JP, Abbas MJ, Dash ME, Akioyamen NO, Okoroha KR. Age Significantly Affects Response Rate to Outcomes Questionnaires Using Mobile Messaging Software. Arthrosc Sports Med Rehabil 2021; 3:e1349-e1358. [PMID: 34712973 PMCID: PMC8527269 DOI: 10.1016/j.asmr.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the demographic factors that influence time to respond (TTR), time to completion (TTC), and response rate when using a text messaging-based system and to determine the feasibility and applicability of mobile messaging-based services for collection of patient-reported outcomes among orthopaedic sports medicine patients. Methods On the day of surgery, patient mobile phone number was collected and the automated mobile messaging service (MOSIO, Seattle, WA) messaged patients for 10 ``days postoperatively. Patient visual analog scale (VAS) scores were collected 3 times daily, side effects were asked each evening, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) Short Form was collected on postoperative day 3 and 7. Results A total of 177 patients were enrolled in the study. The overall response rate to the survey questions was 75.0%. For all patients, the average TTR of questions was 35.09 ± 12.57 minutes. The TTC was 2.75 ± 3.56 minutes for PROMIS-PI, 3.51 ± 1.26 minutes for VAS, and 3.80 ± 6.87 for side-effect questions. When patients were stratified into age groups, the youngest group, 16 to 32 years, had the greatest response rate of 85.2% and patients in the 49 to 59 years group had the lowest response rate of 68.4% and 69.1%, respectively (P < .001). There was no significant difference in the TTR or TTC for VAS, PROMIS-PI, or side-effect questions when patients were stratified by age or sex groups (P > .05). Conclusions Collectively, all age groups successfully achieved a mean response rate of 75%; however, significantly lower response rates were observed for patients >49 years old. Differences in age and sex did not impact the overall TTR or TTC for VAS, PROMIS-PI, or side-effect questions. Mobile-based applications present as an emerging opportunity to track postoperative outcome scores and reduce clinic survey load. Level of Evidence Case series, level of evidence IV.
Collapse
Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Miriam E Dash
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Noel O Akioyamen
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota, U.S.A
| |
Collapse
|
35
|
Ruiz-Burga E, Bruijning-Verhagen P, Palmer P, Sandcroft A, Fernandes G, de Hoog M, Bryan L, Pierre R, Bailey H, Giaquinto C, Thorne C, Christie CDC. The ZIKApp for detection of potential arbovirus infections and pregnancy complications in pregnant women in Jamaica: a pilot study (Preprint). JMIR Form Res 2021; 6:e34423. [PMID: 35896029 PMCID: PMC9377438 DOI: 10.2196/34423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elisa Ruiz-Burga
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Paulette Palmer
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Annalisa Sandcroft
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Georgina Fernandes
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Marieke de Hoog
- University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lenroy Bryan
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Russell Pierre
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Heather Bailey
- Institute for Global Health, University College London, London, United Kingdom
| | - Carlo Giaquinto
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Claire Thorne
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Celia D C Christie
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| |
Collapse
|
36
|
Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
Collapse
|
37
|
Arfaei Chitkar SS, Mohaddes Hakkak HR, Saadati H, Hosseini SH, Jafari Y, Ganji R. The effect of mobile-app-based instruction on the physical function of female patients with knee osteoarthritis: a parallel randomized controlled trial. BMC WOMENS HEALTH 2021; 21:333. [PMID: 34521400 PMCID: PMC8439076 DOI: 10.1186/s12905-021-01451-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 08/13/2021] [Indexed: 01/06/2023]
Abstract
Background Osteoarthritis is a common disease and one of the most important causes of disability in the elderly that negatively affect the quality of their life. The purpose of this study was to evaluate the effectiveness of mobile app-based-instruction in improving physical performance of female patients with knee osteoarthritis. Methods The present study was a randomized clinical trial. The sample included 64 female patients (40 to 70 years old) with knee osteoarthritis in Bojnurd city in 2018. They were selected from the available patients that were randomly divided into comparison and intervention groups. Before the intervention, demographic information questionnaire, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, and 36-item short-form health survey (SF-36) were employed to elicit data on demographic information, arthritis condition and health status of the participants. Intervention lasted for a period of two months for each group. Intervention group received mobile-app-based instruction coupled with routine cares, while comparison group just received the routine cares. After the intervention both groups were evaluated again in terms of arthritis condition and health status using the same scales.
Results After the intervention, significant differences were found between the intervention and comparison groups in terms of overall WOMAC score (p = 0.005), pain aspect of WOMAC (p = 0.005), physical function aspect of WOMAC (p = 0.005), physical function aspect of SF-36 (p ≤ 0.05), and vitality aspect of SF-36 (p > 0.05). Conclusion The use of mobile-app-based instruction can enhance the physical function and quality of life in patients with knee osteoarthritis. Trial registration The research project was registered at Iranian Registry of Clinical Trials (IRCT20161208031300N2).
Collapse
Affiliation(s)
| | - Hamid Reza Mohaddes Hakkak
- Department of Health Education and Health Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hassan Saadati
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Hamid Hosseini
- Department of Health Education and Health Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Yasaman Jafari
- Department of Health Education and Health Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Reza Ganji
- Department of Orthopedic Surgery, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| |
Collapse
|
38
|
Forget P, Dahlberg K. Is multi-source feedback the future of perioperative medicine? Anaesth Crit Care Pain Med 2021; 40:100886. [PMID: 33971371 DOI: 10.1016/j.accpm.2021.100886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Patrice Forget
- Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen; Department of Anaesthesia, NHS Grampian, Foresterhill, AB25 2ZD Aberdeen, United Kingdom.
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
39
|
Franco D, Montenegro T, Gonzalez GA, Hines K, Mahtabfar A, Helgeson MD, Patel R, Harrop J. Telemedicine for the Spine Surgeon in the Age of COVID-19: Multicenter Experiences of Feasibility and Implementation Strategies. Global Spine J 2021; 11:608-613. [PMID: 32677513 PMCID: PMC8119918 DOI: 10.1177/2192568220932168] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Multicenter study. OBJECTIVES The COVID-19 pandemic has obligated physicians to recur to additional resources and make drastic changes regarding the standard physician-patient encounter. In the last century, there has been a substantial improvement in technology, which over the years has opened the door to a new form of medical practicing known as telemedicine. METHODS Healthcare workers from three hospitals involved in the care for COVID-19 patients in the united states were invited to share their experience using telemedicine to deliver clinical care to their patients. RESULTS Since the appearance of this worldwide outbreak, social distancing has been a key factor in preventing the spread of the virus, for which measures have been taken to limit physical contact. Because of the ongoing situation, telemedicine has been progressively incorporated into the physician-patient encounters and quickly has become an essential component in the day-today medical practice. CONCLUSIONS It is feasible to deliver viable spine practice with the use of telemedicine. A proper patient selection of patients requiring virtual treatment versus those requiring in-person visits should be considered.
Collapse
Affiliation(s)
- Daniel Franco
- Thomas Jefferson University
Hospital, Philadelphia, PA, USA,Daniel Franco, Vickie and Jack Farber
Institute for Neuroscience, Department of Neurosurgery, Thomas Jefferson
University Hospital, Philadelphia, PA 19107, USA.
| | | | | | - Kevin Hines
- Thomas Jefferson University
Hospital, Philadelphia, PA, USA
| | - Aria Mahtabfar
- Thomas Jefferson University
Hospital, Philadelphia, PA, USA
| | | | | | - James Harrop
- Thomas Jefferson University
Hospital, Philadelphia, PA, USA
| |
Collapse
|
40
|
Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Weyerbrock A, Bozinov O, Stienen MN, Maldaner N. Patients undergoing surgery for lumbar degenerative spinal disorders favor smartphone-based objective self-assessment over paper-based patient-reported outcome measures. Spine J 2021; 21:610-617. [PMID: 33346155 DOI: 10.1016/j.spinee.2020.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Smartphone-based applications enable new prospects to monitor symptoms and assess functional outcome in patients with lumbar degenerative spinal disorders. However, little is known regarding patient acceptance and preference towards new modes of digital objective outcome assessment. PURPOSE To assess patient preference of an objective smartphone-based outcome measure compared to conventional paper-based subjective methods of outcome assessment. STUDY DESIGN Prospective observational cohort study. PATIENT SAMPLE Fourty-nine consecutive patients undergoing surgery for lumbar degenerative spinal disorder. OUTCOME MEASURES Patients completed a preference survey to assess different methods of outcome assessment. A 5-level Likert scale ranged from strong disagreement (2 points) over neutral (6 points) to strong agreement (10 points) was used. METHODS Patients self-determined their objective functional impairment using the 6-minute Walking Test application (6WT-app) and completed a set of paper-based patient-reported outcome measures (PROMs) before and 6 weeks after surgery. Patients were then asked to rate the methods of outcome assessment in terms of suitability, convenience, and responsiveness to their symptoms. RESULTS The majority of patients considered the 6WT-app a suitable instrument (median 8.0, interquartile range [IQR] 4.0). Patients found the 6WT more convenient (median 10.0, IQR 2.0) than the Zurich Claudication Questionnaire (ZCQ; median 8.0, IQR 4.0, p=.019) and Core Outcome Measure Index (COMI; median 8.0, IQR 4.0, p=.007). There was good agreement that the 6WT-app detects change in physical performance (8.0, IQR 4.0). 78 % of patients considered the 6WT superior in detecting differences in symptoms (vs. 22% for PROMs). Seventy-six percent of patients would select the 6WT over the other, 18% the ZCQ and 6% the COMI. Eighty-two percent of patients indicated their preference to use a smartphone app for the assessment and monitoring of their spine-related symptoms in the future. CONCLUSIONS Patients included in this study favored the smartphone-based evaluation of objective functional impairment over paper-based PROMs. Involving patients more actively by means of digital technology may increase patient compliance and satisfaction as well as diagnostic accuracy.
Collapse
Affiliation(s)
- Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland.
| | | | - Michal Ziga
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| |
Collapse
|
41
|
Huynh B, Barrett J, Joachim A, Smith D, Stafford LC, Abbott DE, Alagoz E. Patient and provider perceptions on utilizing a mobile technology platform to improve surgical outcomes in the perioperative setting. J Surg Oncol 2021; 123:1353-1360. [PMID: 33523484 DOI: 10.1002/jso.26406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 01/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient engagement software is a ubiquitous and expensive commercially available tool designed to improve transitions of care. There are currently no high-quality patient and provider-level data about the usability of these products for surgical oncology patients. This study aims to better understand patient and provider attitudes and perceptions about the implementation of such technology. METHODS Focused interviews were conducted following the demonstration of a provider-built mobile technology platform. Interviews were audio-recorded, transcribed, and analyzed. Data were consensus coded inductively and categorized into themes regarding patient and provider perspectives on the usability and implementation of MobiMD. RESULTS Our interviews revealed four consistent themes: (1) patients feel there is a lack of reliable resources for patient education; (2) both patients and providers are supportive of using a mobile application; (3) providers perceive patient onboarding as an added burden on current workflows; and (4) after onboarding, providers express that such an application would optimize current workflows. CONCLUSIONS Patients perceive a need for improved perioperative education. Providers and patients agree that a mobile technology platform would be an effective solution in addressing this need. Effective implementation of such an intervention may improve patient education and engagement, leading to improved patient outcomes.
Collapse
Affiliation(s)
- Brandon Huynh
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - James Barrett
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Alyssa Joachim
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - David Smith
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Linda C Stafford
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Daniel E Abbott
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Esra Alagoz
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|
42
|
Ooi G, Schwenk ES, Torjman MC, Berg K. A Randomized Trial of Manual Phone Calls Versus Automated Text Messages for Peripheral Nerve Block Follow-Ups. J Med Syst 2021; 45:7. [PMID: 33404791 DOI: 10.1007/s10916-020-01699-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
Mobile phone applications (apps) have been used for patient follow-up in the postoperative period, specifically to assess for complications and patient satisfaction. Few studies have evaluated their use in regional anesthesia. The objective of this study was to compare follow-up response rates using manual phone calls versus an automated patient outreach (APO) app for peripheral nerve block patients. We hypothesized that the response rate would be higher in the APO group. A mobile app, "JeffAnesthesia," was developed, which sends notifications to patients to answer survey questions in the app. We randomly assigned patients who received peripheral nerve blocks for postoperative pain to either a manual phone call or an APO app group, with follow-up in each category occurring between postoperative days (POD) 14-21 and 90-100. In total, 60 patients were assigned to the phone call group and 60 patients to the APO app group. Between POD 14-21, 9 (15%) patients were reached in the manual phone call arm, and 16 (26.7%) patients were reached in the APO arm (p = 0.117). At POD 90-100, follow-up was successful with 5 (8.2%) in the manual phone call group vs. 3 (5.0%) patients in the APO app group (p = 0.300). Overall response rate was poor, with comparable response rates between groups. The APO method may reduce time spent by anesthesia staff on follow-up calls, but our data do not suggest this method improves response rates significantly. Further studies are needed to better understand the reasons for the poor response rate and strategies for improvement.
Collapse
Affiliation(s)
- Gavyn Ooi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Marc C Torjman
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kent Berg
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| |
Collapse
|
43
|
D'Cruz RJ, MacDonald LQ, Zisa N, Zomorrodi A, Murren-Boezem J, Atanda A, Hirschfeld F, Berman L. Institution-initiated text messaging can reduce unplanned emergency department visits after appendectomy. J Pediatr Surg 2021; 56:37-42. [PMID: 33139024 DOI: 10.1016/j.jpedsurg.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to reduce unplanned Emergency Department (ED) visits for minor complaints in children after appendectomy through proactive institution-driven communication and utilization of telehealth resources. METHODS We developed a text messaging system to initiate communication with parents of postappendectomy patients and connect them with a telehealth visit or a phone call with a surgical provider as needed. Using descriptive statistics, chi square, and statistical process control analytics, we compared rates of postoperative ED visits for the 8 months pre- and post-implementation of the messaging system and summarized the feedback we received from patients. RESULTS A total of 791 laparoscopic appendectomies were performed in two institutions (preintervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.8% preimplementation to 2.4% post-implementation (p = 0.02). Over one-fifth of families messaged (21.6%) had questions in the postoperative period. The majority expressed interest in a video visit (52.5%), while some preferred to speak with the surgeon's office (25%). Over 90% of respondents found the system helpful, and 4.9% opted out. CONCLUSION Implementation of a hospital-initiated text messaging system has the potential to reduce ED visits in the immediate postoperative period after appendectomy. This system can be scaled to include different surgeries across multiple disciplines. LEVEL OF EVIDENCE III. TYPE OF STUDY Clinical Retrospective Pre/Post Intervention Study.
Collapse
Affiliation(s)
- Roshan J D'Cruz
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803.
| | - Lisa-Qiao MacDonald
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
| | - Natalina Zisa
- Nemours Children's Hospital, 13535 Nemours Pkwy, Orlando, FL 32827
| | - Arezoo Zomorrodi
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | | | - Alfred Atanda
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | - Fiona Hirschfeld
- Nemours Center for Health Delivery Innovation, Wilmington, Delaware, USA 19803
| | - Loren Berman
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
| |
Collapse
|
44
|
Nagappa M, Querney J, Martin J, John-Baptiste A, Subramani Y, Lanting B, Schlachta C, Von Koughnett J, Speechley K, Correa J, Yunus Chohan M, Rrafshi N, Batohi M, Fayad A, Yang H. Perioperative satisfaction and health economic questionnaires in patients undergoing an elective hip and knee arthroplasty: A prospective observational cohort study. Anesth Essays Res 2021; 15:413-438. [PMID: 35422546 PMCID: PMC9004266 DOI: 10.4103/aer.aer_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the level of preparation/satisfaction and cost associated with management of recovery in the postoperative period were evaluated. Methods: We designed this prospective study to measure patient-reported outcomes and to inform the design of a postoperative home monitoring system. Patients undergoing inpatient total hip or knee replacements were recruited from a preadmission clinic at a university hospital. Patients and caregivers completed preoperative, postoperative, and health economic questionnaires. Bivariate analyses were conducted to understand factors associated with satisfaction with care. Results: Of 239 patients and caregivers recruited, preoperative questionnaire was completed by 98.8% of patients, the postoperative follow-up questionnaire was completed by 94.2% of patients, 75% of informal caregivers completed the postoperative follow-up questionnaires, and 93.7% completed the health economic questionnaire. The postoperative satisfaction scores were higher than the preoperative needs/expectation scores for both the overall and individual subscales. Patients undergoing hip arthroplasty reported higher satisfaction scores for postoperative pain management than patients undergoing knee arthroplasty (hip arthroplasty vs. knee arthroplasty: 4.07 ± 1.11 vs. 3.37 ± 1.51; P < 0.001). Patients who underwent knee arthroplasty reported better satisfaction scores with regard to having enough information on how to manage leg stiffness at home compared to patients undergoing hip arthroplasty (knee arthroplasty vs. hip arthroplasty: 3.13 ± 1.35 vs. 2.78 ± 1.30; P = 0.04). Conclusion: Overall, patients are generally satisfied with perioperative care, but they have distinct needs and expectations regarding perioperative medication and postoperative pain management. Virtual postoperative monitoring may be a useful tool during postoperative care to address many of patients’ concerns.
Collapse
|
45
|
Lyman S, Hidaka C, Fields K, Islam W, Mayman D. Monitoring Patient Recovery After THA or TKA Using Mobile Technology. HSS J 2020; 16:358-365. [PMID: 33380968 PMCID: PMC7749883 DOI: 10.1007/s11420-019-09746-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Smartphones offer the possibility of assessing recovery of mobility after total hip or knee arthroplasty (THA or TKA) passively and reliably, as well as facilitating the collection of patient-reported outcome measures (PROMs) with greater frequency. QUESTIONS/PURPOSES We investigated the feasibility of using mobile technology to collect daily step data and biweekly PROMs to track recovery after total joint arthroplasty. METHODS Pre- and post-operative daily steps were recorded in prospectively enrolled patients (128 THA and 139 TKA) via an app, which uses the phone's accelerometer. During 6-month follow-up, patients also completed PROMs (the pain numeric rating scale, the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS JR] and the Knee Injury and Osteoarthritis Outcome Score Joint Replacement [KOOS JR]), and HOOS or KOOS JR quality of life domain via a mobile-enabled web link. RESULTS At least 6 months of follow-up was completed by 65% for THA and 68% for TKA patients. Reasons for non-completion included time commitment, phone battery, app issues, and health complications. Responses from 78% of requested PROMs were returned with 96% of patients returning at least one post-operative PROM. Step data were available from 92% of days from male patients and 86% of days from female patients. The most robust recovery occurred early, within the first 2 months. The groups with higher pre-operative steps were more likely to recover their maximum daily steps at an earlier time point. Correlations between step counts and PROMs scores were modest. CONCLUSION Assessing large amounts of post-TKA and post-THA step data using mobile technology is feasible. Completion rates were good, making the technology very useful for collecting frequent PROMs. Being unable to ensure that patients always carried their phones limited our analysis of the step counts.
Collapse
Affiliation(s)
- Stephen Lyman
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Chisa Hidaka
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Kara Fields
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Wasif Islam
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - David Mayman
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| |
Collapse
|
46
|
Jia M, Tang J, Xie S, He X, Wang Y, Liu T, Yan T, Li K. Using a Mobile App-Based International Classification of Functioning, Disability, and Health Set to Assess the Functioning of Spinal Cord Injury Patients: Rasch Analysis. JMIR Mhealth Uhealth 2020; 8:e20723. [PMID: 33174860 PMCID: PMC7688391 DOI: 10.2196/20723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background The International Classification of Functioning, Disability, and Health (ICF) is a unified system of functioning terminology that has been used to develop electronic health records and assessment instruments. Its application has been limited, however, by its complex terminology, numerous categories, uncertain operationalization, and the training required to use it well. Together is a mobile health app designed to extend medical support to the families of spinal cord injury (SCI) patients in China. The app’s core framework is a set of only 31 ICF categories. The app also provides rating guidelines and automatically transforms routine assessment results to the terms of the ICF qualifiers. Objective The goal of the research is to examine the suitability of the ICF set used in the app Together for use as an instrument for assessing the functioning of SCI patients. Methods A cross-sectional study was conducted including 112 SCI patients recruited before discharge from four rehabilitation centers in China between May 2018 and October 2019. Nurses used the app to assess patient functioning in face-to-face interviews. The resulting data were then subjected to Rasch analysis. Results After deleting two categories (family relationships and socializing) and one personal factor (knowledge about spinal cord injury) that did not fit the Rasch model, the body functions and body structures, activities and participation, and contextual factors components of the ICF exhibited adequate fit to the Rasch model. All three demonstrated acceptable person separation indices. The 28 categories retained in the set were free of differential item functioning by gender, age, education level, or etiology. Conclusions Together overcomes some of the obstacles to practical application of the ICF. The app is a reliable assessment tool for assessing functioning after spinal cord injury.
Collapse
Affiliation(s)
- Mengmeng Jia
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jie Tang
- Department of Spinal Cord Injury Rehabilitation, Sichuan Provincial Rehabilitation Hospital, Chengdu, China
| | - Sumei Xie
- Department of Spinal Cord Injury Rehabilitation, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Xiaokuo He
- Department of Rehabilitation Medicine, The Fifth Hospital of Xiamen, Xiamen, China
| | - Yingmin Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
47
|
Kneuertz PJ, Jagadesh N, Perkins A, Fitzgerald M, Moffatt-Bruce SD, Merritt RE, D'Souza DM. Improving patient engagement, adherence, and satisfaction in lung cancer surgery with implementation of a mobile device platform for patient reported outcomes. J Thorac Dis 2020; 12:6883-6891. [PMID: 33282391 PMCID: PMC7711421 DOI: 10.21037/jtd.2020.01.23] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Active patient engagement may improve their perioperative experience and outcomes. We sought to evaluate the use of a mobile device application (App) for patient engagement and patient reported outcomes (PROs) assessment following robotic lung cancer surgery. Methods Patients with suspected lung cancer undergoing robotic resection between January–May 2019, were offered the SeamlessMD App, which was customized to meet requirements of the thoracic enhanced recovery pathway. The App guided patients through preoperative preparation, in-hospital recovery, and post-op discharge care with personalized reminders, task lists, education, progress tracking, and surveys. Results Fifty patients participated in the study (22.1%). Of the 50 patients, 20 (40%) patients completed the preoperative compliance survey, and 31 (62%) completed the hospital satisfaction survey. A total of 62 inpatient recovery checks were completed, identifying non-compliance with incentive spirometer use in 2 (3.2%) and patient worries about self-care after discharge in 18 (29%) instances. Postoperative health-checks were completed by 27 (54%) patients with a median of 3 [0–17] completed surveys per patient. Patient reported symptom scores up to 30 days after surgery, demonstrating a significant decrease maximum pain level (P=0.002) and anxiety scores (P<0.001). The App enabled health-checks improved confidence and decreased worries in over 80% of patients. Nine patients (40.9%) reported the health-checks helped avoid 1+ calls and 4 (18.2%) reported the App helped avoid 1+ visits to the hospital. Over 74% of patients reported the App was very or extremely useful in each of the preoperative, inpatient, and post-discharge settings. Conclusions A mobile device platform may serve as an effective mechanism to record perioperative PROs and satisfaction while facilitating patient-provider engagement in perioperative care.
Collapse
Affiliation(s)
- Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Niveditha Jagadesh
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Alicia Perkins
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Morgan Fitzgerald
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| |
Collapse
|
48
|
van Stralen KJ, Ruijter L, Frissen J, den Boer RH, Struben VMD, van Oostveen CJ. Patients want to be seen: The top 3 information needs of patients with inguinal hernia. PLoS One 2020; 15:e0240433. [PMID: 33048961 PMCID: PMC7553313 DOI: 10.1371/journal.pone.0240433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Good patient information has shown to improve surgical outcomes. In this study we explore what kind of pre-surgical information patients need and if the provision of a 360˚ video of a surgical procedure can be of added value to the information provided by the hospital. Methods An explorative qualitative study using semi-structured interviews on information needs was conducted among 17 inguinal hernia patients to gain more insight in the patients’ present surgical information needs. Patients either were planned to receive or already had received a surgical procedure. Questions were asked about the current information provision and, after being shown a 360˚ video of the surgery, whether this would be of added value. Results Of the total group of 17 patients (mean age 56, interquartile range 45–64) 16 were male and one was female. Most had no previous experience with virtual reality (14/17), already had undergone a surgical procedure (11/17). Patient information needs were all about “seeing” which can be viewed from three different perspectives [1] being seen as a unique person in the treatment process, [2] being seen as a partner, and [3] seeing is understanding. Patients wanted the contact with the doctor to be more personal, with the possibility to see the anesthetist in person, the surgeon to see their wound in the recovery phase, and to receive personal answers to questions about their specific situation. Patients found the 360-video not fearsome, and believed that visual content could be beneficial as it appeals more to their imagination than written or oral information and increases their understanding. It also provided them with a better understanding of their treatment options, their pre-, peri-, and post-surgical procedures and identification of the cause of post-operative side effects. Conclusion To address patients’ information needs, complementary tools or services are needed that increase personal contact as well as tailor it to individual patient’s needs. Even though video-apps are a partial alternative, hospitals should still offer patients the possibility of having face-to-face meetings with physicians as this is highly valued by patients and leads to increased trust in physicians’ performance.
Collapse
Affiliation(s)
| | - Lotte Ruijter
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
| | - Judith Frissen
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
| | | | | | - Catharina J. van Oostveen
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
- Erasmus School for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
49
|
The Promise of Smartphone Applications in the Remote Monitoring of Postsurgical Wounds: A Literature Review. Adv Skin Wound Care 2020; 33:489-496. [PMID: 32810062 DOI: 10.1097/01.asw.0000694136.29135.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the clinical and scientific literature on remote monitoring and management of postsurgical wounds using smartphone applications (apps). DATA SOURCES MEDLINE, PubMed, EMBASE, and Cochrane libraries were searched for relevant articles on patients who received surgery and were monitored postdischarge via an app. STUDY SELECTION Articles were selected with the terms "mobile phones," "smartphones," "wounds," "monitor," and "patient preference." DATA EXTRACTION The authors found 276 review articles related to telemedicine in wound care. Investigators reviewed the titles and abstracts of the search results and selected 83 articles that were relevant to the remote monitoring of wounds using smartphone apps. DATA SYNTHESIS The topics explored in selected literature included smartphone app importance to telemedicine, benefits (medical and financial), app examples, and challenges in the context of wound monitoring and management. The authors identified several challenges and limitations that future studies in the field need to address. CONCLUSIONS Remote monitoring and management of wounds using smartphone apps is a valuable technique to enhance the quality of and access to healthcare. However, although some patients may prefer this technology, some lack technological competence, limiting telemedicine's applicability. In addition, issues remain with the reliable interpretation of data collected through apps.
Collapse
|
50
|
Agri F, Hahnloser D, Demartines N, Hübner M. Gains and limitations of a connected tracking solution in the perioperative follow-up of colorectal surgery patients. Colorectal Dis 2020; 22:959-966. [PMID: 32012423 DOI: 10.1111/codi.14998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/25/2020] [Indexed: 01/31/2023]
Abstract
AIM The means to target shorter hospital stay include information technology strategies to improve communication between caregivers and patients in order to limit potentially avoidable readmissions. The aim of the present study was to analyse the benefits and limitations of a smartphone-based connected tracking solution in the perioperative follow-up of colorectal surgery patients. METHOD This was a retrospective monocentric cohort study of consecutive patients after colorectal surgery between February and December 2018. The mobile health application included information delivery and daily structured questionnaires on a personalized patient electronic profile, before the hospital stay and for 7 days post-discharge. The medical team answered automatic alerts in real time. RESULTS A total of 93 eligible patients were approached and 36 had to be excluded (26 no smartphone, five no email, five not French speaking). Among the potential users, 50 (88%) engaged in an mHealth app and seven refused. Of these 50 patients, seven dropped out. Of the remaining 43 patients, the app detected 12 adverse events, and 10 (83%) were handled through the app. Healthcare providers responded to patient-generated alerts after a median time of 90 min (range 9-448 min). Patients' mean satisfaction level was 4 ± 0.97 out of 5. CONCLUSION In total, 88% of smartphone-equipped patients showed a willingness to engage in mHealth. Reasons for exclusion were the absence of connection tools and a language barrier. Patients who responded to the survey were satisfied with the solution and 83% of post-discharge adverse events were solved through the app, avoiding emergency consultations.
Collapse
Affiliation(s)
- F Agri
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| |
Collapse
|