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Özcan H, Burger NB, Derksen ME, Peute LW, Huirne JAF, De Leeuw RA. The differences between adults and adolescents using a mobile health application for menstrual complaints: A usability and qualitative study. Int J Med Inform 2024; 185:105382. [PMID: 38437753 DOI: 10.1016/j.ijmedinf.2024.105382] [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: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND A "Menstruatie Educatie Kalender" application (Menstruation Education Calendar, (MEK-APP)) was developed for adults to evaluate menstrual complaints. The future aim of this app is to use it as a self-diagnostic instrument for menstrual abnormalities for both adults and adolescents. Early identification of the potential of an application for future use by both user groups would increase implementation success and adoption of the application. OBJECTIVE To compare differences in experienced usability by adults versus adolescents and to identify factors influencing future use for both age groups in one mHealth application (in this study the MEK-APP). METHODS This study consisted of three phases: (1) usability testing of the MEK-APP for iOS and Android by think-aloud method, (2) two-month daily use and (3) in-depth individual interview. During the think-aloud sessions, twelve tasks were performed in the application while they were thinking aloud. Usability problems were rated for their severity with Nielsen' Severity Scale. Both the think-aloud sessions and in-depth interviews were verbatim transcribed and thematically analyzed to determine the factors influencing future use for both groups. In addition, the System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI) questionnaires were filled out during the interviews. RESULTS Seven adults (>18 years) and seven adolescents (14-18 years) evaluated the MEK-APP. There were 14 usability issues and 16 bugs in both groups. There were no differences between adults and adolescents. In the thematic qualitative analysis, the following future use factors were identified: user-expectation, motivation, privacy, understandability, and user-experience. The user-expectation, motivation and privacy differed between both groups but did not influence usage. No differences were observed in SUS and IMI scores between both groups. CONCLUSIONS There are five factors influencing the future use of a menstrual-related mHealth application for both adults and adolescents. It is possible to serve different age groups with a single application.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Marloes E Derksen
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Linda W Peute
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands.
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2
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Grygorian A, Montano D, Shojaa M, Ferencak M, Schmitz N. Digital Health Interventions and Patient Safety in Abdominal Surgery: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e248555. [PMID: 38669018 PMCID: PMC11053376 DOI: 10.1001/jamanetworkopen.2024.8555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews. Objective To estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery. Data Sources PubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome. Study Selection Two reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review. Data Extraction and Synthesis Data were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models. Main Outcomes and Measures Number of complications, emergency department (ED) visits, and readmissions. Results A total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.
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Affiliation(s)
- Artem Grygorian
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Diego Montano
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Mahdieh Shojaa
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Maximilian Ferencak
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Norbert Schmitz
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
- Faculty of Medicine, Department of Psychiatry, McGill University, Montreal, Québec, Canada
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3
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Bignami E, Celoria S, Bellini V. Surgical outcomes and patient-centred perioperative programs. J Clin Monit Comput 2023; 37:1641-1643. [PMID: 37460869 DOI: 10.1007/s10877-023-01057-7] [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: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 11/16/2023]
Abstract
Perioperative medicine is changing, and its goals are expanding. More and more attention is paid to the surgical experience and the patient's quality of life. Patient-reported data represent a useful tool in this context. Patient-reported outcomes measures (PROMs) and experience measures (PREMs) are among the most used categories. However, creating perioperative programs capable of integrating traditional perioperative data with these scales is not easy. New technologies, particularly artificial intelligence, thanks to their ability to recognise, interpret, process or simulate human feelings, emotions and moods, could provide the necessary tools to combine all perioperative aspects, placing the patients and their needs at the centre of the process.
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Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy.
| | - Serena Celoria
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
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de Leeuwerk M, de Groot V, Dam ST, Kruizenga H, Weijs P, Geleijn E, van der Leeden M, van der Schaaf M. The efficacy of a blended intervention to improve physical activity and protein intake for optimal physical recovery after oncological gastrointestinal and lung cancer surgery, the Optimal Physical Recovery After Hospitalization (OPRAH) trial: study protocol for a randomized controlled multicenter trial. Trials 2023; 24:757. [PMID: 38008734 PMCID: PMC10680183 DOI: 10.1186/s13063-023-07705-2] [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: 06/21/2023] [Accepted: 10/05/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Improving physical activity, especially in combination with optimizing protein intake, after surgery has a potential positive effect on recovery of physical functioning in patients after gastrointestinal and lung cancer surgery. The aim of this randomized controlled trial is to evaluate the efficacy of a blended intervention to improve physical activity and protein intake after hospital discharge on recovery of physical functioning in these patients. METHODS In this multicenter single-blinded randomized controlled trial, 161 adult patients scheduled for elective gastrointestinal or lung cancer surgery will be randomly assigned to the intervention or control group. The purpose of the Optimal Physical Recovery After Hospitalization (OPRAH) intervention is to encourage self-management of patients in their functional recovery, by using a smartphone application and corresponding accelerometer in combination with coaching by a physiotherapist and dietician during three months after hospital discharge. Study outcomes will be measured prior to surgery (baseline) and one, four, eight, and twelve weeks and six months after hospital discharge. The primary outcome is recovery in physical functioning six months after surgery, and the most important secondary outcome is physical activity. Other outcomes include lean body mass, muscle mass, protein intake, symptoms, physical performance, self-reported limitations in activities and participation, self-efficacy, hospital readmissions and adverse events. DISCUSSION The results of this study will demonstrate whether a blended intervention to support patients increasing their level of physical activity and protein intake after hospital discharge improves recovery in physical functioning in patients after gastrointestinal and lung cancer surgery. TRIAL REGISTRATION The trial has been registered at the International Clinical Trials Registry Platform at 14-10-2021 with registration number NL9793. Trial registration data are presented in Table 1.
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Affiliation(s)
- Marijke de Leeuwerk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.
| | - Vincent de Groot
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Suzanne Ten Dam
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hinke Kruizenga
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Peter Weijs
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, De Boelelaan 1117, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Edwin Geleijn
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Amsterdam UMC, Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
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5
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Chamely EA, Kao LS. Individualising the recovery process through eHealth. Lancet Digit Health 2023:S2589-7500(23)00098-5. [PMID: 37419844 DOI: 10.1016/s2589-7500(23)00098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Elias A Chamely
- Department of General Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lillian S Kao
- Department of General Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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den Bakker CM, Schaafsma FG, Consten ECJ, Schraffordt Koops SE, van der Meij E, van de Ven PM, Bonjer HJ, Huirne JAF, Anema JR. Personalised electronic health programme for recovery after major abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial. Lancet Digit Health 2023:S2589-7500(23)00084-5. [PMID: 37419843 DOI: 10.1016/s2589-7500(23)00084-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/25/2023] [Accepted: 04/12/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Despite the adoption of minimally invasive techniques, recovery after abdominal surgery takes a long time. Electronic health (eHealth) modalities can provide guidance to patients, facilitating early return to normal activities. We aimed to assess the impact of a personalised eHealth programme on patients' return to normal activities after major abdominal surgery. METHODS This single-blind, randomised, placebo-controlled trial was done at 11 teaching hospitals in the Netherlands. Eligible participants were aged 18-75 years who underwent a laparoscopic or open colectomy or hysterectomy. An independent researcher randomly allocated participants (in a 1:1 ratio) to either the intervention or control group by use of computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised eHealth programme consisting of both standard face-to-face care and eHealth, that comprised interactive tools offering goal attainment and a personalised outcome measurement, which managed recovery expectations and provided postoperative guidance tailored to each patient. Patients were provided with an activity tracker and had access to a website and mobile app with an electronic consultation (eConsult) functionality. The control group received standard care and access to a placebo website containing recovery advice provided by the hospital. The primary outcome was the number of days between surgery and personalised return to normal activities, assessed with Kaplan-Meier curves. Intention-to-treat and per-protocol analyses were done with a Cox regression model. This trial is registered with the Netherlands National Trial Register (NTR5686). FINDINGS Between Feb 11, 2016, and Aug 9, 2017, 355 participants were randomly assigned to the intervention (n=178) or control (n=177) groups. 342 participants were included in the intention-to-treat analysis. The median time until return to normal activities was 52 days (IQR 33-111) in the intervention group, and 65 days (39-152) in the control group (adjusted hazard ratio 1·30 [95% CI 1·03-1·64]; p=0·027). The frequency of postoperative complications did not differ between groups. INTERPRETATION This eHealth programme, delivering personalised care based on goal attainment scaling, enabled patients to return to their normal activities 13 days earlier than those who received standard care. FUNDING ZonMw.
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Affiliation(s)
- Chantal M den Bakker
- Department of Occupational and Public Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands; Department of Surgery, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Frederieke G Schaafsma
- Department of Occupational and Public Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - Eva van der Meij
- Department of Occupational and Public Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Peter M van de Ven
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hendrik J Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Judith A F Huirne
- Department of Occupational and Public Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Johannes R Anema
- Department of Occupational and Public Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands.
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7
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van der Storm SL, Bektaş M, Barsom EZ, Schijven MP. Mobile applications in gastrointestinal surgery: a systematic review. Surg Endosc 2023:10.1007/s00464-023-10007-y. [PMID: 37016081 DOI: 10.1007/s00464-023-10007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Mobile applications can facilitate or improve gastrointestinal surgical care by benefiting patients, healthcare providers, or both. The extent to which applications are currently in use in gastrointestinal surgical care is largely unknown, as reported in literature. This systematic review was conducted to provide an overview of the available gastrointestinal surgical applications and evaluate their prospects for surgical care provision. METHODS The PubMed, EMBASE and Cochrane databases were searched for articles up to October 6th 2022. Articles were considered eligible if they assessed or described mobile applications used in a gastrointestinal surgery setting for healthcare purposes. Two authors independently evaluated selected studies and extracted data for analysis. Descriptive data analysis was conducted. The revised Cochrane risk of bias (RoB-2) tool and ROBINS-I assessment tool were used to determine the methodological quality of studies. RESULTS Thirty-eight articles describing twenty-nine applications were included. The applications were classified into seven categories: monitoring, weight loss, postoperative recovery, education, communication, prognosis, and clinical decision-making. Most applications were reported for colorectal surgery, half of which focused on monitoring. Overall, a low-quality evidence was found. Most applications have only been evaluated on their usability or feasibility but not on the proposed clinical benefits. Studies with high quality evidence were identified in the areas of colorectal (2), hepatopancreatobiliary (1) and bariatric surgery (1), reporting significantly positive outcomes in terms of postoperative recovery, complications and weight loss. CONCLUSIONS The interest for applications and their use in gastrointestinal surgery is increasing. From our study, it appears that most studies using applications fail to report adequate clinical evaluation, and do not provide evidence on the effectiveness or safety of applications. Clinical evaluation of objective outcomes is much needed to evaluate the efficacy, quality and safety of applications being used as a medical device across user groups and settings.
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Affiliation(s)
- Sebastiaan L van der Storm
- Amsterdam UMC Location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Mustafa Bektaş
- Amsterdam UMC Location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Esther Z Barsom
- Amsterdam UMC Location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Amsterdam UMC Location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands.
- Amsterdam Public Health, Digital Health, Box 22660, 1105 AZ, Amsterdam, The Netherlands.
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8
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Evans HL, Scalea J. Impact of Digital Health upon the Surgical Patient Experience: The Patient as Consumer. Surg Clin North Am 2023; 103:357-368. [PMID: 36948724 DOI: 10.1016/j.suc.2022.11.006] [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: 03/22/2023]
Abstract
The adoption of digital health services in surgical care delivery is changing the patient experience. The goal of patient-generated health data monitoring incorporated with patient-centered education and feedback is to optimally prepare patients for surgery and personalize postoperative care to improve outcomes that matter to both patients and surgeons. Challenges include the need for the adoption of new methods for implementation and evaluation and equitable application of surgical digital health interventions, with considerations for accessibility as well as the development of new diagnostics and decision support that include the needs and characteristics of all populations served.
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Affiliation(s)
- Heather L Evans
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 417, Charleston, SC 29425, USA.
| | - Joseph Scalea
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 417, Charleston, SC 29425, USA
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9
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Blount E, Davey MG, Joyce WP. Patient reported satisfaction levels with the use of telemedicine for general surgery-A systematic review of randomized control trials. SURGERY IN PRACTICE AND SCIENCE 2023; 12:100152. [PMID: 36570642 PMCID: PMC9769022 DOI: 10.1016/j.sipas.2022.100152] [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: 09/04/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background As healthcare continues to evolve in the wake of COVID-19 pandemic, surgeons are presented with the opportunity to integrate telemedicine into healthcare in tandem with in-person consultations. We aimed to perform a systematic review of randomized controlled trials to assess patient satisfaction with telemedicine interventions in general surgery. Methods A systematic review was performed in accordance to the PRISMA guidelines. Randomized control trials (RCTs) were included. The risk of bias 2.0 assessment was used to determine potential bias. Results In total, 11 prospective, randomized trials involving 1,598 patients (mean age: 49.1 years) were included. Overall 45.5% (5/11) of the trials compared videoconferencing or telephone follow up to traditional in person follow up. Three studies used smart technologies which include activity tracking devices in combination with a website and mobile application (27.3%). The other 3 interventions involved accelerated discharge on post operative day (POD) 1 with tele videoconferencing on POD 2, Post-operative daily text messages with education videos and video calling capability, and supportive text messages post-operatively. Telemedicine was shown to provide similar levels of patient satisfaction compared to controls in all 11 included RCTs. Conclusion Patient reported satisfaction with the use of telemedicine is similar to standard of care models in general surgery. With several shortcomings confounding the results in support of telemedicine, further experimentation with telemedicine interventions will likely improve patient reported satisfaction with using telemedicine for peroperative surgical care.
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Affiliation(s)
- Eoghan Blount
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
| | - William P Joyce
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
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10
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Gögenur I. Introducing machine learning-based prediction models in the perioperative setting. Br J Surg 2023; 110:533-535. [PMID: 36680383 DOI: 10.1093/bjs/znac462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Ismail Gögenur
- Centre for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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11
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Bänziger S, Weisshaar K, Arokoski R, Gerull S, Halter J, Rovó A, Bargetzi M, Goede JS, Senft Y, Valenta S, Passweg JR, Drexler B. Feasibility of electronic patient-reported outcome monitoring and self-management program in aplastic anemia and paroxysmal nocturnal hemoglobinuria-a pilot study (ePRO-AA-PNH). Ann Hematol 2023; 102:199-208. [PMID: 36326854 PMCID: PMC9631592 DOI: 10.1007/s00277-022-05012-5] [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: 05/24/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Electronic patient-reported outcomes (ePRO) are increasingly recognized in health care, as they have been demonstrated to improve patient outcomes in cancer, but have been less studied in rare hematological diseases. The aim of this study was to develop and test the feasibility of an ePRO system specifically customized for aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH). METHODS After performing a user-centered design evaluation an ePRO system for AA and PNH patients could be customized and the application was tested by patients and their medical teams for 6 months. Symptom-reporting triggered self-management advice for patients and prompts them to contact clinicians in case of severe symptoms, while the medical team received alerts of severe symptoms for patient care. RESULTS All nine included patients showed a high adherence rate to the weekly symptom-reporting (72%) and reported high satisfaction. The system was rated high for usage, comprehensibility, and integration into daily life. Most patients (78%) would continue and all would recommend the application to other AA/PNH patients. Technical performance was rarely a barrier and healthcare providers saw ePRO-AA-PNH as a useful supplement, but the lacking integration into the hospital information system was identified as a major barrier to usage. CONCLUSION An ePRO system customized for AA and PNH was feasible in terms of adherence, satisfaction, and performance, showing a high potential for these rare conditions in terms of data collection and patient guidance. However, the integration into clinical workflows is crucial for further routine use. TRIAL REGISTRATION ClinicalTrials.gov NCT04128943.
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Affiliation(s)
- Silas Bänziger
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Kimmo Weisshaar
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | | | - Sabine Gerull
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jörg Halter
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alicia Rovó
- grid.411656.10000 0004 0479 0855Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Mario Bargetzi
- grid.413357.70000 0000 8704 3732Division of Hematology, University Medical Clinic, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Jeroen S. Goede
- grid.452288.10000 0001 0697 1703Division of Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Yuliya Senft
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabine Valenta
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Jakob R. Passweg
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Beatrice Drexler
- grid.410567.1Division of Hematology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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Furumaya A, Haring MPD, van Rosmalen BV, Klompenhouwer AJ, Besselink MG, de Man RA, IJzermans JNM, Thomeer MGJ, Kramer M, Coolsen MME, Tushuizen ME, Schaapherder AF, de Haas RJ, Duiker EW, Kazemier G, van Delden OM, Verheij J, Takkenberg RB, Cuperus FJC, De Meijer VE, Erdmann JI. Study protocol for a multicentre nationwide prospective cohort study to investigate the natural course and clinical outcome in benign liver tumours and cysts in the Netherlands: the BELIVER study. BMJ Open 2022; 12:e055104. [PMID: 36691222 PMCID: PMC9462085 DOI: 10.1136/bmjopen-2021-055104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 06/01/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Benign liver tumours and cysts (BLTCs) comprise a heterogeneous group of cystic and solid lesions, including hepatic haemangioma, focal nodular hyperplasia and hepatocellular adenoma. Some BLTCs, for example, (large) hepatocellular adenoma, are at risk of complications. Incidence of malignant degeneration or haemorrhage is low in most other BLTCs. Nevertheless, the diagnosis BLTC may carry a substantial burden and patients may be symptomatic, necessitating treatment. The indications for interventions remain matter of debate. The primary study aim is to investigate patient-reported outcomes (PROs) of patients with BLTCs, with special regards to the influence of invasive treatment as compared with the natural course of the disease. METHODS AND ANALYSIS A nationwide observational cohort study of patients with BLTC will be performed between October 2021 and October 2026, the minimal follow-up will be 2 years. During surveillance, a questionnaire regarding symptoms and their impact will be sent to participants on a biannual basis and more often in case of invasive intervention. The questionnaire was previously developed based on PROs considered relevant to patients with BLTCs and their caregivers. Most questionnaires will be administered by computerised adaptive testing through the Patient-Reported Outcomes Measurement Information System. Data, such as treatment outcomes, will be extracted from electronic patient files. Multivariable analysis will be performed to identify patient and tumour characteristics associated with significant improvement in PROs or a complicated postoperative course. ETHICS AND DISSEMINATION The study was assessed by the Medical Ethics Committee of the University Medical Center Groningen and the Amsterdam UMC. Local consultants will provide information and informed consent will be asked of all patients. Results will be published in a peer-reviewed journal. STUDY REGISTRATION NL8231-10 December 2019; Netherlands Trial Register.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Martijn P D Haring
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Anne J Klompenhouwer
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs Kramer
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Mariëlle M E Coolsen
- Department of Surgery, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Alexander F Schaapherder
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelien W Duiker
- Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Otto M van Delden
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Frans J C Cuperus
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincent E De Meijer
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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van Hout L, Bökkerink WJV, Vriens PWHE. Clinical feasibility of the Q1.6 Inguinal Hernia application: a prospective cohort study. Hernia 2022; 27:449-458. [PMID: 35840840 DOI: 10.1007/s10029-022-02646-2] [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: 04/06/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential to evaluate inguinal hernia surgery. There is a need for digital and disease-specific PRO measurement. Current measuring instruments (PROMs) have several disadvantages, for example, fixed measuring moments with a chance of recall bias. The Q1.6 Inguinal Hernia application has been developed to overcome these challenges. This pilot study reports the first clinical feasibility results. METHODS All surgically treated inguinal hernia patients were eligible for inclusion. The application uses "twitch crowdsourcing"; after unlocking a smartphone or tablet, a single short question is asked. This can easily be repeated multiple times a day/week/month. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualised set of questions. Alerts are generated when a complication is suspected. RESULTS A total of 229 patients were given over 50.000 questions of which 92% were answered. Pre- and postoperative patient characteristics and their reported clinical outcomes confirmed a standard inguinal hernia population. Compliance with the application was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. After months 3, 6 and 11, respectively, 3.0%, 4.4% and 4.5% of patients reported inguinal pain or discomfort (NRS ≥ 4). Patients were highly satisfied (92.8% preferred the app over standard care). CONCLUSIONS This smartphone application shows promising results for clinical practice. It might allow for continuous digital patient-reported outcome measurement using non-intrusive, concise questions. Remote monitoring may become standard postoperative care after (inguinal hernia) surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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14
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de Leeuwerk ME, Botjes M, van Vliet V, Geleijn E, de Groot V, van Wegen E, van der Schaaf M, Tuynman J, Dickhoff C, van der Leeden M. Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study. JMIR Cancer 2022; 8:e35694. [PMID: 35749165 PMCID: PMC9270713 DOI: 10.2196/35694] [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: 12/14/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies.
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Affiliation(s)
- Marijke Elizabeth de Leeuwerk
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Martine Botjes
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vincent van Vliet
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Edwin Geleijn
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vincent de Groot
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Erwin van Wegen
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Rehabilitation Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jurriaan Tuynman
- General Surgery, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands
| | - Chris Dickhoff
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands.,Cardio-Thoracic Surgery, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marike van der Leeden
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands
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de Leeuwerk ME, Bor P, van der Ploeg HP, de Groot V, van der Schaaf M, van der Leeden M. The effectiveness of physical activity interventions using activity trackers during or after inpatient care: a systematic review and meta-analysis of randomized controlled trials. Int J Behav Nutr Phys Act 2022; 19:59. [PMID: 35606852 PMCID: PMC9125831 DOI: 10.1186/s12966-022-01261-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Promoting physical activity (PA) in patients during and/or after an inpatient stay appears important but challenging. Interventions using activity trackers seem promising to increase PA and enhance recovery of physical functioning. OBJECTIVE To review the effectiveness of physical activity interventions using activity trackers on improving PA and physical functioning, compared to usual care in patients during and/or after inpatient care. In addition, it was determined whether the following intervention characteristics increase the effectiveness of these interventions: the number of behaviour change techniques (BCTs) used, the use of a theoretical model or the addition of coaching by a health professional. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, Cinahl, SportDiscus and Web of Science databases were searched in March 2020 and updated in March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized controlled trials (RCTs) including interventions using activity trackers and feedback on PA in adult patients during, or less than 3 months after, hospitalization or inpatient rehabilitation. METHODS Following database search and title and abstract screening, articles were screened on full text for eligibility and then assessed for risk of bias by using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses, including subgroup analysis on intervention characteristics, were conducted for the outcomes PA and physical functioning. RESULTS Overall, 21 RCTs totalling 2355 patients were included. The trials covered a variety of clinical areas. There was considerable heterogeneity between studies. For the 13 studies that measured PA as an outcome variable(N = 1435), a significant small positive effect in favour of the intervention was found (standardized mean difference (SMD) = 0.34; 95%CI 0.12-0.56). For the 13 studies that measured physical functioning as an outcome variable (N = 1415) no significant effect was found (SMD = 0.09; 95%CI -0.02 - 0.19). Effectiveness on PA seems to improve by providing the intervention both during and after the inpatient period and by using a theoretical model, multiple BCTs and coaching by a health professional. CONCLUSION Interventions using activity trackers during and/or after inpatient care can be effective in increasing the level of PA. However, these improvements did not necessarily translate into improvements in physical functioning. Several intervention characteristics were found to increase the effectiveness of PA interventions. TRIAL REGISTRATION Registered in PROSPERO ( CRD42020175977 ) on March 23th, 2020.
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Affiliation(s)
- Marijke E de Leeuwerk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands. .,Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.
| | - Petra Bor
- University Medical Centre Utrecht, Utrecht University, Department of Rehabilitation, Physical Therapy Science & Sports, Heidelberglaan, 100, Utrecht, the Netherlands
| | - Hidde P van der Ploeg
- Amsterdam UMC location Vrije universiteit Amsterdam, Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands
| | - Vincent de Groot
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
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Singh H, Tang T, Steele Gray C, Kokorelias K, Thombs R, Plett D, Heffernan M, Jarach CM, Armas A, Law S, Cunningham HV, Nie JX, Ellen ME, Thavorn K, Nelson MLA. Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review. JMIR Aging 2022; 5:e35929. [PMID: 35587874 PMCID: PMC9164100 DOI: 10.2196/35929] [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: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-045596
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,March of Dimes Canada, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Plett
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Heffernan
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carlotta M Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alana Armas
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle LA Nelson
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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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]
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Wikström L, Schildmeijer K, Nylander EM, Eriksson K. Patients' and providers' perspectives on e-health applications designed for self-care in association with surgery - a scoping review. BMC Health Serv Res 2022; 22:386. [PMID: 35321707 PMCID: PMC8944084 DOI: 10.1186/s12913-022-07718-8] [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: 10/22/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Before and after major surgery, access to information in a user-friendly way is a prerequisite for patients to feel confident in taking on the responsibility for their surgical preparation and recovery. Several e-health applications have been developed to support patients perioperatively. The aim of this review was to give an overview of e-health applications designed for self-care associated with surgery by providing a scoping overview of perspectives from providers and patients. Methods We searched the following data sources to identify peer-reviewed quantitative and qualitative studies published between 2015 and 2020: CINAHL, Google Scholar, MEDLINE, PsycInfo, Web of Science, and Scopus. After identifying 960 titles, we screened 638 abstracts, of which 72 were screened in full text. Protocol register: 10.17605/OSF.IO/R3QND. Results We included 15 studies which met our inclusion criteria. Data from several surgical contexts revealed that the most common self-care actions in e-health applications were preoperative preparations and self-assessments of postoperative recovery. Motivational factors for self-care were information, combined with supportive reminders and messages, and chat features. Although there was great variance in research designs and technical solutions, a willingness to engage with and adhere to e-health seemed to increase patients’ self-care activities and thereby accelerate return to work and normal activities. In addition, the need for physical visits seemed to decrease. Even though age groups were not primarily studied, the included studies showed that adult patients of any age engaged in surgical self-care supported by e-health. The providers’ perspectives were not found. Conclusions E-health applications supporting perioperative self-care indicated a positive impact on recovery. However, experiences of healthcare professionals delivering e-health associated with surgery are missing. Additionally, studies based on patients’ perspectives regarding willingness, adherence, and motivation for self-care supported by e-health are sparse. A need for studies examining the supporting role of e-health for self-care in the surgical context is therefore needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07718-8.
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Affiliation(s)
- Lotta Wikström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden. .,Department of Nursing Science, School of Health and Welfare, Lotta Wikström, Jönköping University, Box 1026, 551 11, Jönköping, Sweden.
| | | | | | - Kerstin Eriksson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
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19
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Dedden SJ, Bouwsma EVA, Geomini PMAJ, Bongers MY, Huirne JAF. Predictive factors of return to work after hysterectomy: a retrospective study. BMC Surg 2022; 22:84. [PMID: 35246078 PMCID: PMC8896112 DOI: 10.1186/s12893-022-01533-y] [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: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Although hysterectomy is one of the most frequently performed gynaecological surgeries, there is a dearth of evidence on perioperative care. The aim of the current study was to identify sociodemographic, surgical-related and work-related predictors of recovery following different approaches of hysterectomy. Methods Eligible patients for this retrospective cohort study were women who underwent vaginal, abdominal or laparoscopic hysterectomy for both benign and malignant gynaecological disease in 2014 in Máxima Medical Centre in the Netherlands. The main outcome measure was full return to work (RTW). Data were collected using a patient survey. Potential prognostic factors for time to RTW were examined in univariate Cox regression analyses. The strongest prognostic factors were combined in a multivariable model. Results In total 83 women were included. Median time to full return to work was 8 weeks (interquartile range [IQR] 6–12). The multivariable analysis showed that higher age (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.012–1.095) and same day removal of indwelling catheter (HR 0.122, 95% CI 0.028–0.539) were predictors of shorter duration until full RTW after hysterectomy. Conclusions This study provided insight in the predictors of recovery after hysterectomy. By identifying patient specific factors, pre-operative counselling can be individualized, changes can be made in perioperative care and effective interventions can be designed to target those factors.
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Affiliation(s)
- Suzanne J Dedden
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Esther V A Bouwsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
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20
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Wells CI, Xu W, Penfold JA, Keane C, Gharibans AA, Bissett IP, O’Grady G. OUP accepted manuscript. BJS Open 2022; 6:6564495. [PMID: 35388891 PMCID: PMC8988014 DOI: 10.1093/bjsopen/zrac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.
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Affiliation(s)
- Cameron I. Wells
- Correspondence to: Cameron Wells, Department of Surgery, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand (e-mail:)
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - James A. Penfold
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ian P. Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O’Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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A WeChat-Based Mobile Platform for Perioperative Health Education for Gastrointestinal Surgery. Emerg Med Int 2021; 2021:6566981. [PMID: 34868685 PMCID: PMC8639266 DOI: 10.1155/2021/6566981] [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: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Appropriately instructing and guiding patients before and after surgery is essential for their successful recovery. In recent years, however, the development of the enhanced recovery after surgery (ERAS) protocol has restricted the opportunity for healthcare professionals to spend time with their patients before and after surgery because of efficiency-driven, shortened hospital stay. Here, we embedded health education information of the perioperative period for gastrointestinal surgery on a WeChat-based mobile platform and evaluated the platform through medical staff evaluation, patient volunteer evaluation, and quantitative grading rubric. Clinicians and nurses believed that the mobile platform was attractively designed and easy to navigate, valuable, and adequate for patient health education. The content of health education was embedded into the WeChat-based mobile platform, thereby allowing patients and caregivers to access information at their own pace and enable repeat reading.
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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.
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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
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is associated with improved patient experience while reducing overall costs without compromising patient safety. Patient-centered care is crucial for further expansion and success of ambulatory surgery because it is associated with superior patient experience and improved patient satisfaction. This article discusses the approach to improving patient-centered care and patient-reported outcomes (PROs). RECENT FINDINGS It is necessary to recognize that each patient is different and may have different needs and preferences. Patient education and shared decision-making are critical components of patient-centered care. Shared decision-making emphasizes patient engagement in an effort to improve PROs. Implementation of enhanced recovery after surgery principles in ambulatory surgery is necessary to improve PROs. SUMMARY Delivery of patient-centered care will require modification of the current approach to perioperative care. It is imperative to measure PROs by implementing a comprehensive continuous quality improvement program.
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Affiliation(s)
- Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Respiratory Prehabilitation for the Prevention of Postoperative Pulmonary Complications after Major Surgery. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00495-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Xu L, Sanders L, Li K, Chow JCL. Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review. JMIR Cancer 2021; 7:e27850. [PMID: 34847056 PMCID: PMC8669585 DOI: 10.2196/27850] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/02/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023] Open
Abstract
Background Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. Objective This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. Methods A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. Results Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. Conclusions Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine.
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Affiliation(s)
- Lu Xu
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Leslie Sanders
- Department of Humanities, York University, Toronto, ON, Canada
| | - Kay Li
- Department of English, York University, Toronto, ON, Canada
| | - James C L Chow
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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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: 30] [Impact Index Per Article: 10.0] [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.
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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
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Johnsen TL, Johansen T, Momsen AMH, Tveito TH, Nielsen CV, Varsi C, Øyeflaten I. eHealth interventions to facilitate work participation: a scoping review. JBI Evid Synth 2021; 19:2739-2759. [PMID: 34224522 PMCID: PMC8528131 DOI: 10.11124/jbisrir-d-19-00433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review was to identify studies combining the concepts of eHealth and work participation for sick-listed employees across diagnostic groups in health care and workplace contexts. INTRODUCTION There is an increased demand for better health care services and technologies, and eHealth is proposed as a useful tool to improve efficiency and reduce costs. eHealth functions at the intersection of medical informatics, public health, and business, and may be a promising solution for managing the process of return to work among employees on sick leave. Assessment of work outcomes is essential in evaluating the effectiveness of health services, and there is a need to map the research literature on existing eHealth interventions to facilitate work participation. INCLUSION CRITERIA This scoping review considered studies combining two core concepts: eHealth and work participation. It considered studies on eHealth interventions for employees (18 to 65 years of age) on sick leave due to any type of diagnosis or disability, conducted by any stakeholder in workplace or health care contexts and in any country. Empirical data from both quantitative and qualitative studies were included. METHODS Published and unpublished studies from January 1, 2008, to August 21, 2020, written in English were included in this review. The search was conducted in MEDLINE, Scopus, Embase, PsycINFO, WHO clinical registry, and ClinicalTrials.gov. A three-step search strategy was followed. Data extraction was performed by two independent reviewers and undertaken using an extraction tool developed specifically for the scoping review objectives. RESULTS This review identified 15 studies eligible for inclusion. Four studies delivered the eHealth intervention by telephone, while 10 interventions were web-based. Of the web-based interventions, five had a blended approach, such as website and email support, or website and social media platforms. One study used an app-based intervention. Only eight studies targeted employees sick-listed due to common sick leave diagnoses, such as common mental disorders and musculoskeletal disorders. The workplace context was the target of the eHealth intervention in seven studies, although the intervention was still delivered by health personnel such as therapists or occupational physicians. Collaboration on individual cases between the health professional, employer, and employee to facilitate work participation seemed to be rare. Four studies reported both a theoretical and an empirical base for the intervention used. CONCLUSIONS This review demonstrated that the use of eHealth interventions to facilitate work participation is limited, and there is a need for future studies on the use of eHealth technology for this purpose. Developing eHealth interventions specifically for populations at risk of long-term sick leave, and encouraging collaboration between all relevant stakeholders, may help improve work participation.
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Affiliation(s)
- Tone Langjordet Johnsen
- NORCE, Norwegian Research Centre, Bergen, Norway
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Thomas Johansen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Anne-Mette Hedeager Momsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
| | - Torill Helene Tveito
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Horten, Norway
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Region Hospital West Jutland, Denmark
| | - Cecilie Varsi
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Irene Øyeflaten
- NORCE, Norwegian Research Centre, Bergen, Norway
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
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Abstract
OBJECTIVE This systematic review aims to assess what is known about convalescence following abdominal surgery. Through a review of the basic science and clinical literature, we explored the effect of physical activity on the healing fascia and the optimal timing for postoperative activity. BACKGROUND Abdominal surgery confers a 30% risk of incisional hernia development. To mitigate this, surgeons often impose postoperative activity restrictions. However, it is unclear whether this is effective or potentially harmful in preventing hernias. METHODS We conducted 2 separate systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The first assessed available basic science literature on fascial healing. The second assessed available clinical literature on activity after abdominal surgery. RESULTS Seven articles met inclusion criteria for the basic science review and 22 for the clinical studies review. The basic science data demonstrated variability in maximal tensile strength and time for fascial healing, in part due to differences in layer of abdominal wall measured. Some animal studies indicated a positive effect of physical activity on the healing wound. Most clinical studies were qualitative, with only 3 randomized controlled trials on this topic. Variability was reported on clinician recommendations, time to return to activity, and factors that influence return to activity. Interventions designed to shorten convalescence demonstrated improvements only in patient-reported symptoms. None reported an association between activity and complications, such as incisional hernia. CONCLUSIONS This systematic review identified gaps in our understanding of what is best for patients recovering from abdominal surgery. Randomized controlled trials are crucial in safely optimizing the recovery period.
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[Treatment expectations for postoperative pain]. Schmerz 2021; 36:157-165. [PMID: 34459995 PMCID: PMC9156456 DOI: 10.1007/s00482-021-00575-0] [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] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Präoperative Behandlungserwartungen haben einen deutlichen Einfluss auf die postoperativen Schmerzen und Behandlungsergebnisse. Positive Erwartungen sind ein wichtiger Mechanismus von Placeboeffekten und negative Erwartungen ein wichtiger Mechanismus von Noceboeffekten. Fragestellung Welchen Einfluss haben Behandlungserwartungen, wie werden diese im klinischen Setting erhoben und wie können diese Erkenntnisse in der klinischen Praxis umgesetzt werden? Material und Methoden Es wurde eine Literatursuche für klinische Studien mit den Schlagwörtern „expectation“ AND („postoperative“ OR „surgery“) durchgeführt. Ausgewählt wurden alle aktuellen englischen und deutschen Artikel. Zusätzlich wurden die Literaturverzeichnisse der gefundenen Artikel untersucht und mit aufgenommen. Ergebnisse Insgesamt 158 Artikel wurden gefunden, von denen 49 Artikel Erwartungen erheben und ein postoperatives Behandlungsergebnis einbeziehen. Die meisten Artikel untersuchen Erwartungen in der Baseline-Erhebung, um nachzuweisen, dass sich Gruppen in Gruppenvergleichen präoperativ nicht voneinander unterscheiden. Die Studien, die den Einfluss von Erwartungen prospektiv untersuchen, verwenden sehr unterschiedliche Messverfahren, um das Konstrukt „Erwartung“ zu erheben. Somit ist ein Vergleich zwischen den Studien schwer möglich. Es gibt wenige Studien, die untersuchen, ob und wie die Erwartungen perioperativ beeinflusst werden können, und die praxisrelevante Interventionen zu deren Veränderung entwickelt haben. Schlussfolgerung Für eine fundierte Untersuchung der Behandlungserwartung sollten in klinischen Studien valide und reliable Messverfahren verwendet werden. Weitere Studien sollten sich mit Interventionsmöglichkeiten auseinandersetzen, damit Behandlungserwartungen auch in die klinische Standardbehandlung einbezogen werden können.
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Clark TJ, Saridogan E. Is there still need for a further randomised controlled trial on the route of hysterectomy for benign disease? Facts Views Vis Obgyn 2021; 13:103-105. [PMID: 34184841 PMCID: PMC8291981 DOI: 10.52054/fvvo.13.2.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Amin T, Parr WC, Mobbs RJ. Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery. J Pers Med 2021; 11:jpm11060498. [PMID: 34199467 PMCID: PMC8228233 DOI: 10.3390/jpm11060498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022] Open
Abstract
The emergence of 3D-Printing technologies and subsequent medical applications have allowed for the development of Patient-specific implants (PSIs). There have been increasing reports of PSI application to spinal surgery over the last 5 years, including throughout the spine and to a range of pathologies, though largely for complex cases. Through a number of potential benefits, including improvements to the implant–bone interface and surgical workflow, PSIs aim to improve patient and surgical outcomes, as well as potentially provide new avenues for combating challenges routinely faced by spinal surgeons. However, obstacles to widespread acceptance and routine application include the lack of quality long-term data, research challenges and the practicalities of production and navigating the regulatory environment. While recognition of the significant potential of Spinal PSIs is evident in the literature, it is clear a number of key questions must be answered to inform future clinical and research practices. The spinal surgical community must selectively and ethically continue to offer PSIs to patients, simultaneously allowing for the necessary larger, comparative studies to be conducted, as well as continuing to provide optimal patient care, thereby ultimately determining the exact role of this technology and potentially improving outcomes.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
| | - William C.H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick 2031, Australia
- 3DMorphic Pty Ltd., Matraville 2036, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
- Correspondence: ; Tel.: +61-(02)-9650-4766
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Gonzales HM, Fleming JN, Gebregziabher M, Posadas-Salas MA, Su Z, McGillicuddy JW, Taber DJ. Pharmacist-Led Mobile Health Intervention and Transplant Medication Safety: A Randomized Controlled Clinical Trial. Clin J Am Soc Nephrol 2021; 16:776-784. [PMID: 33931415 PMCID: PMC8259471 DOI: 10.2215/cjn.15911020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Medication safety events are predominant contributors to suboptimal graft outcomes in kidney transplant recipients. The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health-based intervention. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a 12-month, single-center, prospective, parallel, two-arm, single-blind, randomized controlled trial. Adult kidney recipients 6-36 months post-transplant were eligible. Participants randomized to intervention received supplemental clinical pharmacist-led medication therapy monitoring and management via a mobile health-based application, integrated with risk-guided televisits and home-based BP and glucose monitoring. The application provided an accurate medication regimen, timely reminders, and side effect surveys. Both the control and intervention arms received usual care, including serial laboratory monitoring and regular clinic visits. The coprimary outcomes were to assess the incidence and severity of medication errors and adverse events. RESULTS In total, 136 kidney transplant recipients were included, 68 in each arm. The mean age was 51 years, 57% were male, and 64% were Black individuals. Participants receiving the intervention experienced a significant reduction in medication errors (61% reduction in the risk rate; incident risk ratio, 0.39; 95% confidence interval, 0.28 to 0.55; P<0.001) and a significantly lower incidence risk of Grade 3 or higher adverse events (incident risk ratio, 0.55, 95% confidence interval, 0.30 to 0.99; P=0.05). For the secondary outcome of hospitalizations, the intervention arm demonstrated significantly lower rates of hospitalizations (incident risk ratio, 0.46; 95% confidence interval, 0.27 to 0.77; P=0.005). CONCLUSIONS We demonstrated a significant reduction in medication errors, adverse events, and hospitalizations using a pharmacist-led, mobile health-based intervention.
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Affiliation(s)
- Haley M. Gonzales
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - James N. Fleming
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | | | - Zemin Su
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - John W. McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David J. Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Sharma V, Piscoran O, Summers A, Woywodt A, van der Veer SN, Ainsworth J, Augustine T. The use of health information technology in renal transplantation: A systematic review. Transplant Rev (Orlando) 2021; 35:100607. [PMID: 33607425 DOI: 10.1016/j.trre.2021.100607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.
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Affiliation(s)
- Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK.
| | - Oana Piscoran
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Angela Summers
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Nephrology, Royal Preston Hospital, Preston, Lancashire, PR2 9HT, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
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Stessel B, Hendrickx M, Pelckmans C, De Wachter G, Appeltans B, Braeken G, Herbots J, Joosten E, Van de Velde M, Buhre WFFA. One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial. PLoS One 2021; 16:e0245774. [PMID: 33497408 PMCID: PMC7837485 DOI: 10.1371/journal.pone.0245774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR. Methods/Design This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test. Results Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups. Conclusions The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile. Trial registration European Union Clinical Trials Register 2015-003987-35.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Diepenbeek, Belgium
- * E-mail:
| | - Maarten Hendrickx
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Caroline Pelckmans
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | | | - Bart Appeltans
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Geert Braeken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Herbots
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Elbert Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marc Van de Velde
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Laferton JAC, Oeltjen L, Neubauer K, Ebert DD, Munder T. The effects of patients' expectations on surgery outcome in total hip and knee arthroplasty: a prognostic factor meta-analysis. Health Psychol Rev 2020; 16:50-66. [PMID: 33228474 DOI: 10.1080/17437199.2020.1854051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients' expectations are among the most frequently studied psychological prognostic factors in total knee and hip arthroplasty (TKA/THA). So far, however, evidence on the effect of patients' preoperative expectations on surgery outcome is inconclusive. Heterogeneity of expectation constructs and the use of psychometrically not evaluated measurement instruments have constituted major obstacles for the integration of the current literature. Using a theory-based model of expectation constructs , this meta-analysis set out to disentangle the conflicting results in the current literature. Systematic literature searches yielded k = 46 studies (N = 10,465) that reported associations of preoperative expectations with postoperative pain, functioning and disability, and satisfaction. Random effects meta-analysis revealed a robust small association (r = .16; 95% CI .13, .19) between patients' positive preoperative expectations and better postoperative outcomes. This effect did not differ between THA and TKA, different outcome categories and different follow-up periods. Studies using psychometrically evaluated expectation measures reported significantly higher effects (r = .19; 95% CI .16, .22). Whether this effect varies among different expectation constructs remains unclear. High-quality studies using validated, multidimensional expectation measures are needed to further understand the role of different expectation constructs in THA and TKA surgery.
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Affiliation(s)
- Johannes A C Laferton
- Division of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.,Division of Clinical Psychology and Psychotherapy, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Division of Psychological Medicine, Department of Medicine, Health and Medical University Potsdam, Potsdam, Germany
| | - Lara Oeltjen
- Department of Psychological Methods, Institute of Psychology, Friedrich-Schiller-Universität Jena, Jena, Germany
| | | | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thomas Munder
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Tamminga SJ, van Vree FM, Volker G, Roorda LD, Terwee CB, Goossens PH, Vliet Vlieland TPM. Changes in the ability to participate in and satisfaction with social roles and activities in patients in outpatient rehabilitation. J Patient Rep Outcomes 2020; 4:73. [PMID: 32870463 PMCID: PMC7462938 DOI: 10.1186/s41687-020-00236-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background One of the main aims of rehabilitation is to improve participation. Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks ‘Ability to Participate in Social roles and Activities, (PROMIS-APS) and ‘Satisfaction with Social Roles and Activities’ (PROMIS-SPS) are promising options to measure participation, but the literature on PROMIS measures of (satisfaction with) participation across diagnoses in rehabilitation is limited. Therefore, the objective of this study was to describe levels of and changes in participation, as assessed with the PROMIS-APS and the PROMIS-SPS short forms, of patients in outpatient rehabilitation. Methods This study had quantitative, observational design with assessments at admission and discharge. Consecutive patients treated between April and August 2018 receiving outpatient multidisciplinary rehabilitation were the population of this study. The following diagnosis categories were included: brain injury (e.g. stroke), spinal cord and nerve injury, neuromuscular disorder (e.g. lateral sclerosis), amputation, musculoskeletal condition (e.g. osteoarthritis) or heart or lung disease (e.g. myocardial infarction, chronic obstructive pulmonary disease). The main patient-reported outcomes (PRO) of this study were the short form of the PROMIS-APS (8 items, Dutch general population reference score 50.6 [SD 9.5]), and PROMIS-SPS (8 items, Dutch general population reference score 47.5 [SD 8.3]. Results Of the 1279 patients invited, 777 (61%) completed the online forms at admission. Of those, 329 patients were invited at discharge, with 209 (64%) completing the forms. The mean (SD) T-scores of the PROMIS-APS and PROMIS-SPS were lower at admission (42.7 [SD 7.4]; (41.4 [SD 7.7]) and discharge (43.6 [SD 7.2]; (43.7 [SD 7.8]) than the Dutch general population. The change scores of the PROMIS-APS and PROMIS-SPS were 1.2 (95% CI 0.4–1.9; p = 0.004; effect size 0.16), and 2.4 (95% CI 1.6–3.2; p < 0.0001; effect size 0.31), respectively. In all diagnostic subgroups with > 30 paired measurements statistically significant improvements of PROMIS-APS, PROMIS-SPS or both were seen. Conclusions Patients undergoing outpatient rehabilitation had, both at admission and discharge, considerably lower PROMIS-APS and PROMIS-SPS T-scores short forms than the general Dutch population, and showed small T-score improvements at discharge.
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Affiliation(s)
- Sietske J Tamminga
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands. .,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Gerard Volker
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Thea P M Vliet Vlieland
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
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Barriers associated with failed completion of an acute care general surgery telehealth clinic visit. Surgery 2020; 168:851-858. [PMID: 32782115 DOI: 10.1016/j.surg.2020.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/09/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A form of telehealth, a surgical electronic clinic (E-clinic, video or telephone visit) is a safe and efficient way for delivering care; however, factors leading to poor clinic utilization are not well-described. This study was performed to gather electronic clinic utilization data and to better define barriers to visit completion. METHODS A retrospective review of 199 patients cared for by a general surgery service with subsequent referral to the electronic clinic (January 2019 to June 2019) was performed. Data regarding demographics, medical characteristics, travel distance, and postoperative complications were collected. Patients were categorized based upon visit completion. The χ2 and Fisher exact analyses were performed as appropriate. Reasons for cancellations were categorized. RESULTS More than 1/5 of all patients (21.6%) failed to complete the visit. No differences were observed in completion rates according to the type of operation, American Society of Anesthesiologists classification, and age. The failed-completion group had a significantly (P < .05) higher proportion of non-Caucasian patients and those with a marital status of single. Travel distance had no impact. Complication rates were low. Pre-clinic readmission within 30 days contributed to failed completion. Reasons for cancellation included medical issues, technical difficulties, and patient preference to have no follow-up in the electronic clinic. CONCLUSION Several factors contribute to a patient's failure to complete an electronic clinic visit including marital status, medical complications, technical issues, and patient preference. Electronic clinic utilization patterns also demonstrate racial disparities. Successful electronic clinic program implementation requires understanding the factors that contribute to failed visits to address them and improve access.
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Feasibility of Perioperative eHealth Interventions for Older Surgical Patients: A Systematic Review. J Am Med Dir Assoc 2020; 21:1844-1851.e2. [PMID: 32694000 DOI: 10.1016/j.jamda.2020.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES EHealth interventions are increasingly being applied in perioperative care but have not been adequately studied for older surgical patients who could potentially benefit from them. Therefore, we evaluated the feasibility of perioperative eHealth interventions for this population. DESIGN A systematic review of prospective observational and interventional studies was conducted. Three electronic databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and July 2019. Study quality was assessed by Methodological Index for Non-Randomized Studies (MINORS) with and without control group. SETTING AND PARTICIPANTS Studies of surgical patients with an average age ≥65 years undergoing any perioperative eHealth intervention with active patient participation (with the exception of telerehabilitation following orthopedic surgery) were included. MEASURES The main outcome measure was feasibility, defined as a patient's perceptions of usability, satisfaction, and/or acceptability of the intervention. Other outcomes included compliance and study completion rate. RESULTS Screening of 1569 titles and abstracts yielded 7 single-center prospective studies with 223 patients (range n = 9-69 per study, average age 66-74 years) undergoing oncological, cardiovascular, or orthopedic surgery. The median MINORS scores were 13.5 of 16 for 6 studies without control group, and 14 of 24 for 1 study with a control group. Telemonitoring interventions were rated as "easy to use" by 89% to 95% of participants in 3 studies. Patients in 3 studies were satisfied with the eHealth intervention and would recommend it to others. Acceptability (derived from consent rate) ranged from 71% to 89%, compliance from 53% to 86%, and completion of study follow-up from 54% to 95%. CONCLUSIONS AND IMPLICATIONS Results of 7 studies involving perioperative eHealth interventions suggest their feasibility and encourage further development of technologies for older surgical patients. Future feasibility studies require clear definitions of appropriate feasibility outcome measures and a comprehensive description of patient characteristics such as functional performance, level of education, and socioeconomic status.
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Grimes CL, Balk EM, Dieter AA, Singh R, Wieslander CK, Jeppson PC, Aschkenazi SO, Kim JH, Truong MD, Gupta AS, Keltz JG, Hobson DT, Sheyn D, Petruska SE, Adam G, Meriwether KV. Guidance for gynecologists utilizing telemedicine during COVID‐19 pandemic based on expert consensus and rapid literature reviews. Int J Gynaecol Obstet 2020. [PMCID: PMC9087699 DOI: 10.1002/ijgo.13276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background COVID‐19 has impacted delivery of outpatient gynecology and shifted care toward use of telemedicine. Objective To rapidly review literature and society guidelines and create expert consensus to provide guidance regarding management of outpatient gynecology scenarios via telemedicine. Search strategy Searches were conducted in Medline and Cochrane databases from inception through April 15, 2020. Selection criteria Literature searches were conducted for articles on telemedicine and abnormal uterine bleeding, chronic pelvic pain, endometriosis, vaginitis, and postoperative care. Searches were restricted to available English language publications. Data collection and analysis Expedited literature review methodology was followed and 10 943 citations were single‐screened. Full‐text articles and relevant guidelines were reviewed and narrative summaries developed. Main results Fifty‐one studies on the use of telemedicine in gynecology were found. Findings were reported for these studies and combined with society guidelines and expert consensus on four topics (abnormal uterine bleeding, chronic pelvic pain and endometriosis, vaginal discharge, and postoperative care). Conclusions Guidance for treating gynecological conditions via telemedicine based on expedited literature review, review of society recommendations, and expert consensus is presented. Due to minimal evidence surrounding telemedicine and gynecology, a final consensus document is presented here that can be efficiently used in a clinical setting. Guidance for gynecologists using telemedicine during COVID‐19 based on rapid literature review, review of society recommendations, and expert consensus in accessible format.
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Affiliation(s)
- Cara L. Grimes
- Division of Female Pelvic Medicine and Reconstructive Surgery Departments of Obstetrics and Gynecology and Urology New York Medical College Valhalla NY USA
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health Brown School of Public Health Brown University Providence RI USA
| | - Alexis A. Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Ruchira Singh
- Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology University of Florida Jacksonville FL USA
| | - Cecilia K. Wieslander
- Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Peter C. Jeppson
- Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology University of New Mexico Albuquerque NM USA
| | - Sarit O. Aschkenazi
- Prohealth Women Services Division of Urogynecology Department of Obstetrics and Gynecology Waukesha Memorial Hospital Medical College of Wisconsin Waukesha WI USA
| | - Jin Hee Kim
- Division of Gynecologic Specialty Surgery Department of Obstetrics and Gynecology Columbia University Medical Center New York NY USA
| | - Mireille D. Truong
- Division of Minimally Invasive Gynecologic Surgery Department of Obstetrics and Gynecology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Ankita S. Gupta
- Department of Obstetrics & Gynecology University of Louisville Louisville KY USA
| | - Julia G. Keltz
- Department of Obstetrics and Gynecology New York Medical College Valhalla NY USA
| | - Deslyn T.G. Hobson
- Department of Obstetrics and Gynecology Wayne State University School of Medicine Detroit MI USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology MetroHealth Medical Center Cleveland OH USA
| | - Sara E. Petruska
- Department of Obstetrics & Gynecology University of Louisville Louisville KY USA
| | - Gaelen Adam
- Center for Evidence Synthesis in Health Brown School of Public Health Brown University Providence RI USA
| | - Kate V. Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology University of New Mexico Albuquerque NM USA
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Straat AC, Coenen P, Smit DJM, Hulsegge G, Bouwsma EVA, Huirne JAF, van Geenen RC, Janssen RPA, Boymans TAEJ, Kerkhoffs GMMJ, Anema JR, Kuijer PPFM. Development of a Personalized m/eHealth Algorithm for the Resumption of Activities of Daily Life Including Work and Sport after Total and Unicompartmental Knee Arthroplasty: A Multidisciplinary Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144952. [PMID: 32659989 PMCID: PMC7400285 DOI: 10.3390/ijerph17144952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022]
Abstract
Evidence for recommendations concerning the resumption of activities of daily life, including work and sport, after knee arthroplasty is lacking. Therefore, recommendations vary considerably between hospitals and healthcare professionals. We aimed to obtain multidisciplinary consensus for such recommendations. Using a Delphi procedure, we strived to reach consensus among a multidisciplinary expert panel of six orthopaedic surgeons, three physical therapists, five occupational physicians and one physician assistant on recommendations regarding the resumption of 27 activities of daily life. The Delphi procedure involved three online questionnaire rounds and one face-to-face consensus meeting. In each of these four rounds, experts independently decided at what time daily life activities could feasibly and safely be resumed after knee arthroplasty. We distinguished patients with a fast, average and slow recovery. After four Delphi rounds, the expert panel reached consensus for all 27 activities. For example, experts agreed that total knee arthroplasty patients with a fast recovery could resume cycling six weeks after the surgery, while those with an average and slow recovery could resume this activity after nine and twelve weeks, respectively. The consensus recommendations will subsequently be integrated into an algorithm of a personalized m/eHealth portal to enhance recovery among knee arthroplasty patients.
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Affiliation(s)
- A. Carlien Straat
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands; (P.C.); (D.J.M.S.); (G.H.); (J.R.A.)
- Coronel Institute of Occupational Health, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands;
- Correspondence: ; Tel.: +31-020-44-44510
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands; (P.C.); (D.J.M.S.); (G.H.); (J.R.A.)
| | - Denise J. M. Smit
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands; (P.C.); (D.J.M.S.); (G.H.); (J.R.A.)
| | - Gerben Hulsegge
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands; (P.C.); (D.J.M.S.); (G.H.); (J.R.A.)
- The Netherlands Organization for Applied Scientific Research, TNO, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands
| | - Esther V. A. Bouwsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.V.A.B.); (J.A.F.H.)
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.V.A.B.); (J.A.F.H.)
| | - Rutger C. van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), 4818 CK Breda, The Netherlands;
| | - Rob P. A. Janssen
- Department of Orthopaedic Surgery and Traumatology, Maxima Medical Center, 5631 BM Veldhoven, The Netherlands;
- Chair Value-Based Health Care, Faculty of Paramedical Sciences, Fontys University of Applied Sciences, 5612 AR Eindhoven, The Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Tim A. E. J. Boymans
- Department of Orthopaedics, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Johannes R. Anema
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands; (P.C.); (D.J.M.S.); (G.H.); (J.R.A.)
| | - P. Paul F. M. Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands;
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Coenen P, Straat C, Kuijer PP. Knee arthroplasty: a window of opportunity to improve physical activity in daily life, sports and work. BMJ Open Sport Exerc Med 2020; 6:e000822. [PMID: 32597904 PMCID: PMC7312336 DOI: 10.1136/bmjsem-2020-000822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pieter Coenen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carlien Straat
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - P Paul Kuijer
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
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Richards HS, Portal A, Absolom K, Blazeby JM, Velikova G, Avery KNL. Patient experiences of an electronic PRO tailored feedback system for symptom management following upper gastrointestinal cancer surgery. Qual Life Res 2020; 30:3229-3239. [PMID: 32535864 PMCID: PMC8528794 DOI: 10.1007/s11136-020-02539-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
Purpose Complications following upper gastrointestinal (UGI) surgery are common. Symptom-monitoring following discharge is not standardized. An electronic patient-reported outcome (ePRO) system providing feedback to patients and clinicians could support patients and improve outcomes. Little is known about patients’ experiences of using such systems. This qualitative sub-study explored patients’ perspectives of the benefits of using a novel ePRO system, developed as part of the mixed methods eRAPID pilot study, to support recovery following discharge after UGI surgery. Methods Patients completed the online ePRO symptom-report system post-discharge. Weekly interviews explored patients’ experiences of using ePRO, the acceptability of feedback generated and its value for supporting their recovery. Interviews were audio-recorded and targeted transcriptions were thematically analysed. Results Thirty-five interviews with 16 participants (11 men, mean age 63 years) were analysed. Two main themes were identified: (1) reassurance and (2) empowerment. Feelings of isolation were common; many patients felt uninformed regarding their expectations of recovery and whether their symptoms warranted clinical investigation. Participants were reassured by tailored feedback advising them to contact their care team, alleviating their anxiety. Patients reported feeling empowered by the ePRO system and in control of their symptoms and recovery. Conclusion Patients recovering at home following major cancer surgery regarded electronic symptom-monitoring and feedback as acceptable and beneficial. Patients perceived that the system enhanced information provision and provided a direct link to their care team. Patients felt that the system provided reassurance at a time of uncertainty and isolation, enabling them to feel in control of their symptoms and recovery. Electronic supplementary material The online version of this article (10.1007/s11136-020-02539-w) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- H S Richards
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - A Portal
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - K Absolom
- Leeds Institute of Medical Research at St James, St James's Hospital, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - G Velikova
- Leeds Institute of Medical Research at St James, St James's Hospital, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - K N L Avery
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Li P, Luo Y, Yu X, Wen J, Mason E, Li W, Jalali MS. Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. J Med Internet Res 2020; 22:e17221. [PMID: 32525483 PMCID: PMC7317627 DOI: 10.2196/17221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.
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Affiliation(s)
- Peiyi Li
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Yunmei Luo
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Xuexin Yu
- Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Elizabeth Mason
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
| | - Weimin Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mohammad S Jalali
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States
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Richards HS, Blazeby JM, Portal A, Harding R, Reed T, Lander T, Chalmers KA, Carter R, Singhal R, Absolom K, Velikova G, Avery KNL. A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery. BMC Cancer 2020; 20:543. [PMID: 32522163 PMCID: PMC7285449 DOI: 10.1186/s12885-020-07027-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63–100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients’ experiences during recovery. Conclusion Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients’ wellbeing after hospital discharge.
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Affiliation(s)
- H S Richards
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - A Portal
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Harding
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Reed
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Lander
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - K A Chalmers
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Carter
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - R Singhal
- Queen Elizabeth Hospital Birmingham, Mindelson Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K Absolom
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - G Velikova
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - K N L Avery
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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Laureij LT, Breunis LJ, Steegers-Theunissen RPM, Rosman AN. Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study. JMIR Form Res 2020; 4:e16202. [PMID: 32452805 PMCID: PMC7284398 DOI: 10.2196/16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Leonieke J Breunis
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
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Coenen P, Hulsegge G, Daams JG, van Geenen RC, Kerkhoffs GM, van Tulder MW, Huirne JA, Anema JR, Kuijer PP. Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis. BMJ Open Sport Exerc Med 2020; 6:e000664. [PMID: 32341795 PMCID: PMC7173989 DOI: 10.1136/bmjsem-2019-000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Orthopaedic surgery is primarily aimed at improving function and pain reduction. Additional integrated care may enhance patient’s participation in sports and work, possibly improving performance of physical activities and quality of life (QoL). We aimed to assess the effectiveness of integrated care among orthopaedic surgery patients. Design Systematic review with meta-analysis. Data source Medline, EMBASE and CINAHL (until 17 June 2019). Eligibility for selecting studies We searched for controlled studies on integrated care interventions consisting of active referral to case managers, rehabilitation with participation-based goals and/or e/mHealth, with outcomes of sports and work participation, performance of physical activities and/or QoL. Outcomes were normalised to 0–100 scales and statistically pooled. Results Seventeen articles (n=2494) of moderate quality were included reporting on patients receiving back, upper limb, knee or hip surgery. Only one study reported on return to sports and found no significant benefit. For return to work, one study did (90% vs 82%) and one did not (relative risk=1.18 (0.80 to 1.70)) observe significant benefits. Integrated care showed small effects for improving performance of physical activities (2.69 (–0.20 to 5.58); eight studies, n=1267) and QoL (2.62 (1.16 to 5.05); nine studies, n=1158) compared with usual care. Summary/Conclusion We found insufficient and inconsistent evidence for the effectiveness of integrated care for orthopaedic surgery patients regarding sport and work participation. Small effects were found for performance of physical activities and QoL. High quality research on integrated care focusing on sports and work participation is needed before integrated care can be implemented for orthopaedic surgery patients.
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Affiliation(s)
- Pieter Coenen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Gerben Hulsegge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,The Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - Joost G Daams
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam, The Netherlands
| | - Rutger C van Geenen
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Gino M Kerkhoffs
- Amsterdam UMC, Academic Medical Center, Vrije Universiteit Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS) AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Amsterdam Movement Sciences research institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith A Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Paul Kuijer
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands
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Timmers T, Janssen L, Kool RB, Kremer JA. Educating Patients by Providing Timely Information Using Smartphone and Tablet Apps: Systematic Review. J Med Internet Res 2020; 22:e17342. [PMID: 32281936 PMCID: PMC7186866 DOI: 10.2196/17342] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/21/2020] [Accepted: 03/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Patient education is a crucial element within health care. It is a known predictor for increased engagement in shared decision making, improved medication and treatment adherence, higher levels of satisfaction, and even better treatment outcomes. Unfortunately, often patients only remember a very limited amount of medical information. An important reason is that most patients are simply not capable of processing large amounts of new medical information in a short time. Apps for smartphones and tablets have the potential to actively educate patients by providing them with timely information through the use of push notifications. Objective The objective of this systematic review is to provide an overview of the effects of using smartphone and tablet apps to educate patients with timely education. Within this review, we focused on patients that receive their care in a hospital setting. We assessed the effects of the interventions on outcomes, such as patients’ knowledge about their illness and treatment, adherence to treatment instructions and to medication usage, and satisfaction with the care they received. Methods A comprehensive search of MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science was conducted. Randomized controlled trials (RCTs) published between January 2015 and November 2019 were eligible for inclusion. Two reviewers independently searched and screened articles, assessed study quality and risk of bias, and extracted the data. Due to the heterogeneity of populations, interventions, and outcomes, a meta-analysis was not deemed appropriate. Instead, a narrative synthesis is presented. Results A total of 21 RCTs with 4106 participants were included. Compared to usual care, overall effectiveness of the interventions was demonstrated in 69% of the outcomes. Effectiveness increased to 82% when the intervention had a duration shorter than one month and increased to 78% when the intervention provided at least one push notification per week. The interventions showed the highest effects on satisfaction with information, adherence to treatment instructions and to medication usage, clinical outcomes, and knowledge. Conclusions This review demonstrates that educating patients with timely medical information through their smartphones or tablets improves their levels of knowledge, medication or treatment adherence, satisfaction, and clinical outcomes, as well as having a positive effect on health care economics. These effects are most pronounced in interventions with a short duration (ie, less than a month) and with a high frequency of messages to patients (ie, once per week or more). With the knowledge that patient education is a predictor for improved outcomes and the fact that patients have obvious difficulties processing large amounts of new medical information, we suggest incorporating the delivery of timely information through smartphone and tablet apps within current medical practices.
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Interactive Studios, Rosmalen, Netherlands
| | | | - Rudolf B Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan Am Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Rowland SP, Fitzgerald JE, Holme T, Powell J, McGregor A. What is the clinical value of mHealth for patients? NPJ Digit Med 2020; 3:4. [PMID: 31970289 PMCID: PMC6957674 DOI: 10.1038/s41746-019-0206-x] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mobile apps should be utilized to add value to patient care. We categorize apps according to their functionality (e.g. preventative behavior change, digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematic reviews and meta-analyses and the relevance to patient care. We discuss the limitations of the current literature describing clinical outcomes from mHealth apps, what FDA clearance means now (510(k)/de novo FDA clearance) and in the future. We discuss data security and privacy as a major concern for patients when using mHealth apps. Patients are often not involved in the development of mobile health guidelines, and professionals' views regarding high-quality health apps may not reflect patients' views. We discuss efforts to develop guidelines for the development of safe and effective mHealth apps in the US and elsewhere and the role of independent app reviews sites in identifying mHealth apps for patient care. There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes.
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Affiliation(s)
- Simon P. Rowland
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Thomas Holme
- Department of trauma and orthopaedic surgery, Epsom and St Helier University Hospitals NHS, London, UK
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alison McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
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Nilsson U, Gruen R, Myles PS. Postoperative recovery: the importance of the team. Anaesthesia 2020; 75 Suppl 1:e158-e164. [DOI: 10.1111/anae.14869] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- U. Nilsson
- Division of Nursing Department of Neurobiology, Care Sciences and Society Karolinska Institute and Peri‐operative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - R. Gruen
- College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - P. S. Myles
- Department of Anaesthesiology and Peri‐operative Medicine Alfred Hospital and Monash University Melbourne Vic. Australia
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Griffin S, McGrath L, Chesnut GT, Benfante N, Assel M, Ostrovsky A, Levine M, Vickers A, Simon B, Laudone V. Impact of caregiver overnight stay on postoperative outcomes. Int J Health Care Qual Assur 2019; 33:18-26. [PMID: 31940152 DOI: 10.1108/ijhcqa-12-2018-0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. DESIGN/METHODOLOGY/APPROACH This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. FINDINGS Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. ORIGINALITY/VALUE This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
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Affiliation(s)
- Susan Griffin
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leigh McGrath
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory T Chesnut
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicole Benfante
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Assel
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Aaron Ostrovsky
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marcia Levine
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brett Simon
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vincent Laudone
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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