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Xu W, Wells CI, Seo SH, Sebaratnam G, Calder S, Gharibans A, Bissett IP, O'Grady G. Feasibility and Accuracy of Wrist-Worn Sensors for Perioperative Monitoring During and After Major Abdominal Surgery: An Observational Study. J Surg Res 2024; 301:423-431. [PMID: 39033592 DOI: 10.1016/j.jss.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/20/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Continuous, ambulatory perioperative monitoring using wearable devices has shown promise for earlier detection of physiological deterioration and postoperative complications, preventing 'failure-to-rescue'. This study aimed to compare the accuracy of vital signs measured by wrist-based wearables with gold standard measurements from vital signs monitors or nurse assessments in major abdominal surgery. METHODS Adult patients were eligible for inclusion in this prospective observational study validating the Empatica E4 wrist sensor intraoperatively and postoperatively. The primary outcomes were the 95% limits of agreement (LoA) between manual and device recordings of heart rate (HR) and temperature evaluated via Bland-Altman analysis. Secondary analysis was conducted using Clarke-Error grid analysis. RESULTS Overall, 31 patients were recruited, and 27 patients completed the study. The median duration of recording per patient was 70.3 h, and a total of 2112 h of data recording were completed. Wrist-based HR measurement was accurate and moderately precise (bias: 0.3 bpm; 95% LoA -15.5 to 17.1), but temperature measurement was neither accurate nor precise (bias -2.2°C; 95% LoA -6.0 to 1.6). On Clarke-Error grid analysis, 74.5% and 29.6% of HR and temperature measurements, respectively, fell within the acceptable range of reference standards. CONCLUSIONS Continuous perioperative monitoring of HR and temperature after major abdominal surgery using wrist-based sensors is feasible but was limited in this study by low precision. While wrist-based devices offer promise for the continuous monitoring of high-risk surgical patients, current technology is inadequate. Ongoing device hardware and software innovation with robust validation is required before such technologies can be routinely adopted in clinical practice.
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Affiliation(s)
- William Xu
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sean Hb Seo
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Stefan Calder
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Armen Gharibans
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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Mascagni P, Alapatt D, Sestini L, Yu T, Alfieri S, Morales-Conde S, Padoy N, Perretta S. Applications of artificial intelligence in surgery: clinical, technical, and governance considerations. Cir Esp 2024; 102 Suppl 1:S66-S71. [PMID: 38704146 DOI: 10.1016/j.cireng.2024.04.009] [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: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Artificial intelligence (AI) will power many of the tools in the armamentarium of digital surgeons. AI methods and surgical proof-of-concept flourish, but we have yet to witness clinical translation and value. Here we exemplify the potential of AI in the care pathway of colorectal cancer patients and discuss clinical, technical, and governance considerations of major importance for the safe translation of surgical AI for the benefit of our patients and practices.
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Affiliation(s)
- Pietro Mascagni
- IHU Strasbourg, Strasbourg, France; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Deepak Alapatt
- University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France
| | - Luca Sestini
- University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France
| | - Tong Yu
- University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France
| | - Sergio Alfieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Nicolas Padoy
- IHU Strasbourg, Strasbourg, France; University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France
| | - Silvana Perretta
- IHU Strasbourg, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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3
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Ueter S, Taebi N, Weiß C, Hetjens M, Reissfelder C, Blank S, Otto M, Yang C. Study protocol for a non-inferiority, multicenter, randomized study to evaluate a smartphone app-based follow-up program after bariatric surgery (BELLA plus trial). Contemp Clin Trials 2024; 144:107615. [PMID: 38944339 DOI: 10.1016/j.cct.2024.107615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Adherence to follow-up (FU) care after bariatric surgery is poor despite strong recommendations. In our pilot Bella trial, we demonstrated that a completely remote follow-up program via smartphone is feasible and safe for patients after bariatric surgery. Building on this, we aim to verify our results in a multicenter, randomized controlled setting. METHODS This trial plans to enroll 410 participants undergoing primary bariatric surgery in seven German bariatric centers. Participants are randomized into two groups: a control group receiving in-person FU according to the standard in the bariatric centers, and an interventional group monitored using a smartphone application (app). The app sends standardized questionnaires and reminders regarding regular vitamin intake and exercises. The built-in messaging function enables patients to communicate remotely with medical care professionals. After one year, all participants are evaluated at their primary bariatric centers. The primary outcome is weight loss 12 months after surgery. The secondary outcomes include obesity-related comorbidities, quality of life, serum values of vitamins and minerals, body impedance analysis, visits to the emergency department or readmission, patient compliance, and medical staff workload. DISCUSSION The current study is the first prospective, individually randomized-controlled, multicenter trial where a mobile application completely replaces traditional in-person visits for post-bariatric surgery follow-ups in bariatric centers.
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Affiliation(s)
- Sophie Ueter
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niki Taebi
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Hetjens
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Cui Yang
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Kavallieros K, Karakozis L, Hayward R, Giannas E, Selvaggi L, Kontovounisios C. Wearable Devices in Colorectal Surgery: A Scoping Review. Cancers (Basel) 2024; 16:2303. [PMID: 39001367 PMCID: PMC11240327 DOI: 10.3390/cancers16132303] [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: 05/21/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Wearable devices are increasingly utilised to monitor patients perioperatively, allowing for continuous data collection and early complication detection. There is considerable variability in the types and usage settings of wearables, particularly within colorectal surgery. To address this, a scoping review was conducted to investigate current utilisation of wearable devices in colorectal surgery. A systematic search across MEDLINE and Embase was conducted following PRISMA Scoping Review guidelines. Results were synthesised narratively, categorised by perioperative phase (preoperative; postoperative; combination), and supplemented with descriptive statistics and tables. Out of 1525 studies initially identified, 20 were included, reporting data on 10 different wearable devices. Use of wearable devices varied across settings with those used preoperatively tending to focus on baseline physical status or prehabilitation, while postoperative use centred around monitoring and identification of complications. Wearable devices can enhance perioperative monitoring, enable proactive interventions, and promote personalised care for improved patient outcomes in colorectal surgery.
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Affiliation(s)
- Konstantinos Kavallieros
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (K.K.); (L.K.); (R.H.); (E.G.); (C.K.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Lampros Karakozis
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (K.K.); (L.K.); (R.H.); (E.G.); (C.K.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Romilly Hayward
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (K.K.); (L.K.); (R.H.); (E.G.); (C.K.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (K.K.); (L.K.); (R.H.); (E.G.); (C.K.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Lucio Selvaggi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (K.K.); (L.K.); (R.H.); (E.G.); (C.K.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
- Department of Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
- 2nd Surgical Department, Evangelismos General Hospital, 10676 Athens, Greece
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Kwasnicki RM, Giannas E, Rizk C, Kungwengwe G, Dutta T, Dunne J, Dex E, Gokani V, Henry FP, Hunter JE, Williams G, Abela C, Warren O, Jones RP, Wood SH. Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial. J Plast Reconstr Aesthet Surg 2024; 93:281-289. [PMID: 38728901 DOI: 10.1016/j.bjps.2024.04.048] [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: 12/01/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). METHODS A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. RESULTS A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). CONCLUSION This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.
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Affiliation(s)
- Richard Mark Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK.
| | - Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chiara Rizk
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Garikai Kungwengwe
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Tanusree Dutta
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Dunne
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Elizabeth Dex
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Vimal Gokani
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Francis P Henry
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Judith E Hunter
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Georgina Williams
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Chris Abela
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Oliver Warren
- Department of General Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Rowan Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Mersey and West Lancashire Teaching Hospitals NHS Trust, London, UK
| | - Simon H Wood
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
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Khetrapal P, Bains PS, Jubber I, Ambler G, Williams NR, Brew-Graves C, Sridhar A, Ta A, Kelly JD, Catto JWF. Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial. Eur Urol Oncol 2024; 7:485-493. [PMID: 37852921 DOI: 10.1016/j.euo.2023.09.021] [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: 07/08/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Efforts to improve recovery after radical cystectomy (RC) are needed. OBJECTIVE To investigate wrist-worn wearable activity trackers in RC participants. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted within the iROC randomised trial. INTERVENTION Patients undergoing RC at nine cancer centres wore wrist-based trackers for 7 days (d) at intervals before and after surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Step counts were compared with participant and operative features, and recovery outcomes. RESULTS AND LIMITATIONS Of 308 participants, 284 (92.2%) returned digital activity data at baseline (median 17 d [interquartile range: 8-32] before RC), and postoperatively (5 [5-6] d) and at weeks 5 (43 [38-43] d), 12 (94 [87-106] d), and 26 (192 [181-205] d) after RC. Compliance was affected by the time from surgery and a coronavirus disease 2019 pandemic lockdown (return rates fell to 0-7%, chi-square p < 0.001). Step counts dropped after surgery (mean of 28% of baseline), before recovering at 5 weeks (wk) (71% of baseline) and 12 wk (95% of baseline; all analysis of variance [ANOVA] p < 0.001). Baseline step counts were not associated with postoperative recovery or death. Patients with extended hospital stays had reduced postoperative step counts, with a difference of 2.2 d (95% confidence interval: 0.856-3.482 d) between the lowest third and highest two-third tertiles (linear regression analysis; p < 0.001). Additionally, they spent less time out of the hospital within 90 d of RC (80.3 vs 74.3 d, p = 0.013). Lower step counts at 5, 12, and 26 wk were seen in those seeking medical help and needing readmission (ANOVA p ≤ 0.002). CONCLUSIONS Baseline step counts were not associated with recovery. Lower postoperative step counts were associated with longer length of stay at the hospital and postdischarge readmissions. Studies are required to determine whether low step counts can identify patients at a risk of developing complications. PATIENT SUMMARY Postoperative step counts appear to be a promising tool to identify patients in the community needing medical help or readmission. More work is needed to understand which measures are most useful and how best to collect these.
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Affiliation(s)
- Pramit Khetrapal
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Parasdeep S Bains
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Ibrahim Jubber
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Norman R Williams
- Surgical & Interventional Trials Unit (SITU), Division of Surgery & Interventional Science, University College London, London, UK
| | - Chris Brew-Graves
- UCL Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, UK
| | - Anthony Ta
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - James W F Catto
- Division of Surgery & Interventional Science, University College London, London, UK; Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Zhao X, Kolbinger FR, Distler M, Weitz J, Makarov D, Bachmann M, Baraban L. Portable droplet-based real-time monitoring of pancreatic α-amylase in postoperative patients. Biosens Bioelectron 2024; 251:116034. [PMID: 38359666 DOI: 10.1016/j.bios.2024.116034] [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: 10/23/2023] [Revised: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
Postoperative complications after pancreatic surgery are frequent and can be life-threatening. Current clinical diagnostic strategies involve time-consuming quantification of α-amylase activity in abdominal drain fluid, which is performed on the first and third postoperative day. The lack of real-time monitoring may delay adjustment of medical treatment upon complications and worsen prognosis for patients. We report a bedside portable droplet-based millifluidic device enabling real-time sensing of drain α-amylase activity for postoperative monitoring of patients undergoing pancreatic surgery. Here, a tiny amount of drain liquid of patient samples is continuously collected and co-encapsulated with a starch reagent in nanoliter-sized droplets to track the fluorescence intensity released upon reaction with α-amylase. Comparing the α-amylase levels of 32 patients, 97 % of the results of the droplet-based millifluidic system matched the clinical data. Our method reduces the α-amylase assay duration to approximately 3 min with the limit of detection 7 nmol/s·L, enabling amylase activity monitoring at the bedside in clinical real-time. The presented droplet-based platform can be extended for analysis of different body fluids, diseases, and towards a broader range of biomarkers, including lipase, bilirubin, lactate, inflammation, or liquid biopsy markers, paving the way towards new standards in postoperative patient monitoring.
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Affiliation(s)
- Xinne Zhao
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e. V, 01328, Dresden, Germany.
| | - Fiona R Kolbinger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav. Carus, TUD Dresden University of Technology, Germany; Else Kröner Fresenius Center for Digital Health (EKFZ), TUD Dresden University of Technology, Germany.
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav. Carus, TUD Dresden University of Technology, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav. Carus, TUD Dresden University of Technology, Germany; Else Kröner Fresenius Center for Digital Health (EKFZ), TUD Dresden University of Technology, Germany
| | - Denys Makarov
- Institute of Ion Beam Physics and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf e. V, 01328, Dresden, Germany.
| | - Michael Bachmann
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e. V, 01328, Dresden, Germany.
| | - Larysa Baraban
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e. V, 01328, Dresden, Germany; Else Kröner Fresenius Center for Digital Health (EKFZ), TUD Dresden University of Technology, Germany.
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8
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Varghese C, Harrison EM, O'Grady G, Topol EJ. Artificial intelligence in surgery. Nat Med 2024; 30:1257-1268. [PMID: 38740998 DOI: 10.1038/s41591-024-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Artificial intelligence (AI) is rapidly emerging in healthcare, yet applications in surgery remain relatively nascent. Here we review the integration of AI in the field of surgery, centering our discussion on multifaceted improvements in surgical care in the preoperative, intraoperative and postoperative space. The emergence of foundation model architectures, wearable technologies and improving surgical data infrastructures is enabling rapid advances in AI interventions and utility. We discuss how maturing AI methods hold the potential to improve patient outcomes, facilitate surgical education and optimize surgical care. We review the current applications of deep learning approaches and outline a vision for future advances through multimodal foundation models.
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Affiliation(s)
- Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, CA, USA.
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9
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Plummer K, Adina J, Mitchell AE, Lee-Archer P, Clark J, Keyser J, Kotzur C, Qayum A, Griffin B. Digital health interventions for postoperative recovery in children: a systematic review. Br J Anaesth 2024; 132:886-898. [PMID: 38336513 DOI: 10.1016/j.bja.2024.01.014] [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: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492). RESULTS The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%). CONCLUSIONS Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022351492).
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Affiliation(s)
- Karin Plummer
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia; Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia.
| | - Japheth Adina
- Parenting and Family Support Centre, School of Psychology, Brisbane, QLD, Australia
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, Brisbane, QLD, Australia; Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia; Midwifery and Social Work, School of Nursing, The University of Queensland, Brisbane, QLD, Australia
| | - Paul Lee-Archer
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Janelle Keyser
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Catherine Kotzur
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Abdul Qayum
- Department of Critical Care, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane, QLD, Australia
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10
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Wang P, Leong QY, Lau NY, Ng WY, Kwek SP, Tan L, Song SW, You K, Chong LM, Zhuang I, Ong YH, Foo N, Tadeo X, Kumar KS, Vijayakumar S, Sapanel Y, Raczkowska MN, Remus A, Blasiak A, Ho D. N-of-1 medicine. Singapore Med J 2024; 65:167-175. [PMID: 38527301 PMCID: PMC11060644 DOI: 10.4103/singaporemedj.smj-2023-243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/19/2024] [Indexed: 03/27/2024]
Abstract
ABSTRACT The fields of precision and personalised medicine have led to promising advances in tailoring treatment to individual patients. Examples include genome/molecular alteration-guided drug selection, single-patient gene therapy design and synergy-based drug combination development, and these approaches can yield substantially diverse recommendations. Therefore, it is important to define each domain and delineate their commonalities and differences in an effort to develop novel clinical trial designs, streamline workflow development, rethink regulatory considerations, create value in healthcare and economics assessments, and other factors. These and other segments are essential to recognise the diversity within these domains to accelerate their respective workflows towards practice-changing healthcare. To emphasise these points, this article elaborates on the concept of digital health and digital medicine-enabled N-of-1 medicine, which individualises combination regimen and dosing using a patient's own data. We will conclude with recommendations for consideration when developing novel workflows based on emerging digital-based platforms.
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Affiliation(s)
- Peter Wang
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Qiao Ying Leong
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Ni Yin Lau
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Wei Ying Ng
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Siong Peng Kwek
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Lester Tan
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Shang-Wei Song
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Kui You
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Li Ming Chong
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Isaiah Zhuang
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Yoong Hun Ong
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Nigel Foo
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Xavier Tadeo
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Kirthika Senthil Kumar
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Smrithi Vijayakumar
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Yoann Sapanel
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marlena Natalia Raczkowska
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
| | - Alexandria Remus
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Heat Resilience Performance Centre (HRPC), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Agata Blasiak
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- The Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Farinella E, Koliakos N, Papakonstantinou D, Breuer N, Pau L, Poras M, Maréchal MT, Briganti G. The Utilisation of Digital Applications for Measuring Patient Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis of Comparative Studies. Obes Surg 2024; 34:635-642. [PMID: 38183593 DOI: 10.1007/s11695-023-07000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
In the context of escalating obesity rates, bariatric surgery holds a crucial role in managing severely obese patients. With a demonstrated effectiveness in weight loss and with the advent of ambulatory surgery, bariatric surgery allows for a streamlined care pathway, ideally suited for postoperative surveillance using digital health applications. The aim of this systematic review and meta-analysis is to evaluate the effect of eHealth-delivered health services or support for adults undergoing bariatric surgery. Five studies, encompassing 2210 patients, were analysed. The intervention group showed a 10% increase in total weight reduction and a 22% reduction in excess weight loss. ED visitation rates also trended towards reduction. Despite the absence of clear statistical superiority for DHA, the findings suggest potential benefits of DHA in postoperative monitoring.
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Affiliation(s)
- Eleonora Farinella
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium.
- Artificial Intelligence and Digital Medicine, Faculty of Medicine, University of Mons, Mons, Belgium.
| | - Nikolaos Koliakos
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Dimitrios Papakonstantinou
- Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nicolas Breuer
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Luca Pau
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Mathilde Poras
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Marie-Therese Maréchal
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Giovanni Briganti
- Artificial Intelligence and Digital Medicine, Faculty of Medicine, University of Mons, Mons, Belgium
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12
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Rossi SMP, Panzera RM, Sangaletti R, Andriollo L, Giudice L, Lecci F, Benazzo F. Problems and Opportunities of a Smartphone-Based Care Management Platform: Application of the Wald Principles to a Survey-Based Analysis of Patients' Perception in a Pilot Center. Healthcare (Basel) 2024; 12:153. [PMID: 38255043 PMCID: PMC10815320 DOI: 10.3390/healthcare12020153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Mobile health (mHealth) solutions can become a means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. The aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary robotic TKA (rTKA) were considered. The mean age of registered patients is 68.6 years. The male (M)/female (F) ratio is 45.1%/54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the app and its features, but also limitations in its use and in its perception by the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is a need to emphasize the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
| | - Rocco Maria Panzera
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
| | - Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Laura Giudice
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
| | - Francesca Lecci
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
- IUSS Istituto Universitario di Studi Superiori, 27100 Pavia, Italy
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13
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Hirai K, Fujimoto Y, Bamba Y, Kageyama Y, Ima H, Ichise A, Sasaki H, Nakagawa R. Continuous Monitoring of Changes in Heart Rate during the Periprocedural Course of Carotid Artery Stenting Using a Wearable Device: A Prospective Observational Study. Neurol Med Chir (Tokyo) 2023; 63:526-534. [PMID: 37648537 PMCID: PMC10725827 DOI: 10.2176/jns-nmc.2023-0093] [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: 04/26/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023] Open
Abstract
This prospective observational study will evaluate the change in heart rate (HR) during the periprocedural course of carotid artery stenting (CAS) via continuous monitoring using a wearable device. The participants were recruited from our outpatient clinic between April 2020 and March 2023. They were instructed to continuously wear the device from the last outpatient visit before admission to the first outpatient visit after discharge. The changes in HR of interest throughout the periprocedural course of CAS were assessed. In addition, the Bland-Altman analysis was adopted to compare the HR measurement made by the wearable device during CAS with that made by the electrocardiogram (ECG). A total of 12 patients who underwent CAS were included in the final analysis. The time-series analysis revealed that a percentage change in HR decrease occurred on day 1 following CAS and that the most significant HR decrease rate was 12.1% on day 4 following CAS. In comparing the measurements made by the wearable device and ECG, the Bland-Altman analysis revealed the accuracy of the wearable device with a bias of -1.12 beats per minute (bpm) and a precision of 3.16 bpm. Continuous HR monitoring using the wearable device indicated that the decrease in HR following CAS could persist much longer than previously reported, providing us with unique insights into the physiology of carotid sinus baroreceptors.
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Affiliation(s)
| | | | - Yohei Bamba
- Department of Neurosurgery, Osaka Rosai Hospital
| | - Yu Kageyama
- Department of Neurosurgery, Osaka Rosai Hospital
| | - Hiroyuki Ima
- Department of Neurosurgery, Osaka Rosai Hospital
| | - Ayaka Ichise
- Department of Neurosurgery, Osaka Rosai Hospital
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14
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Braciszewski JM, Hecht LM, Barnett NP, Moore RS, Carlin AM, Haley EN, Miller-Matero LR. Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach. Surg Endosc 2023; 37:8263-8268. [PMID: 37670188 PMCID: PMC11215496 DOI: 10.1007/s00464-023-10407-0] [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: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. METHODS Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. RESULTS Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. CONCLUSION Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA.
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, USA
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, USA
| | | | - Erin N Haley
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health, Detroit, USA
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health, Detroit, USA
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15
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Yocum DS, Redfern RE, Yergler JD. Delayed Recovery Following Total Knee Arthroplasty Identified by Remote Monitoring With Tibial Extension Sensors. Arthroplast Today 2023; 23:101188. [PMID: 37745970 PMCID: PMC10511335 DOI: 10.1016/j.artd.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 09/26/2023] Open
Abstract
Remote monitoring of patient activity following total knee arthroplasty has grown in popularity over the past decade. Recent technological advances have allowed for implantation of accelerometry devices within the tibial stem for remote monitoring of mobility postoperatively. Remote monitoring is suggested to allow for intervention in the case of events that may occur outside of regular follow-up appointments or traditional patient questionnaires. This report details the ability of an implanted tibial sensor to continuously collect objective mobility data allowing the orthopaedic surgeon to intervene beyond the standard 90-day episode of care.
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16
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Xin Y, Liu H, Hou T, Song X, Tong J, Cui M, Li M, Zhai J. A vital sign signal noise suppression method for wearable piezoelectric devices. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:095104. [PMID: 37695115 DOI: 10.1063/5.0155762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
This paper tackles the problem of noise suppression during vital sign signal monitoring. Physiological signal monitoring is a significant and promising medical monitoring method, and wearable medical monitoring devices based on piezoelectric polymer sensors are a trending way for their advantages of being flexible in the shape, portable to use, and comfortable to wear. However, this raises the question that the measured signal contains much more noise components. To avoid the following shortcoming of low signal to noise ratio (SNR), a noise suppression method based on improved wavelet threshold and empirical mode decomposition combined with singular value decomposition (SVD) screening the intrinsic mode function (IMF) components is proposed. A wavelet transform is first used under the combination of hard and soft thresholds to focus the target range in the low-frequency region where the energy of the physiological signal is concentrated. Then, a complete ensemble empirical mode decomposition is used to decompose the signal effectively, which can resist the influence of random noises. Meanwhile, a SVD decomposition procedure was used to filter out the lower correlated IMF components to retain the validity of the original signal. We verified the effectiveness of the proposed method through simulated and measured experiments as well as the advantages and disadvantages of the algorithm compared with other physiological signal denoising algorithms through SNR filtering results, power spectrum distribution, and other perspectives. The results proved that the proposed method could effectively remove more detailed noise and improve the SNR of the signal efficiently, which is more conducive to the demand for auxiliary medical diagnosis in the future.
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Affiliation(s)
- Yi Xin
- Jilin University, Changchun 130061, China
| | | | | | | | - Junye Tong
- Jilin University, Changchun 130061, China
| | - Meng Cui
- Jilin University, Changchun 130061, China
| | - Meina Li
- Jilin University, Changchun 130061, China
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17
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Marwaha JS, Raza MM, Kvedar JC. The digital transformation of surgery. NPJ Digit Med 2023; 6:103. [PMID: 37258642 PMCID: PMC10232406 DOI: 10.1038/s41746-023-00846-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
Rapid advances in digital technology and artificial intelligence in recent years have already begun to transform many industries, and are beginning to make headway into healthcare. There is tremendous potential for new digital technologies to improve the care of surgical patients. In this piece, we highlight work being done to advance surgical care using machine learning, computer vision, wearable devices, remote patient monitoring, and virtual and augmented reality. We describe ways these technologies can be used to improve the practice of surgery, and discuss opportunities and challenges to their widespread adoption and use in operating rooms and at the bedside.
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Affiliation(s)
- Jayson S Marwaha
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | | | - Joseph C Kvedar
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham, Boston, MA, USA
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18
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Mammen JR, Speck RM, Stebbins GM, Müller MLTM, Yang PT, Campbell M, Cosman J, Crawford JE, Dam T, Hellsten J, Jensen-Roberts S, Kostrzebski M, Simuni T, Barowicz KW, Cedarbaum JM, Dorsey ER, Stephenson D, Adams JL. Mapping Relevance of Digital Measures to Meaningful Symptoms and Impacts in Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225122. [PMID: 37212073 DOI: 10.3233/jpd-225122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Adoption of new digital measures for clinical trials and practice has been hindered by lack of actionable qualitative data demonstrating relevance of these metrics to people with Parkinson's disease. OBJECTIVE This study evaluated of relevance of WATCH-PD digital measures to meaningful symptoms and impacts of early Parkinson's disease from the patient perspective. METHODS Participants with early Parkinson's disease (N = 40) completed surveys and 1:1 online-interviews. Interviews combined: 1) symptom mapping to delineate meaningful symptoms/impacts of disease, 2) cognitive interviewing to assess content validity of digital measures, and 3) mapping of digital measures back to personal symptoms to assess relevance from the patient perspective. Content analysis and descriptive techniques were used to analyze data. RESULTS Participants perceived mapping as deeply engaging, with 39/40 reporting improved ability to communicate important symptoms and relevance of measures. Most measures (9/10) were rated relevant by both cognitive interviewing (70-92.5%) and mapping (80-100%). Two measures related to actively bothersome symptoms for more than 80% of participants (Tremor, Shape rotation). Tasks were generally deemed relevant if they met three participant context criteria: 1) understanding what the task measured, 2) believing it targeted an important symptom of PD (past, present, or future), and 3) believing the task was a good test of that important symptom. Participants did not require that a task relate to active symptoms or "real" life to be relevant. CONCLUSION Digital measures of tremor and hand dexterity were rated most relevant in early PD. Use of mapping enabled precise quantification of qualitative data for more rigorous evaluation of new measures.
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Affiliation(s)
| | | | - Glenn M Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Phillip T Yang
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle Campbell
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | | | | | | | | | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Melissa Kostrzebski
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester, Medical Center, Rochester, NY, USA
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | | | - Jesse M Cedarbaum
- Coeruleus Clinical Sciences LLC, Woodbridge, CT, USA
- Yale Medical School, New Haven, CT, USA
| | - E Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester, Medical Center, Rochester, NY, USA
| | | | - Jamie L Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester, Medical Center, Rochester, NY, USA
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19
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McLean KA, Sgrò A, Brown LR, Buijs LF, Daines L, Potter MA, Bouamrane MM, Harrison EM. Evaluation of remote digital postoperative wound monitoring in routine surgical practice. NPJ Digit Med 2023; 6:85. [PMID: 37147462 PMCID: PMC10161985 DOI: 10.1038/s41746-023-00824-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
Remote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. This was a single-arm pilot implementational study of remote digital postoperative wound monitoring across two tertiary care hospitals in the UK (IDEAL stage 2b, clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery were recruited and received a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients received 30-day postoperative follow-up, including the Telehealth Usability Questionnaire (TUQ). A thematic mixed-methods approach was used, according to the WHO framework for monitoring and evaluating digital health interventions. 200 patients were enroled, of whom 115 (57.5%) underwent emergency surgical procedures. Overall, the 30-day SSI rate was 16.5% (n = 33/200), with 72.7% (n = 24) diagnosed post-discharge. Usage of the intervention was 83.0% (n = 166/200), with subsequently 74.1% (n = 123/166) TUQ completion. There were no issues reported with feasibility of the technology, with the reliability (3.87, 95% CI: 3.73-4.00) and quality of the interface rated highly (4.18, 95%: 4.06-4.30). Patient acceptance was similarly high with regards to ease of use (4.51, 95% CI: 4.41-4.62), satisfaction (4.27, 95% CI: 4.13-4.41), and usefulness (4.07, 95% CI: 3.92-4.23). Despite the desire for more frequent and personalised interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.
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Affiliation(s)
- Kenneth A McLean
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Alessandro Sgrò
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Leo R Brown
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Louis F Buijs
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Luke Daines
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK.
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20
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Deniz-Garcia A, Fabelo H, Rodriguez-Almeida AJ, Zamora-Zamorano G, Castro-Fernandez M, Alberiche Ruano MDP, Solvoll T, Granja C, Schopf TR, Callico GM, Soguero-Ruiz C, Wägner AM. Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges. J Med Internet Res 2023; 25:e44030. [PMID: 37140973 PMCID: PMC10196903 DOI: 10.2196/44030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/19/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
The use of artificial intelligence (AI) and big data in medicine has increased in recent years. Indeed, the use of AI in mobile health (mHealth) apps could considerably assist both individuals and health care professionals in the prevention and management of chronic diseases, in a person-centered manner. Nonetheless, there are several challenges that must be overcome to provide high-quality, usable, and effective mHealth apps. Here, we review the rationale and guidelines for the implementation of mHealth apps and the challenges regarding quality, usability, and user engagement and behavior change, with a special focus on the prevention and management of noncommunicable diseases. We suggest that a cocreation-based framework is the best method to address these challenges. Finally, we describe the current and future roles of AI in improving personalized medicine and provide recommendations for developing AI-based mHealth apps. We conclude that the implementation of AI and mHealth apps for routine clinical practice and remote health care will not be feasible until we overcome the main challenges regarding data privacy and security, quality assessment, and the reproducibility and uncertainty of AI results. Moreover, there is a lack of both standardized methods to measure the clinical outcomes of mHealth apps and techniques to encourage user engagement and behavior changes in the long term. We expect that in the near future, these obstacles will be overcome and that the ongoing European project, Watching the risk factors (WARIFA), will provide considerable advances in the implementation of AI-based mHealth apps for disease prevention and health promotion.
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Affiliation(s)
- Alejandro Deniz-Garcia
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Himar Fabelo
- Complejo Hospitalario Universitario Insular - Materno Infantil, Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Las Palmas de Gran Canaria, Spain
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio J Rodriguez-Almeida
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Garlene Zamora-Zamorano
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Castro-Fernandez
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Del Pino Alberiche Ruano
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Terje Solvoll
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Conceição Granja
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Thomas Roger Schopf
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
| | - Gustavo M Callico
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Cristina Soguero-Ruiz
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana M Wägner
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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21
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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22
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Huelster HL, Zemp L, Turner K, Gonzalez BD, Jim H, Gore LR, Gilbert SM. Mobile Postoperative Symptom Intervention Tool and Biometric Monitoring After Radical Cystectomy: Pilot Study Evaluating Feasibility, Usability, and Potential Utility. J Urol 2023; 209:410-421. [PMID: 36350586 PMCID: PMC10316518 DOI: 10.1097/ju.0000000000003048] [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: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Mobile health technology and integration of patient-reported outcome measures into clinical interventions have the potential to transform patient care. Though patient-reported outcome measure management has been shown to improve outcomes in ambulatory care settings, few studies have examined remote patient-reported outcome measure assessment after major cancer surgery. MATERIALS AND METHODS A multiphased feasibility and usability study was designed. A mobile app-based postoperative symptom intervention tool was developed and evaluated by a focus group of bladder cancer patients and caregivers. Patients were prospectively accrued prior to cystectomy and asked to complete the daily mobile postoperative symptom intervention tool and wear biometric monitoring devices for 30 days post discharge. Retention, postoperative symptom intervention tool completion, and usability were assessed. Exploratory analysis of daily symptoms and patient-generated health information correlated signals with postsurgical complications and hospital readmission. RESULTS Fifteen patients with a median age of 72 years completed 78% of daily surveys over the 30-day recovery period. Average time to complete the postoperative symptom intervention tool was 152 seconds. All patients agreed that the daily survey was easy to use, and most reported it would be a better way to communicate with the care team about symptoms than calling the clinic. Frequency and severity of patient-reported symptoms appeared to cluster prior to or at the time of complication or unplanned health care encounters on visual-analogue mapping. CONCLUSIONS Using smartphone and wearable technology to capture patient-reported symptoms and biometric data is feasible and rated as highly usable by bladder cancer patients after cystectomy. Symptom scores may signal developing complications and help clinicians identify postsurgical patients who may benefit from intervention.
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Affiliation(s)
- Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Heather Jim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - L Robert Gore
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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23
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An orthopaedic intelligence application successfully integrates data from a smartphone-based care management platform and a robotic knee system using a commercial database. INTERNATIONAL ORTHOPAEDICS 2023; 47:485-494. [PMID: 36508053 DOI: 10.1007/s00264-022-05651-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the feasibility of using a smartphone-based care management platform (sbCMP) and robotic-assisted total knee arthroplasty (raTKA) to collect data throughout the episode-of-care and assess if intra-operative measures of soft tissue laxity in raTKA were associated with post-operative outcomes. METHODS A secondary data analysis of 131 patients in a commercial database who underwent raTKA was performed. Pre-operative through six week post-operative step counts and KOOS JR scores were collected and cross-referenced with intra-operative laxity measures. A Kruskal-Wallis test or a Wilcoxon sign-rank was used to assess outcomes. RESULTS There were higher step counts at six weeks post-operatively in knees with increased laxity in both the lateral compartment in extension and medial compartment in flexion (p < 0.05). Knees balanced in flexion within < 0.5 mm had higher KOOS JR scores at six weeks post-operative (p = 0.034) compared to knees balanced within 0.5-1.5 mm. CONCLUSION A smartphone-based care management platform can be integrated with raTKA to passively collect data throughout the episode-of-care. Associations between intra-operative decisions regarding laxity and post-operative outcomes were identified. However, more robust analysis is needed to evaluate these associations and ensure clinical relevance to guide machine learning algorithms.
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24
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van Gorp M, Grootenhuis MA, Darlington AS, Wakeling S, Jenney M, Merks JHM, Hjalgrim LL, Adams M. Patient Reported Outcomes and Measures in Children with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020420. [PMID: 36672371 PMCID: PMC9856469 DOI: 10.3390/cancers15020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
In addition to optimising survival of children with rhabdomyosarcoma (RMS), more attention is now focused on improving their quality of life (QOL) and reducing symptoms during treatment, palliative care or into long-term survivorship. QOL and ongoing symptoms related to the disease and its treatment are outcomes that should ideally be patient-reported (patient-reported outcomes, PROs) and can be assessed using patient-reported outcome measures (PROMS). This commentary aims to encourage PRO and PROM use in RMS by informing professionals in the field of available PROMs for utilisation in paediatric RMS and provide considerations for future use in research and clinical practice. Despite the importance of using PROMs in research and practice, PROMs have been reported scarcely in paediatric RMS literature so far. Available literature suggests lower QOL of children with RMS compared to general populations and occurrence of disease-specific symptoms, but a lack of an RMS-specific PROM. Ongoing developments in the field include the development of PROMs targeted at children with RMS specifically and expansion of PROM evaluation within clinical trials.
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Affiliation(s)
- Marloes van Gorp
- Princes Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sara Wakeling
- Founder, Alice’s Arc, Rhabdomyosarcoma Children’s Cancer Charity, London E4 7RW, UK
| | | | | | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Madeleine Adams
- Children’s Hospital for Wales, Cardiff CF14 4XW, UK
- Correspondence:
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25
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Soley N, Song S, Flaks-Manov N, Overby Taylor C. Risk for Poor Post-Operative Quality of Life Among Wearable Use Subgroups in an All of Us Research Cohort. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2023; 28:31-42. [PMID: 36540962 PMCID: PMC9798526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this research was to build and assess the performance of a prediction model for post-operative recovery status measured by quality of life among individuals experiencing a variety of surgery types. In addition, we assessed the performance of the model for two subgroups (high and moderately consistent wearable device users). Study variables were derived from the electronic health records, questionnaires, and wearable devices of a cohort of individuals with one of 8 surgery types and that were part of the NIH All of Us research program. Through multivariable analysis, high frailty index (OR 1.69, 95% 1.05-7.22, p<0.006), and older age (OR 1.76, 95% 1.55-4.08, p<0.024) were found to be the driving risk factors of poor recovery post-surgery. Our logistic regression model included 15 variables, 5 of which included wearable device data. In wearable use subgroups, the model had better accuracy for high wearable users (81%). Findings demonstrate the potential for models that use wearable measures to assess frailty to inform clinicians of patients at risk for poor surgical outcomes. Our model performed with high accuracy across multiple surgery types and were robust to variable consistency in wearable use.
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Affiliation(s)
- Nidhi Soley
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Song
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA,Division of General Internal Medicine, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
USA,Biomedical Informatics & Data Science Section, The
Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Flaks-Manov
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Casey Overby Taylor
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA,Department of Biomedical Engineering, Johns Hopkins
University, Baltimore, Maryland, USA,Division of General Internal Medicine, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
USA,Biomedical Informatics & Data Science Section, The
Johns Hopkins University School of Medicine, Baltimore, Maryland
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26
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Van Der Horst AY, Bohlmeijer ET, Schreurs KMG, Kelders SM. Strength Back - A qualitative study on the co-creation of a positive psychology digital health intervention for spinal surgery patients. Front Psychol 2023; 14:1117357. [PMID: 37151334 PMCID: PMC10160468 DOI: 10.3389/fpsyg.2023.1117357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Spinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enhance psychological flexibility and mental well-being.The aim of this study is to develop a digital intervention (app) based on Acceptance and Commitment Therapy and positive psychology in co-creation with all stakeholders, including patients and professionals. The aim of the intervention is to increase psychological flexibility and positive skills of spinal surgery patients to promote long-term resilience. Materials and methods In this qualitative study, individual, semi-structured interviews were held with healthcare professionals (N = 9) and spinal surgery patients (N = 12) to identify contextual factors and needs for the app. Subsequently, three focus-group sessions were held with healthcare professionals and newly recruited patients to specify relevant values. Also, a first version of the app, named Strength Back, was developed using a participatory design. Results The interviews confirmed the need for information and digital support to cope with insecurity, anxiety and pain, both before and after surgery. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being. Discussion The intervention Strength Back, containing information as well as Acceptance and Commitment Therapy and positive psychology exercises, has the potential to increase psychological flexibility, enhance well-being and improve postoperative recovery after spinal surgery.
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Affiliation(s)
- Annemieke Y. Van Der Horst
- Centre for eHealth and Wellbeing Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Research Centre Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
- *Correspondence: Annemieke Y. Van Der Horst,
| | - Ernst T. Bohlmeijer
- Centre for eHealth and Wellbeing Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Karlein M. G. Schreurs
- Centre for eHealth and Wellbeing Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Roessingh Research and Development, Enschede, Netherlands
| | - Saskia M. Kelders
- Centre for eHealth and Wellbeing Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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27
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Xu W, Wells CI, McGuinness M, Varghese C, Keane C, Liu C, O'Grady G, Bissett IP, Harmston C. Characterising nationwide reasons for unplanned hospital readmission after colorectal cancer surgery. Colorectal Dis 2023; 25:861-871. [PMID: 36587285 DOI: 10.1111/codi.16467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Readmissions after colorectal cancer surgery are common, despite advancements in surgical care, and have a significant impact on both individual patients and overall healthcare costs. The aim of this study was to determine the 30-and 90 days readmission rate after colorectal cancer surgery, and to investigate the risk factors and clinical reasons for unplanned readmissions. METHOD A multicenter, population-based study including all patients discharged after index colorectal cancer resection from 2010 to 2020 in Aotearoa New Zealand (AoNZ) was completed. The Ministry of Health National Minimum Dataset was used. Rates of readmission at 30 days and 90 days were calculated. Mixed-effect logistic regression models were built to investigate factors associated with unplanned readmission. Reasons for readmission were described. RESULTS Data were obtained on 16,885 patients. Unplanned 30-day and 90-day hospital readmission rates were 15.1% and 23.7% respectively. The main readmission risk factors were comorbidities, advanced disease, and postoperative complications. Hospital level variation was not present. Despite risk adjustment, R2 value of models was low (30 days: 4.3%, 90 days: 5.2%). The most common reasons for readmission were gastrointestinal causes (32.1%) and wound complications (14.4%). Rates of readmission did not improve over the 11 years study period (p = 0.876). CONCLUSION Readmissions following colorectal resections in AoNZ are higher than other comparable healthcare systems and rates have remained constant over time. While patient comorbidities and postoperative complications are associated with readmission, the explanatory value of these variables is poor. To reduce unplanned readmissions, efforts should be focused on prevention and early detection of post-discharge complications.
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Affiliation(s)
- William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of General Surgery, Counties Manukau District Health Board, Auckland, New Zealand
| | - Matthew McGuinness
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Chen Liu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Christopher Harmston
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Northland District Health Board, Whangarei, New Zealand
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28
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Extension of patient safety initiatives to perioperative care. Curr Opin Anaesthesiol 2022; 35:717-722. [PMID: 36302210 DOI: 10.1097/aco.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE OF REVIEW Patient safety has significantly improved during the intraoperative period thanks to the anesthesiologists, surgeons, and nurses. Nowadays, it is within the perioperative period where most of the preventable harm happened to the surgical patient. We aim to highlight the main issues and efforts to improve perioperative patient safety focusing and the relation to intraoperative safety strategies. RECENT FINDINGS There is ongoing research on perioperative safety strategies aiming to initiate multidisciplinary interventions on early stages of the perioperative period as well as an increasing focus on preventing harm from postoperative complications. SUMMARY Any patient safety strategy to be implemented needs to be framed beyond the operating room and include in the intervention the whole perioperative period.
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29
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Kuo C, Patton D, Rooks T, Tierney G, McIntosh A, Lynall R, Esquivel A, Daniel R, Kaminski T, Mihalik J, Dau N, Urban J. On-Field Deployment and Validation for Wearable Devices. Ann Biomed Eng 2022; 50:1372-1388. [PMID: 35960418 DOI: 10.1007/s10439-022-03001-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 11/01/2022]
Abstract
Wearable sensors are an important tool in the study of head acceleration events and head impact injuries in sporting and military activities. Recent advances in sensor technology have improved our understanding of head kinematics during on-field activities; however, proper utilization and interpretation of data from wearable devices requires careful implementation of best practices. The objective of this paper is to summarize minimum requirements and best practices for on-field deployment of wearable devices for the measurement of head acceleration events in vivo to ensure data evaluated are representative of real events and limitations are accurately defined. Best practices covered in this document include the definition of a verified head acceleration event, data windowing, video verification, advanced post-processing techniques, and on-field logistics, as determined through review of the literature and expert opinion. Careful use of best practices, with accurate acknowledgement of limitations, will allow research teams to ensure data evaluated is representative of real events, will improve the robustness of head acceleration event exposure studies, and generally improve the quality and validity of research into head impact injuries.
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Affiliation(s)
- Calvin Kuo
- The University of British Columbia, Vancouver, Canada
| | - Declan Patton
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Tyler Rooks
- United States Army Aeromedical Research Laboratory, Fort Rucker, USA
| | | | - Andrew McIntosh
- McIntosh Consultancy and Research, Sydney, Australia.,Monash University Accident Research Centre Monash University, Melbourne, Australia.,School of Engineering Edith Cowan University, Perth, Australia
| | | | | | - Ray Daniel
- United States Army Aeromedical Research Laboratory, Fort Rucker, USA
| | | | - Jason Mihalik
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nate Dau
- Biocore, LLC, Charlottesville, USA
| | - Jillian Urban
- Wake Forest University School of Medicine, 575 Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA.
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30
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Wijeysundera DN. What defines success after major surgery? Can J Anaesth 2022; 69:687-692. [PMID: 35396650 DOI: 10.1007/s12630-022-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Duminda N Wijeysundera
- Department of Anesthesia, St. Michael's Hospital - Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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31
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Neumann D, Tiberius V, Biendarra F. Adopting wearables to customize health insurance contributions: a ranking-type Delphi. BMC Med Inform Decis Mak 2022; 22:112. [PMID: 35477495 PMCID: PMC9044726 DOI: 10.1186/s12911-022-01851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Wearables, as small portable computer systems worn on the body, can track user fitness and health data, which can be used to customize health insurance contributions individually. In particular, insured individuals with a healthy lifestyle can receive a reduction of their contributions to be paid. However, this potential is hardly used in practice.
Objective This study aims to identify which barrier factors impede the usage of wearables for assessing individual risk scores for health insurances, despite its technological feasibility, and to rank these barriers according to their relevance. Methods To reach these goals, we conduct a ranking-type Delphi study with the following three stages. First, we collected possible barrier factors from a panel of 16 experts and consolidated them to a list of 11 barrier categories. Second, the panel was asked to rank them regarding their relevance. Third, to enhance the panel consensus, the ranking was revealed to the experts, who were then asked to re-rank the barriers. Results The results suggest that regulation is the most important barrier. Other relevant barriers are false or inaccurate measurements and application errors caused by the users. Additionally, insurers could lack the required technological competence to use the wearable data appropriately. Conclusion A wider use of wearables and health apps could be achieved through regulatory modifications, especially regarding privacy issues. Even after assuring stricter regulations, users’ privacy concerns could partly remain, if the data exchange between wearables manufacturers, health app providers, and health insurers does not become more transparent.
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32
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Getachew E, Woldeamanuel Y, Manyazewal T. Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia. Front Digit Health 2022; 4:821390. [PMID: 35295619 PMCID: PMC8918491 DOI: 10.3389/fdgth.2022.821390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background There is a high level of concern that low-income countries lack the capacity and readiness to effectively adopt, implement, and scale up digital health interventions (DHIs). We aimed to assess the infrastructure and human resource capacity and readiness of healthcare facilities to adopt and implement any new DHI for tuberculosis (TB) and HIV care and treatment in Addis Ababa, Ethiopia. Method We carried out a cross-sectional, mixed-methods study in 14 public healthcare facilities that provide TB and HIV care and treatment services. Providers' perceived readiness to adopt and implement digital health was assessed using a self-administered questionnaire designed based on an adapted eHealth readiness assessment model that covers six domains: core readiness, organizational cultural readiness, value proposition readiness, technological readiness, regulatory policy readiness, and operational resource readiness. The infrastructure and human resource capacity were assessed on-site using a tool adapted from the Technology Infrastructure Checklist. Internal consistency was assessed using Cronbach's alpha, and the significant relationship between the composite variables was assessed using Pearson's correlation coefficients (r). Result We assessed 14 facilities on-site and surveyed 60 TB and HIV healthcare providers. According to Cronbach's alpha test, all the six technology acceptance domains had a value of >0.8, suggesting a strong interrelatedness between the measuring items. The correlation between technological readiness and operational resource readiness was significant (r = 0.8). The providers perceived their work environment as good enough in electronic data protection, while more efforts are needed in planning, training, adapting, and implementing digital health. Of the 14 facilities, 64.3% lack the plan to establish a functional local area network, and 43% lack skilled staff on payroll to provide maintenance of computers and other digital technologies. Conclusion Like many developing countries, there was a modest infrastructure and human resource capacity and readiness of public healthcare facilities in Addis Ababa, Ethiopia, to nurture and strengthen DHIs across the TB and HIV cascades of care. Technological and operational resource readiness, including funding and a Well-trained workforce, are essential for successful implementation and use of digital health against the two infectious diseases of global importance in such settings.
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Affiliation(s)
- Emnet Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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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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