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Berrigan MT, Beaulieu-Jones BR, Baines R, Berkowitz S, Evans H, Brat GA. Barriers to Postdischarge Smartphone App Use Among Patients With Traumatic Rib Fractures. JMIR Form Res 2024; 8:e52726. [PMID: 38820574 PMCID: PMC11179035 DOI: 10.2196/52726] [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: 09/13/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 06/02/2024] Open
Abstract
Rib fractures commonly result from traumatic injury and often require hospitalization for pain control and supportive pulmonary care. Although the use of mobile health technology to share patient-generated health data has increased, it remains limited in patients with traumatic injuries. We sought to assess the feasibility of mobile health tracking in patients with rib fractures by using a smartphone app to monitor postdischarge recovery. We encountered patient, institutional, and process-related obstacles that limited app use. The success of future work requires the acknowledgment of these limitations and the use of an implementation science framework to effectively integrate technological tools for personalized trauma care.
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Affiliation(s)
- Margaret T Berrigan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Rachel Baines
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Seth Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Heather Evans
- Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Gabriel A Brat
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
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Claudio MC, Rehany Z, Stachtari K, Guadagno E, Osmanlliu E, Poenaru D. Exploring the digital divide: results of a survey informing mobile application development. Front Digit Health 2024; 6:1382507. [PMID: 38800096 PMCID: PMC11116677 DOI: 10.3389/fdgth.2024.1382507] [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: 02/05/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Mobile health apps risk widening health disparities if they overlook digital inclusion. The digital divide, encompassing access, familiarity, and readiness, poses a significant barrier to medical interventions. Existing literature lacks exploration of the digital divide's contributing factors. Hence, data are needed to comprehend the challenges in developing inclusive health apps. Methods We created a survey to gauge internet and smartphone access, smartphone familiarity, and readiness for using mobile health apps among caregivers of pediatric patients in tertiary care. Open-ended questions solicited feedback and suggestions on mobile health applications. Responses were categorized by similarity and compared. Developed with patient partners, the survey underwent cognitive testing and piloting for accuracy. Results Data from 209 respondents showed that 23% were affected by the digital divide, mainly due to unfamiliarity with digital skills. Among 49 short text responses about health app concerns, 31 mentioned security and confidentiality, with 7 mentioning the impersonal nature of such apps. Desired features included messaging healthcare providers, scheduling, task reminders, and simplicity. Conclusions This study underscores a digital divide among caregivers of pediatric patients, with nearly a quarter affected primarily due to a lack of digital comfort. Respondents emphasized user-friendliness and online security for health apps. Future apps should prioritize digital inclusion by addressing the significant barriers and carefully considering patient and family concerns.
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Affiliation(s)
| | - Zachary Rehany
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Katerina Stachtari
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Dan Poenaru
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
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Singh R, Ambade R, Landge S, Goyal S, Goel S. Comprehensive Review on Distal Femur Fractures: From Epidemiology to Treatment Strategies. Cureus 2024; 16:e57937. [PMID: 38738010 PMCID: PMC11084923 DOI: 10.7759/cureus.57937] [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: 02/04/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Distal femur fractures present a substantial orthopedic challenge, necessitating a comprehensive exploration spanning epidemiology, anatomy, classification, diagnosis, and treatment strategies. This review thoroughly analyzes the multifaceted aspects surrounding distal femur fractures. It delves into the definition and epidemiology, shedding light on the incidence, age distribution, and associated risk factors. An exhaustive examination of the distal femur's anatomy, encompassing ligaments and tendons, establishes the groundwork for understanding fracture patterns and subsequent classification according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) system. Diagnostic considerations encompass physical examination and various imaging modalities, emphasizing the critical importance of prompt and accurate assessment. The extensive discussion on treatment options ranges from non-surgical management, including casting and traction, to surgical interventions, such as open reduction and internal fixation, intramedullary nailing, and external fixation. The implications for clinical practice underscore the necessity for tailored approaches based on fracture characteristics to optimize patient outcomes. However, this review also emphasizes areas necessitating further investigation, including exploring predictive biomarkers, advanced surgical techniques, and innovative rehabilitation protocols. Insights from long-term outcomes and quality-of-life assessments in diverse populations offer promising avenues for enhancing the comprehensive management of distal femur fractures. Continuous research in these areas can refine treatment strategies and elevate the standard of care for individuals grappling with this intricate orthopedic condition.
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Affiliation(s)
- Rahul Singh
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ratnakar Ambade
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhas Landge
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saksham Goyal
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Goel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study. JMIR Hum Factors 2024; 11:e49696. [PMID: 38551641 PMCID: PMC11015373 DOI: 10.2196/49696] [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: 06/06/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. OBJECTIVE This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). METHODS A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. RESULTS Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. CONCLUSIONS In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, Sport Sciences - Performance & Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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Paradis T, Robitaille S, Dumitra T, Liberman AS, Charlebois P, Stein BL, Fiore JF, Feldman LS, Lee L. The impact of patient activation on the effectiveness of digital health remote post-discharge follow-up and same-day-discharge after elective colorectal surgery. Surg Endosc 2024; 38:1548-1555. [PMID: 38114879 DOI: 10.1007/s00464-023-10597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Low patient activation (PA) is associated with worse postoperative outcomes, however, its impact on the effectiveness of digital health interventions is unknown. We sought to determine the impact of PA on the effectiveness of digital health application for remote post-discharge follow-up for patients undergoing elective colectomy. METHODS Data analysis included a control cohort (CC) of patients undergoing elective colorectal surgery from 10/2017 to 04/2018 without the digital health intervention and a digital application cohort (DAC) that received a smart phone application for remote post-discharge follow-up from 03/2021 to 08/2022, including a subset of same-day discharge (SDD) patients. PA was measured using the Patient Activation Measure (PAM; score 0-100) and categorized into low (< 55.1) and high (≥ 55.1). The PAM was administered 4-6 weeks before surgery in the DAC group and on postoperative day (POD) 1 in the CC group. The main outcome measure was 30-day emergency department (ED) visits. RESULTS A total of 164 patients were included (89DAC with 50 SDD, 75CC), with no differences in patient characteristics other than more stoma closures in the DAC group. Overall, 77% of patients had high PA level, with no difference between CC and DAC (77% vs. 81%, p = 0.25). There was no difference in ED visits between CC and DAC (19% vs. 18%, p = 0.90). Overall, low PA was associated more ED visits (29% vs 14%, p = 0.04). In the SDD subgroup, low PA patients had more ED visits (38% vs. 7%, p = 0.015). PA level did not affect app usage metrics. On multiple regression, only low PA remained independently associated with ED visits (OR 3.42, 95%CI 1.27, 9.24). CONCLUSION Low PA remains an important predictor of surgical outcomes after elective colorectal surgery regardless of the use of a digital health application for remote post-discharge follow-up. This suggests that improving PA levels may improve postoperative outcomes.
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Affiliation(s)
- Tiffany Paradis
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Teodora Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Patrick Charlebois
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Barry L Stein
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada.
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Liu AW, Pierce L, Ganeshan S, Brown W, Judson T, Divakaran D, Bini S, Odisho AY, Mourad M. Impact of an automated peri-procedural digital health intervention on rates of emergency department visits and readmissions. Am J Surg 2023; 226:598-602. [PMID: 37604749 DOI: 10.1016/j.amjsurg.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Providing timely peri-procedural education, reminders, and check-ins can improve patient adherence and clinical outcomes. We sought to retrospectively evaluate the impact of a peri-procedural digital health tool on emergency department (ED) visits and readmissions. METHODS A digital health tool for peri-procedural care engaged patients at scheduled intervals, resulting in an overall engagement score. Multivariate models determined predictors of tool engagement and post-procedural 30- and 90-day rehospitalizations and ED visits. RESULTS 11,737 unique completed procedures were analyzed from 10,438 patients. Patients of Black and Latinx race/ethnicity (vs White), those with Medicare and Medicaid insurance (vs commercial), and those with non-activated patient portals (vs activated) were less likely to engage. After adjustment for confounders, higher engagement with the tool was associated with lower rates of 30-day hospitalizations (OR 0.64), 90-day hospitalizations (OR 0.65), and 90-day ED visits (OR 0.77). CONCLUSIONS Highly engaged patients had fewer 30-day and 90-day ED visit and readmissions, even after adjustment for key confounders. Engagement, and thus the resulting benefits, were not equitably distributed.
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Affiliation(s)
- Andrew W Liu
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA
| | - Logan Pierce
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Smitha Ganeshan
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - William Brown
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Timothy Judson
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Office of Population Health, University of California, San Francisco, USA
| | - Dileesh Divakaran
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA
| | - Stefano Bini
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Anobel Y Odisho
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Michelle Mourad
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Langer S, Xu Y, Kong S, Puddy J, Quan ML. Investigating Factors Associated with Postmastectomy Emergency Department Visits: A Population-Based Analysis. Ann Surg Oncol 2023; 30:6499-6505. [PMID: 37454012 DOI: 10.1245/s10434-023-13727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In 2016, a multi-pronged pathway was implemented across 13 hospitals to improve the mastectomy perioperative care experience with one objective being to safely allow same day surgery mastectomy. While the pathway successfully increased same day mastectomy rates from 1.7 to 73.0%, the rate of postoperative emergency department (ED) visits remained high at > 20%, despite focused interventions to enhance perioperative support. AIM To investigate potential factors associated with high postoperative ED visits following mastectomies in Alberta, Canada. METHODS Data was collected using the Discharge Abstract Database and the National Ambulatory Care Reporting System database. Eligible patients included all women over 18 years old who underwent a mastectomy province-wide between 2004 and 2020. Patient demographics were collected. Primary outcome of interest was ED visit within 30 days of mastectomy. Univariate and multivariable analyses were performed to identify independent predictors for post-operative ED visits. RESULTS A total of 19,974 patients had mastectomy during the study period, of which 4590 (23%) had an ED visit within 30 days of surgery. Independent factors associated with ED visits were increasing age, overnight stay mastectomy, reconstruction, certain comorbidities, and living rurally. CONCLUSIONS Post-operative ED visits remain high despite initiating a province-wide surgical pathway in 2016 which emphasizes patient education and improved perioperative care and supports. Currently, the majority of ED visits are manageable in non-emergent settings. Patient populations at higher risk for ED visits groups may benefit from additional targeted support and resources to reduce unplanned ED visits.
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Affiliation(s)
- Steven Langer
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Yuan Xu
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shiying Kong
- Alberta Health Services, Department of Analytics, University of Calgary, Calgary, Canada
| | - Jennifer Puddy
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - May Lynn Quan
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Nene S, Rauch M, Belanger D, Bennett R, Berry G, Saad N, Wall M, Morais JA, Morin SN. Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers. Can Geriatr J 2023; 26:150-175. [PMID: 36865400 PMCID: PMC9953506 DOI: 10.5770/cgj.26.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs). Methods Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation. Results A total of 39 health-care providers, 40 patients, and 22 caregivers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33). Conclusions Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.
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Affiliation(s)
- Sofia Nene
- Faculty of Medicine and Health Sciences, McGill University, Montreal
| | - Magnus Rauch
- Research Institute of the McGill University Health Centre, Montreal
| | - David Belanger
- Division of General Internal Medicine, McGill University, Montreal
| | - Roxanne Bennett
- Research Institute of the McGill University Health Centre, Montreal
| | - Gregory Berry
- Faculty of Medicine and Health Sciences, McGill University, Montreal,Research Institute of the McGill University Health Centre, Montreal,Department of Orthopedic Surgery, McGill University, Montreal
| | - Nathalie Saad
- Division of Respiratory Medicine, McGill University, Montreal
| | - Michelle Wall
- Research Institute of the McGill University Health Centre, Montreal
| | - José A. Morais
- Research Institute of the McGill University Health Centre, Montreal,Division of Geriatrics, McGill University, Montreal, QC
| | - Suzanne N. Morin
- Faculty of Medicine and Health Sciences, McGill University, Montreal,Research Institute of the McGill University Health Centre, Montreal,Division of General Internal Medicine, McGill University, Montreal
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Effectiveness of discharge education for patients undergoing general surgery: A systematic review and meta-analysis. Int J Nurs Stud 2023; 140:104471. [PMID: 36871540 DOI: 10.1016/j.ijnurstu.2023.104471] [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: 09/06/2022] [Revised: 01/24/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed. OBJECTIVE To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes. DESIGN Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life. SETTING Participants were recruited from hospitals. PARTICIPANTS Adult general surgical patients. METHODS MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest. RESULTS Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied. CONCLUSIONS The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes. REGISTRATION PROSPERO CRD42021285392. TWEETABLE ABSTRACT Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
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Mavragani A, Baniasadi T, Shirkhoda M, Rostam Niakan Kalhori S, Mohammadzadeh N, Roudini K, Ghalehtaki R, Memari F, Jalaeefar A. Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things-Based Device: Development and Usability Study. JMIR Cancer 2023; 9:e42250. [PMID: 36790851 PMCID: PMC9978953 DOI: 10.2196/42250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. OBJECTIVE This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. METHODS This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles. RESULTS A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. CONCLUSIONS Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations.
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Affiliation(s)
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Shirkhoda
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Peter L. Reichertz Institute for Medical Informatics (PLRI), Technical University of Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Roudini
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghalehtaki
- Department of Radiation Oncology, Cancer Institute, Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoon Memari
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohsen Jalaeefar
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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11
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Bindal V, Pandey D. E-Health Follow-up: Is it the Way Forward? World J Surg 2023; 47:190-191. [PMID: 36324036 DOI: 10.1007/s00268-022-06793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Vivek Bindal
- Max Super Speciality Hospital Vaishali, Institute of Minimal Access, Bariatric & Robotic Surgery, Ghaziabad, India.
| | - Dhananjay Pandey
- Max Super Speciality Hospital Vaishali, Institute of Minimal Access, Bariatric & Robotic Surgery, Ghaziabad, India
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Faessen JL, van Vugt R, Veldhuizen R, Stoot JHMB. Using an E-Health Application for Post-operative Monitoring After Inguinal Hernia Repair: A Feasibility Study. World J Surg 2023; 47:182-189. [PMID: 35604449 PMCID: PMC9125961 DOI: 10.1007/s00268-022-06590-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND E-Health care is already well established in some (non-) surgical specialties and is considered as a means of improving patient-centred care. Considering the demand of remote health care changes, especially in the COVID-19 pandemic, it is essential to investigate the feasibility of e-Health care within one of the most performed surgery procedures: inguinal hernia repair. METHODS A total of 60 patients used the e-Health application in this study compliant. Primary objectives were to investigate the accuracy of the "deviating post-operative course" alerting by the e-Health application. Secondary objectives included patient perspective and e-Health costs analysis. RESULTS Forty-four patients reported no deviation in the post-operative course using the e-Health application of which 93.2% (n = 41) was in concordance with the findings during standard follow-up. Within 16 patients reporting a deviating post-operative course, a true complication was found in 25% (n = 4). Based on in-hospital costs, a hypothetical e-Health follow-up scenario was more expensive (€59.5 per patient) than current standard follow-up care (€28.2 per patient). Usage of the e-Health application showed a high perceived overall patient satisfaction: 4.2 (on a Likert-scale of 1-5). CONCLUSION An e-Health application is a promising tool for identifying patients who require in-person or phone follow-up assessment. Patients' perspectives surveys revealed high potential and willingness of using this application. A hypothetical e-Health follow-up scenario showed to be more expensive compared to current standard follow-up. If the identified (dis)advantages can be improved, e-Health follow-up care appears to be promising in terms of safety and feasibility. Future studies can leverage on this study and further investigate the use of e-Health within the field of general surgery.
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Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands.
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - R Veldhuizen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
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Enhanced Telehealth Home-Monitoring Intervention for Vulnerable and Frail Patients after Cardiac Surgery (THE-FACS Pilot Intervention Study). BMC Geriatr 2022; 22:836. [PMID: 36333652 PMCID: PMC9636804 DOI: 10.1186/s12877-022-03531-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background Frail cardiac surgery patients have an increased risk of worse postoperative outcomes. The purpose of this study was to evaluate the implementation of a novel Telehealth Home monitoring Enhanced-Frailty And Cardiac Surgery (THE-FACS) intervention and determine its impact on clinical outcomes in frail patients post-cardiac surgery. Methods Frail/vulnerable patients defined by Edmonton Frailty Scale (EFS > 4) undergoing cardiac surgery were prospectively enrolled (November 2019 -March 2020) at the New Brunswick Heart Centre. Exclusion criteria included age < 55 years, emergent status, minimally invasive surgery, lack of home support, and > 10-days postoperative hospital stay. Following standard training on THE-FACS, participants were sent home with a tablet device to answer questions about their health/recovery and measure blood pressure for 30-consecutive days. Transmitted data were monitored by trained cardiac surgery follow-up nurses. Patients were contacted only if the algorithm based on the patient’s self-collected data triggered an alert. Patients who completed the study were compared to historical controls. The primary outcome of interest was to determine the number of patients that could complete THE-FACS; secondary outcomes included participant/caregiver satisfaction and impact on hospital readmission. Results We identified 86 eligible (EFS > 4), out of 254 patients scheduled for elective cardiac surgery during the study period (vulnerable: 34%). The patients who consented to participate in THE-FACS (64/86, 74%) had a mean age of 69.1 ± 6.4 years, 25% were female, 79.7% underwent isolated Coronary Artery Bypass Graft (CABG) and median EFS was 6 (5–8). 29/64 (45%) were excluded post-enrollment due to prolonged hospitalization (15/64) or requirement for hospital-to-hospital transfer (12/64). Of the remaining 35 patients, 21 completed the 30-day follow-up (completion rate:60%). Reasons for withdrawal (14/35, 40%) were mostly due to technical difficulties with the tablet. Hospital readmission, although non-significant, was reduced in THE-FACS participants compared to controls (0% vs. 14.3%). A satisfaction survey revealed > 90% satisfaction and ~ 67% willingness to re-use a home monitoring device. Conclusions THE-FACS intervention can be used to successfully monitor vulnerable patients returning home post-cardiac surgery. However, a significant number of frail patients could not benefit from THE-FACS given prolonged hospitalization and technological challenges. Our findings suggest that despite overall excellent satisfaction in participants who completed THE-FACS, there remain major challenges for wide-scale implementation of technology-driven home monitoring programs as only 24% completed the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03531-4.
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Burrell A, Zrubka Z, Champion A, Zah V, Vinuesa L, Holtorf AP, Di Bidino R, Earla JR, Entwistle J, Boltyenkov AT, Braileanu G, Kolasa K, Roydhouse J, Asche C. How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1469-1479. [PMID: 36049797 DOI: 10.1016/j.jval.2022.04.1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article. METHODS PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores. RESULTS The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms. CONCLUSIONS To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.
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Affiliation(s)
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | | | - Vladimir Zah
- HEOR, Z Rx Outcomes Research Inc, Mississauga, ON, Canada
| | | | | | - Rosella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | - George Braileanu
- National Institute for Health and Care Excellence, Manchester, England, UK
| | - Katarzyna Kolasa
- Health Economics and Healthcare Management, Kozminski University, Warszawa, Poland
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Carl Asche
- University of Illinois College of Medicine, Chicago, IL, USA
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15
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van Hout L, Bökkerink WJV, Vriens PWHE. Clinical feasibility of the Q1.6 Inguinal Hernia application: a prospective cohort study. Hernia 2022; 27:449-458. [PMID: 35840840 DOI: 10.1007/s10029-022-02646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential to evaluate inguinal hernia surgery. There is a need for digital and disease-specific PRO measurement. Current measuring instruments (PROMs) have several disadvantages, for example, fixed measuring moments with a chance of recall bias. The Q1.6 Inguinal Hernia application has been developed to overcome these challenges. This pilot study reports the first clinical feasibility results. METHODS All surgically treated inguinal hernia patients were eligible for inclusion. The application uses "twitch crowdsourcing"; after unlocking a smartphone or tablet, a single short question is asked. This can easily be repeated multiple times a day/week/month. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualised set of questions. Alerts are generated when a complication is suspected. RESULTS A total of 229 patients were given over 50.000 questions of which 92% were answered. Pre- and postoperative patient characteristics and their reported clinical outcomes confirmed a standard inguinal hernia population. Compliance with the application was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. After months 3, 6 and 11, respectively, 3.0%, 4.4% and 4.5% of patients reported inguinal pain or discomfort (NRS ≥ 4). Patients were highly satisfied (92.8% preferred the app over standard care). CONCLUSIONS This smartphone application shows promising results for clinical practice. It might allow for continuous digital patient-reported outcome measurement using non-intrusive, concise questions. Remote monitoring may become standard postoperative care after (inguinal hernia) surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Emery A, Houchens N, Gupta A. Quality and Safety in the Literature: May 2022. BMJ Qual Saf 2022; 31:409-414. [PMID: 35440499 DOI: 10.1136/bmjqs-2022-014848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Albert Emery
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Coppens M, Van Caelenberg E, De Regge M. Postoperative innovative technology for ambulatory anesthesia and surgery. Curr Opin Anaesthesiol 2021; 34:709-713. [PMID: 34269739 DOI: 10.1097/aco.0000000000001036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the impact of different forms of telehealth that are currently used in ambulatory anesthesia and surgery. Telehealth is applicable during the early recovery and intermediate recovery period (e.g. monitoring of quality of recovery), and as a tool for postoperative check-up during the late recovery phase. RECENT FINDINGS Postoperative follow-up after ambulatory surgery is still crucial to maintain quality of care as pain and postoperative nausea and vomiting remain common adverse events. There is a surge of telehealth applications from procedure-specific commercial smartphone apps (mHealth) to complete digital patient platforms instituted by the government. However, patient and healthcare provider engagement is not universal. Usability of these applications is mandatory as well as identifying and overcoming the barriers to its use. SUMMARY Telehealth gives many opportunities for postoperative follow-up of ambulatory surgery patients. Clear evidence on the benefits of telehealth in ambulatory surgery is however still sparse. Future research should focus on telehealth for improving quality and safety of postoperative recovery, convincing policymakers for reimbursement encouraging healthcare providers and patients to engage in telehealth.
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Affiliation(s)
- Marc Coppens
- Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, Ghent University
| | - Els Van Caelenberg
- University Hospital Ghent, Department of Anesthesia and Perioperative Medicine, Ambulatory Surgery Unit
| | - Melissa De Regge
- Faculty of Economics and Business Administration, Department of Marketing, Innovation and Organinsation, Ghent University and Strategic Policy Cel, Ghent University Hospital, Ghent, Belgium
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Verma R, Saldanha C, Ellis U, Sattar S, Haase KR. eHealth literacy among older adults living with cancer and their caregivers: A scoping review. J Geriatr Oncol 2021; 13:555-562. [PMID: 34810146 DOI: 10.1016/j.jgo.2021.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/20/2021] [Accepted: 11/05/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information. METHODS This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of "eHealth Literacy" and "cancer" were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature. RESULTS Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system. CONCLUSION With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted.
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Affiliation(s)
- Ridhi Verma
- School of Healthcare Sciences, Cardiff University, 19 Brent Avenue, Didcot, Oxforshire, United Kingdom
| | - Conchita Saldanha
- School of Physical and Occupational Therapy, McGill University, 5385 rue de Bernieres, Saint Leonard H1R 1M9, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, 4400, 4th Avenue, Rm 108, Regina, Saskatchewan S4T 0H8, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada.
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Mackenzie SP, McLean M, Spasojevic M, Niu R, Kruse L, Gwynne J, Young A, Cass B. Wrist-mounted accelerometers provide objective evidence of disease and recovery in patients with frozen shoulder. JSES Int 2021; 6:111-115. [PMID: 35141684 PMCID: PMC8811392 DOI: 10.1016/j.jseint.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Commercially available wrist-mounted exercise monitors may offer objective data on disease and recovery. This study is the first to evaluate the potential of such devices in the assessment of frozen shoulder and the effects of treatment. Methods Twenty-one patients with isolated, unilateral frozen shoulder wore a wrist-mounted accelerometer (Fitbit Fire II, Fitbit Inc. 2007, California, USA) on each wrist for two separate seven-day periods, one week before and six months after treatment. The monitors produced an activity count for each 24-hour period, accounting for all movements of the upper limb. Three values were calculated for each time period: (1) the mean activity count for each limb, (2) the total activity count for both limbs, and (3) an activity count ratio calculated by dividing the activity of the frozen limb by the unaffected limb. Constant score, American Shoulder and Elbow Surgeons, visual analog scale–pain, and range of movement were recorded before and after treatment. Results Mean activity counts were significantly lower in the frozen shoulder limb than those in the unaffected limb over the initial seven-day period (6066 vs. 7516; P = .04). The activity count ratio significantly improved after treatment (0.83 vs. 096; p 0.01), whereas the mean total activity count remained similar before and after treatment (14915 vs. 12371; P = .18), demonstrating that activity transferred from the unaffected limb back to the previously frozen limb. Range of movement (P < .01), Constant (P < .01), American Shoulder and Elbow Surgeons (P < .01), and visual analog scale–pain (P < .01) scores all significantly improved after treatment, but there was no correlation with the data from the activity monitor. Discussion Wrist-mounted accelerometers are sufficiently sensitive to detect a difference in limb activity in patients affected by frozen shoulder. The movement deficit between the affected and unaffected limbs improved by 14% after treatment. These data could be used in conjunction with subjective scores to offer a clearer insight into patient disease burden and recovery.
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Abstract
Neurosurgeons receive extensive and lengthy training to equip themselves with various technical skills, and neurosurgery require a great deal of pre-, intra- and postoperative clinical data collection, decision making, care and recovery. The last decade has seen a significant increase in the importance of artificial intelligence (AI) in neurosurgery. AI can provide a great promise in neurosurgery by complementing neurosurgeons' skills to provide the best possible interventional and noninterventional care for patients by enhancing diagnostic and prognostic outcomes in clinical treatment and help neurosurgeons with decision making during surgical interventions to improve patient outcomes. Furthermore, AI is playing a pivotal role in the production, processing and storage of clinical and experimental data. AI usage in neurosurgery can also reduce the costs associated with surgical care and provide high-quality healthcare to a broader population. Additionally, AI and neurosurgery can build a symbiotic relationship where AI helps to push the boundaries of neurosurgery, and neurosurgery can help AI to develop better and more robust algorithms. This review explores the role of AI in interventional and noninterventional aspects of neurosurgery during pre-, intra- and postoperative care, such as diagnosis, clinical decision making, surgical operation, prognosis, data acquisition, and research within the neurosurgical arena.
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Affiliation(s)
- Mohammad Mofatteh
- Sir William Dunn School of Pathology, Medical Sciences Division, University of Oxford, South Parks Road, Oxford OX1 3RE, United Kingdom
- Lincoln College, University of Oxford, Turl Street, Oxford OX1 3DR, United Kingdom
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21
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Karim JL, Talhouk A. Person-Generated Health Data in Women's Health: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e26110. [PMID: 34047708 PMCID: PMC8196349 DOI: 10.2196/26110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices. Methods Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research. International Registered Report Identifier (IRRID) DERR1-10.2196/26110
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Affiliation(s)
- Jalisa Lynn Karim
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Aline Talhouk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
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22
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Nardo B, Lugaresi M, Doni M, Vulcano I, Piccione D, Paglione D, Stabile G. WhatsApp video call communication between oncological patients and their families during COVID-19 outbreak. Minerva Surg 2020; 76:146-155. [PMID: 32975387 DOI: 10.23736/s2724-5691.20.08454-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND On March 8th, 2020 the Italian Government implemented extraordinary measures to limit COVID-19 viral transmission. The aim of the study was to verify if the use of WhatsApp facilitates communication, improves health information, perception of safe and security, reduce emotional stress during the COVID-19 emergency. METHODS In this study we identified two period, in the pre-COVID 1-month period (February 9th - March 8th, 2020) 34 patients underwent elective surgery for malignancies (21) and benign (13) diseases, respectively. We provided patients' families on a daily basis with clinical information face-to-face in the ward regarding their postoperative course. In the post-COVID 1-month period (March 9th - April 5th, 2020), 15 patients with malignancies were treated. In this period, patients and their families given a consent form to let the surgical team to communicate clinical data using WhatsApp. At the end of the study period we collected a satisfaction anonymous questionnaire of both patients and families. RESULTS Statistically significant differences were observed in the pre- vs. post- COVID period regarding the number of surgical procedures (P=0.004). In the post-COVID period, the satisfaction questionnaire showed a good reliability (Cronbach's α 0.912) and a high percentage of satisfaction of patients and their families for the adopted communication tool, reassurance, privacy protection and reduction of emotional stress. CONCLUSIONS WhatsApp is a safe and fast technology, it offers the opportunity to facilitate clinical communications, reduce stress, improve patient security, obtain clinical and psychological positive implications in patient's care preserving their privacy in the COVID-19 emergency period.
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Affiliation(s)
- Bruno Nardo
- General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy - .,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Marialuisa Lugaresi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Doni
- General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy
| | - Ignazio Vulcano
- General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy
| | - Domenico Piccione
- General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy
| | - Daniele Paglione
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Gaetano Stabile
- General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy
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Lee MJ, Kim JK, Pokarowski M, Shiff M, Mitton P, Popescu A, Chung CT, Langer JC, Pierro A, Milner J, Lorenzo AJ, Koyle MA. Clinical and Economic Value of Routine Pathological Examination of Hernia Sacs and Scheduled Clinic Follow-Ups After Inguinal Hernia and Hydrocele Repair in a Canadian Tertiary Care Children's Hospital. J Pediatr Surg 2020; 55:1463-1469. [PMID: 31679775 DOI: 10.1016/j.jpedsurg.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The clinical and economical value of routine submission of hernia sacs for pathological examination and scheduled clinic follow-ups after inguinal hernia and hydrocele repair has been questioned. Herein, we assessed the institutional variability in these routine practices. METHODS We retrospectively reviewed patients who underwent unilateral or bilateral inguinal hernia and/or hydrocele repair, open or laparoscopically, at our institution from 2015 to 2018. RESULTS 1181 patients were included (1074 inguinal hernias and 157 hydroceles). Of 531 specimens obtained from 446 (38%) patients, 515 (97%) were normal. 16 (3%) abnormal pathological findings included 7 with mesothelial hyperplasia, 5 with nonfunctional genital ductal remnants, 3 with ectopic adrenal cortical tissues, and 1 epidydimal structure which was not recognized at the time of surgery. 418 (35%) patients had scheduled clinic follow-ups 65 (IQR 46-94) days postoperatively. 44 (4%) patients with unexpected postoperative Emergency Department visits within 30 days of surgery were identified. Only one patient required inpatient treatment, and the rest did not require intervention or admission. The total direct cost of analyzing specimens during the study period was $30,798 CAD ($10,266/year). The average cost to detect a potentially significant finding was $1924.88/specimen and $2053.20/patient. CONCLUSIONS Routine pathological examination of hernia sacs and scheduled clinic follow-ups were associated with significant costs and predominantly nonsignificant findings. They should therefore be reserved for patients with a high clinical suspicion of injuries/abnormalities or risk factors for potential complications. LEVEL OF EVIDENCE This is a level III evidence study.
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Affiliation(s)
- Min Joon Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mitchell Shiff
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Patricia Mitton
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Andreea Popescu
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Catherine T Chung
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joseph Milner
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
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Cherid C, Baghdadli A, Wall M, Mayo NE, Berry G, Harvey EJ, Albers A, Bergeron SG, Morin SN. Current level of technology use, health and eHealth literacy in older Canadians with a recent fracture-a survey in orthopedic clinics. Osteoporos Int 2020; 31:1333-1340. [PMID: 32112118 DOI: 10.1007/s00198-020-05359-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
UNLABELLED Among older adults who have recently sustained a fracture, there is substantial adoption of mobile technology. Furthermore, health and eHealth literacy level reported by participants supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management. INTRODUCTION Electronic health resources are increasingly used in the self-management of medical conditions. We aimed to identify the current level of technology adoption, health, and eHealth literacy among older adults with a recent fracture, to determine if the use of electronic interventions would be feasible and acceptable in this population. METHODS Adults ≥ 50 years with recent fractures were invited to complete a self-administered survey composed of 21 questions, including an 8-item perceived eHealth literacy scale. RESULTS A total of 401 participants completed the survey (women, 64%; ≥ 65 years, 59%; university education, 32%). Most participants reported no difficulty in reading printed health material (67%) and felt confident in filling out medical forms (65%). Younger age and higher levels of education were associated with higher health literacy. Most respondents (81%) owned at least one mobile device (smartphone, 49%; tablet, 45%). eHEALS scores were similar among men (29, IQR 24-32) and women (29, IQR 25-33), and between younger age group categories (50-64 years, 30; IQR 26-33; and 65-74 years, 29; IQR 25-32), but lower in the oldest age group (≥ 75 years, 24; IQR 21-29; p < 0.05). Compared with the youngest group, those ≥ 75 years had higher odds of an eHEALS < 26 (odds ratio, 4.2; 95% confidence interval 2.0-8.9) after adjusting for sex and education level. CONCLUSION There is significant adoption of mobile technology among older adults. Health and eHealth literacy reported by this study population supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management.
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Affiliation(s)
- C Cherid
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - A Baghdadli
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - M Wall
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - N E Mayo
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - G Berry
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
| | - E J Harvey
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
| | - A Albers
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
- St. Mary's Hospital, Montreal, Canada
| | - S G Bergeron
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
- Jewish General Hospital, Montreal, Canada
| | - S N Morin
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada.
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada.
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Conventional Follow-up Versus Mobile Application Home Monitoring for Postoperative Anterior Cruciate Ligament Reconstruction Patients: A Randomized Controlled Trial. Arthroscopy 2020; 36:1906-1916. [PMID: 32268161 DOI: 10.1016/j.arthro.2020.02.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether a mobile app can reduce the need for in-person visits and examine the resulting societal cost differences between mobile and conventional follow-up for postoperative anterior cruciate ligament (ACL) reconstruction patients. METHODS Study design was a single-center, 2-arm parallel group randomized controlled trial. All patients undergoing ACL reconstruction aged 16 to 70 years were screened for inclusion in the study. Competent use of a mobile device and ability to communicate in English was required. Patients were randomly assigned to receive follow-up via a mobile app or conventional appointments. Analysis was intention-to-treat. The primary outcome was the number of in-person visits to any health care professional during the first 6 postoperative weeks. Secondary outcomes included analysis of costs incurred by the health care system and personal patient costs related to both methods of follow-up. Patient-reported satisfaction and convenience scores, rates of complications, and clinical outcomes were also analyzed. RESULTS Sixty patients were analyzed. Participants in the app group attended a mean of 0.36 in-person visits versus 2.44 in-person visits in the conventional group (95% confidence interval 0.08-0.28; P < .0001). On average, patients in the app group spent $211 (Canadian dollars) less than the conventional group over 6 weeks (P < .0001) on personal costs related to follow-up. Health care system costs were also significantly less in the app group ($157.5 vs CAD $202.2; P < .0001). There was no difference between groups in patient satisfaction, convenience, complication rates, or clinical outcome measures. CONCLUSIONS Mobile follow-up can eliminate a significant number of in-person visits during the first 6 postoperative weeks in patients undergoing ACL reconstruction with cost savings to both the patient and health care system. This method should be considered for dissemination among similar orthopaedic procedures during early postoperative care. LEVEL OF EVIDENCE I: Prospective randomized controlled trial.
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Timmers T, Janssen L, Stohr J, Murk JL, Berrevoets MAH. Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study. JMIR Mhealth Uhealth 2020; 8:e19822. [PMID: 32516750 PMCID: PMC7313382 DOI: 10.2196/19822] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) situation demands a lot from citizens, health care providers, and governmental institutions. Citizens need to cope with guidelines on social interaction, work, home isolation, and symptom recognition. Additionally, health care providers and policy makers have to cope with unprecedented and unpredictable pressure on the health care system they need to manage. By providing citizens with an app, they always have access to the latest information and can assess their own health. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. OBJECTIVE The aim of this observational study is to assess people's use of an app to support them with COVID-19 education, self-assessment, and monitoring of their own health for a 7-day period. In addition, we aim to assess the usability of this data for health care providers and policy makers by applying it to an interactive map and combining it with hospital data. The secondary outcomes of the study were user's satisfaction with the information provided in the app, perceived usefulness of the app, health care providers they contacted, and the follow-up actions from this contact. METHODS This observational cohort study was carried out at the nonacademic teaching hospital "Elisabeth Twee Steden" (ETZ) in Tilburg, Netherlands. From April 1, 2020, onwards ETZ offered the COVID-19 education, self-assessment, and symptom tracking diary to their already existing app for patient education and monitoring. RESULTS Between April 1 and April 20, 2020, a total of 6194 people downloaded the app. The self-assessment functionality was used abundantly to check one's health status. In total, 5104 people responded to the question about severe symptoms, from which 242 indicated to suffer from severe symptoms. A total of 4929 people responded to the question about mild symptoms, from which 3248 indicated to suffer from these. The data was successfully applied to an interactive map, displaying user demographics and health status. Furthermore, the data was linked to clinical data. App users were satisfied with the information in the app and appreciated the symptom diary functionality. In total, 102 users reached out to a health care provider, leading to 91 contacts. CONCLUSIONS Our study demonstrated the successful implementation and use of an app with COVID-19 education, self-assessment, and a 7-day symptom diary. Data collected with the app were successfully applied to an interactive map. In addition, we were able to link the data to COVID-19 screening results from the hospital's microbiology laboratory. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. TRIAL REGISTRATION Netherlands Trial Register NL8501; https://www.trialregister.nl/trial/8501.
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Affiliation(s)
- Thomas Timmers
- Interactive Studios, Rosmalen, Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | | | - Joep Stohr
- Elisabeth Twee Steden Hospital, Tilburg, Netherlands
| | - J L Murk
- Elisabeth Twee Steden Hospital, Tilburg, Netherlands
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Pickens R, Cochran A, Tezber K, Berry R, Bhattacharya E, Koo D, King L, Iannitti DA, Martinie JB, Baker EH, Ocuin LM, Hunt J, Vrochides D. Using a Mobile Application for Real-Time Collection of Patient-Reported Outcomes in Hepatopancreatobiliary Surgery within an ERAS® Pathway. Am Surg 2020. [DOI: 10.1177/000313481908500847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient-reported outcomes (PROs) are essential for patient-centered health care. This pilot study implemented a mobile application customized to an hepatopancreatobiliary Enhanced Recovery After Surgery (ERAS®) program—a novel environment—for real-time collection of PROs, including ERAS® pathway compliance. Patients undergoing hepatectomy, distal pancreatectomy, or pancreaticoduodenectomy through the ERAS® program were prospectively enrolled over 10 months. The application provided education and questionnaires before surgery through 30 days postdischarge. Thresholds were set for initial adoption of the application (75%), PRO response rate (50%), and patient satisfaction (75%). Daily postdischarge health checks integrated customized responses to guide out-of-hospital care. Of 165 enrolled patients, 122 met inclusion criteria. Application adoption was 93 per cent (114/122) and in-hospital engagement remained high at 88 per cent (107/122). Patients completed 62 per cent of PRO on quality of life, postoperative pain, nausea, opioid consumption, and compliance to ERAS® pathway items, including ambulation and breathing exercises. During postcharge tracking, 12 patients reported that the application prevented a phone call to the hospital and three patients reported prevention of an emergency room visit. PRO collection through this mobile device created an integrated platform for comprehensive perioperative care, patient-initiated outcome tracking with automatic reporting, and real-time feedback for process change. Improving proactive outpatient management of complex patients through mobile technology could help restructure health-care delivery and improve resource utilization for all patients.
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Affiliation(s)
- Ryan Pickens
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Allyson Cochran
- Department of Surgery, Atrium Health, Carolinas Center for Surgical Outcomes Science, Charlotte, North Carolina
| | - Kendra Tezber
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Renna Berry
- Information and Analytics Services, Atrium Health, Charlotte, North Carolina; and
| | | | | | - Lacey King
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - David A. Iannitti
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - John B. Martinie
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Erin H. Baker
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Lee M. Ocuin
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Jarrett Hunt
- Information and Analytics Services, Atrium Health, Charlotte, North Carolina; and
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Ross TD, Dvorani E, Saskin R, Khoshbin A, Atrey A, Ward SE. Temporal Trends and Predictors of Thirty-Day Readmissions and Emergency Department Visits Following Total Knee Arthroplasty in Ontario Between 2003 and 2016. J Arthroplasty 2020; 35:364-370. [PMID: 31732370 DOI: 10.1016/j.arth.2019.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the second most common surgery performed in Canada. Understanding and improving quality metrics associated with such high-volume procedures is of utmost importance to maximize value within the healthcare system, which is a balance between cost and quality. Although rates and predictors of hospital readmission and emergency department (ED) visits following TKA have previously been described in privatized healthcare settings, few studies have evaluated trends in length of stay (LOS), hospital readmissions, and ED visits following TKA in a universal single-payer system. METHODS Using data from a provincially held and validated registry, the Institute for Clinical and Evaluative Sciences, we undertook a review of all 205,152 TKAs performed in the province of Ontario, Canada, between 2003 and 2016. We determined temporal trends in utilization, LOS, readmissions, and ED visits and evaluated patient and provider predictors of hospital readmissions and ED visits using multivariate logistic regression modeling. We also grouped and described the most common reasons for readmission and ED visits based on the available International Classification of Diseases, Ninth Revision and Tenth Revision coding information. RESULTS LOS decreased significantly over the study period (P < .0001), from a median of 5 days (10th percentile 3 days, 90th percentile 8 days) in 2003 to a median of 3 days (10th percentile 2 days, 90th percentile 4 days) in 2016. All-cause 30-day readmissions did not change significantly over the study period, but the rate of ED visits increased significantly over time. Predictors of 30-day readmission following TKA included older age, male gender, lower income quartile, not having a postoperative visit with a primary care physician (PCP), increased comorbidities, longer LOS, urgent or revision surgery, admission to a teaching hospital, and discharge to an inpatient rehabilitation facility. Variables that predicted increased odds of an ED visit included older age, male gender, lower income quartile, not having a postop visit with a PCP, increasing comorbidities, year of surgery, longer LOS, and revision surgery. Admission to a teaching hospital and discharge to an inpatient rehabilitation facility showed a trend toward increased odds of an ED visit. CONCLUSIONS We identified a significant increase in ED visits following TKA in Ontario between 2003 and 2016, with no corresponding increase in hospital readmissions despite a significant temporal trend toward shorter LOS. Predictors of ED visits and readmissions were similar, including male gender, lower income, higher comorbidities, and lacking a PCP visit postoperatively. Increased rates of ED visits following TKA in Ontario represent a quality problem, as they are associated with increased cost to the public healthcare system without any substantial benefit. Interventions aimed at redirecting patients from the ED for minor postoperative concerns should be investigated, as this is likely to improve care by reducing costs, improving efficiency, and enhancing patient experience.
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Affiliation(s)
- Tayler D Ross
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Erind Dvorani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Semple JL, Evans HL, Lober WB, Lavallee DC. Implementing Mobile Health Interventions to Capture Post-Operative Patient-Generated Health Data. Surg Infect (Larchmt) 2019; 20:566-570. [PMID: 31429637 DOI: 10.1089/sur.2019.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- John L. Semple
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Heather L. Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - William B. Lober
- Departments of Health Informatics and Global Health, University of Washington, Seattle, Washington
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van Hout L, Bökkerink WJV, Ibelings MS, Vriens PWHE. Perioperative monitoring of inguinal hernia patients with a smartphone application. Hernia 2019; 24:179-185. [PMID: 31542838 DOI: 10.1007/s10029-019-02053-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Patient Reported Outcomes have become standard in the evaluation of inguinal hernia repair. However, the chosen outcomes remain heterogeneous and the measurements time-consuming or inadequate. Perioperative measurement of pain and recovery could benefit from the contemporary possibilities that mobile health applications offer. METHODS An application for smartphones and tablets was developed using the twitch crowdsourcing concept, classical questionnaires, experiences from randomised clinical trials, and patients' input. RESULTS Dichotomous questions and numeric rating scales, both pre- and post-operative, were implemented in the freely available Q1.6 application. Content, timing and frequencies were adapted to the inguinal hernia patient's daily life and assumed recovery. Certain combinations of answers were set as alert notifications to detect adverse events. Data are displayed on a web-based dashboard enabling real-time monitoring. Legal aspects were examined and taken into account. DISCUSSION The Q1.6 inguinal hernia app is an innovative tool for perioperative monitoring of pain and recovery of inguinal hernia patients. Previous limitations of classical measurements such as a large heterogeneity, retrospective data recording and different forms of bias can be eliminated. The `big data´ generated in this manner might be used for large-scale research to improve inguinal hernia surgery. The Q1.6 platform is not only hernia specific; it is also an innovative tool to measure PROs in any other domain.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - M S Ibelings
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
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Postanesthesia care by remote monitoring of vital signs in surgical wards. Curr Opin Anaesthesiol 2018; 31:716-722. [DOI: 10.1097/aco.0000000000000650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cornejo-Palma D, Urbach DR. Virtual postoperative clinic: can we push virtual postoperative care further upstream? BMJ Qual Saf 2018; 28:7-9. [DOI: 10.1136/bmjqs-2018-008697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/04/2022]
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Abstract
The Commonwealth Fund 2017 report ranked Canada's healthcare system low in access to care and last among all 11 counties studied in terms of timeliness of care. While long wait times for certain elective surgical procedures appear to be emblematic of Canadian Medicare, they are not inevitable. Wait times could be improved by focusing on public awareness and measurement of wait times and improving the appropriateness, efficiency (eg, with implementation of single-entry models for surgical referrals and greater use of ambulatory surgery), and productivity of surgical care (eg, by activity-based funding for surgical procedures and by reducing the cost of perioperative care). Ideas on how physician leaders can build on recent accomplishments are provided.
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Affiliation(s)
- David R Urbach
- 1 Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
- 2 Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- 3 Women's College Hospital Research Institute, Toronto, Ontario, Canada
- 4 Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- 5 Department of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kroll RR, McKenzie ED, Boyd JG, Sheth P, Howes D, Wood M, Maslove DM. Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study. J Intensive Care 2017; 5:64. [PMID: 29201377 PMCID: PMC5698959 DOI: 10.1186/s40560-017-0261-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/08/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness. METHODS To determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures. RESULTS Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%), sensitivity was low to moderate (69.5%). There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03). Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time. CONCLUSIONS We found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery. TRIAL REGISTRATION Clinicaltrials.gov, NCT02527408.
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Affiliation(s)
- Ryan R. Kroll
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | | | - J. Gordon Boyd
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Prameet Sheth
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
| | - Daniel Howes
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Michael Wood
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
| | - David M. Maslove
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
| | - for the WEARable Information Technology for hospital INpatients (WEARIT-IN) study group
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
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Affiliation(s)
- David R Urbach
- Women's College Hospital; Institute for Health System Solutions and Virtual Care; Toronto General Hospital Research Institute; Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
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