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Alegrete J, Batalha N, Fernandes O, Parraca JA, Rodrigues AM, Londral AR, Sousa JP. Effectiveness of the KC@H programme compared with clinic-based rehabilitation in patients recovering from ACL reconstruction: a study protocol for a single-centre, two-arm, single-blinded, randomised controlled superiority trial. BMJ Open Sport Exerc Med 2024; 10:e001868. [PMID: 38390383 PMCID: PMC10882313 DOI: 10.1136/bmjsem-2023-001868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
Patients who cannot fully comply with conventional clinic-based rehabilitation (CR) sessions after ACL reconstruction (ACLR) may find additional internet-based sessions beneficial. These remote sessions include therapeutic exercises that can be done at home, potentially extending the reach of rehabilitation services to underserved areas, prolonging the duration of care and providing improved supervision. The study's main purpose is to determine if the Knee Care at Home (KC@H) programme is more effective than conventional CR alone in improving patient-reported, clinician-reported and physical functional performance outcome measures after ACLR. Additionally, the trial assesses the significance of changes in outcome measures for clinical practice. This protocol outlines a randomised controlled trial for postoperative recovery following ACLR. Adult participants of both sexes who meet specific criteria will be randomly assigned to either the CR group or the KC@H group. Only the latter group will receive internet-based sessions of therapeutic exercises at home and CR sessions. A follow-up evaluation will be conducted for both groups 12 weeks after the intervention ends. The trial protocol was approved by the Ethics Committee of the Universidade de Évora and complies with the Code of Ethics of the World Medical Association. All recordings will be stored on a secure server with limited access and deleted as soon as they are no longer needed. The KC@H programme is expected to be superior to conventional CR for patients recovering from ACLR across multiple outcome measures. Also, the programme has the potential to promote superior recovery and extend the reach and duration of care. Trial registration number: NCT05828355.
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Affiliation(s)
- Joana Alegrete
- Department of Sport and Health, Universidade de Évora, Evora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
| | - Nuno Batalha
- Department of Sport and Health, Universidade de Évora, Evora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
| | - Orlando Fernandes
- Department of Sport and Health, Universidade de Évora, Evora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
| | - Jose Alberto Parraca
- Department of Sport and Health, Universidade de Évora, Evora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana Rita Londral
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
- NOVA School of Science and Technology, Universidade NOVA de Lisboa, Lisboa, Portugal
- Value for Health CoLAB, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - João Paulo Sousa
- Department of Sport and Health, Universidade de Évora, Evora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Evora, Portugal
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Wang XQ, Wang Y, Yu K, Ma R, Zhang JY, Zhou YQ. Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study. Int J Soc Psychiatry 2023; 69:1453-1461. [PMID: 37036139 DOI: 10.1177/00207640231164010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients' medical mistrust or expectations of care. This study aims to fill that void. METHODS We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi's seven-step method. RESULTS Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. CONCLUSION Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients.
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Affiliation(s)
- Xiao-Qing Wang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kai Yu
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui Ma
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Yuan Zhang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
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Kellish AS, Hakim A, Shahi A, Gutowski CJ, Kleiner MT. The Delivery of Orthopaedic Care midst COVID-19 and Social Distancing. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:371-378. [PMID: 34423083 PMCID: PMC8359650 DOI: 10.22038/abjs.2020.48498.2406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/07/2020] [Indexed: 11/06/2022]
Abstract
In this paper we present the findings of a literature review covering articles published in the last three decades describing the application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articles studying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, and provide an example of our single urban level-1 trauma center's strategy for incorporating telemedicine into the clinical practice of orthopaedic surgeons during the COVID-19 pandemic.
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Affiliation(s)
- Alec S. Kellish
- Cooper Medical School of Rowan University, Camden New Jersey, USA
| | - Abraham Hakim
- Cooper Medical School of Rowan University, Camden New Jersey, USA
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Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115991. [PMID: 34204871 PMCID: PMC8199778 DOI: 10.3390/ijerph18115991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.
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Houghton LC, Howland RE, McDonald JA. Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature. Front Public Health 2019; 7:298. [PMID: 31781525 PMCID: PMC6851054 DOI: 10.3389/fpubh.2019.00298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Breast cancer rates have been increasing worldwide, particularly among young women, suggesting important interactions between genes and health behaviors. At the same time, mobile technology, including smartphones applications (apps), has emerged as a new tool for delivering healthcare and health-related services. As of 2018, there were nearly 600 publicly available breast cancer apps designed to provide disease and treatment information, to manage disease, and to raise overall awareness. However, the extent to which apps are incorporated into breast cancer prevention research is unknown. Therefore, the objective of this review was to determine how mobile applications are being used for breast cancer prevention among women across the cancer control continuum. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Web of Science Core Collection databases using the keywords breast cancer, smartphone, mobile application, and phone app. Full-length journal articles available in English that addressed the research question were included. We categorized articles by prevention type (primary, secondary, and tertiary) and phase of research (protocol, development, feasibility, pilot, measurement, and effectiveness), and identified common themes and gaps. Results: Our search yielded 82 studies (69 unique) that used apps in breast cancer prevention research across 20 countries. Approximately half of the named apps were publicly available. The majority (73%) of studies targeted tertiary prevention; 15% targeted secondary and 13% targeted primary prevention. Apps were used across all phases of research with the predominant phase being feasibility in tertiary prevention (34%), effectiveness in secondary prevention (63%), and development (30%) and effectiveness (30%) in primary prevention. Common uses included assessing outcomes relevant to clinical care coordination, quality of life, increasing self-efficacy and screening behaviors, and tracking and managing health behaviors. Conclusions: We identified the following gaps: few effectiveness studies in tertiary prevention, minimal use of apps for breast cancer etiology or early detection, and few interventions in those at average risk of breast cancer. These findings suggest that while mobile apps can inform breast cancer prevention across the continuum, more work is needed to incorporate apps into primary prevention.
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Affiliation(s)
- Lauren C. Houghton
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
| | - Renata E. Howland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Jasmine A. McDonald
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
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Dumestre DO, Fraulin F. Avoiding Breach of Patient Confidentiality: Trial of a Smartphone Application That Enables Secure Clinical Photography and Communication. Plast Surg (Oakv) 2019; 28:12-18. [PMID: 32110641 DOI: 10.1177/2292550319880910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate a smartphone application for clinical photography that prioritizes and facilitates patient security. Methods Ethics was obtained to trial the application Sharesmart. Calgary plastic surgeons/residents used the application for clinical photography and communication. Surveys gauging the application usability, incorporated consent process, and photograph storage/sharing were then sent to surgeons and patients. Results Over a 1-year trial period, 16 Calgary plastic surgeons and 24 residents used the application to photograph 84 patients. Half (56%) of the patients completed the survey. The majority of patients found the applications consent process acceptable (89%) and felt their photograph was secure (89%). Half (51%) of the surgeons/residents completed the survey and would use the application as is (67%) or with modifications (33%). The consent process was felt to be superior (73%) or equivalent (23%) to participant's prior methods and was felt to resolve issues present with current photography practices of secure transmission and storage of photographs by 100% and 95% of respondents, respectively. Perceived limitations of the application included difficulties in use with poor cellphone service or Internet, decreased speed compared to current practices, the lack of a desktop platform, video capability, and ability to transmit the photograph directly to the patient's medical record. Conclusions A smartphone clinical photography application addresses the risks of patient confidentiality breach present with current photography methods; broad implementation should be considered.
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Affiliation(s)
- Danielle O Dumestre
- Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Frankie Fraulin
- Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Mendez CB, Salum NC, Junkes C, Amante LN, Mendez CML. Mobile educational follow-up application for patients with peripheral arterial disease. Rev Lat Am Enfermagem 2019; 27:e3122. [PMID: 30698220 PMCID: PMC6336362 DOI: 10.1590/1518-8345.2693-3122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE to describe the development of a prototype mobile educational application for nursing follow-up aimed at patients diagnosed with peripheral arterial disease. METHOD a prototype-based technological production study. The construction followed the contextualized instructional design model using two steps: analysis and design and development. RESULTS the pedagogical content of the application was based on a survey of needs of patients with Peripheral Arterial Disease and treatments recommended in the literature. The prototype developed contained concepts, risk factors, signs and symptoms, treatment, importance of medications and their side effects, frequent doubts, necessary health care, and follow-up of patients by monitoring the evolution of the cicatricial process of lesions and possible complications, clarification of doubts and stimulus for continuation of treatment. CONCLUSION the use of health applications is a technological tool with the potential to improve the follow-up of patients regarding the progress of the disease and self-care, monitoring of risk factors, co-participation of the patient in the treatment, family participation, as well as planning of individualized care, and cost reduction for the health system.
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Affiliation(s)
- Cristiane Baldessar Mendez
- Universidade Federal de Santa Catarina, Hospital Universitário Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Nádia Chiodelli Salum
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
| | - Cintia Junkes
- Universidade Federal de Santa Catarina, Hospital Universitário Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Lucia Nazareth Amante
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
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Herrera-Usagre M, Santana V, Burgos-Pol R, Oliva JP, Sabater E, Rita-Acosta M, Casado MA, Cruces S, Pacheco M, Solorzano Perez C. Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10938. [PMID: 30664480 PMCID: PMC6352007 DOI: 10.2196/10938] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients' preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10938.
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Affiliation(s)
- Manuel Herrera-Usagre
- Andalusian Agency for Healthcare Quality, Sevilla, Spain.,Department of Sociology, Pablo de Olavide University, Sevilla, Spain
| | | | - Ramon Burgos-Pol
- Pharmacoeconomics & Outcomes Research Iberia, Paseo de Joaquín Rodrigo 4-I, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - Juan Pedro Oliva
- Hospital de Alta Resolución de Utrera, APS Bajo Guadalquivir, Utrera, Sevilla, Spain
| | - Eliazar Sabater
- Pharmacoeconomics & Outcomes Research Iberia, Paseo de Joaquín Rodrigo 4-I, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - Maria Rita-Acosta
- Hospital de Alta Resolución Sierra Norte, APS Bajo Guadalquivir, Constantina, Sevilla, Spain
| | - Miguel Angel Casado
- Pharmacoeconomics & Outcomes Research Iberia, Paseo de Joaquín Rodrigo 4-I, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - Susana Cruces
- Hospital de Alta Resolución de Utrera, APS Bajo Guadalquivir, Utrera, Sevilla, Spain
| | - Manuel Pacheco
- Andalusian Agency for Healthcare Quality, Sevilla, Spain
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Lin JC, Crutchfield JM, Zurawski DK, Stevens C. Implementation of a virtual vascular clinic with point-of-care ultrasound in an integrated health care system. J Vasc Surg 2018; 68:213-218. [DOI: 10.1016/j.jvs.2017.11.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022]
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Pozza ED, D'Souza GF, DeLeonibus A, Fabiani B, Gharb BB, Zins JE. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up. Aesthet Surg J 2017; 38:101-109. [PMID: 29117293 DOI: 10.1093/asj/sjx079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. OBJECTIVES The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? METHODS From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. RESULTS A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. CONCLUSIONS The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Anthony DeLeonibus
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Brianna Fabiani
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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Lau AY, Piper K, Bokor D, Martin P, Lau VS, Coiera E. Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study. JMIR Hum Factors 2017; 4:e31. [PMID: 29217504 PMCID: PMC5740262 DOI: 10.2196/humanfactors.8096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/23/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians.
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Affiliation(s)
- Annie Ys Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kalman Piper
- Department of Orthopaedic Surgery, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, Australia
| | - Desmond Bokor
- Department of Orthopaedic Surgery, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, Australia
| | - Paige Martin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Victor Sl Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Armstrong KA, Coyte PC, Brown M, Beber B, Semple JL. Effect of Home Monitoring via Mobile App on the Number of In-Person Visits Following Ambulatory Surgery: A Randomized Clinical Trial. JAMA Surg 2017; 152:622-627. [PMID: 28329223 DOI: 10.1001/jamasurg.2017.0111] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance In the age of information and patient-centered care, new methods of delivering postoperative care must be developed and evaluated. Objective To determine whether follow-up care delivered via a mobile app can be used to avert in-person follow-up care visits compared with conventional, in-person follow-up care in the first 30 days following ambulatory surgery. Design, Setting, and Participants A randomized clinical trial was conducted from February 1 to August 31, 2015, among ambulatory patients undergoing breast reconstruction at an academic ambulatory care hospital. Patients were randomly assigned to receive follow-up care via a mobile app or at an in-person visit during the first 30 days after the operation. Analysis was intention-to-treat. Main Outcomes and Measures The primary end point was the number of in-person follow-up visits during the first 30 days after the operation. Secondary end points were the number of telephone calls and emails to health care professionals, patient-reported convenience and satisfaction scores, and rates of complications. Results Of the 65 women in the study (mean [SD] age, 47.7 [13.4] years), 32 (49%) were in the mobile app group, and 33 (51%) were in the in-person follow-up care group. Those in the mobile app group attended a mean of 0.66 in-person visits, vs 1.64 in-person visits in the in-person follow-up care group, for a difference of 0.40 times fewer in-person visits (95% CI, 0.24-0.66; P < .001) and sent more emails to their health care professionals during the first 30 days after the operation (mean, 0.65 vs 0.15; incidence rate ratio, 4.13; 95% CI, 1.55-10.99; P = .005) than did patients in the in-person follow-up care group. This statistically significant difference was maintained at 3 months postoperatively. The mobile app group reported higher convenience scores than the in-person follow-up care group (incidence rate ratio, 1.39; 95% CI, 1.09-1.77; P = .008). There was no difference between groups in the number of telephone communications, satisfaction scores, or complication rates. Conclusions and Relevance Patients undergoing ambulatory breast reconstruction can use follow-up care via a mobile app to avert in-person follow-up visits during the first 30 days after the operation. Mobile app follow-up care affects neither complication rates nor patient-reported satisfaction scores, but it improves patient-reported convenience scores. Trial Registration clinicaltrials.gov Identifier: NCT02318953.
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Affiliation(s)
- Kathleen A Armstrong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Brown
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brett Beber
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John L Semple
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Price BA, Bednarski BK, You YN, Manandhar M, Dean EM, Alawadi ZM, Bryce Speer B, Gottumukkala V, Weldon M, Massey RL, Wang X, Qiao W, Chang GJ. Accelerated enhanced Recovery following Minimally Invasive colorectal cancer surgery ( RecoverMI): a study protocol for a novel randomised controlled trial. BMJ Open 2017; 7:e015960. [PMID: 28729319 PMCID: PMC5642654 DOI: 10.1136/bmjopen-2017-015960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Definitive treatment of localised colorectal cancer involves surgical resection of the primary tumour. Short-stay colectomies (eg, 23-hours) would have important implications for optimising the efficiency of inpatient care with reduced resource utilisation while improving the overall recovery experience with earlier return to normalcy. It could permit surgical treatment of colorectal cancer in a wider variety of settings, including hospital-based ambulatory surgery environments. While a few studies have shown that discharge within the first 24 hours after minimally invasive colectomy is possible, the safety, feasibility and patient acceptability of a protocol for short-stay colectomy for colorectal cancer have not previously been evaluated in a prospective randomised study. Moreover, given the potential for some patients to experience a delay in recovery of bowel function after colectomy, close outpatient monitoring may be necessary to ensure safe implementation. METHODS AND ANALYSIS In order to address this gap, we propose a prospective randomised trial of accelerated enhanced Recovery following Minimally Invasive colorectal cancer surgery (RecoverMI) that leverages the combination of minimally invasive surgery with enhanced recovery protocols and early coordinated outpatient remote televideo conferencing technology (TeleRecovery) to improve postoperative patien-provider communication, enhance postoperative treatment navigation and optimise postdischarge care. We hypothesise that RecoverMI can be safely incorporated into multidisciplinary practice to improve patient outcomes and reduce the overall 30-day duration of hospitalisation while preserving the quality of the patient experience. ETHICS AND DISSEMINATION: RecoverMI has received institutional review board approval and funding from the American Society of Colorectal Surgeons (ASCRS; LPG103). Results from RecoverMI will be published in a peer-reviewed publication and be used to inform a multisite trial. TRIAL REGISTRATION NUMBER NCT02613728; Pre-results.
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Affiliation(s)
- Brandee A Price
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian K Bednarski
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y Nancy You
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Meryna Manandhar
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - E Michelle Dean
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zeinab M Alawadi
- UTHealth Center for Clinical and Translational Sciences, Houston, Texas, USA
- University of Texas Health Science Center, Houston, Texas, USA
| | - B Bryce Speer
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marla Weldon
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert L Massey
- Department of Nursing, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George J Chang
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Semple JL, Armstrong KA. Mobile applications for postoperative monitoring after discharge. CMAJ 2016; 189:E22-E24. [PMID: 27920015 DOI: 10.1503/cmaj.160195] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- John L Semple
- Division of Plastic Surgery (Semple, Armstrong), Women's College Hospital; Department of Surgery (Semple), University of Toronto, Toronto, Ont.
| | - Kathleen A Armstrong
- Division of Plastic Surgery (Semple, Armstrong), Women's College Hospital; Department of Surgery (Semple), University of Toronto, Toronto, Ont
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Warren-Stomberg M, Jacobsson J, Brattwall M, Jildenstål P. At-home monitoring after surgery/anaesthesia - a challenge. J Eval Clin Pract 2016; 22:882-886. [PMID: 27134050 DOI: 10.1111/jep.12551] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Day surgery is evolving, with a majority of recoveries occurring at home. There is, in parallel, an evolution in telemedical technology. The aim of the present project was to identify patients' willingness to use predefined follow-up techniques and to clinically test preferred techniques at home using a two-step study.┅ METHODS: In Part I, a paper-based questionnaire study of identified patients' attitudes with three follow-up techniques was used. In Part II, a feasibility test of a mobile (smart-phone) application for follow-up at home was used. RESULTS Part I showed overall positive attitudes to telemedical follow-ups. Part II showed the preference for a follow-up technique with a mobile application was not fully consistent with the clinical study of the smart-phone app, where there was a large non-response. The application provided safe transfer of data to the hospital and helped make it easy to retrieve and analyse patient self-assessment of recovery. This application is one-way directed, and no feedback to the patient was given, which may have influenced the non-response. CONCLUSION Bringing telemedicine into follow-up after surgery/anaesthesia is requested, and furthermore, the feasibility study on day surgery presented here shows that it is technically easy to perform and will provide robust information. It should be noted that further studies are needed in order to find better patient cooperation.
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Affiliation(s)
- Margareta Warren-Stomberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Jacobsson
- Anaesthesia & Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - Metha Brattwall
- Sahlgrenska University Hospital, Anesthesiology and Intensive Care, Unit of Daysurgery, Mölndal Gothenburg, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Department of Anesthesia, Surgery and Intensive Care, Gothenburg, Sweden
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