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JMIR Perioperative Medicine

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Journal Description

JMIR Perioperative Medicine (JPOP, Editor-in-chief: John F. Pearson MD, Harvard Medical School) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2016: 5.175), focusing on technologies, medical devices, apps, engineering, informatics and patient education for perioperative medicine and nursing, including pre- and post-operative education, preventative interventions and clinical care for surgery and anaesthesiology patients, as well as informatics applications in anesthesia, surgery, critical care and pain medicine.

As open access journal we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!

 

Recent Articles:

  • Example of daily reporting in RAPP. Source: Image created by the Authors; Copyright: Ulrica Nilsson; URL: http://periop.jmir.org/2018/1/e2/; License: Licensed by JMIR.

    Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up: Secondary Analysis of a Randomized Controlled Trial

    Abstract:

    Background: Previous studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery. Objective: The aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP. Methods: This study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP. Results: There were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups. Conclusions: This study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge. Trial Registration: ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 (Archived by WebCite at http://www.webcitation.org/6y2UtMbvz)

  • Source: Pexels.com; Copyright: freestocks.org; URL: https://www.pexels.com/photo/google-nexus-4-lg-smartphone-technology-12829/; License: Public Domain (CC0).

    Accessible Communication Tools for Surgical Site Infection Monitoring and Prevention in Joint Reconstruction: Feasibility Study

    Abstract:

    Background: The National Surgical Quality Improvement Program logs surgical site infections (SSIs) as the most common cause of unplanned postoperative readmission for a variety of surgical interventions. Hospitals are making significant efforts preoperatively and postoperatively to reduce SSIs and improve care. Telemedicine, defined as using remote technology to implement health care, has the potential to improve outcomes across a wide range of parameters, including reducing SSIs. Objective: The purpose of this study was to assess the feasibility and user satisfaction of two automated messaging systems, EpxDecolonization and EpxWound, to improve perioperative care in a quality improvement project for patients undergoing total joint replacement. Methods: We designed two automated text messaging and calling systems named EpxDecolonization, which reminded patients of their preoperative decolonization protocol, and EpxWound, which monitored pain, wound, and fever status postoperatively. Daily patient responses were recorded and a post-usage survey was sent out to participants to assess satisfaction with the systems. Results: Over the 40-week study period, 638 and 642 patients were enrolled in EpxDecolonization (a preoperative decolonization reminder) and EpxWound (a postoperative surgical site infection telemonitoring system), respectively. Patients could be enrolled in either or both EpxDecolonization and EpxWound, with the default option being dual enrollment. The proportion of sessions responded to was 85.2% for EpxDecolonization and 78.4% for EpxWound. Of the 1280 patients prescribed EpxWound and EpxDecolonization, 821 (64.14%) fully completed the postoperative system satisfaction survey. The median survey score (scale 1-9) was 9 for patient-rated overall care and 8 for whether the telemonitoring systems improved patient communication with providers. The majority of patients (69.0%, 566/821) indicated that the systems sent out an ideal number of messages (not too many, not too few). Conclusions: EpxDecolonization and EpxWound demonstrated high response rates and improved patient-rated communication with providers. These preliminary data suggest that these systems are well tolerated and potentially beneficial to both patients and providers. The systems have the potential to improve both patient satisfaction scores and compliance with preoperative protocols and postoperative wound monitoring. Future efforts will focus on testing the sensitivity and specificity of alerts generated by each system and on demonstrating the ability of these systems to improve clinical quality metrics with more authoritative data.

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Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Virtual Reality for Proton Therapy - Child-life guided interactive tour for adolescents

    Date Submitted: Jun 8, 2018

    Open Peer Review Period: Jun 12, 2018 - Aug 7, 2018

    Background: Proof-of-concept study to determine the feasibility of incorporating a virtual reality tour for children scheduled to receive radiation therapy. The secondary objective was to qualitativel...

    Background: Proof-of-concept study to determine the feasibility of incorporating a virtual reality tour for children scheduled to receive radiation therapy. The secondary objective was to qualitatively describe each subject's virtual reality experience. Methods: Children ages 13 or older scheduled to receive proton radiation therapy were included in the study. Subjects watched the virtual reality tour of the radiation therapy facility with a child life therapist experienced in coaching children receiving radiation therapy and completed a survey after the tour. Results: Eight subjects consented for participation and 6 completed the virtual reality tour. All of the enrolled patients completed the virtual reality tour successfully. Two subjects did not complete the survey. Two subjects requested to pause the tour to ask questions about the facility. Five subjects said the virtual reality tour was helpful preparation before undergo proton radiation therapy. Subjects stated that the tour was helpful because ‘it showed me what’s to come’ and it was helpful to see ‘what it’s like to lay in the machine.’ One subject said ‘it made me feel less nervous.’ Six subjects stated that they would like to see this type of tour available for other areas of the hospital, such as diagnostic imaging rooms. None of the subjects experienced nausea or vomiting. Conclusions: The virtual reality video tour allowed patients to explore the treatment facility in a comfortable environment. Participants expressed that the tour was beneficial and would appreciate seeing other parts of the hospital in this way.

  • A Healthy Volunteer Study: Does Trendelenburg position lead to cognitive decline?

    Date Submitted: Jun 4, 2018

    Open Peer Review Period: Jun 6, 2018 - Aug 1, 2018

    Background: Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after surgical intervention. Aspects of cognitive function can be assessed using various validated c...

    Background: Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after surgical intervention. Aspects of cognitive function can be assessed using various validated cognitive function tests including: N back; Stroop; and Lexical Decision Making Task (LDT). There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD. Objective: To assess the effect of the time spent in Trendelenburg position on cognitive function. Methods: Volunteers were placed in Trendelenburg for 3 hours, then supine for 30 minutes. Validated cognitive function tests including: 1,2, 3 back; Stroop; and LDT were performed at baseline and every 30 minutes after Trendelenburg position. Cognitive decline was defined as per the ISPOCD trial [1]: a decrease in accuracy from the volunteers’ baseline or an increase in response time (RT) from the volunteers’ baseline by > 2 control group standard deviations (SD). Results: Fifteen healthy volunteers were recruited (8 male, 7 female), average age of 69 years (range:57-81) and average BMI of 27.7 kg/m2 (range:20.9-33). Accuracy remained within 2 SDs at all time-points. An increase in RT did occur with 20% showing cognitive decline after 30 minutes in Trendelenburg position, 26.7% after 1 hour, 33.3% after 90 minutes, 26.7% after 120 and 150 minutes; and 40% after 180 minutes. When moved supine, 33.3% had cognitive decline. Conclusions: The results of this study indicate that Trendelenburg positioning appears to lead to cognitive decline. This may have implications for patients undergoing prolonged Trendelenburg positioning in laparoscopic colorectal surgery.

  • Observational study evaluating variation of intra-ocular pressure (IOP) with positional change during colorectal laparoscopic surgery

    Date Submitted: Jun 4, 2018

    Open Peer Review Period: Jun 4, 2018 - Jul 30, 2018

    Background: The incidence of perioperative visual loss following colorectal surgery is quoted as 1.24 per 10,000 in USA. Raised IOP during extreme Trendelenburg position leading to reduced optic nerve...

    Background: The incidence of perioperative visual loss following colorectal surgery is quoted as 1.24 per 10,000 in USA. Raised IOP during extreme Trendelenburg position leading to reduced optic nerve perfusion is thought to be a cause. Objective: Assess the effect of the degree of Trendelenburg tilt and time spent in Trendelenburg on IOP during laparoscopic colorectal surgery. Methods: Fifty patients undergoing laparoscopic colorectal surgery were recruited. IOP measurements using a Tonopen® XL applanation tonometer were taken, and repeated hourly during surgery and each time the operating table was tilted. A correlation coefficient for the degree of Trendelenburg tilt and IOP was calculated for each patient. Group 1 included patients undergoing a right-sided colonic procedure and Group 2 included all left-sided colonic procedures. Results: Group 1 (n=25) had a mean age of 68.7years (SD=13.9) and Group 2 (n=25) 62.5years (SD=16.4), (p>0.05). The average length of surgery for Group 1 was 141.6minutes (SD=48.3) and Group 2 was 267.7minutes (SD=99) (P≤0.05). The mean maximum degree of Trendelenburg tilt in Group 1 was 9.7o (SD=7.4) and Group 2 was 18.6o (SD=5.8), (p≤0.05). The mean IOP rise was 9.3mmHg (SD=5.3) in Group 1 and 15.2mmHg (SD=5.2) in Group 2 (p≤0.05). An overall correlation coefficient for the degree of Trendelenburg tilt and IOP change (n=48) was 0.78. Conclusions: There is a strong correlation between IOP rises during laparoscopic colorectal surgery and the degree of Trendelenburg tilt. This may be significant for patients undergoing prolonged surgery and especially those with glaucoma.

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