@Article{info:doi/10.2196/67290, author="Dagli, Marcel Mert and Turlip, William Ryan and Oettl, C. Felix and Emara, Mohamed and Gujral, Jaskeerat and Chauhan, Daksh and Ahmad, S. Hasan and Santangelo, Gabrielle and Wathen, Connor and Ghenbot, Yohannes and Arena, D. John and Golubovsky, L. Joshua and Gu, J. Ben and Shin, H. John and Yoon, Won Jang and Ozturk, K. Ali and Welch, C. William", title="Comparison of Outcomes Between Staged and Same-Day Circumferential Spinal Fusion for Adult Spinal Deformity: Systematic Review and Meta-Analysis", journal="Interact J Med Res", year="2025", month="Mar", day="6", volume="14", pages="e67290", keywords="adults", keywords="circumferential fusion", keywords="scoliosis", keywords="spinal curvature", keywords="spinal fusion", keywords="spinal deformity", keywords="intraoperative", keywords="postoperative", keywords="perioperative", keywords="systematic reviews", keywords="meta-analysis", keywords="PRISMA", abstract="Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as staged or same-day procedures. However, evidence guiding the choice between these approaches is lacking. Objective: This study aims to compare patient outcomes following staged and same-day CF for ASD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in PubMed, MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus. Eligibility criteria included studies comparing outcomes following staged and same-day CF in adults with ASD. Searches were exported to Covidence, and records were deduplicated automatically. Title and abstract screening, full-text review, and data extraction were performed by two independent reviewers, with all conflicts being resolved by a third reviewer. A meta-analysis was conducted for outcomes reported in 3 or more studies. Results: Seven studies with 741 patients undergoing CF for ASD were included in the review (staged: n=331, 44.7\% and same-day: n=410, 55.3\%). Four studies that had comparable outcomes were merged for the quantitative meta-analysis and split based on observed measures. The meta-analysis revealed significantly shorter hospital length of stay (mean difference 3.98, 95\% CI 2.23-5.72 days; P<.001) for same-day CF. Three studies compared the operative time between staged and same-day CF, with all reporting a lower mean operative time for same-day CF (mean between 291-479, SD 129 minutes) compared to staged CF (mean between 426-541, SD 124 minutes); however, inconsistent reporting of mean and SD made quantitative analyses unattainable. Of the 4 studies that compared estimated blood loss (EBL) in the relevant groups, 3 presented a lower EBL (mean between 412-1127, SD 954 mL) in same-day surgery compared to staged surgery (mean between 642, SD 550 to 1351, SD 869 mL). Both studies that reported intra- and postoperative adverse events showed more intraoperative adverse events in staged CF (10.9\% and 13.6\%, respectively) compared to same-day CF (9.1\% and 3.6\%, respectively). Four studies measuring any perioperative adverse events showed a higher incidence of adverse events in staged CF than all studies combined. However, quantitative analysis of EBL, intraoperative adverse events, and perioperative adverse events found no statistically significant difference. Postoperative adverse events, reoperation, infection rates, and readmission rates showed inconsistent findings between studies. Data quality assessment revealed a moderate degree of bias for all included studies. Conclusions: Same-day CF may offer shorter operating time and hospital stay compared to staged CF for ASD. However, there was marked heterogeneity in perioperative outcomes reporting, and continuous variables were inconsistently presented. This underscored the need for standardized reporting of clinical variables and patient-reported outcomes and higher evidence of randomized controlled trials to elucidate the clinical superiority of either approach. Trial Registration: PROSPERO CRD42022339764; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=339764 International Registered Report Identifier (IRRID): RR2-10.2196/42331 ", doi="10.2196/67290", url="https://www.i-jmr.org/2025/1/e67290", url="http://www.ncbi.nlm.nih.gov/pubmed/40053742" } @Article{info:doi/10.2196/63556, author="Luo, Yang and Li, Sisi and Feng, Lijuan and Zheng, Junyi and Peng, Chunfen and Bao, Lihong", title="Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e63556", keywords="psychological resilience", keywords="fear of pain", keywords="postsurgical recovery", keywords="fear avoidance belief", keywords="pain management", keywords="activity recovery", abstract="Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual's capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=?5.822) and age (coefficient=?2.853) were negatively correlated with it. These average R2 of these models was 73\% (SD 6\%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes. ", doi="10.2196/63556", url="https://formative.jmir.org/2025/1/e63556" } @Article{info:doi/10.2196/52943, author="Guida, Stefania and Vitale, Antonino Jacopo and Swinnen, Eva and Beckw{\'e}e, David and Bargeri, Silvia and Pennestr{\`i}, Federico and Castellini, Greta and Gianola, Silvia", title="Effects of Prehabilitation With Advanced Technologies in Patients With Musculoskeletal Diseases Waiting for Surgery: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Dec", day="12", volume="26", pages="e52943", keywords="prehabilitation", keywords="advanced technologies", keywords="musculoskeletal diseases", keywords="joint arthroplasty", keywords="elective surgery", keywords="patient outcomes", keywords="mobile health", keywords="postoperative function", abstract="Background: Prehabilitation delivered with advanced technologies represents a great chance for patients to optimize pre- and postoperative outcomes, reduce costs, and overcome travel-related barriers. Objective: We aim to evaluate the effects of prehabilitation delivered with advanced technologies on clinically relevant outcomes among patients affected by musculoskeletal diseases and waiting for surgery. Methods: We searched the PubMed, EMBASE, Cochrane Library, PEDro, and CINAHL databases up to February 2, 2023. ClinicalTrials.gov was also searched for registered protocols. Randomized controlled trials and nonrandomized intervention studies with adult participants of both sexes, affected by any musculoskeletal disease, and undergoing prehabilitation with advanced technologies or standard care were included. Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. Certainty of evidence was assessed for the primary outcome with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The primary outcome was function. Secondary outcomes were pain, strength, risk of fall, autonomy in the activities of daily living, patient satisfaction, health-related quality of life, adverse events, and adherence to treatment. Results: Six studies (7 reports), focusing on patients undergoing total knee or hip arthroplasty and primary meniscal tear and spine surgery were included. We found different prehabilitation programs: mindfulness-based stress reduction, exercise, education, or a combination thereof. Prehabilitation delivered with advanced technologies proved to be more effective in improving function in candidates for knee or hip replacement (Western Ontario McMaster Osteoarthritis Index ``function'' subscale before surgery: mean difference [MD] --7.45, 95\% CI --10.71 to --4.19; I2=0\%; after surgery: MD --7.84, 95\% CI --11.80 to --3.88; I2=75.3\%), preoperative pain (MD --1.67, 95\% CI --2.50 to --0.48; I2=0\%), risk of fall (MD --2.54, 95\% CI --3.62 to --1.46; I2=0\%), and postoperative stiffness (MD --2.00, 95\% CI --2.01 to --1.99; I2=87\%). No differences were found in pain 1 month after surgery. Data from studies including participants undergoing primary meniscal tear and spinal surgery could not be pooled. Conclusions: Prehabilitation delivered with advanced technologies may be better than standard care in improving pre- and postoperative function among candidates for knee or hip arthroplasty. No quantitative results have been achieved on spine surgery candidates or other musculoskeletal diseases. Trial Registration: PROSPERO CRD42022345811; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=345811 ", doi="10.2196/52943", url="https://www.jmir.org/2024/1/e52943" } @Article{info:doi/10.2196/55880, author="Taccone, Silvio Fabio and Brunkhorst, Martin Frank and Bottari, Gabriella and Hidalgo, Jorge and Kribben, Andreas and Teboul, Jean-Louis and Tomescu, Dana and Klaus, Teresa and Scheier, Joerg and Deliargyris, Efthymios and Ferrer, Ricard", title="The COSMOS Registry of CytoSorb Hemoadsorption Therapy in Critically Ill Patients: Protocol for an International, Prospective Registry", journal="JMIR Res Protoc", year="2024", month="Nov", day="5", volume="13", pages="e55880", keywords="extracorporeal blood purification", keywords="CytoSorb", keywords="hemoadsorption", keywords="hemoperfusion", keywords="adsorption", keywords="hyperinflammation", keywords="sepsis", keywords="septic shock", keywords="liver failure", keywords="rhabdomyolysis", keywords="hospital care", keywords="mortality", abstract="Background: Extracorporeal blood purification with CytoSorb has been increasingly used as an adjunctive therapy in several hyperinflammatory critical care conditions, as well as to remove elevated levels of myoglobin or bilirubin in patients with rhabdomyolysis or liver failure. Despite the increasing worldwide use of hemoadsorption, data from large international multicenter studies are still lacking. Objective: The COSMOS (CytoSorb Treatment Of Critically Ill Patients) registry is a company-sponsored registry by CytoSorbents Corporation and CytoSorbents Medical Inc. and will provide a data repository and reporting infrastructure for the surveillance of CytoSorb use in real-world critical care settings in an unselected, critically ill patient population. The gathered data will serve as a comprehensive resource to assess the effects of such therapy on patients' management. Methods: The international COSMOS registry is collecting prospective data for patients treated with CytoSorb during routine care in various critical care indications, based on the decision of the treating physicians. Data are collected at baseline, during CytoSorb therapy, 24 hours thereafter, at discharge from the intensive care unit and the hospital, and on day 90. Key outcomes assessed include change in inflammatory biomarkers, vasopressor requirements, fluid balance, organ function and organ support, length of intensive care unit and hospital stay, occurrence of adverse events, and mortality. Results: The COSMOS registry started with the inclusion of the first patient on July 15, 2022, and is now actively enrolling in 4 countries (Germany, Spain, Portugal, and Italy), with plans to expand to other countries outside of Europe. An initial readout is planned for presentation at an international Critical Care conference in 2024. Conclusions: The COSMOS registry is intended to provide comprehensive real-world data on patient outcomes with CytoSorb in various critical care indications, thereby contributing to optimization of patient selection, timing of initiation, and dosing of hemoadsorption treatment. Trial Registration: ClinicalTrials.gov NCT05146336; https://clinicaltrials.gov/study/NCT05146336 International Registered Report Identifier (IRRID): DERR1-10.2196/55880 ", doi="10.2196/55880", url="https://www.researchprotocols.org/2024/1/e55880" } @Article{info:doi/10.2196/58022, author="Dennin, L{\"a}titia and Kleeff, J{\"o}rg and Klose, Johannes and Ronellenfitsch, Ulrich and Rebelo, Artur", title="Methodology for Measuring Intraoperative Blood Loss: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Oct", day="16", volume="13", pages="e58022", keywords="intraoperative blood loss", keywords="estimation of blood loss", keywords="intraoperative monitoring", keywords="surgery", keywords="surgical care", keywords="postoperative care", keywords="quality improvement", abstract="Background: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Therefore, better standardized methods are needed. Objective: This study aims to conduct a scoping review to present the currently available methods for measuring intraoperative blood loss. This should help to capture the current status and map and summarize the available evidence for measuring blood loss to identify any gaps. Methods: We will use a state-of-the-art methodological framework. The databases PubMed (MEDLINE) and Cochrane Library will be searched using a search strategy based on the PICO (Population, Intervention, Comparator, and Outcome) scheme. The search period will be limited to January 01, 2012, to December 31, 2023, and our search will be restricted to clinical trials or clinical studies, randomized controlled trials, and observational studies (in line with PubMed definition of study types). Only publications in English and German will be considered. The intention is to identify clinical studies that define ``blood loss'' as a target criterion or as a primary or secondary end point. EndNote (version 20.6; Clarivate) will be used for the screening process. The data will be collected and analyzed using Microsoft Excel (version 16.77.1). Results: The included studies will be listed in a database, and the following basic data will be extracted: title, year of publication, country, language, study type, surgical specialty, and type of procedure. The number of participants will be listed and the distribution of the participants will be documented in terms of gender and age. The following results are extracted: the type of measurement method used to measure blood loss in this study and whether the parameter ``blood loss'' was recorded as a primary or secondary outcome. Conclusions: Currently, there is no comparable review, resulting in ambiguous data regarding the prevailing measurement methods for intraoperative blood loss. The aim of this study is to provide a comprehensive overview---from methods of measurement to various formulae for calculating blood loss---and to establish a status quo. This could then serve as a foundation for further studies. International Registered Report Identifier (IRRID): DERR1-10.2196/58022 ", doi="10.2196/58022", url="https://www.researchprotocols.org/2024/1/e58022", url="http://www.ncbi.nlm.nih.gov/pubmed/39412859" } @Article{info:doi/10.2196/50585, author="Wang, Shiqi and Ji, Gang and Feng, Xiangying and Huang, Luguang and Luo, Jialin and Yu, Pengfei and Zheng, Jiyang and Yang, Bin and Wang, Xiangjie and Zhao, Qingchuan", title="Temperature Measurement Timings and the Fever Detection Rate After Gastrointestinal Surgery: Retrospective Cross-Sectional Study", journal="Interact J Med Res", year="2024", month="Oct", day="9", volume="13", pages="e50585", keywords="fever", keywords="gastrointestinal surgery", keywords="temperature measurement", keywords="temperature", keywords="detection", keywords="gastrointestinal", keywords="cross-sectional study", abstract="Background: Postoperative fever frequently indicates surgical complications and is commonly used to evaluate the efficacy of interventions against surgical stress. However, the presence of circadian rhythms in body temperature may compromise the accurate detection of fever. Objective: This study aimed to investigate the detection rate of fever under intermittent measurement. Methods: We retrospectively reviewed the clinical records of patients who underwent nonemergency gastrointestinal surgery between November 2020 and April 2021. Patients' temperature data were continuously collected every 4 seconds using a wireless axillary thermometer, and fever was defined as a temperature exceeding 38 {\textdegree}C within a day. To simulate intermittent measurement in clinical practice, the body temperature at each hour was selected from the continuously collected temperature dataset. Considering that temperatures are measured multiple times per day, all possible measurement plans using intermittent measurement were composed by combining 1-24 time points from the 24-hour daily cycle. Fever was clinically diagnosed based on the temperature readings at the selected time points per day. The fever detection rates for each plan, with varying measurement times, were listed and ranked. Results: Based on the temperature data continuously collected by the thermometer, fever occurred in 60 (40.8\%) of the 147 included patients within 3 days after surgery. Of the measurement plans that included 1-24 measurements daily, the fever detection rates ranged from 3.3\% (2/60) to 85\% (51/60). The highest detection rates and corresponding timings for measurement plans with 1, 2, 3, and 4 measurements daily were 38.3\% (23/60; at 8 PM), 56.7\% (34/60; at 3 AM and 7 or 8 PM), 65\% (39/60; at 3 AM, 8 PM, and 10 or 11 PM), and 70\% (42/60; at 12 AM, 3 AM, 8 PM, and 11 PM), respectively; and the lowest detection rates were 3.3\% (2/60), 6.7\% (4/60), 6.7\% (4/60), and 8.3\% (5/60), respectively. Although fever within 3 days after surgery was not correlated with an increased incidence of postoperative complications (5/60, 8.3\% vs 6/87, 6.9\%; P=.76), it was correlated with a longer hospital stay (median 7, IQR 6-9 days vs median 6, IQR 5-7 days; P<.001). Conclusions: The fever detection rate of the intermittent approach is determined by the timing and frequency of measurement. Measuring at randomly selected time points can miss many fever events after gastrointestinal surgery. However, we can improve the fever detection rate by optimizing the timing and frequency of measurement. ", doi="10.2196/50585", url="https://www.i-jmr.org/2024/1/e50585" } @Article{info:doi/10.2196/48959, author="Orgil, Zandantsetseg and Karthic, Anitra and Bell, F. Nora and Heisterberg, M. Lisa and Williams, E. Sara and Ding, Lili and Kashikar-Zuck, Susmita and King, D. Christopher and Olbrecht, A. Vanessa", title="Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study", journal="JMIR Perioper Med", year="2024", month="Sep", day="16", volume="7", pages="e48959", keywords="virtual reality", keywords="biofeedback", keywords="biofeedback-based virtual reality", keywords="acute pain", keywords="postoperative pain", keywords="pediatrics", keywords="postoperative", keywords="pain", keywords="anxiety", keywords="children", keywords="adolescents", keywords="perioperative management", keywords="acceptability", keywords="feasibility", keywords="pain reduction", abstract="Background: Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established. Objectives: The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF. Methods: A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF. Results: Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95\% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95\% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95\% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95\% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95\% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85\%). Few patients reported VR-BF as beneficial for pain (8/20, 40\%). Conclusions: Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. Trial Registration: ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874 ", doi="10.2196/48959", url="https://periop.jmir.org/2024/1/e48959", url="http://www.ncbi.nlm.nih.gov/pubmed/38742940" } @Article{info:doi/10.2196/59067, author="Campos, A. Brian and Cummins, Emily and Sonnay, Yves and Brindle, E. Mary and Cauley, E. Christy", title="A Digital Communication Intervention to Support Older Adults and Their Care Partners Transitioning Home After Major Surgery: Protocol for a Qualitative Research Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="28", volume="13", pages="e59067", keywords="mHealth", keywords="geriatric", keywords="surgery", keywords="care partner", keywords="qualitative study", keywords="digital intervention", keywords="intervention development", abstract="Background: Older adults (aged ?65 years) account for approximately 30\% of inpatient procedures in the United States. After major surgery, they are at high risk of a slow return to their previous functional status, loss of independence, and complications like delirium. With the development and refinement of Enhanced Recovery After Surgery protocols, older patients often return home much earlier than historically anticipated. This put a larger burden on care partners, close family or friends who partner with the patient and guide them through recovery. Without adequate preparation, both patients and their care partners may experience poor long-term outcomes. Objective: This study aimed to improve and streamline recovery for patients aged ?65 years by exploring the communication needs of patients and their care partners. Information from this study will be used to inform an intervention developed to address these needs and define processes for its implementation across surgical clinics. Methods: This qualitative research protocol has two aims. First, we will define patient and care partner needs and perspectives related to digital health innovation. To achieve this aim, we will recruit dyads of patients (aged ?65 years) who underwent elective major surgery 30-90 days prior and their respective care partners (aged ?18 years). Participants will complete individual interviews and surveys to obtain demographic data, characterize their perceptions of the surgical experience, identify intervention targets, and assess for the type of intervention modality that would be most useful. Next, we will explore clinician perspectives, tools, and strategies to develop a blueprint for a digital intervention. To achieve this aim, clinicians (eg, geriatricians, surgeons, and nurses) will be recruited for focus groups to identify current obstacles affecting surgical outcomes for older patients, and we will review current assessments and tools used in their clinical practice. A hybrid deductive-inductive approach will be undertaken to identify relevant themes. Insights from both clinicians and patient-care partners will guide the development of a digital intervention strategy to support older patients and their care partners after surgery. Results: This study has been approved by the Massachusetts General Hospital and Harvard Institutional Review Boards. Recruitment began in December 2023 for the patient and care partner interviews. As of August 2024, over half of the interviews have been performed, deidentified, and transcribed. Clinician recruitment is ongoing, with no focus groups conducted yet. The study is expected to be completed by fall 2024. Conclusions: This study will help create a scalable digital health option for older patients undergoing major surgery and their care partners. We aim to enhance our understanding of patient recovery needs; improve communication with surgical teams; and ultimately, reduce the overall burden on patients, their care partners, and health care providers through real-time assessment. International Registered Report Identifier (IRRID): DERR1-10.2196/59067 ", doi="10.2196/59067", url="https://www.researchprotocols.org/2024/1/e59067", url="http://www.ncbi.nlm.nih.gov/pubmed/39196629" } @Article{info:doi/10.2196/57344, author="Choucair, Kareem and Corrigan, Mark and O'Sullivan, Adrian and Barber, Sean and Stankiewicz, Lucja and Henn, Patrick and Dennehy, Oscar and Kayyal, Yasser Mohd and Tan, Yu Yong and Fadahunsi, Philip Kayode and O'Donoghue, John", title="Acceptability, Perceptions, and Experiences Regarding Electronic Patient-Reported Outcomes After Laparoscopic Cholecystectomy: Protocol for a Mixed Methods Feasibility Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="19", volume="13", pages="e57344", keywords="patient-reported outcomes", keywords="digital technology", keywords="hepatobiliary surgery", keywords="surgery", keywords="laparoscopic cholecystectomy", keywords="electronic patient", keywords="general surgeon", keywords="mixed methods", keywords="prospective study", keywords="quantitative", keywords="qualitative", keywords="Qualtrics", keywords="interview", keywords="Microsoft Teams", keywords="data collection", keywords="patient care", keywords="patient-centric", keywords="patient-doctor communication", keywords="eHealth", abstract="Background: Patient-reported outcomes (PROs) can be defined as any report of a patient's health taken directly from the patient. Routine collection of PRO data has been shown to offer potential benefits to patient-doctor communication. Electronic forms of PRO measures (PROMs) could be more beneficial in comparison to traditional PROMs in obtaining PROs from patients. However, it is currently unclear whether the routine collection of electronic PRO data could result in better outcomes for patients undergoing laparoscopic cholecystectomy (LC). Objective: This study aims to explore the perspectives of patients and surgeons on the use of electronic PROMs. Based on prior research, technical skill and experience level of the surgeon, long-term quality of life, patient involvement in decision-making, communication skills of the surgeon, cleanliness of the ward environment, and standards of nursing care are identified to be the most important factors for the patients. Methods: This is a mixed methods prospective study that will collect both quantitative (survey) and qualitative (interview) data. The study has two components. The first involves the distribution of an electronic presurvey to patients who received elective LC within 48 hours of their surgery (n=80). This survey will explore the perspective of patients regarding the procedure, hospital experience, long-term outcomes, and the perceived value of using PROMs. These patients will then be followed up after 1 year and given another survey. The second component involves the distribution of the same survey and the completion of structured interviews with general surgeons (n=10). The survey will ascertain what PROs from the participants are most useful for the surgeons and the interviews will focus on how the surgeons view routine PRO collection. A convenience sampling approach will be used. Surveys will be distributed through Qualtrics and interviews will be completed on Microsoft Teams. Results: Data collection began on February 14, 2023. As of February 12, 2024, 71 of 80 recruited patients have been given the presurvey. The follow-up with the patients and the general surgeon components of the study have not begun. The expected completion date of this study is in April 2025. Conclusions: Overall, this study will investigate the potential of electronic PRO collection to offer value for patients and general surgeons. This approach will ensure that patient care is investigated in a multifaceted way, offering patient-centric guidance to surgeons in their approach to care. International Registered Report Identifier (IRRID): DERR1-10.2196/57344 ", doi="10.2196/57344", url="https://www.researchprotocols.org/2024/1/e57344" } @Article{info:doi/10.2196/52278, author="Turzhitsky, Vladimir and Bash, D. Lori and Urman, D. Richard and Kattan, Michael and Hofer, Ira", title="Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis", journal="JMIR Perioper Med", year="2024", month="Jul", day="22", volume="7", pages="e52278", keywords="neuromuscular blockade", keywords="sugammadex", keywords="neostigmine", keywords="rocuronium, vecuronium, intubation, counterfactual", keywords="anesthesia", keywords="anesthetic", keywords="anesthesiologist", keywords="anesthesiologists", keywords="surgery", keywords="surgical", keywords="preference", keywords="preferences", keywords="retrospective", keywords="utilization", keywords="pattern", keywords="patterns", keywords="trend", keywords="trends", keywords="national", keywords="healthcare database", keywords="healthcare databases", keywords="COVID-19", keywords="time-trend analysis", keywords="neuromuscular", keywords="longitudinal analysis", keywords="longitudinal", keywords="neuromuscular blockade agent", keywords="clinical", keywords="surgical procedure", keywords="inpatient", keywords="inpatient surgery", keywords="retrospective analysis", keywords="USA", keywords="United States", abstract="Background: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. Objective: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. Methods: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19--era patients would have been treated before the pandemic. Results: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post--COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre--COVID-19 trend (odds ratio [OR] 1.008, 95\% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95\% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95\% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95\% CI 0.983-0.992; P<.001). Conclusions: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends. ", doi="10.2196/52278", url="https://periop.jmir.org/2024/1/e52278" } @Article{info:doi/10.2196/48802, author="Park, Sunghee and Lee, Sohye and Howard, Sheri and Yi, Jeeseon", title="Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="8", volume="12", pages="e48802", keywords="technology", keywords="music intervention", keywords="anxiety", keywords="pain", abstract="Background: Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions. Objective: We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles. Methods: The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2. Results: Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50\% (13/21, 62\%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions. Conclusions: Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients. ", doi="10.2196/48802", url="https://mhealth.jmir.org/2024/1/e48802" } @Article{info:doi/10.2196/55948, author="Zhao, Li and Guo, Yiping and Zhou, Xuelei and Mao, Wei and Chen, Linlin and Xie, Ying and Li, Linji", title="Efficacy and Safety of Remimazolam Versus Etomidate for Induction of General Anesthesia: Protocol for a Systematic Review and Meta-Analysis", journal="JMIR Res Protoc", year="2024", month="Jun", day="12", volume="13", pages="e55948", keywords="general anesthesia", keywords="anesthesia induction", keywords="postinduction hypotension", keywords="remimazolam", keywords="etomidate", keywords="meta-analysis", abstract="Background: Postinduction hypotension (PIHO) is a hemodynamic abnormality commonly observed during the induction of general anesthesia. Etomidate is considered a safer drug for the induction of anesthesia because it has only minor adverse effects on the cardiovascular and pulmonary systems. Recent evidence indicates that the novel benzodiazepine remimazolam has minimal inhibitory effects on the circulation and respiration. However, the efficacy and safety of remimazolam versus etomidate in the induction of anesthesia are unclear. Objective: To further understand the potential of remimazolam in anesthesia induction, it is necessary to design a meta-analysis to compare its effects versus the classic safe anesthetic etomidate. The aim of this study is to determine which drug has more stable hemodynamics and a lower incidence of PIHO. Our study will also yield data on sedation efficiency, time to loss of consciousness, time to awakening, incidence of injection pain, and postoperative nausea and vomiting with the two drugs. Methods: We plan to search the Web of Science, Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure, and Wanfang databases from the date of their creation until March 31, 2025. The language is limited to English and Chinese. The search terms are ``randomized controlled trials,'' ``etomidate,'' and ``remimazolam.'' The incidence of PIHO is the primary outcome measure. Secondary outcomes include depth of anesthesia after induction, sedation success rate, time to loss of consciousness, hemodynamic profiles, recovery time, incidence of injection pain, and postoperative nausea and vomiting. Reviews, meta-analyses, case studies, abstracts from conferences, and commentaries will not be included. The heterogeneity of the results will be evaluated by sensitivity and subgroup analyses. RevMan software and Stata software will be used for data analysis. We will evaluate the quality of included studies using version 2 of the Cochrane risk-of-bias tool. The confidence of the evidence will be assessed through the Grading of Recommendations, Assessments, Developments, and Evaluations system. Results: The protocol was registered in the international PROSPERO (Prospective Register of Systematic Reviews) registry in November 2023. As of June 2024, we have performed a preliminary article search and retrieval for further review. The review and analyses are expected to be completed in March 2025. We expect to submit manuscripts for peer review by the end of June 2025. Conclusions: By synthesizing the available evidence and comparing remimazolam and etomidate, we hope to provide valuable insights into the selection of anesthesia-inducing drugs to reduce the incidence of PIHO and improve patient prognosis. Trial Registration: PROSPERO CRD42023463120; https://tinyurl.com/333jb8bm International Registered Report Identifier (IRRID): PRR1-10.2196/55948 ", doi="10.2196/55948", url="https://www.researchprotocols.org/2024/1/e55948", url="http://www.ncbi.nlm.nih.gov/pubmed/38865185" } @Article{info:doi/10.2196/54089, author="Neuhaus, Melina and Friedrichs, Juliane and Grilli, Maurizio and Ukkat, J{\"o}rg and Klose, Johannes and Ronellenfitsch, Ulrich and Kleeff, J{\"o}rg and Rebelo, Artur", title="Multivisceral Oncological Resections Involving the Pancreas: Protocol for a Systematic Review and Meta-Analysis", journal="JMIR Res Protoc", year="2024", month="Jun", day="11", volume="13", pages="e54089", keywords="meta-analysis", keywords="systematic review", keywords="multivisceral resection", keywords="pancreatic resection", keywords="oncological resection", keywords="surgery", keywords="outcomes", keywords="mortality", keywords="morbidity", keywords="survival", keywords="cancer", keywords="tumor", keywords="pancreas", abstract="Background: With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. Objective: This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing evidence concerning the outcomes of multivisceral oncological pancreatic resections across diverse tumor entities. Methods: We will conduct a systematic search of the PubMed or MEDLINE, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The predefined outcomes encompass postoperative mortality, postoperative morbidity, overall and disease-free survival (1- to 5-year survival rates), the proportion of macroscopically complete (R0) resections (according to the Royal College of Pathologists definition), duration of hospital stay (in days), reoperation rate (\%), postoperative complications (covering all complications according to the Clavien-Dindo classification), as well as pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying (all according to the definitions of the International Study Group of Pancreas Surgery). Results: Systematic database searches will begin in July 2024. The completion of the meta-analysis is anticipated by December 2024. Before completion, the literature search will be checked for new publications that must be considered in the context of the work. Conclusions: The forthcoming findings will provide an up-to-date overview of the feasibility, safety, and oncological efficacy of multivisceral pancreatic resections across diverse tumor entities. This data will serve as a valuable resource for health care professionals and patients to make well-informed clinical decisions. Trial Registration: PROSPERO CRD42023437858; https://tinyurl.com/bde5xmfw International Registered Report Identifier (IRRID): PRR1-10.2196/54089 ", doi="10.2196/54089", url="https://www.researchprotocols.org/2024/1/e54089", url="http://www.ncbi.nlm.nih.gov/pubmed/38861712" } @Article{info:doi/10.2196/47525, author="Chabrak, Sonia and Haggui, Abdeddayem and Allouche, Emna and Ouali, Sana and Ben Halima, Afef and Kacem, Slim and Krichen, Salma and Marrakchi, Sonia and Fehri, Wafa and Mourali, Sami Mohamed and Jabbari, Zeineb and Ben Halima, Manel and Neffati, Elyes and Heraiech, Aymen? and Slim, Mehdi and Kachboura, Salem and Gamra, Habib and Hassine, Majed and Kraiem, Sondes and Kammoun, Sofien and Bezdah, Leila and Jridi, Gouider and Bouraoui, Hatem and Kammoun, Samir and Hammami, Rania and Chettaoui, Rafik and Ben Ameur, Youssef and Azaiez, Fares and Tlili, Rami and Battikh, Kais and Ben Slima, Hedi and Chrigui, Rim and Fazaa, Samia and Sanaa, Islem and Ellouz, Yassine and Mosrati, Mohamed and Milouchi, Sami and Jarmouni, Soumaya and Ayadi, Wacef and Akrout, Malek and Razgallah, Rabie and Neffati, Wissal and Drissa, Meriem and Charfeddine, Selma and Abdessalem, Salem and Abid, Leila and Zakhama, Lilia", title="National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="8", volume="13", pages="e47525", keywords="Tunisia", keywords="study", keywords="pacemaker", keywords="implantable cardioverter defibrillator", keywords="cardiac resynchronization therapy", keywords="design", keywords="complication", abstract="Background: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. Objective: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. Methods: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). Results: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60\%) patients were from the public sector, while 600 (40\%) patients were from the private sector. A total of 1298 (86.3\%) patients received a conventional pacemaker and 75 (5\%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5\%) patients. Of these patients, 45 (3\%) underwent CRT-D implantation. Conclusions: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial Registration: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID): RR1-10.2196/47525 ", doi="10.2196/47525", url="https://www.researchprotocols.org/2024/1/e47525", url="http://www.ncbi.nlm.nih.gov/pubmed/38588529" } @Article{info:doi/10.2196/52125, author="Esper, Andrew Stephen and Holder-Murray, Jennifer and Meister, Ann Katie and Lin, Sylvia Hsing-Hua and Hamilton, Kojo David and Groff, Jan Yram and Zuckerbraun, Scott Brian and Mahajan, Aman", title="A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System", journal="JMIR Perioper Med", year="2024", month="Apr", day="4", volume="7", pages="e52125", keywords="digital health solution", keywords="feasibility", keywords="length of stay reduction", keywords="patient engagement", keywords="patient satisfaction", keywords="perioperative medicine", abstract="Background: Pip is a novel digital health platform (DHP) that combines human health coaches (HCs) and technology with patient-facing content. This combination has not been studied in perioperative surgical optimization. Objective: This study's aim was to test the feasibility of the Pip platform for deploying perioperative, digital, patient-facing optimization guidelines to elective surgical patients, assisted by an HC, at predefined intervals in the perioperative journey. Methods: We conducted an institutional review board--approved, descriptive, prospective feasibility study of patients scheduled for elective surgery and invited to enroll in Pip from 2.5 to 4 weeks preoperatively through 4 weeks postoperatively at an academic medical center between November 22, 2022, and March 27, 2023. Descriptive primary end points were patient-reported outcomes, including patient satisfaction and engagement, and Pip HC evaluations. Secondary end points included mean or median length of stay (LOS), readmission at 7 and 30 days, and emergency department use within 30 days. Secondary end points were compared between patients who received Pip versus patients who did not receive Pip using stabilized inverse probability of treatment weighting. Results: A total of 283 patients were invited, of whom 172 (60.8\%) enrolled in Pip. Of these, 80.2\% (138/172) patients had ?1 HC session and proceeded to surgery, and 70.3\% (97/138) of the enrolled patients engaged with Pip postoperatively. The mean engagement began 27 days before surgery. Pip demonstrated an 82\% weekly engagement rate with HCs. Patients attended an average of 6.7 HC sessions. Of those patients that completed surveys (95/138, 68.8\%), high satisfaction scores were recorded (mean 4.8/5; n=95). Patients strongly agreed that HCs helped them throughout the perioperative process (mean 4.97/5; n=33). The average net promoter score was 9.7 out of 10. A total of 268 patients in the non-Pip group and 128 patients in the Pip group had appropriate overlapping distributions of stabilized inverse probability of treatment weighting for the analytic sample. The Pip cohort was associated with LOS reduction when compared to the non-Pip cohort (mean 2.4 vs 3.1days; median 1.9, IQR 1.0-3.1 vs median 3.0, IQR 1.1-3.9 days; mean ratio 0.76; 95\% CI 0.62-0.93; P=.009). The Pip cohort experienced a 49\% lower risk of 7-day readmission (relative risk [RR] 0.51, 95\% CI 0.11-2.31; P=.38) and a 17\% lower risk of 30-day readmission (RR 0.83, 95\% CI 0.30-2.31; P=.73), though these did not reach statistical significance. Both cohorts had similar 30-day emergency department returns (RR 1.06, 95\% CI 0.56-2.01, P=.85). Conclusions: Pip is a novel mobile DHP combining human HCs and perioperative optimization content that is feasible to engage patients in their perioperative journey and is associated with reduced hospital LOS. Further studies assessing the impact on clinical and patient-reported outcomes from the use of Pip or similar DHPs HC combinations during the perioperative journey are required. ", doi="10.2196/52125", url="https://periop.jmir.org/2024/1/e52125", url="http://www.ncbi.nlm.nih.gov/pubmed/38573737" } @Article{info:doi/10.2196/54344, author="Rohatgi, Nidhi", title="JMIR Perioperative Medicine: A Global Journal for Publishing Interdisciplinary Innovations, Research, and Perspectives", journal="JMIR Perioper Med", year="2023", month="Nov", day="21", volume="6", pages="e54344", keywords="JMIR Perioperative Medicine", keywords="innovation", keywords="technology", keywords="digital health", keywords="research", keywords="interdisciplinary", keywords="perioperative medicine", doi="10.2196/54344", url="https://periop.jmir.org/2023/1/e54344", url="http://www.ncbi.nlm.nih.gov/pubmed/37988142" } @Article{info:doi/10.2196/50212, author="Smith, Ben and Paton, Christopher and Ramaraj, Prashanth", title="Teaching Basic Surgical Skills Using a More Frugal, Near-Peer, and Environmentally Sustainable Way: Mixed Methods Study", journal="JMIR Perioper Med", year="2023", month="Nov", day="15", volume="6", pages="e50212", keywords="basic surgical skills", keywords="frugal", keywords="low cost", keywords="peer-assisted learning", keywords="near-peer learning", keywords="environmentally sustainable", keywords="free", keywords="surgical education", abstract="Background: The Royal College of Surgeons Basic Surgical Skills (BSS) course is ubiquitous among UK surgical trainees but is geographically limited and costly. The COVID-19 pandemic has reduced training quality. Surveys illustrate reduced logbook completion and increased trainee attrition. Local, peer-led teaching has been shown to be effective at increasing confidence in surgical skills in a cost-effective manner. Qualitative data on trainee well-being, recruitment, and retention are lacking. Objective: This study aims to evaluate the impact of a novel program of weekly, lunchtime BSS sessions on both quantitative and qualitative factors. Methods: A weekly, lunchtime BSS course was designed to achieve the outcomes of the Royal College of Surgeons BSS course over a 16-week period overlapping with 1 foundation doctor rotation. All health care workers at the study center were eligible to participate. The study was advertised via the weekly, trust-wide information email. Course sessions included knot tying, suturing, abscess incision and drainage, fracture fixation with application of plaster of Paris, joint aspirations and reductions, abdominal wall closure, and basic laparoscopic skills. The hospital canteen sourced unwanted pig skin from the local butcher for suturing sessions and pork belly for abscess and abdominal wall closure sessions. Out-of-date surgical equipment was used. This concurrent, nested, mixed methods study involved descriptive analysis of perceived improvement scores in each surgical skill before and after each session, over 4 iterations of the course (May 2021 to August 2022). After the sessions, students completed a voluntary web-based feedback form scoring presession and postsession confidence levels on a 5-point Likert scale. Qualitative thematic analysis of voluntary semistructured student interview transcripts was also performed to understand the impact of a free-to-attend, local, weekly, near-peer teaching course on perceived well-being, quality of training, and interest in a surgical career. Students consented to the use of feedback and interview data for this study. Ethics approval was requested but deemed not necessary by the study center's ethics committee. Results: There were 64 responses. Confidence was significantly improved from 47\% to 73\% (95\% CI 15\%-27\%; P<.001; t13=5.3117) across all surgical skills over 4 iterations. Among the 7 semistructured interviews, 100\% (7/7) of the participants reported improved perceived well-being, value added to training, and positivity toward near-peer teaching and 71\% (5/7) preferred local weekly teaching. Interest in a surgical career was unchanged. Conclusions: This course was feasible around clinical workloads, resourced locally at next to no cost, environmentally sustainable, and free to attend. The course offered junior doctors not only a weekly opportunity to learn but also to teach. Peer-led, decentralized surgical education increases confidence and has a positive effect on perceptions about well-being and training. We hope to disseminate this course, leading to reproduction in other centers, refinement, and wide implementation. ", doi="10.2196/50212", url="https://periop.jmir.org/2023/1/e50212", url="http://www.ncbi.nlm.nih.gov/pubmed/37966886" } @Article{info:doi/10.2196/40831, author="Ramaswamy, Priya and Shah, Aalap and Kothari, Rishi and Schloemerkemper, Nina and Methangkool, Emily and Aleck, Amalia and Shapiro, Anne and Dayal, Rakhi and Young, Charlotte and Spinner, Jon and Deibler, Carly and Wang, Kaiyi and Robinowitz, David and Gandhi, Seema", title="An Accessible Clinical Decision Support System to Curtail Anesthetic Greenhouse Gases in a Large Health Network: Implementation Study", journal="JMIR Perioper Med", year="2022", month="Dec", day="8", volume="5", number="1", pages="e40831", keywords="clinical decision support", keywords="sustainability", keywords="intraoperative", keywords="perioperative", keywords="anesthetic gas", keywords="waste reduction", keywords="fresh gas flow", abstract="Background: Inhaled anesthetics in the operating room are potent greenhouse gases and are a key contributor to carbon emissions from health care facilities. Real-time clinical decision support (CDS) systems lower anesthetic gas waste by prompting anesthesia professionals to reduce fresh gas flow (FGF) when a set threshold is exceeded. However, previous CDS systems have relied on proprietary or highly customized anesthesia information management systems, significantly reducing other institutions' accessibility to the technology and thus limiting overall environmental benefit. Objective: In 2018, a CDS system that lowers anesthetic gas waste using methods that can be easily adopted by other institutions was developed at the University of California San Francisco (UCSF). This study aims to facilitate wider uptake of our CDS system and further reduce gas waste by describing the implementation of the FGF CDS toolkit at UCSF and the subsequent implementation at other medical campuses within the University of California Health network. Methods: We developed a noninterruptive active CDS system to alert anesthesia professionals when FGF rates exceeded 0.7 L per minute for common volatile anesthetics. The implementation process at UCSF was documented and assembled into an informational toolkit to aid in the integration of the CDS system at other health care institutions. Before implementation, presentation-based education initiatives were used to disseminate information regarding the safety of low FGF use and its relationship to environmental sustainability. Our FGF CDS toolkit consisted of 4 main components for implementation: sustainability-focused education of anesthesia professionals, hardware integration of the CDS technology, software build of the CDS system, and data reporting of measured outcomes. Results: The FGF CDS system was successfully deployed at 5 University of California Health network campuses. Four of the institutions are independent from the institution that created the CDS system. The CDS system was deployed at each facility using the FGF CDS toolkit, which describes the main components of the technology and implementation. Each campus made modifications to the CDS tool to best suit their institution, emphasizing the versatility and adoptability of the technology and implementation framework. Conclusions: It has previously been shown that the FGF CDS system reduces anesthetic gas waste, leading to environmental and fiscal benefits. Here, we demonstrate that the CDS system can be transferred to other medical facilities using our toolkit for implementation, making the technology and associated benefits globally accessible to advance mitigation of health care--related emissions. ", doi="10.2196/40831", url="https://periop.jmir.org/2022/1/e40831", url="http://www.ncbi.nlm.nih.gov/pubmed/36480254" } @Article{info:doi/10.2196/38690, author="Venkatraman, Vishal and Kirsch, P. Elayna and Luo, Emily and Kunte, Sameer and Ponder, Madison and Gellad, F. Ziad and Liu, Beiyu and Lee, Hui-Jie and Jung, Sin-Ho and Haglund, M. Michael and Lad, P. Shivanand", title="Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis", journal="JMIR Perioper Med", year="2022", month="Oct", day="26", volume="5", number="1", pages="e38690", keywords="digital health", keywords="spine surgery", keywords="surgical outcomes", keywords="mobile health", keywords="mobile application", keywords="surgery", keywords="postoperative", keywords="mobile app", keywords="mHealth", keywords="recovery", abstract="Background: Digital health solutions have been shown to enhance outcomes for individuals with chronic medical illnesses, but few have been validated for surgical patients. The digital health platform ManageMySurgery (MMS) has been validated for spine surgery as a feasible method for patients along their surgical journey through in-app education and completion of patient-reported outcomes surveys. Objective: The aim of this study is to determine the rates of 90-day emergency room (ER) visits, readmissions, and complications in patients undergoing spine surgery using MMS compared to patients using traditional perioperative care alone. Methods: Patients undergoing spine surgery at a US-based academic hospital were invited to use MMS perioperatively between December 2017 and September 2021. All patients received standard perioperative care and were classified as MMS users if they logged into the app. Demographic information and 90-day outcomes?were acquired via electronic health record review. The odds ratios of having 90-day ER visits, readmissions, mild complications, and severe complications between the MMS and non-MMS groups were estimated using logistic regression models. Results: A total of 1015 patients were invited, with 679 using MMS. MMS users and nonusers had similar demographics: the average ages were 57.9 (SD 12.5) years and 61.5 (SD 12.7) years, 54.1\% (367/679) and 47.3\% (159/336) were male, and 90.1\% (612/679) and 88.7\% (298/336) had commercial or Medicare insurance, respectively. Cervical fusions (559/1015, 55.07\%) and single-approach lumbar fusions (231/1015, 22.76\%) were the most common procedures for all patients. MMS users had a lower 90-day readmission rate (55/679, 8.1\%) than did nonusers (30/336, 8.9\%). Mild complications (MMS: 56/679, 8.3\%; non-MMS: 32/336, 9.5\%) and severe complications (MMS: 66/679, 9.7\%; non-MMS: 43/336, 12.8\%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1\%; non-MMS: 45/336, 13.4\%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32\% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95\% CI 0.45-1.02; P=.06). Conclusions: This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes. ", doi="10.2196/38690", url="https://periop.jmir.org/2022/1/e38690", url="http://www.ncbi.nlm.nih.gov/pubmed/36287589" } @Article{info:doi/10.2196/33276, author="Comp{\`e}re, Vincent and Mauger, Alban and Allard, Etienne and Clavier, Thomas and Selim, Jean and Besnier, Emmanuel", title="Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study", journal="JMIR Perioper Med", year="2022", month="Oct", day="25", volume="5", number="1", pages="e33276", keywords="day surgery", keywords="postoperative pain", keywords="emergency consultation", keywords="rehospitalization", keywords="ambulatory management", keywords="pain management", keywords="postsurgery", keywords="postoperative", keywords="ambulatory surgery", keywords="hospitalization", keywords="health care", keywords="mobile health", keywords="mobile platform", abstract="Background: The most frequent complication observed after ambulatory surgery is acute postoperative pain. Objective: The purpose of this study was to evaluate the late incidence of postoperative pain at 7 days after day surgery. Methods: We retrospectively included patients who underwent day surgery under general or regional anesthesia and those who underwent local anesthesia in Rouen University Hospital from January 2018 to February 2020. Data collected were moderate-to-severe pain reports defined as numeric rating scale (NRS)>3/10 at 1 day (secondary end point) and 7 days (primary end point) after surgery. These data were collected using a semi-intelligent SMS text messaging platform to follow up with the patient at home after ambulatory surgery. Univariate and multivariate analyses were performed to analyze the risk factors for pain. Results: We analyzed 6099 patients. On the day after the surgery, 5.2\% (318/6099) of the patients presented with moderate-to-severe pain: 5.9\% (248/4187) in the general or regional anesthesia group and 3.7\% (70/1912) in the local anesthesia group. At 7 days after the surgery, 18.6\% (1135/6099) of the patients presented with moderate-to-severe pain, including 21.3\% (892/4187) of the patients in the general or regional anesthesia group and 12.7\% (243/1912) of the patients in the local anesthesia group. General surgery (odds ratio [OR] 1.54, 95\% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95\% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95\% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95\% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95\% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1\% (679/6099). Late postoperative pain (OR 2.54, 95\% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95\% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95\% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95\% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95\% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization. Conclusions: Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18\% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates. ", doi="10.2196/33276", url="https://periop.jmir.org/2022/1/e33276", url="http://www.ncbi.nlm.nih.gov/pubmed/36282551" } @Article{info:doi/10.2196/33414, author="Harris, A. Ian and Peng, Yi and Ackerman, Ilana and Graves, E. Stephen", title="The Association Between Preoperative Patient-Reported Health Status and Postoperative Survey Completion Following Arthroplasty: Registry-Based Cohort Study", journal="JMIR Perioper Med", year="2022", month="Jun", day="30", volume="5", number="1", pages="e33414", keywords="total knee arthroplasty", keywords="total hip arthroplasty", keywords="patient-reported outcomes", keywords="perioperative medicine", keywords="postoperative medicine", keywords="knee surgery", keywords="arthroplasty", keywords="quality of life", keywords="surgical outcomes", keywords="cohort study", keywords="survey", keywords="health survey", keywords="hip", keywords="knee", keywords="", abstract="Background: Patient-reported outcome measures (PROMs) are commonly used to report outcomes after hip and knee arthroplasty, but response rates are rarely complete. Given that preoperative health status (as measured by PROMs) is a strong predictor of outcomes (using the same measures) and that these outcomes may influence the response rate, it is possible that postoperative response rates (the proportion of patients providing preoperative PROMs who also provide postoperative PROMs) may be influenced by preoperative health status. Objective: This study aims to test the association between preoperative PROMs and postoperative response status following hip and knee arthroplasty. Methods: Data from the PROMs program of the Australian national joint registry were used. The preoperative PROMs were the Oxford Hip Score or Oxford Knee Score, The EQ-5D Utility Index, and the EQ visual analog scale (VAS) for overall health. Logistic regression, adjusting for age, sex, BMI, and the American Society of Anesthesiologists (ASA) Physical Status Classification System, was used to test the association between each preoperative PROM and response status for the 6-month postsurgery survey. Results: Data from 9499 and 16,539 patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis, respectively, were included in the analysis. Adjusting for age, sex, BMI, and ASA, there was no significant difference in response status at the postoperative follow-up based on the preoperative Oxford Hip or Knee Scores (odds ratio [OR] 1.00, 95\% CI 0.99-1.01 for both; P=.70 for THA and P=.85 for TKA). Healthier patients (based on the EQ VAS scores) preoperatively were more likely to respond postoperatively, but this difference was negligible (OR 1.00, 95\% CI 1.00-1.01 for THA and TKA; P=.004 for THA and P<.001 for TKA). The preoperative EQ Utility Index was not associated with the postoperative response rate for THA (OR 1.14, 95\% CI 0.96-1.36; P=.13) or TKA patients (OR 1.05, 95\% CI 0.91-1.22; P=.49). Conclusions: The likelihood of responding to a postoperative PROMs survey for patients undergoing hip or knee arthroplasty was not associated with clinically important differences in preoperative patient-reported joint pain, function, or health-related quality of life. This suggests that the assessment of postoperative outcomes in hip and knee arthroplasty is not biased by differences in preoperative health measures between responders and nonresponders. ", doi="10.2196/33414", url="https://periop.jmir.org/2022/1/e33414", url="http://www.ncbi.nlm.nih.gov/pubmed/35771616" } @Article{info:doi/10.2196/33926, author="Jalilian, Laleh and Wu, Irene and Ing, Jakun and Dong, Xuezhi and Sadik, Joshua and Pan, George and Hitson, Heather and Thomas, Erin and Grogan, Tristan and Simkovic, Michael and Kamdar, Nirav", title="Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study", journal="JMIR Perioper Med", year="2022", month="Apr", day="27", volume="5", number="1", pages="e33926", keywords="COVID-19", keywords="pain management", keywords="telemedicine", keywords="cost savings", keywords="patient satisfaction", abstract="Background: An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, health care providers have used telemedicine for pain management of both interventional patients and those with chronic pain. Objective: In this study, we aimed to describe the implementation of a telemedicine program for pain management in an academic pain division in a large metropolitan area. We also aimed to estimate patient cost savings from telemedicine, before and after the California COVID-19 ``Safer at Home'' directive, and to estimate patient satisfaction with telemedicine for pain management care. Methods: This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1398 patients and conducted 2948 video visits for remote pain management care. We used the publicly available Internal Revenue Service's Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimated median travel time and travel distance with Google Maps' Distance Matrix application programming interface, direct cost of travel with median value for regular fuel cost in California, and time-based opportunity savings from estimated hourly earnings and round-trip time. We reported patient satisfaction scores derived from a postvisit satisfaction survey containing questions with responses on a 5-point Likert scale. Results: Patients who attended telemedicine visits avoided an estimated median round-trip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within the sample, their median hourly earnings were US \$28 (IQR US \$21-\$39) per hour. Patients saved a median of US \$22 on gas and parking and a median total of US \$52 (IQR US \$36-\$75) per telemedicine visit based on estimated hourly earnings and travel time. Patients who were evaluated serially with telemedicine for medication management saved a median of US \$156 over a median of 3 visits. A total of 91.4\% (286/313) of patients surveyed were satisfied with their telemedicine experience. Conclusions: Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for patients with pain. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings. ", doi="10.2196/33926", url="https://periop.jmir.org/2022/1/e33926", url="http://www.ncbi.nlm.nih.gov/pubmed/35023841" } @Article{info:doi/10.2196/34522, author="Kunkes, Taylor and Makled, Basiel and Norfleet, Jack and Schwaitzberg, Steven and Cavuoto, Lora", title="Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis", journal="JMIR Perioper Med", year="2022", month="Apr", day="21", volume="5", number="1", pages="e34522", keywords="knowledge elicitation", keywords="knowledge acquisition", keywords="medical simulation", keywords="medical training", keywords="medical assessment", keywords="critical care", keywords="cognitive task analysis", keywords="qualitative methods", keywords="qualitative", keywords="endotracheal intubation", keywords="preoperative", keywords="training", keywords="health care professional", keywords="medical education", keywords="cognitive skill", abstract="Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. ", doi="10.2196/34522", url="https://periop.jmir.org/2022/1/e34522", url="http://www.ncbi.nlm.nih.gov/pubmed/35451970" } @Article{info:doi/10.2196/35415, author="Aminabadi, Asl Naser and Golsanamlou, Ozra and Halimi, Zohreh and Jamali, Zahra", title="Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial", journal="JMIR Perioper Med", year="2022", month="Apr", day="18", volume="5", number="1", pages="e35415", keywords="virtual reality", keywords="anxiety", keywords="behavior", keywords="oral health training", abstract="Background: Compared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry. Objective: This study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status. Methods: This study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants' anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions. Results: The greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18). Conclusions: The most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children. Trial Registration: Iranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475 ", doi="10.2196/35415", url="https://periop.jmir.org/2022/1/e35415", url="http://www.ncbi.nlm.nih.gov/pubmed/35436233" } @Article{info:doi/10.2196/34936, author="Traxler, D. Brett and Rucker, M. Brayden and Greenough, C. Mary and Sajjadi, B. Nicholas and Hartwell, Micah", title="Influence of the COVID-19 Pandemic on Clinical Trial Discontinuation in Anesthesiology: Cross-sectional Analysis", journal="JMIR Perioper Med", year="2022", month="Apr", day="5", volume="5", number="1", pages="e34936", keywords="clinical trials", keywords="anesthesia", keywords="anesthesiology", keywords="COVID-19", keywords="pandemic", keywords="perioperative care", keywords="lockdown", abstract="Background: The COVID-19 pandemic drastically altered perioperative medical practice owing to safety concerns, postponing elective or nonemergent procedures, supply chain shortages, and reallocating perioperative staff to care for patients with COVID-19. However, the impact of the pandemic on the conduct on anesthesiology clinical research is unknown. Objective: The primary objective was to quantify the magnitude of the COVID-19 pandemic's impact on anesthesiology clinical research. Methods: We performed a systematic search using ClinicalTrials.gov to identify clinical trials related to the practice of anesthesiology. We screened trials with status updates from January 1, 2020, through October 1, 2021, to capture trials potentially affected by the COVID-19 pandemic by the time of our search. Investigators screened for relevant studies and extracted trial characteristics along with the reason for discontinuation reported on the clinical trial registry. Results: A total of 823 clinical trials met inclusion criteria, and 146 clinical trials were discontinued within the designated date range. In total, 24 (16.4\%) of the 146 clinical trials were halted explicitly owing to the COVID-19 pandemic. A significant association existed between trial enrollment numbers and the likelihood of discontinuation due to the COVID-19 pandemic, as larger trials were more likely to be disrupted (z=--2.914, P=.004). Conclusions: The COVID-19 pandemic is reportedly associated with the discontinuation of anesthesiology-related clinical trials. With the uncertain course of the COVID-19 pandemic, developing anesthesia trial protocols to help minimize social interaction and prevent premature trial disruption are imperative. ", doi="10.2196/34936", url="https://periop.jmir.org/2022/1/e34936", url="http://www.ncbi.nlm.nih.gov/pubmed/35358057" } @Article{info:doi/10.2196/35584, author="Matava, Clyde and So, Jeannette and Williams, RJ and Kelley, Simon and ", title="A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19--Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends---Extra Lists (ORRACLE-Xtra) Implementation Study", journal="JMIR Perioper Med", year="2022", month="Mar", day="15", volume="5", number="1", pages="e35584", keywords="waiting lists", keywords="quality improvement", keywords="patient satisfaction", keywords="COVID-19", keywords="ambulatory surgery", keywords="pandemics", keywords="Canada", abstract="Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends---Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5\% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5\%), with 38.1\% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8\% (110/121), with 79\% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. ", doi="10.2196/35584", url="https://periop.jmir.org/2022/1/e35584", url="http://www.ncbi.nlm.nih.gov/pubmed/34887242" } @Article{info:doi/10.2196/23090, author="Nilsson, Ulrica and Dahlberg, Karuna and Jaensson, Maria", title="Swedish Web Version of the Quality of Recovery Scale Adapted for Patients Undergoing Local Anesthesia and Peripheral Nerve Blockade (SwQoR-LA): Prospective Psychometric Evaluation Study", journal="JMIR Perioper Med", year="2021", month="Jan", day="15", volume="4", number="1", pages="e23090", keywords="day surgery", keywords="local anesthesia", keywords="peripheral nerve blockade", keywords="postoperative recovery", keywords="psychometric evaluation", abstract="Background: The frequency and timing of assessing patient symptoms and discomfort during postoperative recovery are goals. Therefore, real-time recovery evaluation has been suggested to identify specific deficits in patient recovery. Objective: This study aimed to psychometrically evaluate the Swedish Web Version of the Quality of Recovery (SwQoR) Scale adapted for patients undergoing local and peripheral nerve block (SwQoR-LA). Methods: This was a secondary analysis of a psychometric evaluation of 107 patients aged ?18 years undergoing day surgery under local or peripheral nerve block anesthesia at 4 different day surgery departments in Sweden. The SwQoR-LA, available through a mobile app called Recovery Assessment by Phone Points (RAPP), was completed daily on postoperative days 1-7. Results: Some evidence of construct validity was supported, and discriminant validity was found in 7 of 8 items related to general anesthesia. The internal consistency was acceptable (.87-.89), and the split-half reliability was 0.80-0.86. Cohen d effect size was 0.98, and the percentage of change from baseline was 43.4\%. No floor nor ceiling effects were found. Conclusions: The SwQoR-LA is valid, reliable, responsive, and clinically feasible for digital real-time recovery assessment of patient recovery to identify specific deficits in patient recovery and detect those patients who might bene?t from a timely intervention. Trial Registration: ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-009901 ", doi="10.2196/23090", url="http://periop.jmir.org/2021/1/e23090/", url="http://www.ncbi.nlm.nih.gov/pubmed/33448932" } @Article{info:doi/10.2196/17669, author="Winchester, E. David and Cagino, Leigh", title="A Redesigned Order Entry System for Reducing Low-Value Preprocedural Cardiology Consultations: Quality-Improvement Cohort Study", journal="JMIR Perioper Med", year="2020", month="May", day="1", volume="3", number="1", pages="e17669", keywords="quality improvement", keywords="preoperative care", keywords="medical order entry systems", abstract="Background: Preprocedural cardiac evaluation is a common reason for outpatient cardiology visits. Many patients who are referred to cardiology clinics for preprocedural evaluation are at low risk of perioperative events and do not require any further management. Our facility treats patients over a large geographic area; avoiding low-value consultations reduces time and travel burdens for patients. Objective: Our study objective was to assess the impact of a novel algorithm in the electronic order entry system aimed to guide clinicians toward patients who may benefit from cardiovascular referral. Methods: We retrospectively reviewed in-person consultations and electronic consultations (e-consults) to our cardiology service before and after implementation of the novel algorithm to assess changes in patterns of care. Data were stored in a custom electronic database on internal servers. Results: We reviewed 603 consultations to our cardiology clinic and found that 89 (14.7\%) were sent for preprocedural evaluation. Of these, 39 (43.8\% of preprocedural consultations) were e-consults. After implementation, we reviewed 360 consultations. The proportion of consultations for preprocedural evaluation did not decrease (n=47, 13.0\%; P=.39). We observed an absolute increase of 13.6\% in the proportion of consultations ordered as e-consults (27/47, 57.4\%). During the postintervention period, we received no remarks, concerns, or criticisms from ordering clinicians about the process change and no reports of adverse events. Conclusions: Implementation of an ordering algorithm to reduce low-value preprocedural cardiology evaluations did not lead to a reduction in the number of overall preprocedural cardiology consultations. The number of patients seen electronically increased, potentially improving clinic access and reducing travel burden for patients. ", doi="10.2196/17669", url="https://periop.jmir.org/2020/1/e17669", url="http://www.ncbi.nlm.nih.gov/pubmed/33393916" } @Article{info:doi/10.2196/10728, author="Dave, Arpit and Yi, Johnny and Boothe, Andy and Brashear, Helene and Byrne, Jeffrey and Gad, Yash", title="Listening to the HysterSisters: A Retrospective Keyword Frequency Analysis of Conversations About Hysterectomy Recovery", journal="JMIR Perioper Med", year="2019", month="Sep", day="26", volume="2", number="2", pages="e10728", keywords="hysterectomy", keywords="gynecology", keywords="social media", keywords="perceived recovery", abstract="Background: In the postoperative period, individual patient experiences vary widely and are based on a diverse set of input variables influenced by all stakeholders in and throughout the surgical process. Although clinical research has primarily focused on clinical and administrative datasets to characterize the postoperative recovery experience, there is increasing interest in patient-reported outcome measures (PROMs). The growth of online communities in which patients themselves participate provides a venue to study PROMs directly. One such forum-based community is HysterSisters, dedicated to helping individuals through the experience of hysterectomy, a major surgery which removes the uterus. The surgery can be performed by a variety of methods such as minimally invasive approaches or the traditional abdominal approach using a larger incision. The community offers support for ``medical and emotional issues [...] from diagnosis, to treatment, to recovery.'' Users can specify when and what type of hysterectomy they underwent. They can discuss their shared experience of hysterectomy and provide, among other interactions, feedback, reassurance, sympathy, or advice, thus providing a unique view into conversations surrounding the hysterectomy experience. Objective: We aimed to characterize conversations about hysterectomy recovery as experienced by users of the HysterSisters online community. Methods: A retrospective keyword frequency analysis of the HysterSisters Hysterectomy Recovery forum was performed. Results: Within the Hysterectomy Recovery forum, 33,311 unique users declared their hysterectomy date and type and posted during the first 12 weeks postsurgery. A taxonomy of 8 primary symptom groups was created using a seed list of keywords generated from a term frequency analysis of these threads. Pain and bleeding were the two most mentioned symptom groups and account for almost half of all symptom mentions (19,965/40,127). For symptoms categories such as pain and hormones and emotions, there was no difference in the proportion of users mentioning related keywords, regardless of the type of hysterectomy, whereas bleeding-related or intimacy-related keywords were mentioned more frequently by users undergoing certain minimally invasive approaches when compared with those undergoing abdominal hysterectomy. Temporal patterns in symptom mentions were noted as well. The majority of all posting activity occurred in the first 3 weeks. Across all keyword groups, individuals reporting minimally invasive procedures ceased forum use of these keywords significantly earlier than those reporting abdominal hysterectomy. Peaks in conversation volume surrounding particular symptom categories were also identified at 1, 3, and 6 weeks postoperatively. Conclusions: The HysterSisters Hysterectomy Recovery forum and other such forums centered on users' health care experience can provide novel actionable insights that can improve patient-centered care during the postoperative period. This study adds another dimension to the utility of social media analytics by demonstrating that measurement of post volumes and distribution of symptom mentions over time reveal key opportunities for beneficial symptom-specific patient engagement. ", doi="10.2196/10728", url="http://periop.jmir.org/2019/2/e10728/", url="http://www.ncbi.nlm.nih.gov/pubmed/33393919" } @Article{info:doi/10.2196/14501, author="Havel, Camille and Selim, Jean and Besnier, Emmanuel and Gouin, Philippe and Veber, Benoit and Clavier, Thomas", title="Impact of an Intensive Care Information System on the Length of Stay of Surgical Intensive Care Unit Patients: Observational Study", journal="JMIR Perioper Med", year="2019", month="Sep", day="04", volume="2", number="2", pages="e14501", keywords="intensive care unit", keywords="length of stay", keywords="software", keywords="critically ill patient", abstract="Background: The implementation of computerized monitoring and prescription systems in intensive care has proven to be reliable in reducing the rate of medical error and increasing patient care time. They also showed a benefit in reducing the length of stay in the intensive care unit (ICU). However, this benefit has been poorly studied, with conflicting results. Objective: This study aimed to show the impact of computerization on the length of stay in ICUs. Methods: This was a before-after retrospective observational study. All patients admitted in the surgical ICU at the Rouen University Hospital were included, from June 1, 2015, to June 1, 2016, for the before period and from August 1, 2016, to August 1, 2017, for the after period. The data were extracted from the hospitalization report and included the following: epidemiological data (age, sex, weight, height, and body mass index), reason for ICU admission, severity score at admission, length of stay and mortality in ICU, mortality in hospital, use of life support during the stay, and ICU readmission during the same hospital stay. The consumption of antibiotics, biological analyses, and the number of chest x-rays during the stay were also analyzed. Results: A total of 1600 patients were included: 839 in the before period and 761 in the after period. Only the severity score Simplified Acute Physiology Score II was significantly higher in the postcomputerization period (38 [SD 20] vs 40 [SD 21]; P<.05). There was no significant difference in terms of length of stay in ICU, mortality, or readmission during the stay. There was a significant increase in the volume of prescribed biological analyses (5416 [5192-5956] biological exams prescribed in the period before Intellispace Critical Care and Anesthesia [ICCA] vs 6374 [6013-6986] biological exams prescribed in the period after ICCA; P=.002), with an increase in the total cost of biological analyses, to the detriment of hematological and biochemical blood tests. There was also a trend toward reduction in the average number of chest x-rays, but this was not significant (0.55 [SD 0.39] chest x-rays per day per patient before computerization vs 0.51 [SD 0.37] chest x-rays per day per patient after computerization; P=.05). On the other hand, there was a decrease in antibiotic prescribing in terms of cost per patient after the implementation of computerization ({\texteuro}149.50 [\$164 USD] per patient before computerization vs {\texteuro}105.40 [\$155 USD] per patient after computerization). Conclusions: Implementation of an intensive care information system at the Rouen University Hospital in June 2016 did not have an impact on reducing the length of stay. ", doi="10.2196/14501", url="http://periop.jmir.org/2019/2/e14501/", url="http://www.ncbi.nlm.nih.gov/pubmed/33393935" } @Article{info:doi/10.2196/11219, author="Vitish-Sharma, Parveen and Maxwell-Armstrong, Charles and Guo, Boliang and Yick, Crystal and Acheson, G. Austin", title="The Trendelenburg Position and Cognitive Decline: A Case-Control Interventional Study Involving Healthy Volunteers", journal="JMIR Perioper Med", year="2019", month="Jan", day="15", volume="2", number="1", pages="e11219", keywords="POCD", keywords="Trendelenburg", keywords="cognitive function", keywords="laparoscopic", abstract="Background: Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after a surgical intervention. Aspects of cognitive function can be assessed using various validated cognitive function tests including the N-back task, the Stroop task, and the lexical decision-making task (LDT). There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD. Objective: The objective of this study was to assess the effect of time spent in the Trendelenburg position on cognitive function. Methods: Volunteers were placed in the Trendelenburg position for 3 hours and, then, supine for 30 minutes. Validated cognitive function tests including 1-, 2-, and 3-back tasks, Stroop test, and LDT were performed at baseline and every 30 minutes after Trendelenburg positioning. Cognitive decline was defined per the International Study of Postoperative Cognitive Dysfunction trial: a decrease in accuracy from the volunteers' baseline or an increase in response time from the volunteers' baseline by >2 control group SDs. Results: We recruited 15 healthy volunteers (8 males, 7 females) with an average age of 69 years (range 57-81) and average body mass index of 27.7 kg/m2 (range 20.9-33). Accuracy remained within 2 SDs at all time points. An increase in response time did occur, and of 15 participants, 3 (20\%) showed cognitive decline in the Trendelenburg position after 30 minutes, 4 (27\%) after 1 hour, 5 (33\%) after 90 minutes, 4 (27\%) after 120 and 150 minutes, and 6 (40\%) after 180 minutes. On moving to a supine position, 33\% (5/15) participants showed cognitive decline. Conclusions: The results of this study indicate that Trendelenburg positioning leads to cognitive decline. This may have implications for patients undergoing prolonged Trendelenburg positioning during laparoscopic colorectal surgery. ", doi="10.2196/11219", url="http://periop.jmir.org/2019/1/e11219/", url="http://www.ncbi.nlm.nih.gov/pubmed/33393930" }