@Article{info:doi/10.2196/22387,
author="van Rossum, Mathilde
and Leenen, Jobbe
and Kingma, Feike
and Breteler, Martine
and van Hillegersberg, Richard
and Ruurda, Jelle
and Kouwenhoven, Ewout
and van Det, Marc
and Luyer, Misha
and Nieuwenhuijzen, Grard
and Kalkman, Cor
and Hermens, Hermie",
title="Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons",
journal="JMIR Perioper Med",
year="2021",
month="Feb",
day="12",
volume="4",
number="1",
pages="e22387",
keywords="telemedicine",
keywords="physiological monitoring",
keywords="vital signs",
keywords="esophagectomy",
keywords="postoperative complications",
abstract="Background: Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective: This study explored nurses' and surgeons' expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. Methods: Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. Results: The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. Conclusions: Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome. ",
doi="10.2196/22387",
url="http://periop.jmir.org/2021/1/e22387/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33576743"
}


@Article{info:doi/10.2196/23402,
author="van der Velde, Miriam
and Valkenet, Karin
and Geleijn, Edwin
and Kruisselbrink, Marjoke
and Marsman, Marije
and Janssen, MJ Liedewij
and Ruurda, P. Jelle
and van der Peet, L. Donald
and Aarden, J. Jesse
and Veenhof, Cindy
and van der Leeden, Marike",
title="Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="7",
volume="9",
number="1",
pages="e23402",
keywords="preoperative care",
keywords="smartphone",
keywords="mhealth",
keywords="risk behavior",
keywords="prehabilitation",
keywords="usability",
abstract="Background: Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective: The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results: Seventy-nine people---40 in the intervention group and 39 in the control group---were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values ($\beta$=--2.4 [95\% CI --5.9 to 1.1]). Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. Trial Registration: Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623 ",
doi="10.2196/23402",
url="http://mhealth.jmir.org/2021/1/e23402/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33410758"
}


@Article{info:doi/10.2196/14787,
author="Dittrich, Florian
and Back, Alexander David
and Harren, Katharina Anna
and Landgraeber, Stefan
and Reinecke, Felix
and Serong, Sebastian
and Beck, Sascha",
title="Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="30",
volume="4",
number="11",
pages="e14787",
keywords="mHealth",
keywords="smartphone",
keywords="communication",
keywords="medicine",
keywords="surveys and questionnaires",
keywords="technology",
keywords="orthopedics",
keywords="trauma surgery",
abstract="Background: In the course of digitization, smartphones are affecting an increasing number of areas of users' lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians' current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants' app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100\%) owned a smartphone, and 79.1\% (159/201) used the device, while 64.7\% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1\% (181/201) of the participants. However, 62.5\% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were ``intuitive usability'' (167/201, 83.1\%), ``no advertising'' (145/201, 72.1\%), and ``free apps'' (92/201, 45.8\%). The attributes ``transparent app development and app sponsoring'' (75/201, 37.3\%) and the existence of an ``easy-to-understand privacy statement'' (50/201, 24.9\%) were of minor relevance. The majority of the participants (162/194, 83.5\%) considered that future apps in the field of ``medical research'' would provide the greatest benefit. The greatest predicted risks were ``data misuse'' (147/189, 77.8\%), ``usage of untrustworthy apps'' (135/189, 71.4\%), and ``alienation from patients'' (51/189, 27.0\%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95\% CI 0.86-0.97; P=.002) and app (OR 0.90, 95\% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. ",
doi="10.2196/14787",
url="http://formative.jmir.org/2020/11/e14787/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33252340"
}


@Article{info:doi/10.2196/20072,
author="Lorenzoni, Giulia
and Azzolina, Danila
and Fraccaro, Chiara
and Di Liberti, Alessandro
and D'Onofrio, Augusto
and Cavalli, Chiara
and Fabris, Tommaso
and D'Amico, Gianpiero
and Cibin, Giorgia
and Nai Fovino, Luca
and Ocagli, Honoria
and Gerosa, Gino
and Tarantini, Giuseppe
and Gregori, Dario",
title="Using Wearable Devices to Monitor Physical Activity in Patients Undergoing Aortic Valve Replacement: Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="12",
volume="9",
number="11",
pages="e20072",
keywords="surgical aortic valve replacement",
keywords="transcatheter aortic valve replacement",
keywords="physical function",
keywords="wearable devices",
abstract="Background: In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice. Objective: This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients. Methods: This is a prospective observational study. The enrollment will be conducted 1 month before patients' SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin v{\'i}voactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality. Results: The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing. Conclusions: The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients. Trial Registration: Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y International Registered Report Identifier (IRRID): DERR1-10.2196/20072 ",
doi="10.2196/20072",
url="https://www.researchprotocols.org/2020/11/e20072",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180023"
}


@Article{info:doi/10.2196/19953,
author="Su, Yanfang
and Heitner, Jesse
and Yuan, Changzheng
and Si, Yafei
and Wang, Dan
and Zhou, Zhiying
and Zhou, Zhongliang",
title="Effect of a Text Messaging--Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="3",
volume="8",
number="11",
pages="e19953",
keywords="cesarean section",
keywords="short message service",
keywords="SMS text messaging",
keywords="quasirandomized controlled trial",
keywords="mobile health",
abstract="Background: Consensus exists that appropriate regional cesarean rates should not exceed 15\% of births, but China's cesarean rate exceeds 50\% in some areas, prompting numerous calls for its reduction. At present, China's 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi'an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother's birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few ``basic'' messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman's gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women's likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 ",
doi="10.2196/19953",
url="https://mhealth.jmir.org/2020/11/e19953",
url="http://www.ncbi.nlm.nih.gov/pubmed/33141099"
}


@Article{info:doi/10.2196/21138,
author="Ponder, Madison
and Ansah-Yeboah, A. Abena
and Charalambous, T. Lefko
and Adil, M. Syed
and Venkatraman, Vishal
and Abd-El-Barr, Muhammad
and Haglund, Michael
and Grossi, Peter
and Yarbrough, Chester
and Dharmapurikar, Rajeev
and Gellad, Ziad
and Lad, P. Shivanand",
title="A Smartphone App With a Digital Care Pathway for Patients Undergoing Spine Surgery: Development and Feasibility Study",
journal="JMIR Perioper Med",
year="2020",
month="Oct",
day="16",
volume="3",
number="2",
pages="e21138",
keywords="development",
keywords="digital interventions",
keywords="digital health",
keywords="smartphone app",
keywords="surgery",
keywords="behavior change",
keywords="mobile app",
keywords="technology",
keywords="mobile phone",
keywords="mHealth",
abstract="Background: There is a great unmet clinical need to provide patients undergoing spinal surgery and their caregivers with ongoing, high-quality care before and after surgery in an efficiency-focused health care environment. Objective: The objective of this study is to design, develop, and evaluate the acceptability and feasibility of a novel planning-, outcomes-, and analytics-based smartphone app called ManageMySurgery (MMS) in patients undergoing elective spine surgery (MMS-Spine). Methods: The development process of the MMS app was conducted over 2 sequential stages: (1) an evidence-based intervention design with refinement from surgeon and patient feedback and (2) feasibility testing in a clinical pilot study. We developed a novel, mobile-based, Health Insurance Portability and Accountability Act--compliant platform for interventional and surgical procedures. It is a patient-centric mobile health app that streamlines patients' interactions with their care team. MMS divides the patient journey into phases, making it feasible to provide customized care pathways that meet patients' unique needs. Patient-reported outcomes are easily collected and conform to the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) standard. Results: We tested the feasibility of the MMS-Spine app with patients undergoing elective spine surgery at a large academic health system. A total of 47 patients undergoing elective spine surgery (26 cervical spine and 21 lumbar spine surgeries) downloaded and used MMS-Spine to navigate their surgical journey, quantify their baseline characteristics and postoperative outcomes, and provide feedback on the utility of the app in preparing for and recovering from their spinal surgery. The median age was 59.0 (range 33-77) years, 22 of the 47 patients (47\%) were women, and 26 patients (55\%) had commercial insurance. Of the 47 patients, a total of 33 (70\%) logged in on an iOS device, 11 (23\%) on an Android device, and 3 (6\%) on a computer or tablet. A total of 17 of the 47 patients (36\%) added a caregiver, of which 7 (41\%) logged in. The median number of sign-ins was 2. A total of 38 of 47 patients (81\%) completed their baseline preoperative PROMIS-29 outcomes, and 14 patients (30\%) completed at least one PROMIS-29 survey during the postoperative period. Of the 24 patients who completed the MMS survey, 21 (88\%) said it was helpful during preparation for their procedure, 16 (67\%) said it was helpful during the postoperative period, and 23 (96\%) said that they would recommend MMS to a friend or family member. Conclusions: We used a patient-centered approach based on proven behavior change techniques to develop a comprehensive smartphone app for patients undergoing elective spine surgery. The optimized version of the app is ready for formal testing in a larger randomized clinical study to establish its cost-effectiveness and effect on patients' self-management skills and long-term outcomes. ",
doi="10.2196/21138",
url="http://periop.jmir.org/2020/2/e21138/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393924"
}


@Article{info:doi/10.2196/18367,
author="Dallas-Orr, David
and Penev, Yordan
and Schultz, Robert
and Courtier, Jesse",
title="Comparing Computed Tomography--Derived Augmented Reality Holograms to a Standard Picture Archiving and Communication Systems Viewer for Presurgical Planning: Feasibility Study",
journal="JMIR Perioper Med",
year="2020",
month="Sep",
day="24",
volume="3",
number="2",
pages="e18367",
keywords="augmented reality",
keywords="mixed reality",
keywords="picture archiving and communication system",
keywords="presurgical planning",
keywords="new technology evaluation",
keywords="medical imaging",
keywords="surgery",
abstract="Background: Picture archiving and communication systems (PACS) are ubiquitously used to store, share, and view radiological information for preoperative planning across surgical specialties. Although traditional PACS software has proven reliable in terms of display accuracy and ease of use, it remains limited by its inherent representation of medical imaging in 2 dimensions. Augmented reality (AR) systems present an exciting opportunity to complement traditional PACS capabilities. Objective: This study aims to evaluate the technical feasibility of using a novel AR platform, with holograms derived from computed tomography (CT) imaging, as a supplement to traditional PACS for presurgical planning in complex surgical procedures. Methods: Independent readers measured objects of predetermined, anthropomorphically correlated sizes using the circumference and angle tools of standard-of-care PACS software and a newly developed augmented reality presurgical planning system (ARPPS). Results: Measurements taken with the standard PACS and the ARPPS showed no statistically significant differences. Bland-Altman analysis showed a mean difference of 0.08\% (95\% CI --4.20\% to 4.36\%) for measurements taken with PACS versus ARPPS' circumference tools and --1.84\% (95\% CI --6.17\% to 2.14\%) for measurements with the systems' angle tools. Lin's concordance correlation coefficients were 1.00 and 0.98 for the circumference and angle measurements, respectively, indicating almost perfect strength of agreement between ARPPS and PACS. Intraclass correlation showed no statistically significant difference between the readers for either measurement tool on each system. Conclusions: ARPPS can be an effective, accurate, and precise means of 3D visualization and measurement of CT-derived holograms in the presurgical care timeline. ",
doi="10.2196/18367",
url="http://periop.jmir.org/2020/2/e18367/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393933"
}


@Article{info:doi/10.2196/14346,
author="Peuchot, Jeremy
and Allard, Etienne
and Dureuil, Bertrand
and Veber, Benoit
and Comp{\`e}re, Vincent",
title="Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="10",
volume="8",
number="9",
pages="e14346",
keywords="outpatient surgery",
keywords="short message service (SMS)",
keywords="patient information",
keywords="organizational",
keywords="cost",
keywords="unanticipated admission",
keywords="preoperative instructions",
abstract="Background: Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective: The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods: We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results: A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77\%) with a difference between SMS group (8/2228, 0.36\%) and telephone group (26/2160, 1.20\%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions: In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting. ",
doi="10.2196/14346",
url="https://mhealth.jmir.org/2020/9/e14346",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909948"
}


@Article{info:doi/10.2196/22417,
author="Nemetz, Anne Elisheva Tamar
and Urbach, Robert David
and Devon, Michelle Karen",
title="The Art of Surgery: Balancing Compassionate With Virtual Care",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="27",
volume="22",
number="8",
pages="e22417",
keywords="bioethics",
keywords="medical ethics",
keywords="virtual care",
keywords="telehealth",
keywords="virtual care in surgery",
keywords="video care in surgery",
keywords="telehealth in surgery",
keywords="surgical communication",
keywords="COVID-19 and virtual care",
keywords="consent",
keywords="privacy",
keywords="medical education",
keywords="surgery",
doi="10.2196/22417",
url="http://www.jmir.org/2020/8/e22417/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32852276"
}


@Article{info:doi/10.2196/14282,
author="Clausen, Jan-Dierk
and Nahen, Niclas
and Horstmann, Hauke
and Lasch, Florian
and Krutsch, Werner
and Krettek, Christian
and Weber-Spickschen, Sanjay Thomas",
title="Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach",
journal="JMIR Serious Games",
year="2020",
month="Jan",
day="24",
volume="8",
number="1",
pages="e14282",
keywords="serious gaming",
keywords="knee trainer",
keywords="games, experimental",
keywords="exercise therapy",
keywords="physical and rehabilitation medicine",
keywords="anterior cruciate ligament reconstruction",
keywords="knee injuries",
abstract="Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and --4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention -- control) of 59.7 N (95\% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement. ",
doi="10.2196/14282",
url="https://games.jmir.org/2020/1/e14282",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012046"
}


@Article{info:doi/10.2196/12859,
author="Russ, Stephanie
and Latif, Zahira
and Hazell, Leah Ahmarah
and Ogunmuyiwa, Helen
and Tapper, Josephine
and Wachuku-King, Sylvia
and Sevdalis, Nick
and Ocloo, Josephine",
title="A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Community-Based Evaluation Using a Participatory Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="20",
volume="8",
number="1",
pages="e12859",
keywords="patient safety",
keywords="surgery",
keywords="smartphone",
keywords="mobile phone",
keywords="patient empowerment",
abstract="Background: MySurgery is a smartphone app designed to increase patient and carer involvement in behaviors that contribute toward safety in surgical care. Objective: This study presents a pilot evaluation of MySurgery in which we evaluated surgical patients' perceptions of the app in terms of its content, usability, and potential impacts on communication and safety. Methods: A participatory action research (PAR) approach was used to formulate a research steering group consisting of 5 public representatives and 4 researchers with equal decision-making input. Surgical patients were recruited from the community using multiple approaches, including Web based (eg, social media, recruitment websites, and charitable or voluntary organizations) and face to face (via community centers). Participants referred to MySurgery before, during, and after their surgery and provided feedback via an embedded questionnaire and using reflective notes. Results: A diverse mix of 42 patients took part with good representation from 2 ``seldom heard'' groups: those with a disability and those from a black, Asian, or minority ethnic group. Most were very supportive of MySurgery, particularly those with previous experience of surgery and those who felt comfortable to be involved in conversations and decisions around their care. The app showed particular potential to empower patients to become involved in their care conversations and safety-related behaviors. Perceptions did not differ according to age, ethnicity, or length of hospital stay. Suggestions for improving the app included how to make it more accessible to certain groups, for example, those with a disability. Conclusions: MySurgery is a novel technology-driven approach for empowering patients to play a role in improving surgical safety that seems feasible for use within the United Kingdom's National Health Service. Adopting a PAR approach and the use of a diversity strategy considerably enhanced the research process in terms of gaining diverse participant recruitment and patient and public involvement. Further testing with stakeholder groups will follow. ",
doi="10.2196/12859",
url="https://mhealth.jmir.org/2020/1/e12859",
url="http://www.ncbi.nlm.nih.gov/pubmed/31958067"
}


@Article{info:doi/10.2196/13559,
author="G{\"o}rges, Matthias
and West, C. Nicholas
and Petersen, L. Christian
and Ansermino, Mark J.",
title="Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study",
journal="JMIR Perioper Med",
year="2019",
month="Aug",
day="05",
volume="2",
number="2",
pages="e13559",
keywords="communication systems",
keywords="patient monitoring",
keywords="user-centered design",
keywords="human factors",
keywords="anesthesia",
abstract="Background: In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. Objective: The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. Methods: telePORT's client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. Results: telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34\% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3\%/day). Conclusions: The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms. ",
doi="10.2196/13559",
url="http://periop.jmir.org/2019/2/e13559/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393912"
}


@Article{info:doi/10.2196/12587,
author="Dufour, Sin{\'e}ad
and Fedorkow, Donna
and Kun, Jessica
and Deng, Xiaoxuan Shirley
and Fang, Qiyin",
title="Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="11",
volume="7",
number="7",
pages="e12587",
keywords="postpartum",
keywords="pelvic floor",
keywords="mobile health",
keywords="feasibility study",
keywords="wireless technology",
keywords="wearable technology",
keywords="computer games",
keywords="biofeedback",
abstract="Background: The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective: The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods: A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne's interpretive description approach. Results: A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77\%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77\%), a cumbersome initiation process (n=8, 61\%), and discomfort from the device (n=8, 61\%) were reasons impeding intervention acceptability. Most participants (n=17, 74\%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions: Our pilot study demonstrated the potential for mHealth solution--enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration: ClinicalTrials.gov NCT02865954;?https://clinicaltrials.gov/ct2/show/NCT02865954 ",
doi="10.2196/12587",
url="http://mhealth.jmir.org/2019/7/e12587/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31298221"
}


@Article{info:doi/10.2196/14592,
author="Zhang, Zhaotian
and Li, Fei
and Zhang, Haochuan
and Miao, Zhipeng
and Wei, Yantao
and Wang, Li
and Zhang, Shaochong",
title="Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="26",
volume="7",
number="6",
pages="e14592",
keywords="intraocular pressure",
keywords="mobile phone",
keywords="vitrectomy",
keywords="air",
abstract="Background: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle's law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods: The app was developed on the iOS and Android operating systems. Boyle's law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale--based questionnaire with 2 main items to evaluate the participants' user experience and attitudes toward the app. Results: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40\% (range: 10\%-75\%) and 41\% (range: 9\%-78\%), respectively (P=.63). The median altitude of the participants' destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons' and patients' judgments (bias of ?0.3\%), with 95\% limits of agreement of ?5.8\% to 5.3\%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication. ",
doi="10.2196/14592",
url="http://mhealth.jmir.org/2019/6/e14592/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31244482"
}


@Article{info:doi/10.2196/13447,
author="Boillat, Thomas
and Grantcharov, Peter
and Rivas, Homero",
title="Increasing Completion Rate and Benefits of Checklists: Prospective Evaluation of Surgical Safety Checklists With Smart Glasses",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="29",
volume="7",
number="4",
pages="e13447",
keywords="smart glasses",
keywords="surgical safety checklists",
keywords="surgery",
keywords="usability",
keywords="time-out event",
abstract="Background: Studies have demonstrated that surgical safety checklists (SSCs) can significantly reduce surgical complications and mortality rates. Such lists rely on traditional posters or paper, and their contents are generic regarding the type of surgery being performed. SSC completion rates and uniformity of content have been reported as modest and widely variable. Objective: This study aimed to investigate the feasibility and potential of using smart glasses in the operating room to increase the benefits of SSCs by improving usability through contextualized content and, ideally, resulting in improved completion rates. Methods: We prospectively evaluated and compared 80 preoperative time-out events with SSCs at a major academic medical center between June 2016 and February 2017. Participants were assigned to either a conventional checklist approach (poster, memory, or both) or a smart glasses app running on Google Glass. Results: Four different surgeons conducted 41 checklists using conventional methods (ie, memory or poster) and 39 using the smart glasses app. The average checklist completion rate using conventional methods was 76\%. Smart glasses allowed a completion rate of up to 100\% with a decrease in average checklist duration of 18\%. Conclusions: Compared with alternatives such as posters, paper, and memory, smart glasses checklists are easier to use and follow. The glasses allowed surgeons to use contextualized time-out checklists, which increased the completion rate to 100\% and reduced the checklist execution time and time required to prepare the equipment during surgical cases. ",
doi="10.2196/13447",
url="http://mhealth.jmir.org/2019/4/e13447/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033451"
}


@Article{info:doi/10.2196/13226,
author="Schild, Stefanie
and Sedlmayr, Brita
and Schumacher, Ann-Kathrin
and Sedlmayr, Martin
and Prokosch, Hans-Ulrich
and St.Pierre, Michael
and ",
title="A Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management: Results of the User-Centered Design Process",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="29",
volume="7",
number="4",
pages="e13226",
keywords="anesthesiology",
keywords="checklist",
keywords="crew resource management, healthcare",
keywords="emergency treatment",
keywords="ergonomics",
keywords="human factors",
keywords="practice guideline",
keywords="reference books, medical",
keywords="resuscitation",
keywords="user-computer interface",
abstract="Background: Stressful situations during intraoperative emergencies have negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments. Objective: This paper aimed to provide a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements and is highly user-friendly. Methods: A user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered 4 aspects: analysis of the context of use, specification of user requirements, development of design solutions, and evaluation of design solutions. Three prototypes were developed and evaluated by end users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype, the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive Web-based questionnaire. The evaluation of the third prototype included a think-aloud protocol. Results: The chosen methods enabled a comprehensive collection of requirements and helped to improve the design of the application. The first prototype achieved an average SUS score of 74 (SD 12), indicating good usability. The second prototype included the following main revisions: 2-column layout, initial selection of patient type (infant, adult, or parturient), 4 offered search options, and the option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, and add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD 15). The evaluation of the think-aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue. Conclusions: Anesthesiology---as an acute medical field---is particularly characterized by its high demands on decision making and action in dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment. ",
doi="10.2196/13226",
url="http://mhealth.jmir.org/2019/4/e13226/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033445"
}


@Article{info:doi/10.2196/12028,
author="Birnie, A. Kathryn
and Campbell, Fiona
and Nguyen, Cynthia
and Lalloo, Chitra
and Tsimicalis, Argerie
and Matava, Clyde
and Cafazzo, Joseph
and Stinson, Jennifer",
title="iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="22",
volume="3",
number="2",
pages="e12028",
keywords="postoperative pain",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="pain management",
keywords="self-management",
keywords="adolescent",
abstract="Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. ",
doi="10.2196/12028",
url="http://formative.jmir.org/2019/2/e12028/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008704"
}


@Article{info:doi/10.2196/11472,
author="Jeon, Byoungjun
and Jeong, Boseong
and Jee, Seunghoon
and Huang, Yan
and Kim, Youngmin
and Park, Ho Gee
and Kim, Jungah
and Wufuer, Maierdanjiang
and Jin, Xian
and Kim, Wha Sang
and Choi, Hyun Tae",
title="A Facial Recognition Mobile App for Patient Safety and Biometric Identification: Design, Development, and Validation",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="08",
volume="7",
number="4",
pages="e11472",
keywords="facial recognition",
keywords="patient identification systems",
keywords="biometric identification",
keywords="patient safety",
keywords="smartphone",
keywords="mobile applications",
abstract="Background: Patient verification by unique identification is an important procedure in health care settings. Risks to patient safety occur throughout health care settings by failure to correctly identify patients, resulting in the incorrect patient, incorrect site procedure, incorrect medication, and other errors. To avoid medical malpractice, radio-frequency identification (RFID), fingerprint scanners, iris scanners, and other technologies have been implemented in care settings. The drawbacks of these technologies include the possibility to lose the RFID bracelet, infection transmission, and impracticality when the patient is unconscious. Objective: The purpose of this study was to develop a mobile health app for patient identification to overcome the limitations of current patient identification alternatives. The development of this app is expected to provide an easy-to-use alternative method for patient identification. Methods: We have developed a facial recognition mobile app for improved patient verification. As an evaluation purpose, a total of 62 pediatric patients, including both outpatient and inpatient, were registered for the facial recognition test and tracked throughout the facilities for patient verification purpose. Results: The app was developed to contain 5 main parts: registration, medical records, examinations, prescriptions, and appointments. Among 62 patients, 30 were outpatients visiting plastic surgery department and 32 were inpatients reserved for surgery. Whether patients were under anesthesia or unconscious, facial recognition verified all patients with 99\% accuracy even after a surgery. Conclusions: It is possible to correctly identify both outpatients and inpatients and also reduce the unnecessary cost of patient verification by using the mobile facial recognition app with great accuracy. Our mobile app can provide valuable aid to patient verification, including when the patient is unconscious, as an alternative identification method. ",
doi="10.2196/11472",
url="https://mhealth.jmir.org/2019/4/e11472/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30958275"
}


@Article{info:doi/10.2196/10938,
author="Herrera-Usagre, Manuel
and Santana, Vicente
and Burgos-Pol, Ramon
and Oliva, Pedro Juan
and Sabater, Eliazar
and Rita-Acosta, Maria
and Casado, Angel Miguel
and Cruces, Susana
and Pacheco, Manuel
and Solorzano Perez, Carlos",
title="Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Jan",
day="16",
volume="8",
number="1",
pages="e10938",
keywords="ambulatory surgical procedures",
keywords="cost-benefit analysis",
keywords="mobile phone",
keywords="patient compliance",
keywords="patient safety",
keywords="preoperative care",
keywords="telemedicine",
abstract="Background: Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25\% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. Objective: The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). Methods: A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ?18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. Results: The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. Conclusions: Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients' preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. International Registered Report Identifier (IRRID): DERR1-10.2196/10938 ",
doi="10.2196/10938",
url="http://www.researchprotocols.org/2019/1/e10938/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30664480"
}


@Article{info:doi/10.2196/11090,
author="Spyropoulos, C. Alex
and Myrka, Anne
and Triller, M. Darren
and Ragan, Stephen
and York, Collin
and King, Jaz-Michael
and Lee, Ti-Kuang",
title="Uptake and Utilization of the Management of Anticoagulation in the Periprocedural Period App: Longitudinal Analysis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="21",
volume="6",
number="12",
pages="e11090",
keywords="adverse drug event",
keywords="anticoagulant",
keywords="app",
keywords="mobile phone",
keywords="periprocedural",
keywords="warfarin",
abstract="Background: Anticoagulants are major contributors to preventable adverse drug events, and their optimal management in the periprocedural period is particularly challenging. Traditional methods of disseminating clinical guidelines and tools cannot keep pace with the rapid expansion of available therapeutic agents, approved indications for use, and published medical evidence, so a mobile app, Management of Anticoagulation in the Periprocedural Period (MAPPP), was developed and disseminated to provide clinicians with guidance that reflects the most current medical evidence. Objective: The objective of this study was to assess the global, national, and state-level acquisition of a mobile app since its initial release and characterize individual episodes of use based on drug selection, procedural bleeding risk, and patient thromboembolic risk. Methods: Data were extracted from a mobile app usage tracker (Google Analytics) to characterize new users and completed episodes temporally (by calendar quarter) and geographically (globally, nationally, and in the targeted US state of New York) for the period between April 1, 2016 and September 30, 2017. Results: The app was acquired by 2866 new users in the measurement period, and the users completed nearly 10,000 individual episodes of use. Acquisition and utilization spanned 51 countries globally, predominantly in the United States and particularly in New York State. Warfarin and rivaroxaban were the most frequently selected drugs, and completed episodes most frequently included the selection of high bleeding risk (4888/9963, 49.06\%) and high thromboembolic risk categories (4500/9963, 45.17\%). Conclusions: The MAPPP app is a successful means of disseminating current guidance on periprocedural anticoagulant use, as indicated by broad global uptake and upward trends in utilization. Limitations in access to provider and patient-specific data preclude objective evaluation of the clinical impact of the app. An ongoing study incorporating app logic into electronic health record systems at participant health systems will provide a more definitive evaluation of the clinical impact of the app logic. ",
doi="10.2196/11090",
url="http://mhealth.jmir.org/2018/12/e11090/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578235"
}


@Article{info:doi/10.2196/10802,
author="Downey, Candice
and Randell, Rebecca
and Brown, Julia
and Jayne, G. David",
title="Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="11",
volume="20",
number="12",
pages="e10802",
keywords="general surgery",
keywords="monitoring",
keywords="physiological",
keywords="randomized controlled trial",
keywords="vital signs",
abstract="Background: Vital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards. Objective: The aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial. Methods: We performed a prospective, cluster-randomized, parallel-group, unblinded, controlled pilot study. Patients admitted to 2 surgical wards at a large tertiary hospital received either continuous and intermittent vital signs monitoring or intermittent monitoring alone using an early warning score system. Continuous monitoring was provided by a wireless patch, worn on the patient's chest, with data transmitted wirelessly every 2 minutes to a central monitoring station or a mobile device carried by the patient's nurse. The primary outcome measure was time to administration of antibiotics in sepsis. The secondary outcome measures included the length of hospital stay, 30-day readmission rate, mortality, and patient acceptability. Results: Overall, 226 patients were randomized between January and June 2017. Of 226 patients, 140 were randomized to continuous remote monitoring and 86 to intermittent monitoring alone. On average, patients receiving continuous monitoring were administered antibiotics faster after evidence of sepsis (626 minutes, n=22, 95\% CI 431.7-820.3 minutes vs 1012.8 minutes, n=12, 95\% CI 425.0-1600.6 minutes), had a shorter average length of hospital stay (13.3 days, 95\% CI 11.3-15.3 days vs 14.6 days, 95\% CI 11.5-17.7 days), and were less likely to require readmission within 30 days of discharge (11.4\%, 95\% CI 6.16-16.7 vs 20.9\%, 95\% CI 12.3-29.5). Wide CIs suggest these differences are not statistically significant. Patients found the monitoring device to be acceptable in terms of comfort and perceived an enhanced sense of safety, despite 24\% discontinuing the intervention early. Conclusions: Remote continuous vital signs monitoring on surgical wards is practical and acceptable to patients. Large, well-controlled studies in high-risk populations are required to determine whether the observed trends translate into a significant benefit for continuous over intermittent monitoring. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN60999823; http://www.isrctn.com /ISRCTN60999823 (Archived by WebCite at http://www.webcitation.org/73ikP6OQz) ",
doi="10.2196/10802",
url="https://www.jmir.org/2018/12/e10802/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30538086"
}


@Article{info:doi/10.2196/periop.9463,
author="Stolk-Vos, C. Aline
and van der Steen, JE Jolet
and Drossaert, HC Constance
and Braakman-Jansen, Annemarie
and Zijlmans, LM Bart
and Kranenburg, W. Leonieke
and de Korne, F. Dirk",
title="A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study",
journal="JMIR Perioper Med",
year="2018",
month="Jul",
day="16",
volume="1",
number="2",
pages="e3",
keywords="patient participation",
keywords="checklist",
keywords="cataract",
keywords="surgery",
keywords="patient safety",
keywords="handheld computers",
keywords="health information management",
keywords="health communication",
keywords="information technology",
abstract="Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process. Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact. Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This ``EYEpad'' checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding. Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad. Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power. ",
doi="10.2196/periop.9463",
url="http://periop.jmir.org/2018/2/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33401370"
}


@Article{info:doi/10.2196/periop.9874,
author="Jaensson, Maria
and Dahlberg, Karuna
and Nilsson, Ulrica",
title="Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Perioper Med",
year="2018",
month="Mar",
day="26",
volume="1",
number="1",
pages="e2",
keywords="sex",
keywords="mHealth",
keywords="telemedicine",
keywords="mobile phone",
keywords="cell phone",
keywords="patient outcome assessment",
keywords="postoperative complications",
keywords="postoperative period",
abstract="Background: Previous studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery. Objective: The aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP. Methods: This study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP. Results: There were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups. Conclusions: This study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge. Trial Registration: ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 (Archived by WebCite at http://www.webcitation.org/6y2UtMbvz) ",
doi="10.2196/periop.9874",
url="http://periop.jmir.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33401367"
}


@Article{info:doi/10.2196/mhealth.9409,
author="Wei, J. Nancy
and Dougherty, Bryn
and Myers, Aundria
and Badawy, M. Sherif",
title="Using Google Glass in Surgical Settings: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="06",
volume="6",
number="3",
pages="e54",
keywords="Google Glass",
keywords="wearable",
keywords="wearable device",
keywords="head-mounted wearable device",
keywords="surgery",
keywords="surgical setting",
keywords="surgical condition",
abstract="Background: In recent years, wearable devices have become increasingly attractive and the health care industry has been especially drawn to Google Glass because of its ability to serve as a head-mounted wearable device. The use of Google Glass in surgical settings is of particular interest due to the hands-free device potential to streamline workflow and maintain sterile conditions in an operating room environment. Objective: The aim is to conduct a systematic evaluation of the literature on the feasibility and acceptability of using Google Glass in surgical settings and to assess the potential benefits and limitations of its application. Methods: The literature was searched for articles published between January 2013 and May 2017. The search included the following databases: PubMed MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO (EBSCO), and IEEE Xplore. Two reviewers independently screened titles and abstracts and assessed full-text articles. Original research articles that evaluated the feasibility, usability, or acceptability of using Google Glass in surgical settings were included. This review was completed following the Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines. Results: Of the 520 records obtained, 31 met all predefined criteria and were included in this review. Google Glass was used in various surgical specialties. Most studies were in the United States (23/31, 74\%) and all were conducted in hospital settings: 29 in adult hospitals (29/31, 94\%) and two in children's hospitals (2/31, 7\%). Sample sizes of participants who wore Google Glass ranged from 1 to 40. Of the 31 studies, 25 (81\%) were conducted under real-time conditions or actual clinical care settings, whereas the other six (19\%) were conducted under simulated environment. Twenty-six studies were pilot or feasibility studies (84\%), three were case studies (10\%), and two were randomized controlled trials (6\%). The majority of studies examined the potential use of Google Glass as an intraoperative intervention (27/31, 87\%), whereas others observed its potential use in preoperative (4/31, 13\%) and postoperative settings (5/31, 16\%). Google Glass was utilized as a videography and photography device (21/31, 68\%), a vital sign monitor (6/31, 19\%), a surgical navigation display (5/31, 16\%), and as a videoconferencing tool to communicate with remote surgeons intraoperatively (5/31, 16\%). Most studies reported moderate or high acceptability of using Google Glass in surgical settings. The main reported limitations of using Google Glass utilization were short battery life (8/31, 26\%) and difficulty with hands-free features (5/31, 16\%). Conclusions: There are promising feasibility and usability data of using Google Glass in surgical settings with particular benefits for surgical education and training. Despite existing technical limitations, Google Glass was generally well received and several studies in surgical settings acknowledged its potential for training, consultation, patient monitoring, and audiovisual recording. ",
doi="10.2196/mhealth.9409",
url="http://mhealth.jmir.org/2018/3/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510969"
}


@Article{info:doi/10.2196/periop.7874,
author="Lu, Keyin
and Chermside-Scabbo, J. Christopher
and Marino, Evan Nikolas
and Concepcion, Angela
and Yugawa, Craig
and Aladegbami, Bola
and Paar, Theodora
and St John, A. Theresa
and Ross, Will
and Clohisy, C. John
and Kirby, P. John",
title="Accessible Communication Tools for Surgical Site Infection Monitoring and Prevention in Joint Reconstruction: Feasibility Study",
journal="JMIR Perioper Med",
year="2018",
month="Jan",
day="17",
volume="1",
number="1",
pages="e1",
keywords="communication tool",
keywords="decolonization",
keywords="mobile health",
keywords="surgical site infection",
keywords="automated",
keywords="messaging",
abstract="Background: The National Surgical Quality Improvement Program logs surgical site infections (SSIs) as the most common cause of unplanned postoperative readmission for a variety of surgical interventions. Hospitals are making significant efforts preoperatively and postoperatively to reduce SSIs and improve care. Telemedicine, defined as using remote technology to implement health care, has the potential to improve outcomes across a wide range of parameters, including reducing SSIs. Objective: The purpose of this study was to assess the feasibility and user satisfaction of two automated messaging systems, EpxDecolonization and EpxWound, to improve perioperative care in a quality improvement project for patients undergoing total joint replacement. Methods: We designed two automated text messaging and calling systems named EpxDecolonization, which reminded patients of their preoperative decolonization protocol, and EpxWound, which monitored pain, wound, and fever status postoperatively. Daily patient responses were recorded and a post-usage survey was sent out to participants to assess satisfaction with the systems. Results: Over the 40-week study period, 638 and 642 patients were enrolled in EpxDecolonization (a preoperative decolonization reminder) and EpxWound (a postoperative surgical site infection telemonitoring system), respectively. Patients could be enrolled in either or both EpxDecolonization and EpxWound, with the default option being dual enrollment. The proportion of sessions responded to was 85.2\% for EpxDecolonization and 78.4\% for EpxWound. Of the 1280 patients prescribed EpxWound and EpxDecolonization, 821 (64.14\%) fully completed the postoperative system satisfaction survey. The median survey score (scale 1-9) was 9 for patient-rated overall care and 8 for whether the telemonitoring systems improved patient communication with providers. The majority of patients (69.0\%, 566/821) indicated that the systems sent out an ideal number of messages (not too many, not too few). Conclusions: EpxDecolonization and EpxWound demonstrated high response rates and improved patient-rated communication with providers. These preliminary data suggest that these systems are well tolerated and potentially beneficial to both patients and providers. The systems have the potential to improve both patient satisfaction scores and compliance with preoperative protocols and postoperative wound monitoring. Future efforts will focus on testing the sensitivity and specificity of alerts generated by each system and on demonstrating the ability of these systems to improve clinical quality metrics with more authoritative data. ",
doi="10.2196/periop.7874",
url="http://periop.jmir.org/2018/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33401369"
}