@Article{info:doi/10.2196/13123,
author="Zhu, Zhihui
and Zhang, Haibo
and Li, Yuehuan
and Meng, Xu
and Jiao, Yuqing
and Qin, Ying
and Li, Yan
and Han, Jie
and Liu, Kun
and Liu, Chongyang",
title="Establishment of a New Platform for the Management of Patients After Cardiac Surgery: Descriptive Study",
journal="JMIR Med Inform",
year="2019",
month="Apr",
day="01",
volume="7",
number="2",
pages="e13123",
keywords="follow-up",
keywords="cardiac surgery",
keywords="telemedicine",
abstract="Background: Medical care for the Chinese population has been focused on first-line treatment, but with little follow-up on treated patients. As an important part of clinical work, follow-up evaluations are of great significance for the long-term survival of patients and for clinical and scientific research. However, the overall follow-up rate of discharged patients after surgery has been low for many years because of the limitations of certain follow-up methods and the presence of objective, practical problems. Objective: This study aimed to construct a new two-way interactive telemedicine follow-up platform to improve the collection of clinical data after cardiac surgery and provide reliable and high-quality follow-up services. Methods: Computer and network technologies were employed in the context of ``Internet +'' to develop follow-up databases and software compatible with a mobile network. Postoperative follow-up quality data including the follow-up rate and important postoperative indices were used as standards to evaluate the new follow-up management model after cardiac surgery. Results: This system has been officially operated for more than 5 years. A total of 5347 patients undergoing cardiac surgery have been enrolled, and the total follow-up rate was 90.22\%. In addition, 6349 echocardiographic images, 4717 electrocardiographic images, and 3504 chest radiographic images have been uploaded during follow-up assessments. The international standardized ratio was 20,696 person-times. Conclusions: This new management follow-up platform can be used to effectively collect clinical data, provide technical support for academic research, extend medical services, and provide more help to patients. It is of great significance for managing patients after cardiac surgery. ",
doi="10.2196/13123",
url="https://medinform.jmir.org/2019/2/e13123/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30932865"
}


@Article{info:doi/10.2196/10169,
author="Yang, Homer
and Dervin, Geoff
and Madden, Susan
and Fayad, Ashraf
and Beaul{\'e}, Paul
and Gagn{\'e}, Sylvain
and Crossan, Lou Mary
and Wheeler, Kathryn
and Afagh, Melody
and Zhang, Tinghua
and Taljaard, Monica",
title="Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls",
journal="JMIR Perioper Med",
year="2018",
month="Nov",
day="05",
volume="1",
number="2",
pages="e10169",
keywords="postoperative care",
keywords="postoperative home monitoring",
keywords="postoperative emergency department visit",
keywords="postoperative readmissions",
keywords="continuity of care",
keywords="cost reductions",
keywords="length of stay",
abstract="Background: A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements. Objective: The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis. Methods: After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2. Results: A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can \$5826.32 (SD 1418.89) in the POHM group and Can \$9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7\%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5\%) and 2 readmissions (1.9\%) in the control group. No mortalities occurred in either group. Conclusions: The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38\% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively. Trial Registration: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P) ",
doi="10.2196/10169",
url="http://periop.jmir.org/2018/2/e10169/"
}


@Article{info:doi/10.2196/11547,
author="Rollin, Audrey
and Ridout, Brad
and Campbell, Andrew",
title="Digital Health in Melanoma Posttreatment Care in Rural and Remote Australia: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Sep",
day="24",
volume="20",
number="9",
pages="e11547",
keywords="digital health",
keywords="eHealth",
keywords="technology",
keywords="melanoma",
keywords="posttreatment care",
keywords="support care services",
keywords="rural areas",
keywords="remote communities",
keywords="patient-centric",
keywords="oncology",
abstract="Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services. Objective: The aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas. Methods: A systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes. Results: Five studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers' acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare. Conclusions: Digital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations. ",
doi="10.2196/11547",
url="http://www.jmir.org/2018/9/e11547/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249578"
}


@Article{info:doi/10.2196/10168,
author="Yang, Homer
and Dervin, Geoff
and Madden, Susan
and Beaul{\'e}, E. Paul
and Gagn{\'e}, Sylvain
and Crossan, L. Mary
and Fayad, Ashraf
and Wheeler, Kathryn
and Afagh, Melody
and Zhang, Tinghua
and Taljaard, Monica",
title="Postoperative Home Monitoring After Joint Replacement: Feasibility Study",
journal="JMIR Perioper Med",
year="2018",
month="Sep",
day="05",
volume="1",
number="2",
pages="e10168",
keywords="postoperative home monitoring",
keywords="postoperative transitional care",
keywords="surgical length of stay",
keywords="postoperative wireless monitoring",
keywords="patient confidentiality during wireless monitoring",
keywords="mobile phone",
abstract="Background: We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. Objective: The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ?90\%. Methods: Patients with an expected length of stay ?1 day, age 18-80 years, Revised Cardiac Risk Index ? class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. Results: We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4\% (SD 5.9\%; 95\% CI 94.8-98.0). The median response to ``I would recommend the Remote Monitoring System program to future patients'' was 4.5 (interquartile range 4-5), with 1 being ``strongly disagree'' and 5 ``strongly agree.'' At 30 days postop, there was no mortality or readmission. Conclusions: This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. Trial Registration: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk) ",
doi="10.2196/10168",
url="http://periop.jmir.org/2018/2/e10168/"
}


@Article{info:doi/10.2196/10387,
author="Dahlberg, Karuna
and Jaensson, Maria
and Nilsson, Ulrica
and Eriksson, Mats
and Odencrants, Sigrid",
title="Holding It Together---Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="25",
volume="6",
number="5",
pages="e10387",
keywords="ambulatory surgical procedures",
keywords="mobile apps",
keywords="postoperative period",
keywords="qualitative research",
abstract="Background: There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery. Objective: The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery. Methods: This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis. Results: A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you've got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin. Conclusions: It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery. ",
doi="10.2196/10387",
url="http://mhealth.jmir.org/2018/5/e10387/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29802094"
}


@Article{info:doi/10.2196/resprot.7470,
author="Rouholiman, Dara
and Gamble, G. Jamison
and Dobrota, D. Sylvie
and Encisco, M. Ellen
and Shah, G. Ashish
and Grajales III, J. Francisco
and Chu, F. Larry",
title="Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2018",
month="Mar",
day="26",
volume="7",
number="3",
pages="e82",
keywords="ostomy",
keywords="quality of life",
keywords="eHealth",
abstract="Background: Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients. Objective: In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy-specific, health-related quality of life as compared to baseline measurement before the use of the sensor. Methods: A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, cross-over pilot study using an Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy-specific, health-related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy-specific, health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for Patients with an Ostomy. Secondary outcomes of general health-related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey and the Olbrisch Ostomy Adjustment Scale Short Form 2. Results: The project was funded by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Enrollment is currently underway and data analysis is expected to be completed in 2018. Conclusions: Proposed benefits of mobile, internet-linked personal health monitors, such as the Ostom-i, include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an inpatient as well as improved quality of life. Prior studies have demonstrated decreased health-related quality of life in patients with an ostomy bag. We aim to examine the extent to which the Ostom-i alert sensor affects the health-related quality of life of its users. The Ostom-i alert sensor has the potential to improve quality of life of users by giving them the freedom and confidence to partake in daily activities with the knowledge that they can check how full their ostomy bag is in a private, discrete manner. Trial Registration: ClinicalTrials.gov NCT02319434; https://clinicaltrials.gov/ct2/show/NCT02319434 (Archived at WebCite at http://www.webcitation.org/6xhFDThmq) ",
doi="10.2196/resprot.7470",
url="http://www.researchprotocols.org/2018/3/e82/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29581087"
}


@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/"
}


@Article{info:doi/10.2196/cardio.9075,
author="Hermans, C. Mathilde
and Van Mourik, S. Martijn
and Hermens, J. Hermie
and Baan Jr, Jan
and Vis, M. Marije",
title="Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring",
journal="JMIR Cardio",
year="2018",
month="Mar",
day="16",
volume="2",
number="1",
pages="e9",
keywords="transcatheter aortic valve replacement",
keywords="postoperative care",
keywords="electrocardiography",
keywords="telemonitoring",
keywords="telemedicine",
abstract="Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories. Objective: This study aimed to outline a potential set-up of telemonitoring after TAVR. Methods: A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the intentions, People, Activities, Context, Technology (iPACT) and Functionality, Interaction, Content, Services (FICS) methods and identified corresponding technical requirements. Results: In this scenario, a wearable sensor system is used to continuously transmit ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, automatic event detection, and user-friendly interfaces. Conclusions: The suggested telemonitoring set-up involves a new approach to patient follow-up that could bring durable solutions for the growing scarcities in health care and for improving health care quality. To further explore the potential and feasibility of post-TAVR telemonitoring, we recommend evaluation of the overall impact on patient outcomes and of the safety, social, ethical, legal, organizational, and financial factors. ",
doi="10.2196/cardio.9075",
url="http://cardio.jmir.org/2018/1/e9/"
}


@Article{info:doi/10.2196/mhealth.8230,
author="Lalloo, Chitra
and Shah, Ushma
and Birnie, A. Kathryn
and Davies-Chalmers, Cleo
and Rivera, Jordan
and Stinson, Jennifer
and Campbell, Fiona",
title="Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="23",
volume="5",
number="10",
pages="e162",
keywords="pain, postoperative",
keywords="smartphone",
keywords="mobile applications",
keywords="review",
keywords="pain management",
keywords="self care",
abstract="Background: Recently, the use of smartphones to deliver health-related content has experienced rapid growth, with more than 165,000 mobile health (mHealth) apps currently available in the digital marketplace. With 3 out of 4 Canadians currently owning a smartphone, mHealth apps offer opportunities to deliver accessible health-related knowledge and support. Many individuals experience pain after surgery, which can negatively impact their health-related quality of life, including sleep, emotional, and social functioning. Smartphone apps that provide remote real-time monitoring and symptom management have the potential to improve self-management skills in patients experiencing postoperative pain. Increased confidence and practice of self-management skills could contribute to decreased postoperative pain and reduce risk of developing persistent pain. Published reviews of general pain self-management apps demonstrate a lack of evidence-based content, theoretical grounding, and health care professional involvement. However, no review to date has focused on the app marketplace specific for individuals with postoperative pain. Objective: The aim of this study was to characterize and critically appraise the content and functionality of commercially available postoperative pain self-management apps. Methods: An electronic search and extraction was conducted between December 2016 and March 2017 of the official Canadian app stores for the three major smartphone operating systems (iPhone operating system [iOS], Android, and Windows). Stores were searched separately using predetermined search terms. Two authors screened apps based on information provided in the public app description. Metadata from all included apps were abstracted into a standard spreadsheet. Two authors verified the data with reference to the apps and downloaded apps themselves. The content and functionality of each app as it pertained to postoperative pain self-management was rated. Results: A total of 10 apps met the inclusion criteria. All included apps were designed exclusively for the Android platform. Education was the most common self-management feature offered (8/10, 80\%), with none of the apps offering features related to goal setting or social support. Overall, no single app was comprehensive in terms of pain self-management content. Five (50\%) apps reported the involvement of a health care provider in their development. However, not a single app involved end users in their development, and none of the apps underwent scientific evaluation. Additionally, none of the apps were designed for use in pediatric patients. Conclusions: Currently available postoperative pain apps for patients lack evidence-based content, goal setting, and social support functions. There is a need to develop and test comprehensive theory-based apps to support patients with pain self-management care following surgery. ",
doi="10.2196/mhealth.8230",
url="http://mhealth.jmir.org/2017/10/e162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29061558"
}


@Article{info:doi/10.2196/resprot.5763,
author="McGillion, Michael
and Yost, Jennifer
and Turner, Andrew
and Bender, Duane
and Scott, Ted
and Carroll, Sandra
and Ritvo, Paul
and Peter, Elizabeth
and Lamy, Andre
and Furze, Gill
and Krull, Kirsten
and Dunlop, Valerie
and Good, Amber
and Dvirnik, Nazari
and Bedini, Debbie
and Naus, Frank
and Pettit, Shirley
and Henry, Shaunattonie
and Probst, Christine
and Mills, Joseph
and Gossage, Elaine
and Travale, Irene
and Duquette, Janine
and Taberner, Christy
and Bhavnani, Sanjeev
and Khan, S. James
and Cowan, David
and Romeril, Eric
and Lee, John
and Colella, Tracey
and Choini{\`e}re, Manon
and Busse, Jason
and Katz, Joel
and Victor, Charles J.
and Hoch, Jeffrey
and Isaranuwatchai, Wanrudee
and Kaasalainen, Sharon
and Ladak, Salima
and O'Keefe-McCarthy, Sheila
and Parry, Monica
and Sessler, I. Daniel
and Stacey, Michael
and Stevens, Bonnie
and Stremler, Robyn
and Thabane, Lehana
and Watt-Watson, Judy
and Whitlock, Richard
and MacDermid, C. Joy
and Leegaard, Marit
and McKelvie, Robert
and Hillmer, Michael
and Cooper, Lynn
and Arthur, Gavin
and Sider, Krista
and Oliver, Susan
and Boyajian, Karen
and Farrow, Mark
and Lawton, Chris
and Gamble, Darryl
and Walsh, Jake
and Field, Mark
and LeFort, Sandra
and Clyne, Wendy
and Ricupero, Maria
and Poole, Laurie
and Russell-Wood, Karsten
and Weber, Michael
and McNeil, Jolene
and Alpert, Robyn
and Sharpe, Sarah
and Bhella, Sue
and Mohajer, David
and Ponnambalam, Sem
and Lakhani, Naeem
and Khan, Rabia
and Liu, Peter
and Devereaux, PJ",
title="Technology-Enabled Remote Monitoring and Self-Management --- Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2016",
month="Aug",
day="01",
volume="5",
number="3",
pages="e149",
keywords="technology-enabled self-management",
keywords="remote automated external monitoring",
keywords="usability testing",
keywords="randomized controlled trial",
abstract="Background: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT---VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. Objective: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). Methods: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise---death, myocardial infarction, and nonfatal stroke--- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups. Results: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016. Conclusions: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS. ",
doi="10.2196/resprot.5763",
url="http://www.researchprotocols.org/2016/3/e149/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27480247"
}


@Article{info:doi/10.2196/mhealth.4649,
author="Jaensson, Maria
and Dahlberg, Karuna
and Eriksson, Mats
and Gr{\"o}nlund, {\AA}ke
and Nilsson, Ulrica",
title="The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="11",
volume="3",
number="3",
pages="e86",
keywords="cellular phone",
keywords="postoperative recovery",
keywords="day care",
abstract="Background: In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process.  The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort. Objective: The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery. Methods: The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient's private mobile phone, and (2) an administrator interface for the researchers. Results: The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the app with 10 day surgery patients. Some minor adjustments were made concerning text size and screen color. Conclusions: Taking advantage of joint expertise, a useable Web-based app adaptable to different technical platforms was constructed. In addition, the SwQoR was successfully transferred into digital format for use on mobile phones. ",
doi="10.2196/mhealth.4649",
url="http://mhealth.jmir.org/2015/3/e86/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26362403"
}