@Article{info:doi/10.2196/67007,
author="Luo, Ziyue
and Deng, Sisi
and Zhou, Ruihao
and Ye, Ling
and Zhu, Tao
and Chen, Guo",
title="Comparative Efficacy of Video Games Versus Midazolam in Reducing Perioperative Anxiety in Pediatric Patients: Systematic Review and Meta-Analysis",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="10",
volume="13",
pages="e67007",
keywords="video games",
keywords="midazolam",
keywords="perioperative period",
keywords="anxiety",
keywords="meta-analysis",
keywords="pediatric patients",
abstract="Background: Pediatric patients undergoing surgery frequently experience significant anxiety, which can result in adverse effects such as prolonged sedation and behavioral changes associated with pharmacological interventions such as oral midazolam. Video games offer a nonpharmacological distraction method that shows promise in alleviating procedural anxiety without significant adverse effects. However, the effectiveness of video games compared to midazolam in managing perioperative anxiety remains uncertain. Objective: This study aimed to evaluate the effectiveness of video game interventions in reducing perioperative anxiety in pediatric patients undergoing general anesthesia. Methods: We conducted a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library, supplemented by reference screening. Primary outcomes included anxiety levels assessed during parent separation and mask induction procedures, while secondary outcomes encompassed emergence delirium, postoperative behavior, and length of stay in the postanesthesia care unit (PACU). The risk of bias was assessed using the Risk of Bias 2 scale. Data were synthesized descriptively and through meta-analysis, with the certainty of the evidence evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Six randomized controlled trials involving 612 participants were included in the analysis. Children who participated in video game interventions reported significantly lower anxiety levels during parent separation (standardized mean difference, SMD ?0.31, 95\% CI ?0.50 to ?0.12; P=.001), with high certainty, and during mask induction (SMD ?0.29, 95\% CI ?0.52 to ?0.05; P=.02), with moderate certainty, compared to those receiving oral midazolam. Additionally, significant differences in postoperative behavior changes in children were observed compared to oral midazolam (SMD ?0.35, 95\% CI ?0.62 to ?0.09; P=.008). Children in the video game intervention groups also had a shorter length of stay in the PACU (mean difference, MD ?19.43 min, 95\% CI ?31.71 to ?7.16; P=.002). However, no significant differences were found in emergence delirium (MD ?2.01, 95\% CI ?4.62 to 0.59; P=.13). Conclusions: Video game interventions were more effective than midazolam in reducing perioperative anxiety among pediatric patients, improving postoperative behavior, and shortening the length of stay in the PACU. However, video games alone did not outperform midazolam in managing emergence delirium. Further high-quality research is needed for more conclusive results. Trial Registration: PROSPERO CRD42023486085; https://tinyurl.com/yc3suavb ",
doi="10.2196/67007",
url="https://games.jmir.org/2025/1/e67007"
}


@Article{info:doi/10.2196/63556,
author="Luo, Yang
and Li, Sisi
and Feng, Lijuan
and Zheng, Junyi
and Peng, Chunfen
and Bao, Lihong",
title="Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e63556",
keywords="psychological resilience",
keywords="fear of pain",
keywords="postsurgical recovery",
keywords="fear avoidance belief",
keywords="pain management",
keywords="activity recovery",
abstract="Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual's capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=?5.822) and age (coefficient=?2.853) were negatively correlated with it. These average R2 of these models was 73\% (SD 6\%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes. ",
doi="10.2196/63556",
url="https://formative.jmir.org/2025/1/e63556"
}


@Article{info:doi/10.2196/64561,
author="Sablewski, Armin
and Eimer, Christine
and Nemeth, Marcus
and Miller, Clemens",
title="Preoperative Anxiety Management Practices in Pediatric Anesthesia: Comparative Analysis of an Online Survey Presented to Experts and Social Media Users",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="27",
volume="8",
pages="e64561",
keywords="pediatric anesthesia",
keywords="pharmacological interventions",
keywords="nonpharmacological interventions",
keywords="preoperative",
keywords="anxiety",
keywords="anxiety management",
keywords="practices",
keywords="anesthesia",
keywords="comparative analysis",
keywords="online survey",
keywords="preoperative anxiety",
keywords="challenges",
keywords="postoperative outcome",
keywords="pediatric",
keywords="infant",
keywords="baby",
keywords="neonatal",
keywords="toddler",
keywords="child",
keywords="social media",
keywords="survey",
keywords="anesthesia provider",
abstract="Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children's anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches. Objective: A public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups. Methods: Two surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the ``Expert Group'' (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the ``Social Media Group'' (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management). Results: A total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, P<.001), higher specialist status (97.6\% vs 64.6\%, P<.001), and a greater pediatric anesthesia volume (43.9\% vs 12\% with more than 500 cases per year, P<.001). Regarding the representativity, 2 items out of 4 were statistically significant (level of care of institution, annual caseload of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups. Conclusions: Despite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals' knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children. ",
doi="10.2196/64561",
url="https://pediatrics.jmir.org/2025/1/e64561"
}


@Article{info:doi/10.2196/54049,
author="Kondylakis, Haridimos
and Giglioli, Chicchi Irene Alice
and Katehakis, Dimitrios
and Aldemir, Hatice
and Zikas, Paul
and Papagiannakis, George
and Hors-Fraile, Santiago
and Gonz{\'a}lez-Sanz, L. Pedro
and Apostolakis, Konstantinos
and Stephanidis, Constantine
and N{\'u}{\~n}ez-Benjumea, J. Francisco
and Ba{\~n}os-Rivera, M. Rosa
and Fernandez-Luque, Luis
and Kouroubali, Angelina",
title="Stress Reduction in Perioperative Care: Feasibility Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="7",
volume="27",
pages="e54049",
keywords="CARINAE",
keywords="digital health",
keywords="patient empowerment",
keywords="stress and anxiety management",
keywords="mHealth",
keywords="virtual reality",
keywords="feasibility",
keywords="perioperative",
keywords="randomized controlled trial",
keywords="surgery",
keywords="risk",
keywords="wearable devices",
keywords="patient education",
keywords="mobile app",
keywords="psychological",
keywords="self-efficacy",
keywords="self-management",
keywords="well-being",
keywords="patient monitoring",
abstract="Background: Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support. Objective: This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support. Methods: A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress. Results: The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the?hospital improved at admission by 5\% and at hospital discharge by?11.1\% and Visual Analogue Scale Pain at admission improved by 31.2\%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6\%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5\%. Overall, patients in the intervention study spent 17.12\% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the?CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions. Conclusions: Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication. Trial Registration: ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725 International Registered Report Identifier (IRRID): RR2-10.2196/38536 ",
doi="10.2196/54049",
url="https://www.jmir.org/2025/1/e54049"
}


@Article{info:doi/10.2196/65198,
author="Luo, Jessica
and West, C. Nicholas
and Pang, Samantha
and Robillard, M. Julie
and Page, Patricia
and Chadha, K. Neil
and Gan, Heng
and Correll, R. Lynnie
and Ridgway, Randa
and Broemling, Natasha
and G{\"o}rges, Matthias
and ",
title="Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey",
journal="JMIR Perioper Med",
year="2024",
month="Dec",
day="20",
volume="7",
pages="e65198",
keywords="narrative analysis",
keywords="qualitative data",
keywords="family feedback",
keywords="narrative feedback",
keywords="pediatric surgery",
keywords="perioperative care",
keywords="pain management",
keywords="surgical recovery",
abstract="Background: Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. Objective: This study aimed to understand families' perspectives regarding their children's surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model. Methods: Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child's surgical experience. Results: In total, 91\% (453/500) of enrolled families completed at least 1 postoperative survey; 53\% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 66\% (160/242) being male. Patients underwent orthopedic (60/242, 25\%), urological (39/242, 16\%), general (36/242,15\%), otolaryngological (31/242, 13\%), ophthalmological (32/242, 13\%), dental (27/242, 11\%), and plastic (17/242, 7\%) surgeries. Largely positive comments (398/485, 82\%) were made on the recovery and clinical care experience. A key theme for improvement included ``communication,'' with subthemes highlighting parental concerns regarding the ``preoperative discussions,'' ``clarity of discharge instructions,'' and ``continuity of care.'' Other themes included ``length of stay'' and ``recovery experience.'' Feedback also suggested survey design amendments for future iterations of this instrument. Conclusions: Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families. ",
doi="10.2196/65198",
url="https://periop.jmir.org/2024/1/e65198"
}


@Article{info:doi/10.2196/52943,
author="Guida, Stefania
and Vitale, Antonino Jacopo
and Swinnen, Eva
and Beckw{\'e}e, David
and Bargeri, Silvia
and Pennestr{\`i}, Federico
and Castellini, Greta
and Gianola, Silvia",
title="Effects of Prehabilitation With Advanced Technologies in Patients With Musculoskeletal Diseases Waiting for Surgery: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="12",
volume="26",
pages="e52943",
keywords="prehabilitation",
keywords="advanced technologies",
keywords="musculoskeletal diseases",
keywords="joint arthroplasty",
keywords="elective surgery",
keywords="patient outcomes",
keywords="mobile health",
keywords="postoperative function",
abstract="Background: Prehabilitation delivered with advanced technologies represents a great chance for patients to optimize pre- and postoperative outcomes, reduce costs, and overcome travel-related barriers. Objective: We aim to evaluate the effects of prehabilitation delivered with advanced technologies on clinically relevant outcomes among patients affected by musculoskeletal diseases and waiting for surgery. Methods: We searched the PubMed, EMBASE, Cochrane Library, PEDro, and CINAHL databases up to February 2, 2023. ClinicalTrials.gov was also searched for registered protocols. Randomized controlled trials and nonrandomized intervention studies with adult participants of both sexes, affected by any musculoskeletal disease, and undergoing prehabilitation with advanced technologies or standard care were included. Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. Certainty of evidence was assessed for the primary outcome with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The primary outcome was function. Secondary outcomes were pain, strength, risk of fall, autonomy in the activities of daily living, patient satisfaction, health-related quality of life, adverse events, and adherence to treatment. Results: Six studies (7 reports), focusing on patients undergoing total knee or hip arthroplasty and primary meniscal tear and spine surgery were included. We found different prehabilitation programs: mindfulness-based stress reduction, exercise, education, or a combination thereof. Prehabilitation delivered with advanced technologies proved to be more effective in improving function in candidates for knee or hip replacement (Western Ontario McMaster Osteoarthritis Index ``function'' subscale before surgery: mean difference [MD] --7.45, 95\% CI --10.71 to --4.19; I2=0\%; after surgery: MD --7.84, 95\% CI --11.80 to --3.88; I2=75.3\%), preoperative pain (MD --1.67, 95\% CI --2.50 to --0.48; I2=0\%), risk of fall (MD --2.54, 95\% CI --3.62 to --1.46; I2=0\%), and postoperative stiffness (MD --2.00, 95\% CI --2.01 to --1.99; I2=87\%). No differences were found in pain 1 month after surgery. Data from studies including participants undergoing primary meniscal tear and spinal surgery could not be pooled. Conclusions: Prehabilitation delivered with advanced technologies may be better than standard care in improving pre- and postoperative function among candidates for knee or hip arthroplasty. No quantitative results have been achieved on spine surgery candidates or other musculoskeletal diseases. Trial Registration: PROSPERO CRD42022345811; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=345811 ",
doi="10.2196/52943",
url="https://www.jmir.org/2024/1/e52943"
}


@Article{info:doi/10.2196/46367,
author="Sommer, L. Jordana
and Reynolds, Kristin
and Hebbard, Pamela
and Smith, D. Michael S.
and Mota, Natalie
and Mutch, C. W. Alan
and Maples-Keller, Jessica
and Roos, Leslie
and El-Gabalawy, Ren{\'e}e",
title="Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="17",
volume="8",
pages="e46367",
keywords="virtual reality",
keywords="preoperative anxiety and distress",
keywords="breast cancer surgery",
keywords="anesthesia",
keywords="feasibility",
keywords="pilot",
abstract="Background: Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. Objective: This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Methods: Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Results: Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57\% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean\% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean\% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, ``It was realistic to my past surgical experiences''), impacting their degree of preparedness and expectations for surgery (eg, ``The sounds and sights and procedures give you a test run; they prepare you for the actual day''), and having a calming or relaxing effect (eg, ``You feel more relaxed for the surgery''). Conclusions: This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. Trial Registration: ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618 ",
doi="10.2196/46367",
url="https://formative.jmir.org/2024/1/e46367",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231570"
}


@Article{info:doi/10.2196/28018,
author="Vogt, Lina
and Klasen, Martin
and Rossaint, Rolf
and Goeretz, Ute
and Ebus, Peter
and Sopka, Sasa",
title="Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="1",
volume="23",
number="9",
pages="e28018",
keywords="anesthesia",
keywords="anxiety",
keywords="exposure",
keywords="operating theater",
keywords="patient empowerment",
keywords="periperative trait anxiety",
keywords="STOA",
keywords="STAI",
keywords="virtual reality",
keywords="VR",
abstract="Background: Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. Objective: This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. Methods: We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. Results: There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. Conclusions: The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. Trial Registration: ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354 ",
doi="10.2196/28018",
url="https://www.jmir.org/2021/9/e28018",
url="http://www.ncbi.nlm.nih.gov/pubmed/34252034"
}


@Article{info:doi/10.2196/21350,
author="Brescia, A. Alexander
and Piazza, R. Julie
and Jenkins, N. Jessica
and Heering, K. Lindsay
and Ivacko, J. Alexander
and Piazza, C. James
and Dwyer-White, C. Molly
and Peters, L. Stefanie
and Cepero, Jesus
and Brown, H. Bailey
and Longi, N. Faraz
and Monaghan, P. Katelyn
and Bauer, W. Frederick
and Kathawate, G. Varun
and Jafri, M. Sara
and Webster, C. Melissa
and Kasperek, M. Amanda
and Garvey, L. Nickole
and Schwenzer, Claudia
and Wu, Xiaoting
and Lagisetty, H. Kiran
and Osborne, H. Nicholas
and Waljee, F. Jennifer
and Riba, Michelle
and Likosky, S. Donald
and Byrnes, E. Mary
and Deeb, Michael G.",
title="The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="16",
volume="10",
number="2",
pages="e21350",
keywords="cardiac surgery",
keywords="patient experience",
keywords="nonpharmacological interventions",
keywords="child life specialists",
keywords="opioids",
keywords="anxiety",
keywords="stress",
keywords="depression",
abstract="Background: Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. Objective: This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. Methods: To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. Results: This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. Conclusions: Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial Registration: ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID): DERR1-10.2196/21350 ",
doi="10.2196/21350",
url="https://www.researchprotocols.org/2021/2/e21350",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591291"
}


@Article{info:doi/10.2196/19752,
author="Ahmadpour, Naseem
and Weatherall, David Andrew
and Menezes, Minal
and Yoo, Soojeong
and Hong, Hanyang
and Wong, Gail",
title="Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="17",
volume="22",
number="7",
pages="e19752",
keywords="virtual reality",
keywords="periprocedural anxiety",
keywords="children",
keywords="adolescents",
keywords="stakeholder perspective",
keywords="design",
keywords="VR",
keywords="pediatrics",
keywords="patient experience",
keywords="app",
keywords="eHealth",
abstract="Background: Virtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients. Objective: We used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety. Methods: This study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions. Conclusions: We propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient's experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety. ",
doi="10.2196/19752",
url="http://www.jmir.org/2020/7/e19752/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706671"
}


@Article{info:doi/10.2196/12431,
author="Buffel, Connor
and van Aalst, June
and Bangels, Anne-Marie
and Toelen, Jaan
and Allegaert, Karel
and Verschueren, Sarah
and Vander Stichele, Geert",
title="A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2019",
month="Jun",
day="1",
volume="7",
number="2",
pages="e12431",
keywords="serious games for health",
keywords="behavior change",
keywords="perioperative pain",
keywords="perioperative anxiety",
keywords="pediatric",
keywords="ambulatory surgery",
abstract="Background: As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective: The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Results: Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions: Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. Trial Registration: ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc) ",
doi="10.2196/12431",
url="http://games.jmir.org/2019/2/e12431/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199324"
}


@Article{info:doi/10.2196/12429,
author="Verschueren, Sarah
and van Aalst, June
and Bangels, Anne-Marie
and Toelen, Jaan
and Allegaert, Karel
and Buffel, Connor
and Vander Stichele, Geert",
title="Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study",
journal="JMIR Serious Games",
year="2019",
month="Jun",
day="1",
volume="7",
number="2",
pages="e12429",
keywords="serious games for health",
keywords="behavior change",
keywords="perioperative pain",
keywords="perioperative anxiety",
keywords="pediatric",
keywords="ambulatory surgery",
abstract="Background: An increasing number of children undergo ambulatory surgery each year, and a significant proportion experience substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts the physical, psychosocial, and economic outcomes. Existing nonpharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, nonpharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games hold a unique potential to change health beliefs and behaviors in children. Objective: The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: The SERES Framework for serious game development was used to create the serious game, CliniPup. In particular, we used a mixed methods approach that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting serious game was relevant, realistic, and theory driven. A participatory design approach was applied, wherein clinical experts qualitatively reviewed several versions of the serious game, and an iterative creative process was used to integrate the applicable feedback. Results: CliniPup, a serious game, was developed to incorporate a scientific evidence base from a structured literature review, realistic content collected during ethnographic research such as expert interviews, explicit pedagogical objectives from scientific literature, and game mechanics and user interface design that address key aspects of the evidence. Conclusions: This report details the systematic development of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup's underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described. ",
doi="10.2196/12429",
url="http://games.jmir.org/2019/2/e12429/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199333"
}


@Article{info:doi/10.2196/jmir.9596,
author="O'Sullivan, Benjamin
and Alam, Fahad
and Matava, Clyde",
title="Creating Low-Cost 360-Degree Virtual Reality Videos for Hospitals: A Technical Paper on the Dos and Don'ts",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="16",
volume="20",
number="7",
pages="e239",
keywords="360-degree video",
keywords="VR",
keywords="virtual reality",
keywords="video production",
keywords="anesthetic preparation",
keywords="preoperative anxiety",
keywords="preoperative preparation",
doi="10.2196/jmir.9596",
url="http://www.jmir.org/2018/7/e239/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30012545"
}


@Article{info:doi/10.2196/jmir.9104,
author="Wray, Jo
and Brown, Katherine
and Tregay, Jenifer
and Crowe, Sonya
and Knowles, Rachel
and Bull, Kate
and Gibson, Faith",
title="Parents' Experiences of Caring for Their Child at the Time of Discharge After Cardiac Surgery and During the Postdischarge Period: Qualitative Study Using an Online Forum",
journal="J Med Internet Res",
year="2018",
month="May",
day="09",
volume="20",
number="5",
pages="e155",
keywords="congenital heart disease",
keywords="parents",
keywords="online forum",
keywords="isolation",
abstract="Background: Congenital heart disease (CHD) is the most common class of birth defects, which encompasses a broad spectrum of severity ranging from relatively minor to extremely complex. Improvements in surgery and intensive care have resulted in an increasing number of infants with the most complex lesions surviving after surgery until the time of discharge from the hospital, but there remain concerns about out-of-hospital mortality, variability in how services are provided at the time of discharge and beyond, and difficulties experienced by some families in accessing care. Objective: As part of a mixed-methods program of research, this study aimed to elicit parental experiences of caring for a child with CHD after hospital discharge following a cardiac surgery and collect information to inform interviews for a subsequent stage of the project. Methods: A closed online discussion group was set up via the main Facebook page of the Children's Heart Federation (CHF), a national charity offering support to children with heart disease and their families. The discussion group was advertised through the charity's webpage, and interested participants were directed to the charity's Facebook page from where they could access the closed Facebook group and respond to questions posted. The CHF moderated the forum, and the research team provided questions to be posted on the forum. Responses were collated into a single transcript and subjected to thematic analysis. Results: The forum was open for 4 months, and 91 participants (mean age 35 years, range 23-58 years, 89 females, 89 parents, and 2 grandparents) submitted demographic information and were given access to the closed forum group. A common experience of isolation emerged from the data, with descriptions of how that isolation was experienced (physical, social, knowledge) and its psychological impact, together with the factors that made it worse or better. Woven through this theme was the notion that parents developed expertise over time. Conclusions: The use of an online forum provided a means for eliciting data from a large number of parents regarding their experiences of caring for their child after hospital discharge following cardiac surgery. Parents engaged with the forum and were able to articulate what went well and what went less well, together with sharing their stories and supporting each other through doing so. Some parents clearly found participating in the forum a positive experience in itself, demonstrating the potential of social media as a mechanism for providing support and reducing isolation. Information gained from the forum was used to shape questions for interviews with parents in a subsequent phase of the study. Furthermore, the themes identified in the online forum have contributed to identifying ways of improving the provision of care and support for parents of high-risk babies following discharge after cardiac surgery. ",
doi="10.2196/jmir.9104",
url="http://www.jmir.org/2018/5/e155/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29743157"
}