JMIR perioperative medicine最新文献

{"title":"Implementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study.","authors":"Zyad James Carr, Daniel Agarkov, Judy Li, Jean Charchaflieh, Andres Brenes-Bastos, Jonah Freund, Jill Zafar, Robert B Schonberger, Paul Heerdt","doi":"10.2196/65805","DOIUrl":"10.2196/65805","url":null,"abstract":"<p><strong>Background: </strong>Precise functional capacity assessment is a critical component for preoperative risk stratification. Brief submaximal cardiopulmonary exercise testing (smCPET) has shown diagnostic utility in various cardiopulmonary conditions.</p><p><strong>Objective: </strong>This study aims to determine if smCPET could be implemented in a high-volume presurgical evaluation clinic and, when compared to structured functional capacity surveys, if smCPET could better discriminate low functional capacity (≤4.6 metabolic equivalents [METs]).</p><p><strong>Methods: </strong>After institutional approval, 43 participants presenting for noncardiac surgery who met the following inclusion criteria were enrolled: aged 60 years and older, a Revised Cardiac Risk Index of ≤2, and self-reported METs of ≥4.6 (self-endorsed ability to climb 2 flights of stairs). Subjective METs assessments, Duke Activity Status Index (DASI) surveys, and a 6-minute smCPET trial were conducted. The primary end points were (1) operational efficiency, based on the time of the experimental session being ≤20 minutes; (2) modified Borg survey of perceived exertion, with a score of ≤7 indicating no more than moderate exertion; (3) high participant satisfaction with smCPET task execution, represented as a score of ≥8 (out of 10); and (4) high participant satisfaction with smCPET scheduling, represented as a score of ≥8 (out of 10). Student's t test was used to determine the significance of the secondary end points. Correlation between comparable structured surveys and smCPET measurements was assessed using the Pearson correlation coefficient. A Bland-Altman analysis was used to assess agreement between the methods.</p><p><strong>Results: </strong>The mean session time was 16.9 (SD 6.8) minutes. The mean posttest modified Borg survey score was 5.35 (SD 1.8). The median patient satisfaction (on a scale of 1=worst to 10=best) was 10 (IQR 10-10) for scheduling and 10 (IQR 9-10) for task execution. Subjective METs were higher when compared to smCPET equivalents (extrapolated peak METs; mean 7.6, SD 2.0 vs mean 6.7, SD 1.8; t<sub>42</sub>=2.1; P<.001). DASI-estimated peak METs were higher when compared to smCPET peak METs (mean 8.8, SD 1.2 vs mean 6.7, SD 1.8; t<sub>42</sub>=7.2; P<.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg<sup>-1</sup> min<sup>-1</sup> vs mean 23.6, SD 6.5 mL kg<sup>-1</sup> min<sup>-1</sup>; t<sub>42</sub>=7.2; P<.001).</p><p><strong>Conclusions: </strong>Implementation of smCPET in a presurgical evaluation clinic is both patient centered and clinically feasible. Brief smCPET measures, supportive of published reports regarding low sensitivity of provider-driven or structured survey measures for low functional capacity, were lower than those from structured surveys. Future studies will analyze the prediction of perioperative complications and cost-effectiveness.</p><p><strong>Trial registration: <","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e65805"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study.","authors":"Daan Toben, Astrid de Wind, Eva van der Meij, Judith A F Huirne, Johannes R Anema","doi":"10.2196/71874","DOIUrl":"https://doi.org/10.2196/71874","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/58878.].</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e71874"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Quadruple Health Outcomes After Thoracic Surgery: Feasibility Pilot Randomized Controlled Trial Using Digital Home Monitoring.","authors":"Mahesh Nagappa, Yamini Subramani, Homer Yang, Natasha Wood, Jill Querney, Lee-Anne Fochesato, Derek Nguyen, Nida Fatima, Janet Martin, Ava John-Baptiste, Rahul Nayak, Mehdi Qiabi, Richard Inculet, Dalilah Fortin, Richard Malthaner","doi":"10.2196/58998","DOIUrl":"https://doi.org/10.2196/58998","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department (ED) and readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a 2-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into 2 groups: the DHM group and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day ED visit rates, 30-day readmission rates, postoperative complications, length of stay, postdischarge 30-day opioid consumption, 30-day quality of recovery, patient-program satisfaction, caregiver satisfaction, health care provider satisfaction, and cost per case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI 79.4%-93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI 89.4%-99.2%) and 98.7% (95% CI 92.9%-99.9%), respectively. In total, 80 patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the 2 groups. The DHM group had fewer unplanned ED visits (2.7% vs 20.5%; P=.02), fewer unplanned admission rates (0% vs 7.6%; P=.24), lower rates of postoperative complications (20% vs 47.5%, P=.01) shorter hospital stays (4.0 vs 6.9 days; P=.05), but more opioid consumption (111.6, SD 110.9) vs 74.3, SD 71.9 mg morphine equivalents; P=.08) compared to the control group. DHM also resulted in shorter ED visit times (130, SD 0 vs 1048, SD 1093 minutes; P=.48) and lower cost per case (CAD $12,145 [US $ 8436.34], SD CAD $8779 [US $ 6098.20] vs CAD $17,247 [US $11,980.37], SD CAD $15,313 [US $10,636.95]; P=.07). The quality of recovery scores was clinically significantly better than the controls (185.4, SD 2.6 vs 178.3, SD 3.3; P&lt;.001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI 90.5%-100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the fourth week post hospital discharge (47.7%; 95% CI 35.7%-59.1%). Health care providers reported a 100% satisfaction rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This pilot RCT demonstrates the feasibility of cond","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e58998"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement Between Provider-Completed and Patient-Completed Preoperative Frailty Screening Using the Clinical Risk Analysis Index: Cross-Sectional Questionnaire Study.","authors":"Mehraneh Khalighi, Amy C Thomas, Karl J Brown, Katherine C Ritchey","doi":"10.2196/66440","DOIUrl":"10.2196/66440","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with postoperative morbidity and mortality. Preoperative screening and management of persons with frailty improves postoperative outcomes. The Clinical Risk Analysis Index (RAI-C) is a validated provider-based screening tool for assessing frailty in presurgical populations. Patient self-screening for frailty may provide an alternative to provider-based screening if resources are limited; however, the agreement between these 2 methods has not been previously explored.</p><p><strong>Objective: </strong>The objective of our study was to examine provider-completed versus patient-completed RAI-C assessments to identify areas of disagreement between the 2 methods and inform best practices for RAI-C screening implementation.</p><p><strong>Methods: </strong>Orthopedic physicians and physician assistants completed the RAI-C assessment on veterans aged 65 years and older undergoing elective total joint arthroplasty (eg, total hip or knee arthroplasty) and documented scores into the electronic health record during their preoperative clinic evaluation. Participants were then mailed the same RAI-C form after preoperative evaluation and returned responses to study coordinators. Agreement between provider-completed and patient-completed RAI-C assessments and differences within individual domains were compared.</p><p><strong>Results: </strong>A total of 49 participants aged 65 years and older presenting for total joint arthroplasty underwent RAI-C assessment between November 2022 and August 2023. In total, 41% (20/49) of participants completed and returned an independent postvisit RAI-C assessment before surgery and within 180 days of their initial evaluation. There was a moderate but statistically significant correlation between provider-completed and patient-completed RAI-C assessments (r=0.62; 95% CI 0.25-0.83; P=.003). Provider-completed and patient-completed RAI-C assessments resulted in the same frailty classification in 60% (12/20) of participants, but 40% (8/20) of participants were reclassified to a more frail category based on patient-completed assessment. Agreement was the lowest between provider-completed and patient-completed screening questions regarding memory and activities of daily living.</p><p><strong>Conclusions: </strong>RAI-C had moderate agreement when completed by providers versus the participants themselves, with more than a third of patient-completed screens resulting in a higher frailty classification. Future studies will need to explore the differences between and accuracy of RAI-C screening approaches to inform best practices for preoperative RAI-C assessment implementation.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e66440"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study.","authors":"Daan Toben, Astrid de Wind, Eva van der Meij, Judith A F Huirne, Johannes R Anema","doi":"10.2196/58878","DOIUrl":"10.2196/58878","url":null,"abstract":"<p><strong>Background: </strong>Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital.</p><p><strong>Objective: </strong>We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was \"How well are patients able to use ikHerstel independently of their health care professional?\"</p><p><strong>Methods: </strong>We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data.</p><p><strong>Results: </strong>Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients.</p><p><strong>Conclusions: </strong>In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e58878"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study.","authors":"Eric P Kraybill, David Chen, Saadat Khan, Praveen Kalra","doi":"10.2196/64921","DOIUrl":"10.2196/64921","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inhalational anesthetic agents are a major source of potent greenhouse gases in the medical sector, and reducing their emissions is a readily addressable goal. Nitrous oxide (N&lt;sub&gt;2&lt;/sub&gt;O) has a long environmental half-life relative to carbon dioxide combined with a low clinical potency, leading to relatively large amounts of N&lt;sub&gt;2&lt;/sub&gt;O being stored in cryogenic tanks and H cylinders for use, increasing the chance of pollution through leaks. Building on previous findings, Stanford Health Care's (SHC's) N&lt;sub&gt;2&lt;/sub&gt;O emissions were analyzed at 2 campuses and targeted for waste reduction as a precursor to system-wide reductions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to determine the extent of N&lt;sub&gt;2&lt;/sub&gt;O pollution at SHC and subsequently whether using E-cylinders for N&lt;sub&gt;2&lt;/sub&gt;O storage and delivery at the point of care in SHC's ambulatory surgery centers could reduce system-wide emissions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In phase 1, total SHC (Palo Alto, California) N&lt;sub&gt;2&lt;/sub&gt;O purchase data for calendar year 2022 were collected and compared (volume and cost) to total Palo Alto clinical delivery data using Epic electronic health records. In phase 2, a pilot study was conducted in the 8 operating rooms of SHC campus A (Redwood City). The central N&lt;sub&gt;2&lt;/sub&gt;O pipelines were disconnected, and E-cylinders were used in each operating room. E-cylinders were weighed before and after use on a weekly basis for comparison to Epic N&lt;sub&gt;2&lt;/sub&gt;O delivery data over a 5-week period. In phase 3, after successful implementation, the same methodology was applied to campus B, one of 3 facilities in Palo Alto.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In phase 1, total N&lt;sub&gt;2&lt;/sub&gt;O purchased in 2022 was 8,217,449 L (33,201.8 lbs) at a total cost of US $63,298. Of this, only 780,882.2 L (9.5%) of N&lt;sub&gt;2&lt;/sub&gt;O was delivered to patients, with 7,436,566.8 L (90.5%) or US $57,285 worth lost or wasted. In phase 2, the total mass of N&lt;sub&gt;2&lt;/sub&gt;O use from E-cylinders was 7.4 lbs (1 lb N&lt;sub&gt;2&lt;/sub&gt;O=247.5 L) or 1831.5 L at campus A. Epic data showed that the total N&lt;sub&gt;2&lt;/sub&gt;O volume delivered was 1839.3 L (7.4 lbs). In phase 3, the total mass of N&lt;sub&gt;2&lt;/sub&gt;O use from E-cylinders was 10.4 lbs or 2574 L at campus B (confirming reliability within error propagation margins). Epic data showed that the total N&lt;sub&gt;2&lt;/sub&gt;O volume delivered was 2840.3 L (11.5 lbs). Over phases 2 and 3, total use for campuses A and B was less than the volume of 3 E-cylinders (1 E-cylinder=1590 L).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Converting N&lt;sub&gt;2&lt;/sub&gt;O delivery from centralized storage to point-of-care E-cylinders dramatically reduced waste and expense with no detriment to patient care. Our results provide strong evidence for analyzing N&lt;sub&gt;2&lt;/sub&gt;O storage in health care systems that rely on centralized storage, and consideration of E-cylinder implementation to reduce emissions. The reduction in N&lt;sub&gt;2&lt;/sub&gt;O waste will help meet SHC","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e64921"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Routine Electronic Health Record-Based Delirium Prediction Model for Surgical Patients Without Dementia: Retrospective Case-Control Study.","authors":"Emma Holler, Christina Ludema, Zina Ben Miled, Molly Rosenberg, Corey Kalbaugh, Malaz Boustani, Sanjay Mohanty","doi":"10.2196/59422","DOIUrl":"10.2196/59422","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication after major surgery and is associated with poor outcomes in older adults. Early identification of patients at high risk of POD can enable targeted prevention efforts. However, existing POD prediction models require inpatient data collected during the hospital stay, which delays predictions and limits scalability.</p><p><strong>Objective: </strong>This study aimed to develop and externally validate a machine learning-based prediction model for POD using routine electronic health record (EHR) data.</p><p><strong>Methods: </strong>We identified all surgical encounters from 2014 to 2021 for patients aged 50 years and older who underwent an operation requiring general anesthesia, with a length of stay of at least 1 day at 3 Indiana hospitals. Patients with preexisting dementia or mild cognitive impairment were excluded. POD was identified using Confusion Assessment Method records and delirium International Classification of Diseases (ICD) codes. Controls without delirium or nurse-documented confusion were matched to cases by age, sex, race, and year of admission. We trained logistic regression, random forest, extreme gradient boosting (XGB), and neural network models to predict POD using 143 features derived from routine EHR data available at the time of hospital admission. Separate models were developed for each hospital using surveillance periods of 3 months, 6 months, and 1 year before admission. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Each model was internally validated using holdout data and externally validated using data from the other 2 hospitals. Calibration was assessed using calibration curves.</p><p><strong>Results: </strong>The study cohort included 7167 delirium cases and 7167 matched controls. XGB outperformed all other classifiers. AUROCs were highest for XGB models trained on 12 months of preadmission data. The best-performing XGB model achieved a mean AUROC of 0.79 (SD 0.01) on the holdout set, which decreased to 0.69-0.74 (SD 0.02) when externally validated on data from other hospitals.</p><p><strong>Conclusions: </strong>Our routine EHR-based POD prediction models demonstrated good predictive ability using a limited set of preadmission and surgical variables, though their generalizability was limited. The proposed models could be used as a scalable, automated screening tool to identify patients at high risk of POD at the time of hospital admission.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e59422"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey.","authors":"Jessica Luo, Nicholas C West, Samantha Pang, Julie M Robillard, Patricia Page, Neil K Chadha, Heng Gan, Lynnie R Correll, Randa Ridgway, Natasha Broemling, Matthias Görges","doi":"10.2196/65198","DOIUrl":"10.2196/65198","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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 alig","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e65198"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study.","authors":"Nicole Kasia Stachura, Sukham K Brar, Jacob Davidson, Claire A Wilson, Celia Dann, Mike Apostol, John Vecchio, Shannon Bilodeau, Anna Gunz, Diana Catalina Casas-Lopez, Ruediger Noppens, Ken Leslie, Julie E Strychowsky","doi":"10.2196/59790","DOIUrl":"10.2196/59790","url":null,"abstract":"<p><strong>Background: </strong>In Canada, the health care system has been estimated to generate 33 million metric tons of greenhouse gas emissions annually. Health care systems, specifically operating rooms (ORs), are significant contributors to greenhouse gas emissions, using 3 to 6 times more energy than the hospital's average unit.</p><p><strong>Objective: </strong>This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff members and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation.</p><p><strong>Methods: </strong>A total of 2 surveys were developed, consisting of 27 questions for staff members and 22 questions for patients and caregivers. Topics included demographics, knowledge and attitudes regarding environmental sustainability, opportunities for initiatives, and perceived barriers. Multiple-choice, Likert-scale, and open-ended questions were used.</p><p><strong>Results: </strong>A total of 174 staff members and 37 patients participated. The majority (152/174, 88%) of staff members had received no and minimal training on sustainability, while 93% (162/174) cited practicing sustainability at work as moderately to extremely important. Among patients and caregivers, 54% (20/37) often or always noticed when a hospital is being eco-friendly. Both staff members and patients agreed that improving sustainability would boost satisfaction (125/174, 71.8% and 22/37, 59.4%, respectively) and hospital reputation (22/37, 59.4% and 25/37, 69.5%, respectively). The staff members' highest-rated environmental initiatives included transitioning to reusables, education, and improved energy consumption, while patients prioritized increased nature, improved food sourcing, and education. Perceived barriers to these initiatives included cost, lack of education, and lack of incentives.</p><p><strong>Conclusions: </strong>Staff members and patients and caregivers in a large academic health care center acknowledge the significance of environmental sustainability in the OR. While they do not perceive a direct impact on patient care, they anticipate positive effects on satisfaction and hospital reputation. Aligning initiatives with staff members and patient and caregiver preferences can help drive meaningful change within the OR and beyond.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e59790"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Consumer Wearables Data on Pediatric Surgery Clinicians' Management: Multi-Institutional Scenario-Based Usability Study.","authors":"Michela Carter, Samuel C Linton, Suhail Zeineddin, J Benjamin Pitt, Christopher De Boer, Angie Figueroa, Ankush Gosain, David Lanning, Aaron Lesher, Saleem Islam, Chethan Sathya, Jane L Holl, Hassan Mk Ghomrawi, Fizan Abdullah","doi":"10.2196/58663","DOIUrl":"10.2196/58663","url":null,"abstract":"<p><strong>Background: </strong>At present, parents lack objective methods to evaluate their child's postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent's subjective assessment of the child's health status and the child's ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment.</p><p><strong>Objective: </strong>This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians' management.</p><p><strong>Methods: </strong>In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children's hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making.</p><p><strong>Results: </strong>In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations.</p><p><strong>Conclusions: </strong>The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians' remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e58663"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}