JMIR perioperative medicine最新文献

{"title":"Evaluating the Impact of Virtual Reality on Orthopedic Trauma Skills Acquisition Among Surgical Residents: Randomized Crossover Study.","authors":"Sandipan Chatterjee, Khairul Faizi Mohammad, Monica Ghidinelli","doi":"10.2196/79343","DOIUrl":"10.2196/79343","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic trauma skills training is time-consuming and expensive. Current training modalities rely heavily on synthetic bone models, anatomical laboratory simulations, or assistance in surgeries (the apprenticeship model). Virtual reality (VR) appears to present a promising complement to current training modalities.</p><p><strong>Objective: </strong>This study evaluated the effectiveness of VR training on surgical performance and gauged learning preferences among orthopedic trauma residents in Malaysia.</p><p><strong>Methods: </strong>In total, 123 orthopedic residents were randomly assigned to 2 groups. One group practiced for about 30 minutes using VR glasses, followed by conventional nailing exercises on synthetic bones, while the other group first performed the nailing exercise, followed by VR practice. Performance was measured by time to completion of the exercise, and participants completed a postexercise survey.</p><p><strong>Results: </strong>Participants who completed VR training before the synthetic bone nailing exercise were significantly faster, completing the task between 4 (P=.05) and 7 (P=.002) minutes more quickly than without VR training. In addition, VR training improved self-assessed performance during the exercise. Survey data revealed that while 43% (50/117) of participants preferred conventional methods of learning (lectures, discussions, and hands-on simulations), 89% (104/117) of participants supported VR use as an adjunct to conventional methods of learning. Less than 2% (2/117, 1.7%) of participants indicated that conventional methods of learning were outdated.</p><p><strong>Conclusions: </strong>A single session of VR training significantly reduced completion times and improved self-assessment of competence in orthopedic trauma simulation exercises. Although learners continue to value conventional training modalities, there is a strong desire to include VR as a supplementary tool. Its integration into surgical curricula may accelerate skill acquisition, especially in low-resource settings with limited access to high-fidelity simulation labs. In addition, the availability of VR training modules in hospitals could help residents and junior consultants prepare for surgery.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e79343"},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846979","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":"Physician Perspectives on ChatGPT-4o as a Patient Resource for Abdominal Cancer Surgeries: Cross-Sectional Survey.","authors":"Christina V Lindsay, Devika A Shenoy, Allison N Martin, Christie L Clipper, Kevin N Shah, Michael E Lidsky, Daniel P Nussbaum, Ralph Snyderman","doi":"10.2196/81374","DOIUrl":"https://doi.org/10.2196/81374","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) models are being increasingly integrated into clinical care. Moreover, the availability of publicly accessible AI resources makes them attractive to patients seeking clinical information. Little is known regarding the use of large language models as patient resources for navigating major cancer diagnoses.</p><p><strong>Objective: </strong>This study aimed to evaluate the content, readability, and safety of ChatGPT (OpenAI; GPT-4o)-generated responses to common perioperative queries about hepatic, pancreatic, and colon cancers.</p><p><strong>Methods: </strong>A 28-question survey was developed based on frequently asked surgical questions for select malignancies. Surgical oncologists rated ChatGPT-4o-generated responses on a 5-point Likert scale for accuracy, quality, and tangibility. Readability was assessed using the Flesch-Kincaid Reading Grade Level (FKRGL) and Flesch Reading Ease (FRE). Respondents provided free-text comments and reported their comfort with patients using ChatGPT. Survey completion implied consent.</p><p><strong>Results: </strong>A total of 7 attending surgical oncologists with a median of 7 (IQR 4-13) years in practice completed the survey. Responses received mean scores of 3.5/5 (SD 0.28) for quality, 3.6/5 (SD 0.34) for accuracy, and 3.6/5 (SD 0.29) for tangibility. The responses had a median FKRGL score of 14.6 (IQR 13.3-15.6) and FRE score of 29.4 (IQR 20.5-36.3). On a post hoc analysis for select questions, the median FKRGL was 15.6 (IQR 14.4-16.7), decreasing to 7.1 (IQR 6.1-8.3) and 14.5 (IQR 13.2-15.4) with prompting and rephrasing, and the median FRE was 18.1 (IQR 14.6-24.7), increasing to 73.8 (IQR 66.6-79.3) and 32.0 (IQR 27.0-37.7) with prompting and rephrasing. Numerous inaccuracies and content gaps were reported, and approximately 43% (3/7) of providers did not report feeling \"comfortable\" in having patients consult publicly available AI for medical information.</p><p><strong>Conclusions: </strong>This study provides cautionary, yet optimistic, findings regarding the value of publicly accessible ChatGPT as a patient resource for abdominal malignancies. Providers should be prepared to effectively counsel patients to identify their educational attainment level when using ChatGPT to mitigate readability challenges.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e81374"},"PeriodicalIF":0.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847023","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":"ASSOCIATION BETWEEN COMPLICATIONS AND DEATH WITHIN 30 DAYS AFTER ORTHOPEDIC SURGERY: A VASCULAR EVENTS IN NONCARDIAC SURGERY PATIENTS COHORT EVALUATION (VISION) SUBSTUDY.","authors":"Lily J Park, P J Devereaux, Ameen Patel, Vikas Tandon, Diane Heels-Ansdell, Lehana Thabane, Pablo E Serrano, Matthew Tv Chan, Wojciech Szczeklik, Sadeesh Srinathan, Ignacio Garutti, Gerard Urrutia, Ernesto Guerra-Farfan, Hassaan Abdel Khalik, Emmanuelle Duceppe, Sandra Ofori, Maura Marcucci, David Conen, Michael K Wang, Jessica Spence, Daniel Tushinski, Kamal Bali, Anthony Adili, Vickas Khanna, Ana Claudia Tonelli, Francesca Mulazzani, Wenjun Jiang, Olufemi R Ayeni, Gerard Slobegean, Theodore Miclau, Mohit Bhandari, Flavia K Borges","doi":"10.2196/90823","DOIUrl":"https://doi.org/10.2196/90823","url":null,"abstract":"<p><strong>Background: </strong>The contemporary causes of postoperative mortality in orthopedic surgery are not well characterized.</p><p><strong>Objective: </strong>The objective was to describe the epidemiology of postoperative complications among adult orthopedic surgery patients and inform their relationships with 30-day mortality.</p><p><strong>Methods: </strong>Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) was a prospective cohort study involving 40,004 adult patients who underwent noncardiac surgery across 28 centres in 14 countries. For the subset of orthopedic surgery patients, a Cox proportional hazards model was used to determine time-dependent associations between various surgical complications and 30-day postoperative mortality. Analyses were adjusted for preoperative and surgical variables.</p><p><strong>Results: </strong>Among 8385 patients who underwent an orthopedic surgery in VISION, 132 (1.6%) patients died within 30 days of surgery. Of these deaths, 84 (63.6%) occurred in hospital during the index hospitalization, while 48 (36.4%) deaths occurred after discharge. The incidence of death across the subcategories of orthopedic surgery was: above knee amputation (30/221, 13.6%), internal fixation of femur (29/750, 3.9%), lower leg amputation (9/252, 3.6%), major hip or pelvic surgery (49/2898, 1.7%), major spine surgery (8/1405, 0.6%), and knee arthroplasty (7/2876, 0.2%). Six postoperative complications (myocardial injury after noncardiac surgery [MINS], major bleeding, infection without sepsis, sepsis, stroke, atrial fibrillation) were associated with death on adjusted analyses. The greatest attributable fraction of postoperative mortality (i.e., proportion of deaths in the cohort that can be attributed to each complication, if causality were established) were from MINS (N=1454, 17.3%, hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.38-3.14, P<.001, attributable fraction 20.7%), major bleeding (N=2422, 28.9%, HR 1.95, 95%CI 1.34-2.85, P<.001, attributable fraction 16.5%), and sepsis (N=318, 3.8%, HR 6.24, 95%CI 3.85-10.12, P<.001, attributable fraction 9.7%).</p><p><strong>Conclusions: </strong>The complications most attributable to 30-day mortality following orthopedic surgery were MINS, major bleeding, and sepsis. These findings highlight areas for further study to mitigate perioperative mortality in orthopedic surgery. MINS demonstrated the highest attributable fraction for mortality (20.7%), emphasizing the importance of appropriate MINS screening, diagnosis and management.</p><p><strong>Clinicaltrial: </strong></p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846971","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":"Comparison Between Ultrasound and Magnetic Resonance Imaging Measurements of the Optic Nerve Sheath Diameter in Patients Undergoing Intracranial Surgery: Prospective Observational Single-Center Study.","authors":"Mauricio Giraldo, Luz Maria Lopera, Aly Balbaa, Nelson Gonzalez, Raffael Pereira Cezar Zamper, Michael Mayich, Mel Boulton","doi":"10.2196/67480","DOIUrl":"https://doi.org/10.2196/67480","url":null,"abstract":"<p><strong>Background: </strong>Measuring the optic nerve sheath diameter (ONSD) with ultrasound is a promising, noninvasive way to estimate intracranial pressure (ICP). While magnetic resonance imaging (MRI) provides high-resolution imaging, it is less accessible in urgent or perioperative settings. Comparing ONSD measurements between ultrasound and MRI may help confirm the use of ultrasound in neurosurgical patients.</p><p><strong>Objective: </strong>The aim of this study is to evaluate how closely ultrasound and MRI measurements of ONSD align in patients undergoing surgery for supratentorial brain tumors.</p><p><strong>Methods: </strong>This prospective, single-center observational study included 50 adult patients scheduled for elective supratentorial tumor resection. ONSD was measured preoperatively using both transorbital ultrasound and MRI. Measurements were compared using Pearson and Spearman correlation coefficients, the intraclass correlation coefficient, and Bland-Altman analysis.</p><p><strong>Results: </strong>The average ONSD measured by ultrasound was 5.94 (0.99) mm, compared to 5.75 (SD 1.08) mm via MRI. The two methods showed a strong correlation (Pearson r=0.88, P<.001) and good agreement (intraclass correlation coefficient=0.86). Bland-Altman analysis showed a mean bias of 0.19 mm (95% limits of agreement: -0.62 to 1.00 mm).</p><p><strong>Conclusions: </strong>Ultrasound-based ONSD measurements closely matched those obtained by MRI in this patient group. These findings support the use of ultrasound as a practical tool for noninvasive ICP assessment in the perioperative care of patients with intracranial tumors.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e67480"},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719084","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":"Immersive Virtual Reality for Pain and Relaxation in Older Adults Following Elective Inpatient Abdominal Surgery: Single-Arm Study Examining Feasibility and Acceptability.","authors":"Christina Keny, Ujala Shafiq, Karl Lorenz, Marcia Russell, Heather Leutwyler, Laura M Wagner, Victoria Tang, Linda G Park","doi":"10.2196/81791","DOIUrl":"10.2196/81791","url":null,"abstract":"<p><strong>Background: </strong>There is mounting evidence to suggest that immersive virtual reality (IVR) can improve pain in older adults in community settings, yet the use of IVR postoperatively in the acute postoperative period following major elective abdominal surgery remains largely underexplored.</p><p><strong>Objective: </strong>This single-arm pilot study aimed to assess the feasibility, acceptability, and preliminary impact of IVR on self-reported postoperative pain and relaxation levels in older adults following elective major abdominal surgery.</p><p><strong>Methods: </strong>We recruited individuals aged 55 years and older undergoing elective abdominal surgery at an academic medical center from October 2023 to February 2024. We evaluated feasibility through accrual rate, intervention completion, and questionnaire compliance; acceptability via the System Usability Scale (SUS) and a user experience survey; and tolerability by monitoring self-reported side effects. The preliminary impact of IVR on self-reported pain intensity and relaxation levels was assessed through pre- and postintervention comparisons.</p><p><strong>Results: </strong>A total of 29 participants, with a median age of 73 (IQR 55-81) years, were enrolled and completed at least 1 IVR session, with 19 also completing a second session. Perceived usability and overall acceptance of IVR were high, with minimal side effects reported. In terms of the preliminary impact of IVR, statistically significant improvements were observed in both pain and relaxation levels from pre- to post-IVR on day 1 and day 2.</p><p><strong>Conclusions: </strong>This study suggests the feasibility and acceptability of IVR as a potential future intervention for postoperative pain management and enhancing relaxation among older adults following elective inpatient abdominal surgery. The preliminary findings suggest the need for large-scale studies across additional complex inpatient abdominal surgeries to confirm the acceptance and efficacy of IVR as a postoperative pain management intervention across a wide range of diverse older demographics. Future research is critical to evaluating the therapeutic potential of IVR in a variety of surgical and patient-specific contexts.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e81791"},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719054","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":"Benchmark Development for Fundamental Arthroscopic Skills Using a Simulation-Based Training Program: Observational Study.","authors":"Eric Davis, Brianna Caraet, Robert Pedowitz, Gregg Nicandri","doi":"10.2196/82723","DOIUrl":"10.2196/82723","url":null,"abstract":"<p><strong>Background: </strong>Surgical education has shifted from the traditional Halstedian apprenticeship model toward incorporating simulation due to work-hour restrictions, increasing case complexity, and economic and liability pressures. Building on the success of the Fundamentals of Laparoscopic Surgery program for general surgery, the Fundamentals of Arthroscopic Surgery Training (FAST) program was developed to establish proficiency benchmarks for orthopedic trainees in basic arthroscopic skills.</p><p><strong>Objective: </strong>We aimed to establish benchmarks for 5 FAST workstation modules.</p><p><strong>Methods: </strong>Sports medicine fellowship-trained faculty members were given instructions on the modules and 2 minutes of practice time, and they then performed each task 3 times with both their dominant and nondominant hand. For each module, mean faculty performance was used to establish an efficiency benchmark (time) and precision benchmark (errors).</p><p><strong>Results: </strong>The Probing module should be completed in less than 95 seconds with no errors. The Ring Transfer module should be completed in less than 134 seconds with no more than 1 error. The Maze module should be completed in less than 99 seconds with no errors. The Meniscectomy module should be completed in less than 68 seconds with no more than 1 error. Lastly, the Suture Passing module should be completed in less than 195 seconds with no more than 1 error.</p><p><strong>Conclusions: </strong>The FAST workstation can be used as a proficiency-based learning tool for residents to safely and effectively develop arthroscopic skills outside of the operating room. These benchmarks were established via a method previously validated in surgical simulation and balance precision and efficiency for skills that are considered generalizable and transferable to arthroscopic surgeries.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e82723"},"PeriodicalIF":0.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13060741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640945","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":"Clinical Feasibility and Outcomes of Surgeon-Performed Laparoscopic-Guided Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Prospective Observational Study.","authors":"Sarun Mahasupachai, Thawatchai Tullavardhana","doi":"10.2196/87622","DOIUrl":"10.2196/87622","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed approach to postoperative analgesia in laparoscopic cholecystectomy (LC), allowing direct visual confirmation of local anesthetic delivery without ultrasound guidance. However, evidence regarding its clinical outcomes, particularly in patients with complicated gallstone disease, remains limited.</p><p><strong>Objective: </strong>This study aimed to evaluate postoperative analgesic outcomes and identify factors associated with opioid requirement following laparoscopic-guided subcostal TAP block.</p><p><strong>Methods: </strong>A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Patients (aged 18-80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Postoperative pain was assessed using the Visual Analog Scale at 2, 4, 6, 8, 12, and 24 hours. Morphine administration within the first 24 hours was recorded. Associations between perioperative variables and opioid requirement were analyzed using univariate and exploratory multivariable logistic regression.</p><p><strong>Results: </strong>A total of 42 patients were included in the analysis. Of these, 21 (50%) did not require postoperative opioids, while the remaining patients (n=21, 50%) received a mean cumulative morphine dose of 3.86 (SD 1.39) mg within 24 hours. Pain scores were lower during the early postoperative period (2, 4, and 12 h) in patients who did not require opioids. Higher American Society of Anesthesiologists classification was independently associated with postoperative morphine requirement (odds ratio 6.51, 95% CI 1.37-30.96; P=.01). No major complications or local anesthetic toxicity were observed.</p><p><strong>Conclusions: </strong>In this prospective observational cohort, laparoscopic-guided subcostal TAP block may be associated with favorable early postoperative analgesic profiles and relatively low opioid requirements after LC, including in patients with gallstone-related complications. Higher American Society of Anesthesiologists classification may be associated with increased opioid demand, highlighting the importance of individualized, risk-adapted analgesic strategies. Although limited by the absence of a control group and modest sample size, these findings support the clinical feasibility of surgeon-performed TAP block for consideration within multimodal analgesia approaches in enhanced recovery after surgery-oriented perioperative care.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e87622"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517363","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":"Virtual Reality for the Management of Postoperative Pain and Anxiety in Children and Adolescents Undergoing Nuss Repair of Pectus Excavatum: Randomized Controlled Trial.","authors":"Charlotte M Walter, Dillon Froass, Nora Bell, Lauren Haack, Chloe Boehmer, Claudia Bruguera Torres, Rachel Spivak, Max Chou, Kristie Geisler, Keith O'Conor, Sara E Williams, Lili Ding, Christopher D King, Vanessa A Olbrecht","doi":"10.2196/80902","DOIUrl":"10.2196/80902","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is a novel technology with implications for pain and sensory processing. VR may serve as a novel, scalable method to deliver clinically validated therapy for pain management as an alternative or adjunct to opioids for acute pain. Given that psychological factors and pain perception are both components of postoperative pain, it may also be beneficial to incorporate modalities that decrease anxiety, such as active relaxation and guided meditation with VR. Unfortunately, these therapies are not widely available due to multiple barriers. VR has the potential to deliver pain-reducing, psychologically based therapy to children, thereby enhancing multimodal analgesia and potentially decreasing opioid use. This study investigates the role of VR in reducing pain and anxiety after surgery. Given the substantial risks associated with opioid use, particularly in younger populations, alternative pain management strategies are crucial.</p><p><strong>Objective: </strong>The primary aim of this study was to evaluate the efficacy of VR as a nonpharmacological intervention for managing postoperative pain intensity, pain unpleasantness, anxiety, and opioid use in children and adolescents undergoing Nuss repair of pectus excavatum.</p><p><strong>Methods: </strong>A single-center, prospective, randomized, controlled trial was conducted at a tertiary care children's hospital and research center. Ninety children and adolescents (8-18 y) undergoing the Nuss procedure were randomized to guided relaxation or mindfulness VR (n=30) and distraction-based gaming VR (n=30), combined to form the VR group (n=60), and a control group using a passive 360° video (n=30). Patients received a 10-minute session on postoperative days 1 and 2. Pain intensity, pain unpleasantness, and anxiety were evaluated before and 0-, 15-, and 30-minute post-session. In-hospital pain scores, anxiety scores, and opioid use were collected.</p><p><strong>Results: </strong>Children and adolescents who participated in VR reported a significantly greater decrease in pain intensity from baseline (0.41, SE 0.23) compared with those in the 360° video group at 30 minutes (P=.04) before multiplicity adjustment but not after multiplicity adjustment. There were no significant differences in pain scores or opioid use between the VR and control groups on postoperative day 1 or 2, nor were there changes in pain unpleasantness or anxiety at any time after the intervention.</p><p><strong>Conclusions: </strong>Daily, 10-minute VR sessions provided some trends toward transient analgesic and anxiolytic effects, albeit none that were statistically significant. VR did not significantly decrease overall pain scores or opioid usage, possibly due to the limited intervention duration and high standardized opioid use. Future studies should investigate extended and more frequent VR sessions and the integration of VR with other therapeutic modalities.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e80902"},"PeriodicalIF":0.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438165","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":"Multidimensional Assessment of Recovery After Total Knee Arthroplasty in Clinical Practice: Critical Narrative Review.","authors":"Abderrahmane Boukabache, Nimalan Maruthainar, Vikrant Manhas, Darren Player","doi":"10.2196/84011","DOIUrl":"10.2196/84011","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is the primary treatment for advanced knee osteoarthritis. Despite its clinical success and favorable patient-reported outcome measures (PROMs), approximately 20% to 30% of patients continue to experience persistent functional limitations and muscle weakness. This highlights the need for a comprehensive evaluation of recovery parameters beyond pain and range of motion. Given the wide range of methods available for assessing TKA outcomes, clinicians often select tools based on personal preference and understanding, which may affect accuracy and consistency; for example, the Knee Injury and Osteoarthritis Outcome Score may overestimate function compared to gait analysis studies.</p><p><strong>Objective: </strong>The aim of this study was to conduct a narrative review focusing on the use, strengths, and limitations of different outcome measures used in routine orthopedic practice to optimize post-TKA evaluation.</p><p><strong>Methods: </strong>A literature search was conducted in February 2025 across 2 databases (PubMed and Web of Science). Eligible studies included original research articles, systematic reviews, and meta-analyses that focused on validated measures used to evaluate TKA. Case reports, conference abstracts, and studies focused exclusively on surgical techniques were excluded. Themes were identified across studies to structure the results according to types of assessments and clinical applicability.</p><p><strong>Results: </strong>A total of 6831 studies were retrieved and screened in this review, with 4 themes emerging around muscle mass, strength, performance, and PROMs. The Oxford Knee Score is favored for its ease of use and minimal ceiling effects. Broader tools like the Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index provide detailed insights but are less practical clinically. For muscle strength, the portable fixed dynamometer showed high reliability and comparability to isokinetic dynamometry. Dual-energy X-ray absorptiometry remains the gold standard for assessing muscle mass, while bioelectrical impedance analysis offers a practical alternative. The 5-Repetition Sit-to-Stand test effectively evaluates lower limb power and speed.</p><p><strong>Conclusions: </strong>Clinicians should integrate both objective (muscle mass, strength, and performance) and subjective (PROMs) measures to improve TKA recovery assessment. This multidimensional approach has the potential to enhance the accuracy of patient evaluation and supports the development of tailored rehabilitation strategies that address individual deficits and optimize functional outcomes.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e84011"},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12935420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147292098","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":"Survival Prediction in Patients With Bladder Cancer Undergoing Radical Cystectomy Using a Machine Learning Algorithm: Retrospective Single-Center Study.","authors":"Francesco Andrea Causio, Vittorio De Vita, Andrea Nappi, Melissa Sawaya, Bernardo Rocco, Nazario Foschi, Giuseppe Maioriello, Pierluigi Russo","doi":"10.2196/86666","DOIUrl":"10.2196/86666","url":null,"abstract":"<p><strong>Background: </strong>Traditional statistical models often fail to capture the complex dynamics influencing survival outcomes in patients with bladder cancer after radical cystectomy, a procedure where approximately 50% of patients develop metastases within 2 years. The integration of artificial intelligence (AI) offers a promising avenue for enhancing prognostic accuracy and personalizing treatment strategies.</p><p><strong>Objective: </strong>This study aimed to develop and evaluate a machine learning algorithm for predicting disease-free survival (DFS), overall survival (OS), and the cause of death in patients with bladder cancer undergoing cystectomy, using a comprehensive dataset of clinical and pathological variables.</p><p><strong>Methods: </strong>Retrospective data of 370 patients with bladder cancer who underwent radical cystectomy at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, were collected. The dataset comprised 20 input variables, encompassing demographics, tumor characteristics, treatment variables, and inflammatory markers. For specific analyses and models, we used patient subcohorts. The CatBoost algorithm was used for regression tasks (DFS in 346 patients, OS in 347 patients) and a binary classification task (tumor-related death in 312 patients). Model performance was assessed using mean absolute error (MAE) for regression and F1-score for classification, prioritizing a minimum recall of 75% for tumor-related deaths. Five-fold cross-validation and Shapley additive explanations (SHAP) values were used to ensure robustness and interpretability.</p><p><strong>Results: </strong>For DFS prediction, the CatBoost model achieved an MAE of 18.68 months, with clinical tumor stage and pathological tumor classification identified as the most influential predictors. OS prediction yielded an MAE of 17.2 months, which improved to 14.6 months after feature filtering, where tumor classification and the systemic immune-inflammation index (SII) were most impactful. For tumor-related death classification, the model achieved a recall of 78.6% and an F1-score of 0.44 for the positive class (tumor-related deaths), correctly identifying 11 of 14 cases. Bladder tumor position was the most influential feature for cause-of-death prediction.</p><p><strong>Conclusions: </strong>The developed machine learning algorithm demonstrates promising accuracy in predicting survival and the cause of death in patients with bladder cancer after cystectomy. The key predictors include clinical and pathological tumor staging, systemic inflammation (SII), and bladder tumor position. These findings highlight the potential of AI in providing clinicians with an objective, data-driven tool to improve personalized prognostic assessment and guide clinical decision-making.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e86666"},"PeriodicalIF":0.0,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230022","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}