JMIR perioperative medicine最新文献

{"title":"Use of Virtual Reality in the Pediatric Perioperative Setting and for Induction of Anesthesia: Mixed Methods Pilot Feasibility Study.","authors":"Yu Tong Huang, Sofia Addab, Gianluca Bertolizio, Reggie Hamdy, Kelly Thorstad, Argerie Tsimicalis","doi":"10.2196/58905","DOIUrl":"https://doi.org/10.2196/58905","url":null,"abstract":"<p><strong>Background: </strong>Children commonly experience high levels of anxiety prior to surgery. This distress is associated with postoperative maladaptive behaviors. Virtual reality (VR) is an innovative tool for reducing anxiety and pain during various medical procedures. Previous randomized controlled trials have demonstrated its efficacy in reducing children's anxiety in the preoperative waiting room or during induction.</p><p><strong>Objective: </strong>The primary aim of this study was to examine the feasibility of VR distraction throughout the perioperative period, from the waiting room until the induction of general anesthesia (GA). Secondary aims were to assess its clinical utility, tolerability, and initial clinical efficacy.</p><p><strong>Methods: </strong>A mixed methods, concurrent triangulation feasibility trial was piloted at the Shriners Hospitals for Children-Canada. Participants played an interactive VR game throughout the perioperative period, starting from the waiting room until induction. Feasibility was examined with the duration of the VR intervention, recording the number of interruptions, and taking field notes. Clinical utility was assessed using a perception questionnaire. Tolerability was evaluated by the Child Simulator Sickness Questionnaire (CSSQ). Initial clinical efficacy was assessed by the Faces Pain Scale-Revised, Faces Anxiety Scale, Graphic Rating Scale for multidimensional pain, the Induction Compliance Checklist, and the Pediatric Anesthesia Emergence Delirium scale. Quantitative data were supported with field notes and semistructured interviews with patients and parents. Quantitative and qualitative themes were compared via the triangulation protocol to produce final themes.</p><p><strong>Results: </strong>A total of 39 patients, with a mean age of 11.9 (SD 2.8) years, undergoing elective surgery under GA participated in the study. Stakeholders, including patients, parents, and health care providers, were receptive and willing to adapt to VR. Of the 39 patients, 19 (49%) continued to use VR during transportation and 6 (15%) were induced with VR. Barriers to feasibility included (1) interruptions to VR in 92% (36/39) of patients by health care professionals, (2) unpredictable surgery delays prolonging the duration of the VR intervention (mean 23.1, SD 24.4 minutes; range 5-150 minutes), and (3) discontinuation of VR before induction due to mask seal (n=3) and discomfort with supine positioning (n=2). Patients were generally satisfied with VR, deemed it acceptable and easy to use, and would recommend it to others. VR was tolerable with no self-reported simulator sickness (CSSQ: mean 0.01, SD 0.1). The mean Faces Anxiety Score was 1.5 (SD 1.1) at baseline and 0.7 (SD 0.9) during VR.</p><p><strong>Conclusions: </strong>While VR demonstrated good clinical utility and was well tolerated in the broad perioperative setting, this study highlighted important feasibility barriers in the waiting room and especial","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e58905"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082640","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":"Quantification of Metamorphopsia Using a Smartphone-Based Hyperacuity Test in Patients With Idiopathic Epiretinal Membranes: Prospective Observational Study.","authors":"Daria Amon, Christoph Leisser, Andreas Schlatter, Manuel Ruiss, Caroline Pilwachs, Natascha Bayer, Josef Huemer, Oliver Findl","doi":"10.2196/60959","DOIUrl":"https://doi.org/10.2196/60959","url":null,"abstract":"<p><strong>Background: </strong>Quality of vision in patients with idiopathic epiretinal membranes (iERMs) is closely linked to distorted vision (metamorphopsia), which is often underestimated in clinical settings. Current surgical decision-making relies heavily on visual acuity and optical coherence tomography findings, which do not adequately reflect the patient's functional vision or the severity of metamorphopsia. There is a clinical need for tools that can reliably quantify this symptom to improve patient outcomes and streamline care pathways.</p><p><strong>Objectives: </strong>This study is the first to assess the use of a novel smartphone-based hyperacuity test (SHT) in quantifying metamorphopsia before and after surgical intervention for iERMs, comparing it with a conventional printed chart.</p><p><strong>Methods: </strong>This prospective observational study included 27 patients with iERMs with symptomatic metamorphopsia detected on the Amsler grid scheduled for vitrectomy with membrane peeling. The SHT (Alleye, Oculocare Medical Inc) and the horizontal (MH) and vertical (MV) M-chart (Inami & Co, Ltd) tests were performed 3 times before and 3 months after surgery. Pre- and postoperative metamorphopsia scores, changes in distance-corrected visual acuity, optical coherence tomography biomarkers, and subjective perception of metamorphopsia were evaluated.</p><p><strong>Results: </strong>The mean SHT score significantly (r=0.686; P<.001) improved from 55.2 (SD 18.9) before surgery to 63.5 (SD 16.3) after surgery while the improvement of the M-chart scores were insignificant (MH r=0.37, P=.06; MV r=0.18, P=.36). Pre- and postoperative SHT scores showed very weak and insignificant correlations with the MH, MV, and MH+MV scores. Both metamorphopsia tests showed good reliability (intraclass correlation coefficients >0.75).</p><p><strong>Conclusions: </strong>The SHT showed a significant improvement in postoperative metamorphopsia scores, indicating that it could be a valuable tool for quantifying visual distortion in patients with iERMs. While discrepancies with M-chart results were observed, both tests demonstrated good reliability. Clinically, the SHT may offer a practical solution for monitoring metamorphopsia and guiding complex surgical decision-making, particularly in telemedicine settings. Its accessibility could improve patient management, potentially enhancing preoperative triaging and reducing unnecessary visits.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e60959"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060581","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":"Quantification of Metamorphopsia using a Smartphone-based Hyperacuity Test in Patients with Idiopathic Epiretinal Membranes: Prospective Observational Study.","authors":"Daria Amon, Chritstoph Leisser, Andreas Schlatter, Manuel Ruiss, Caroline Pilwachs, Natascha Bayer, Josef Huemer, Oliver Findl","doi":"10.2196/60959","DOIUrl":"10.2196/60959","url":null,"abstract":"<p><strong>Background: </strong>Quality of vision in patients with idiopathic epiretinal membranes (iERM) is closely linked to distorted vision (metamorphopsia), which is often underestimated in clinical settings. Current surgical decision-making relies heavily on visual acuity and OCT findings, which do not adequately reflect the patient's functional vision or the severity of metamorphopsia. There is a clinical need for tools that can reliably quantify this symptom to improve patient outcomes and streamline care pathways.</p><p><strong>Objective: </strong>This study is the first to assess the utility of a novel smartphone-based hyperacuity test (SHT) in quantifying metamorphopsia before and after surgical intervention for iERM, comparing it to a conventional printed chart.</p><p><strong>Methods: </strong>This prospective observational study included 27 iERM patients with symptomatic metamorphopsia detected on the Amsler grid scheduled for vitrectomy with membrane peeling. The SHT (Alleye, Oculocare medical Inc., Zurich, Switzerland) and the horizontal (MH) and vertical (MV) M-chart (Inami & Co., Ltd., Tokyo, Japan) tests were performed three times before and three months after surgery. Pre- and postoperative metamorphopsia scores, changes in distance-corrected visual acuity (DCVA), optical coherence tomography (OCT) biomarkers and subjective perception of metamorphopsia were evaluated.</p><p><strong>Results: </strong>The mean SHT score significantly (r=.686, P<.001) improved from 55.2 ± 18.9 before surgery to 63.5 ± 16.3 after surgery while the improvement of the M-chart scores were insignificant (MH r=.37, P=.06; MV r=.18, P=.36). Pre- and postoperative SHT scores showed very weak and insignificant correlations with the MH, MV, and MH+MV scores. Both metamorphopsia tests showed good reliability (intraclass correlation coefficients >0.75).</p><p><strong>Conclusions: </strong>The smartphone-based hyperacuity test (SHT) showed a significant improvement in postoperative metamorphopsia scores, indicating that it could be a valuable tool for quantifying visual distortion in iERM patients. While discrepancies with M-chart results were observed, both tests demonstrated good reliability. Clinically, the SHT may offer a practical solution for monitoring metamorphopsia and guiding complex surgical decision-making, particularly in telemedicine settings. Its accessibility could improve patient management, potentially enhancing pre-operative triaging and reducing unnecessary visits.</p><p><strong>Clinicaltrial: </strong>ClinicalTrials.gov NCT05138315.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574967","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":"Feasibility of a Comprehensive eCoach to Support Patients Undergoing Colorectal Surgery: Longitudinal Observational Study.","authors":"A Daniëlle Talen, Jobbe P L Leenen, Geert van der Sluis, Hilbrand K E Oldenhuis, Joost M Klaase, Gijsbert A Patijn","doi":"10.2196/67425","DOIUrl":"10.2196/67425","url":null,"abstract":"<p><strong>Background: </strong>The mainstay of colorectal cancer care is surgical resection, which carries a significant risk of complications. Efforts to improve outcomes have recently focused on intensive multimodal prehabilitation programs to better prepare patients for surgery, which make the perioperative process even more complex and demanding for patients. Digital applications (eCoaches) seem promising tools to guide patients during their care journey. We developed a comprehensive eCoach to support, guide, and monitor patients undergoing elective colorectal surgery through the perioperative phase of the care pathway.</p><p><strong>Objective: </strong>The primary aim of this study was to determine its feasibility, in terms of recruitment rate, retention rate, and compliance. Also, usability and patient experience were examined.</p><p><strong>Methods: </strong>A single-center cohort study was conducted from April to September 2023 in a tertiary teaching hospital in the Netherlands. All elective colorectal surgery patients were offered an eCoach that provided preoperative coaching of the prehabilitation protocol, guidance by giving timely information, and remote monitoring of postoperative recovery and complications. Recruitment and retention rate, as well as compliance for each part of the care pathway, were determined. Secondary, patient-reported usability measured by the Usefulness, Satisfaction, and Ease of Use questionnaire and patient experiences were reported.</p><p><strong>Results: </strong>The recruitment rate for the eCoach was 74% (49/66). Main reasons for exclusion were digital illiteracy (n=10), not owning a smartphone (n=3), and the expected burden of use being too high (n=2). The retention rate was 80% (37/46). Median preoperative compliance with required actions in the app was 92% (IQR 87-95), and postoperative compliance was 100% (IQR 100-100). Patient-reported usability was good and patient experiences were mostly positive, although several suggestions for improvement were reported.</p><p><strong>Conclusions: </strong>Our results demonstrate the feasibility of a comprehensive eCoach for guiding and monitoring patients undergoing colorectal surgery encompassing the entire perioperative pathway, including prehabilitation and postdischarge monitoring. Compliance was excellent for all phases of the care pathway and recruitment and retention rates were comparable with rates reported in the literature. The study findings provide valuable insights for the further development of the eCoach and highlight the potential of digital health applications in perioperative support.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e67425"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505852","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":"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":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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&lt;sub&gt;42&lt;/sub&gt;=2.1; P&lt;.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&lt;sub&gt;42&lt;/sub&gt;=7.2; P&lt;.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg&lt;sup&gt;-1&lt;/sup&gt; min&lt;sup&gt;-1&lt;/sup&gt; vs mean 23.6, SD 6.5 mL kg&lt;sup&gt;-1&lt;/sup&gt; min&lt;sup&gt;-1&lt;/sup&gt;; t&lt;sub&gt;42&lt;/sub&gt;=7.2; P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959816","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412042","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412043","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384290","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":"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}