JMIR perioperative medicine最新文献

{"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}

{"title":"Blood Bonds: Transforming Blood Donation Through Innovation, Inclusion, and Engagement.","authors":"Ankita Sagar","doi":"10.2196/63817","DOIUrl":"10.2196/63817","url":null,"abstract":"<p><p>The journey of receiving blood as a patient with transfusion-dependent beta thalassemia has profoundly shaped my understanding of the life-saving power of blood donation. This personal experience underscores the critical importance of blood donors, not just for individual recipients but for the broader community, enhancing public health, productivity, and well-being. There are several challenges to securing a blood donor pool in current health care climate. Solutions that focus on the engagement of donors, clinicians, and patients are key to improving the donor pool and utilizing the blood supply in a judicious manner.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e63817"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333893","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":"Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study.","authors":"Zandantsetseg Orgil, Anitra Karthic, Nora F Bell, Lisa M Heisterberg, Sara E Williams, Lili Ding, Susmita Kashikar-Zuck, Christopher D King, Vanessa A Olbrecht","doi":"10.2196/48959","DOIUrl":"10.2196/48959","url":null,"abstract":"<p><strong>Background: </strong>Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established.</p><p><strong>Objectives: </strong>The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF.</p><p><strong>Methods: </strong>A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF.</p><p><strong>Results: </strong>Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85%). Few patients reported VR-BF as beneficial for pain (8/20, 40%).</p><p><strong>Conclusions: </strong>Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery.</p><p><strong>Trial registration: </strong>ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e48959"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923868","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 of a Novel Electronic Form for Preoperative Cardiac Risk Assessment With Reduction in Cardiac Consultations and Testing: Retrospective Cohort Study.","authors":"Mandeep Kumar, Kathryn Wilkinson, Ya-Huei Li, Rohit Masih, Mehak Gandhi, Haleh Saadat, Julie Culmone","doi":"10.2196/63076","DOIUrl":"10.2196/63076","url":null,"abstract":"<p><strong>Background: </strong>Preoperative cardiac risk assessment is an integral part of preoperative evaluation; however, there is significant variation among providers, leading to inappropriate referrals for cardiology consultation or excessive low-value cardiac testing. We implemented a novel electronic medical record (EMR) form in our preoperative clinics to decrease variation.</p><p><strong>Objective: </strong>This study aimed to investigate the impact of the EMR form on the preoperative utilization of cardiology consultation and cardiac diagnostic testing (echocardiograms, stress tests, and cardiac catheterization) and evaluate postoperative outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted. Patients who underwent outpatient preoperative evaluation prior to an elective surgery over 2 years were divided into 2 cohorts: from July 1, 2021, to June 30, 2022 (pre-EMR form implementation), and from July 1, 2022, to June 30, 2023 (post-EMR form implementation). Demographics, comorbidities, resource utilization, and surgical characteristics were analyzed. Propensity score matching was used to adjust for differences between the 2 cohorts. The primary outcomes were the utilization of preoperative cardiology consultation, cardiac testing, and 30-day postoperative major adverse cardiac events (MACE).</p><p><strong>Results: </strong>A total of 25,484 patients met the inclusion criteria. Propensity score matching yielded 11,645 well-matched pairs. The post-EMR form, matched cohort had lower cardiology consultation (pre-EMR form: n=2698, 23.2% vs post-EMR form: n=2088, 17.9%; P<.001) and echocardiogram (pre-EMR form: n=808, 6.9% vs post-EMR form: n=591, 5.1%; P<.001) utilization. There were no significant differences in the 30-day postoperative outcomes, including MACE (all P>.05). While patients with \"possible indications\" for cardiology consultation had higher MACE rates, the consultations did not reduce MACE risk. Most algorithm end points, except for active cardiac conditions, had MACE rates <1%.</p><p><strong>Conclusions: </strong>In this cohort study, preoperative cardiac risk assessment using a novel EMR form was associated with a significant decrease in cardiology consultation and testing utilization, with no adverse impact on postoperative outcomes. Adopting this approach may assist perioperative medicine clinicians and anesthesiologists in efficiently decreasing unnecessary preoperative resource utilization without compromising patient safety or quality of care.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e63076"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302678","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":"Gamified Mobile App (MobERAS) for Telemonitoring Patients in the Postoperative Period Based on the Enhanced Recovery after Surgery Program: Development and Validation Study.","authors":"Aline Evangelista Santiago, Victor Pezzi Gazzinelli Cruz, Rafaela Souza Furtado, Eduardo Batista Cândido, Wladmir Cardoso Brandão, Agnaldo Lopes Silva Filho","doi":"10.2196/56033","DOIUrl":"10.2196/56033","url":null,"abstract":"<p><strong>Background: </strong>Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results.</p><p><strong>Objective: </strong>This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use.</p><p><strong>Methods: </strong>We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient's walking time and distance and is connected to a virtual database that stores the collected data.</p><p><strong>Results: </strong>Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3% (SD 12.1%, range 41.7%-100%), and ambulation data were obtained for 60 (92.3%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app's usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10).</p><p><strong>Conclusions: </strong>MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e56033"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984087","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":"Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study.","authors":"Yamini Subramani, Jill Querney, Priyanka Singh, Yifan Zhang, Lee-Anne Fochesato, Nida Fatima, Natasha Wood, Mahesh Nagappa","doi":"10.2196/57541","DOIUrl":"10.2196/57541","url":null,"abstract":"<p><strong>Background: </strong>The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments.</p><p><strong>Objective: </strong>This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow.</p><p><strong>Methods: </strong>A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days.</p><p><strong>Results: </strong>The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions.</p><p><strong>Conclusions: </strong>The quality improvement process significantly enhanced the institution's preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e57541"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11310641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763085","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":"Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis.","authors":"Vladimir Turzhitsky, Lori D Bash, Richard D Urman, Michael Kattan, Ira Hofer","doi":"10.2196/52278","DOIUrl":"10.2196/52278","url":null,"abstract":"<p><strong>Background: </strong>Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents.</p><p><strong>Objective: </strong>We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19-era patients would have been treated before the pandemic.</p><p><strong>Results: </strong>More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R²>0.99). Multivariate analysis showed that the post-COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre-COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001).</p><p><strong>Conclusions: </strong>We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and a","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"7 ","pages":"e52278"},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749919","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}