%0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e66186 %T Effect of Immersive Virtual Reality Teamwork Training on Safety Behaviors During Surgical Cases: Nonrandomized Intervention Versus Controlled Pilot Study %A Mazur,Lukasz %A Butler,Logan %A Mitchell,Cody %A Lashani,Shaian %A Buchanan,Shawna %A Fenison,Christi %A Adapa,Karthik %A Tan,Xianming %A An,Selina %A Ra,Jin %K Teamwork Evaluation of Non-Technical Skills %K TENTS %K Team Strategies and Tools to Enhance Performance and Patient Safety %K TeamSTEPPS %K immersive virtual reality %K virtual reality %K VR %K safety behavior %K surgical error %K operating room %K OR %K training intervention %K training %K pilot study %K nontechnical skills %K surgery %K surgical %K patient safety %K medical training %K medical education %D 2025 %7 1.5.2025 %9 %J JMIR Med Educ %G English %X Background: Approximately 4000 preventable surgical errors occur per year in the US operating rooms, many due to suboptimal teamwork and safety behaviors. Such errors can result in temporary or permanent harm to patients, including physical injury, emotional distress, or even death, and can also adversely affect care providers, often referred to as the “second victim.” Objective: Given the persistence of adverse events in the operating rooms, the objective of this study was to quantify the effect of an innovative and immersive virtual reality (VR)–based educational intervention on (1) safety behaviors of surgeons in the operating rooms and (2) sense-making regarding the overall training experience. Methods: This mixed methods pre- versus postintervention pilot study was conducted in a large academic medical center with 55 operating rooms. Safety behaviors were observed and quantified using validated Teamwork Evaluation of Non-Technical Skills instrument during surgical cases at baseline (101 observations; 83 surgeons) and postimmersive VR based intervention (postintervention: 24 observations within each group; intervention group [with VR training; 10 surgeons] and control [no VR training; 10 surgeons]). VR intervention included a 45-minute immersive VR-based training incorporating a pre- and postdebriefing based on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) principles to improve safety behaviors. A 2-tailed, 2-sample t-test with adjustments for multiplicity of the tests was used to test for significance in observable safety behaviors between the groupings. The debriefing data underwent analysis through the phenomenological analysis method to gain insights into how participants interpreted the training. Results: Preintervention, all safety behaviors averaged slightly above “acceptable” scores, with an overall average of 2.2 (range 2‐2.3; 0‐3 scale). The 10 surgeons that underwent our intervention showed statistically significant (P<.05) improvements in 90% (18/20) of safety behaviors when compared to the 10 surgeons that did not receive the intervention (overall average 2.5, range 2.3‐2.7 vs overall average 2.1, range 1.9‐2.2). Our qualitative analysis based on 492 quotes from participants suggests that the observed behavioral changes are a result of an immersive experience and sense-making of key TeamSTEPPS training concepts. Conclusions: VR-based immersive training intervention focused on TeamSTEPPS principles seems effective in improving safety behaviors in the operating rooms as quantified via observations using the Teamwork Evaluation of Non-Technical Skills instrument. Further research with larger, more diverse sample sizes is needed to confirm the generalizability of these findings. International Registered Report Identifier (IRRID): RR2-10.2196/40445. %R 10.2196/66186 %U https://mededu.jmir.org/2025/1/e66186 %U https://doi.org/10.2196/66186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65937 %T Localization and Classification of Adrenal Masses in Multiphase Computed Tomography: Retrospective Study %A Yang,Liuyang %A Zhang,Xinzhang %A Li,Zhenhui %A Wang,Jian %A Zhang,Yiwen %A Shan,Liyu %A Shi,Xin %A Si,Yapeng %A Wang,Shuailong %A Li,Lin %A Wu,Ping %A Xu,Ning %A Liu,Lizhu %A Yang,Junfeng %A Leng,Jinjun %A Yang,Maolin %A Zhang,Zhuorui %A Wang,Junfeng %A Dong,Xingxiang %A Yang,Guangjun %A Yan,Ruiying %A Li,Wei %A Liu,Zhimin %A Li,Wenliang %+ Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519, Kunzhou Road, Xishan District, Kunming, 650118, China, 86 0871 6818903, liwenliang@kmmu.edu.cn %K MA-YOLO model %K multi-class adrenal masses %K multi-phase CT images %K localization %K classification %D 2025 %7 24.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The incidence of adrenal incidentalomas is increasing annually, and most types of adrenal masses require surgical intervention. Accurate classification of common adrenal masses based on tumor computed tomography (CT) images by radiologists or clinicians requires extensive experience and is often challenging, which increases the workload of radiologists and leads to unnecessary adrenal surgeries. There is an urgent need for a fully automated, noninvasive, and precise approach for the identification and accurate classification of common adrenal masses. Objective: This study aims to enhance diagnostic efficiency and transform the current clinical practice of preoperative diagnosis of adrenal masses. Methods: This study is a retrospective analysis that includes patients with adrenal masses who underwent adrenalectomy from January 1, 2021, to May 31, 2023, at Center 1 (internal dataset), and from January 1, 2016, to May 31, 2023, at Center 2 (external dataset). The images include unenhanced, arterial, and venous phases, with 21,649 images used for the training set, 2406 images used for the validation set, and 12,857 images used for the external test set. We invited 3 experienced radiologists to precisely annotate the images, and these annotations served as references. We developed a deep learning–based adrenal mass detection model, Multi-Attention YOLO (MA-YOLO), which can automatically localize and classify 6 common types of adrenal masses. In order to scientifically evaluate the model performance, we used a variety of evaluation metrics, in addition, we compared the improvement in diagnostic efficacy of 6 doctors after incorporating model assistance. Results: A total of 516 patients were included. In the external test set, the MA-YOLO model achieved an intersection over union of 0.838, 0.885, and 0.890 for the localization of 6 types of adrenal masses in unenhanced, arterial, and venous phase CT images, respectively. The corresponding mean average precision for classification was 0.885, 0.913, and 0.915, respectively. Additionally, with the assistance of this model, the classification diagnostic performance of 6 radiologists and clinicians for adrenal masses improved. Except for adrenal cysts, at least 1 physician significantly improved diagnostic performance for the other 5 types of tumors. Notably, in the categories of adrenal adenoma (for senior clinician: P=.04, junior radiologist: P=.01, and senior radiologist: P=.01) and adrenal cortical carcinoma (junior clinician: P=.02, junior radiologist: P=.01, and intermediate radiologist: P=.001), half of the physicians showed significant improvements after using the model for assistance. Conclusions: The MA-YOLO model demonstrates the ability to achieve efficient, accurate, and noninvasive preoperative localization and classification of common adrenal masses in CT examinations, showing promising potential for future applications. %M 40273442 %R 10.2196/65937 %U https://www.jmir.org/2025/1/e65937 %U https://doi.org/10.2196/65937 %U http://www.ncbi.nlm.nih.gov/pubmed/40273442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e62659 %T Effectiveness of Stromal Vascular Fraction (SVF) and Platelet-Rich Plasma (PRP) in Patients With Knee Osteoarthritis: Protocol for a Phase 3, Prospective, Randomized, Controlled, Multicenter Study (SPOST Study) %A Schwitzguebel,Adrien %A Ramirez Cadavid,David Andres %A Da Silva,Tamara %A Decavel,Pierre %A Benaim,Charles %+ , Sports Medicine Division, Hôpital de la Providence, Av. du Premier-Mars 29, Neuchâtel, 2000, Switzerland, 41 32 720 327, adrien.schwitzguebel@gmail.com %K stromal vascular fraction %K platelet-rich plasma %K osteoarthritis %K adjuvant therapy %K tissue regeneration %K clinical efficacy %D 2025 %7 8.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Available evidence on the conservative treatment of knee osteoarthritis still leaves questions about the efficacy of platelet-rich plasma (PRP) and whether stromal vascular fraction (SVF) offers a superior therapeutic tool. Objective: This study aims to assess the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration for knee osteoarthritis. Methods: In a multicenter, randomized, triple-blind, controlled trial, 108 individuals with knee osteoarthritis will be block-randomized in a 1:1 ratio. Patients will receive an initial single PRP or PRP + SVF injection followed by PRP doses at 1 month and 2 months. The primary endpoint is functional improvement measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at the 6-month follow-up. Secondary endpoints, collected at the 1-month, 2-month, 3-month, 6-month, and 12-month follow-ups, will include the pain visual analogue scale during maximal physical activity, WOMAC score, length of time to return to work and sports in days, magnetic resonance imaging (MRI)–based Whole-Organ Magnetic Resonance Imaging Score (WORMS), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, MRI Area Measurement and Depth and Underlying Structures (AMADEUS) score at 6 months and at 12 months, adverse events, and serious adverse events. Results: Participant recruitment and data collection are expected to begin in July 2025 and finish in July 2027. Final end points will be gathered in August 2027, and the results are expected to be published in late 2027. Conclusions: The study results will provide insight into the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration in patients with knee osteoarthritis. Trial Registration: ClinicalTrials.gov (NCT05660824); https://clinicaltrials.gov/study/NCT05660824 International Registered Report Identifier (IRRID): PRR1-10.2196/62659 %M 40198111 %R 10.2196/62659 %U https://www.researchprotocols.org/2025/1/e62659 %U https://doi.org/10.2196/62659 %U http://www.ncbi.nlm.nih.gov/pubmed/40198111 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e54651 %T Policy Spotlight Effects on Critical Time-Sensitive Diseases: Nationwide Retrospective Cohort Study on Taiwan’s Hospital Emergency Capability Categorization Policy %A Lin,Chih-Yuan %A Liu,Chih-Ching %A Huang,Yu-Tung %A Lee,Yue-Chune %+ Institute of Health and Welfare, College of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei, Taiwan, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan, 886 225916681 ext 1526, DAS73@tpech.gov.tw %K categorization of hospital emergency capability %K quality %K time-sensitive diseases %K emergency care %K difference-in-differences %D 2025 %7 25.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Taiwan’s categorization of hospital emergency capability (CHEC) policy is designed to regionalize and dispatch critical patients. The policy was designed in 2009 to improve the quality of emergency care for critical time-sensitive diseases (CTSDs). The CHEC policy primarily uses time-based quality surveillance indicators. Objective: We aimed to investigate the impact of Taiwan’s CHEC policy on CTSDs. Methods: Using Taiwan’s 2005 Longitudinal Health Insurance Database, this nationwide retrospective cohort study examined the CHEC policy’s impact from 2005 to 2011. Propensity score matching and difference-in-differences analysis within a generalized estimating equation framework were used to compare pre- and postimplementation periods. The study focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. AIS and STEMI cases, monitored with time-based indicators, were evaluated for adherence to diagnostic and treatment guidelines as process quality measures. Mortality and medical use served as outcome indicators. Major trauma, with evolving guidelines and no time-based monitoring, acted as a control to test for policy spotlight effects. Results: In our cohort of 9923 patients, refined through 1:1 propensity score matching, 5566 (56.09%) were male and were mostly older adults. Our analysis revealed that the CHEC policy effectively improved system efficiency and patient outcomes, resulting in significant reductions in medical orders (–7.29 items, 95% CI –10.09 to –4.48; P<.001), short-term mortality rates (–0.09%, 95% CI –0.17% to –0.02%; P=.01) and long-term mortality rates (–0.09%, 95% CI –0.15% to –0.04%; P=.001), and total medical expenses (–5328.35 points per case, 95% CI –10,387.10 to –269.60; P=.04), despite a modest increase in diagnostic fees (376.37 points, 95% CI 92.42-660.33; P=.01). The CHEC policy led to notable increases in diagnostic fees, major treatments, and medical orders for AIS and STEMI cases. For AIS cases, significant increases were observed in major treatments (β=0.77; 95% CI 0.21-1.33; P=.007) and medical orders (β=15.20; 95% CI 5.28-25.11; P=.003) compared to major trauma. In STEMI cases, diagnostic fees significantly increased (β=1983.75; 95% CI 84.28-3883.21; P=.04), while upward transfer rates significantly decreased (β=–0.59; 95% CI –1.18 to –0.001; P=.049). There were also trends toward increased major treatments (β=0.30; 95% CI –0.03 to 0.62, P=.07), medical orders (β=11.92; 95% CI –0.90 to 24.73; P=.07), and medical expenses (β=24,275.54; 95% CI –640.71 to 4,991,991.78; P=.06), although these were not statistically significant. In contrast, no significant changes were identified in process or outcome quality indicators for septic shock. These findings suggest policy spotlight effects, reflecting a greater emphasis on diseases directly prioritized under the CHEC policy. Conclusions: The CHEC policy demonstrated the dual benefits of reducing costs and improving patient outcomes. We observed unintended consequences of policy spotlight effects, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs with time-based surveillance indicators. %M 40132185 %R 10.2196/54651 %U https://www.i-jmr.org/2025/1/e54651 %U https://doi.org/10.2196/54651 %U http://www.ncbi.nlm.nih.gov/pubmed/40132185 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60728 %T Optimizing the Pharmacotherapy of Vascular Surgery Patients at Hospital Admission and Discharge (PHAROS): Protocol for a Quasi-Experimental Clinical Uncontrolled Trial %A Porubcova,Slavka %A Lajtmanova,Kristina %A Szmicsekova,Kristina %A Slezakova,Veronika %A Tomka,Jan %A Tesar,Tomas %+ Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Odbojarov 10, Bratislava, 832 32, Slovakia, 421 2 9016 9348, tesar@fpharm.uniba.sk %K pharmacotherapy %K hospital pharmacy %K vascular surgery %K patient safety %K risk reduction %K pharmacist-proposed interventions %D 2025 %7 19.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patient safety is essential in pharmacotherapy, especially in surgical contexts, due to the elevated risk of drug-related complications. Vascular surgery patients are particularly susceptible because of their complex medication needs and underlying health conditions. Improved safety monitoring and targeted pharmaceutical care in collaboration with physicians are crucial to minimize these risks and enhance patient outcomes. Objective: This protocol evaluates whether structured pharmaceutical care interventions—including medication reconciliation, medication review, and patient education—can reduce the prevalence of drug-related problems at hospital admission and discharge in vascular surgery patients. Methods: This prospective, uncontrolled study was conducted over 1 year in the Vascular Surgery Department at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. The study included adult patients with carotid artery disease or lower extremity artery disease who were on 3 or more medications, with an estimated sample size of approximately 100 patients. The primary intervention involved 3 key changes in practice: medication reconciliation at both admission and discharge, where hospital pharmacists review and verify medication lists; medication review to identify and address drug-related problems; and patient education at discharge. Pharmacist-proposed interventions were documented and communicated to the physician for treatment adjustments. The primary outcome is the change in drug-related problem prevalence from hospital admission to discharge. Secondary outcomes include the acceptance rate of pharmacist recommendations and patient understanding of pharmacotherapy. Data collection involved documenting the number, type, and frequency of drug-related problems; the anatomical therapeutic chemical classification of medications associated with drug-related problems; and patients’ social, demographic, and clinical characteristics, with a focus on factors related to drug-related problems, comorbidities, and medication use. Data analysis will use the paired Wilcoxon signed-rank test to compare the prevalence of drug-related problems and medication counts between admission and discharge. Continuous variables will be presented as means (SDs), while categorical variables will be reported as counts and percentages. Patient understanding of pharmacotherapy will be evaluated using a 3-point scale, classifying understanding as good (2-3 points per medication), modest (1-2 points), or poor (0-1 point). Results: Recruitment began in September 2021 and concluded in August 2022. Data collection occurred continuously during hospital stays, capturing demographics, comorbidities, pharmacotherapy, and drug-related problems at admission and discharge. Important milestones included the initial data review, which began in August 2023 to assess recruitment and data quality, including an early evaluation of drug-related problems. The primary analysis was completed in January 2024, focusing on the reduction in drug-related problems, intervention acceptance, and patient understanding. The final report was to be prepared by June 2024, disseminating the findings on pharmacist-led intervention impacts. Conclusions: This study should demonstrate that pharmacist-led interventions in collaboration with physicians can reduce pharmacotherapy risks and optimize medicine management for patient safety. Trial Registration: ClinicalTrials.gov NCT04930302; https://clinicaltrials.gov/study/NCT04930302 International Registered Report Identifier (IRRID): RR1-10.2196/60728 %M 40106812 %R 10.2196/60728 %U https://www.researchprotocols.org/2025/1/e60728 %U https://doi.org/10.2196/60728 %U http://www.ncbi.nlm.nih.gov/pubmed/40106812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68354 %T Machine Learning–Based Prediction of Early Complications Following Surgery for Intestinal Obstruction: Multicenter Retrospective Study %A Huang,Pinjie %A Yang,Jirong %A Zhao,Dizhou %A Ran,Taojia %A Luo,Yuheng %A Yang,Dong %A Zheng,Xueqin %A Zhou,Shaoli %A Chen,Chaojin %+ Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, No.600, Tianhe Road, Guangzhou, Guangzhou, 510630, China, 86 13430322182, chenchj28@mail.sysu.edu.cn %K postoperative complications %K intestinal obstruction %K machine learning %K early intervention %K risk calculator %K prediction model %K Shapley additive explanations %D 2025 %7 3.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Early complications increase in-hospital stay and mortality after intestinal obstruction surgery. It is important to identify the risk of postoperative early complications for patients with intestinal obstruction at a sufficiently early stage, which would allow preemptive individualized enhanced therapy to be conducted to improve the prognosis of patients with intestinal obstruction. A risk predictive model based on machine learning is helpful for early diagnosis and timely intervention. Objective: This study aimed to construct an online risk calculator for early postoperative complications in patients after intestinal obstruction surgery based on machine learning algorithms. Methods: A total of 396 patients undergoing intestinal obstruction surgery from April 2013 to April 2021 at an independent medical center were enrolled as the training cohort. Overall, 7 machine learning methods were used to establish prediction models, with their performance appraised via the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and F1-score. The best model was validated through 2 independent medical centers, a publicly available perioperative dataset the Informative Surgical Patient dataset for Innovative Research Environment (INSPIRE), and a mixed cohort consisting of the above 3 datasets, involving 50, 66, 48, and 164 cases, respectively. Shapley Additive Explanations were measured to identify risk factors. Results: The incidence of postoperative complications in the training cohort was 47.44% (176/371), while the incidences in 4 external validation cohorts were 34% (17/50), 56.06% (37/66), 52.08% (25/48), and 48.17% (79/164), respectively. Postoperative complications were associated with 8-item features: Physiological Severity Score for the Enumeration of Mortality and Morbidity (POSSUM physiological score), the amount of colloid infusion, shock index before anesthesia induction, ASA (American Society of Anesthesiologists) classification, the percentage of neutrophils, shock index at the end of surgery, age, and total protein. The random forest model showed the best overall performance, with an AUROC of 0.788 (95% CI 0.709-0.869), accuracy of 0.756, sensitivity of 0.695, specificity of 0.810, and F1-score of 0.727 in the training cohort. The random forest model also achieved a comparable AUROC of 0.755 (95% CI 0.652-0.839) in validation cohort 1, a greater AUROC of 0.817 (95% CI 0.695-0.913) in validation cohort 2, a similar AUROC of 0.786 (95% CI 0.628-0.902) in validation cohort 3, and the comparable AUROC of 0.720 (95% CI 0.671-0.768) in validation cohort 4. We visualized the random forest model and created a web-based online risk calculator. Conclusions: We have developed and validated a generalizable random forest model to predict postoperative early complications in patients undergoing intestinal obstruction surgery, enabling clinicians to screen high-risk patients and implement early individualized interventions. An online risk calculator for early postoperative complications was developed to make the random forest model accessible to clinicians around the world. %M 40053794 %R 10.2196/68354 %U https://www.jmir.org/2025/1/e68354 %U https://doi.org/10.2196/68354 %U http://www.ncbi.nlm.nih.gov/pubmed/40053794 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67660 %T Interdisciplinary Strategies to Reduce Surgical Infectious Risk in the Operating Theater: Protocol for Scoping Review %A Joubert,Dominique %A Boloré,Sylvain %A Baroni,Carelle %A Hans,Anne-Sophie %A Wasser,Aline %A Kivrak,Selin %A Murat-Ringot,Audrey %A Dussart,Claude %+ Health Care Directorate, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 079 553 03 34, dominique.joubert@hcuge.ch %K surgical site infection %K infection prevention %K interdisciplinary strategies %K surgical team %K operating room %K standardized operating procedures %D 2025 %7 12.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Surgical site infections (SSIs) represent one of the most prevalent and significant complications associated with surgical procedures, often leading to prolonged hospitalization and delayed patient recovery. While recent international consensus guidelines have proposed evidence-based strategies to mitigate SSIs, they fall short in addressing the efficient and interdisciplinary implementation of these measures within the operating theater. Consequently, further research is required to identify and evaluate optimal interdisciplinary organizational approaches for the prevention of SSIs. Objective: This study aims to map the scope, diversity, and nature of research on interdisciplinary strategies aimed at reducing SSIs and to analyze the impact of interdisciplinary on the effectiveness of preventive interventions. Methods: Using the Joanna Briggs Institute (JBI) methodology for scoping reviews, a comprehensive search will be conducted across databases including Embase (encompassing MEDLINE and PubMed-not-MEDLINE), CINAHL, and the Cochrane Library, supplemented by manual searches of reference lists from included papers. This review targets studies published between 2016 and 2024, aligning with the World Health Organization’s 2016 SSI prevention guidelines, which introduced significant advancements in practice and remain the global benchmark. Only studies published in English or French will be considered. Around 5 reviewers independently distributed the included papers for detailed reading and data extraction, while the lead author concurrently and independently reviewed all papers. Inclusion criteria follow the Participants, Concept, and Context (PCC) framework, specifying that the eligible population comprises surgical teams. The primary concept of interest is interdisciplinary strategies aimed at preventing infection risk. The context focuses on adult surgical procedures within the operating room during turnover periods. Studies using experimental, quasi-experimental, preexperimental, observational, case-control, or cross-sectional designs will be included. Results: From the 1679 papers initially identified, 45 were selected for detailed analysis by 5 reviewers, with the selection process completed by November 2024. Conclusions: Emerging interdisciplinary strategies demonstrate significant potential in reducing the incidence of SSIs. This initiative forms part of a broader global project focused on codeveloping standardized protocols for preoperative preparation within the operating room to mitigate SSI risks. The findings of this scoping review will serve as the foundation for a subsequent qualitative survey and a pre-post quasi-experimental quantitative study to evaluate the integration and effectiveness of these strategies in clinical practice. The review protocol will be formally registered in the Open Science Framework (OSF) in 2024. International Registered Report Identifier (IRRID): DERR1-10.2196/67660 %M 39938079 %R 10.2196/67660 %U https://www.researchprotocols.org/2025/1/e67660 %U https://doi.org/10.2196/67660 %U http://www.ncbi.nlm.nih.gov/pubmed/39938079 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e56269 %T A Serious Game to Study Reduced Field of View in Keyhole Surgery: Development and Experimental Study %A Whitley,Phoebe %A Creasey,Connor %A Clarkson,Matthew J %A Thompson,Stephen %+ Advanced Research Computing, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2076792000, s.thompson@ucl.ac.uk %K keyhole surgery %K laparoscopic surgery %K serious games %K image mosaicking %K field of view %K javascript %K html %K opensource %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: During keyhole surgery, the surgeon is required to perform highly demanding tasks while only being able to see part of the patient’s anatomy. This limited field of view is widely cited as a key limitation of the procedure, and many computational methods have been proposed to overcome it. However, the precise effects of a limited field of view on task performance remain unknown due to the lack of tools to study these effects effectively. Objective: This paper describes our work on developing a serious game with 2 objectives: (1) to create an engaging game that communicates some of the challenges of keyhole surgery, and (2) to test the effect of a limited field of view on task performance. The development of a serious game that can be played by a wide range of participants will enable us to gather quantitative data on the effects of the reduced field of view on task performance. These data can inform the future development of technologies to help surgeons reduce the impact of a limited field of view on clinical outcomes for patients. The game is open source and may be adapted and used by other researchers to study related problems. Methods: We implemented an open-source serious game in JavaScript, inspired by the surgical task of selectively cauterizing blood vessels during twin-to-twin transfusion surgery. During the game, the player is required to identify and cut the correct blood vessel under different fields of view and varying levels of vascular complexity. We conducted a quantitative analysis of task performance time under different conditions and a formative analysis of the game using participant questionnaires. Results: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking significantly longer (P<.001) to perform otherwise identical tasks (mean 6.4 seconds, 95% CI 5.0-7.8 seconds vs mean 13.6 seconds, 95% CI 10.3-16.9 seconds). Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery. Conclusions: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking statistically significantly longer (16.4 vs 9.8 seconds; P=.05) to perform otherwise identical tasks. Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery. %M 39933172 %R 10.2196/56269 %U https://games.jmir.org/2025/1/e56269 %U https://doi.org/10.2196/56269 %U http://www.ncbi.nlm.nih.gov/pubmed/39933172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70168 %T Authors’ Reply: Advancing Insights Into Postoperative Sleep Quality and Influencing Factors %A Shang,Chen %A Yang,Ya %A He,Chengcheng %A Feng,Junqi %A Li,Yan %A Tian,Meimei %A Zhao,Zhanqi %A Gao,Yuan %A Li,Zhe %+ Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New District, Shanghai, 200127, China, 86 68383162, slamy1987@126.com %K sleep quality %K wearable sleep monitoring wristband %K intensive care unit %K minimally invasive surgery %K traditional open surgery %D 2025 %7 3.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39899853 %R 10.2196/70168 %U https://www.jmir.org/2025/1/e70168 %U https://doi.org/10.2196/70168 %U http://www.ncbi.nlm.nih.gov/pubmed/39899853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69193 %T Advancing Insights Into Postoperative Sleep Quality and Influencing Factors %A Zhao,Yining %A Hu,Xin %+ Department of Cardiology, Faculty of Medicine, The First Hospital of Shanxi Medical University, 85 Jiefang South St, Shanxi, 030001, China, 86 18535223677, 630324540@qq.com %K sleep quality %K wearable sleep monitoring wristband %K intensive care unit %K minimally invasive surgery %K traditional open surgery %D 2025 %7 3.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39899843 %R 10.2196/69193 %U https://www.jmir.org/2025/1/e69193 %U https://doi.org/10.2196/69193 %U http://www.ncbi.nlm.nih.gov/pubmed/39899843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58108 %T Use of Augmented Reality for Training Assistance in Laparoscopic Surgery: Scoping Literature Review %A Celdrán,Francisco Javier %A Jiménez-Ruescas,Javier %A Lobato,Carlos %A Salazar,Lucía %A Sánchez-Margallo,Juan Alberto %A Sánchez-Margallo,Francisco M %A González,Pascual %+ I3A, LoUISE Research Group, University of Castilla-La Mancha, C/ Investigación 2, Albacete, 02071, Spain, 34 666649104, franciscoj.celdran@uclm.es %K laparoscopic surgery %K surgical training %K surgical simulator %K augmented reality–based laparoscopic simulator %K AR-based laparoscopic simulator %K augmented reality %K mobile phone %D 2025 %7 28.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Laparoscopic surgery training is a demanding process requiring technical and nontechnical skills. Surgical training has evolved from traditional approaches to the use of immersive digital technologies such as virtual, augmented, and mixed reality. These technologies are now integral to laparoscopic surgery training. Objective: This scoping literature review aimed to analyze the current augmented reality (AR) solutions used in laparoscopic surgery training. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using 4 databases: Scopus, IEEE Xplore, PubMed, and ACM. Inclusion and exclusion criteria were applied to select relevant articles. Exclusion criteria were studies not using AR, not focused on laparoscopic surgery, not focused on training, written in a language other than English, or not providing relevant information on the topics studied. After selecting the articles, research questions (RQs) were formulated to guide the review. In total, 2 independent reviewers then extracted relevant data, and a descriptive analysis of the results was conducted. Results: Of 246 initial records, 172 (69.9%) remained after removing duplicates. After applying the exclusion criteria, 76 articles were selected, with 25 (33%) later excluded for not meeting quality standards, leaving 51 (67%) in the final review. Among the devices analyzed (RQ 1), AR video–based devices were the most prevalent (43/51, 84%). The most common information provided by AR devices (RQ 1) focused on task execution and patient-related data, both appearing in 20% (10/51) of studies. Regarding sensorization (RQ 2), most studies (46/51, 90%) incorporated some form of sensorized environment, with computer vision being the most used technology (21/46, 46%) and the trainee the most frequently sensorized element (41/51, 80%). Regarding training setups (RQ 3), 39% (20/51) of the studies used commercial simulators, and 51% (26/51) made use of artificial models. Concerning the evaluation methods (RQ 4), objective evaluation was the most used, featured in 71% (36/51) of the studies. Regarding tasks (RQ 5), 43% (22/51) of studies focused on full surgical procedures, whereas 57% (29/51) focused on simple training tasks, with suturing being the most common among the latter (11/29, 38%). Conclusions: This scoping review highlights the evolving role of AR technologies in laparoscopic surgery training, although the impact of optical see-through devices remains unclear due to their limited use. It underscores the potential of emerging technologies such as haptic feedback, computer vision, and eye tracking to further enhance laparoscopic skill acquisition. While most relevant articles from other databases were included, some studies may have been missed due to the specific databases and search strategies used. Moreover, the need for standardized evaluation metrics is emphasized, paving the way for future research into AR’s full potential in laparoscopic skill acquisition. %M 39874568 %R 10.2196/58108 %U https://www.jmir.org/2025/1/e58108 %U https://doi.org/10.2196/58108 %U http://www.ncbi.nlm.nih.gov/pubmed/39874568 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59203 %T Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study %A Möllmann,Henriette Louise %A Alhammadi,Eman %A Boulghoudan,Soufian %A Kuhlmann,Julian %A Mevissen,Anica %A Olbrich,Philipp %A Rahm,Louisa %A Frohnhofen,Helmut %+ Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 15206802915, henriettelouise.moellmann@med.uni-duesseldorf.de %K delirium %K older patients %K perioperative assessment %K age-related surgical risk factors %K geriatric assessment %K gerontology %K aging %K surgical medicine %K surgical care %K surgery %K multidisciplinary %K prospective study %K perioperative %K screening %K palliative care %K health informatics %D 2025 %7 22.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. Objective: This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient’s life. Methods: We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Results: Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. Conclusions: In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. Trial Registration: German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614 International Registered Report Identifier (IRRID): DERR1-10.2196/59203 %M 39841510 %R 10.2196/59203 %U https://www.researchprotocols.org/2025/1/e59203 %U https://doi.org/10.2196/59203 %U http://www.ncbi.nlm.nih.gov/pubmed/39841510 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e59850 %T Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study %A Teng,Peng %A Xu,Youran %A Qian,Kaoliang %A Lu,Ming %A Hu,Jun %+ , Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing, , China, 86 02568303196, junhu89@vip.sina.com %K case-based learning %K virtual reality %K pelvic fracture %K severe pelvic trauma %K hemodynamic instability %K clinical skill training %K VR %K pelvic trauma %K medical student %K pilot study %K orthopedic surgery %K theoretical teaching %K acceptability %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students’ knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation’s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students’ clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. %M 39823600 %R 10.2196/59850 %U https://mededu.jmir.org/2025/1/e59850 %U https://doi.org/10.2196/59850 %U http://www.ncbi.nlm.nih.gov/pubmed/39823600 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e54609 %T Evaluation of the Feasibility of Transfusing Leukocyte Depletion Filter–Processed Intraoperative Cell Salvage Blood in Metastatic Spine Tumor Surgery: Protocol for a Non–Randomized Study %A Kumar,Naresh %A Hui,Si Jian %A Lee,Renick %A Athia,Sahil %A Tan,Joel Yong Hao %A Tan,Jonathan Jiong Hao %+ Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Rd, Singapore, 119228, Singapore, 65 67725611, dosksn@nus.edu.sg %K blood transfusion %K autologous blood transfusion %K operative blood salvage %K leukocyte reduction filtration %K intraoperative blood cell salvage %K extramedullary spinal cord compression %K metastases %K tumors %K leukocytes %D 2025 %7 17.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Metastatic spine tumor surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is the mainstay of blood replenishment but with immune-mediated postoperative complications. Alternative blood management techniques (salvaged blood transfusion [SBT]) allow us to overcome such complications. Despite widespread use of intraoperative cell salvage (IOCS) in oncological and nononcological surgical procedures, surgeons remain reluctant to use IOCS in MSTS. Objective: This study aims to analyze safety of IOCS-leukocyte depletion filter (LDF)–processed blood transfusion for patients undergoing MSTS by assessing clinical outcomes—disease progression: tumor progression and overall survival. This study evaluates whether reinfusion of IOCS-LDF–processed blood reduces ABT rates in patients undergoing MSTS by sorting patients undergoing MSTS who require ABT into patients who consent to receive or not receive SBT. Methods: We aim to recruit a minimum of 90 patients—30 patients for SBT, 30 patients for ABT, and 30 patients with no blood transfusion. SBT and ABT form the 2 experimental arms, whereas no blood transfusion forms the control cohort. Available patient data will be reviewed to determine tumor burden secondary to metastasis and postoperative survival and disease progression, improvement in pain, and neurological and ambulatory status. Data collected will be studied postoperatively at 3, 6, 12, 24, 36, and 48 months or until demise, whichever occurs first. Outcomes of the experimental groups will be compared with those of the control group. Outcomes will be analyzed using 1-way ANOVA and Fisher exact test. The Kaplan-Meier curve and a log-rank test will be used to study overall survival. A multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumor progression. All statistical analyses will be done using Stata Special Edition 14.0 (StataCorp LP). Results: This is the largest clinical study on use of IOCS in MSTS from various primary malignancies to date. It will provide significant clinical evidence regarding the safety and applicability of IOCS in MSTS. It will help reduce use of ABT, improving overall blood management of patients undergoing MSTS. A limitation of this study is that not all patients undergoing MSTS will survive for the follow-up period (4 years), theoretically leading to underreporting of disease progression. Study commenced in 2016 and patient recruitment continued till 2019. As of September 2019, we have collected operative data on 140 patients. However, the 2-year outcomes of about 40.0% (56/140) of patients are in the process of collection. The study is aimed to be published in the years 2023-2024. Conclusions: Results will be disseminated via peer-reviewed publications, paving the way for future studies. International Registered Report Identifier (IRRID): DERR1-10.2196/54609 %M 39823595 %R 10.2196/54609 %U https://www.researchprotocols.org/2025/1/e54609 %U https://doi.org/10.2196/54609 %U http://www.ncbi.nlm.nih.gov/pubmed/39823595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55046 %T A Supervised Explainable Machine Learning Model for Perioperative Neurocognitive Disorder in Liver-Transplantation Patients and External Validation on the Medical Information Mart for Intensive Care IV Database: Retrospective Study %A Ding,Zhendong %A Zhang,Linan %A Zhang,Yihan %A Yang,Jing %A Luo,Yuheng %A Ge,Mian %A Yao,Weifeng %A Hei,Ziqing %A Chen,Chaojin %+ Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China, 86 13430322182, chenchj28@mail.sysu.edu.cn %K machine learning %K risk factors %K liver transplantation %K perioperative neurocognitive disorders %K MIMIC-Ⅳ database %K external validation %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients undergoing liver transplantation (LT) are at risk of perioperative neurocognitive dysfunction (PND), which significantly affects the patients’ prognosis. Objective: This study used machine learning (ML) algorithms with an aim to extract critical predictors and develop an ML model to predict PND among LT recipients. Methods: In this retrospective study, data from 958 patients who underwent LT between January 2015 and January 2020 were extracted from the Third Affiliated Hospital of Sun Yat-sen University. Six ML algorithms were used to predict post-LT PND, and model performance was evaluated using area under the receiver operating curve (AUC), accuracy, sensitivity, specificity, and F1-scores. The best-performing model was additionally validated using a temporal external dataset including 309 LT cases from February 2020 to August 2022, and an independent external dataset extracted from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database including 325 patients. Results: In the development cohort, 201 out of 751 (33.5%) patients were diagnosed with PND. The logistic regression model achieved the highest AUC (0.799) in the internal validation set, with comparable AUC in the temporal external (0.826) and MIMIC-Ⅳ validation sets (0.72). The top 3 features contributing to post-LT PND diagnosis were the preoperative overt hepatic encephalopathy, platelet level, and postoperative sequential organ failure assessment score, as revealed by the Shapley additive explanations method. Conclusions: A real-time logistic regression model-based online predictor of post-LT PND was developed, providing a highly interoperable tool for use across medical institutions to support early risk stratification and decision making for the LT recipients. %M 39813086 %R 10.2196/55046 %U https://www.jmir.org/2025/1/e55046 %U https://doi.org/10.2196/55046 %U http://www.ncbi.nlm.nih.gov/pubmed/39813086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62740 %T Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study %A Schneider,Tim %A Cetin,Timur %A Uppenkamp,Stefan %A Weyhe,Dirk %A Muender,Thomas %A Reinschluessel,Anke V %A Salzmann,Daniela %A Uslar,Verena %+ University Hospital for Visceral Surgery, PIUS-Hospital, Department for Human Medicine, Faculty VI, University of Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 4412292922, tim.schneider@uol.de %K workload measurement %K virtual reality %K VR %K augmented reality %K AR %K electroencephalography %K EEG %K event-related potential %K ERP %K auditory evoked potential %K AEP %K oddball experiment %K National Aeronautics and Space Administration Task Load Index %K NASA-TLX %K surgical planning %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of advanced technologies such as augmented reality (AR) and virtual reality (VR) into surgical procedures has garnered significant attention. However, the introduction of these innovations requires thorough evaluation in the context of human-machine interaction. Despite their potential benefits, new technologies can complicate surgical tasks and increase the cognitive load on surgeons, potentially offsetting their intended advantages. It is crucial to evaluate these technologies not only for their functional improvements but also for their impact on the surgeon’s workload in clinical settings. A surgical team today must increasingly navigate advanced technologies such as AR and VR, aiming to reduce surgical trauma and enhance patient safety. However, each innovation needs to be evaluated in terms of human-machine interaction. Even if an innovation appears to bring advancements to the field it is applied in, it may complicate the work and increase the surgeon’s workload rather than benefiting the surgeon. Objective: This study aims to establish a method for objectively determining the additional workload generated using AR or VR glasses in a clinical context for the first time. Methods: Electroencephalography (EEG) signals were recorded using a passive auditory oddball paradigm while 9 participants performed surgical planning for liver resection across 3 different conditions: (1) using AR glasses, (2) VR glasses, and (3) the conventional planning software on a computer. Results: The electrophysiological results, that is, the potentials evoked by the auditory stimulus, were compared with the subjectively perceived stress of the participants, as determined by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions. The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses. In addition, EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition. For the P1 component, the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms). Conclusions: The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model. Additionally, the alignment between subjectively determined results and objectively determined results confirms the validity of the study design applied in this research. %M 39773449 %R 10.2196/62740 %U https://formative.jmir.org/2025/1/e62740 %U https://doi.org/10.2196/62740 %U http://www.ncbi.nlm.nih.gov/pubmed/39773449 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 2 %N %P e60792 %T Augmented Reality in Enhancing Operating Room Crisis Checklist Adherence: Randomized Comparative Efficacy Study %A Ebnali Harari,Rayan %A Altaweel,Abdullah %A Anderson,Erik %A Pozner,Charles %A Grossmann,Rafael %A Goldsmith,Andrew %A Shokoohi,Hamid %K augmented reality %K operating room %K crisis checklist %K checklist %K guideline adherence %K quality improvement %K patient safety %K cardiac arrest %K hypotension %K hyperthermia %K critical care %K emergency department %D 2025 %7 6.1.2025 %9 %J JMIR XR Spatial Comput %G English %X Background: Effective crisis management in operating rooms (ORs) is crucial for patient safety. Despite their benefits, adherence to OR crisis checklists is often limited, highlighting the need for innovative solutions. Objective: The objective of this study was to evaluate the efficacy of augmented reality (AR)-enhanced checklists in improving protocol adherence, compared to traditional paper checklists and no checklist scenarios during simulated OR crises. Methods: This study was a randomized comparative efficacy study comparing the utility of AR checklists, paper checklists, and no checklist scenarios using 4 validated and simulated OR crises scenarios: asystolic cardiac arrest, air embolism, unexplained hypotension/hypoxia, and malignant hyperthermia. The study took place in a simulated OR setting and had applicability to the standard procedures in ORs, critical care units, and urgent care scenarios in the emergency department. To form the 24 OR teams, 50 professionals including 24 anesthesiologists, 24 nurses, 1 surgeon, and 1 scrub nurse from two academic hospitals were included. The primary outcome measured was the failure to adhere (FTA) rate for critical actions during simulated OR crises. Adherence was determined using retrospective video analysis involving 595 key processes evaluated across 24 surgical teams. Interrater reliability was assessed using a Cohen κ. Secondary outcomes included checklist usability and cognitive load, as measured by the low-frequency to high-frequency (LF/HF) ratio of the heart rate variability. Results: The AR checklist group showed a significantly lower FTA rate (mean 15.1%, SD 5.77%) compared to the paper checklist (mean 8.32%, SD 5.65%; t23=−2.08; P=.048) and the no checklist groups (mean 29.81%, SD 5.59%; t23=−6.47; P<.001). The AR checklist also resulted in a higher LF/HF ratio for anesthesiologists (F2,46=4.88; P=.02), showing a potential increase in the level of cognitive load. Survey data indicated positive receptions for both AR and paper checklists. Conclusions: These results suggest that AR checklists could offer a viable method for enhancing adherence to critical care protocols. Although, further research is needed to fully assess their impact on clinical outcomes and to address any associated increase in cognitive load. %R 10.2196/60792 %U https://xr.jmir.org/2025/1/e60792 %U https://doi.org/10.2196/60792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56777 %T Quantitative Impact of Traditional Open Surgery and Minimally Invasive Surgery on Patients’ First-Night Sleep Status in the Intensive Care Unit: Prospective Cohort Study %A Shang,Chen %A Yang,Ya %A He,Chengcheng %A Feng,Junqi %A Li,Yan %A Tian,Meimei %A Zhao,Zhanqi %A Gao,Yuan %A Li,Zhe %+ Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New District, Shanghai, 200127, China, 86 68383162, slamy1987@126.com %K sleep quality %K wearable sleep monitoring wristband %K intensive care unit %K minimally invasive surgery %K traditional open surgery %D 2024 %7 22.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The sleep status of patients in the surgical intensive care unit (ICU) significantly impacts their recoveries. However, the effects of surgical procedures on sleep are rarely studied. Objective: This study aimed to investigate quantitatively the impact of traditional open surgery (TOS) versus minimally invasive surgery (MIS) on patients’ first-night sleep status in a surgical ICU. Methods: Patients transferred to the ICU after surgery were prospectively screened. The sleep status on the night of surgery was assessed by the patient- and nurse-completed Richards-Campbell Sleep Questionnaire (RCSQ) and Huawei wearable sleep monitoring wristband. Surgical types and sleep parameters were analyzed. Results: A total of 61 patients were enrolled. Compared to patients in the TOS group, patients in the MIS group had a higher nurse-RCSQ score (mean 60.9, SD 16.9 vs mean 51.2, SD 17.3; P=.03), self-RCSQ score (mean 58.6, SD 16.2 vs mean 49.5, SD 14.8; P=.03), and Huawei sleep score (mean 77.9, SD 4.5 vs mean 68.6, SD 11.1; P<.001). Quantitative sleep analysis of Huawei wearable data showed a longer total sleep period (mean 503.0, SD 91.4 vs mean 437.9, SD 144.0 min; P=.04), longer rapid eye movement sleep period (mean 81.0, 52.1 vs mean 55.8, SD 44.5 min; P=.047), and higher deep sleep continuity score (mean 56.4, SD 7.0 vs mean 47.5, SD 12.1; P=.001) in the MIS group. Conclusions: MIS, compared to TOS, contributed to higher sleep quality for patients in the ICU after surgery. %R 10.2196/56777 %U https://www.jmir.org/2024/1/e56777 %U https://doi.org/10.2196/56777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65728 %T Evaluation of an App-Based Mobile Triage System for Mass Casualty Incidents: Within-Subjects Experimental Study %A Schmollinger,Martin %A Gerstner,Jessica %A Stricker,Eric %A Muench,Alexander %A Breckwoldt,Benjamin %A Sigle,Manuel %A Rosenberger,Peter %A Wunderlich,Robert %+ University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str.3, Tübingen, 72076, Germany, 49 70712981116, Robert.Wunderlich@med.uni-tuebingen.de %K disaster medicine %K mass casualty incidents %K digitalization %K triage %K Germany %K mobile triage app %D 2024 %7 21.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digitalization in disaster medicine holds significant potential to accelerate rescue operations and ultimately save lives. Mass casualty incidents demand rapid and accurate information management to coordinate effective responses. Currently, first responders manually record triage results on patient cards, and brief information is communicated to the command post via radio communication. Although this process is widely used in practice, it involves several time-consuming and error-prone tasks. To address these issues, we designed, implemented, and evaluated an app-based mobile triage system. This system allows users to document responder details, triage categories, injury patterns, GPS locations, and other important information, which can then be transmitted automatically to the incident commanders. Objective: This study aims to design and evaluate an app-based mobile system as a triage and coordination tool for emergency and disaster medicine, comparing its effectiveness with the conventional paper-based system. Methods: A total of 38 emergency medicine personnel participated in a within-subject experimental study, completing 2 triage sessions with 30 patient cards each: one session using the app-based mobile system and the other using the paper-based tool. The accuracy of the triages and the time taken for each session were measured. Additionally, we implemented the User Experience Questionnaire along with other items to assess participants’ subjective ratings of the 2 triage tools. Results: Our 2 (triage tool) × 2 (tool order) mixed multivariate analysis of variance revealed a significant main effect for the triage tool (P<.001). Post hoc analyses indicated that participants were significantly faster (P<.001) and more accurate (P=.005) in assigning patients to the correct triage category when using the app-based mobile system compared with the paper-based tool. Additionally, analyses showed significantly better subjective ratings for the app-based mobile system compared with the paper-based tool, in terms of both school grading (P<.001) and across all 6 scales of the User Experience Questionnaire (all P<.001). Of the 38 participants, 36 (95%) preferred the app-based mobile system. There was no significant main effect for tool order (P=.24) or session order (P=.06) in our model. Conclusions: Our findings demonstrate that the app-based mobile system not only matches the performance of the conventional paper-based tool but may even surpass it in terms of efficiency and usability. This advancement could further enhance the potential of digitalization to optimize processes in disaster medicine, ultimately leading to the possibility of saving more lives. %M 39474975 %R 10.2196/65728 %U https://www.jmir.org/2024/1/e65728 %U https://doi.org/10.2196/65728 %U http://www.ncbi.nlm.nih.gov/pubmed/39474975 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60575 %T A Video-Based Communication Intervention for Fecal Ostomy Surgery (CI-oSurg): Protocol for Open Pilot Testing to Improve Intervention Acceptability and Feasibility %A Cauley,Christy Elaine %A Rubio,Atziri %A Brindle,Mary %A Cooper,Zara %A Vranceanu,Ana-Maria %A Ritchie,Christine S %+ Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, United States, 1 6177268129, ccauley@mgh.harvard.edu %K fecal ostomy %K distress %K open pilot %K fecal ostomy surgeryl CI-oSurg %K intervention acceptability %K biopsychosocial outcomes %K psychosocial support %K ostomy care %D 2024 %7 15.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 100,000 patients undergo fecal ostomy operations annually across the United States. This patient population experiences high surgical complication rates and poor biopsychosocial outcomes. Surgical teams are not trained to address the psychosocial needs that often arise during recovery after fecal ostomy surgery. Objective: This study aims to refine and establish the acceptability and usability of the Communication Intervention for fecal ostomy Surgery (CI-oSurg), a web-based communication intervention aimed at reducing distress among patients recovering from ostomy surgery. Methods: We describe the proposed study design, methodology, and training protocol. We will conduct an open pilot (n=24 patients and n=8 clinicians) of video-based training to first identify the level and types of distress patients are experiencing. Next, patients will view web videos that address frequent challenges faced by ostomy patients, considering practical management and emotional and adaptation concerns. Qualitative one-to-one semistructured interviews will be conducted with participants to explore the acceptability and feasibility of the program and refine the intervention and study procedures. Results: This study has been approved by the Mass General Brigham Institutional Review Board. Study funding has been obtained, and recruitment is planned for the fall of 2024. Conclusions: Through this study, we will refine CI-oSurg, a web-based communication intervention focused on reducing distress after ostomy surgery, to improve intervention acceptability and usability. These improvements will allow us to establish the usability and acceptability of the intervention before efficacy testing to determine the ability of this intervention to reduce distress after fecal ostomy surgery. Trial Registration: ClinicalTrials.gov NCT06320002; https://clinicaltrials.gov/study/NCT06320002 International Registered Report Identifier (IRRID): PRR1-10.2196/60575 %M 39546348 %R 10.2196/60575 %U https://www.researchprotocols.org/2024/1/e60575 %U https://doi.org/10.2196/60575 %U http://www.ncbi.nlm.nih.gov/pubmed/39546348 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e60940 %T Impact of Ophthalmic Knowledge Assessment Program Scores and Surgical Volume on Subspecialty Fellowship Application in Ophthalmology Residency: Retrospective Cohort Study %A Hertel,Amanda Kay %A Ajlan,Radwan S %K residency %K fellowship %K ophthalmology %K OKAP %K surgical training %K ophthalmology resident %K ophthalmology residency program %K examination %K surgical volume exposure %K fellowship training %K surgical volume %K exposure %K Ophthalmic Knowledge Assessment Program %D 2024 %7 13.11.2024 %9 %J JMIR Med Educ %G English %X Background: Ophthalmology residents take the Ophthalmic Knowledge Assessment Program (OKAP) exam annually, which provides percentile rank for multiple categories and the total score. In addition, ophthalmology residency training programs have multiple subspecialty rotations with defined minimum procedure requirements. However, residents’ surgical volumes vary, with some residents exceeding their peers in specific subspecialty rotations. Objective: This study aims to identify if there is a difference in OKAP examination scores and surgical volume exposure during ophthalmology residency training between nonfellowship and fellowship applicants and among various subspecialties. Methods: A retrospective review of OKAP scores and surgical procedure numbers of graduating residents in an accredited academic ophthalmology residency program in the Midwest United States was conducted. Data were collected from 2012 to 2022. Results: A total of 31 residents were identified. Most residents decided to pursue fellowship training upon graduation (20/31, 65% residents), and the rest chose to practice comprehensive ophthalmology (11/31, 35% residents). A total of 18/31 residents had OKAP score reports available. The fellowship group outperformed the nonfellowship group in multiple subsections and the total exam (P=.04). Those pursuing fellowship training in glaucoma performed higher on the Glaucoma section (P=.004) and the total exam (P=.005). Residents pursuing cornea performed higher on nearly all subsections, including External Disease and Cornea (P=.02) and the total exam (P=.007). The majority of the surgical volume exposure was identical between fellowship and nonfellowship groups. Those who pursued glaucoma fellowship performed more glaucoma filtering and shunting procedures (P=.03). Residents going into pediatrics fellowship were primary surgeons in more strabismus cases (P=.01), assisted in fewer strabismus cases (P<.001), and had no difference in the total number of strabismus surgeries. Conclusions: In our program, residents pursuing fellowship training had higher OKAP scores on multiple sections and the total exam. There was no significant difference in the overall surgical volume averages between fellowship and nonfellowship groups, but few differences existed in subspecialty procedures among fellowship applicants. Larger multicenter studies are needed to clarify the relationship between OKAP scores and ophthalmology fellowship decisions nationwide. %R 10.2196/60940 %U https://mededu.jmir.org/2024/1/e60940 %U https://doi.org/10.2196/60940 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59014 %T Influence of Distraction Factors on Performance in Laparoscopic Surgery in Immersive Virtual Reality: Study Protocol of a Cross-Over Trial in Medical Students and Residents—DisLapVR %A Hanke,Laura %A Schulte,Richard %A Boedecker,Christian %A Huettl,Florentine %A Saalfeld,Patrick %A Chheang,Vuthea %A Wessels,Marlene %A von Castell,Christoph %A Hecht,Heiko %A Hansen,Christian %A Lang,Hauke %A Huber,Tobias %+ Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, 49 06131177291, tobias.huber@unimedizin-mainz.de %K immersive virtual reality %K distractions in surgery %K %K laparoscopy %K medical training %K medical students %K surgical education %K surgical training %K VR %K cognitive load %K multitasking %K stress resilience %D 2024 %7 5.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Working in an operating room (OR) is physically and mentally challenging: the operation itself demands the surgeon's full attention, while time and cost efficiency constraints, daily planning, and emergency care interfere with the procedure. Thus, multitasking becomes an integral surgical competence. This study aims to examine the effect of disruptions during surgery in a highly immersive virtual reality (IVR) operation environment combined with a virtual reality (VR) laparoscopy simulator. Objective: This study aims to identify distractions in the OR and their importance in the clinical setting. Methods: An IVR environment was created using a high-resolution, stereoscopic 360° video of the OR. Different distractions were identified, classified as auditory, visual, or audio-visual, and recorded accordingly. The surrounding was combined with a VR laparoscopic simulator. Participants—medical students and surgical residents—received proficiency-based training in basic laparoscopic skills and were blinded to the aim of the experiment. Following a cross-over design, each participant received a unique order of virtual distraction factors while performing tasks on the laparoscopic simulator. During the experiment, subjective passing of time, stress, heart rate, and visually induced motion sickness are recorded. After the experiment, validated questionnaires for usability, immersion, and stress were completed, as well as subjective evaluation of the distractions. The questionnaires used included the system usability scale, Self-Assessment Manikin score, National Aeronautics and Space Administration Task Load Index, and the immersion rating scale as described by Nichols. Performance in the laparoscopic tasks in relation to distractions will be evaluated by the Wilcoxon test and ANOVA for continuous variables. Subgroup analyses in regard to age, gender, and expertise (medical students vs surgical residents) are planned. Results: The described trial started in August 2022 and is ongoing. By July 2024, a total of 30 medical students and 9 surgeons have completed the study. Conclusions: We present a study protocol aiming to identify the impact of different disruptions in OR during laparoscopic training in IVR. Hence, it may lead to an improved awareness of distractions and facilitate accommodations toward an improved work environment. Prior research leads to the hypothesis that the performance of a more experienced surgeon is less impacted by distractions than the performance of inexperienced surgeons and medical students. Furthermore, we investigate which type of distraction has the largest impact on performance. With this knowledge, specific multitasking training can be devised, which may be particularly useful in medical education, for which VR might play a leading role. Additionally, workplace surroundings in the OR can be optimized with this knowledge. Trial Registration: German Registry for Clinical Trials DRKS00030033; https://drks.de/search/en/trial/DRKS00030033 International Registered Report Identifier (IRRID): DERR1-10.2196/59014 %M 39500487 %R 10.2196/59014 %U https://www.researchprotocols.org/2024/1/e59014 %U https://doi.org/10.2196/59014 %U http://www.ncbi.nlm.nih.gov/pubmed/39500487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58776 %T A Deep Learning Model to Predict Breast Implant Texture Types Using Ultrasonography Images: Feasibility Development Study %A Kim,Ho Heon %A Jeong,Won Chan %A Pi,Kyungran %A Lee,Angela Soeun %A Kim,Min Soo %A Kim,Hye Jin %A Kim,Jae Hong %+ The W Clinic, 9F Kukdong B/D, 596 Gangnam-daero, Gangnam-gu, Seoul, 06038, Republic of Korea, 82 2 517 7617, stenkaracin@gmail.com %K breast implants %K mammoplasty %K ultrasonography: AI-assisted diagnosis %K cshell surface topography %K artificial intelligence %K deep learning %K machine learning %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast implants, including textured variants, have been widely used in aesthetic and reconstructive mammoplasty. However, the textured type, which is one of the shell texture types of breast implants, has been identified as a possible etiologic factor for lymphoma, specifically breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Identifying the shell texture type of the implant is critical to diagnosing BIA-ALCL. However, distinguishing the shell texture type can be difficult due to the loss of human memory and medical history. An alternative approach is to use ultrasonography, but this method also has limitations in quantitative assessment. Objective: This study aims to determine the feasibility of using a deep learning model to classify the shell texture type of breast implants and make robust predictions from ultrasonography images from heterogeneous sources. Methods: A total of 19,502 breast implant images were retrospectively collected from heterogeneous sources, including images captured from both Canon and GE devices, images of ruptured implants, and images without implants, as well as publicly available images. The Canon images were trained using ResNet-50. The model’s performance on the Canon dataset was evaluated using stratified 5-fold cross-validation. Additionally, external validation was conducted using the GE and publicly available datasets. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (PRAUC) were calculated based on the contribution of the pixels with Gradient-weighted Class Activation Mapping (Grad-CAM). To identify the significant pixels for classification, we masked the pixels that contributed less than 10%, up to a maximum of 100%. To assess the model’s robustness to uncertainty, Shannon entropy was calculated for 4 image groups: Canon, GE, ruptured implants, and without implants. Results: The deep learning model achieved an average AUROC of 0.98 and a PRAUC of 0.88 in the Canon dataset. The model achieved an AUROC of 0.985 and a PRAUC of 0.748 for images captured with GE devices. Additionally, the model predicted an AUROC of 0.909 and a PRAUC of 0.958 for the publicly available dataset. This model maintained the PRAUC values for quantitative validation when masking up to 90% of the least-contributing pixels and the remnant pixels in breast shell layers. Furthermore, the prediction uncertainty increased in the following order: Canon (0.066), GE (0072), ruptured implants (0.371), and no implants (0.777). Conclusions: We have demonstrated the feasibility of using deep learning to predict the shell texture type of breast implants. This approach quantifies the shell texture types of breast implants, supporting the first step in the diagnosis of BIA-ALCL. %M 39499915 %R 10.2196/58776 %U https://formative.jmir.org/2024/1/e58776 %U https://doi.org/10.2196/58776 %U http://www.ncbi.nlm.nih.gov/pubmed/39499915 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52282 %T Differences in Messenger RNA Expression of Fibulin-1, Elastin, Matrix Metalloproteinase-1, Basic Fibroblast Growth Factor, and α-Smooth Muscle Actin Between the Ventral and Dorsal Tunica Dartos in Patients With Hypospadias and Chordee: Protocol for a Prospective Cohort Study %A Pitoyo,Joko %A Alvarino, %A Darwin,Eryati %A Yanwirasti, %+ Faculty of Medicine, Universitas Andalas, Perintis Kemerdekaan No. 94, Fakultas Kedokteran Kampus Jati, Padang, 25127, Indonesia, 62 62 751 31746, jokopitoyodr@lecturer.unri.ac.id %K chordee %K gene expression %K hypospadias %K polymerase chain reaction %K mRNA %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypospadias is a common congenital anomaly characterized by the displacement of the urethral opening to the ventral side of the penis. Surgical correction is often necessary for functional and psychological reasons. The etiology involves genetic and environmental factors, and chordee, a downward curvature of the penis, is a common complication. Proteins such as fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin play roles in hypospadias development. Objective: The study’s aim is to investigate the differences in messenger RNA (mRNA) expression of fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin between the ventral and dorsal tunica dartos in patients with hypospadias and chordee. Methods: This prospective cohort study aims to investigate differences in mRNA expression of the abovementioned proteins between the ventral and dorsal tunica dartos in patients with hypospadias and chordee. Ethics approval has been obtained, and consent from parents will be obtained before data collection. Eligible participants are aged 6-18 months, diagnosed with hypospadias and chordee, and planned for urethroplasty. Tissue samples will be collected from both aspects of the tunica dartos and analyzed using real-time quantitative reverse transcription–polymerase chain reaction. Data analysis will involve statistical tests and normalization of housekeeping genes. Results: This study is at the protocol development stage. A pilot study regarding its feasibility has been ongoing as of August 2023. The study results are expected to be available by the end of 2024. Conclusions: The study of mRNA expressions of various proteins in the tunica dartos of patients with hypospadias and chordee is expected to improve the understanding and expand the knowledge of the pathophysiology of hypospadias and chordee. International Registered Report Identifier (IRRID): DERR1-10.2196/52282 %M 39476852 %R 10.2196/52282 %U https://www.researchprotocols.org/2024/1/e52282 %U https://doi.org/10.2196/52282 %U http://www.ncbi.nlm.nih.gov/pubmed/39476852 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55029 %T Effects of Injury Registry Data on Policy Making, Hospitalizations, and Mortality: Protocol for a Systematic Review and Meta-Analysis %A Medeiros-de-Souza,Ana Cláudia %A Lopes,Luana Emanuelly Sinhori %A de Oliveira,Bruno Zocca %A Rother,Edna Terezinha %A Correia,Lucas Reis %+ Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, L1 Floor, Room 134, Sao Paulo, 05653-000, Brazil, 55 11989249946, ana.cms@einstein.br %K injury registry %K trauma registry %K policy making %K health policy %K wounds and injuries %K outcome assessments, health surveillance %K hospitalizations %K mortality %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. Objective: A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer “What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?” Methods: The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. Results: This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. Conclusions: This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. Trial Registration: PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528 International Registered Report Identifier (IRRID): PRR1-10.2196/55029 %M 39475822 %R 10.2196/55029 %U https://www.researchprotocols.org/2024/1/e55029 %U https://doi.org/10.2196/55029 %U http://www.ncbi.nlm.nih.gov/pubmed/39475822 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58022 %T Methodology for Measuring Intraoperative Blood Loss: Protocol for a Scoping Review %A Dennin,Lätitia %A Kleeff,Jörg %A Klose,Johannes %A Ronellenfitsch,Ulrich %A Rebelo,Artur %+ Department of Visceral, Vascular and Endocrine Surgery, University Hospital of Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale), 06120, Germany, 49 345 557 2314, laetitia.dennin@gmail.com %K intraoperative blood loss %K estimation of blood loss %K intraoperative monitoring %K surgery %K surgical care %K postoperative care %K quality improvement %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Therefore, better standardized methods are needed. Objective: This study aims to conduct a scoping review to present the currently available methods for measuring intraoperative blood loss. This should help to capture the current status and map and summarize the available evidence for measuring blood loss to identify any gaps. Methods: We will use a state-of-the-art methodological framework. The databases PubMed (MEDLINE) and Cochrane Library will be searched using a search strategy based on the PICO (Population, Intervention, Comparator, and Outcome) scheme. The search period will be limited to January 01, 2012, to December 31, 2023, and our search will be restricted to clinical trials or clinical studies, randomized controlled trials, and observational studies (in line with PubMed definition of study types). Only publications in English and German will be considered. The intention is to identify clinical studies that define “blood loss” as a target criterion or as a primary or secondary end point. EndNote (version 20.6; Clarivate) will be used for the screening process. The data will be collected and analyzed using Microsoft Excel (version 16.77.1). Results: The included studies will be listed in a database, and the following basic data will be extracted: title, year of publication, country, language, study type, surgical specialty, and type of procedure. The number of participants will be listed and the distribution of the participants will be documented in terms of gender and age. The following results are extracted: the type of measurement method used to measure blood loss in this study and whether the parameter “blood loss” was recorded as a primary or secondary outcome. Conclusions: Currently, there is no comparable review, resulting in ambiguous data regarding the prevailing measurement methods for intraoperative blood loss. The aim of this study is to provide a comprehensive overview—from methods of measurement to various formulae for calculating blood loss—and to establish a status quo. This could then serve as a foundation for further studies. International Registered Report Identifier (IRRID): DERR1-10.2196/58022 %M 39412859 %R 10.2196/58022 %U https://www.researchprotocols.org/2024/1/e58022 %U https://doi.org/10.2196/58022 %U http://www.ncbi.nlm.nih.gov/pubmed/39412859 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57784 %T Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT Study): Protocol for a Randomized Controlled Trial %A Overstreet,Morgan %A Culpepper,Hannah %A DeHoff,Deanna %A Gebregziabher,Mulugeta %A Posadas Salas,Maria Aurora %A Su,Zemin %A Chandler,Jessica %A Bartlett,Felicia %A Dunton,Paige %A Carcella,Taylor %A Taber,David %+ Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425-8900, United States, 1 18437928896, overstrm@musc.edu %K kidney transplant %K mobile health %K medication adherence %K mHealth %K nephrology %K transplant surgery %K postoperative monitoring %K telemedicine %K eHealth %D 2024 %7 10.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The outcome disparities for African American recipients of kidney transplant is a public health issue that has plagued the field of transplant since its inception. Based on national data, African American recipients have nearly twice the risk of graft loss at 5 years after transplant, when compared with White recipients. Evidence demonstrates that medication nonadherence and high tacrolimus variability substantially impact graft outcomes and racial disparities, most notably late (>2 years) after the transplant. Nonadherence is a leading cause of graft loss. Prospective multicenter data demonstrate that one-third of all graft loss are directly attributed to nonadherence. We have spent 10 years of focused research to develop a comprehensive model explaining the predominant risk factors leading to disparities in African American kidney recipients. However, there are still gaps in patient-level data that hinder the deeper understanding of the disparities. Lack of data from the patient often lead to provider biases, which will be addressed with this intervention. Culturally competent, pharmacist-led interventions in medication therapy management will also address therapeutic inertia. Pharmacist interventions will mitigate medication access barriers as well (cost and insurance denials). Thus, this multidimensional intervention addresses patient, provider, and structural factors that drive racial disparities in African American kidney recipients. Objective: This prospective, randomized controlled trial aimed to determine the impact of multimodal health services intervention on health outcomes disparities in African American recipients of kidney transplant. The aims of this study are to improve adherence and control of late clinical issues, which are predominant factors for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. Methods: The Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT) study is a 24-month, 2-arm, single-center (Medical University of South Carolina), 1:1 randomized controlled trial involving 190 participants (95 in each arm), measuring the impact on adherence and control of late clinical issues for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. The key clinical issues for this study include tacrolimus variability, blood pressure, and glucose control (in those with diabetes mellitus). We will also assess the impact of the intervention on health care use (hospitalizations and emergency department visits) and conduct a cost-benefit analysis. Finally, we will assess the impact of the intervention on acute rejection and graft survival rates as compared with a large contemporary national cohort. Results: This study was funded in July 2023. Enrolled began in April 2024 and is expected to be complete in 2026. All patients will complete the study by the end of 2028. Conclusions: In this protocol, we describe the study design, methods, aims, and outcome measures that will be used in the ongoing MITIGAAT clinical trials. Trial Registration: ClinicalTrials.gov NCT06023615; https://www.clinicaltrials.gov/study/NCT06023615 International Registered Report Identifier (IRRID): PRR1-10.2196/57784 %M 39388231 %R 10.2196/57784 %U https://www.researchprotocols.org/2024/1/e57784 %U https://doi.org/10.2196/57784 %U http://www.ncbi.nlm.nih.gov/pubmed/39388231 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50585 %T Temperature Measurement Timings and the Fever Detection Rate After Gastrointestinal Surgery: Retrospective Cross-Sectional Study %A Wang,Shiqi %A Ji,Gang %A Feng,Xiangying %A Huang,Luguang %A Luo,Jialin %A Yu,Pengfei %A Zheng,Jiyang %A Yang,Bin %A Wang,Xiangjie %A Zhao,Qingchuan %+ Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Street, Xi'an, 710032, China, 86 2984771533, wsqfmmu@126.com %K fever %K gastrointestinal surgery %K temperature measurement %K temperature %K detection %K gastrointestinal %K cross-sectional study %D 2024 %7 9.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Postoperative fever frequently indicates surgical complications and is commonly used to evaluate the efficacy of interventions against surgical stress. However, the presence of circadian rhythms in body temperature may compromise the accurate detection of fever. Objective: This study aimed to investigate the detection rate of fever under intermittent measurement. Methods: We retrospectively reviewed the clinical records of patients who underwent nonemergency gastrointestinal surgery between November 2020 and April 2021. Patients’ temperature data were continuously collected every 4 seconds using a wireless axillary thermometer, and fever was defined as a temperature exceeding 38 °C within a day. To simulate intermittent measurement in clinical practice, the body temperature at each hour was selected from the continuously collected temperature dataset. Considering that temperatures are measured multiple times per day, all possible measurement plans using intermittent measurement were composed by combining 1-24 time points from the 24-hour daily cycle. Fever was clinically diagnosed based on the temperature readings at the selected time points per day. The fever detection rates for each plan, with varying measurement times, were listed and ranked. Results: Based on the temperature data continuously collected by the thermometer, fever occurred in 60 (40.8%) of the 147 included patients within 3 days after surgery. Of the measurement plans that included 1-24 measurements daily, the fever detection rates ranged from 3.3% (2/60) to 85% (51/60). The highest detection rates and corresponding timings for measurement plans with 1, 2, 3, and 4 measurements daily were 38.3% (23/60; at 8 PM), 56.7% (34/60; at 3 AM and 7 or 8 PM), 65% (39/60; at 3 AM, 8 PM, and 10 or 11 PM), and 70% (42/60; at 12 AM, 3 AM, 8 PM, and 11 PM), respectively; and the lowest detection rates were 3.3% (2/60), 6.7% (4/60), 6.7% (4/60), and 8.3% (5/60), respectively. Although fever within 3 days after surgery was not correlated with an increased incidence of postoperative complications (5/60, 8.3% vs 6/87, 6.9%; P=.76), it was correlated with a longer hospital stay (median 7, IQR 6-9 days vs median 6, IQR 5-7 days; P<.001). Conclusions: The fever detection rate of the intermittent approach is determined by the timing and frequency of measurement. Measuring at randomly selected time points can miss many fever events after gastrointestinal surgery. However, we can improve the fever detection rate by optimizing the timing and frequency of measurement. %M 39383527 %R 10.2196/50585 %U https://www.i-jmr.org/2024/1/e50585 %U https://doi.org/10.2196/50585 %U http://www.ncbi.nlm.nih.gov/pubmed/39383527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56674 %T Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study %A Trò,Rosella %A Orecchia,Angelica %A Disma,Nicola %A Uva,Paolo %A Cavanna,Roberto %A Zanardi,Nicolò %A Torre,Michele %A Fato,Marco Massimo %+ Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Via all'Opera Pia 13, Genoa, 16145, Italy, 39 3408716911, rosella.tro@edu.unige.it %K pectus excavatum %K pain assessment %K web platform %K health care informatics %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. Objective: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children’s Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. Methods: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Results: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. Conclusions: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality. %M 39378419 %R 10.2196/56674 %U https://formative.jmir.org/2024/1/e56674 %U https://doi.org/10.2196/56674 %U http://www.ncbi.nlm.nih.gov/pubmed/39378419 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58763 %T Racial and Ethnic Differences in Traumatic Brain Injury Outcomes From 2009 to 2023: Protocol for a Systematic Review %A Pappadis,Monique R %A Talley,Kelli G %A Garcia,Patricia %A Aguirre,Caitlin R %A Onwudebe,Chinedu K %A Smith,Michelle %A Lequerica,Anthony H %+ Sealy Center on Aging, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0177, United States, 1 409 747 1632, mrpappad@utmb.edu %K traumatic brain injury %K TBI %K health disparities %K racial and ethnic differences %K injury outcomes %K outcomes assessment %K social determinants of health %K neurorehabilitation %K evidence-based interventions %D 2024 %7 3.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. Objective: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. Methods: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). Results: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. Conclusions: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. Trial Registration: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b International Registered Report Identifier (IRRID): PRR1-10.2196/58763 %M 39361416 %R 10.2196/58763 %U https://www.researchprotocols.org/2024/1/e58763 %U https://doi.org/10.2196/58763 %U http://www.ncbi.nlm.nih.gov/pubmed/39361416 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58740 %T Enhancing Performance of the National Field Triage Guidelines Using Machine Learning: Development of a Prehospital Triage Model to Predict Severe Trauma %A Chen,Qi %A Qin,Yuchen %A Jin,Zhichao %A Zhao,Xinxin %A He,Jia %A Wu,Cheng %A Tang,Bihan %+ Department of Health Management, Naval Medical University, No 800 Xiangyin Road, Shanghai, 200433, China, 86 02181871425, mangotangbihan@126.com %K severe trauma %K field triage %K machine learning %K prediction model %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Prehospital trauma triage is essential to get the right patient to the right hospital. However, the national field triage guidelines proposed by the American College of Surgeons have proven to be relatively insensitive when identifying severe traumas. Objective: This study aimed to build a prehospital triage model to predict severe trauma and enhance the performance of the national field triage guidelines. Methods: This was a multisite prediction study, and the data were extracted from the National Trauma Data Bank between 2017 and 2019. All patients with injury, aged 16 years of age or older, and transported by ambulance from the injury scene to any trauma center were potentially eligible. The data were divided into training, internal, and external validation sets of 672,309; 288,134; and 508,703 patients, respectively. As the national field triage guidelines recommended, age, 7 vital signs, and 8 injury patterns at the prehospital stage were included as candidate variables for model development. Outcomes were severe trauma with an Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary). The triage model was developed using an extreme gradient boosting model and Shapley additive explanation analysis. The model’s accuracy regarding discrimination, calibration, and clinical benefit was assessed. Results: At a fixed specificity of 0.5, the model showed a sensitivity of 0.799 (95% CI 0.797-0.801), an undertriage rate of 0.080 (95% CI 0.079-0.081), and an overtriage rate of 0.743 (95% CI 0.742-0.743) for predicting severe trauma. The model showed a sensitivity of 0.774 (95% CI 0.772-0.776), an undertriage rate of 0.158 (95% CI 0.157-0.159), and an overtriage rate of 0.609 (95% CI 0.608-0.609) when predicting critical resource use, fixed at 0.5 specificity. The triage model’s areas under the curve were 0.755 (95% CI 0.753-0.757) for severe trauma prediction and 0.736 (95% CI 0.734-0.737) for critical resource use prediction. The triage model’s performance was better than those of the Glasgow Coma Score, Prehospital Index, revised trauma score, and the 2011 national field triage guidelines RED criteria. The model’s performance was consistent in the 2 validation sets. Conclusions: The prehospital triage model is promising for predicting severe trauma and achieving an undertriage rate of <10%. Moreover, machine learning enhances the performance of field triage guidelines. %M 39348683 %R 10.2196/58740 %U https://www.jmir.org/2024/1/e58740 %U https://doi.org/10.2196/58740 %U http://www.ncbi.nlm.nih.gov/pubmed/39348683 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57820 %T Improving the Care of Severe, Open Fractures and Postoperative Infections of the Lower Extremities: Protocol for an Interdisciplinary Treatment Approach %A Rosslenbroich,Steffen %A Laumann,Marion %A Hasebrook,Joachim %A Rodde,Sibyll %A Grosser,John %A Greiner,Wolfgang %A Hirsch,Tobias %A Windrich,Stefan %A Raschke,Michael J %+ ZEB Business School, Steinbeis University, Breitscheidstr 51, Madgeburg, 39114, Germany, 49 15152647546, jhasebrook@zeb-bs.de %K open fracture %K open soft tissue damage %K telemedicine %K plastic surgery %K infectiology %K limb function %K health-related quality of life %K workload %K work engagement %K health economic evaluation %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with open fractures often experience complications during their injury. The treatments incur high costs. Interdisciplinary cooperation between different medical disciplines may improve treatment outcomes. Such cooperation has not yet been envisaged in the German health care system. Objective: The aim of the study is to improve the treatment of fractures with open soft tissue damage or postoperative complications in terms of duration and sustainability in a region in northwest Germany. Largely standardized diagnostics and therapy are intended to optimize processes in hospitals. In addition, a reduction in the duration of treatment and treatment costs is to be achieved. Methods: Using a digital platform, physicians from 31 hospitals present patient cases to an interdisciplinary group of experts from the fields of plastic surgery, infectiology, hygiene, and others. The group of experts from the environment of the University Hospital Münster promptly makes a joint treatment recommendation for the individual case. The plan is to examine 3300 patients with open fractures or surgical complications. As consortium partners, there are also 3 statutory health insurance companies. The extent to which the therapy recommendations are effective and contribute to cost reduction in the health care system will be empirically investigated in a stepped-wedge cluster-randomized design. In addition, medical and nonmedical professional groups involved in the project will be asked about their work in the project (in total, 248 clinic employees). The primary outcome is the complication rate of open fractures or the occurrence of postoperative complications. As secondary outcomes, the number of antibiotics administered, limb function, and quality of life will be assessed. The health economic evaluation refers to the costs of health services and absenteeism. For the work-related evaluation, workload, work engagement, work-related resources, readiness for technology, and ergonomic aspects of the new telemedical technology will be collected. In addition, clinic employees will give their assessments of the success of the project in a structured telephone interview based on scaled and open-ended questions. Results: The project started in June 2022; data collection started in April 2023. As of mid-June 2024, data from 425 patients had been included. In total, 146 members of staff had taken part in the questionnaire survey and 15 had taken part in the interviews. Conclusions: Standardized treatment pathways in the standard care of patients with open fractures and postoperative infections will be established to reduce complications, improve chances of recovery, and reduce costs. Unnecessary and redundant treatment steps will be avoided through standardized diagnostics and therapy. The interdisciplinary treatment perspective allows for a more individualized therapy. In the medium term, outpatient or inpatient treatment centers specialized in the patient group could be set up where the new diagnostic and therapeutic pathways could be competently applied. Trial Registration: German Clinical Trials Register DRKS00031308; https://drks.de/search/de/trial/DRKS00031308 International Registered Report Identifier (IRRID): DERR1-10.2196/57820 %R 10.2196/57820 %U https://www.researchprotocols.org/2024/1/e57820 %U https://doi.org/10.2196/57820 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50106 %T Splenectomy as a Risk Factor for Graft Rejection Following Endothelial Transplantation: Retrospective Study %A Kammrath Betancor,Paola %A Böhringer,Daniel %A Maier,Philip %A Lapp,Thabo %A Reinhard,Thomas %+ Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, Freiburg, 79106, Germany, 49 761 270 40010, paola.kammrath.betancor@uniklinik-freiburg.de %K anterior chamber–associated immune deviation %K ACAID %K Descemet membrane endothelial keratoplasty %K DMEK %K splenectomy %D 2024 %7 10.9.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Anterior chamber–associated immune deviation (ACAID) is an active immunotolerance mechanism, which is induced by placing antigen into the anterior eye chamber as long as a major surgical trauma is avoided. For this reason, ACAID may be a major contributor to the favorable immunologic outcomes in Descemet membrane endothelial keratoplasty (DMEK). Rodent models have demonstrated the importance of a functional spleen for the development of an ACAID. Objective: This study aimed to investigate whether splenectomy leads to increased rejection rates after DMEK in humans. Methods: A retrospective evaluation was conducted on the course following DMEK at the Eye Center, Medical Center, University of Freiburg, for patients with a self-reported history of splenectomy compared to patients without this condition. Potential study patients were contacted by mail. A questionnaire to self-report splenectomy and the time thereof was sent out. The medical records of all consenting patients at the Eye Center were reviewed for graft survival and immune reactions. Results: We asked 1818 patients after DMEK to report their history of splenectomy. A total of 1340 patients responded and were included in the study. Of these 1340 patients, 16 (1.2%) reported a history of splenectomy (ie, 26 DMEKs, with 10 patients being transplanted in both eyes and 6 patients being transplanted in 1 eye; median age at surgery 73.7, range 66.7-76.1 y). The remaining patients (1324 patients, ie, 1941 eyes) served as controls, with 1941 DMEKs (median age at surgery 71.5, range 64.1-77.2 y). Five (19%) out of the 26 eyes from the splenectomy group required a second transplant due to dislocation (n=2.8%), failure (n=2.8%), and rejection (n=1.4%). Kaplan-Meier analysis revealed no relevant difference compared with controls. Conclusions: Our results suggest that splenectomy has no major effect on the outcome following DMEK. Subsequent, ACAID may not be the main reason for the favorable immunological outcomes in DMEK, or the camero-splenic axis may be subordinate in humans. However, we only included 16 patients who underwent splenectomy, so it might be possible that we missed a minor effect. %M 39255482 %R 10.2196/50106 %U https://www.i-jmr.org/2024/1/e50106 %U https://doi.org/10.2196/50106 %U http://www.ncbi.nlm.nih.gov/pubmed/39255482 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59428 %T Using Systems Engineering and Implementation Science to Design an Implementation Package for Preoperative Comprehensive Geriatric Assessment Among Older Adults Having Major Abdominal Surgery: Protocol for a 3-Phase Study %A Berian,Julia R %A Schwarze,Margaret L %A Werner,Nicole E %A Mahoney,Jane E %A Shah,Manish N %+ Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, United States, 1 6082634224, berian@wisc.edu %K systems engineering %K participatory design %K user-centered design %K implementation science %K surgery %K aging research %K randomized controlled trial %D 2024 %7 9.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older Americans, a growing segment of the population, have an increasing need for surgical services, and they experience a disproportionate burden of postoperative complications compared to their younger counterparts. A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, which has been identified as vulnerable. The pCGA optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social and environmental support. The pCGA has been shown to decrease postoperative morbidity, mortality, and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of the pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic medical centers. By applying implementation science and human factors engineering methods, this study will provide the necessary evidence to optimize the implementation of the pCGA in a variety of health care settings. Objective: The purpose of this paper is to describe the study protocol to design an adaptable, user-centered pCGA implementation package for use among older adults before major abdominal surgery. Methods: This protocol uses systems engineering methods to develop, tailor, and pilot-test a user-centered pCGA implementation package, which can be adapted to community-based hospitals in preparation for a multisite implementation trial. The protocol is based upon the National Institutes of Health Stage Model for Behavioral Intervention Development and aligns with the goal to develop behavioral interventions with an eye to real-world implementation. In phase 1, we will use observation and interviews to map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery. In phase 2, we will apply user-centered design methods, engaging health care providers, patients, and caregivers to co-design a pCGA implementation package. This package will be applicable to a diverse population of older patients undergoing major abdominal surgery at a large academic hospital and an affiliate community site. In phase 3, we will pilot-test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness trial. We anticipate that this study will take approximately 60 months (April 2023-March 2028). Results: This study protocol will generate (1) a detailed process map of the pCGA; (2) an adaptable, user-centered pCGA implementation package ready for feasibility testing in a pilot trial; and (3) preliminary pilot data on the implementation and effectiveness of the package. We anticipate that these data will serve as the basis for future multisite hybrid implementation-effectiveness clinical trials of the pCGA in older adults undergoing major abdominal surgery. Conclusions: The expected results of this study will contribute to improving perioperative care processes for older adults before major abdominal surgery. International Registered Report Identifier (IRRID): DERR1-10.2196/59428 %M 39250779 %R 10.2196/59428 %U https://www.researchprotocols.org/2024/1/e59428 %U https://doi.org/10.2196/59428 %U http://www.ncbi.nlm.nih.gov/pubmed/39250779 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56727 %T Surgical Residents’ Perception of Feedback on Their Education: Protocol for a Scoping Review %A Costa,Carlos Dario da Silva %A Silva,Gabriela Gouvea %A Santos,Emerson Roberto dos %A Engel,Ana Maria Rita Pedroso Vilela Torres de Carvalho %A Costa,Ana Caroline dos Santos %A da Silva,Taisa Morete %A da Conceição,Washington Henrique %A Cristóvão,Helena %A Lima,Alba Regina de Abreu %A Brienze,Vânia MS %A Bizotto,Thaís Santana Gastardelo %A Oliani,Antonio Hélio %A André,Júlio César %+ Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo, 15090-000, Brazil, 55 1732015700, carlosdariocosta@hotmail.com %K medical education %K occupational training %K surgical residents %K feedback %K perception %D 2024 %7 19.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner’s perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. Objective: The aim of this study is to identify and map out data from studies that report surgical residents’ perception of the feedback received during their education. Methods: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies’ titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. Results: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. Conclusions: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents’ learning progress. Trial Registration: Open Science Framework yexb; https://osf.io/yexkb. International Registered Report Identifier (IRRID): PRR1-10.2196/56727 %M 39158942 %R 10.2196/56727 %U https://www.researchprotocols.org/2024/1/e56727 %U https://doi.org/10.2196/56727 %U http://www.ncbi.nlm.nih.gov/pubmed/39158942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52878 %T Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game %A Noroozi,Mohammad %A St John,Ace %A Masino,Caterina %A Laplante,Simon %A Hunter,Jaryd %A Brudno,Michael %A Madani,Amin %A Kersten-Oertel,Marta %+ Applied Perception Lab, Department of Computer Science and Software Engineering, Concordia University, 2155 Guy Street ER923, Montreal, QC, H3G 1M8, Canada, 1 8482424 ext 5830, marta.kersten@concordia.ca %K gamification %K serious games %K surgery %K education %K laparoscopic cholecystectomy %K artificial intelligence %K AI %K laparoscope %K gallbladder %K cholecystectomy %K mobile game %K gamify %K educational game %K interactive %K decision-making %K mobile phone %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. Objective:  To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. Methods:  LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Results:  Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. Conclusions:  LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees. %M 39052314 %R 10.2196/52878 %U https://formative.jmir.org/2024/1/e52878 %U https://doi.org/10.2196/52878 %U http://www.ncbi.nlm.nih.gov/pubmed/39052314 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e47127 %T Using the Kirkpatrick Model to Evaluate the Effect of a Primary Trauma Care Course on Health Care Workers’ Knowledge, Attitude, and Practice in Two Vietnamese Local Hospitals: Prospective Intervention Study %A Nguyen,Ba Tuan %A Nguyen,Van Anh %A Blizzard,Christopher Leigh %A Palmer,Andrew %A Nguyen,Huu Tu %A Quyet,Thang Cong %A Tran,Viet %A Skinner,Marcus %A Perndt,Haydn %A Nelson,Mark R %K trauma care %K emergency medicine %K primary trauma care course %K short course %K medical education %K trauma %K emergency %K urgent %K professional development %K workshop %K injury %K injured %K injuries %K primary care %D 2024 %7 23.7.2024 %9 %J JMIR Med Educ %G English %X Background: The Primary Trauma Care (PTC) course was originally developed to instruct health care workers in the management of patients with severe injuries in low- and middle-income countries (LMICs) with limited medical resources. PTC has now been taught for more than 25 years. Many studies have demonstrated that the 2-day PTC workshop is useful and informative to frontline health staff and has helped improve knowledge and confidence in trauma management; however, there is little evidence of the effect of the course on changes in clinical practice. The Kirkpatrick model (KM) and the knowledge, attitude, and practice (KAP) model are effective methods to evaluate this question. Objective: The aim of this study was to investigate how the 2-day PTC course impacts the satisfaction, knowledge, and skills of health care workers in 2 Vietnamese hospitals using a conceptual framework incorporating the KAP model and the 4-level KM as evaluation tools. Methods: The PTC course was delivered over 2 days in the emergency departments (EDs) of Thanh Hoa and Ninh Binh hospitals in February and March 2022, respectively. This study followed a prospective pre- and postintervention design. We used validated instruments to assess the participants’ satisfaction, knowledge, and skills before, immediately after, and 6 months after course delivery. The Fisher exact test and the Wilcoxon matched-pairs signed rank test were used to compare the percentages and mean scores at the pretest, posttest, and 6-month postcourse follow-up time points among course participants. Results: A total of 80 health care staff members attended the 2-day PTC course and nearly 100% of the participants were satisfied with the course. At level 2 of the KM (knowledge), the scores on multiple-choice questions and the confidence matrix improved significantly from 60% to 77% and from 59% to 71%, respectively (P<.001), and these improvements were seen in both subgroups (nurses and doctors). The focus of level 3 was on practice, demonstrating a significant incremental change, with scenarios checklist points increasing from a mean of 5.9 (SD 1.9) to 9.0 (SD 0.9) and bedside clinical checklist points increasing from a mean of 5 (SD 1.5) to 8.3 (SD 0.8) (both P<.001). At the 6-month follow-up, the scores for multiple-choice questions, the confidence matrix, and scenarios checklist all remained unchanged, except for the multiple-choice question score in the nurse subgroup (P=.005). Conclusions: The PTC course undertaken in 2 local hospitals in Vietnam was successful in demonstrating improvements at 3 levels of the KM for ED health care staff. The improvements in the confidence matrix and scenarios checklist were maintained for at least 6 months after the course. PTC courses should be effective in providing and sustaining improvement in knowledge and trauma care practice in other LMICs such as Vietnam. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN 12621000371897; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380970 %R 10.2196/47127 %U https://mededu.jmir.org/2024/1/e47127 %U https://doi.org/10.2196/47127 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56127 %T Collaborative Human–Computer Vision Operative Video Analysis Algorithm for Analyzing Surgical Fluency and Surgical Interruptions in Endonasal Endoscopic Pituitary Surgery: Cohort Study %A Wong,Chia-En %A Chen,Pei-Wen %A Hsu,Heng-Jui %A Cheng,Shao-Yang %A Fan,Chen-Che %A Chen,Yen-Chang %A Chiu,Yi-Pei %A Lee,Jung-Shun %A Liang,Sheng-Fu %+ Department of Computer Science and Information Engineering, National Cheng Kung University, No 1, University Road, Tainan, 701, Taiwan, 886 62757575, sfliang@ncku.edu.tw %K algorithm %K computer vision %K endonasal endoscopic approach %K pituitary %K transsphenoidal surgery %D 2024 %7 4.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The endonasal endoscopic approach (EEA) is effective for pituitary adenoma resection. However, manual review of operative videos is time-consuming. The application of a computer vision (CV) algorithm could potentially reduce the time required for operative video review and facilitate the training of surgeons to overcome the learning curve of EEA. Objective: This study aimed to evaluate the performance of a CV-based video analysis system, based on OpenCV algorithm, to detect surgical interruptions and analyze surgical fluency in EEA. The accuracy of the CV-based video analysis was investigated, and the time required for operative video review using CV-based analysis was compared to that of manual review. Methods: The dominant color of each frame in the EEA video was determined using OpenCV. We developed an algorithm to identify events of surgical interruption if the alterations in the dominant color pixels reached certain thresholds. The thresholds were determined by training the current algorithm using EEA videos. The accuracy of the CV analysis was determined by manual review, and the time spent was reported. Results: A total of 46 EEA operative videos were analyzed, with 93.6%, 95.1%, and 93.3% accuracies in the training, test 1, and test 2 data sets, respectively. Compared with manual review, CV-based analysis reduced the time required for operative video review by 86% (manual review: 166.8 and CV analysis: 22.6 minutes; P<.001). The application of a human-computer collaborative strategy increased the overall accuracy to 98.5%, with a 74% reduction in the review time (manual review: 166.8 and human-CV collaboration: 43.4 minutes; P<.001). Analysis of the different surgical phases showed that the sellar phase had the lowest frequency (nasal phase: 14.9, sphenoidal phase: 15.9, and sellar phase: 4.9 interruptions/10 minutes; P<.001) and duration (nasal phase: 67.4, sphenoidal phase: 77.9, and sellar phase: 31.1 seconds/10 minutes; P<.001) of surgical interruptions. A comparison of the early and late EEA videos showed that increased surgical experience was associated with a decreased number (early: 4.9 and late: 2.9 interruptions/10 minutes; P=.03) and duration (early: 41.1 and late: 19.8 seconds/10 minutes; P=.02) of surgical interruptions during the sellar phase. Conclusions: CV-based analysis had a 93% to 98% accuracy in detecting the number, frequency, and duration of surgical interruptions occurring during EEA. Moreover, CV-based analysis reduced the time required to analyze the surgical fluency in EEA videos compared to manual review. The application of CV can facilitate the training of surgeons to overcome the learning curve of endoscopic skull base surgery. Trial Registration: ClinicalTrials.gov NCT06156020; https://clinicaltrials.gov/study/NCT06156020 %M 38963694 %R 10.2196/56127 %U https://www.jmir.org/2024/1/e56127 %U https://doi.org/10.2196/56127 %U http://www.ncbi.nlm.nih.gov/pubmed/38963694 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58390 %T Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies %A Adrien,Vladimir %A Bosc,Nicolas %A Peccia Galletto,Claire %A Diot,Thomas %A Claverie,Damien %A Reggente,Nicco %A Trousselard,Marion %A Bui,Eric %A Baubet,Thierry %A Schoeller,Félix %+ Department of Infectious and Tropical Diseases, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, 125 rue de Stalingrad, Bobigny, 93000, France, 33 148955421, vladimir.adrien@aphp.fr %K posttraumatic stress disorder %K PTSD %K agency %K proprioception %K trauma %K self-control %K sensorimotor technology %K enactive perspective %K peritraumatic dissociation %K proprioceptive reafferent fibers %K gesture sonification devices %D 2024 %7 1.7.2024 %9 Viewpoint %J J Med Internet Res %G English %X Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD. %M 38742989 %R 10.2196/58390 %U https://www.jmir.org/2024/1/e58390 %U https://doi.org/10.2196/58390 %U http://www.ncbi.nlm.nih.gov/pubmed/38742989 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e51573 %T The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials %A Maheta,Bhagvat %A Shehabat,Mouhamad %A Khalil,Ramy %A Wen,Jimmy %A Karabala,Muhammad %A Manhas,Priya %A Niu,Ashley %A Goswami,Caroline %A Frezza,Eldo %+ California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, United States, 1 (916) 378 3491, eldo.frezza@cnsuedu.onmicrosoft.com %K patient %K education %K surgeries %K laparoscopic %K postoperative %K outcomes %K systematic review %D 2024 %7 27.6.2024 %9 Review %J JMIR Perioper Med %G English %X Background: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. Objective: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. Methods: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Results: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Conclusions: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. Trial Registration: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698 %M 38935953 %R 10.2196/51573 %U https://periop.jmir.org/2024/1/e51573 %U https://doi.org/10.2196/51573 %U http://www.ncbi.nlm.nih.gov/pubmed/38935953 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48212 %T Radiological Progression of Degenerative Cervical Myelopathy in a Clinically Stable Patient: Case Report %A Umeria,Rishi %A Mowforth,Oliver %A Veremu,Munashe %A Davies,Benjamin %A Kotter,Mark %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 1223 336946, mrk25@cam.ac.uk %K degenerative cervical myelopathy %K neurosurgery %K radiology %K magnetic resonance imaging %D 2024 %7 27.6.2024 %9 Case Report %J Interact J Med Res %G English %X Degenerative cervical myelopathy (DCM) is a common neurological condition, with disease progression that is both variable and difficult to predict. Here, we present a case of DCM in a gentleman in his late 60s with significant radiological disease progression without consequent change in clinical symptoms. The case serves as a reminder of an enduring medical aphorism that clinical history and examination should be prioritized above more complex data, such as imaging investigations. In addition, the case also highlights that guidelines should be contextualized within individual clinical circumstances. %M 38935951 %R 10.2196/48212 %U https://www.i-jmr.org/2024/1/e48212 %U https://doi.org/10.2196/48212 %U http://www.ncbi.nlm.nih.gov/pubmed/38935951 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52001 %T Assessing the Reproducibility of the Structured Abstracts Generated by ChatGPT and Bard Compared to Human-Written Abstracts in the Field of Spine Surgery: Comparative Analysis %A Kim,Hong Jin %A Yang,Jae Hyuk %A Chang,Dong-Gune %A Lenke,Lawrence G %A Pizones,Javier %A Castelein,René %A Watanabe,Kota %A Trobisch,Per D %A Mundis Jr,Gregory M %A Suh,Seung Woo %A Suk,Se-Il %+ Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342, Dongil-Ro, Nowon-Gu, Seoul, 01757, Republic of Korea, 82 2 950 1284, dgchangmd@gmail.com %K artificial intelligence %K AI %K ChatGPT %K Bard %K scientific abstract %K orthopedic surgery %K spine %K journal guidelines %K plagiarism %K ethics %K spine surgery %K surgery %K language model %K chatbot %K formatting guidelines %K abstract %D 2024 %7 26.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to recent advances in artificial intelligence (AI), language model applications can generate logical text output that is difficult to distinguish from human writing. ChatGPT (OpenAI) and Bard (subsequently rebranded as “Gemini”; Google AI) were developed using distinct approaches, but little has been studied about the difference in their capability to generate the abstract. The use of AI to write scientific abstracts in the field of spine surgery is the center of much debate and controversy. Objective: The objective of this study is to assess the reproducibility of the structured abstracts generated by ChatGPT and Bard compared to human-written abstracts in the field of spine surgery. Methods: In total, 60 abstracts dealing with spine sections were randomly selected from 7 reputable journals and used as ChatGPT and Bard input statements to generate abstracts based on supplied paper titles. A total of 174 abstracts, divided into human-written abstracts, ChatGPT-generated abstracts, and Bard-generated abstracts, were evaluated for compliance with the structured format of journal guidelines and consistency of content. The likelihood of plagiarism and AI output was assessed using the iThenticate and ZeroGPT programs, respectively. A total of 8 reviewers in the spinal field evaluated 30 randomly extracted abstracts to determine whether they were produced by AI or human authors. Results: The proportion of abstracts that met journal formatting guidelines was greater among ChatGPT abstracts (34/60, 56.6%) compared with those generated by Bard (6/54, 11.1%; P<.001). However, a higher proportion of Bard abstracts (49/54, 90.7%) had word counts that met journal guidelines compared with ChatGPT abstracts (30/60, 50%; P<.001). The similarity index was significantly lower among ChatGPT-generated abstracts (20.7%) compared with Bard-generated abstracts (32.1%; P<.001). The AI-detection program predicted that 21.7% (13/60) of the human group, 63.3% (38/60) of the ChatGPT group, and 87% (47/54) of the Bard group were possibly generated by AI, with an area under the curve value of 0.863 (P<.001). The mean detection rate by human reviewers was 53.8% (SD 11.2%), achieving a sensitivity of 56.3% and a specificity of 48.4%. A total of 56.3% (63/112) of the actual human-written abstracts and 55.9% (62/128) of AI-generated abstracts were recognized as human-written and AI-generated by human reviewers, respectively. Conclusions: Both ChatGPT and Bard can be used to help write abstracts, but most AI-generated abstracts are currently considered unethical due to high plagiarism and AI-detection rates. ChatGPT-generated abstracts appear to be superior to Bard-generated abstracts in meeting journal formatting guidelines. Because humans are unable to accurately distinguish abstracts written by humans from those produced by AI programs, it is crucial to exercise special caution and examine the ethical boundaries of using AI programs, including ChatGPT and Bard. %M 38924787 %R 10.2196/52001 %U https://www.jmir.org/2024/1/e52001 %U https://doi.org/10.2196/52001 %U http://www.ncbi.nlm.nih.gov/pubmed/38924787 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54497 %T Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report %A Qsous,Ghaith %A Ramaraj,Prashanth %A Avtaar Singh,Sanjeet Singh %A Herd,Philip %A Sooraj,Nayandra Runveer %A Will,Malcolm Brodie %+ Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, United Kingdom, 44 01315361000 ext 21076, Prashanth.ramaraj@nhs.net %K capnodissection %K pleurectomy %K VATS %K video-assisted thorascopic surgery %K novel technique %K thoracic surgery %K surgical innovation %K pneumothorax %K spontaneous pneumothorax %K pleurodesis %K management %K bullectomy %K bullae %K young patient %K lung diseases %K chronic obstructive pulmonary disease %K COPD %K surgical treatment %K male %K capnothorax %D 2024 %7 21.6.2024 %9 Case Report %J Interact J Med Res %G English %X Spontaneous pneumothorax is one of the most common conditions encountered in thoracic surgery. This condition can be treated conservatively or surgically based on indications and guidelines. Traditional surgical management includes pleurodesis (mechanical or chemical) in addition to bullectomy if the bullae can be identified. Mechanical pleurodesis is usually performed by surgical pleurectomy or pleural abrasion. In this case report, we present a case of a young patient with spontaneous pneumothorax who needed a surgical intervention. We performed a new, innovative surgical technique for surgical pleurectomy where we used carbon dioxide for dissection of the parietal pleura (capnodissection). This technique may provide similar efficiency to the traditional procedure but with less risk of bleeding and complications. %M 38905630 %R 10.2196/54497 %U https://www.i-jmr.org/2024/1/e54497 %U https://doi.org/10.2196/54497 %U http://www.ncbi.nlm.nih.gov/pubmed/38905630 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54910 %T Communication and Contextual Factors in Robotic-Assisted Surgical Teams: Protocol for Developing a Taxonomy %A Nyein,Kyi Phyu %A Condron,Claire %+ SIM Centre for Simulation Education and Research, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, 123 St Stephen’s Green, Dublin 2, Dublin, D02 YN77, Ireland, 353 (01) 402 2100, kyiphyunyein@rcsi.ie %K communication %K teams %K robotic surgery %K robotic-assisted %K simulation %D 2024 %7 17.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Robotic-assisted surgery (RAS) has been rapidly integrated into surgical practice in the past few decades. The setup in the operating theater for RAS differs from that for open or laparoscopic surgery such that the operating surgeon sits at a console separate from the rest of the surgical team and the patient. Communication and team dynamics are altered due to this physical separation and visual barriers imposed by the robotic equipment. However, the factors that might comprise effective communication among members of RAS teams and the contextual factors that facilitate or inhibit effective communication in RAS remain unknown. Objective: We aim to develop a taxonomy of communication behaviors and contextual factors that influence communication in RAS teams. We also aim to examine the patterns of communication behaviors based on gender. Methods: We will first perform a scoping review on communication in RAS to develop a preliminary taxonomy of communication based on the existing literature. We will then conduct semistructured interviews with RAS team members, including the surgeon, assisting surgeon or trainee, bedside or first assistant, nurses, and anesthetists. Participants will represent different disciplines, including urology, general surgery, and gynecology, and have a range of experiences in RAS. We will use a reflexive thematic analysis to analyze the data and further refine the taxonomy. We will also observe live robotic surgeries at Royal College of Surgeons in Ireland (RCSI)–affiliated hospitals. We will observe varying lengths and conditions of RAS procedures to a capture a wide range of communication behaviors and contextual factors to help finalize the taxonomy. Although we anticipate conducting 30 interviews and 30 observations, we will collect data until we achieve data sufficiency. We will conduct data collection in parallel with data analysis such that if we identify a new behavior in an interview, we will follow up with questions related to that behavior in additional interviews and/or observations. Results: The taxonomy from this project will include a list of actionable communication behaviors, contextual factors, their descriptions, and examples. As of May 2024, this project has been approved by the RCSI Research and Ethics Committee. Data collection started in June 2024 and will continue throughout the year. We plan to publish the findings as meaningful results emerge in our data analysis in 2024 and 2025. Conclusions: The results from this project will be used to observe and train surgical teams in a simulated environment to effectively communicate with each other and prevent communication breakdowns. The developed taxonomy will also add to the knowledge base on the role of gender in communication in RAS and produce recommendations that can be incorporated into training. Overall, this project will contribute to the improvement of communication skills of surgical teams and the quality and safety of patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/54910 %M 38885018 %R 10.2196/54910 %U https://www.researchprotocols.org/2024/1/e54910 %U https://doi.org/10.2196/54910 %U http://www.ncbi.nlm.nih.gov/pubmed/38885018 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56081 %T The Relationship Between Physical Activity and Mental Health Among Individuals With Spinal Cord Injury: Protocol for a Scoping Review %A Ong,Winslet %A Omar,Noor Arfa %A Zanudin,Asfarina %A Alias,Muhamad Faiz %A Hui Wen,Lim %A Thang Xue Ee,Angel %A Mohd Nordin,Nor Azlin %A Manaf,Haidzir %A Husin,Basri %A Ahmad,Mahadir %A Hisham,Hafifi %+ Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 1121215931, hafifi.hisham@ukm.edu.my %K access barriers %K depression %K disability %K exercise interventions %K mental health %K mobility limitations %K physical activity %K psychological outcomes %K quality of life %K spinal cord injury %K SCI %K mobility %K scoping review %K exercise %K effectiveness %K mental health %K well-being %K impairments %K physical function %K disability %K prevalence %D 2024 %7 12.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Spinal cord injury (SCI) is a devastating condition that often leads to significant impairments in physical function, leading to disability and mental health disorders. Hence, understanding the prevalence of SCI and the relationship between physical activity and mental health in individuals with SCI is crucial for informing rehabilitation strategies and optimizing outcomes. Objective: This study aims to comprehensively analyze existing research on the link between physical activity and mental health and identify the level of physical activity and mental health status, the barriers to physical activity, and SCI’s impacts on psychological well-being in individuals with SCI. Methods: An electronic search strategy will be used to identify prevalence studies published since 1993 in health-related databases such as PubMed, MEDLINE, COCHRANE Library, and Wiley Library using the following query: “Spinal Cord Injury” OR “Paraplegia” OR “Tetraplegia” AND “Physical Activity” OR “Exercise” AND “Mental Health” OR “Mental Illness” OR “Mental Disorder.” Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies. The risk of bias in the included studies will be appraised using the Joanna Briggs Institute checklist for prevalence studies by 2 review authors. Any disagreement will be resolved by reaching a consensus. Results: Funding was received in October 2023, data collection will commence in July 2024, and the results are expected by 2025. We will summarize the selection of the eligible studies using a flowchart. The data from the studies will be extracted and tabulated. This scoping review will be published in a peer-reviewed journal in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Conclusions: This scoping review underscores the complex relationship between physical activity and mental health among individuals with SCI, highlighting the level of physical activity and mental health status, barriers to physical activity engagement, and psychological implications. Understanding these dynamics is crucial in devising tailored interventions aimed at enhancing mental well-being. This synthesis of evidence emphasizes the need for personalized strategies to promote physical activity, addressing unique challenges faced by this population to foster improved mental health outcomes and overall quality of life. Trial Registration: Open Science Framework osf.io/ugx7d; https://osf.io/ugx7d/ International Registered Report Identifier (IRRID): PRR1-10.2196/56081 %M 38865699 %R 10.2196/56081 %U https://www.researchprotocols.org/2024/1/e56081 %U https://doi.org/10.2196/56081 %U http://www.ncbi.nlm.nih.gov/pubmed/38865699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50398 %T Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study %A Szkodny,Dominika %A Wróblewska-Czajka,Ewa %A Stryja,Mikołaj %A Gara,Filip %A Wylęgała,Edward %+ Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, Panewnicka 65, Katowice, 40-570, Poland, 48 32 605 35 55, dominikacholewa1@gmail.com %K eye donor %K corneal transplant %K donor shortage %K mHealth %K mobile health %K app %K apps %K applications %K application %K tissue procurement %K organ %K procurement %K donor %K donors %K donation %K transplant %K transplantation %K transplants %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K survey %K surveys %K questionnaire %K questionnaires %K reporting %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals’ attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals’ perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application’s usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. %M 38748474 %R 10.2196/50398 %U https://formative.jmir.org/2024/1/e50398 %U https://doi.org/10.2196/50398 %U http://www.ncbi.nlm.nih.gov/pubmed/38748474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e46698 %T Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation %A Hoffmann,Christin %A Avery,Kerry %A Macefield,Rhiannon %A Dvořák,Tadeáš %A Snelgrove,Val %A Blazeby,Jane %A Hopkins,Della %A Hickey,Shireen %A Gibbison,Ben %A Rooshenas,Leila %A Williams,Adam %A Aning,Jonathan %A Bekker,Hilary L %A McNair,Angus GK %A , %+ National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 117 455 5993, c.hoffmann@bristol.ac.uk %K surgery %K shared decision-making %K patient participation %K mixed methods %K surgery %K real-time measurement %K patient-reported measure %K electronic data collection %K usability %K data collection %K patient reported %K satisfaction %K mobile phone %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients’ experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. Objective: This study examined the usability of an electronic real-time measurement system to monitor surgical patients’ experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. Methods: We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients’ experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). Results: A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8%) and the survey response rate was good (2254/5794, 38.9%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. Conclusions: A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients’ experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079155 %M 38598276 %R 10.2196/46698 %U https://humanfactors.jmir.org/2024/1/e46698 %U https://doi.org/10.2196/46698 %U http://www.ncbi.nlm.nih.gov/pubmed/38598276 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54425 %T User Experience Evaluation of a Spinal Surgery Robot: Workload, Usability, and Satisfaction Study %A Choi,Hyeonkyeong %A Kim,Seunghee %A Jang,Wonseuk %+ Department of Medical Device Engineering and Management, Yonsei University College of Medicine, 20 63rd Road, Unju-ro, Gangnam-gu, Seoul, 06229, Republic of Korea, 82 1091485404, WS.JANG@yuhs.ac %K robot spine surgery %K usability %K satisfaction %K System Usability Scale %K surgical navigation systems %K robotics %K surgery %K neurosurgery %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Robotic spine surgery has continued to evolve since its US Food and Drug Administration approval in 2004, with products now including real-time video guidance and navigation during surgery. As the market for robotic surgical devices evolves, it is important to consider usability factors. Objective: The primary objective of this study was to determine the user experience of a surgical-assistive robotic device. The secondary objective was to evaluate workload, usability, the After-Scenario Questionnaire (ASQ), and the System Usability Scale (SUS). In addition, this study compares the workload, usability, and satisfaction survey of the device among different occupational groups using the device. Methods: Doctors (n=15) and nurses (n=15), the intended users of the surgical assistant robot, participated in the usability evaluation. Participants performed essential scenarios for the surgical assistant robot and provided scenario-specific satisfaction (ASQ), workload (NASA Task Load Index), and usability (SUS) scores. Results: Both doctors and nurses had task success rates of 85% or higher for each scenario. ASQ results showed that both doctors and nurses were least satisfied with ease of completing the task of registration (group 1: mean 4.73, SD 1.57 and group 2: mean 4.47, SD 1.8), amount of time it took (group 1: mean 4.47, SD 1.63 and group 2: mean 4.40, SD 2.09), and support information satisfaction (group 1: mean 5.13, SD 1.50 and group 2: mean 5.13, SD 1.89). All participants had low workloads, and the overall Task Load Index score had a P value of .77, which is greater than .05. The SUS results showed that the overall usability mean for doctors was 64.17 (SD 16.52) and the mean for nurses was 61.67 (SD 19.18), with a P value of .84, which is greater than .05, indicating no difference between the 2 groups. Conclusions: In this study, doctors and nurses evaluated the interaction of the device in a simulated environment, the operating room. By evaluating the use experience and usability of the device with real intended users, we can develop a more effective and convenient user interface. %M 38432688 %R 10.2196/54425 %U https://humanfactors.jmir.org/2024/1/e54425 %U https://doi.org/10.2196/54425 %U http://www.ncbi.nlm.nih.gov/pubmed/38432688 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54857 %T Investigating the Impact of AI on Shared Decision-Making in Post-Kidney Transplant Care (PRIMA-AI): Protocol for a Randomized Controlled Trial %A Osmanodja,Bilgin %A Sassi,Zeineb %A Eickmann,Sascha %A Hansen,Carla Maria %A Roller,Roland %A Burchardt,Aljoscha %A Samhammer,David %A Dabrock,Peter %A Möller,Sebastian %A Budde,Klemens %A Herrmann,Anne %+ Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450614368, bilgin.osmanodja@charite.de %K shared decision-making %K SDM %K kidney transplantation %K artificial intelligence %K AI %K decision-support system %K DSS %K qualitative research %D 2024 %7 1.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients after kidney transplantation eventually face the risk of graft loss with the concomitant need for dialysis or retransplantation. Choosing the right kidney replacement therapy after graft loss is an important preference-sensitive decision for kidney transplant recipients. However, the rate of conversations about treatment options after kidney graft loss has been shown to be as low as 13% in previous studies. It is unknown whether the implementation of artificial intelligence (AI)–based risk prediction models can increase the number of conversations about treatment options after graft loss and how this might influence the associated shared decision-making (SDM). Objective: This study aims to explore the impact of AI-based risk prediction for the risk of graft loss on the frequency of conversations about the treatment options after graft loss, as well as the associated SDM process. Methods: This is a 2-year, prospective, randomized, 2-armed, parallel-group, single-center trial in a German kidney transplant center. All patients will receive the same routine post–kidney transplant care that usually includes follow-up visits every 3 months at the kidney transplant center. For patients in the intervention arm, physicians will be assisted by a validated and previously published AI-based risk prediction system that estimates the risk for graft loss in the next year, starting from 3 months after randomization until 24 months after randomization. The study population will consist of 122 kidney transplant recipients >12 months after transplantation, who are at least 18 years of age, are able to communicate in German, and have an estimated glomerular filtration rate <30 mL/min/1.73 m2. Patients with multi-organ transplantation, or who are not able to communicate in German, as well as underage patients, cannot participate. For the primary end point, the proportion of patients who have had a conversation about their treatment options after graft loss is compared at 12 months after randomization. Additionally, 2 different assessment tools for SDM, the CollaboRATE mean score and the Control Preference Scale, are compared between the 2 groups at 12 months and 24 months after randomization. Furthermore, recordings of patient-physician conversations, as well as semistructured interviews with patients, support persons, and physicians, are performed to support the quantitative results. Results: The enrollment for the study is ongoing. The first results are expected to be submitted for publication in 2025. Conclusions: This is the first study to examine the influence of AI-based risk prediction on physician-patient interaction in the context of kidney transplantation. We use a mixed methods approach by combining a randomized design with a simple quantitative end point (frequency of conversations), different quantitative measurements for SDM, and several qualitative research methods (eg, records of physician-patient conversations and semistructured interviews) to examine the implementation of AI-based risk prediction in the clinic. Trial Registration: ClinicalTrials.gov NCT06056518; https://clinicaltrials.gov/study/NCT06056518 International Registered Report Identifier (IRRID): PRR1-10.2196/54857 %M 38557315 %R 10.2196/54857 %U https://www.researchprotocols.org/2024/1/e54857 %U https://doi.org/10.2196/54857 %U http://www.ncbi.nlm.nih.gov/pubmed/38557315 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e48146 %T Finite Element Analysis for Degenerative Cervical Myelopathy: Scoping Review of the Current Findings and Design Approaches, Including Recommendations on the Choice of Material Properties %A Davies,Benjamin %A Schaefer,Samuel %A Rafati Fard,Amir %A Newcombe,Virginia %A Sutcliffe,Michael %+ Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 07766692608, bd375@cam.ac.uk %K scoping review %K fine element analysis %K cervical spine %K spinal cord %K degenerative cervical myelopathy %D 2024 %7 28.3.2024 %9 Review %J JMIR Biomed Eng %G English %X Background: Degenerative cervical myelopathy (DCM) is a slow-motion spinal cord injury caused via chronic mechanical loading by spinal degenerative changes. A range of different degenerative changes can occur. Finite element analysis (FEA) can predict the distribution of mechanical stress and strain on the spinal cord to help understand the implications of any mechanical loading. One of the critical assumptions for FEA is the behavior of each anatomical element under loading (ie, its material properties). Objective: This scoping review aims to undertake a structured process to select the most appropriate material properties for use in DCM FEA. In doing so, it also provides an overview of existing modeling approaches in spinal cord disease and clinical insights into DCM. Methods: We conducted a scoping review using qualitative synthesis. Observational studies that discussed the use of FEA models involving the spinal cord in either health or disease (including DCM) were eligible for inclusion in the review. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The MEDLINE and Embase databases were searched to September 1, 2021. This was supplemented with citation searching to retrieve the literature used to define material properties. Duplicate title and abstract screening and data extraction were performed. The quality of evidence was appraised using the quality assessment tool we developed, adapted from the Newcastle-Ottawa Scale, and shortlisted with respect to DCM material properties, with a final recommendation provided. A qualitative synthesis of the literature is presented according to the Synthesis Without Meta-Analysis reporting guidelines. Results: A total of 60 papers were included: 41 (68%) “FEA articles” and 19 (32%) “source articles.” Most FEA articles (33/41, 80%) modeled the gray matter and white matter separately, with models typically based on tabulated data or, less frequently, a hyperelastic Ogden variant or linear elastic function. Of the 19 source articles, 14 (74%) were identified as describing the material properties of the spinal cord, of which 3 (21%) were considered most relevant to DCM. Of the 41 FEA articles, 15 (37%) focused on DCM, of which 9 (60%) focused on ossification of the posterior longitudinal ligament. Our aggregated results of DCM FEA indicate that spinal cord loading is influenced by the pattern of degenerative changes, with decompression alone (eg, laminectomy) sufficient to address this as opposed to decompression combined with other procedures (eg, laminectomy and fusion). Conclusions: FEA is a promising technique for exploring the pathobiology of DCM and informing clinical care. This review describes a structured approach to help future investigators deploy FEA for DCM. However, there are limitations to these recommendations and wider uncertainties. It is likely that these will need to be overcome to support the clinical translation of FEA to DCM. %M 38875683 %R 10.2196/48146 %U https://biomedeng.jmir.org/2024/1/e48146 %U https://doi.org/10.2196/48146 %U http://www.ncbi.nlm.nih.gov/pubmed/38875683 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e57012 %T Blood Management: A Current Opportunity in Perioperative Medicine %A Auron,Moises %+ Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, United States, 1 2164458383, auronm@ccf.org %K blood management %K perioperative %K anemia %K plasma %K transfusion %D 2024 %7 8.3.2024 %9 Viewpoint %J JMIR Perioper Med %G English %X The purpose of this viewpoint is to provide awareness of the current opportunities to enhance a high-value care approach to blood product transfusion. It provides a historical context to the evolution of blood management, as well as of the patient safety and high-value care movement. Leveraging current technology for enhanced education, as well as clinical decision support, is also discussed. %M 38457232 %R 10.2196/57012 %U https://periop.jmir.org/2024/1/e57012 %U https://doi.org/10.2196/57012 %U http://www.ncbi.nlm.nih.gov/pubmed/38457232 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e45126 %T Comparing Anesthesia and Surgery Controlled Time for Primary Total Knee and Hip Arthroplasty Between an Academic Medical Center and a Community Hospital: Retrospective Cohort Study %A Nguyen,Thy B %A Weitzel,Nathaen %A Hogan,Craig %A Kacmar,Rachel M %A Williamson,Kayla M %A Pattee,Jack %A Jevtovic-Todorovic,Vesna %A Simmons,Colby G %A Faruki,Adeel Ahmad %+ Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Faculty Center, Floor 13, FC13.2000, 1400 Holcombe Blvd, Unit 409, Houston, TX, United States, 1 713 792 6911, aafaruki@mdanderson.org %K anesthesia controlled time %K surgery-controlled time %K total joint arthroplasty %K healthcare operations %K efficiency %K total joint replacement %K knee %K hip %K arthroplasty %K anesthesia %K surgery %K surgical duration %K community hospital %K surgeon %K reliability %K operating room %K anesthesiology %K orthopedics %K perioperative %K medicine %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Osteoarthritis is a significant cause of disability, resulting in increased joint replacement surgeries and health care costs. Establishing benchmarks that more accurately predict surgical duration could help to decrease costs, maximize efficiency, and improve patient experience. We compared the anesthesia-controlled time (ACT) and surgery-controlled time (SCT) of primary total knee (TKA) and total hip arthroplasties (THA) between an academic medical center (AMC) and a community hospital (CH) for 2 orthopedic surgeons. Objective: This study aims to validate and compare benchmarking times for ACT and SCT in a single patient population at both an AMC and a CH. Methods: This retrospective 2-center observational cohort study was conducted at the University of Colorado Hospital (AMC) and UCHealth Broomfield Hospital (CH). Cases with current procedural terminology codes for THA and TKA between January 1, 2019, and December 31, 2020, were assessed. Cases with missing data were excluded. The primary outcomes were ACT and SCT. Primary outcomes were tested for association with covariates of interest. The primary covariate of interest was the location of the procedure (CH vs AMC); secondary covariates of interest included the American Society of Anesthesiologists (ASA) classification and anesthetic type. Linear regression models were used to assess the relationships. Results: Two surgeons performed 1256 cases at the AMC and CH. A total of 10 THA cases and 12 TKA cases were excluded due to missing data. After controlling for surgeon, the ACT was greater at the AMC for THA by 3.77 minutes and for TKA by 3.58 minutes (P<.001). SCT was greater at the AMC for THA by 11.14 minutes and for TKA by 14.04 minutes (P<.001). ASA III/IV classification increased ACT for THA by 3.76 minutes (P<.001) and increased SCT for THA by 6.33 minutes after controlling for surgeon and location (P=.008). General anesthesia use was higher at the AMC for both THA (29.2% vs 7.3%) and TKA (23.8% vs 4.2%). No statistically significant association was observed between either ACT or SCT and anesthetic type (neuraxial or general) after adjusting for surgeon and location (all P>.05). Conclusions: We observed lower ACT and SCT at the CH for both TKA and THA after controlling for the surgeon of record and ASA classification. These findings underscore the efficiency advantages of performing primary joint replacements at the CH, showcasing an average reduction of 16 minutes in SCT and 4 minutes in ACT per case. Overall, establishing more accurate benchmarks to improve the prediction of surgical duration for THA and TKA in different perioperative environments can increase the reliability of surgical duration predictions and optimize scheduling. Future studies with study populations at multiple community hospitals and academic medical centers are needed before extrapolating these findings. %M 38407957 %R 10.2196/45126 %U https://periop.jmir.org/2024/1/e45126 %U https://doi.org/10.2196/45126 %U http://www.ncbi.nlm.nih.gov/pubmed/38407957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54600 %T Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study %A van der Horst,Annemieke %A Meijer,Laura %A van Os - Medendorp,Harmieke %A Jukema,Jan S %A Bohlmeijer,Ernst %A Schreurs,Karlein MG %A Kelders,Saskia %+ Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, PO BOX 217, Enschede, 7500 AE, Netherlands, 31 (0)53 489 4470, a.vanderhorst-1@utwente.nl %K pilot feasibility study %K spinal surgery %K digital health intervention %K positive psychology %K acceptance and commitment therapy %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. Objective: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). Methods: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum–Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. Results: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum–Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted. %M 38324374 %R 10.2196/54600 %U https://formative.jmir.org/2024/1/e54600 %U https://doi.org/10.2196/54600 %U http://www.ncbi.nlm.nih.gov/pubmed/38324374 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51510 %T Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study %A Spierings,Jelle %A Willinge,Gijs %A Kokke,Marike %A Twigt,Bas %A de Lange,Wendela %A Geerdink,Thijs %A van der Velde,Detlef %A Repping,Sjoerd %A Goslings,Carel %+ Department of Traumasurgery, St Antonius Hospital, Soestwetering 1, Utrecht, 3543AZ, Netherlands, 31 883203000, j.spierings@antoniusziekenhuis.nl %K application %K direct discharge %K eHealth %K experience %K healthcare professional %K mixed method study %K orthopaedic surgery %K orthopaedic %K policy %K policymaker %K self-care application %K self-care %K trauma surgery %K utilization %K virtual fracture clinic %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To cope with the rising number of patients with trauma in an already constrained Dutch health care system, Direct Discharge (DD) has been introduced in over 25 hospitals in the Netherlands since 2019. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit, and patients are supported through information leaflets, a smartphone app, and a telephone helpline. DD reduces secondary health care use, with comparable patient satisfaction and primary health care use. Currently, little is known about the experiences of in-hospital health care professionals with DD. Objective: The aim of this study was to explore the experiences of health care professionals with the DD protocol to enhance durable adoption and improve the protocol. Methods: We conducted a mixed methods study parallel to the implementation of DD in 3 hospitals. Data were collected through a preimplementation survey, a postimplementation survey, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data were reported using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptability, preliminary efficacy, demand, and applicability. Preimplementation expectations were compared with postimplementation experiences. Health care professionals involved in the daily clinical care of patients with low-complex, stable injuries were eligible for this study. Results: Of the 217 eligible health care professionals, 128 started the primary survey, 37 completed both surveys (response rate of 17%), and 15 participated in semistructured interviews. Health care professionals expressed satisfaction with the DD protocol (median 7.8, IQR 6.8-8.9) on a 10-point scale, with 82% (30/37) of participants noting improved information quality and uniformity and 73% (27/37) of patients perceiving reduced outpatient follow-up and imaging. DD was perceived as safe by 79% (28/37) of participants in its current form, but a feedback system to reassure health care professionals that patients had recovered adequately was suggested to improve DD. The introduction of DD had varying effects on workload and job satisfaction among different occupations. Health care professionals expressed intentions to continue using DD due to increased efficiency, patient empowerment, and self-management. Conclusions: Health care professionals perceive DD as an acceptable, applicable, safe, and efficacious alternative to traditional treatment. A numerical in-app feedback system (eg, in-app communication tools or recovery scores) could alleviate health care professionals’ concerns about adequate recovery and further improve DD protocols. DD can reduce health care use, which is important in times of constrained resources. Nonetheless, both advantages and disadvantages should be considered while evaluating this type of treatment. In the future, clinicians and policy makers can use these insights to further optimize and implement DD in clinical practice and guidelines. %M 38306162 %R 10.2196/51510 %U https://mhealth.jmir.org/2024/1/e51510 %U https://doi.org/10.2196/51510 %U http://www.ncbi.nlm.nih.gov/pubmed/38306162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51798 %T Exploring the Potential of ChatGPT-4 in Predicting Refractive Surgery Categorizations: Comparative Study %A Ćirković,Aleksandar %A Katz,Toam %+ Care Vision Germany, Ltd, Zeltnerstraße 1-3, Nuremberg, 90443, Germany, 49 9119564950, aleksandar.cirkovic@mailbox.org %K artificial intelligence %K machine learning %K decision support systems %K clinical %K refractive surgical procedures %K risk assessment %K ophthalmology %K health informatics %K predictive modeling %K data analysis %K medical decision-making %K eHealth %K ChatGPT-4 %K ChatGPT %K refractive surgery %K categorization %K AI-powered algorithm %K large language model %K decision-making %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Refractive surgery research aims to optimally precategorize patients by their suitability for various types of surgery. Recent advances have led to the development of artificial intelligence–powered algorithms, including machine learning approaches, to assess risks and enhance workflow. Large language models (LLMs) like ChatGPT-4 (OpenAI LP) have emerged as potential general artificial intelligence tools that can assist across various disciplines, possibly including refractive surgery decision-making. However, their actual capabilities in precategorizing refractive surgery patients based on real-world parameters remain unexplored. Objective: This exploratory study aimed to validate ChatGPT-4’s capabilities in precategorizing refractive surgery patients based on commonly used clinical parameters. The goal was to assess whether ChatGPT-4’s performance when categorizing batch inputs is comparable to those made by a refractive surgeon. A simple binary set of categories (patient suitable for laser refractive surgery or not) as well as a more detailed set were compared. Methods: Data from 100 consecutive patients from a refractive clinic were anonymized and analyzed. Parameters included age, sex, manifest refraction, visual acuity, and various corneal measurements and indices from Scheimpflug imaging. This study compared ChatGPT-4’s performance with a clinician’s categorizations using Cohen κ coefficient, a chi-square test, a confusion matrix, accuracy, precision, recall, F1-score, and receiver operating characteristic area under the curve. Results: A statistically significant noncoincidental accordance was found between ChatGPT-4 and the clinician’s categorizations with a Cohen κ coefficient of 0.399 for 6 categories (95% CI 0.256-0.537) and 0.610 for binary categorization (95% CI 0.372-0.792). The model showed temporal instability and response variability, however. The chi-square test on 6 categories indicated an association between the 2 raters’ distributions (χ²5=94.7, P<.001). Here, the accuracy was 0.68, precision 0.75, recall 0.68, and F1-score 0.70. For 2 categories, the accuracy was 0.88, precision 0.88, recall 0.88, F1-score 0.88, and area under the curve 0.79. Conclusions: This study revealed that ChatGPT-4 exhibits potential as a precategorization tool in refractive surgery, showing promising agreement with clinician categorizations. However, its main limitations include, among others, dependency on solely one human rater, small sample size, the instability and variability of ChatGPT’s (OpenAI LP) output between iterations and nontransparency of the underlying models. The results encourage further exploration into the application of LLMs like ChatGPT-4 in health care, particularly in decision-making processes that require understanding vast clinical data. Future research should focus on defining the model’s accuracy with prompt and vignette standardization, detecting confounding factors, and comparing to other versions of ChatGPT-4 and other LLMs to pave the way for larger-scale validation and real-world implementation. %M 38153777 %R 10.2196/51798 %U https://formative.jmir.org/2023/1/e51798 %U https://doi.org/10.2196/51798 %U http://www.ncbi.nlm.nih.gov/pubmed/38153777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46714 %T Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider’s Perspective %A Muschol,Jennifer %A Heinrich,Martin %A Heiss,Christian %A Hernandez,Alher Mauricio %A Knapp,Gero %A Repp,Holger %A Schneider,Henning %A Thormann,Ulrich %A Uhlar,Johanna %A Unzeitig,Kai %A Gissel,Christian %+ Department of Health Economics, Justus Liebig University, Klinikstrasse 29, Giessen, 35392, Germany, 49 641 99 48550, cg@phec.de %K digital health %K economic evaluation %K health economics %K orthopedic %K personnel costs %K productivity gains %K telemedicine %K trauma surgery %K utility %K video consultations %D 2023 %7 25.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders’ decision-making on the long-term implementation of digital health. Objective: This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. Methods: We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. Results: After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25% (€2.14 [US $2.35]/€8.67 [US $9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10% of the hospital’s outpatient cases resulted in personnel cost savings of €73,056 (US $ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). Conclusions: Our study supports stakeholders’ decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. Trial Registration: German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445 %M 38145481 %R 10.2196/46714 %U https://www.jmir.org/2023/1/e46714 %U https://doi.org/10.2196/46714 %U http://www.ncbi.nlm.nih.gov/pubmed/38145481 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47222 %T Minimally Invasive Posterior Spinal Nonfusion Surgery in Patients With Adolescent Idiopathic Scoliosis Using a Bipolar One-Way Self-Expanding Rod System: Protocol for a Single-Center Clinical Cohort Study %A Post,Anne Mareille %A Berends,Hanneke I %A van Royen,Barend J %+ Department of Orthopedic Surgery and Sports Medicine, University Medical Center Amsterdam, room K1-207, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205662672, a.m.post@amsterdamumc.nl %K adolescent idiopathic scoliosis %K minimally invasive %K nonfusion %K posterior spinal surgery %K protocol %K one-way self-expanding rod %K scoliosis %K idiopathic scoliosis %K spinal fusion %K spinal deformity surgery %K nonfusion techniques %K surgery %K intraoperative %K surgical technique %K operation %K musculoskeletal %K orthopedic %D 2023 %7 25.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current surgical treatment for patients diagnosed with progressive and severe adolescent idiopathic scoliosis (AIS) consists of the correction of the spinal curvature, followed by posterior spinal fusion (PSF). However, research has uncovered short- and long-term complications of posterior spinal fusion in patients with AIS. Minimally invasive growing rod techniques have successfully been used to treat patients with early-onset scoliosis and neuromuscular scoliosis. It may be questioned if minimally invasive posterior spinal nonfusion (PSnF) surgery with bipolar instrumentation can be used for the treatment of AIS. Objective: This study will be performed to monitor the efficacy and safety of PSnF surgery by using a commercially available Conformité Européenne-certified spinal implant consisting of bilateral bipolar one-way self-expanding rods (OWSER) for the treatment of patients diagnosed with AIS. Methods: In 14 selected patients with AIS with Lenke 1-6 curves, minimally invasive PSnF surgery with the OWSER system is performed after the failure of conservative treatment (curve progression of >5° within 1 year). The patients are over 7 years of age, with a major Cobb angle of ≥30°, sufficient flexibility, and a Risser stage of ≤2. Patients will be followed over time, according to the standard medical care. Efficacy will be measured using radiological and patient satisfaction assessments and safety will be determined by the amount of perioperative complications. Results: Patient inclusion started on November 17, 2021 and we hope to finalize patient inclusion by the beginning of 2025. The first results will be expected by the beginning of 2024. Conclusions: Minimally invasive PSnF in patients with AIS is presented as a less invasive surgical technique that prevents the progression of the scoliotic curve and that allows minor posture correction of coronal imbalance. This will be the first study to examine whether the PSnF bipolar OWSER instrumentation will be the next generation of surgical instrumentation in AIS. Trial Registration: ClinicalTrials.gov NCT04441411; https://clinicaltrials.gov/study/NCT04441411 International Registered Report Identifier (IRRID): DERR1-10.2196/47222 %M 38145474 %R 10.2196/47222 %U https://www.researchprotocols.org/2023/1/e47222 %U https://doi.org/10.2196/47222 %U http://www.ncbi.nlm.nih.gov/pubmed/38145474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50677 %T The Effects of Reinforcement Techniques in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Protocol for a Web-Based Survey, Systematic Review, and Meta-Analysis %A Xie,Yunhui %A Wen,Jun %A Zhu,Hongmei %A Liu,Yanjun %+ Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu, 610014, China, 86 16608502559, hmei2323@gmail.com %K protocol %K reinforcement technique %K sleeve gastrectomy %K Roux-en-Y gastric bypass %K systematic review %K meta-analysis %K bariatric surgery %K survey %K effectiveness %K surgical site %K blood loss %K blood %K gastric bypass %K gastrectomy %D 2023 %7 22.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effects of reinforcement are still controversial in bariatric surgery, and variations may exist in using this technique. Objective: This protocol describes a study that aims to survey the views of bariatric surgeons on reinforcement techniques and evaluate the effects of applying reinforcement techniques in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods: This study is composed of 2 parts. Part 1 will investigate the differences of using reinforcement techniques among surgeons worldwide who perform SG or RYGB through a survey. The survey will be conducted by email and social media. Part 2 will evaluate the safety and effectiveness of using omentopexy or staple line reinforcement in SG and RYGB by systematic review and meta-analysis. In this part, literature searches will be performed in English databases, including CENTRAL, EMBASE CINAHL, Web of Science, and PubMed, and Chinese databases, including Wanfang, China National Knowledge Infrastructure, Database of Chinese Technical Periodicals, and Chinese Biological Medicine, from their establishment to November 2023. Randomized controlled trials and case-control studies will be included. The primary outcomes are rates of postoperative bleeding and gastric leakage. The secondary outcomes include anastomotic stenosis, surgical site infection, reoperation, estimated intraoperative blood loss, operative time (minutes), length of hospital stay (days), overall complications, and 30-day mortality. The meta-analysis will be conducted using RevMan 5.4 under the random-effects model, as well as through extensive subgroup and sensitivity analyses. P values <0.05 will be considered statistically significant. This study was registered with PROSPERO (Prospective Register of Systematic Reviews) in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols). Results: The results of this study will be published in a peer-reviewed journal. The web-based survey and initial title or abstract review of papers identified by the search strategy will be completed in November 2023. The second round of title or abstract review and downloading of the papers for full-text inclusion will be completed in January 2024. We aim to complete data extraction and meta-analysis by February 2024 and expect to publish the findings by the end of March 2024. Conclusions: This study aims to investigate the impact of reinforcement techniques on reducing the incidence of postoperative complications in SG and RYGB procedures and provide assistance for standardizing the procedures of SG and RYGB operations for bariatric surgeons. Trial Registration: PROSPERO CRD42022376438; https://tinyurl.com/2d53uf8n International Registered Report Identifier (IRRID): PRR1-10.2196/50677 %M 38133924 %R 10.2196/50677 %U https://www.researchprotocols.org/2023/1/e50677 %U https://doi.org/10.2196/50677 %U http://www.ncbi.nlm.nih.gov/pubmed/38133924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49277 %T Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience %A Beesoon,Sanjay %A Drobot,Ashley %A Smokeyday,Melissa %A Ali,Al-Bakir %A Collins,Zoe %A Reynolds,Colin %A Berzins,Sandra %A Gibson,Alison %A Nelson,Gregg %+ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3260 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada, 1 5877170011, gregg.nelson@ahs.ca %K app %K digital health %K patient experience %K provider satisfaction %K application %K recovery %K cost-effective %K evaluation %K implementation %K gynecologic oncology %K colorectal surgery %K surgery %K care %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. Objective: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. Methods: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. Results: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. Conclusions: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world. %R 10.2196/49277 %U https://formative.jmir.org/2023/1/e49277/ %U https://doi.org/10.2196/49277 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49582 %T Treatments for Trauma-Induced Coagulopathy: Protocol for a Systematic Review and Meta-Analysis %A Itagaki,Yuki %A Hayakawa,Mineji %A Takahashi,Yuki %A Sakamoto,Yuichiro %A Kushimoto,Shigeki %A Eguchi,Yutaka %A Seki,Yoshinobu %A Okamoto,Kohji %+ Department of Emergency Medicine, Hokkaido Univerisity, Kita15, Nishi7, Kita-ku, Sapporo, Japan, 81 9090861380, koaraninaritaizo@gmail.com %K trauma-induced coagulopathy %K coagulation factor %K transfusion %K blood %K clot %K clotting %K coagulation %K coagulopathy %K systematic %K review methods %K review methodology %K meta-analysis %K meta-analyses %K bleeding %K trauma %K hemorrhage %K traumatic %K injury %D 2023 %7 11.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Trauma-induced coagulopathy (TIC) is a common and potentially life-threatening coagulopathy as a result of traumatic injury, characterized by abnormal blood clotting and bleeding. Although several treatments have been proposed for TIC, their effectiveness and safety remain unclear. Further, numerous systematic reviews and meta-analyses on trauma have been conducted; however, to our knowledge, there is no systematic review and meta-analysis that specifically focuses on TIC management. Therefore, a comprehensive synthesis of the available evidence on interventions for TIC is needed. Objective: This systematic review and meta-analysis aim to evaluate the effectiveness and safety of interventions for the management of TIC. Methods: We will conduct a systematic review and meta-analysis of randomized and nonrandomized controlled trials as well as observational studies regarding severe trauma in patients with TIC. The interventions will include administration of coagulation factor concentrates, tranexamic acid, and blood component products. The control group will be managed with an ordinal transfusion or administered placebo. The primary outcome will be in-hospital mortality. We will search the electronic databases of MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials. Two reviewers will independently screen the titles and abstracts, retrieve the full text of the selected articles, and extract essential data. We will apply uniform criteria for evaluating the risk of bias associated with individual randomized controlled trials and nonrandomized trials based on the Cochrane risk-of-bias tool. Risk ratio values will be expressed as point estimates with 95% CIs. Continuous variables will be expressed as the mean difference along with their 95% CIs and P values. We will assess the strength of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. This review will be the first systematic review and meta-analysis providing information on the effectiveness and safety of interventions for the management of TIC, including the administration of coagulation factor concentrates, tranexamic acid, and blood component products. Ethics approval and patient consent were not required for this study protocol, as we conducted a systematic review and meta-analysis of publicly available data, without any direct involvement of human participants. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. The results of the meta-analysis will be depicted using figures and forest plots. Conclusions: This systematic review will provide updated information on the efficacy and safety of using coagulation factor concentrates, tranexamic acid, and blood component products for patients with TIC. To our knowledge, there is no systematic review and meta-analysis that specifically focuses on treatments for TIC. Trial Registration: UMIN registry UMIN000050170; https://tinyurl.com/yr8pcrj6 International Registered Report Identifier (IRRID): DERR1-10.2196/49582 %M 38079205 %R 10.2196/49582 %U https://www.researchprotocols.org/2023/1/e49582 %U https://doi.org/10.2196/49582 %U http://www.ncbi.nlm.nih.gov/pubmed/38079205 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e49186 %T Survey of the Impact of Decision Support in Preoperative Management of Anemia (i-Anemia): Survey Study %A Mignanelli,Gaëtan %A Boyer,Richard %A Bonifas,Nicolas %A Rineau,Emmanuel %A Moussali,Yassine %A Le Guen,Morgan %+ Department of Anesthesia and Pain Medicine, Hôpital Foch, Université Versailles Saint Quentin, 51 Rue Edouard Nortier, Neuilly sur Seine, 92200, France, 33 0646288339, gaetanms@gmail.com %K anemia %K transfusion %K patient blood management %K preoperative optimization %K preoperative %K blood %K decision support %K randomized %K case %K survey %K anesthesiologists %K anesthesiologist %K anesthesia %K anesthesiology %K professional development %K digital health %K surgery %K perioperative %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Major surgery on patients with anemia has demonstrated an increased risk of perioperative blood transfusions and postoperative morbidity and mortality. Recent studies have shown that integrating preoperative anemia treatment as a component of perioperative blood management may reduce blood product utilization and improve outcomes in both cardiac and noncardiac surgery. However, outpatient management of anemia falls outside of daily practice for most anesthesiologists and is probably weakly understood. Objective: We conducted a simulated case survey with anesthesiologists to accomplish the following aims: (1) evaluate the baseline knowledge of the preoperative optimization of anemia and (2) determine the impact of real-time clinical decision support on anemia management. Methods: We sent a digital survey (i-Anemia) to members of the French Society of Anaesthesia and Critical Care. The i-Anemia survey contained 7 simulated case vignettes, each describing a patient’s brief clinical history and containing up to 3 multiple-choice questions related to preoperative anemia management (12 questions in total). The cases concerned potential situations of preoperative anemia and were created and validated with a committee of patient blood management experts. Correct answers were determined by the current guidelines or by expert consensus. Eligible participants were randomly assigned to control or decision support groups. In the decision support group, the primary outcome measured was the correct response rate. Results: Overall, 1123 participants were enrolled and randomly divided into control (n=568) and decision support (n=555) groups. Among them, 763 participants fully responded to the survey. We obtained a complete response rate of 65.6% (n=364) in the group receiving cognitive aid and 70.2% (n=399) in the group without assistance. The mean duration of response was 10.2 (SD 6.8) minutes versus 7.8 (SD 5) minutes for the decision support and control groups, respectively (P<.001). The score significantly improved with cognitive aid (mean 10.3 out of 12, SD 2.1) in comparison to standard care (mean 6.2 out of 12, SD 2.1; P<.001). Conclusions: Management strategies to optimize preoperative anemia are not fully known and applied by anesthesiologists in daily practice despite their clinical importance. However, adding a decision support tool can significantly improve patient care by reminding practitioners of current recommendations. %M 38039068 %R 10.2196/49186 %U https://periop.jmir.org/2023/1/e49186 %U https://doi.org/10.2196/49186 %U http://www.ncbi.nlm.nih.gov/pubmed/38039068 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e44708 %T Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study %A Schwarzkopf,Sophie-Caroline %A Distler,Marius %A Welsch,Thilo %A Krause-Jüttler,Grit %A Weitz,Jürgen %A Kolbinger,Fiona R %+ Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstrasse 74, Dresden, 01307, Germany, 49 351 458 ext 19624, fiona.kolbinger@uniklinikum-dresden.de %K Serious game %K surgical education %K clinical reasoning %K medical education %K postoperative complications %K educational games %K computer-based learning %K colorectal surgery %K decision-making %K pancreatic surgery %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. Objective: This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. Methods: In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants’ proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. Results: A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Conclusions: Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care. %M 37943588 %R 10.2196/44708 %U https://games.jmir.org/2023/1/e44708 %U https://doi.org/10.2196/44708 %U http://www.ncbi.nlm.nih.gov/pubmed/37943588 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e44139 %T Efficacy of Electronic Reminders in Increasing the Enhanced Recovery After Surgery Protocol Use During Major Breast Surgery: Prospective Cohort Study %A Gopwani,Sumeet %A Bahrun,Ehab %A Singh,Tanvee %A Popovsky,Daniel %A Cramer,Joseph %A Geng,Xue %+ Department of Anesthesiology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, United States, 1 7344764041, sumeet.gopwani@medstar.net %K ERAS protocol %K electronic notification system %K clinical decision support system %K postoperative outcomes %K breast surgery %K surgery %K surgical %K postoperative %K decision support %K notification %K recovery %K anesthesia %K cohort study %K patient outcome %K enhanced recovery %K patient education %K surgical stress %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room. Objective: Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers’ adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols. Methods: This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient’s record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements. Results: Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance. Conclusions: This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols. %M 37921854 %R 10.2196/44139 %U https://periop.jmir.org/2023/1/e44139 %U https://doi.org/10.2196/44139 %U http://www.ncbi.nlm.nih.gov/pubmed/37921854 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46765 %T Prehabilitation in an Integrative Medicine Day Clinic for Patients Undergoing Neoadjuvant Treatment: Single-Center Feasibility Pilot Study %A Raff,Christian %A Dörr-Harim,Colette %A Otto,Stephanie %A Thiele,Johanna %A Mihaljevic,Andre %A Kramer,Klaus %+ Department of General and Visceral Surgery, Working Group of Integrative Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany, 49 73150053538, christian.raff@uniklinik-ulm.de %K supportive care %K prehabilitation %K neoadjuvant treatment %K integrative medicine %K multimodal prehabilitation %K cancer %K oncology %K surgery %K preoperative %K feasibility %K integrative %K naturopathy %K naturopathic %K diet %K nutrition %D 2023 %7 18.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients’ needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. Objective: The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. Methods: The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). Results: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). Conclusions: The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. Trial Registration: Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126 International Registered Report Identifier (IRRID): DERR1-10.2196/46765 %M 37851493 %R 10.2196/46765 %U https://www.researchprotocols.org/2023/1/e46765 %U https://doi.org/10.2196/46765 %U http://www.ncbi.nlm.nih.gov/pubmed/37851493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43895 %T Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study %A Castellucci,Clara %A Malorgio,Amos %A Budowski,Alexandra Dinah %A Akbas,Samira %A Kolbe,Michaela %A Grande,Bastian %A Braun,Julia %A Noethiger,Christoph B %A Spahn,Donat R %A Tscholl,David Werner %A Roche,Tadzio Raoul %+ Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 0432530255, tadzioraoul.roche@usz.ch %K avatar technology %K coagulation management %K high-fidelity simulation %K point-of-care testing %K thrombelastography %K user-centered design %K Visual Clot %D 2023 %7 12.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness–oriented design. Objective: This study aims to compare the effects of Visual Clot versus conventional viscoelastic test results (rotational thrombelastometry [ROTEM] temograms) on the coagulation management performance of anesthesia teams in critical bleeding situations. Methods: We conducted a prospective, randomized, high-fidelity simulation study in which anesthesia teams (consisting of a senior anesthesiologist, a resident anesthesiologist, and an anesthesia nurse) managed perioperative bleeding scenarios. Teams had either Visual Clot or ROTEM temograms available to perform targeted coagulation management. We analyzed the 15-minute simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. In addition, we have conducted a qualitative survey on user acceptance of Visual Clot. We used Poisson regression, Cox regression, and mixed logistic regression models, adjusted for various potential confounders, to analyze the data. Results: We analyzed 59 simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (rate ratio 1.56, 95% CI 1.00-2.47; P=.05) and administer the first targeted coagulation product faster (hazard ratio 2.58, 95% CI 1.37-4.85; P=.003). In addition, participants showed higher decision confidence with Visual Clot (odds ratio 3.60, 95% CI 1.49-8.71; P=.005). We found no difference in workload (coefficient –0.03, 95% CI –3.08 to 2.88; P=.99). Conclusions: Using Visual Clot led to a more accurate and faster-targeted coagulation therapy than using ROTEM temograms. We suggest that relevant viscoelastic test manufacturers consider augmenting their complex result presentation with intuitive, easy-to-understand visualization to ease users’ burden from unnecessary cognitive load and enhance patient care. %M 37824182 %R 10.2196/43895 %U https://www.jmir.org/2023/1/e43895 %U https://doi.org/10.2196/43895 %U http://www.ncbi.nlm.nih.gov/pubmed/37824182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45665 %T Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Survey Study %A Youssef,Yasmin %A Scherer,Julian %A Niemann,Marcel %A Ansorg,Jörg %A Back,David Alexander %A Gehlen,Tobias %+ Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany, 49 0341 9717004, yasmin.youssef@medizin.uni-leipzig.de %K communication %K digitalization %K Facebook %K Germany %K implementation %K Instagram %K management %K musculoskeletal %K orthopedic surgeon %K orthopedic %K orthopedics and traumatology %K patient %K physician %K questionnaire %K social media management %K social media %K social networking %K surgeon %K trauma surgeon %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has gained importance in the health care sector as a means of communication and a source of information for physicians and patients. However, the scope of professional SM use by orthopedic and trauma surgeons remains largely unknown. Objective: This study presents an overview of professional SM use among orthopedic and trauma surgeons in Germany in terms of the platforms used, frequency of use, and SM content management. Methods: We developed a web-based questionnaire with 33 variables and 2 separate sections based on a review of current literature. This study analyzed the first section of the questionnaire and included questions on demographics, type of SM used, frequency of use, and SM content management. Statistical analysis was performed using SPSS (version 26.0). Subgroup analysis was performed for sex, age groups (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Differences between groups were assessed with a chi-square test for categorical data. Results: A total of 208 participants answered the questionnaire (166/208, 79.8% male), of whom 70.2% (146/208) were younger than 60 years and 77.4% (161/208) worked in a practice. All participants stated that they use SM for private and professional purposes. On average, participants used 1.6 SM platforms for professional purposes. More than half had separate SM accounts for private and professional use. The most frequently used SM platforms were messenger apps (119/200, 59.5%), employment-oriented SM (60/200, 30%), and YouTube (54/200, 27%). All other SM, including Facebook and Instagram, were only used by a minority of the participants. Women and younger participants were more likely to use Instagram (P<.001 and P=.03, respectively). The participants working in a hospital were more likely to use employment-oriented SM (P=.02) and messenger apps (P=.009) than participants working in a practice. In a professional context, 20.2% (39/193) of the participants produced their own content on SM, 24.9% (48/193) used SM daily, 39.9% (77/193) used SM during work, and 13.8% (26/188) stated that they checked the number of followers they had. Younger participants were more likely to have participated in professional SM training and to have separate private and professional accounts (P=.04 and P=.02, respectively). Younger participants tended toward increased production of their own content (P=.06). Conclusions: SM is commonly used for professional purposes by orthopedic and trauma surgeons in Germany. However, it seems that professional SM use is not exploited to its full potential, and a structured implementation into daily professional work routines is still lacking. SM can have a profound impact on medical practices and communication, so orthopedic and trauma surgeons in Germany should consider increasing their SM presence by actively contributing to SM. %M 37738084 %R 10.2196/45665 %U https://formative.jmir.org/2023/1/e45665 %U https://doi.org/10.2196/45665 %U http://www.ncbi.nlm.nih.gov/pubmed/37738084 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e47398 %T Dashboard of Short-Term Postoperative Patient Outcomes for Anesthesiologists: Development and Preliminary Evaluation %A Sreepada,Rama Syamala %A Chang,Ai Ching %A West,Nicholas C %A Sujan,Jonath %A Lai,Brendan %A Poznikoff,Andrew K %A Munk,Rebecca %A Froese,Norbert R %A Chen,James C %A Görges,Matthias %+ Research Institute, BC Children's Hospital, Rm V3-317 - 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgoerges@bcchr.ca %K quality improvement %K feedback %K anesthesiologists %K patient reported outcome measures %K data display %K user-centered design %K surgical outcome %K discharge %K anesthesiology %K postoperative care %K registry %K dashboard %K interactive %K practice %K performance %K patient outcome %K mobile phone %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Anesthesiologists require an understanding of their patients’ outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients’ outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children’s Hospital’s postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists. Objective: This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers. Methods: The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists’ feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly. Results: The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist’s case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice. Conclusions: We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients’ short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes. %M 37725426 %R 10.2196/47398 %U https://periop.jmir.org/2023/1/e47398 %U https://doi.org/10.2196/47398 %U http://www.ncbi.nlm.nih.gov/pubmed/37725426 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46526 %T Supervised Home-Based Exercise Prehabilitation in Unfit Patients Scheduled for Pancreatic Surgery: Protocol for a Multicenter Feasibility Study %A Hildebrand,Nicole D %A Wijma,Allard G %A Bongers,Bart C %A Rensen,Sander S %A den Dulk,Marcel %A Klaase,Joost M %A Olde Damink,Steven W M %+ Department of Surgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 (0)43 3875492, nicole.hildebrand@mumc.nl %K preoperative care %K prehabilitation %K preoperative training %K high-intensity interval training %K pancreatic resection %K cardiorespiratory fitness %D 2023 %7 7.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Morbidity rates in pancreatic surgery are high, and frail patients with low aerobic capacity are especially at risk of complications and require prophylactic interventions. Previous studies of small patient cohorts receiving intra-abdominal surgery have shown that an exercise prehabilitation program increases aerobic capacity, leading to better treatment outcomes. Objective: In this study, we aim to assess the feasibility of a home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery on a larger scale. Methods: In this multicenter study, adult patients scheduled for elective pancreatic surgery with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min or a VO2 at peak exercise ≤18 mL/kg/min will be recruited. A total of 30 patients will be included in the 4-week, home-based, partly supervised exercise prehabilitation program. The program comprises 25-minute high-intensity interval training on an advanced cycle ergometer 3 times a week. Training intensity will be based on steep ramp test performance (ie, a short-term maximal exercise test on a cycle ergometer), aiming to improve aerobic capacity. Twice a week, patients will perform functional task exercises to improve muscle function and functional mobility. A steep ramp test will be repeated weekly, and training intensity will be adjusted accordingly. Next to assessing the feasibility (participation rate, reasons for nonparticipation, adherence, dropout rate, reasons for dropout, adverse events, and patient and therapist appreciation) of this program, individual patients’ responses to prehabilitation on aerobic capacity, functional mobility, body composition, quality of life, and immune system factors will be evaluated. Results: Recruitment for this study began in January 2022 and is expected to be completed in the summer of 2023. Conclusions: Results of this study will provide important clinical and scientific knowledge on the feasibility of a partly supervised home-based exercise prehabilitation program in a vulnerable patient population. This might ease the path to implementing prehabilitation programs in unfit patients undergoing complex abdominal surgery, such as pancreatic surgery. Trial Registration: ClinicalTrials.gov NCT05496777; https://classic.clinicaltrials.gov/ct2/show/NCT05496777 International Registered Report Identifier (IRRID): DERR1-10.2196/46526 %M 37676715 %R 10.2196/46526 %U https://www.researchprotocols.org/2023/1/e46526 %U https://doi.org/10.2196/46526 %U http://www.ncbi.nlm.nih.gov/pubmed/37676715 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48616 %T Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study %A Parajuli,Sanket %A Dhakhwa,Parami %A Adhikary,Rabindra %+ Reiyukai Eiko Masunaga Eye Hospital, Budol, Banepa, Kavrepalanchowk, 45210, Nepal, 977 9827430614, sanketparajuli@gmail.com %K cataract surgery %K operational research %K SICS %K small-incision cataract surgery %K postoperative visits %K cataract %K follow-up visit %K postoperative care %K surgery %D 2023 %7 31.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services. Objective: We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30. Methods: A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart. Results: The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed. Conclusions: We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits. International Registered Report Identifier (IRRID): PRR1-10.2196/48616 %M 37651180 %R 10.2196/48616 %U https://www.researchprotocols.org/2023/1/e48616 %U https://doi.org/10.2196/48616 %U http://www.ncbi.nlm.nih.gov/pubmed/37651180 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e44483 %T Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards: Retrospective Observational Study %A van Rossum,Mathilde C %A Bekhuis,Robin E M %A Wang,Ying %A Hegeman,Johannes H %A Folbert,Ellis C %A Vollenbroek-Hutten,Miriam M R %A Kalkman,Cornelis J %A Kouwenhoven,Ewout A %A Hermens,Hermie J %+ Department of Cardiovascular and Respiratory Physiology, University of Twente, PO box 217, Enschede, 7500 AE, Netherlands, 31 53 489 4152, m.c.vanrossum@utwente.nl %K early warning scores %K vital signs %K telemedicine %K physiological monitoring %K clinical alarms %K postoperative complications %K perioperative nursing %D 2023 %7 30.8.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. Objective: This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms). Methods: Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30%) and without (control group: 32/46, 70%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR). Results: The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P<.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80%-67%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85%) to 1.2 (FDR=83%) alarms per patient per day respectively. The sensitivity of sensor EWS–based alarms was higher than that of nurse EWS–based alarms (maximum=40%) but lower than that of single-parameter alarms (87%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS–based alarms were higher than that of nurse EWS–based alarms (maximum=0.6 alarm/patient/d; FDR=80%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute. Conclusions: EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes. %M 37647104 %R 10.2196/44483 %U https://periop.jmir.org/2023/1/e44483 %U https://doi.org/10.2196/44483 %U http://www.ncbi.nlm.nih.gov/pubmed/37647104 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46900 %T Appropriateness and Comprehensiveness of Using ChatGPT for Perioperative Patient Education in Thoracic Surgery in Different Language Contexts: Survey Study %A Shao,Chen-ye %A Li,Hui %A Liu,Xiao-long %A Li,Chang %A Yang,Li-qin %A Zhang,Yue-juan %A Luo,Jing %A Zhao,Jun %+ Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, Suzhou, 215006, China, 86 15250965957, zhaojia0327@126.com %K patient education %K ChatGPT %K Generative Pre-trained Transformer %K thoracic surgery %K evaluation %K patient %K education %K surgery %K thoracic %K language %K language model %K clinical workflow %K artificial intelligence %K AI %K workflow %K communication %K feasibility %D 2023 %7 14.8.2023 %9 Short Paper %J Interact J Med Res %G English %X Background: ChatGPT, a dialogue-based artificial intelligence language model, has shown promise in assisting clinical workflows and patient-clinician communication. However, there is a lack of feasibility assessments regarding its use for perioperative patient education in thoracic surgery. Objective: This study aimed to assess the appropriateness and comprehensiveness of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. Methods: This pilot study was conducted in February 2023. A total of 37 questions focused on perioperative patient education in thoracic surgery were created based on guidelines and clinical experience. Two sets of inquiries were made to ChatGPT for each question, one in English and the other in Chinese. The responses generated by ChatGPT were evaluated separately by experienced thoracic surgical clinicians for appropriateness and comprehensiveness based on a hypothetical draft response to a patient’s question on the electronic information platform. For a response to be qualified, it required at least 80% of reviewers to deem it appropriate and 50% to deem it comprehensive. Statistical analyses were performed using the unpaired chi-square test or Fisher exact test, with a significance level set at P<.05. Results: The set of 37 commonly asked questions covered topics such as disease information, diagnostic procedures, perioperative complications, treatment measures, disease prevention, and perioperative care considerations. In both the English and Chinese contexts, 34 (92%) out of 37 responses were qualified in terms of both appropriateness and comprehensiveness. The remaining 3 (8%) responses were unqualified in these 2 contexts. The unqualified responses primarily involved the diagnosis of disease symptoms and surgical-related complications symptoms. The reasons for determining the responses as unqualified were similar in both contexts. There was no statistically significant difference (34/37, 92% vs 34/37, 92%; P=.99) in the qualification rate between the 2 language sets. Conclusions: This pilot study demonstrates the potential feasibility of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. ChatGPT is expected to enhance patient satisfaction, reduce anxiety, and improve compliance during the perioperative period. In the future, there will be remarkable potential application for using artificial intelligence, in conjunction with human review, for patient education and health consultation after patients have provided their informed consent. %M 37578819 %R 10.2196/46900 %U https://www.i-jmr.org/2023/1/e46900 %U https://doi.org/10.2196/46900 %U http://www.ncbi.nlm.nih.gov/pubmed/37578819 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48801 %T Using Presurgical Biopsychosocial Features to Develop an Advanced Clinical Decision-Making Support Tool for Predicting Recovery Trajectories in Patients Undergoing Total Knee Arthroplasty: Protocol for a Prospective Observational Study %A Ribbons,Karen %A Johnson,Sarah %A Ditton,Elizabeth %A Wills,Adrian %A Mason,Gillian %A Flynn,Traci %A Cochrane,Jodie %A Pollack,Michael %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, Kookaburra Circuit, New Lambton Heights, 2305, Australia, 61 240420758, karen.ribbons@newcastle.edu.au %K biopsychosocial %K total knee arthroplasty %K prospective %K recovery trajectories %K patient-reported outcomes %K predictive clinical decision tool %K clinical decision support %K knee arthroplasty %K rehabilitation %K psychosocial %K patient-reported outcome %K quality of life %K patient recruitment %K presurgery %K patient stratification %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet individuals’ needs. However, despite their potential clinical benefit, the application of such tools remains limited. Objective: This study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified individual biopsychosocial needs. Methods: In this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. Results: Patient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. Conclusions: Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient’s individual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. International Registered Report Identifier (IRRID): DERR1-10.2196/48801 %M 37556181 %R 10.2196/48801 %U https://www.researchprotocols.org/2023/1/e48801 %U https://doi.org/10.2196/48801 %U http://www.ncbi.nlm.nih.gov/pubmed/37556181 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45477 %T Internet of Things and New Technologies for Tracking Perioperative Patients With an Innovative Model for Operating Room Scheduling: Protocol for a Development and Feasibility Study %A Bottani,Eleonora %A Bellini,Valentina %A Mordonini,Monica %A Pellegrino,Mattia %A Lombardo,Gianfranco %A Franchi,Beatrice %A Craca,Michelangelo %A Bignami,Elena %+ Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, Parma, 43126, Italy, 39 0521 033609, elenagiovanna.bignami@unipr.it %K internet of things %K artificial intelligence %K machine learning %K perioperative organization %K operating rooms %D 2023 %7 5.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Management of operating rooms is a critical point in health care organizations because surgical departments represent a significant cost in hospital budgets. Therefore, it is increasingly important that there is effective planning of elective, emergency, and day surgery and optimization of both the human and physical resources available, always maintaining a high level of care and health treatment. This would lead to a reduction in patient waiting lists and better performance not only of surgical departments but also of the entire hospital. Objective: This study aims to automatically collect data from a real surgical scenario to develop an integrated technological-organizational model that optimizes operating block resources. Methods: Each patient is tracked and located in real time by wearing a bracelet sensor with a unique identifier. Exploiting the indoor location, the software architecture is able to collect the time spent for every step inside the surgical block. This method does not in any way affect the level of assistance that the patient receives and always protects their privacy; in fact, after expressing informed consent, each patient will be associated with an anonymous identification number. Results: The preliminary results are promising, making the study feasible and functional. Times automatically recorded are much more precise than those collected by humans and reported in the organization’s information system. In addition, machine learning can exploit the historical data collection to predict the surgery time required for each patient according to the patient’s specific profile. Simulation can also be applied to reproduce the system’s functioning, evaluate current performance, and identify strategies to improve the efficiency of the operating block. Conclusions: This functional approach improves short- and long-term surgical planning, facilitating interaction between the various professionals involved in the operating block, optimizing the management of available resources, and guaranteeing a high level of patient care in an increasingly efficient health care system. Trial Registration: ClinicalTrials.gov NCT05106621; https://clinicaltrials.gov/ct2/show/NCT05106621 International Registered Report Identifier (IRRID): DERR1-10.2196/45477 %M 37405821 %R 10.2196/45477 %U https://www.researchprotocols.org/2023/1/e45477 %U https://doi.org/10.2196/45477 %U http://www.ncbi.nlm.nih.gov/pubmed/37405821 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e41906 %T The Variability of Lumbar Sequential Motion Patterns: Observational Study %A Caelers,Inge %A Boselie,Toon %A van Hemert,Wouter %A Rijkers,Kim %A De Bie,Rob %A van Santbrink,Henk %+ Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, Netherlands, 31 652593545, inge.caelers@mumc.nl %K lumbar spine %K cinematographic recordings %K sequence %K motion pattern %K flexion %K extension %K rotation %K physiological %K musculoskeletal %K motion %K spine %K upper lumbar %K observational study %K physiological motion %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Physiological motion of the lumbar spine is a topic of interest for musculoskeletal health care professionals since abnormal motion is believed to be related to lumbar complaints. Many researchers have described ranges of motion for the lumbar spine, but only few have mentioned specific motion patterns of each individual segment during flexion and extension, mostly comprising the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion is still lacking. For the lower cervical spine, a consistent pattern of segmental contributions in a flexion-extension movement in young healthy individuals was described, resulting in a definition of physiological motion of the cervical spine. Objective: This study aimed to define the lumbar spines’ physiological motion pattern by determining the sequence of segmental contribution in sagittal rotation of each vertebra during maximum flexion and extension in healthy male participants. Methods: Cinematographic recordings were performed twice in 11 healthy male participants, aged 18-25 years, without a history of spine problems, with a 2-week interval (time point T1 and T2). Image recognition software was used to identify specific patterns in the sequence of segmental contributions per individual by plotting segmental rotation of each individual segment against the cumulative rotation of segments L1 to S1. Intraindividual variability was determined by testing T1 against T2. Intraclass correlation coefficients were tested by reevaluation of 30 intervertebral sequences by a second researcher. Results: No consistent pattern was found when studying the graphs of the cinematographic recordings during flexion. A much more consistent pattern was found during extension, especially in the last phase. It consisted of a peak in rotation in L3L4, followed by a peak in L2L3, and finally, in L1L2. This pattern was present in 71% (15/21) of all recordings; 64% (7/11) of the participants had a consistent pattern at both time points. Sequence of segmental contribution was less consistent in the lumbar spine than the cervical spine, possibly caused by differences in facet orientation, intervertebral discs, overprojection of the pelvis, and muscle recruitment. Conclusions: In 64% (7/11) of the recordings, a consistent motion pattern was found in the upper lumbar spine during the last phase of extension in asymptomatic young male participants. Physiological motion of the lumbar spine is a broad concept, influenced by multiple factors, which cannot be captured in a firm definition yet. Trial Registration: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID): RR2-10.2196/14741 %M 38875682 %R 10.2196/41906 %U https://biomedeng.jmir.org/2023/1/e41906 %U https://doi.org/10.2196/41906 %U http://www.ncbi.nlm.nih.gov/pubmed/38875682 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46629 %T Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review %A Fuchita,Mikita %A Ridgeway,Kyle J %A Kimzey,Clinton %A Melanson,Edward L %A Fernandez-Bustamante,Ana %+ Department of Anesthesiology, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States, 1 848 848 3691, mikita.fuchita@cuanschutz.edu %K abdominal surgery %K accelerometry %K early mobilization %K physical activity %K postoperative care %K wearable %D 2023 %7 15.5.2023 %9 Review %J Interact J Med Res %G English %X Background: It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. Objective: We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. Methods: We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. Results: We identified 15 studies. Risk of bias was high in 14 (93%) of the 15 studies. Most of the studies (11/15, 73%) had sample sizes of <100. Of the 15 studies, 13 (87%) included the general surgery population, 1 (7%) was a study of patients who had undergone gynecologic surgery, and 1 (7%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80%). In the observational studies (9/15, 60%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40%), only 1 (17%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67%) of the 6 RCTs did not result in increased postoperative physical activity. Conclusions: Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery. %M 37184924 %R 10.2196/46629 %U https://www.i-jmr.org/2023/1/e46629 %U https://doi.org/10.2196/46629 %U http://www.ncbi.nlm.nih.gov/pubmed/37184924 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41555 %T The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review %A Romero Rangel,José Alberto Israel %A Jiménez Ponce,Fiacro %A Wong Chew,Rosa Maria %A Talavera Piña,Juan Osvaldo %A Martínez Tovar,Adolfo %+ Spine Clinic, Neurological Center, The American-British Cowdray Medical Center IAP, Av Carlos Graef Fernández #154, Col Tlaxala Santa Fe, Cuajimalpa de Morelos, Mexico City, 05330, Mexico, 52 5582015788, gmaisrael@gmail.com %K biomarker behavior profile %K biomarkers %K C-reactive protein %K degenerative spinal diseases %K Dickkopf-1 %K erythrocyte sedimentation rate %K inflammatory biomarker %K inflammatory disease %K neuroscience %K postoperative spinal infection %K procalcitonin %K serum biomarkers %K spinal infection %K spinal surgical site infection %K spine surgery %K review %K systematic review %D 2023 %7 28.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. Objective: This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. Results: No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. Conclusions: This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient’s physical and mental health, and reducing the disease burden. Trial Registration: PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645 International Registered Report Identifier (IRRID): DERR1-10.2196/41555 %M 36703491 %R 10.2196/41555 %U https://www.researchprotocols.org/2023/1/e41555 %U https://doi.org/10.2196/41555 %U http://www.ncbi.nlm.nih.gov/pubmed/36703491 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41870 %T The Development, Deployment, and Evaluation of the CLEFT-Q Computerized Adaptive Test: A Multimethods Approach Contributing to Personalized, Person-Centered Health Assessments in Plastic Surgery %A Harrison,Conrad %A Apon,Inge %A Ardouin,Kenny %A Sidey-Gibbons,Chris %A Klassen,Anne %A Cano,Stefan %A Wong Riff,Karen %A Pusic,Andrea %A Versnel,Sarah %A Koudstaal,Maarten %A Allori,Alexander C %A Rogers-Vizena,Carolyn %A Swan,Marc C %A Furniss,Dominic %A Rodrigues,Jeremy %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar Research Centre, Oxford, OX3 7LD, United Kingdom, 44 1865227374, conrad.harrison@medsci.ox.ac.uk %K cleft lip %K cleft palate %K patient-reported outcome measures %K outcome assessment %K CLEFT-Q %K computerized adaptive test %K CAT %D 2023 %7 27.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Routine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) may improve care in a range of surgical conditions. However, most available CATs are neither condition-specific nor coproduced with patients and lack clinically relevant score interpretation. Recently, a PROM called the CLEFT-Q has been developed for use in the treatment of cleft lip or palate (CL/P), but the assessment burden may be limiting its uptake into clinical practice. Objective: We aimed to develop a CAT for the CLEFT-Q, which could facilitate the uptake of the CLEFT-Q PROM internationally. We aimed to conduct this work with a novel patient-centered approach and make source code available as an open-source framework for CAT development in other surgical conditions. Methods: CATs were developed with the Rasch measurement theory, using full-length CLEFT-Q responses collected during the CLEFT-Q field test (this included 2434 patients across 12 countries). These algorithms were validated in Monte Carlo simulations involving full-length CLEFT-Q responses collected from 536 patients. In these simulations, the CAT algorithms approximated full-length CLEFT-Q scores iteratively, using progressively fewer items from the full-length PROM. Agreement between full-length CLEFT-Q score and CAT score at different assessment lengths was measured using the Pearson correlation coefficient, root-mean-square error (RMSE), and 95% limits of agreement. CAT settings, including the number of items to be included in the final assessments, were determined in a multistakeholder workshop that included patients and health care professionals. A user interface was developed for the platform, and it was prospectively piloted in the United Kingdom and the Netherlands. Interviews were conducted with 6 patients and 4 clinicians to explore end-user experience. Results: The length of all 8 CLEFT-Q scales in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set combined was reduced from 76 to 59 items, and at this length, CAT assessments reproduced full-length CLEFT-Q scores accurately (with correlations between full-length CLEFT-Q score and CAT score exceeding 0.97, and the RMSE ranging from 2 to 5 out of 100). Workshop stakeholders considered this the optimal balance between accuracy and assessment burden. The platform was perceived to improve clinical communication and facilitate shared decision-making. Conclusions: Our platform is likely to facilitate routine CLEFT-Q uptake, and this may have a positive impact on clinical care. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs. %M 37104031 %R 10.2196/41870 %U https://www.jmir.org/2023/1/e41870 %U https://doi.org/10.2196/41870 %U http://www.ncbi.nlm.nih.gov/pubmed/37104031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37599 %T Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review %A Sun,Peng %A Zhao,Yao %A Men,Jie %A Ma,Zhe-Ru %A Jiang,Hao-Zhuo %A Liu,Cheng-Yan %A Feng,Wei %+ Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, 1 Xinmin Street, Chang chun, 130000, China, 86 0431 81875596, feng_wei@jlu.edu.cn %K virtual reality %K augmented reality %K hip %K pelvis %K arthroplasty %K mobile phone %D 2023 %7 10.3.2023 %9 Review %J J Med Internet Res %G English %X Background: Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery–related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation. Objective: With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery. Methods: We searched the PubMed and Web of Science databases using the following key search terms: (“virtual reality” OR “augmented reality”) AND (“pelvis” OR “hip”). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected. Results: A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale. Conclusions: VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness. %M 36651587 %R 10.2196/37599 %U https://www.jmir.org/2023/1/e37599 %U https://doi.org/10.2196/37599 %U http://www.ncbi.nlm.nih.gov/pubmed/36651587 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e40541 %T Advantages of a Training Course for Surgical Planning in Virtual Reality for Oral and Maxillofacial Surgery: Crossover Study %A Ulbrich,Max %A Van den Bosch,Vincent %A Bönsch,Andrea %A Gruber,Lennart Johannes %A Ooms,Mark %A Melchior,Claire %A Motmaen,Ila %A Wilpert,Caroline %A Rashad,Ashkan %A Kuhlen,Torsten Wolfgang %A Hölzle,Frank %A Puladi,Behrus %+ Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 80 88231, bpuladi@ukaachen.de %K virtual surgical planning %K virtual reality %K Elucis %K 3D Slicer %K oral and maxillofacial surgery %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: As an integral part of computer-assisted surgery, virtual surgical planning (VSP) leads to significantly better surgery results, such as for oral and maxillofacial reconstruction with microvascular grafts of the fibula or iliac crest. It is performed on a 2D computer desktop screen (DS) based on preoperative medical imaging. However, in this environment, VSP is associated with shortcomings, such as a time-consuming planning process and the requirement of a learning process. Therefore, a virtual reality (VR)–based VSP application has great potential to reduce or even overcome these shortcomings due to the benefits of visuospatial vision, bimanual interaction, and full immersion. However, the efficacy of such a VR environment has not yet been investigated. Objective: This study aimed to demonstrate the possible advantages of a VR environment through a substep of VSP, specifically the segmentation of the fibula (calf bone) and os coxae (hip bone), by conducting a training course in both DS and VR environments and comparing the results. Methods: During the training course, 6 novices were taught how to use a software application in a DS environment (3D Slicer) and in a VR environment (Elucis) for the segmentation of the fibula and os coxae, and they were asked to carry out the maneuvers as accurately and quickly as possible. Overall, 13 fibula and 13 os coxae were segmented for each participant in both methods (VR and DS), resulting in 156 different models (78 fibula and 78 os coxae) per method (VR and DS) and 312 models in total. The individual learning processes in both environments were compared using objective criteria (time and segmentation performance) and self-reported questionnaires. The models resulting from the segmentation were compared mathematically (Hausdorff distance and Dice coefficient) and evaluated by 2 experienced radiologists in a blinded manner. Results: A much faster learning curve was observed for the VR environment than the DS environment (β=.86 vs β=.25). This nearly doubled the segmentation speed (cm3/min) by the end of training, leading to a shorter time (P<.001) to reach a qualitative result. However, there was no qualitative difference between the models for VR and DS (P=.99). The VR environment was perceived by participants as more intuitive and less exhausting, and was favored over the DS environment. Conclusions: The more rapid learning process and the ability to work faster in the VR environment could save time and reduce the VSP workload, providing certain advantages over the DS environment. %M 36656632 %R 10.2196/40541 %U https://games.jmir.org/2023/1/e40541 %U https://doi.org/10.2196/40541 %U http://www.ncbi.nlm.nih.gov/pubmed/36656632 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e39907 %T Definition and Classification of Postoperative Complications After Cardiac Surgery: Pilot Delphi Study %A Lapp,Linda %A Bouamrane,Matt-Mouley %A Roper,Marc %A Kavanagh,Kimberley %A Schraag,Stefan %+ Department of Computer and Information Sciences, University of Strathclyde, 26 Richmond St, Glasgow, G1 1XH, United Kingdom, 44 141 548, linda.lapp@strath.ac.uk %K Delphi study %K cardiac surgery %K postoperative complications %K morbidity %K postoperative %K cardiology %K postoperative %K surgery %K complications %K cardiac %K health services %K society %K pilot %K development %K system %K surgeons %K anesthetists %K clinical %K quality %K resources %K risk management %K communication %K research %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Postoperative complications following cardiac surgery are common and represent a serious burden to health services and society. However, there is a lack of consensus among experts on what events should be considered as a “complication” and how to assess their severity. Objective: This study aimed to consult domain experts to pilot the development of a definition and classification system for complications following cardiac surgery with the goal to allow the progression of standardized clinical processes and systems in cardiac surgery. Methods: We conducted a Delphi study, which is a well-established method to reach expert consensus on complex topics. We sent 2 rounds of surveys to domain experts, including cardiac surgeons and anesthetists, to define and classify postoperative complications following cardiac surgery. The responses to open-ended questions were analyzed using a thematic analysis framework. Results: In total, 71 and 37 experts’ opinions were included in the analysis in Round 1 and Round 2 of the study, respectively. Cardiac anesthetists and cardiac critical care specialists took part in the study. Cardiac surgeons did not participate. Experts agreed that a classification for postoperative complications for cardiac surgery is useful, and consensus was reached for the generic definition of a postoperative complication in cardiac surgery. Consensus was also reached on classification of complications according to the following 4 levels: “Mild,” “Moderate,” “Severe,” and “Death.” Consensus was also reached on definitions for “Mild” and “Severe” categories of complications. Conclusions: Domain experts agreed on the definition and classification of complications in cardiac surgery for “Mild” and “Severe” complications. The standardization of complication identification, recording, and reporting in cardiac surgery should help the development of quality benchmarks, clinical audit, care quality assessment, resource planning, risk management, communication, and research. %M 36222812 %R 10.2196/39907 %U https://periop.jmir.org/2022/1/e39907 %U https://doi.org/10.2196/39907 %U http://www.ncbi.nlm.nih.gov/pubmed/36222812 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e34501 %T Augmented Reality in Vascular and Endovascular Surgery: Scoping Review %A Eves,Joshua %A Sudarsanam,Abhilash %A Shalhoub,Joseph %A Amiras,Dimitri %+ Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Marys Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 7881389569, joshua.eves@nhs.net %K augmented reality %K surgery %K vascular %K endovascular %K head-mounted display %K mobile phone %D 2022 %7 23.9.2022 %9 Review %J JMIR Serious Games %G English %X Background: Technological advances have transformed vascular intervention in recent decades. In particular, improvements in imaging and data processing have allowed for the development of increasingly complex endovascular and hybrid interventions. Augmented reality (AR) is a subject of growing interest in surgery, with the potential to improve clinicians’ understanding of 3D anatomy and aid in the processing of real-time information. This study hopes to elucidate the potential impact of AR technology in the rapidly evolving fields of vascular and endovascular surgery. Objective: The aim of this review is to summarize the fundamental concepts of AR technologies and conduct a scoping review of the impact of AR and mixed reality in vascular and endovascular surgery. Methods: A systematic search of MEDLINE, Scopus, and Embase was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies written in English from inception until January 8, 2021, were included in the search. Combinations of the following keywords were used in the systematic search string: (“augmented reality” OR “hololens” OR “image overlay” OR “daqri” OR “magic leap” OR “immersive reality” OR “extended reality” OR “mixed reality” OR “head mounted display”) AND (“vascular surgery” OR “endovascular”). Studies were selected through a blinded process between 2 investigators (JE and AS) and assessed using data quality tools. Results: AR technologies have had a number of applications in vascular and endovascular surgery. Most studies (22/32, 69%) used 3D imaging of computed tomography angiogram–derived images of vascular anatomy to augment clinicians’ anatomical understanding during procedures. A wide range of AR technologies were used, with heads up fusion imaging and AR head-mounted displays being the most commonly applied clinically. AR applications included guiding open, robotic, and endovascular surgery while minimizing dissection, improving procedural times, and reducing radiation and contrast exposure. Conclusions: AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. These include reductions in patient risk and operating times as well as in contrast and radiation exposure for radiological interventions. Further technological advances are required to overcome current limitations, including processing capacity and vascular deformation by instrumentation. %M 36149736 %R 10.2196/34501 %U https://games.jmir.org/2022/3/e34501 %U https://doi.org/10.2196/34501 %U http://www.ncbi.nlm.nih.gov/pubmed/36149736 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e37544 %T Shared Learning Utilizing Digital Methods in Surgery to Enhance Transparency in Surgical Innovation: Protocol for a Scoping Review %A Hoffmann,Christin %A Kobetic,Matthew %A Alford,Natasha %A Blencowe,Natalie %A Ramirez,Jozel %A Macefield,Rhiannon %A Blazeby,Jane M %A Avery,Kerry N L %A Potter,Shelley %+ National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 01173313995, c.hoffmann@bristol.ac.uk %K innovation %K surgery %K surgical %K shared learning %K scoping review %K operative %K procedures %K digital %K training %K learning %K feedback %K digital method %K review %K review methodology %K surgeon %K education %K medical education %K eHealth %K digital health %K digital tool %D 2022 %7 8.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Surgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices are disseminated informally and in an unstandardized way (eg, through social media). This can lead to ineffective and inefficient knowledge sharing among surgeons, which can result in the harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through the development of novel, real-time methods, informed by a contemporary and comprehensive investigation of existing methods. Objective: The aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will (1) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (2) examine the impact of their application, and (3) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. Methods: This study will adhere to the recommended guidelines for conducting scoping reviews. A total of 6 different searches will be conducted within multiple sources (2 electronic databases, journals, social media, gray literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in the English language within the last 5 years. Wherever possible, a 2-stage study selection process will be followed whereby the eligibility of articles will be assessed through the title, abstract, and full-text screening independently by 2 reviewers. Inclusion criteria will be articles providing data on (1) fully qualified theater staff involved in performing invasive procedures, (2) one or more methods for shared learning (ie, digital means for training/education and feedback), and (3) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries, and principles of thematic analysis. Results: The study commenced in October 2021 and is planned to be completed in 2023. To date, systematic searches were applied to 2 electronic databases (MEDLINE and Web of Science) and returned a total of 10,093 records. The results of this scoping review will be published as open access in a peer-reviewed journal. Conclusions: This scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize the evaluation of early-phase surgical research and reduce harmful innovation. International Registered Report Identifier (IRRID): PRR1-10.2196/37544 %M 36074555 %R 10.2196/37544 %U https://www.researchprotocols.org/2022/9/e37544 %U https://doi.org/10.2196/37544 %U http://www.ncbi.nlm.nih.gov/pubmed/36074555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40445 %T A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study %A Mazur,Lukasz M %A Khasawneh,Amro %A Fenison,Christi %A Buchanan,Shawna %A Kratzke,Ian M %A Adapa,Karthik %A An,Selena J %A Butler,Logan %A Zebrowski,Ashlyn %A Chakravarthula,Praneeth %A Ra,Jin H %+ Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27713, United States, 1 9196169702, lmazur@med.unc.edu %K virtual reality training %K patient safety culture %K patient safety events %K sensemaking %K high reliability organizations %D 2022 %7 24.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. Objective: We aim to assess the effect of VR training on health care workers’ (HCWs’) understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. Methods: This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs’ understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. Results: Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. Conclusions: Our findings will help assess the effectiveness of VR training in improving HCWs’ understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties. %M 36001370 %R 10.2196/40445 %U https://www.researchprotocols.org/2022/8/e40445 %U https://doi.org/10.2196/40445 %U http://www.ncbi.nlm.nih.gov/pubmed/36001370 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e37942 %T Mesh-Tissue Integration of Platelet-Rich Plasma–Decellularized Amnion Scaffold–Polypropylene Mesh Sandwiches Implanted in the Vesicovaginal Spaces of Hypoestrogenic Rabbit Models: Protocol for a Randomized Controlled Trial %A Meutia,Alfa Putri %A Santoso,Budi Iman %A Hestiantoro,Andon %A Wuyung,Puspita Eka %A Prihartono,Joedo %A Boediono,Arief %A Djusad,Suskhan %A Fauzi,Amir %A Budinurdjaja,Pribakti %+ Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, l Salemba Raya No. 6, Kenari, Senen, Jakarta, 10430, Indonesia, 62 81398751983, a.meutia.urogyne@gmail.com %K pelvic organ prolapse %K vaginal mesh %K platelet-rich plasma %D 2022 %7 9.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mesh-augmented surgery with polypropylene meshes (PPMs) is often used in urogynecology and pelvic reconstructive surgery. However, the various complications that arise from its integration process have resulted in a decrease in the number of mesh-augmented surgeries performed worldwide. An approach to improving mesh-tissue integration is coating PPMs with anti-inflammatory and wound-healing molecules, such as platelet-rich plasma (PRP), which is a component of biotechnologies that are capable of accelerating wound healing. Estrogen is also known to have a beneficial effect on wound remodeling; therefore, a hypoestrogenic status may have negative implications for wound healing. The mechanism of how PRP plays a role in wound remodeling, especially among individuals in a hypoestrogenic state, has not been fully described until now. Objective: Our aim is to investigate the impact of applying PRP to PPMs in hypoestrogenic rabbit models. Methods: Our study will be a randomized controlled trial involving hypoestrogenic rabbit models. Samples were categorized into either the PRP group or the PPM group (1:1 ratio), with a minimum sample size of 16 in each arm, via simple random sampling. All samples were put into a hypoestrogenic state via bilateral oophorectomy. After confirming a decrease in estradiol level, the meshes were implanted in the vesicovaginal space. The samples were euthanized on the 14th, 28th, or 90th day of the surgery. The mesh-tissue integration process will be analyzed based on inflammatory parameters (inflammatory infiltrate, interleukin-17, and interleukin-1B expression); angiogenesis (CD31 expression); and collagen deposition, which will be assessed by using Masson trichrome staining. Results: Our study is in the protocol development stage. A preliminary study regarding its feasibility, including the feasibility of the preparation of hypoestrogenic rabbit models, mesh implantation in the rabbits’ vesicovaginal spaces, the PRP and amnion scaffold, started in February 2022. The results of our study are expected to be available by the end of 2022. Conclusions: Our randomized controlled trial is designed to provide high-quality evidence on the effect of applying a PRP-decellularized amnion scaffold to PPMs in the vesicovaginal spaces of hypoestrogenic rabbit models. International Registered Report Identifier (IRRID): PRR1-10.2196/37942 %M 35943784 %R 10.2196/37942 %U https://www.researchprotocols.org/2022/8/e37942 %U https://doi.org/10.2196/37942 %U http://www.ncbi.nlm.nih.gov/pubmed/35943784 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e35805 %T Influence of COVID-19 Protocols on the Efficiency of Trauma Theater: Retrospective Observational Study %A Mohammed,Faisal %A Mohaddis,Momin %A Cheruvu,Manikandar Srinivas %A Morris,Richard M %A Naim,Zahra %A Khan,Sarfraz %A Mushtaq,Muhammad Babar %A Chandran,Prakash %+ Warrington Hospital, Lovely Ln, Warrington, WA51QG, United Kingdom, 44 7849015979, gdfaisal@gmail.com %K operation theatre %K COVID-19 %K utilization %K efficiency %K pandemic %K health care %K trauma management %K infection control %K health care delivery %K trauma theater %D 2022 %7 12.7.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic has influenced health care delivery significantly. Numerous studies have highlighted that trauma theater efficiency has decreased during the COVID-19 pandemic; however, there is limited information as to exactly which stage of the patient theater journey is causing this decreased efficiency and whether efficiency can be improved. In the trauma theater of Warrington Hospital, United Kingdom, we have attempted to maintain trauma theater efficiency despite the requirement for increased infection control. Objective: The aim of this study was to evaluate the effects of additional COVID-19 infection control protocols on trauma theater efficiency in our center, considering the length of time taken for specific theater events, and to find out whether our interventions were successful in maintaining theater efficiency. Methods: We compared the efficiency of the trauma theater in a busy unit in December 2019 (pre–COVID-19) and December 2020 (with COVID-19 protocols in place). We collected time logs for different theater events for each patient in December of both years and compared the data. Results: There was no significant difference in the average number of cases performed per session between the COVID-19 and pre–COVID-19 time periods (P=.17). Theater start time was significantly earlier during the COVID-19 period (P<.001). There was no significant difference between the two periods in transport time, check-in time, preprocedure time, anesthetic time, and the time between cases (P>.05). A significant difference was observed in the check-out time between the two groups in the two time periods, with checking out taking longer during the COVID-19 period (P<.001). Conclusions: Our results show that our theater start times were earlier during the COVID-19 pandemic, and the overall theater efficiency was maintained despite the additional COVID-19 infection control protocols that were in place. These findings suggest that well-planned infection control protocols do not need to impede trauma theater efficiency in certain settings. %M 35704770 %R 10.2196/35805 %U https://www.i-jmr.org/2022/2/e35805 %U https://doi.org/10.2196/35805 %U http://www.ncbi.nlm.nih.gov/pubmed/35704770 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e31529 %T Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study %A Schwartz-Lasfargues,Christel %A Roux-Gendron,Camille %A Edomskis,Pim %A Marque,Isabelle %A Bayon,Yves %A Lange,Johan F %A Faucheron,Jean Luc %A Trilling,Bertrand %+ Public Health Department, CHU Grenoble Alpes, Pavillon Taillefer, Grenoble, 38700, France, 33 476767961, imarque1@chu-grenoble.fr %K user-centered design %K usability %K formative evaluation %K medical device %K innovation %K Internet of Things %K IoT %K colorectal surgery %K colorectal anastomotic leakage %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals’ daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development. Objective: The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices. Methods: UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months. Results: Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design. Conclusions: This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case. %M 35802406 %R 10.2196/31529 %U https://humanfactors.jmir.org/2022/3/e31529 %U https://doi.org/10.2196/31529 %U http://www.ncbi.nlm.nih.gov/pubmed/35802406 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36681 %T Should Expert Surgeon Guidance Be Given Remotely? Comment on “User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service” %A Soussi,Daniella %A Vedi,Chiara Jade %+ School of Medicine, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BX, United Kingdom, 44 02075895111, d.soussis@yahoo.gr %K telemedicine %K user experience %K satisfaction %K technology acceptance %K usability %K perioperative %K surgery %K consultation %K surgeons %K performance %K evaluation %K tele-guidance %K telehealth %K telemedicine implementation %K telementoring %K surgical consultation %K usefulness %D 2022 %7 29.6.2022 %9 Letter to the Editor %J JMIR Hum Factors %G English %X %M 35767326 %R 10.2196/36681 %U https://humanfactors.jmir.org/2022/2/e36681 %U https://doi.org/10.2196/36681 %U http://www.ncbi.nlm.nih.gov/pubmed/35767326 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e30656 %T Assessing Trauma Management in Urban and Rural Populations in Norway: A National Register-Based Research Protocol %A Nilsbakken,Inger Marie Waal %A Sollid,Stephen %A Wisborg,Torben %A Jeppesen,Elisabeth %+ Department of Research, Norwegian Air Ambulance Foundation, Postboks 414 Sentrum, Oslo, 0103, Norway, 47 48226224, inger.nilsbakken@norskluftambulanse.no %K trauma %K emergency medicine %K prehospital care %K trauma registries %K epidemiology %K quality of health care %D 2022 %7 17.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Time is considered an essential determinant in the initial care of trauma patients. In Norway, response time (ie, time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. The recent centralization of trauma services and closure of emergency hospitals have increased prehospital transport distances, predominantly for rural trauma patients. However, the impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described. Objective: The project will assess injured patients’ initial pathways through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at the national level, and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time. Methods: Three quantitative registry-based retrospective cohort studies are planned. The studies are based on data from the Norwegian Trauma Registry (NTR; studies 1, 2, and 3) and the local Emergency Medical Communications Center (study 2). All injured patients admitted to a Norwegian hospital and registered in the NTR in the period between January 1, 2015, and December 31, 2020, will be included in the analysis. Trauma registry data will be analyzed using descriptive and relevant statistical methods to compare prehospital time in rural and central areas, including regression analyses and adjusting for confounders. Results: The project received funding in fall 2020 and was approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40,000 trauma patients will be extracted during the first quarter of 2022, and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022. Conclusions: Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries. International Registered Report Identifier (IRRID): PRR1-10.2196/30656 %M 35713952 %R 10.2196/30656 %U https://www.researchprotocols.org/2022/6/e30656 %U https://doi.org/10.2196/30656 %U http://www.ncbi.nlm.nih.gov/pubmed/35713952 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e35044 %T Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study %A Mbwogge,Mathew %A Nkumbe,Henry Ebong %+ See Acknowledgments, Alumni Relations, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 7424409211, m.mbwoge@gmail.com %K ophthalmologic surgical procedures %K access to health care %K ophthalmology %K patient-centered care %K ethnography %K health knowledge %K attitudes %K practice %D 2022 %7 9.6.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Vision 2020: The Right to Sight, was one potential way to deal with the barriers surrounding cataract surgery and improve access to eye care. To this effect, the Magrabi International Council of Ophthalmology (ICO) Cameroon Eye Institute (MICEI) has performed more than 1000 sight-restoring cataract surgeries among patients referred from outreach camps. However, quite a good number of patients diagnosed with cataracts during community screening camps fail to present for surgery. This study sought to explore some of the challenges to accepting cataract surgery among community-diagnosed patients with cataract, patients operated for cataract, and community members. Objective: The study objective was 5-fold: (1) to assess the level of awareness about cataract and available treatment, (2) to explore barriers to cataract surgery uptake, (3) to assess people’s perception about the outcome of cataract surgery, (4) to understand people’s perception about free cataract surgery, and (5) to explore reasons for outright refusal of cataract surgery. Methods: This was a focused ethnographic study from December 2018 through February 2019 in 3 different communities of the Center Region of Cameroon, in which patients with cataract were diagnosed. The study sample was composed of patients operated for cataract, those diagnosed with cataract, key informants, and community members. Focus group discussions (FGDs), personalized in-depth interviews, and a short demographic questionnaire were used to collect data. Data were analyzed using a Microsoft Excel spreadsheet and Stata 14 (StataCorp). Data were presented using tabular and graphical methods. Results: A total of 29 subjects (19 men) with a mean age of 54.5 (SD 14.5) years took part in the study. The most prominent barriers to cataract surgery were found to be cost (25/29, 86%) and fear of surgery (17/29, 59%). It was also noted by 41% (12/29) of subjects that those who do not take up cataract surgery turn to traditional medicine. Other barriers included the lack of awareness of available treatment (6/29, 21%), no perceived need (5/29, 17%), cultural beliefs and superstition (4/29, 14%), and negligence (4/29, 14%). Conclusions: We found cost (25/29, 86%) and fear (17/29, 59%) to be the main barriers. Belief in traditional medicine and superstition were the main drivers of fear. The implementation of a tiered pricing system, counseling training for key informants, incentives for the referral of patients with cataract, mass media engagement, advocacy, training and active involvement of traditional doctors as key informants, acquisition of a 4×4 outreach van, and motorbikes for camp organizers were some of the recommendations based on our results. %M 27725695 %R 10.2196/35044 %U https://med.jmirx.org/2022/2/e35044 %U https://doi.org/10.2196/35044 %U http://www.ncbi.nlm.nih.gov/pubmed/27725695 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e29045 %T The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study %A Teo,Zhe Hao Timothy %A Huey,Cheong Wei Terence %A Low,Jee Keem %A Junnarkar,Sameer Padmakumar %A Shelat,Vishalkumar G %+ Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore, 65 98557225, timothy.teo@mohh.com.sg %K audit %K coronavirus %K COVID-19 %K pandemic %K surgery %K impact %K cancer %K liver, pancreas %K resource %K elective surgery %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: At the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice. Objective: The aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume. Methods: We performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265). Results: The elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01). Conclusions: The reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x %M 35486909 %R 10.2196/29045 %U https://periop.jmir.org/2022/1/e29045 %U https://doi.org/10.2196/29045 %U http://www.ncbi.nlm.nih.gov/pubmed/35486909 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37092 %T Using Artificial Intelligence to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY): Protocol for the Development of a Clinical Prediction Model %A Farrow,Luke %A Ashcroft,George Patrick %A Zhong,Mingjun %A Anderson,Lesley %+ Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom, 44 01224552908, luke.farrow@abdn.ac.uk %K orthopedics %K prediction modelling %K machine learning %K artificial intelligence %K imaging %K hip %K knee %K arthroplasty %K health care %K patient care %K arthritis %D 2022 %7 11.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hip and knee osteoarthritis is substantially prevalent worldwide, with large numbers of older adults undergoing joint replacement (arthroplasty) every year. A backlog of elective surgery due to the COVID-19 pandemic, and an aging population, has led to substantial issues with access to timely arthroplasty surgery. A potential method to improve the efficiency of arthroplasty services is by increasing the percentage of patients who are listed for surgery from primary care referrals. The use of artificial intelligence (AI) techniques, specifically machine learning, provides a potential unexplored solution to correctly and rapidly select suitable patients for arthroplasty surgery. Objective: This study has 2 objectives: (1) develop a cohort of patients with referrals by general practitioners regarding assessment of suitability for hip or knee replacement from National Health Service (NHS) Grampian data via the Grampian Data Safe Haven and (2) determine the demographic, clinical, and imaging characteristics that influence the selection of patients to undergo hip or knee arthroplasty, and develop a tested and validated patient-specific predictive model to guide arthroplasty referral pathways. Methods: The AI to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY) project will be delivered through 2 linked work packages conducted within the Grampian Data Safe Haven and Safe Haven Artificial Intelligence Platform. The data set will include a cohort of individuals aged ≥16 years with referrals for the consideration of elective primary hip or knee replacement from January 2015 to January 2022. Linked pseudo-anonymized NHS Grampian health care data will be acquired including patient demographics, medication records, laboratory data, theatre records, text from clinical letters, and radiological images and reports. Following the creation of the data set, machine learning techniques will be used to develop pattern classification and probabilistic prediction models based on radiological images. Supplemental demographic and clinical data will be used to improve the predictive capabilities of the models. The sample size is predicted to be approximately 2000 patients—a sufficient size for satisfactory assessment of the primary outcome. Cross-validation will be used for development, testing, and internal validation. Evaluation will be performed through standard techniques, such as the C statistic (area under curve) metric, calibration characteristics (Brier score), and a confusion matrix. Results: The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed. Conclusions: This project provides a first step toward delivering an automated solution for arthroplasty selection using routinely collected health care data. Following appropriate external validation and clinical testing, this project could substantially improve the proportion of referred patients that are selected to undergo surgery, with a subsequent reduction in waiting time for arthroplasty appointments. Trial Registration: ISRCTN Registry ISRCTN18398037; https://www.isrctn.com/ISRCTN18398037 International Registered Report Identifier (IRRID): PRR1-10.2196/37092 %M 35544289 %R 10.2196/37092 %U https://www.researchprotocols.org/2022/5/e37092 %U https://doi.org/10.2196/37092 %U http://www.ncbi.nlm.nih.gov/pubmed/35544289 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e29936 %T Virtual Prehabilitation in Patients With Cancer Undergoing Surgery During the COVID-19 Pandemic: Protocol for a Prospective Feasibility Study %A Lambert,Genevieve %A Drummond,Kenneth %A Tahasildar,Bhagya %A Carli,Francesco %+ Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal General Hospital, L10.105, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada, 1 514 934 1934 ext 43728, genevieve.lambert@mail.mcgill.ca %K prehabilitation %K telehealth %K functional capacity %K cancer care %K exercise %K malnutrition %K psychosocial support %D 2022 %7 6.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the beginning of the COVID-19 pandemic, preoperative care, also termed prehabilitation, has become increasingly relevant due to the decreasing functional and psychosocial health of patients with cancer, which is a result of the pandemic restrictions. Concurrently, access to telehealth has improved; telehealth comprises all remote care delivery facilitated by information technologies (ie, virtually). Objective: The aim of this protocol is to describe the rationale and methodology for a major trial investigating the feasibility and safety of multimodal virtual prehabilitation services (ie, teleprehabilitation). Methods: This single-arm feasibility trial aims to recruit 100 patients with cancer to receive teleprehabilitation throughout their preoperative period. The inclusion criteria are as follows: (1) 18 years of age or older, (2) scheduled for elective cancer surgery and referred by a surgeon, (3) medically cleared by the referring physician to engage in physical activity, and (4) have a good comprehension of the English or French language. Feasibility will be assessed by documenting recruitment, adherence, and retention rates, in addition to patients’ motives for not participating in the trial, low participation, or discontinuation. The secondary outcome of safety will be assessed by reporting program-related adverse events. Results: The Montreal General Hospital Foundation funded the project in August 2020. The protocol was then approved by the Research Ethics Board of the McGill University Health Centre in January 2021 (ID No. 2021-6730). The first patient was recruited in March 2021, and recruitment is expected to end in September 2022. As of March 2022, 36 patients have been recruited, including 24 who have completed their participation. No adverse events have been reported. Data collection is expected to conclude in November 2022. Data analysis will be performed, and the results will be published by the beginning of 2023. Conclusions: This trial will provide guidance on the use of telehealth in the administration of prehabilitation services. The trial will provide a large amount of information that will respond to gaps in the literature, as there are minimal reports on the use of telehealth rehabilitation and prehabilitation services among elderly populations and in acute contexts, such as the preoperative period. Trial Registration: ClinicalTrials.gov NCT0479956; https://clinicaltrials.gov/ct2/show/NCT04799561 International Registered Report Identifier (IRRID): DERR1-10.2196/29936 %M 35522464 %R 10.2196/29936 %U https://www.researchprotocols.org/2022/5/e29936 %U https://doi.org/10.2196/29936 %U http://www.ncbi.nlm.nih.gov/pubmed/35522464 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e37030 %T From the Cochrane Library: Hydrosurgical Debridement Versus Conventional Surgical Debridement for Acute Partial-Thickness Burns %A Kokoska,Ryan E %A Szeto,Mindy D %A Sivesind,Torunn E %A Dellavalle,Robert P %A Wormald,Justin C R %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court, 3rd Floor, Mailstop F703, Aurora, CO, 80045, United States, 1 7208480500, mindy.d.szeto@gmail.com %K Cochrane %K systematic review %K randomized controlled trial %K hydrosurgery %K hydrosurgical debridement %K debridement %K burns %K wound healing %D 2022 %7 4.5.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632860 %R 10.2196/37030 %U https://derma.jmir.org/2022/2/e37030 %U https://doi.org/10.2196/37030 %U http://www.ncbi.nlm.nih.gov/pubmed/37632860 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31003 %T Buccal Mucosal Grafts as a Novel Treatment for the Repair of Rectovaginal Fistulas: Protocol for an Upcoming Prospective Single-Surgeon Case Series %A Cahill,Caitlin %A Kruger,Natalia %A Heine,John %+ Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada, 1 403 880 1775, natalia.kruger@ucalgary.ca %K surgical protocol %K colorectal surgery, rectovaginal fistulas %K fistula %K surgery %K gynecology %K grafts %K perioperative medicine %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Rectovaginal fistulas (RVFs) are abnormal communications between the rectum/anus and the vagina. They are most frequently formed a result of obstetric injury and have deleterious effects on patients’ quality of life. Despite several treatment modalities, RVFs remain difficult problems to manage, and many patients fail multiple attempts at surgical repair. Buccal mucosal grafts (BMGs) may be a solution to this problem. A BMG is an oral mucosal tissue harvested from the inner cheek. There are 2 case reports that describe the successful use of BMGs in the repair of RVFs. Objective: Our objective is to validate these findings with a prospective case series while also addressing the key issues of indication, technical details, procedure safety, and short-term outcomes. Methods: A prospective single-surgeon case series will be undertaken at a university-affiliated academic tertiary care hospital in Calgary, Alberta (Canada). The estimated recruitment is between 3 and 5 patients. Patients will undergo surgical repair of their RVFs with an autologous BMG. Data on patient characteristics, fistula characteristics, and surgical variables will be collected and analyzed prospectively. The primary outcome is fistula closure. This study has been approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB20-1123). Results: Two previous case reports have described the successful use of BMGs in the repair of RVFs. We have received ethics approval to attempt to validate these findings through a prospective case series. Conclusions: RVFs cause significant patient morbidity and are difficult problems to manage. Bolstered by the successful use of BMGs in urologic surgery and the previously published case reports demonstrating success in RVFs, we believe that BMGs may be a solution to RVFs. International Registered Report Identifier (IRRID): PRR1-10.2196/31003 %M 35486431 %R 10.2196/31003 %U https://www.researchprotocols.org/2022/4/e31003 %U https://doi.org/10.2196/31003 %U http://www.ncbi.nlm.nih.gov/pubmed/35486431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36753 %T Stigma Toward Bariatric Surgery in the Netherlands, France, and the United Kingdom: Protocol for a Cross-cultural Mixed Methods Study %A Garcia,Franshelis K %A Verkooijen,Kirsten T %A Veen,Esther J %A Mulder,Bob C %A Koelen,Maria A %A Hazebroek,Eric J %+ Health and Society, Department of Social Sciences, Wageningen University, Hollandseweg 1, Wageningen, 6706 KN, Netherlands, 31 (0) 317480292, franshelis.garcia@wur.nl %K bariatric surgery %K obesity surgery %K weight loss surgery %K stigma %K cross-cultural study %K France %K the Netherlands %K the United Kingdom %D 2022 %7 28.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bariatric surgery is an effective procedure for the treatment of obesity. Despite this, only 0.1% to 2% of eligible individuals undergo surgery worldwide. The stigma surrounding surgery might be a reason for this. Thus far, no research has systematically studied the nature and implications of bariatric surgery stigma. The limited studies on bariatric surgery stigma are often conducted from the perspective of the public or health care professions and either use small and nonrepresentative samples or fail to capture the full essence and implications of the stigma altogether, including attitudes toward patients and perpetrators of the stigma. In addition, studies from patients’ perspectives are limited and tend to address bariatric surgery stigma superficially or implicitly. Finally, the extent to which cultural factors shape and facilitate this stigma and the experiences of patients have not yet been researched. Objective: This study aimed to explore the perceptions, experiences, and consequences of bariatric surgery stigma from the perspective of the public, health care professionals, and patients before and after bariatric surgery. Furthermore, although the concept of stigma is universal, every society has specific cultural norms and values that define acceptable attributes and behaviors for its members. Therefore, this study also aimed to explore the extent to which cultural factors influence bariatric surgery stigma by comparing the Netherlands, France, and the United Kingdom. Methods: This paper describes the protocol for a multiphase mixed methods research design. In the first part, we will conduct a scoping review to determine the current knowledge on bariatric surgery stigma and identify knowledge gaps. In the second part, semistructured interviews among patients before and after bariatric surgery will be conducted to explore their experiences and consequences of bariatric surgery stigma. In the third part, surveys will be conducted among both the public and health care professionals to determine the prevalence, nature, and impact of bariatric surgery stigma. Surveys and interviews will be conducted in the Netherlands, France, and the United Kingdom. Finally, data integration will be conducted at the interpretation and reporting levels. Results: The study began in September 2020 and will continue through September 2025. With the results of the review, we will create an overview of the current knowledge regarding bariatric surgery stigma from patients’ perspectives. Qualitative data will provide insights into patients’ experiences with bariatric surgery stigma. Quantitative data will provide information related to the prevalence and nature of bariatric surgery stigma from the perspective of the public and health care professionals. Both qualitative and quantitative data will be compared for each country. Conclusions: The findings from this study will lead to new insights that can be used to develop strategies to reduce bariatric surgery stigma and improve access, use, and outcomes of bariatric surgery. International Registered Report Identifier (IRRID): PRR1-10.2196/36753 %M 35482364 %R 10.2196/36753 %U https://www.researchprotocols.org/2022/4/e36753 %U https://doi.org/10.2196/36753 %U http://www.ncbi.nlm.nih.gov/pubmed/35482364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35243 %T Lymph Node Yield in Gastrointestinal Cancer Surgery With or Without Prior Neoadjuvant Therapy: Protocol for a Systematic Review and Meta-analysis %A Ronellenfitsch,Ulrich %A Mathis,Nika %A Friedrichs,Juliane %A Kleeff,Jörg %+ Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany, 49 3455572327, ulrich.ronellenfitsch@uk-halle.de %K lymph node yield %K lymph node harvest %K neoadjuvant therapy %K neoadjuvant chemotherapy %K neoadjuvant radiotherapy %K surgery %K resection %K gastrointestinal cancer %K chemotherapy %K cancer %D 2022 %7 28.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lymph node yield is the number of lymph nodes retrieved during oncological resection and histopathologically identified in the resection specimen. It is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas, as well as a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. Objective: This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the lymph node yield, an oncological surrogate marker, in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant therapy compared to those undergoing surgery without neoadjuvant therapy. Methods: Randomized and nonrandomized studies comparing oncological resection of esophageal, stomach, pancreatic, and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in 2 electronic databases: PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include the number of harvested metastatic lymph nodes, operation time, postoperative complications, pathological TNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy, as well as in defined subgroups (neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy; and patients with esophageal, gastric, pancreatic, or rectal cancer), will be compared. Results: The literature search and data collection started in October 2021. Results are expected to be published in mid-2022. Conclusions: This meta-analysis will provide the most up-to-date and complete summary of the evidence on an association between neoadjuvant therapy and lymph node yield in gastrointestinal cancer surgery. The underlying hypothesis is that neoadjuvant therapy decreases the number and size of lymph nodes through lymphocyte depletion and radiation-induced fibrosis, thus leading to a lower possible lymph node yield. The findings of the meta-analysis will show if this hypothesis is supported by evidence. Trial Registration: PROSPERO CRD218459; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021218459 International Registered Report Identifier (IRRID): DERR1-10.2196/35243 %M 35482374 %R 10.2196/35243 %U https://www.researchprotocols.org/2022/4/e35243 %U https://doi.org/10.2196/35243 %U http://www.ncbi.nlm.nih.gov/pubmed/35482374 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e34781 %T Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study %A Puladi,Behrus %A Ooms,Mark %A Bellgardt,Martin %A Cesov,Mark %A Lipprandt,Myriam %A Raith,Stefan %A Peters,Florian %A Möhlhenrich,Stephan Christian %A Prescher,Andreas %A Hölzle,Frank %A Kuhlen,Torsten Wolfgang %A Modabber,Ali %+ Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 80 88231, bpuladi@ukaachen.de %K digital health in surgery %K surgical technique %K surgical training %K computer-assisted surgery %K optical see-through head-mounted display %K HoloLens %K surgical navigation %K medical regulation %K open-source %K AR %K augmented reality %K surgery %K surgeon %K cadaver %K serious game %K head-mounted display %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although nearly one-third of the world’s disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective: The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods: We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results: The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions: The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD–guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD–guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies. %M 35468090 %R 10.2196/34781 %U https://games.jmir.org/2022/2/e34781 %U https://doi.org/10.2196/34781 %U http://www.ncbi.nlm.nih.gov/pubmed/35468090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e28338 %T Frailty Factors and Outcomes in Patients Undergoing Orthopedic Surgery: Protocol for a Systematic Review and Meta-analysis %A Wang,Duanyang %A Yin,Pengbin %A Li,Yi %A Chen,Ming %A Cui,Xiang %A Cheng,Shi %A Lin,Yuan %A Yan,Jinglong %A Zhang,Licheng %A Tang,Peifu %+ Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150001, China, 86 0451 86296061, yjl_g6@aliyun.com %K frailty %K orthopedic surgery %K systemic review %K meta-analysis %K older adults %K elderly %K surgery %K orthopedics %D 2022 %7 15.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Frailty is an aggregate expression of susceptibility to adverse health outcomes because of age- and disease-related deficits that accumulate across multiple domains. Previous studies have found the presence of preoperative frailty is associated with an increased risk of adverse outcomes. The number of older adults undergoing orthopedic surgery is rapidly increasing. However, there has been no evidence-based study on the relationship between frailty and outcomes in patients undergoing orthopedic surgery. Objective: The aims of this study are to investigate the association between frailty and outcomes in patients who underwent orthopedic surgery as well as patient factors associated with frailty. Methods: The methods to be used for this systematic review are reported according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) 2015 checklist. An extensive search will be conducted in PubMed, Embase, the Cochrane Library, and other mainstream databases. Any study where patients undergoing orthopedic surgery were assessed using a defined or validated measure of frailty and the association of frailty with patient factors and/or outcomes was reported will be included. A total of 2 researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. We will perform a narrative synthesis of the factors associated with frailty, prevalence of frailty, effect of frailty on patient outcomes, and interventions for patients who are frail. A meta-analysis focusing on individual factors associated with frailty and the effect of frailty on patient outcomes will be performed, if applicable. The risk of bias will be evaluated. A subgroup analysis and sensitivity analysis will be performed. Results: Literature searches were conducted in September 2021 and the review is anticipated to be completed by the end of July 2022. Conclusions: This systematic review and meta-analysis will provide an overview of frailty and investigate the relationship between frailty and patient outcomes as well as the relationship between patient factors and frailty in patients undergoing orthopedic surgery. This study could potentially increase patients’ awareness of the outcomes associated with frailty, compel clinical specialties to further acknowledge the concept of frailty, and enhance the development of assessment instruments and tools for frailty. Trial Registration: PROSPERO CRD42020181846; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181846 International Registered Report Identifier (IRRID): DERR1-10.2196/28338 %M 35436222 %R 10.2196/28338 %U https://www.researchprotocols.org/2022/4/e28338 %U https://doi.org/10.2196/28338 %U http://www.ncbi.nlm.nih.gov/pubmed/35436222 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e34661 %T The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review %A Payne,Thomas %A Kevric,Jasmina %A Stelmach,Wanda %A To,Henry %+ Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Melbourne, 3010, Australia, 61 03 9035 5511, henry.to.surgeon@gmail.com %K telemedicine %K telehealth %K electronic consultation %K electronic referral %K surgery %K outpatient %K consultation %K usage %K review %K referral %K advice %K communication %K framework %K efficacy %K safety %K limit %D 2022 %7 14.4.2022 %9 Review %J JMIR Perioper Med %G English %X Background: Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective: We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods: We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results: A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions: The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research. %M 35436223 %R 10.2196/34661 %U https://periop.jmir.org/2022/1/e34661 %U https://doi.org/10.2196/34661 %U http://www.ncbi.nlm.nih.gov/pubmed/35436223 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31019 %T Left Ventricular Outflow Tract Obstruction in Patients Treated With Milrinone for Cerebral Vasospasm: Case Report and Literature Review %A Baulier,Charles %A Lessert,Marc %A Chauvet,Jean-Louis %A Garel,Pauline %A Bergis,Alexandre %A Burdeau,Julie %A Clavier,Thomas %+ Anesthesia and Intensive Care Department, Rouen University Hospital, 1 rue de Germont, Rouen, 76000, France, 33 668527500, charles.baulier@gmail.com %K ventricular outflow obstruction %K subarachnoid hemorrhage %K vasospasm %K intracranial %K milrinone %K hemorrhage %K neurosurgery %K neurology %K surgery %K pharmaceutical %D 2022 %7 11.4.2022 %9 Case Report %J JMIRx Med %G English %X Subarachnoid hemorrhage is associated with high morbidity and mortality, and cerebral arterial vasospasm is one of its main complications that determines neurological prognosis. The use of intravenous milrinone is becoming more common in the treatment of vasospasm. This molecule has positive inotropic and vasodilating properties by inhibiting phosphodiesterase-3. Its most described side effects are cardiac arrhythmias and arterial hypotension. In this paper, we raise a new issue concerning milrinone and discuss an undescribed side effect of this treatment, left ventricular outflow tract obstruction (LVOTO). Dynamic LVOTO is a clinical situation favored by hypovolemia, decreased left ventricular afterload, and excessive inotropism that can lead to severe hemodynamic failure and pulmonary edema. To our knowledge, this is the first study describing milrinone-induced LVOTO. This could compromise cerebral perfusion and therefore the neurological prognosis of patients. While it is known that catecholamines may induce LVOTO, milrinone-induced LVOTO appears to be a new pathophysiological entity of which neurosurgical intensivists should be aware. %M 37463041 %R 10.2196/31019 %U https://med.jmirx.org/2022/2/e31019 %U https://doi.org/10.2196/31019 %U http://www.ncbi.nlm.nih.gov/pubmed/37463041 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e34096 %T Pilot Project for a Web-Based Dynamic Nomogram to Predict Survival 1 Year After Hip Fracture Surgery: Retrospective Observational Study %A McLeod,Graeme %A Kennedy,Iain %A Simpson,Eilidh %A Joss,Judith %A Goldmann,Katriona %+ Department of Anaesthesia, Ninewells Hospital, National Health Service Tayside, James Arnott Drive, Dundee, DD1 9SY, United Kingdom, 44 1382 632175, g.a.mcleod@dundee.ac.uk %K hip fracture %K survival %K prediction %K nomogram %K web %K surgery %K postoperative %K machine learning %K model %K survival %K mortality %K hip %K fracture %D 2022 %7 30.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Hip fracture is associated with high mortality. Identification of individual risk informs anesthetic and surgical decision-making and can reduce the risk of death. However, interpreting mathematical models and applying them in clinical practice can be difficult. There is a need to simplify risk indices for clinicians and laypeople alike. Objective: Our primary objective was to develop a web-based nomogram for prediction of survival up to 365 days after hip fracture surgery. Methods: We collected data from 329 patients. Our variables included sex; age; BMI; white cell count; levels of lactate, creatinine, hemoglobin, and C-reactive protein; physical status according to the American Society of Anesthesiologists Physical Status Classification System; socioeconomic status; duration of surgery; total time in the operating room; side of surgery; and procedure urgency. Thereafter, we internally calibrated and validated a Cox proportional hazards model of survival 365 days after hip fracture surgery; logistic regression models of survival 30, 120, and 365 days after surgery; and a binomial model. To present the models on a laptop, tablet, or mobile phone in a user-friendly way, we built an app using Shiny (RStudio). The app showed a drop-down box for model selection and horizontal sliders for data entry, model summaries, and prediction and survival plots. A slider represented patient follow-up over 365 days. Results: Of the 329 patients, 24 (7.3%) died within 30 days of surgery, 65 (19.8%) within 120 days, and 94 (28.6%) within 365 days. In all models, the independent predictors of mortality were age, BMI, creatinine level, and lactate level. The logistic model also incorporated white cell count as a predictor. The Cox proportional hazards model showed that mortality differed as follows: age 80 vs 60 years had a hazard ratio (HR) of 0.6 (95% CI 0.3-1.1), a plasma lactate level of 2 vs 1 mmol/L had an HR of 2.4 (95% CI 1.5-3.9), and a plasma creatinine level of 60 vs 90 mol/L had an HR of 2.3 (95% CI 1.3-3.9). Conclusions: In conclusion, we provide an easy-to-read web-based nomogram that predicts survival up to 365 days after hip fracture. The Cox proportional hazards model and logistic models showed good discrimination, with concordance index values of 0.732 and 0.781, respectively. %M 35238320 %R 10.2196/34096 %U https://www.i-jmr.org/2022/1/e34096 %U https://doi.org/10.2196/34096 %U http://www.ncbi.nlm.nih.gov/pubmed/35238320 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29513 %T Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis %A Paralkar,Tapasvini Anmol %A Lay,Phoebe %A Stubbs,Sawyer %A Ahmed,Syed Hadi %A Ghani,Minha %A Osier,Nico %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 (512) 471 7913, nicoosier@utexas.edu %K COVID-19 %K coronavirus %K pandemic %K clinical recruitment %K traumatic brain injury %K children %K participant-focused %K recruitment %K enrollment %K digital screening %K brain %K EHR %K electronic health record %K database %D 2022 %7 23.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team’s internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED’s electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act–compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1%) than in 2019 (195/908, 21.4%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5%) than in 2019 (103/195, 52.8%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5%) in 2020 than in 2019 (11/103, 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. %M 35225820 %R 10.2196/29513 %U https://www.i-jmr.org/2022/1/e29513 %U https://doi.org/10.2196/29513 %U http://www.ncbi.nlm.nih.gov/pubmed/35225820 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35584 %T A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19–Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends—Extra Lists (ORRACLE-Xtra) Implementation Study %A Matava,Clyde %A So,Jeannette %A Williams,RJ %A Kelley,Simon %A , %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, 1 4168137445, clyde.matava@sickkids.ca %K waiting lists %K quality improvement %K patient satisfaction %K COVID-19 %K ambulatory surgery %K pandemics %K Canada %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends—Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5%), with 38.1% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% (110/121), with 79% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. %M 34887242 %R 10.2196/35584 %U https://periop.jmir.org/2022/1/e35584 %U https://doi.org/10.2196/35584 %U http://www.ncbi.nlm.nih.gov/pubmed/34887242 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30456 %T Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study %A Sadeghi,Amir H %A Peek,Jette J %A Max,Samuel A %A Smit,Liselot L %A Martina,Bryan G %A Rosalia,Rodney A %A Bakhuis,Wouter %A Bogers,Ad JJC %A Mahtab,Edris AF %+ Department of Cardiothoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 10 704 0704, h.sadeghi@erasmusmc.nl %K cardiac surgery %K cardiopulmonary resuscitation %K emergency resternotomy %K virtual reality %K simulation training %K serious games %K virtual reality simulation %K digital health %K medical training %K virtual training %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective: We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods: Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator’s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results: Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post–cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions: We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform. %M 35234652 %R 10.2196/30456 %U https://games.jmir.org/2022/1/e30456 %U https://doi.org/10.2196/30456 %U http://www.ncbi.nlm.nih.gov/pubmed/35234652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30351 %T Examining Diurnal Differences in Multidisciplinary Care Teams at a Pediatric Trauma Center Using Electronic Health Record Data: Social Network Analysis %A Durojaiye,Ashimiyu %A Fackler,James %A McGeorge,Nicolette %A Webster,Kristen %A Kharrazi,Hadi %A Gurses,Ayse %+ Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, 750 E. Pratt St. 15th Floor, Baltimore, MD, 21202, United States, 1 410 637 4387, agurses1@jhmi.edu %K pediatric trauma %K multidisciplinary health team %K multi-team systems %K social network analysis %K electronic health record %K process mining %K fluid teams %D 2022 %7 4.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on the time of day. Objective: This study aims to identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social network analysis on electronic health record (EHR) data. Methods: Metadata of clinical activities were extracted from the EHR and processed into an event log, which was divided into 6 different event logs based on shift (day or night) and location (emergency department, pediatric intensive care unit, and floor). Social networks were constructed from each event log by creating an edge among the functional roles captured within a similar time interval during a shift. Overlapping communities were identified from the social networks. Day and night network structures for each care location were compared and validated via comparison with secondary analysis of qualitatively derived care team data, obtained through semistructured interviews; and member-checking interviews with clinicians. Results: There were 413 encounters in the 1-year study period, with 65.9% (272/413) and 34.1% (141/413) beginning during day and night shifts, respectively. A single community was identified at all locations during the day and in the pediatric intensive care unit at night, whereas multiple communities corresponding to individual specialty services were identified in the emergency department and on the floor at night. Members of the trauma service belonged to all communities, suggesting that they were responsible for care coordination. Health care professionals found the networks to be largely accurate representations of the composition of the care teams and the interactions among them. Conclusions: Social network analysis was successfully used on EHR data to identify and describe diurnal differences in the composition and organization of multidisciplinary care teams at a pediatric trauma center. %M 35119372 %R 10.2196/30351 %U https://www.jmir.org/2022/2/e30351 %U https://doi.org/10.2196/30351 %U http://www.ncbi.nlm.nih.gov/pubmed/35119372 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e31082 %T The Effects of Intravenous Iron Infusion on Preoperative Hemoglobin Concentration in Iron Deficiency Anemia: Retrospective Observational Study %A Nicholls,Guy %A Mehta,Rajan %A McVeagh,Karen %A Egan,Matthew %+ Anaesthetics and Critical Care, Southend University Hospital, Prittlewell Chase, Southend on Sea, SS0 0RY, United Kingdom, 44 7379867037, Guy.a.nicholls91@gmail.com %K anemia %K perioperative medicine %K anesthetics %K preoperative %K perioperative %K surgery %K hemoglobin %K hemoglobin concentration %K iron deficiency %K intravenous %K blood %D 2022 %7 3.2.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: An iron infusion pathway using Ferrinject (ferric carboxymaltose) was implemented at Southend University Hospital for preoperative surgical patients with iron deficiency anemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting and colleagues according to the international consensus statement on perioperative management of anemia and the UK National Institute for Health and Care Excellence (NICE) guidelines. These guidelines state that intravenous iron is indicated when oral iron is poorly tolerated or ineffective, there is insufficient time to surgery, or due to a functional iron deficiency. Objective: The objective of this study was to evaluate the change in adult hemoglobin (Hb) concentration (g/L) after Ferrinject infusion at the time of surgery. Methods: Data were retrospectively collected on all surgical patients that received an iron infusion preoperatively for iron deficiency anemia from July 2019 to April 2020. Nonsurgical, obstetric, and pediatric patients, and those without a postinfusion Hb level measurement were excluded. Data collected included the Hb, ferritin, and transferrin levels pre and postinfusion; correct dose of intravenous iron received; and any adverse reactions noted. Results: Thirty-two surgical patients with iron deficiency anemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion Hb concentration across the cohort was 97 g/L and 114 g/L, respectively (18% increase; P=.001). Two (6%) patients had a posttransfusion Hb level ≥130 g/L prior to surgery after infusion. Nine patients had both a pre and postinfusion ferritin level recorded, which showed an increase from 12 ng/mL preinfusion to 94 ng/mL postinfusion (P=.02). Twenty-three (72%) patients did not receive the full dose of intravenous iron based on their Hb level and weight. Twenty-four (75%) patients received an iron infusion >2 weeks prior to surgery and the other 8 (25%) patients received the infusion <2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L, 95% CI 13-28) and 5% (5 g/L, 95% CI 1-10), respectively, across the two groups (P=.03). There were no documented adverse reactions to intravenous iron. Conclusions: Intravenous iron is an effective intervention to improve the Hb concentration in patients with iron deficiency anemia despite the majority of patients not receiving the full dose based on their baseline Hb level and weight. Increasing the interval time between infusion and surgery was associated with a greater increase in Hb, with only a minimal increase observed if given less than 2 weeks prior to surgery. %M 35113024 %R 10.2196/31082 %U https://www.i-jmr.org/2022/1/e31082 %U https://doi.org/10.2196/31082 %U http://www.ncbi.nlm.nih.gov/pubmed/35113024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19750 %T Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study %A Flippo,Brittany %A Stone,Bradley %A Stahr,Shelbie %A Khalil,Mahmoud %A Davis,Rodney %A Kamel,Mohamed %A Singh,Manisha %+ University of Arkansas for Medical Sciences, #501, 4301 West Markham st, Little Rock, AR, 72205, United States, 1 5012405804, msingh@uams.edu %K renal outcomes %K renal cell carcinoma %K minimally invasive vs open partial nephrectomy %K obesity %K kidney %K cancer %K surgery %K retrospective %K outcome %K short-term %K long-term %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective: This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods: We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results: A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). Conclusions: We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.  %M 35006078 %R 10.2196/19750 %U https://formative.jmir.org/2022/1/e19750 %U https://doi.org/10.2196/19750 %U http://www.ncbi.nlm.nih.gov/pubmed/35006078 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30867 %T User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Groth,Kristina %A Arnelo,Urban %+ Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11 C, Huddinge, Stockholm, 14157, Sweden, 46 8 790 60 00, hedvigam@kth.se %K telemedicine %K user experience %K satisfaction %K technology acceptance %K usability %K perioperative %K surgery %K consultation %K surgeons %K performance %K evaluation %K teleguidance %K telehealth %K telemedicine implementation %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective: We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods: We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results: In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). Conclusions: Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. %M 34851302 %R 10.2196/30867 %U https://humanfactors.jmir.org/2021/4/e30867 %U https://doi.org/10.2196/30867 %U http://www.ncbi.nlm.nih.gov/pubmed/34851302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32170 %T Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis %A Roberts,Derek J %A Dreksler,Hannah %A Nagpal,Sudhir K %A Li,Allen %A Parsons Leigh,Jeanna %A Brandys,Timothy %A Jetty,Prasad %A Dubois,Luc %A Stelfox,Henry T %A McIsaac,Daniel I %+ Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Civic Campus, Room A-280, 1053 Carling Avenue, Ottawa, ON, K1Y4E9, Canada, 1 613 798 5555 ext 16268, Derek.Roberts01@gmail.com %K epidural anesthesia %K lower limb revascularization surgery %K neuraxial anesthesia %K peripheral artery disease %K spinal anesthesia %K vascular surgery %K anesthesia %K surgery %K limb %K nerves %K spine %K outcome %K protocol %K review %K artery %K cardiovascular %K hospital %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. Objective: The aim is to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. Methods: We will search electronic bibliographic databases (MEDLINE, EMBASE, the seven databases in Evidence-Based Medicine Reviews, medRxiv, bioRxiv, and Google Scholar), review papers identified during the search, and included article bibliographies. We will include randomized and nonrandomized studies comparing the use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate the risk of bias. The primary outcome will be short-term (in-hospital or 30-day) mortality. Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, renal, and limb events; delirium; deep vein thrombosis or pulmonary embolism; neuraxial or regional anesthesia–related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios (ORs) and standardized mean differences (SMDs) using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using the Begg and Egger tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to make an overall rating of the quality of evidence in our effect estimates. Results: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We executed the peer-reviewed search strategy on March 2, 2021. We completed the review of titles and abstracts on July 30, 2021, and plan to complete the review of full-text papers by September 30, 2021. We will complete full-text study data extraction and the risk-of-bias assessment by November 15, 2021, and conduct qualitative and then quantitative data synthesis and GRADE assessment of results by January 1, 2022, before drafting the manuscript. We anticipate that we will be able to submit the manuscript for peer review by the end of February 2022. Conclusions: This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. Trial Registration: Prospero CRD42021237060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=237060 International Registered Report Identifier (IRRID): PRR1-10.2196/32170 %M 34507273 %R 10.2196/32170 %U https://www.researchprotocols.org/2021/11/e32170 %U https://doi.org/10.2196/32170 %U http://www.ncbi.nlm.nih.gov/pubmed/34507273 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e27893 %T Health-Related Quality of Life of Lebanese Women With Breast Cancer: Protocol for a Prospective Cohort Study %A El Haidari,Rana %A Anota,Amelie %A Abou-Abbas,Linda %A Nerich,Virginie %+ INSERM (French Institut of Health and Medical Research), EFS BFC (Etablissement français du sang Bourgogne Franche-Comté), UMR1098 (Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique), University of Bourgogne Franche-Comté, RIGHT Interactio, 32 avenue de l'observatoire, Besancon, 25000, France, 33 71662058, ranahaidari14@hotmail.com %K breast cancer %K cohort %K health-related quality of life %K Lebanese women %K prospective %D 2021 %7 23.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the past few decades, Lebanon has witnessed a significant increase in the incidence rates of women diagnosed with breast cancer. This increase, which is associated with the advancements in treatment modalities, emphasizes the need to evaluate the health-related quality of life (HRQoL) of women with breast cancer and to compare its patterns before and after breast-conserving surgery (BCS). Objective: This study aims to describe changes in HRQoL according to body image pre- and post-BCS and just before initiation of adjuvant therapy in newly diagnosed patients with breast cancer in Lebanon. Methods: A prospective cohort study targeting Lebanese women newly diagnosed with breast cancer and who have an indication for BCS will be conducted in 2 health care facilities. Baseline characteristics and clinical data will be collected. The European Organization for Research and Treatment of Cancer Quality-of-Life cancer-specific and breast cancer–specific questionnaires will be used to assess HRQoL. The outcomes will be measured at baseline and 1 day after breast surgery. The primary outcome will be the body image dimensions of the Quality-of-Life breast cancer–specific questionnaire. Statistical analyses will include descriptive statistics, paired 2-tailed t test, and stepwise multiple regression. A total of 120 patients will be required. Results: A total of 120 patients were enrolled in the study. Future outcomes will be published in professional peer-reviewed health-related research journals. Conclusions: This study is strengthened by its follow-up nature, allowing us to draw conclusions about causality. The results of this study will identify the most affected components of HRQoL, as well as the factors that could play a role in improving HRQoL among women undergoing BCS. The findings of this study will help decision makers, physicians, and social workers to design a comprehensive program with multidisciplinary components for the management and care of patients with breast cancer in Lebanon. International Registered Report Identifier (IRRID): DERR1-10.2196/27893 %M 34817382 %R 10.2196/27893 %U https://www.researchprotocols.org/2021/11/e27893 %U https://doi.org/10.2196/27893 %U http://www.ncbi.nlm.nih.gov/pubmed/34817382 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e28032 %T Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study %A Doumouchtsis,Stergios K %A Nama,Vivek %A Falconi,Gabriele %A Rada,Maria Patricia %A Manonai,Jittima %A Iancu,George %A Haddad,Jorge Milhem %A Betschart,Cornelia %+ Department of Gynecology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland, 41 44 255 18 06, cornelia.betschart@usz.ch %K core outcome sets %K core outcome measures sets %K cosmetic gynecological surgery %K intervention %K labiaplasty %K vulva %K gynecology %K cosmetic surgery %K surgery %K framework %K outcome %K effective %K implementation %D 2021 %7 15.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions. Objective: This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions. Methods: An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes. Results: Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed. Conclusions: This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care. Trial Registration: Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh International Registered Report Identifier (IRRID): PRR1-10.2196/28032 %M 34779787 %R 10.2196/28032 %U https://www.researchprotocols.org/2021/11/e28032 %U https://doi.org/10.2196/28032 %U http://www.ncbi.nlm.nih.gov/pubmed/34779787 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e29390 %T Discussion of Weight Loss Surgery in Instagram Posts: Successive Sampling Study %A Meleo-Erwin,Zoe C %A Basch,Corey H %A Fera,Joseph %A Smith,Bonnie %+ Department of Public Health, William Paterson University of New Jersey, 300 Pompton Rd, University Hall, Suite 359 – Office 370, Wayne, NJ, 07470, United States, 1 9737202394, erwinz@wpunj.edu %K bariatric surgery %K social media %K Instagram %K health promotion %K post-operative medicine %K Instagram %K online health information %K information accuracy %K surgery %K information quality %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The majority of American adults search for health and illness information on the internet. However, the quality and accuracy of this information are notoriously variable. With the advent of social media, US individuals have increasingly shared their own health and illness experiences, including those related to bariatric surgery, on social media platforms. Previous research has found that peer-to-peer requesting and giving of advice related to bariatric surgery on social media is common, that such advice is often presented in stark terms, and that the advice may not reflect patient standards of care. These previous investigations have helped to map bariatric surgery content on Facebook and YouTube. Objective: This objective of this study was to document and compare weight loss surgery (WLS)–related content on Instagram in the months leading up to the COVID-19 pandemic and 1 year later. Methods: We analyzed a total of 300 Instagram posts (50 posts per week for 3 consecutive weeks in late February and early March in both 2020 and 2021) uploaded using the hashtag #wls. Descriptive statistics were reported, and independent 1-tailed chi-square tests were used to determine if a post’s publication year statistically affected its inclusion of a particular type of content. Results: Overall, advice giving and personal responsibility for outcomes were emphasized by WLS posters on Instagram. However, social support was less emphasized. The safety, challenges, and risks associated with WLS were rarely discussed. The majority of posts did not contain references to facts from reputable medical sources. Posts published in 2021 were more likely to mention stress/hardships of living with WLS (45/150, 30%, vs 29/150, 19.3%; P=.03); however, those published in 2020 more often identified the importance of ongoing support for WLS success (35/150, 23.3%, vs 16/150, 10.7%; P=.004). Conclusions: Given that bariatric patients have low rates of postoperative follow-up, yet post-operative care and yet support are associated with improved health and weight loss outcomes, and given that health content on the web is of mixed accuracy, bariatric professionals may wish to consider including an online support forum moderated by a professional as a routine part of postoperative care. Doing so may not only improve follow-up rates but may offer providers the opportunity to counter inaccuracies encountered on social media. %M 34723828 %R 10.2196/29390 %U https://periop.jmir.org/2021/2/e29390 %U https://doi.org/10.2196/29390 %U http://www.ncbi.nlm.nih.gov/pubmed/34723828 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e33241 %T Surgical Surprise: Cutaneous Metastasis Presenting for Mohs Micrographic Surgery Without a Prior Diagnostic Biopsy %A Dunaway,Spencer %A Aggarwal,Pushkar %A Shaughnessy,Cristin %A Neltner,Scott %+ University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, United States, 1 240 200 0896, aggarwpr@mail.uc.edu %K cutaneous metastasis %K Mohs surgery %K biopsy %K micrographic surgery %K dermatology %K dermatologist %K skin cancer %K melanoma %D 2021 %7 1.11.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632877 %R 10.2196/33241 %U https://derma.jmir.org/2021/2/e33241 %U https://doi.org/10.2196/33241 %U http://www.ncbi.nlm.nih.gov/pubmed/37632877 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e33158 %T An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study %A Chaudhari,Hanu %A Schneeweiss,Michelle %A Rebinsky,Reid %A Rullo,Enrico %A Eltorki,Mohamed %+ Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada, 1 416 985 4520, hanu.chaudhari@medportal.ca %K quality improvement %K pediatric %K nursing %K medical directive %K appendicitis %K emergency department flow %K nursing directive %D 2021 %7 20.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric appendicitis accounts for an estimated 7% to 10% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration. Objective: This study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment. Methods: This study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward. Results: There are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022. Conclusions: This study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies. International Registered Report Identifier (IRRID): RR1-10.2196/33158 %M 34668867 %R 10.2196/33158 %U https://www.researchprotocols.org/2021/10/e33158 %U https://doi.org/10.2196/33158 %U http://www.ncbi.nlm.nih.gov/pubmed/34668867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e26709 %T Diagnosis and Management of Traumatic Subarachnoid Hemorrhage: Protocol for a Scoping Review %A Griswold,Dylan P %A Fernandez,Laura %A Rubiano,A M %+ Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Av Cra 9 No 131 A - 02, Bogota, 018000, Colombia, 57 300 6154775, rubianoam@gmail.com %K diagnostic criteria %K management %K neurosurgery %K neurotrauma %K SAH %K scoping review %K TBI %K trauma %D 2021 %7 20.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, 69 million people suffer from traumatic brain injury (TBI) each year and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and an increase in morbidity and mortality, but there are a limited number of studies which evaluate recent trends in the diagnostic and management of SAH in the context of trauma. Objective: The objective of this scoping review was to understand the extent and type of evidence in relation to the diagnostic criteria and management of TSAH. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A 3-step search strategy (an initial limited search in PubMed and Scopus databases; a main search of EMBASE, Web of Science, EBSCO, MEDLINE; and manual searches of reference lists of included articles) will be utilized. The search will be limited to studies with human participants and published in English, Spanish, and French between 2005 and 2020. This review will consider studies of adolescent and adult patients with SAH secondary to trauma. Study selection will be performed by 2 authors (DG and LF) in a 2-phase process; if any disagreement arises, a third author (AR) will be consulted. Data to be extracted from each study will include population, intervention, comparator and outcome measures, and a summary of findings. Citation screening, full-text review, risk of bias assessment, and extraction of study characteristics and outcomes will be carried out using a web-based software platform that streamlines the production of scoping reviews. Results: Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at conferences that engage the most pertinent stakeholders. Conclusions: This scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide. International Registered Report Identifier (IRRID): PRR1-10.2196/26709 %M 34668871 %R 10.2196/26709 %U https://www.researchprotocols.org/2021/10/e26709 %U https://doi.org/10.2196/26709 %U http://www.ncbi.nlm.nih.gov/pubmed/34668871 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 10 %P e32771 %T Predictability of Mortality in Patients With Myocardial Injury After Noncardiac Surgery Based on Perioperative Factors via Machine Learning: Retrospective Study %A Shin,Seo Jeong %A Park,Jungchan %A Lee,Seung-Hwa %A Yang,Kwangmo %A Park,Rae Woong %+ Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 206, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 0312194471, veritas@ajou.ac.kr %K myocardial injury after noncardiac surgery %K high-sensitivity cardiac troponin %K machine learning %K extreme gradient boosting %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Myocardial injury after noncardiac surgery (MINS) is associated with increased postoperative mortality, but the relevant perioperative factors that contribute to the mortality of patients with MINS have not been fully evaluated. Objective: To establish a comprehensive body of knowledge relating to patients with MINS, we researched the best performing predictive model based on machine learning algorithms. Methods: Using clinical data from 7629 patients with MINS from the clinical data warehouse, we evaluated 8 machine learning algorithms for accuracy, precision, recall, F1 score, area under the receiver operating characteristic (AUROC) curve, and area under the precision-recall curve to investigate the best model for predicting mortality. Feature importance and Shapley Additive Explanations values were analyzed to explain the role of each clinical factor in patients with MINS. Results: Extreme gradient boosting outperformed the other models. The model showed an AUROC of 0.923 (95% CI 0.916-0.930). The AUROC of the model did not decrease in the test data set (0.894, 95% CI 0.86-0.922; P=.06). Antiplatelet drugs prescription, elevated C-reactive protein level, and beta blocker prescription were associated with reduced 30-day mortality. Conclusions: Predicting the mortality of patients with MINS was shown to be feasible using machine learning. By analyzing the impact of predictors, markers that should be cautiously monitored by clinicians may be identified. %M 34647900 %R 10.2196/32771 %U https://medinform.jmir.org/2021/10/e32771 %U https://doi.org/10.2196/32771 %U http://www.ncbi.nlm.nih.gov/pubmed/34647900 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e30473 %T Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study %A Chan,Kai Siang %A Wang,Bei %A Tan,Yen Pin %A Chow,Jaclyn Jie Ling %A Ong,Ee Ling %A Junnarkar,Sameer P %A Low,Jee Keem %A Huey,Cheong Wei Terence %A Shelat,Vishal G %+ Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577807, vishal_g_shelat@ttsh.com.sg %K enhanced recovery after surgery %K early mobilization %K liver resection %K pancreas surgery %K quality improvement project %K pancreaticoduodenectomy %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. Objective: We report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. Methods: We divided our study into 4 phases—phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post–CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post–CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. Results: A total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre–CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). Conclusions: This follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability. %M 34559668 %R 10.2196/30473 %U https://periop.jmir.org/2021/2/e30473 %U https://doi.org/10.2196/30473 %U http://www.ncbi.nlm.nih.gov/pubmed/34559668 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31212 %T Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis %A Rebelo,Artur %A Ukkat,Jörg %A Klose,Johannes %A Ronellenfitsch,Ulrich %A Kleeff,Jörg %+ Department of General, Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, Halle/Saale, 06120, Germany, 49 3455573045, artur.rebelo@uk-halle.de %K meta-analysis %K cholangiocarcinoma %K arterial resection %K surgery %K vascular resections %K cardiology %K outcomes %K mortality %K morbidity %K perioperative %K cancer %K tumor %K liver %K liver cancer %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective: The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. Methods: A systematic literature search in the databases PubMed/MEDLINE, Cochrane Library, and CINAHL, and the trial registries ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform will be carried out. Predefined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3-, and 5-year survival), complete/incomplete resection rates, histologic arterial invasion, and lymph node positivity (number of positive lymph nodes and lymph node ratio). Results: Database searches will commence in December 2020. The meta-analysis will be completed by December 2021. Conclusions: Our findings will enable us to present the current evidence on the feasibility, safety, and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. Our data will support health care professionals and patients in their clinical decision-making. Trial Registration: PROSPERO 223396; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223396 International Registered Report Identifier (IRRID): DERR1-10.2196/31212 %M 34609321 %R 10.2196/31212 %U https://www.researchprotocols.org/2021/10/e31212 %U https://doi.org/10.2196/31212 %U http://www.ncbi.nlm.nih.gov/pubmed/34609321 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28759 %T Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis %A Roberts,Derek J %A Nagpal,Sudhir K %A Stelfox,Henry T %A Brandys,Tim %A Corrales-Medina,Vicente %A Dubois,Luc %A McIsaac,Daniel I %+ Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Room A-280, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada, 1 613 798 5555 ext 16828, Derek.Roberts01@gmail.com %K lower limb revascularization surgery %K peripheral artery disease %K risk factors %K surgical site infection %K systematic review %D 2021 %7 16.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Surgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important. Objective: The aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease. Methods: We will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ≥18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ≤30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI. Results: The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022. Conclusions: This study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242557 International Registered Report Identifier (IRRID): PRR1-10.2196/28759 %M 34161251 %R 10.2196/28759 %U https://www.researchprotocols.org/2021/9/e28759 %U https://doi.org/10.2196/28759 %U http://www.ncbi.nlm.nih.gov/pubmed/34161251 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e16846 %T Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study %A Humphry,Nia Angharad %A Wilson,Thomas %A Cox,Michael Christian %A Carter,Ben %A Arkesteijn,Marco %A Reeves,Nicola Laura %A Brakenridge,Scott %A McCarthy,Kathryn %A Bunni,John %A Draper,John %A Hewitt,Jonathan %+ School of Medicine, Cardiff University, 9th Floor Neuadd Meirionydd, University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom, 44 7815913222, HumphryNA1@cardiff.ac.uk %K sarcopenia %K frailty %K nutritional status %K urine metabolomics %K surgery %K geriatric medicine %D 2021 %7 17.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/16846 %M 34402798 %R 10.2196/16846 %U https://www.researchprotocols.org/2021/8/e16846 %U https://doi.org/10.2196/16846 %U http://www.ncbi.nlm.nih.gov/pubmed/34402798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28671 %T Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL) %A Nathan,Arjun %A Fricker,Monty %A Patel,Sonam %A Georgi,Maria %A Hang,Man Kien %A Asif,Aqua %A Sinha,Amil %A Mullins,William %A Shea,Jessie %A Hanna,Nancy %A Lamb,Benjamin %A Kelly,John %A Sridhar,Ashwin %A Collins,Justin %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 7595189982, arjun.nathan.11@ucl.ac.uk %K digital education %K digital health %K education %K surgery %K surgical skills %K surgical training %K surgical %K suturing %K telemedicine %K virtual classroom %K virtual training %D 2021 %7 22.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility. Objective: We aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills. Methods: This is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots. Results: The primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (δ) will be defined using historical data. Conclusions: This study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098 International Registered Report Identifier (IRRID): PRR1-10.2196/28671 %M 34292162 %R 10.2196/28671 %U https://www.researchprotocols.org/2021/7/e28671 %U https://doi.org/10.2196/28671 %U http://www.ncbi.nlm.nih.gov/pubmed/34292162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26505 %T Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Arnelo,Urban %A Groth,Kristina %+ Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Teknikringen 42, Stockholm, 11428, Sweden, 46 734606075, hedvigam@kth.se %K telemedicine %K telementoring %K implementation context %K surgical guidance %K health technology %K usability %K work domain analysis %K cognitive work analysis %D 2021 %7 21.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative “discovery and modeling” approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment. %M 34152278 %R 10.2196/26505 %U https://formative.jmir.org/2021/6/e26505 %U https://doi.org/10.2196/26505 %U http://www.ncbi.nlm.nih.gov/pubmed/34152278 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 1 %P e24644 %T Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study %A Thompson,Daniel %+ Department of Vascular Surgery, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, 3065, Australia, 61 92312211, Daniel.thompson@svha.org.au %K app %K audit %K data collection %K data %K feasibility %K medical education %K mHealth %K surgery %K surgical audit %K surgical education %K utility %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Surgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields. Objective: This feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools. Methods: Using the iOS Shortcuts app, we created a shortcut “Operation Note,” which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data. Results: The shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (P<.001; 95% CI 61.6-77.7). Conclusions: This feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data. %M 33983132 %R 10.2196/24644 %U https://periop.jmir.org/2021/1/e24644 %U https://doi.org/10.2196/24644 %U http://www.ncbi.nlm.nih.gov/pubmed/33983132 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25207 %T Chest Computed Tomography for the Diagnosis of COVID-19 in Emergency Trauma Surgery Patients Who Require Urgent Care During the Pandemic: Protocol for an Umbrella Review %A Griswold,Dylan %A Gempeler,Andrés %A Rosseau,Gail %A Kaseje,Neema %A Johnson,Walter D %A Kolias,Angelos %A Hutchinson,Peter J %A Rubiano,Andres M %+ Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Av Cra 9 No 131 A - 02, Bogota, 110121, Colombia, 57 3006154775, rubianoam@gmail.com %K systematic review %K broad-evidence synthesis %K COVID-19 %K global health %K trauma surgery %K evidence-based practice %K chest CT %K rapid testing %K testing %K diagnosis %K scan %K computed tomography %K review %K antigen %K immune system %K health care worker %K surgery %K emergency %K protocol %D 2021 %7 6.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting. Objective: This paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients. Methods: We will conduct several searches in the L·OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence. Results: Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders. Conclusions: During the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=198267 International Registered Report Identifier (IRRID): PRR1-10.2196/25207 %M 33878019 %R 10.2196/25207 %U https://www.researchprotocols.org/2021/5/e25207 %U https://doi.org/10.2196/25207 %U http://www.ncbi.nlm.nih.gov/pubmed/33878019 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23784 %T Acceptance, Barriers, and Future Preferences of Mobile Health Among Patients Receiving Trauma and Orthopedic Surgical Care: Paper-Based Survey in a Prospective Multicenter Study %A Reinecke,Felix %A Dittrich,Florian %A Dudda,Marcel %A Stang,Andreas %A Polan,Christina %A Müller,Roman %A Beck,Paula %A Kauther,Max Daniel %+ Department of Orthopedics and Orthopedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Straße, Building 37-38, Homburg, 66421, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K trauma surgery %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown. Objective: The aim of this study was to define target groups, evaluate patient requirements, and the potential and pitfalls regarding medical apps specific for patients receiving orthopedic and trauma surgical care. Methods: A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression were performed. Results: A total of 1055 questionnaires were included in our statistical analysis. Approximately 89.57% (945/1055) of the patients in this study owned a smartphone. Smartphone ownership probability decreased with every decade of life and increased with higher levels of education. Medical information was obtained via mobile web access by 62.65% (661/1055) of the patients; this correlated with smartphone ownership in regard to age and educational level. Only 11.18% (118/1055) of the patients reported previous medical app usage, and 3.50% (37/1055) of the patients received an app recommendation from a physician. More than half (594/1055, 56.30%) of the patients were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines, and medical record archival. An improved treatment experience was reported through the suggested app features by 71.18% (751/1055) of the patients. Conclusions: Mobile devices are a widely used source of information for medical content, but only a minority of the population reported previous medical app usage. The main target group for medical apps among patients receiving orthopedic and trauma surgical care tends to be the younger population, which results in a danger of excluding fringe groups, especially the older adults. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps primarily focusing on an optimized patient education and flow of information seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group–oriented app developments, further evidence on the clinical application, feasibility, and acceptance of app usage are necessary in order to avoid patient endangerment and to limit socioeconomic costs. %M 33881401 %R 10.2196/23784 %U https://mhealth.jmir.org/2021/4/e23784 %U https://doi.org/10.2196/23784 %U http://www.ncbi.nlm.nih.gov/pubmed/33881401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e20986 %T Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study %A Marlin,Nadine %A Rivas,Carol %A Allotey,John %A Dodds,Julie %A Horne,Andrew %A Ball,Elizabeth %+ UCL Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, United Kingdom, 44 2076126923, c.rivas@ucl.ac.uk %K endometriosis %K algorithm %K laparoscopy %K pain %K therapeutic %D 2021 %7 5.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Endometriosis is a chronic inflammatory condition affecting 6%-10% of women of reproductive age and is defined by the presence of endometrial-like tissue outside the uterus (lesions), commonly affecting the pelvis and ovaries. It is associated with debilitating pelvic pain, infertility, and fatigue and often has devastating effects on the quality of life (QoL). Although it is as common as back pain, it is poorly understood, and treatment and diagnosis are often delayed, leading to unnecessary suffering. Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. Objective: This study aims to determine which women with confirmed endometriosis benefit from surgical improvement in pain and QoL and whether these women could be identified from clinical symptoms measured before laparoscopy. Methods: First, we will carry out a systematic search and review and, if appropriate, meta-analysis of observational cohort and case-control studies reporting one or more risk factors for endometriosis and postsurgical treatment success. We will search PubMed, Embase, and Cochrane databases from inception without language restrictions and supplement the reference lists by manual searches. Second, we will develop separate clinical prediction models for women with confirmed and suspected diagnoses of endometriosis. A total of three suitable databases have been identified for development and external validation (the MEDAL [ISRCTN13028601] and LUNA [ISRCTN41196151] studies, and the BSGE database), and access has been guaranteed. The models will be developed using a linear regression approach that links candidate factors to outcomes. Third, we will hold 2 stakeholder co-design workshops involving eight clinicians and eight women with endometriosis separately and then bring all 16 participants together. Participants will discuss the implementation, delivery, usefulness, and sustainability of the prediction models. Clinicians will also focus on the ease of use and access to clinical prediction tools. Results: This project was funded in March 2018 and approved by the Institutional Research Ethics Board in December 2019. At the time of writing, this study was in the data analysis phase, and the results are expected to be available in April 2021. Conclusions: This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. International Registered Report Identifier (IRRID): DERR1-10.2196/20986 %M 33818394 %R 10.2196/20986 %U https://www.researchprotocols.org/2021/4/e20986 %U https://doi.org/10.2196/20986 %U http://www.ncbi.nlm.nih.gov/pubmed/33818394 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15443 %T Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study %A Boet,Sylvain %A Etherington,Cole %A Lam,Sandy %A Lê,Maxime %A Proulx,Laurie %A Britton,Meghan %A Kenna,Julie %A Przybylak-Brouillard,Antoine %A Grimshaw,Jeremy %A Grantcharov,Teodor %A Singh,Sukhbir %+ Department of Anesthesiology and Pain Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, 1 613 798 5555 ext 78187, sboet@toh.ca %K patient safety %K implementation science %K quality improvement %K health personnel %K operating rooms %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective: We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods: Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results: During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions: This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients. %M 33724199 %R 10.2196/15443 %U https://www.jmir.org/2021/3/e15443 %U https://doi.org/10.2196/15443 %U http://www.ncbi.nlm.nih.gov/pubmed/33724199 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25941 %T Transition of Renal Patients Using AlloSure Into Community Kidney Care (TRACK): Protocol for Long-Term Allograft Surveillance in Renal Transplant Recipients %A Dale,Bethany L %A Bose,Subhasish %A Kuo,Sheng %A Burns,Alana %A Daou,Pierre %A Short,Jenna %A Miles,Jake %+ CareDx, 1 Tower Place, 9th Floor, Brisbane, CA, 94080, United States, 1 9293635937, jmiles@caredx.com %K donor-derived cell free DNA (dd-cfDNA) %K molecular inflammation %K molecular injury %K acute rejection %K allograft injury %K allograft surveillance %K renal transplant %K renal %K transplant %K injury %K graft rejection %K kidney %K kidney disease %K transplantation %D 2021 %7 15.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with end-stage kidney disease require complex and expensive medical management. Kidney transplantation remains the treatment of choice for end-stage kidney disease and is considered superior to all other modalities of renal replacement therapy or dialysis. However, access to kidney transplant is limited by critical supply and demand, making it extremely important to ensure longevity of transplanted kidneys. This is prevented through lifelong immunosuppression, with caution not to overly suppress the immune system, resulting in toxicity and harm. Transition of care to community nephrologists after initial kidney transplantation and monitoring at a transplant center is an important process to ensure delivery of effective and patient-centric care closer to home. Once transplanted, laborious surveillance of the immune system and monitoring for potential rejection and injury are undertaken through an armamentarium of screening modalities. Posttransplant surveillance for kidney function and injury remains key to follow-up care. While kidney function, quantified by estimated glomerular filtration rate and serum creatinine, and kidney injury, measured by proteinuria and hematuria, are standard biomarkers used to monitor injury and rejection posttransplant, they have recently been demonstrated to be inferior in performance to that of AlloSure (CareDx Inc, Brisbane, CA) circulating donor-derived, cell-free DNA (dd-cfDNA). Objective: The outcomes and methods of monitoring renal transplant recipients posttransplant have remained stagnant over the past 15 years. The aim of this study is to consider intensive surveillance using AlloSure dd-cfDNA in an actively managed protocol, assessing whether it increases long-term allograft survival in kidney transplant recipients compared with current standard clinical care in community nephrology. Methods: The study protocol will acquire data from a phase IV observational trial to assess a cohort of renal transplant patients managed using AlloSure dd-cfDNA and patient care managers versus 1000 propensity-matched historic controls using United Network for Organ Sharing U.S. Scientific Registry of Transplant Recipients data. Data will be managed in a centralized electronic data server. The primary outcome will be superior allograft survival, as a composite of return to dialysis, retransplant, death due to allograft failure, and death with a functional graft (infection, malignancy, and cardiovascular death). The secondary endpoints will assess improved kidney function through decline in estimated glomerular filtration rate and immune activity through development of donor-specific antibodies. Results: The total sample is anticipated to be 3500 (2500 patients managed with AlloSure dd-cfDNA and 1000 propensity-matched controls). Active enrollment began in November 2020. Conclusions: Based on a significant literature base, we believe implementing the surveillance of dd-cfDNA in the kidney transplant population will have a positive impact on graft survival. Through early identification of rejection and facilitating timely intervention, prolongation of allograft survival versus those not managed by dd-cfDNA surveillance protocol should be superior. International Registered Report Identifier (IRRID): PRR1-10.2196/25941 %M 33720033 %R 10.2196/25941 %U https://www.researchprotocols.org/2021/3/e25941 %U https://doi.org/10.2196/25941 %U http://www.ncbi.nlm.nih.gov/pubmed/33720033 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25581 %T The Impact of Enhanced Recovery After Surgery on Total Joint Arthroplasty: Protocol for a Systematic Review and Meta-analysis %A Rele,Siddharth %A Shadbolt,Cade %A Schilling,Chris %A Taylor,Nicholas F %A Dowsey,Michelle M %A Choong,Peter F M %+ Department of Surgery, St Vincent’s Hospital, University of Melbourne, Level 2, Clinical Sciences Building, 29 Reagent Street, Melbourne, 3065, Australia, 61 390355511, srele@student.unimelb.edu.au %K enhanced recovery after surgery %K total knee arthroplasty %K total hip arthroplasty %K systematic review %K meta-analysis %K postoperative outcomes %K economic evaluation %D 2021 %7 12.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of total joint arthroplasties (TJAs) being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients’ recovery of function. This effort has culminated in the formulation of enhanced recovery after surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for TJA. Objective: The objective of this study is to assess the utility of ERAS programs on patient, health service, and economic outcomes for primary, elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: A systematic search will be conducted in Medline (Ovid), EMCARE (Ovid), EMBASE (Ovid), Web of Science, CINAHL, National Health Service Economic Evaluations Database, and the Cochrane Library. Analytical, observational, and experimental designs will be included in this systematic review. Only studies including patients undergoing primary TKA and THA comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety, and economic evaluation will be extracted. Results: The search terms and primary database searches have been finalized. Findings will be reported in narrative and tabular form. Where appropriate, random effects meta-analyses will be conducted for each outcome, and heterogeneity quantified with Cochran Q test and I2 statistic. Measures of effect or mean differences will be reported with 95% confidence intervals. The results of this systematic review will be disseminated in a peer-reviewed journal. Conclusions: This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary THA and TKA. Trial Registration: Open Science Framework osf.io/y4bhs; https://osf.io/y4bhs International Registered Report Identifier (IRRID): PRR1-10.2196/25581 %M 33709944 %R 10.2196/25581 %U https://www.researchprotocols.org/2021/3/e25581 %U https://doi.org/10.2196/25581 %U http://www.ncbi.nlm.nih.gov/pubmed/33709944 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e17237 %T Addressing Disciplinary Misconceptions: Mentorship Programs and Student-Led Surgical Societies. Comment on “Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study” %A Poole,Grace Olivia Jane %A Melamed,Naomi %A Hubbard,Ella %+ St George's University of London, Cranmer Terrace, Tooting, London, SW170RE, United Kingdom, 44 7807831588, gracepoole06@icloud.com %K medical education %K plastic surgery %K students %D 2021 %7 4.3.2021 %9 Letter to the Editor %J Interact J Med Res %G English %X %M 33661131 %R 10.2196/17237 %U https://www.i-jmr.org/2021/1/e17237 %U https://doi.org/10.2196/17237 %U http://www.ncbi.nlm.nih.gov/pubmed/33661131 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26552 %T Investigating the Ethical and Data Governance Issues of Artificial Intelligence in Surgery: Protocol for a Delphi Study %A Lam,Kyle %A Iqbal,Fahad M %A Purkayastha,Sanjay %A Kinross,James M %+ Imperial College London, 10th Floor QEQM Building, Praed St, London, , United Kingdom, 44 796 490 4213, k.lam@imperial.ac.uk %K artificial intelligence %K digital surgery %K Delphi %K ethics %K data governance %K digital technology %K operating room %K surgery %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The rapid uptake of digital technology into the operating room has the potential to improve patient outcomes, increase efficiency of the use of operating rooms, and allow surgeons to progress quickly up learning curves. These technologies are, however, dependent on huge amounts of data, and the consequences of their mismanagement are significant. While the field of artificial intelligence ethics is able to provide a broad framework for those designing and implementing these technologies into the operating room, there is a need to determine and address the ethical and data governance challenges of using digital technology in this unique environment. Objective: The objectives of this study are to define the term digital surgery and gain expert consensus on the key ethical and data governance issues, barriers, and future research goals of the use of artificial intelligence in surgery. Methods: Experts from the fields of surgery, ethics and law, policy, artificial intelligence, and industry will be invited to participate in a 4-round consensus Delphi exercise. In the first round, participants will supply free-text responses across 4 key domains: ethics, data governance, barriers, and future research goals. They will also be asked to provide their understanding of the term digital surgery. In subsequent rounds, statements will be grouped, and participants will be asked to rate the importance of each issue on a 9-point Likert scale ranging from 1 (not at all important) to 9 (critically important). Consensus is defined a priori as a score of 7 to 9 by 70% of respondents and 1 to 3 by less than 30% of respondents. A final online meeting round will be held to discuss inclusion of statements and draft a consensus document. Results: Full ethical approval has been obtained for the study by the local research ethics committee at Imperial College, London (20IC6136). We anticipate round 1 to commence in January 2021. Conclusions: The results of this study will define the term digital surgery, identify the key issues and barriers, and shape future research in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/26552 %M 33616543 %R 10.2196/26552 %U https://www.researchprotocols.org/2021/2/e26552 %U https://doi.org/10.2196/26552 %U http://www.ncbi.nlm.nih.gov/pubmed/33616543 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21350 %T The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study %A Brescia,Alexander A %A Piazza,Julie R %A Jenkins,Jessica N %A Heering,Lindsay K %A Ivacko,Alexander J %A Piazza,James C %A Dwyer-White,Molly C %A Peters,Stefanie L %A Cepero,Jesus %A Brown,Bailey H %A Longi,Faraz N %A Monaghan,Katelyn P %A Bauer,Frederick W %A Kathawate,Varun G %A Jafri,Sara M %A Webster,Melissa C %A Kasperek,Amanda M %A Garvey,Nickole L %A Schwenzer,Claudia %A Wu,Xiaoting %A Lagisetty,Kiran H %A Osborne,Nicholas H %A Waljee,Jennifer F %A Riba,Michelle %A Likosky,Donald S %A Byrnes,Mary E %A Deeb,G Michael %+ Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Frankel Cardiovascular Center 5th Floor, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 734 232 5028, abrescia@med.umich.edu %K cardiac surgery %K patient experience %K nonpharmacological interventions %K child life specialists %K opioids %K anxiety %K stress %K depression %D 2021 %7 16.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. Objective: This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. Methods: To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. Results: This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. Conclusions: Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study’s findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial Registration: ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID): DERR1-10.2196/21350 %M 33591291 %R 10.2196/21350 %U https://www.researchprotocols.org/2021/2/e21350 %U https://doi.org/10.2196/21350 %U http://www.ncbi.nlm.nih.gov/pubmed/33591291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25284 %T Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design %A Alfred,Myrtede C %A Cohen,Tara N %A Cohen,Kate A %A Kanji,Falisha F %A Choi,Eunice %A Del Gaizo,John %A Nemeth,Lynne S %A Alekseyenko,Alexander V %A Shouhed,Daniel %A Savage,Stephen J %A Anger,Jennifer T %A Catchpole,Ken %+ Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, 167 Ashley Avenue, Suite 300 (MSC 912), Charleston, SC, 29425, United States, 1 8438761838, alfredm@musc.edu %K robotic surgical procedures %K patient safety %K ergonomics %K crossover design %D 2021 %7 9.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. Objective: This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals. Methods: The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention (including through direct observation of a sample of surgeries in each observational phase), operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis. Results: The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 (CSMC and MDRH: Pro00056245; VCMC: STUDY 270; MUSC: Pro00088741). After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites. Conclusions: This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/25284 %M 33560239 %R 10.2196/25284 %U https://www.researchprotocols.org/2021/2/e25284 %U https://doi.org/10.2196/25284 %U http://www.ncbi.nlm.nih.gov/pubmed/33560239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e18837 %T Comparison of Endoscopy First and Laparoscopic Cholecystectomy First Strategies for Patients With Gallstone Disease and Intermediate Risk of Choledocholithiasis: Protocol for a Clinical Randomized Controlled Trial %A Aleknaite,Ausra %A Simutis,Gintaras %A Stanaitis,Juozas %A Jucaitis,Tomas %A Drungilas,Mantas %A Valantinas,Jonas %A Strupas,Kestutis %+ Center of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Klinikos, Santariskiu 2, Vilnius, 08406, Lithuania, 370 61818076, ausra.aleknaite@santa.lt %K choledocholithiasis %K endoscopic ultrasound %K intraoperative cholangiography %K common bile duct stone %K endoscopic retrograde cholangiopancreatography %K laparoscopic cholecystectomy %D 2021 %7 4.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The optimal approach for patients with gallbladder stones and intermediate risk of choledocholithiasis remains undetermined. The use of endoscopic retrograde cholangiopancreatography for diagnosis should be minimized as it carries considerable risk of postprocedural complications, and nowadays, less invasive and safer techniques are available. Objective: This study compares the two management strategies of endoscopic ultrasound before laparoscopic cholecystectomy and intraoperative cholangiography for patients with symptomatic cholecystolithiasis and intermediate risk of choledocholithiasis. Methods: This is a randomized, active-controlled, single-center clinical trial enrolling adult patients undergoing laparoscopic cholecystectomy for symptomatic gallbladder stones with intermediate risk of choledocholithiasis. The risk of choledocholithiasis is calculated using an original prognostic score (the Vilnius University Hospital Index). This index in a retrospective evaluation showed better prognostic performance than the score proposed by the American Society for Gastrointestinal Endoscopy in 2010. A total of 106 participants will be included and randomized into two groups. Evaluation of bile ducts using endoscopic ultrasound and endoscopic retrograde cholangiography on demand will be performed before laparoscopic cholecystectomy for one arm (“endoscopy first”). Intraoperative cholangiography during laparoscopic cholecystectomy and postoperative endoscopic retrograde cholangiopancreatography on demand will be performed in another arm (“cholecystectomy first”). Postoperative follow-up is 6 months. The primary endpoint is the length of hospital stay. The secondary endpoints are accuracy of the different management strategies, adverse events of the interventions, duct clearance and technical success of the interventions (intraoperative cholangiography, endoscopic ultrasound, and endoscopic retrograde cholangiography), and cost of treatment. Results: The trial protocol was approved by the Vilnius Regional Biomedical Research Ethics Committee in December 2017. Enrollment of patients was started in January 2018. As of June 2020, 66 patients have been enrolled. Conclusions: This trial is planned to determine the superior strategy for patients with intermediate risk of common bile duct stones and to define a simple and safe algorithm for managing choledocholithiasis. Trial Registration: ClinicalTrials.gov NCT03658863; https://clinicaltrials.gov/ct2/show/NCT03658863. International Registered Report Identifier (IRRID): DERR1-10.2196/18837 %M 33538700 %R 10.2196/18837 %U https://www.researchprotocols.org/2021/2/e18837 %U https://doi.org/10.2196/18837 %U http://www.ncbi.nlm.nih.gov/pubmed/33538700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20692 %T Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Arnelo,Urban %A Frennert,Susanne %+ Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, Stockholm, 141 57 Huddinge, Sweden, 46 8 790 80 71, hedvigam@kth.se %K telemedicine %K telementoring %K teleconsulting %K technology acceptance model %K professional users %K specialties, surgical/education %K attitude %K clinical staff %K surgery %K framework %K surgeon %K user-centered %K interview %K survey %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective: Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation. Results: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05). Conclusions: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes. %M 33427670 %R 10.2196/20692 %U https://formative.jmir.org/2021/1/e20692 %U https://doi.org/10.2196/20692 %U http://www.ncbi.nlm.nih.gov/pubmed/33427670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22536 %T Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study %A Likosky,Donald %A Yule,Steven J %A Mathis,Michael R %A Dias,Roger D %A Corso,Jason J %A Zhang,Min %A Krein,Sarah L %A Caldwell,Matthew D %A Louis,Nathan %A Janda,Allison M %A Shah,Nirav J %A Pagani,Francis D %A Stakich-Alpirez,Korana %A Manojlovich,Milisa M %+ Department of Cardiac Surgery, University of Michigan, 5346 CVC, Ann Arbor, MI, 48109, United States, 1 7342324216, likosky@umich.edu %K cardiac surgery %K quality %K protocol %K study %K coronary artery bypass grafting surgery %K complications %K patient risk %K variation %K intraoperative %K improvement %D 2021 %7 8.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Objective: The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. Methods: This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. Results: The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. Conclusions: We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/22536 %M 33416505 %R 10.2196/22536 %U https://www.researchprotocols.org/2021/1/e22536 %U https://doi.org/10.2196/22536 %U http://www.ncbi.nlm.nih.gov/pubmed/33416505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17978 %T Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases %A Novak,Laurie Lovett %A Simpson,Christopher L %A Coco,Joseph %A McNaughton,Candace D %A Ehrenfeld,Jesse M %A Bloos,Sean M %A Fabbri,Daniel %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, TN, 37203, United States, 1 615 936 6497, laurie.l.novak@vumc.org %K trauma handoffs %K military field medicine %K documentation %K trauma %K health records %K hospital %K emergency %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Current methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. Objective: To identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. Methods: Using a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. Results: Comparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. Conclusions: An ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve. %M 32975522 %R 10.2196/17978 %U http://www.jmir.org/2020/9/e17978/ %U https://doi.org/10.2196/17978 %U http://www.ncbi.nlm.nih.gov/pubmed/32975522 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e14282 %T Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach %A Clausen,Jan-Dierk %A Nahen,Niclas %A Horstmann,Hauke %A Lasch,Florian %A Krutsch,Werner %A Krettek,Christian %A Weber-Spickschen,Thomas Sanjay %+ Trauma Department, Hannover Medical School, Carl-Neuberg Straße 1, Hannover, 30625, Germany, 49 17615329663, clausen.jan-dierk@mh-hannover.de %K serious gaming %K knee trainer %K games, experimental %K exercise therapy %K physical and rehabilitation medicine %K anterior cruciate ligament reconstruction %K knee injuries %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement. %M 32012046 %R 10.2196/14282 %U https://games.jmir.org/2020/1/e14282 %U https://doi.org/10.2196/14282 %U http://www.ncbi.nlm.nih.gov/pubmed/32012046 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14592 %T Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study %A Zhang,Zhaotian %A Li,Fei %A Zhang,Haochuan %A Miao,Zhipeng %A Wei,Yantao %A Wang,Li %A Zhang,Shaochong %+ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China, 86 2087330415, zhangshaochong@gzzoc.com %K intraocular pressure %K mobile phone %K vitrectomy %K air %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle’s law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods: The app was developed on the iOS and Android operating systems. Boyle’s law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale–based questionnaire with 2 main items to evaluate the participants’ user experience and attitudes toward the app. Results: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively (P=.63). The median altitude of the participants’ destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons’ and patients’ judgments (bias of −0.3%), with 95% limits of agreement of −5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication. %M 31244482 %R 10.2196/14592 %U http://mhealth.jmir.org/2019/6/e14592/ %U https://doi.org/10.2196/14592 %U http://www.ncbi.nlm.nih.gov/pubmed/31244482 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e14028 %T Orthopedic Surgeons’ Perspectives on the Decision-Making Process for the Use of Bioprinter Cartilage Grafts: Web-Based Survey %A Salvador Verges,Àngels %A Fernández-Luque,Luis %A López Seguí,Francesc %A Yildirim,Meltem %A Salvador-Mata,Bertran %A García Cuyàs,Francesc %+ Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, 11, Magi Casanovas, Barcelona, 08870, Spain, 34 630887995, angels.salvador@uvic.cat %K orthopedic surgeons %K online survey %K 3D bioprinting %K cartilage %K graft %D 2019 %7 15.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic and degenerative lesions in the cartilage are one of the most difficult and frustrating types of injuries for orthopedic surgeons and patients. Future developments in medical science, regenerative medicine, and materials science may allow the repair of human body parts using 3D bioprinting techniques and serve as a basis for new therapies for tissue and organ regeneration. One future possibility is the treatment of joint cartilage defects with in vivo 3D printing from biological/biocompatible materials to produce a suitable cell attachment and proliferation environment in the damaged site and employ the natural recovery potential of the body. This study focuses on the perspectives of orthopedic surgeons regarding the key factors/determinants and perceived clinical value of a new therapeutic option. Objective: This study aimed to determine the knowledge and expectations of orthopedic surgeons regarding the clinical use of bioprinted cartilage. Methods: The survey, conducted anonymously and self-managed, was sent to orthopedic surgeons from the Catalan Society of Orthopedic and Traumatology Surgery. In accordance with the method devised by Eysenbach, the Checklist for Reporting Results of Internet E-Surveys was used to analyze the results. The following factors were taken into consideration: the type and origin of the information received; its relevance; the level of acceptance of new technologies; and how the technology is related to age, years, and place of experience in the field. Results: Of the 86 orthopedic surgeons included, 36 believed the age of the patient was a restriction, 53 believed the size of the lesion should be between 1 and 2 cm to be considered for this type of technology, and 51 believed that the graft should last more than 5 years. Surgeons over 50 years of age (38/86, 44%) gave more importance to clinical evidence as compared to surgeons from the other age groups. Conclusions: The perspective of orthopedic surgeons depends highly on the information they receive and whether it is specialized and consistent, as this will condition their acceptance and implementation of the bioprinted cartilage. %M 31094326 %R 10.2196/14028 %U http://www.i-jmr.org/2019/2/e14028/ %U https://doi.org/10.2196/14028 %U http://www.ncbi.nlm.nih.gov/pubmed/31094326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11925 %T Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review %A Alvarez-Lopez,Fernando %A Maina,Marcelo Fabián %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Avinguda del Tibidabo 39-43, Barcelona, 08035, Spain, 34 933263622, fsaigi@uoc.edu %K minimally invasive surgery %K user-computer interface %K operating room %K education, medical %K computer-assisted surgery %D 2019 %7 03.05.2019 %9 Review %J J Med Internet Res %G English %X Background: The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture–based human-computer interaction is currently being explored as a solution in surgical environments. Objective: The aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS). Methods: For this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected. Results: A total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms. Conclusions: COTS devices applied to hand and instrument gesture–based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up. %M 31066679 %R 10.2196/11925 %U https://www.jmir.org/2019/5/e11925/ %U https://doi.org/10.2196/11925 %U http://www.ncbi.nlm.nih.gov/pubmed/31066679 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12999 %T Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study %A Mortada,Hatan Hisham %A Alqahtani,Yara Aayed %A Seraj,Hadeel Zakaria %A Albishi,Wahbi Khalid %A Aljaaly,Hattan A %+ Division of Plastic & Reconstructive Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Al Sulaymaniyah, Jeddah,, Saudi Arabia, 966 55 552 0175, hattanaljaaly@gmail.com %K plastic surgery %K perception %K knowledge %K medical students %K media %K King Abdulaziz University %K Jeddah %K Saudi Arabia %D 2019 %7 03.04.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Although plastic surgery has been gaining a lot of popularity recently, there seems to be limited perception and a poor understanding of this field by both medical professionals, including medical students, and the general public. This might alter referral patterns as well as medical students’ choice to pursue a career in plastic surgery. Objective: The purpose of this study was to assess knowledge and perception of plastic surgery among medical students and to explore the influencing factors underlying particular beliefs. Methods: Data for this cross-sectional study were collected between August 22 and December 22, 2017. The questionnaire was formulated on the basis of our own study objectives and from available questionnaires with similar objectives. It was composed of 14 questions divided into three main parts: demographics, the specialty of plastic surgery, and media involvement and its effect on plastic surgery. The study was conducted via an online questionnaire among medical students in all years at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20. Results: A total of 886 medical students participated in this study. We achieved a response rate of 56.79%. The mean age of the participants was 21.2 years. The mean awareness score was 9.7 (SD 4.2) for female students and 8.3 (SD 4.2) for male students (P<.001). The condition most commonly known to be treated by a plastic surgeon was burns (70.3% of responses). Conclusions: Medical students do not have adequate awareness of plastic surgery, and early exposure to this specialty may enhance their awareness. %M 30942694 %R 10.2196/12999 %U http://www.i-jmr.org/2019/2/e12999/ %U https://doi.org/10.2196/12999 %U http://www.ncbi.nlm.nih.gov/pubmed/30942694 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12625 %T Detecting the Interdisciplinary Nature and Topic Hotspots of Robotics in Surgery: Social Network Analysis and Bibliometric Study %A Shen,Lining %A Wang,Shimin %A Dai,Wei %A Zhang,Zhiguo %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No.13 Hangkong Road, Wuhan, 430030, China, 86 027 83692730, shenln@163.com %K robotics %K robotic surgery %K interdisciplinary collaboration %K topic hotspot %K topic bursts %K co-word analysis %K bibliometric analysis %K bibliometrics %K social network analysis %K robotic surgical procedures %K laparoscopy %D 2019 %7 26.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: With the widespread application of a robot to surgery, growing literature related to robotics in surgery (RS) documents widespread concerns from scientific researchers worldwide. Although such application is helpful to considerably improve the accuracy of surgery, we still lack the understanding of the multidiscipline-crossing status and topic distribution related to RS. Objective: The aim of this study was to detect the interdisciplinary nature and topic hotspots on RS by analyzing the current publication outputs related to RS. Methods: The authors collected publications related to RS in the last 21 years, indexed by the Web of Science Core Collection. Various bibliometric methods and tools were used, including literature distribution analysis at the country and institution level and interdisciplinary collaboration analysis in the different periods of time. Co-word analysis was performed based on the keywords with high frequency. The temporal visualization bar presented the evolution of topics over time. Results: A total of 7732 bibliographic records related to RS were identified. The United States plays a leading role in the publication output related to RS, followed by Italy and Germany. It should be noted that the Yonsei University in South Korea published the highest number of RS-related publications. Furthermore, the interdisciplinary collaboration is uneven; the number of disciplines involved in each paper dropped from the initial 1.60 to the current 1.31. Surgery; Engineering; Radiology, Nuclear Medicine, and Medical Imaging; and Neurosciences and Neurology are the 4 core disciplines in the field of RS, all of which have extensive cooperation with other disciplines. The distribution of topic hotspots is in imbalanced status, which can be categorized into 7 clusters. Moreover, 3 areas about the evolution of topic were identified, namely (1) the exploration of techniques that make RS implemented, (2) rapid development of robotic systems and related applications in surgery, and (3) application of a robot to excision of tissues or organs targeted at various specific diseases. Conclusions: This study provided important insights into the interdisciplinary nature related to RS, which indicates that the researchers with different disciplinary backgrounds should strengthen cooperation to publish a high-quality output. The research topic hotspots related to RS are relatively scattered, which has begun to turn to the application of RS targeted at specific diseases. Our study is helpful to provide a potential guide to the direction of the field of RS for future research in the field of RS. %M 30912752 %R 10.2196/12625 %U http://www.jmir.org/2019/3/e12625/ %U https://doi.org/10.2196/12625 %U http://www.ncbi.nlm.nih.gov/pubmed/30912752 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e12511 %T Mobile Phone–Based Smoking-Cessation Intervention for Patients Undergoing Elective Surgery: Protocol for a Randomized Controlled Trial %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 13 28 10 00, marcus.bendtsen@liu.se %K smoking cessation %K mobile phone–based interventions %K SMS %K mHealth interventions %D 2019 %7 26.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Several large studies have shown that the risk of cardiovascular, respiratory, and wound-healing complications (including death) within 30 days of surgery is greater for smokers than for nonsmokers. However, there is evidence that even short-term perioperative smoking cessation may reduce postoperative morbidity. Over the past few years, it has become more evident that short message service (SMS)–based interventions can help individuals quit smoking. Objective: The overall aim of this project is to fill the knowledge gap on whether an SMS-based smoking-cessation intervention can be effective in helping patients stop smoking perioperatively. The aim of this trial is to evaluate the effectiveness of an SMS-based intervention on smoking behavior of patients undergoing elective surgery. Methods: A two-arm parallel-group randomized controlled trial will be conducted at 20 surgical departments in southeast Sweden. Smokers undergoing elective surgery who own a mobile phone will be included. Power calculations indicate that it will be necessary to randomize 434 participants. One group will be given access to a novel 12-week SMS program, which includes daily SMS messages with behavior change–enforcing text content and hyperlinks to interactive modules, while the other group will not be given access to the intervention. Both groups will have access to the surgical departments’ current routine for smoking cessation prior to surgery. Primary outcome measures, prolonged abstinence, and point prevalence of smoking cessation will be measured through questionnaires at 3, 6, and 12 months after randomization. Logistic regression models adjusted using baseline characteristics will be explored to identify potential effects of the intervention. Results: Recruitment started in late October 2018 and is expected to last for a maximum of 30 months. The first results are expected to be available approximately 3 months after the final date of recruitment. Conclusions: Owing to the structural problems and scarcity of time and resources, patients at most Swedish surgical departments are simply instructed to quit smoking, and perhaps, referred to a primary health care clinic. An SMS-based smoking-cessation aid can be effective in helping individuals quit smoking and is a very simple and time-efficient tool for surgical departments to use. Trial Registration: ISRCTN Registry ISRCTN33869008; http://www.isrctn.com/ISRCTN33869008 International Registered Report Identifier (IRRID): PRR1-10.2196/12511 %M 30912757 %R 10.2196/12511 %U http://www.researchprotocols.org/2019/3/e12511/ %U https://doi.org/10.2196/12511 %U http://www.ncbi.nlm.nih.gov/pubmed/30912757 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e12769 %T Awareness and Level of Knowledge About Surgical Site Infections and Risks of Wound Infection Among Medical Physicians in King Abdulaziz University Hospital: Cross-Sectional Study %A Albishi,Wahbi %A Albeshri,Marwan Ahmad %A Mortada,Hatan Hisham %A Alzahrani,Khaled %A Alharbi,Rakan %A Aljuhani,Farrah %A Aldaqal,Saleh %+ College of Medicine, King Abdulaziz University, Abdullah Alsulaiman Road, Jeddah,, Saudi Arabia, 966 582903138, albeshrimarwan@gmail.com %K surgical site infections %K knowledge %K attitude %K infection %D 2019 %7 06.03.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Surgical site infections (SSIs) are one of the leading causes of death, and its prevention is a key element of applying the concept of patient safety and quality care. Objective: This study aimed to assess the level of knowledge about SSIs and risks of wound infection among medical physicians in King Abdulaziz University Hospital. Methods: All surgical and medical consultants, specialists, residents, and medical interns were invited to participate in the study. A 20-Item multiple-choice questionnaire was developed by reviewing the previous literature and with the help of a group of certified surgeons to assess the level of knowledge in all participants. Results: A total of 119 doctors were included in this study. Among all respondents, 92 (77.3%) were intern doctors, 16 (13.4%) were resident doctors, and 11 (9.2%) were specialist doctors. Moreover, 66 (55.5%) doctors knew the definition of SSI. Only one-quarter, that is, 30 (25.2%) doctors knew about the incidence of SSI. In addition, 8 doctors (6.7%) had good knowledge, 75 (63.0%) had fair knowledge, and 36 (30.2%) had poor knowledge regarding SSI according to this study. Conclusions: Level of knowledge about SSIs and risks of wound infections among medical physicians should be improved to ensure better wound care and quality care for the patients. %M 30839280 %R 10.2196/12769 %U http://www.i-jmr.org/2019/1/e12769/ %U https://doi.org/10.2196/12769 %U http://www.ncbi.nlm.nih.gov/pubmed/30839280 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 4 %P e12338 %T The Impact of Visualization Format and Navigational Options on Laypeople’s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey %A Eggeling,Marie %A Bientzle,Martina %A Shiozawa,Thomas %A Cress,Ulrike %A Kimmerle,Joachim %+ Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 363, j.kimmerle@iwm-tuebingen.de %K attitude %K decision aids %K emotions %K informed decision making %K knowledge acquisition %K medical decision making %K surgery %K video %D 2018 %7 22.11.2018 %9 Original Paper %J J Participat Med %G English %X Background: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. Objective: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability. Methods: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. Results: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. Conclusion: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. Trial Registration: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN) %R 10.2196/12338 %U http://jopm.jmir.org/2018/4/e12338/ %U https://doi.org/10.2196/12338 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e16 %T Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons %A Martens,Jill %A de Jong,Guido %A Rovers,Maroeska %A Westert,Gert %A Bartels,Ronald %+ Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Department of Neurosurgery, huispost 636, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 681557132, jill.martens@radboudumc.nl %K evidence-based medicine %K neurosurgery %K levels of evidence %D 2018 %7 12.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. Objective: The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. Methods: A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. Results: The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). Conclusions: According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals. %M 30314961 %R 10.2196/ijmr.9617 %U http://www.i-jmr.org/2018/2/e16/ %U https://doi.org/10.2196/ijmr.9617 %U http://www.ncbi.nlm.nih.gov/pubmed/30314961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e155 %T Parents’ Experiences of Caring for Their Child at the Time of Discharge After Cardiac Surgery and During the Postdischarge Period: Qualitative Study Using an Online Forum %A Wray,Jo %A Brown,Katherine %A Tregay,Jenifer %A Crowe,Sonya %A Knowles,Rachel %A Bull,Kate %A Gibson,Faith %+ Charles West Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom, 44 207405 ext 9200, jo.wray@gosh.nhs.uk %K congenital heart disease %K parents %K online forum %K isolation %D 2018 %7 09.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Congenital heart disease (CHD) is the most common class of birth defects, which encompasses a broad spectrum of severity ranging from relatively minor to extremely complex. Improvements in surgery and intensive care have resulted in an increasing number of infants with the most complex lesions surviving after surgery until the time of discharge from the hospital, but there remain concerns about out-of-hospital mortality, variability in how services are provided at the time of discharge and beyond, and difficulties experienced by some families in accessing care. Objective: As part of a mixed-methods program of research, this study aimed to elicit parental experiences of caring for a child with CHD after hospital discharge following a cardiac surgery and collect information to inform interviews for a subsequent stage of the project. Methods: A closed online discussion group was set up via the main Facebook page of the Children’s Heart Federation (CHF), a national charity offering support to children with heart disease and their families. The discussion group was advertised through the charity’s webpage, and interested participants were directed to the charity’s Facebook page from where they could access the closed Facebook group and respond to questions posted. The CHF moderated the forum, and the research team provided questions to be posted on the forum. Responses were collated into a single transcript and subjected to thematic analysis. Results: The forum was open for 4 months, and 91 participants (mean age 35 years, range 23-58 years, 89 females, 89 parents, and 2 grandparents) submitted demographic information and were given access to the closed forum group. A common experience of isolation emerged from the data, with descriptions of how that isolation was experienced (physical, social, knowledge) and its psychological impact, together with the factors that made it worse or better. Woven through this theme was the notion that parents developed expertise over time. Conclusions: The use of an online forum provided a means for eliciting data from a large number of parents regarding their experiences of caring for their child after hospital discharge following cardiac surgery. Parents engaged with the forum and were able to articulate what went well and what went less well, together with sharing their stories and supporting each other through doing so. Some parents clearly found participating in the forum a positive experience in itself, demonstrating the potential of social media as a mechanism for providing support and reducing isolation. Information gained from the forum was used to shape questions for interviews with parents in a subsequent phase of the study. Furthermore, the themes identified in the online forum have contributed to identifying ways of improving the provision of care and support for parents of high-risk babies following discharge after cardiac surgery. %M 29743157 %R 10.2196/jmir.9104 %U http://www.jmir.org/2018/5/e155/ %U https://doi.org/10.2196/jmir.9104 %U http://www.ncbi.nlm.nih.gov/pubmed/29743157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e47 %T Public Awareness of Uterine Power Morcellation Through US Food and Drug Administration Communications: Analysis of Google Trends Search Term Patterns %A Wood,Lauren N %A Jamnagerwalla,Juzar %A Markowitz,Melissa A %A Thum,D Joseph %A McCarty,Philip %A Medendorp,Andrew R %A Raz,Shlomo %A Kim,Ja-Hong %+ Department of Urology, University of California, Los Angeles, 200 Medical Plaza, Suite 140, Los Angeles, CA,, United States, 1 310 794 0206, laurennwood@gmail.com %K Google %K internet search activity %K FDA safety communication %K uterine morcellation %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Uterine power morcellation, where the uterus is shred into smaller pieces, is a widely used technique for removal of uterine specimens in patients undergoing minimally invasive abdominal hysterectomy or myomectomy. Complications related to power morcellation of uterine specimens led to US Food and Drug Administration (FDA) communications in 2014 ultimately recommending against the use of power morcellation for women undergoing minimally invasive hysterectomy. Subsequently, practitioners drastically decreased the use of morcellation. Objective: We aimed to determine the effect of increased patient awareness on the decrease in use of the morcellator. Google Trends is a public tool that provides data on temporal patterns of search terms, and we correlated this data with the timing of the FDA communication. Methods: Weekly relative search volume (RSV) was obtained from Google Trends using the term “morcellation.” Higher RSV corresponds to increases in weekly search volume. Search volumes were divided into 3 groups: the 2 years prior to the FDA communication, a 1-year period following, and thereafter, with the distribution of the weekly RSV over the 3 periods tested using 1-way analysis of variance. Additionally, we analyzed the total number of websites containing the term “morcellation” over this time. Results: The mean RSV prior to the FDA communication was 12.0 (SD 15.8), with the RSV being 60.3 (SD 24.7) in the 1-year after and 19.3 (SD 5.2) thereafter (P<.001). The mean number of webpages containing the term “morcellation” in 2011 was 10,800, rising to 18,800 during 2014 and 36,200 in 2017. Conclusions: Google search activity about morcellation of uterine specimens increased significantly after the FDA communications. This trend indicates an increased public awareness regarding morcellation and its complications. More extensive preoperative counseling and alteration of surgical technique and clinician practice may be necessary. %M 29699965 %R 10.2196/publichealth.9913 %U http://publichealth.jmir.org/2018/2/e47/ %U https://doi.org/10.2196/publichealth.9913 %U http://www.ncbi.nlm.nih.gov/pubmed/29699965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e74 %T Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis %A Molinari,Michele %A Puttarajappa,Chethan %A Wijkstrom,Martin %A Ganoza,Armando %A Lopez,Roberto %A Tevar,Amit %+ Division of Transplant Surgery, Department of Surgery, University of Pittsburgh Medical Center, 3459 Fifth Avenue, N 758 Montefiore Hospital, Pittsburgh, PA, 15213, United States, 1 412 647 5734, molinarim@upmc.edu %K renal transplantation %K obesity %K cost benefit analysis %K markov model %D 2018 %7 08.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent studies have reported a significant decrease in wound problems and hospital stay in obese patients undergoing renal transplantation by robotic-assisted minimally invasive techniques with no difference in graft function. Objective: Due to the lack of cost-benefit studies on the use of robotic-assisted renal transplantation versus open surgical procedure, the primary aim of our study is to develop a Markov model to analyze the cost-benefit of robotic surgery versus open traditional surgery in obese patients in need of a renal transplant. Methods: Electronic searches will be conducted to identify studies comparing open renal transplantation versus robotic-assisted renal transplantation. Costs associated with the two surgical techniques will incorporate the expenses of the resources used for the operations. A decision analysis model will be developed to simulate a randomized controlled trial comparing three interventional arms: (1) continuation of renal replacement therapy for patients who are considered non-suitable candidates for renal transplantation due to obesity, (2) transplant recipients undergoing open transplant surgery, and (3) transplant patients undergoing robotic-assisted renal transplantation. TreeAge Pro 2017 R1 TreeAge Software, Williamstown, MA, USA) will be used to create a Markov model and microsimulation will be used to compare costs and benefits for the two competing surgical interventions. Results: The model will simulate a randomized controlled trial of adult obese patients affected by end-stage renal disease undergoing renal transplantation. The absorbing state of the model will be patients' death from any cause. By choosing death as the absorbing state, we will be able simulate the population of renal transplant recipients from the day of their randomization to transplant surgery or continuation on renal replacement therapy to their death and perform sensitivity analysis around patients' age at the time of randomization to determine if age is a critical variable for cost-benefit analysis or cost-effectiveness analysis comparing renal replacement therapy, robotic-assisted surgery or open renal transplant surgery. After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values. Conclusions: After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values. %M 29519780 %R 10.2196/resprot.8294 %U http://www.researchprotocols.org/2018/3/e74/ %U https://doi.org/10.2196/resprot.8294 %U http://www.ncbi.nlm.nih.gov/pubmed/29519780 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e54 %T Using Google Glass in Surgical Settings: Systematic Review %A Wei,Nancy J %A Dougherty,Bryn %A Myers,Aundria %A Badawy,Sherif M %+ Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box #30, Chicago, IL, 60611, United States, 1 3122274836, sbadawy@luriechildrens.org %K Google Glass %K wearable %K wearable device %K head-mounted wearable device %K surgery %K surgical setting %K surgical condition %D 2018 %7 06.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: In recent years, wearable devices have become increasingly attractive and the health care industry has been especially drawn to Google Glass because of its ability to serve as a head-mounted wearable device. The use of Google Glass in surgical settings is of particular interest due to the hands-free device potential to streamline workflow and maintain sterile conditions in an operating room environment. Objective: The aim is to conduct a systematic evaluation of the literature on the feasibility and acceptability of using Google Glass in surgical settings and to assess the potential benefits and limitations of its application. Methods: The literature was searched for articles published between January 2013 and May 2017. The search included the following databases: PubMed MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO (EBSCO), and IEEE Xplore. Two reviewers independently screened titles and abstracts and assessed full-text articles. Original research articles that evaluated the feasibility, usability, or acceptability of using Google Glass in surgical settings were included. This review was completed following the Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines. Results: Of the 520 records obtained, 31 met all predefined criteria and were included in this review. Google Glass was used in various surgical specialties. Most studies were in the United States (23/31, 74%) and all were conducted in hospital settings: 29 in adult hospitals (29/31, 94%) and two in children’s hospitals (2/31, 7%). Sample sizes of participants who wore Google Glass ranged from 1 to 40. Of the 31 studies, 25 (81%) were conducted under real-time conditions or actual clinical care settings, whereas the other six (19%) were conducted under simulated environment. Twenty-six studies were pilot or feasibility studies (84%), three were case studies (10%), and two were randomized controlled trials (6%). The majority of studies examined the potential use of Google Glass as an intraoperative intervention (27/31, 87%), whereas others observed its potential use in preoperative (4/31, 13%) and postoperative settings (5/31, 16%). Google Glass was utilized as a videography and photography device (21/31, 68%), a vital sign monitor (6/31, 19%), a surgical navigation display (5/31, 16%), and as a videoconferencing tool to communicate with remote surgeons intraoperatively (5/31, 16%). Most studies reported moderate or high acceptability of using Google Glass in surgical settings. The main reported limitations of using Google Glass utilization were short battery life (8/31, 26%) and difficulty with hands-free features (5/31, 16%). Conclusions: There are promising feasibility and usability data of using Google Glass in surgical settings with particular benefits for surgical education and training. Despite existing technical limitations, Google Glass was generally well received and several studies in surgical settings acknowledged its potential for training, consultation, patient monitoring, and audiovisual recording. %M 29510969 %R 10.2196/mhealth.9409 %U http://mhealth.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mhealth.9409 %U http://www.ncbi.nlm.nih.gov/pubmed/29510969 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e2 %T A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments %A Barbieri,Stefania %A Feltracco,Paolo %A Lucchetta,Vittorio %A Gaudio,Rosa Maria %A Tredese,Alberto %A Bergamini,Mauro %A Vettore,Gianna %A Pietrantonio,Vincenzo %A Avato,Francesco Maria %A Donato,Daniele %A Boemo,Deris Gianni %A Nesoti,Maria Vittoria %A Snenghi,Rossella %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani 2, Padova,, Italy, 39 3479812611, stefibarbieri118@gmail.com %K alcohol drinking %K drinking behavior %K underage drinking %K binge drinking %K alcoholic intoxication %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 31.01.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes. %M 29386170 %R 10.2196/ijmr.6573 %U http://www.i-jmr.org/2018/1/e2/ %U https://doi.org/10.2196/ijmr.6573 %U http://www.ncbi.nlm.nih.gov/pubmed/29386170 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e150 %T Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique %A Saremi,AboTaleb %A Bahrami,Homa %A Feizy,Fariba %+ Sarem Women’s Hospital, Phase-3 Shahrak-e-Ekbatan, Tehran, 1396956111, Islamic Republic Of Iran, 98 9126348518, fariba.feizy@aol.com %K hysterectomy %K uterine %K fundectomy %D 2017 %7 10.10.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy. Objective: We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures. Methods: Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it. Results: Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018. Conclusions: Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications. %M 29017989 %R 10.2196/resprot.7536 %U http://www.researchprotocols.org/2017/10/e150/ %U https://doi.org/10.2196/resprot.7536 %U http://www.ncbi.nlm.nih.gov/pubmed/29017989 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e5 %T Thoracic Surgery Information on the Internet: A Multilingual Quality Assessment %A Davaris,Myles %A Barnett,Stephen %A Abouassaly,Robert %A Lawrentschuk,Nathan %+ Austin Hospital, Department of Surgery, University of Melbourne, Suite 5, 210 Burgundy Street, Heidelberg, Melbourne,, Australia, 61 394553363, lawrentschuk@gmail.com %K thoracic %K Internet %K multilingualism %K language %K websites %D 2017 %7 12.05.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery. Objective: The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment. Methods: Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types. Results: Overall, there are a considerable number of websites devoted to thoracic surgery: “lung cancer” returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (P<.001) and tertiles (P<.001) of the first 150 websites, but not between languages. Oncological keywords regarding conditions and procedures were found to return a higher percentage of HON-accreditation. The percentage of HON-accredited sites was similar across all four languages (P=.77). In general, the first tertile contained a higher percentage of HON-accredited sites for every keyword. Conclusions: Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them. %M 28500021 %R 10.2196/ijmr.6732 %U http://www.i-jmr.org/2017/1/e5/ %U https://doi.org/10.2196/ijmr.6732 %U http://www.ncbi.nlm.nih.gov/pubmed/28500021 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e4 %T Planking or the “Lying-Down Game:” Two Case Reports %A Barbieri,Stefania %A Feltracco,Paolo %A Omizzolo,Luca %A Snenghi,Rossella %A El Mazloum,Rafi %A Vettore,Gianna %A Bergamini,Mauro %A Stefanati,Armando %A Donato,Daniele %A Ferronato,Cecilia %A Avato,Francesco Maria %A Tredese,Alberto %A Gaudio,Rosa Maria %+ Preventive Medicine and Risk Assessment, University of Ferrara, Via Fossalto di Mortara 64, Ferrara,, Italy, 39 3479812611, stefibarbieri118@gmail.com %K planking %K the lying down game %K serious games %K blunt trauma %K multiple trauma %K social networks %K health care costs %D 2017 %7 23.03.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The monitoring and management of risks regarding children and young people admitted to the emergency department as a result of dangerous behaviors distributed via the Internet should be based on clinical reasoning and knowledge about these social media–related phenomena. Here we examine 2 cases of teenagers who reported severe injuries while performing the “planking” craze, a challenge that consists in lying face-down stiffly like a board on any kind of surface. Objective: Our objective is to examine and describe the Internet craze called planking, also known as the “lying-down game,“ through 2 case reports from our experience, enriching this study with information gained through discussions with secondary school teenagers. Methods: Details of the 2 case reports were taken from electronic medical records giving information on care support processes, care management, and the costs of traumatic episodes. Demographic data, hemoglobin and serum lactate values, and Injury Severity Scores were evaluated. The study took place in secondary schools of our city from 2013 to 2014 during medical education courses, with the aim of analyzing the influence of social media on teenagers' activities and behaviors. Results: Both patients suffered multiple trauma injuries and needed high-level health assistance. The first patient underwent a splenectomy and the second one a nephrectomy; both of them required a long hospital stay (14 and 20 days, respectively), and the costs for their management have been estimated at US $27,000 and US $37,000, respectively. Their decision to perform the planking in dangerous locations was due to their ambition to gain peers' acclaim through shared videos and pictures. Conclusions: Reporting and understanding these cases may potentially help prevent future events occurring in similar circumstances: the scientific community cannot leave this problem unaddressed. There is also a role of education resources for health care professionals; for this, we must identify and follow up strange or misleading information found on websites. A key element of this research study was to report physicians’ misperceptions concerning planking and, with these cases used for teaching purposes, improve knowledge of the clinical and forensic aspects of this emerging problem. %M 28336507 %R 10.2196/ijmr.6568 %U http://www.i-jmr.org/2017/1/e4/ %U https://doi.org/10.2196/ijmr.6568 %U http://www.ncbi.nlm.nih.gov/pubmed/28336507 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e10 %T YouTube Videos to Create a “Virtual Hospital Experience” for Hip and Knee Replacement Patients to Decrease Preoperative Anxiety: A Randomized Trial %A O'Connor,Mary I %A Brennan,Katharyn %A Kazmerchak,Shari %A Pratt,Jason %+ Center for Musculoskeletal Care, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 1450 Chapel Street, Selina Lewis 4th Floor, New Haven, CT, 06511, United States, 1 203 789 4378, mary.oconnor@yale.edu %K hip arthroplasty %K hip replacement %K knee arthroplasty %K knee replacement %K preoperative anxiety %K virtual hospital experience %K YouTube videos %D 2016 %7 18.04.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: With declining reimbursement to health care systems, face-to-face time between patients and providers to optimize preoperative education and counseling may be challenging. Objective: Because high patient anxiety prior to surgery has been linked to more severe and persistent pain after joint replacement surgery, the Orthopedic Surgery Department at Mayo Clinic in Florida created a playlist of 16 YouTube videos aimed at creating a virtual hospital experience for primary total hip and knee joint replacement patients. A randomized trial was then performed to evaluate the potential impact of viewing this playlist on preoperative anxiety. Methods: Each patient completed a Generalized Anxiety Disorder (GAD) score assessment at the time of the routine preoperative clinic visit and then randomized based on his/her gender, type of surgery, and initial GAD score to either the control group of standard education (education at face-to-face clinical visits as well as printed educational materials) or the treatment group (standard education plus access to the YouTube playlist). On the morning of the patient’s surgery, the same survey was repeated. Of the 65 patients who consented to participate in the study, 53 completed the study (82%) with 28 of 29 (97% completed) in the control group and 25 of 36 (69% completed) in the treatment group. Results: Overall, the results showed a trend toward less anxiety in patients who viewed the YouTube videos; this was exhibited by a reduction in the median GAD score by 1 point. This trend is more clearly present in patients with high preoperative anxiety (predominantly women), as seen in the reduction of the median GAD score by 6 points in the treatment group. Conclusions: Although our experience is limited, our results indicate that a series of tailored videos may decrease patient anxiety preoperatively. We recommend further exploration of both this concept and the use of social media tools in preoperative patient education. Trial Registration: Clinicaltrials.gov NCT02546180; http://clinicaltrials.gov/ct2/show/NCT02546180 (Archived by WebCite at http://www.webcitation.org/6f6y0Dw7d). %M 27091674 %R 10.2196/ijmr.4295 %U http://www.i-jmr.org/2016/2/e10/ %U https://doi.org/10.2196/ijmr.4295 %U http://www.ncbi.nlm.nih.gov/pubmed/27091674 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 3 %P e29 %T Optimizing Patient Preparation and Surgical Experience Using eHealth Technology %A Waller,Amy %A Forshaw,Kristy %A Carey,Mariko %A Robinson,Sancha %A Kerridge,Ross %A Proietto,Anthony %A Sanson-Fisher,Rob %+ University of Newcastle & Hunter Medical Research Institute, Health Behaviour Research Group, W4 HMRI Building, University of Newcastle, Callaghan, 2305, Australia, 61 2 4042 0708, amy.waller@newcastle.edu.au %K eHealth %K perioperative %K postoperative %K preoperative %K surgery %D 2015 %7 01.09.2015 %9 Viewpoint %J JMIR Med Inform %G English %X With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients’ preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed. %M 26330206 %R 10.2196/medinform.4286 %U http://medinform.jmir.org/2015/3/e29/ %U https://doi.org/10.2196/medinform.4286 %U http://www.ncbi.nlm.nih.gov/pubmed/26330206 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e15 %T What Kind of Information About Marginal Donors Is Available Through Sources Other Than Health Care Professionals for Patients on the Waiting List for Organ Transplantation? %A Kamran,Sara %A Calmus,Yvon %A Pomey,Marie Pascale %A Vidal-Trécan,Gwenaëlle %+ Paris Center University Hospitals, Public Health ward: Quality and Risk Management, Assistance Publique - Hôpitaux de Paris, 27, rue du faubourg Saint Jacques, Paris, 75014, France, 33 158412050, sara.kamran@cch.aphp.fr %K access to information %K marginal donor %K online health information %K health information exchange %K organ transplantation %K lung %K liver %K kidney %K heart %D 2015 %7 14.07.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The current organ shortage has necessitated expanding the criteria for potential donations to marginal donors (older or sick donors whose organs would have been considered unsuitable before). In France, physicians are not required to provide information to recipients about marginal donors except for hepatitis C or hepatitis B infection and non-heart-beating donations. We hypothesized that patients can be informed about these risks by other information sources than health care professionals, such as websites and patient associations. Objective: The objectives of the study were to identify the main health information sources of transplant patients other than health professionals and to evaluate the information provided by websites and associations to patients about the risks of transplantation from marginal donors. Methods: In this study, the information sources for kidney, liver, heart, and lung patients that had already received transplants or registered on waiting lists were identified by a survey in four transplant centers. Further, the information proposed by French and English language websites and patient associations were evaluated, respectively, by a systematic review of websites and a survey among the presidents of kidney, liver, heart, and lung patient associations. Results: For the first survey, (367/402) 91.3% responses were registered. Apart from health professionals identified as the principal information source (363/367) 98.9%, 19 liver and 28 heart patients searched for information on the websites, while 37 kidney and 42 lung patients were more informed by patients’ associations. Our two last surveys showed that information about marginal donors is accessible by websites and (10/34) 30% of associations. All of the 60 Internet documents evaluated on French language and English language websites proposed information about marginal donors. Otherwise, (52/65) 80% of these documents were dedicated to health professionals and contained specialized information, difficult to understand by patients. Certain associations, (20/34) 59%, provided information about the risks of transplantation. There were 45/115 patients considering associations as their main information source that were informed by an association’s website. However, only (5/22) 23% of associations communicated the risks of transplantation with patients through their websites. Conclusions: Currently, patients want to be more informed by other information sources than health professionals, particularly by the websites. Nevertheless, they cannot always trust information proposed by these sources. They need to have their physicians inform them about specialized keywords and present them with reliable information sources. So reliable centers such as universities, transplant centers, and associations should develop the quality and quantity of information proposed to patients on their websites. %M 26175096 %R 10.2196/ijmr.4301 %U http://www.i-jmr.org/2015/3/e15/ %U https://doi.org/10.2196/ijmr.4301 %U http://www.ncbi.nlm.nih.gov/pubmed/26175096 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e8 %T Optimizing Inter-Professional Communications in Surgery: Protocol for a Mixed-Methods Exploratory Study %A Hallet,Julie %A Wallace,David %A El-Sedfy,Abraham %A Hall,Trevor NT %A Ahmed,Najma %A Bridge,Jennifer %A Taggar,Ru %A Smith,Andy J %A Nathens,Avery B %A Coburn,Natalie G %A Gotlib-Conn,Lesley %+ Sunnybrook Health Sciences Centre, Division of General Surgery, 2075 Bayview Avenue, T-wing, Toronto, ON, M4N 3M5, Canada, 1 416 480 6106, natalie.coburn@sunnybrook.ca %K communication %K interprofessional %K pager %K resident %K nurse %K education %K patient safety %D 2015 %7 05.03.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Effective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction. Objective: This study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care. Methods: We will use a mixed-methods multiphasic approach. In phase 1, a quantitative and content analysis of alpha-numeric pages (ANP) received by general surgery residents will be conducted to develop a paging taxonomy. Frequency, timing (on-call vs regular duty hours), and interval between pages will be described using a 4-week sample of pages. Results will be compared between pages sent to junior and senior residents. Finally, using an inductive analysis, two independent assessors will classify ANP thematically. In Phase 2, a qualitative constructivist approach will explore stakeholders’ experiences with interprofessional communication, including paging, through interviews and shadowing of 40 residents and 40 nurses at two institutions. Finally, a survey will be developed, tested, and administered to all general surgery nurses and residents at the same two institutions, to evaluate their attitudes about the effectiveness and quality of interprofessional communication, and assess their satisfaction. Results: Describing the profile of current pages is the first step towards identifying areas and root causes of IPC inefficiency. This study will identify key contextual barriers to surgical nurse-house staff communication, and existing interprofessional knowledge and practice gaps. Conclusions: Our findings will inform the design of a guideline and tailored intervention to improve IPC in order to ensure high quality patient care, optimal educational experience, and provider satisfaction. %M 25745882 %R 10.2196/resprot.3623 %U http://www.researchprotocols.org/2015/1/e8/ %U https://doi.org/10.2196/resprot.3623 %U http://www.ncbi.nlm.nih.gov/pubmed/25745882 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 3 %P e11 %T The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes %A Pitter,Michael C %A Simmonds,Christopher %A Seshadri-Kreaden,Usha %A Hubert,Helen B %+ Newark Beth Israel Medical Center, Minimally Invasive & Gynecologic Robotic Surgery, 201 Lyons Avenue, L-2, Newark, NJ, 07112, United States, 1 973 926 4600, mptmd@aol.com %K hysterectomy %K vaginal hysterectomy %K robotics %K laparoscopy %K patient satisfaction %K patient outcomes assessment %K Internet %D 2014 %7 17.07.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: There is an ongoing debate regarding the cost-benefit of different surgical modalities for hysterectomy. Studies have relied primarily on evaluation of clinical outcomes and medical expenses. Thus, a paucity of information on patient-reported outcomes including satisfaction, recovery, and recommendations exists. Objective: The objective of this study was to identify differences in patient satisfaction and recommendations by approach to a hysterectomy. Methods: We recruited a large, geographically diverse group of women who were members of an online hysterectomy support community. US women who had undergone a benign hysterectomy formed this retrospective study cohort. Self-reported characteristics and experiences were compared by surgical modality using chi-square tests. Outcomes over time were assessed with the Jonkheere-Terpstra trend test. Logistic regression identified independent predictors of patient satisfaction and recommendations. Results: There were 6262 women who met the study criteria; 41.74% (2614/6262) underwent an abdominal hysterectomy, 10.64% (666/6262) were vaginal, 27.42% (1717/6262) laparoscopic, 18.94% (1186/6262) robotic, and 1.26% (79/6262) single-incision laparoscopic. Most women were at least college educated (56.37%, 3530/6262), and identified as white, non-Hispanic (83.17%, 5208/6262). Abdominal hysterectomy rates decreased from 68.2% (152/223) to 24.4% (75/307), and minimally invasive surgeries increased from 31.8% (71/223) to 75.6% (232/307) between 2001 or prior years and 2013 (P<.001 all trends). Trends in overall patient satisfaction and recommendations showed significant improvement over time (P<.001).There were differences across the surgical modalities in all patient-reported experiences (ie, satisfaction, time to walking, driving and working, and whether patients would recommend or use the same technique again; P<.001). Significantly better outcomes were evident among women who had vaginal, laparoscopic, and robotic procedures than among those who had an abdominal procedure. However, robotic surgery was the only approach that was an independent predictor of better patient experience; these patients were more satisfied overall (odds ratio [OR] 1.31, 95% CI 1.13-1.51) and on six other satisfaction measures, and more likely to recommend (OR 1.64, 95% CI 1.39-1.94) and choose the same modality again (OR 2.07, 95% CI 1.67-2.57). Abdominal hysterectomy patients were more dissatisfied with outcomes after surgery and less likely to recommend (OR 0.36, 95% CI 0.31-0.40) or choose the same technique again (OR 0.29, 95% CI 0.25-0.33). Quicker return to normal activities and surgery after 2007 also were independently associated with better overall satisfaction, willingness to recommend, and to choose the same surgery again. Conclusions: Consistent with other US data, laparoscopic and robotic hysterectomy rates increased over time, with a concomitant decline in abdominal hysterectomy. While inherent shortcomings of this retrospective Web-based study exist, findings show that patient experience was better for each of the major minimally invasive approaches than for abdominal hysterectomy. However, robotic-assisted hysterectomy was the only modality that independently predicted greater satisfaction and willingness to recommend and have the same procedure again. %M 25048103 %R 10.2196/ijmr.3160 %U http://www.i-jmr.org/2014/3/e11/ %U https://doi.org/10.2196/ijmr.3160 %U http://www.ncbi.nlm.nih.gov/pubmed/25048103 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e4 %T What Influences Patient Participation in an Online Forum for Weight Loss Surgery? A Qualitative Case Study %A Das,Anita %A Faxvaag,Arild %+ Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk Teknisk Forskningssenter, Trondheim, 7491, Norway, 47 73551531, anita.das@ntnu.no %K obesity %K eHealth %K bariatric surgery %K online forum %K communication %K social support %D 2014 %7 06.02.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Many patients who undergo weight loss (bariatric) surgery seek information and social support in online discussion forums, but the vast amount of available information raises concerns about the impact of such information. A secure online discussion forum was developed and offered to bariatric surgery patients. The forum was moderated and allowed contact with peers and health care professionals. Objective: The purposes of this study were to explore how individuals undergoing bariatric surgery used the moderated discussion forum and to better understand what influenced their participation in the forum. Methods: The study was designed as an explorative case study. We conducted participant observation of the discussion forum over a time period of approximately six months. For further insight, we carried out in-depth semistructured interviews with seven patients who had access to the forum. We analyzed the material inductively, using content and thematic analysis. Results: The patients used the forum as an arena in which to interact with peers and providers, as well as to provide and achieve informational and social support. The analysis suggests that there are three major themes that influenced participation in the online discussion forum: (1) the participant’s motivation to seek information, advice, and guidance, (2) the need for social support and networking among peers, and (3) concerns regarding self-disclosure. Conclusions: The findings of this study imply that a moderated discussion forum for bariatric surgery patients has potential for use in a therapeutic context. The discussion forum fulfilled the informational and support needs of the bariatric surgery patients and was particularly useful for those who excluded themselves from the traditional program and experienced barriers to expressing their own needs. Even though our findings imply that the patients benefitted from using the forum regardless of their active or passive participation, restraining factors, such as considerations regarding self-disclosure, must be further investigated to prevent certain users from being precluded from participation. %M 24509408 %R 10.2196/ijmr.2847 %U http://www.i-jmr.org/2014/1/e4/ %U https://doi.org/10.2196/ijmr.2847 %U http://www.ncbi.nlm.nih.gov/pubmed/24509408 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 2 %P e14 %T An Evaluation Framework for Defining the Contributions of Telestration in Surgical Telementoring %A Budrionis,Andrius %A Augestad,Knut Magne %A Patel,Hiten RH %A Bellika,Johan Gustav %+ University Hospital of Northern Norway, Tromsø Science Park in Breivika, Sykehusvn. 23, Tromsø, Norway, 47 77 75 40 30, andrius.budrionis@telemed.no %K telementoring %K telestration %K annotation %K impact %K benefits %K theoretical models %K evaluation framework %D 2013 %7 25.07.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: An increasing quantity of research in the domain of telemedicine show a growing popularity and acceptance of care over distance systems among both clinicians and patients. We focus on telementoring solutions, developed for providing remote guidance to less experienced surgeons. Telestration is often regarded as an extra functionality of some telementoring systems. However, we advocate that telestration must be viewed as a core feature of telementoring due to its advantages. Objective: To analyze and define concepts, parameters, and measurement procedures to evaluate the impact of using telestration while telementoring. Methods: A systematic review of research dealing with telestration during remote guidance sessions was performed by querying three major online research databases (MEDLINE, Association of Computing Machinery, and Institute of Electrical and Electronics Engineers) using a predefined set of keywords (“laparoscopy”, “annotate”, “telestrate”, “telestration”, “annotation”, “minimally invasive”, and “MIS”). Results: The keyword-based search identified 117 papers. Following the guidelines for performing a systematic review, only 8 publications were considered relevant for the final study. Moreover, a gap in research defining the impacts of telestration during telementoring was identified. To fill this niche, a framework for analyzing, reporting, and measuring the impacts of telestration was proposed. Conclusions: The presented framework lays the basics for the structured analysis and reporting of telestration applied to telementoring systems. It is the first step toward building an evidence knowledge base documenting the advantages of live video content annotation and supporting the presented connections between the concepts. %M 23887078 %R 10.2196/ijmr.2611 %U http://www.i-jmr.org/2013/2/e14/ %U https://doi.org/10.2196/ijmr.2611 %U http://www.ncbi.nlm.nih.gov/pubmed/23887078