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- Aminoff, Hedvig, et al.
(författare)
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Context and Complexity in Telemedicine Evaluation : Work Domain Analysis in a Surgical Setting
- 2021
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Ingår i: JMIR Perioperative Medicine. - : JMIR Publications Inc.. - 2561-9128. ; 4:2, s. e26580-e26580
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Tidskriftsartikel (refereegranskat)abstract
- Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about howto best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growinginterest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation.This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key tounderstanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where atelemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modelingcan provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.
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| 2. |
- Jaensson, Maria, 1967-, et al.
(författare)
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Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up : Secondary Analysis of a Randomized Controlled Trial
- 2018
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 20:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery.Objective: The aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP.Methods: This study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP.Results: There were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups.Conclusions: This study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge.
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| 5. |
- Merchant, Richard Neville, et al.
(författare)
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Preoperative Fasting Practices Across Three Anesthesia Societies : Survey of Practitioners
- 2020
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Ingår i: JMIR perioperative medicine. - : JMIR Publications. - 2561-9128. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain.OBJECTIVE: This study aimed to determine the current practices of anesthetists with respect to fasting guidelines.METHODS: An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed.RESULTS: A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%).CONCLUSIONS: Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.
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| 6. |
- Nilsson, Ulrica, et al.
(författare)
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The Swedish Web Version of the Quality of Recovery Scale Adapted for Patients Undergoing Local Anaesthesia and Peripheral Nerve Blockade, SwQoR-LA : Prospective Psychometric Evaluation Study
- 2021
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Ingår i: JMIR Perioperative Medicine. - : JMIR Publications, Inc.. - 2561-9128. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Frequency and timing of the assessment of patients’ symptoms and discomfort during postoperative recovery is a goal. Therefore, real-time-recovery evaluation has been suggested in order to identify specific deficits in patients’ recovery.Objective: To psychometric evaluate the Swedish Web Version of the Quality of Recovery (SwQoR) Scale adapted for patients undergoing local and peripheral nerve block: SwQoR-LA.Methods: This was a secondary analysis of a psychometric evaluation of 107 patients aged ≥18 years undergoing day surgery under local or peripheral nerve block anaesthesia at four different day surgery departments in Sweden. The SwQoR-LA, inserted into a mobile application (app) called Recovery Assessment by Phone Points (RAPP), was completed daily on postoperative days 1–7.Results: Some evidence of construct validity was supported, and discriminant validity was found in seven of eight items related to general anaesthesia. The internal consistency was acceptable (0.87–0.89) and the split-half reliability was .80– .86. Cohen’s d effect size was 0.98 and the percentage of change from the baseline was 43.4%. No floor or ceiling effects were found.Conclusions: The SwQoR-LA is valid, reliable, responsive and clinically feasible for real-time-recovery digital assessment of patient recovery in order to identify specific deficits in patients’ recovery and detect those patients who might benefit from a timely intervention.
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