Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Aims: To evaluate the effectiveness of web‐based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre‐operative anxiety and secondary outcomes were postoperative pain and parents’ anxiety and satisfaction with entire course of the day surgery.Design: A systematic review and meta‐analysis of randomized controlled trials.Data Sources: CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018).Review Methods: Studies were appraised using the Cochrane risk of bias tool. A random effect meta‐analysis of children's pre‐operative anxiety was performed.Results: Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web‐based mobile health interventions, including age‐appropriate videos, web‐based game apps, and educational preparation games made for the hospital environment, was examined in pre‐operative settings. A meta‐analysis (N = 560 children) based on six studies found a statistically significant reduction in pre‐operative anxiety measured by the Modified Yale Pre‐operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction.Conclusion: Web‐based mobile health interventions can reduce children's pre‐operative anxiety and increase parental satisfaction. Web‐based mobile health interventions could be considered as non‐pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions.Impact: Web‐based mobile health interventions reduce children´s pre‐operative anxiety and could therefore be considered as non‐pharmacological distraction tools for children in nursing.

Background: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration: ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363

Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.