Optimized post-operative surveillance of permanent pacemakers by home monitoring: the OEDIPE trial Ambulatory Orthopaedic Surgery Patients' Emotions When Using Two Different Patient Education Methods Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. Bridging the transition from hospital to home: effects of the VITAL telehealth program on recovery for CABG surgery patients and their caregivers. [Pre-employment examinations for preventing occupational injury and disease in workers]. Effectiveness of an interactive virtual telerehabilitation system in patients after total knee arthoplasty: a randomized controlled trial. Using the Web to reduce postoperative pain following ambulatory surgery Ambulatory Orthopaedic Surgery Patient Education and Cost of Care Postoperative robotic telerounding: a multicenter randomized assessment of patient outcomes and satisfaction. Research paper: Impact on Quality of Life of a Telemedicine System Supporting Head and Neck Cancer Patients: A Controlled Trial During the Postoperative Period at Home Health information: what can mobile phone assessments add? A randomized controlled trial of home telerehabilitation for post-knee arthroplasty Impact of an early recovery management intervention on functioning in postoperative coronary artery bypass patients with diabetes. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Evaluation of a ubiquitous and interoperable computerised system for remote monitoring of ambulatory post-operative pain: a randomised controlled trial. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. The use of a computer website prior to scheduled surgery (a pilot study): impact on patient information, acquisition, anxiety level, and overall satisfaction with anesthesia care. Symptom management intervention in elderly coronary artery bypass graft patients. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. Perioperative cataract OP management by means of teleconsultation Web-Based Education Prior to Knee Arthroscopy Enhances Informed Consent and Patient Knowledge Recall: A Prospective, Randomized Controlled Study. Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty Web-Based Nursing Intervention for Self-Management of Pain After Cardiac Surgery: Pilot Randomized Controlled Trial Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work. Telerounding and patient satisfaction after surgery. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Gender differences in recovery outcomes after an early recovery symptom management intervention. Role of interactive home telemedicine for early and protected discharge 1 day after carotid endarterectomy. The Benefits of an Interactive, Individualized Online Patient Pathway for Patients Undergoing Minimally Invasive Radioguided Parathyroidectomy: A Prospective, Double-Blinded, Randomized Clinical Trial Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial.
Aims The ŒDIPE trial examined the safety and efficacy of an abbreviated hospitalization after implantation or replacement of dual-chamber pacemakers ( PM )  using a telecardiology-based ambulatory surveillance programme . Methods and results Patients were r and omly assigned to ( i ) an active group  , discharged from the hospital 24 h after a first PM implant  or 4–6 h after replacement  , and followed for 4 weeks with Home-Monitoring ( HM ) , or ( ii ) a control group followed for 4 weeks according to usual medical practice s. The primary objective was to confirm that the proportion of patients who experienced one or more major adverse events ( MAE ) was not higher in the active than in the control group . The study included 379 patients . At least one treatment-related MAE was observed in 9.2 % of patients ( n = 17 ) assigned to the active group vs. 13.3 % of patients ( n = 26 ) in the control group ( P = 0.21 ) , a 4.1 % absolute risk reduction ( 95 % CI −2.2 to 10.4 ; P = 0.98 ) . By study design , the mean hospitalization duration was 34 % shorter in the active than in the control group ( P < 0.001 ) , and HM facilitated the early detection of technical issues and detectable clinical anomalies . Conclusion Early discharge with HM after PM implantation or replacement was safe and facilitated the monitoring of patients in the month following the procedure A r and omised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients '  emotions during internet-based patient education or face-to-face education with a nurse .  The internet-based patient education was design ed for this study and patients used websites individually based on their needs . Patients in the control group  participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit . The theoretical basis for both types of education was the same . Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process , though their scores also changed during the surgical process . Emotion scores did not decrease after patient education . No differences in patients ' emotions were found to result from either of the two different patient education methods BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee . Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function . Access to high- quality rehabilitation services is not always possible , especially for those who live in rural or remote areas . The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty . METHODS this investigation was a single-blinded , prospect i ve , r and omized , controlled noninferiority trial . Sixty-five participants were r and omized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program . The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) measured at baseline and six weeks by a blinded independent assessor . Secondary outcomes included the Patient-Specific Functional Scale , the timed up- and -go test , pain intensity , knee flexion and extension , quadriceps muscle strength , limb girth measurements , and an assessment of gait . Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics . RESULTS baseline characteristics between groups were similar , and all participants had significant improvement on all outcome measures with the intervention ( p < 0.01 for all ) . After the six-week intervention , participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion , muscle strength , limb girth , pain , timed up- and -go test , quality of life , and clinical gait and WOMAC scores . Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group ( p < 0.05 ) . The telerehabilitation intervention was well received by participants , who reported a high level of satisfaction with this novel technology . CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation . LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence The purpose of this r and omized trial was to determine whether coronary artery bypass graft surgery patients and their caregivers who received  telehealth follow-up  had greater improvements in anxiety levels from pre-surgery to 3 weeks after discharge than did those who received st and ard care . Secondary outcomes included changes in depressive symptoms and patients ' contacts with physicians . No group differences were noted in changes in patients ' anxiety and depressive symptoms , but patients in the telehealth group had fewer physician contacts ( p = .04 ) . Female caregivers in the telehealth group had greater decreases in anxiety than those in st and ard care ( p < .001 ) , and caregivers of both genders in the telehealth group had greater decreases in depressive symptoms ( p = .03 ) Background Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence . Objectives To evaluate the effectiveness of pre-employment examinations of job applicants  in preventing occupational injury , disease and sickness absence compared to no intervention or alternative interventions . Search strategy We search ed CENTRAL ( The Cochrane Library ) , MEDLINE , EMBASE , CINAHL , PsycINFO and PEDro ( to December 2009 ) not restricted by date , language or publication type . Selection criteria We included r and omised controlled trials ( RCTs ) , controlled before-after studies ( CBA ) , and interrupted time-series ( ITS ) of health examinations to prevent occupational diseases and injuries in job applicants . Data collection and analysis Four review authors ( NM , ML , JV , ES ) independently selected studies , extracted data , and determined study quality . The studies were too heterogeneous for statistical pooling of results . Main results We included two RCTs , five CBA studies and two ITS .  Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process . Of those studies that evaluated the screening process , one study found that a general examination did not reduce sick leave ( Mean Difference -0.1 95 % CI -0.5 to 0.3 ) but another study found that a more task focused examination did ( MD -36 95 % CI -68.3 to -3.8 ) . One study found that incorporation of a bronchial challenge test decreased occupational asthma ( trend change -2.6 95 % CI -3.6 to -1.5 ) . Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits . The rates of rejecting job applicants varied from 2 % to 35 % . Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented . We rated the evidence for all outcomes as very low quality . Authors ' conclusions There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease , injury , or sickness absence . This supports the current policy to restrict pre-employment examinations to job-specific examinations . More studies are needed that take into account the harms of rejecting job applicants OBJECTIVE To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty . DESIGN R and omized , controlled , single-blind clinical trial . PARTICIPANTS A total of 142 total knee arthroplasty patients . METHODS Participants were r and omly assigned to receive either : ( i ) conventional out-patient physical therapy ; or ( ii ) interactive virtual telerehabilitation system . The main outcome was function assessed with active range of knee movement . Other variables , such as muscle strength , walk speed , pain and the Western Ontario and McMaster Universities osteoarthritis index , were also collected . Comparisons were made on the basis of data collected routinely before surgery , at the end of the rehabilitation programme , and at 3 months follow-up . Quantitative variables were compared by Mann-Whitney U test . The agreed alpha risk for all hypothesis testing was 0.05 . RESULTS Baseline characteristics between groups were comparable . All participants improved after the 2-week intervention on all outcome variables ( p < 0.05 ) . Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group . CONCLUSION A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy . Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty , especially for those patients who have difficulty with transportation to rehabilitation centres To test the hypothesis that educational information provided via the web would not only be accessed by our patients , but could also reduce postoperative pain  following ambulatory surgery , we enrolled 195 patients into a r and omized controlled study . Fifty-two percent of our ambulatory surgery patients already knew how to use and had access to the Internet . Eighty-five percent of our study patients accessed the re sources made available to them on the web site . Patients who had access to the pain management information on the ambulatory surgery web site reported significantly less postoperative pain on arrival to their home after surgery ( p < 0.016 ) and into the night after surgery ( p < 0.013 ) . These patients also reported significantly less postoperative pain for the day immediately following surgery ( p < 0.037 ) . We conclude that using the Internet to provide just-in-time patient education can significantly effect the clinical outcome of care PURPOSE : To describe and compare ambulatory orthopaedic surgery patients ' reported cost of care ( out-of-pocket costs , use of time , and consultations with healthcare organizations ) and nurses ' cost of care ( use of time and consultations with other professionals such as other nurses , physicians , and anesthesiologists ) when patients receive 2 different types of patient education ( Internet-based or face-to-face ) .  METHOD : Pretest/posttest design . SAMPLE : R and om assignment of all ambulatory orthopaedic surgery patients in a university hospital in Finl and . INTERVENTION : The experimental group received Web-based patient education and the control group received face-to-face patient education . OUTCOMES OF INTEREST : Financial and time costs . FINDINGS : Pre- , intra- , and postoperative costs did not differ between the groups . However , Internet-based education was more time-consuming for the patient and face-to-face education was more time-consuming for the nurse . There were no differences between the groups in patients ' use of consultations of healthcare professionals . Nurses ' consultations were few and did not differ between the groups . The small number of patients ' and nurses ' consultations indicates that patients in both education methods had enough knowledge to deal with the surgery HYPOTHESIS Patient safety and satisfaction are adversely affected when robotic videoconferencing ( telerounding ) is used in the postoperative setting . DESIGN R and omized controlled trial . SETTING Three academic institutions . PATIENTS A total of 270 adults undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours were r and omized to receive either traditional bedside rounds or robotic telerounds .  MAIN OUTCOME MEASURES The primary outcome measure was postoperative patient morbidity . Secondary outcomes were patient-reported satisfaction and hospital length of stay . Other variables assessed included demographics , procedure , operative time , estimated blood loss , and mortality . Patients also completed a vali date d satisfaction instrument 2 weeks after hospital discharge . RESULTS Patients were equally distributed based on the baseline demographic and operative measures . Morbidity rates were similar between the study arms ( st and ard rounds vs telerounds : 16 % vs 13 % ; P = .64 ) . Length of stay was similar in both arms ( st and ard rounds vs telerounds : 2.8 vs 2.8 days ; P = .94 ) . In addition , patient satisfaction was equivalently high in both arms of the study . CONCLUSIONS Robotic telerounds matched the performance of st and ard bedside rounds after urologic surgical procedures . Virtual visits did not result in missed or increased postoperative complications . Hospital length of stay and ratings of hospital satisfaction were on par with those for traditional rounding OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients In healthcare , pain assessment is a key factor in effectively treating postoperative pain and reducing the risk of developing chronic pain . The overall aim of this study was to investigate whether a mobile phone support system can be used as a basis to continuously document patients ' health information in real time and provide conditions for optimal , individual pain management after cholecystectomy and hysterectomy procedures .In this pilot study , two r and omly selected groups of patients provided information about their pain for one week postoperatively . One group responded via cell phones , and the other , a control group , responded using paper-based question naires . The mobile phone system was found to provide a fast and safe basis for reporting pain postoperatively in real time . The results indicate that on days 3 and 4 the mobile phone group reported significantly higher levels of pain than the control group , and the cholecystectomy patients reported significantly more pain at movement on days 3 and 4 than the hysterectomy patients .The mobile phone approach is an adaptation to modern technology and the mobility of individuals . This technology is user friendly and requires minimal support . However , as the sample size was small ( n = 37 ) , further studies are needed before additional conclusions can be drawn We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery ( total knee arthroplasty , TKA ) . Forty-eight patients ( mean age 66 years ) who received TKA were recruited prior to discharge from hospital after surgery and were r and omly assigned to telerehabilitation or usual care . Telerehabilitation sessions ( 16 per participant over two months ) were conducted by trained physiotherapists using videoconferencing to the patient 's home via an Internet connection ( 512 kbit/s upload speed ) . Disability and function were measured using st and ardized outcome measures in face-to-face evaluations at three times ( prior to and at the end of treatment , and four months after the end of treatment ) . Clinical outcomes improved significantly for all subjects in both groups between endpoints . Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group . Home telerehabilitation  is at least as effective as usual care , and has the potential to increase access to therapy in areas with high speed Internet services BACKGROUND Approximately 30 % of patients undergoing coronary artery bypass graft ( CABG ) procedures have diabetes and , as such , are at increased risk for postoperative complications and a lengthy recovery . OBJECTIVE To test the feasibility of an in-home early recovery management intervention to improve physical and psychosocial functioning in the diabetic CABG population . METHODS This pilot study was a 2-group , r and omized , experimental study . The 6-week in-home early recovery intervention was delivered by way of a device called the Health Buddy ( Health Hero Network , Redwood City , CA ) . Subjects were 49 diabetic patients who had undergone a first-time CABG procedure .  RESULTS Although no statistical differences between groups were found , descriptively , the intervention group 's baseline means on Medical Outcomes Study Short Form-36 subscales measuring physical functioning were lower but improved to levels comparable with that of the control group . Improvements in psychosocial functioning were comparable between the 2 groups . CONCLUSION This in-home telehealth intervention may have promise for improving functioning outcomes in high-risk CABG patients with diabetes . However , weaknesses of the intervention and the need for a more focused , directive intervention were identified OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND For economic reasons , i.e. , to reduce costs of in-hospital patient accommodations , constant pressure has been applied in recent years to increase the percentage of ambulatory surgeries . Effective control of post-operative pain after ambulatory surgery is challenging to all health professionals . Computerised systems are being implemented more frequently for remote patient monitoring , including during the at-home post-operative period . OBJECTIVE This study evaluates the feasibility of delivering a computerised system , developed in-house , for remote pain monitoring . It evaluates the user-friendliness of the system and the extent of patient compliance . Finally , a comparative assessment of the system is made with respect to the quality of pain treatment in ambulatory surgery . METHODS The participants included 32 adults , aged 18 - 75 , r and omly assigned to a control group or to a computerised treatment group .  The primary treatment outcome was measured by pain intensity ratings ( 0 - 10 NRS ) reported several times per day during a five-day monitoring period , using an electronic pain diary combined with a web-based personal health record . RESULTS AND CONCLUSIONS The findings demonstrated the feasibility and suitability of the proposed system for pain management . Its h and ling was user-friendly , without requiring advanced skill or prior experience . In addition , the results showed that the guidance of health care professionals is essential to patients ' satisfaction and positive experience with the system . There were no significant group differences with respect to improvements in the quality of pain treatment ; however , this can be explained by the low pain scores registered in both groups , related to the type of surgical interventions recruited and the degrees of pain that are easily treated . To evaluate the benefits from a patient-centred perspective , studies of major ambulatory surgeries or of patients in chronic pain , including oncologic and non-oncologic pain resistant to treatment , are necessary OBJECTIVE Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery ( CABS ) . The study objective was to determine whether a 6-week early recovery telehealth intervention , design ed to improve self-efficacy and management related to symptoms after CABS , was effective in improving outcomes ( physical activity , physiologic , and psychologic functioning ) for older adults ( aged > 65 years ) with higher disease burden . METHODS A descriptive , repeated- measures experimental design was used . Follow-up data were collected at 3 and 6 weeks and 3 months after CABS . Subjects were drawn from a larger r and omized clinical trial . Parent study subjects who had high disease burden preoperatively ( physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6 ) were included ( N = 55 ) , with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group ( n = 31 ) . Subjects ranged in age from 65 to 85 years ( M = 71.6 + 5.1 years ) . RESULTS There was a significant main effect by group ( F[1,209 ] = 4.66 , P < .05 ) . The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer ( Stayhealthy , Inc , Monrovia , CA ) . Both groups had significantly improved physical ( F[2,171 ] = 3.26 , P < .05 ) and role-physical ( F[2,171 ] = 6.64 , P < .005 ) functioning over time . CONCLUSION The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention . Improving patients '  physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events Scheduled surgery can often be a stressful time for patients . While anesthesia providers give a full explanation of care to the patient , research suggests that anxiety and time constraints imposed by the system may hinder the amount and quality of information provided . Use of technology to augment dissemination of information may have an impact . The purpose of this study was to determine the impact of a website on : ( 1 ) preoperative patient education , ( 2 ) patient anxiety , and ( 3 ) patient satisfaction with anesthesia care . The week prior to surgery , 64 ASA class I and II subjects at a 350-bed urban university affiliated hospital completed a  demographic question naire , State Trait Anxiety Inventory ( STAI ) and modified St and ard Anesthesia Learning Test ( mSALT )  , and the experimental group was given website information . On the day of surgery , all subjects completed the STAI and mSALT . Before discharge , subjects rated satisfaction . The experimental group had a significant increase in posttest mSALT scores ( P = .004 ) . Neither the experimental nor the control group had a significant change in posttest state anxiety ( P = .279 and .762 ) or trait anxiety ( P = .823 and .570 ) . The experimental group differed significantly from the control group in satisfaction with teaching ( P = .019 ) The purpose of this pilot study was to test the impact of a symptom management intervention ( using a device called the Health Buddy ) on recovery outcomes ( symptom evaluation and response and postoperative problems ) of elderly coronary artery bypass graft patients at time of discharge , at 2 , 4 , and 6 weeks after surgery , and at 6 months after surgery . While there were no statistically significant differences found for many of the study variables , there were trends in the intervention group of more improvement for many of the outcome variables , supporting the need for a r and omized clinical trial OBJECTIVE The purpose of this study is to determine the impact of a home communication intervention ( HCI ) for ischemic heart failure Coronary Artery Bypass Graft ( CABG ) patients > /= 65 years of age on self-efficacy , coronary artery disease risk factor modification and functioning posthospitalization . DESIGN A r and omized clinical trial with repeated measures was used . SAMPLE A sub sample of ischemic heart failure CABG surgery patients ( n = 35 ) was drawn from the parent study of 180 CABG patients . RESULTS HCI participants ( n = 18 ) had significantly higher adjusted mean self-efficacy scores [ F(1 , 29 ) = 6.40 , P < .05 ] and adjusted mean levels of functioning ( physical , general health , mental , and vitality functioning ) compared with the routine care group ( n = 17 ) , using repeated measures analysis of covariance with baseline scores as covariates . There were also significant effects of time on bodily pain and role emotional functioning . Significantly higher exercise adherence ( t = 3.09 , P < .01 ) and lower reported stress ( t = 3.77 , P < .01 ) at 3 months after surgery was reported by HCI subjects . CONCLUSIONS Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients Abstract . Background : Teleconsultation services have the potential to improve the communication among different medical care providers and between them and the patient . Increasing effectiveness in the shape of a savings in time or cost is often the result of better communication . Methods : A study was performed in order to demonstrate the feasibility of  teleconsultation services  , using the perioperative management of cataract patients as an example , and to provide data on the quality , acceptance and effectiveness of these services in comparison with a control group experiencing normal treatment . Results : Over a period of 3 months 42 patients of the teleconsultation group and 20 controls were studied . There were two referring ophthalmologists and three surgeons . The teleconsultation group had one consultation fewer with the ophthalmic surgeon because of the teleconsultation service . Patient satisfaction was slightly higher using the new technology . Patients would like to see this technique used again should surgery on the second eye become necessary . Conclusions : Teleconsultation services are ready to support and improve perioperative cataract management . Patients ' confidence in their medical treatment was increased by using teleconsultation services . Physicians will exp and the use of teleconsultation BACKGROUND Preoperative patient education is an important part of the informed consent process , and a perceived lack of information can lower patient satisfaction . We sought to evaluate the effect of a web-based multimedia patient education tool on the perioperative experience of patients undergoing first-time knee arthroscopy for a meniscal tear . METHODS Adult patients undergoing knee arthroscopy for the first time for a primary diagnosis of a meniscal tear were consecutively enrolled into the study from January 2014 through June 2014 . Patients were equally r and omized to a control group , who received st and ard preoperative counseling , or the intervention group , who completed a twenty-minute web-based multimedia tutorial in addition to st and ard counseling . The web-based tutorial covered relevant anatomy , pathology , and general perioperative instructions , and it was completed prior to the preoperative visit . Patients completed surveys that evaluated their preparedness for surgery and knowledge recall at the preoperative visit , on the day of surgery , and after the first postoperative visit . RESULTS Sixty-four patients were enrolled , and fifty-five patients ( 86 % ; twenty-nine in the control group and twenty-six in the intervention group ) with complete data sets were included in the analysis . Preoperatively , the intervention group felt significantly more informed about the surgery and more clearly understood the risks and benefits of , and alternatives to , the surgery ( all p < 0.001 ) . Postoperatively , the intervention group reported being significantly more satisfied with the perioperative education that they had received and felt more informed about their surgery and rehabilitation ( p ≤ 0.05 ) . Patients in the intervention group were significantly more likely to correctly answer questions regarding their surgical details at the first postoperative visit ( p ≤ 0.03 ) . CONCLUSIONS Patients who completed the web-based tutorial had improved preoperative knowledge and preparedness as well as enhanced postoperative knowledge recall regarding their surgical procedure . The tutorial received high user satisfaction scores with low user burden scores and was an effective tool for enhancing the patients ' perioperative experience Background Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty ( TKA ) . As dem and s for rehabilitation at home are growing and becoming more difficult to meet , in-home telerehabilitation has been proposed as an alternate service delivery method . However , there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation . Objective The objective of this study was to document , analyze , and compare real costs of two service delivery methods : in-home telerehabilitation and conventional home visits . Methods The economic analysis was conducted as part of a multicenter r and omized controlled trial ( RCT ) on telerehabilitation for TKA , and involved data from 197 patients , post-TKA . Twice a week for 8 weeks , participants received supervised physiotherapy via two delivery methods , depending on their study group allocation : in-home telerehabilitation ( TELE ) and home-visit rehabilitation ( VISIT ) . Patients were recruited from eight hospitals in the province of Quebec , Canada . The TELE group intervention was delivered by videoconferencing over high-speed Internet . The VISIT group received the same intervention at home . Costs related to the delivery of the two services ( TELE and VISIT ) were calculated . Student ’s t tests were used to compare costs per treatment between the two groups . To take distance into account , the two treatment groups were compared within distance strata using two-way analyses of variance ( ANOVAs ) . Results The mean cost of a single session was Can $ 93.08 for the VISIT group ( SD $ 35.70 ) and $ 80.99 for the TELE group ( SD $ 26.60 ) . When comparing both groups , real total cost analysis showed a cost differential in favor of the TELE group ( TELE minus VISIT : -$263 , 95 % CI -$382 to -$143 ) . However , when the patient ’s home was located less than 30 km round-trip from the health care center , the difference in costs between TELE and VISIT treatments was not significant ( P=.25 , .26 , and .11 for the < 10 , 10 - 19 , and 20 - 29 km strata , respectively ) . The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more ( 30 - 49 km : $ 81<$103 , P=.002 ; ≥50 km : $ 90<$152 , P<.001 ) . Conclusions To our knowledge , this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient ’s home . The cost for a single session of  in-home telerehabilitation  compared to conventional home-visit rehabilitation was lower or about the same , depending on the distance between the patient ’s home and health care center . Under the controlled conditions of an RCT , a favorable cost differential was observed when the patient was more than 30 km from the provider . Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic . Trial Registration International St and ard Registered Clinical Study Number ( IS RCT N ) : 66285945 ; http://www.is rct n.com/IS RCT N66285945 ( Archived by WebCite at http://www.webcitation.org/6WlT2nuX4 ) Background Most adults undergoing cardiac surgery suffer from moderate to severe pain for up to 6 days after surgery . Individual barriers and attitudes regarding pain and its relief make patients reluctant to report their pain and ask for analgesic medication , which results in inadequate pain management . More innovative educational interventions for postoperative pain relief are needed . We developed a Web-based nursing intervention to influence patient ’s involvement in postoperative pain management . The intervention ( SOULAGE-TAVIE ) includes a preoperative 30-minute Web-based session and 2 brief face-to-face postoperative booster sessions . The Web application generates reflective activities and tailored educational messages according to patients ’ beliefs and attitudes . The messages are transmitted through videos of a virtual nurse , animations , stories , and texts . Objective The aim of this single-blinded pilot r and omized trial was to investigate the preliminary effects of a virtual nursing intervention ( SOULAGE-TAVIE ) to improve pain relief in patients undergoing cardiac surgery . Methods Participants ( N = 60 ) were adults scheduled for their first cardiac surgery . They were r and omly assigned to the experimental group using SOULAGE-TAVIE ( n = 30 ) or the control group using usual care , including an educational pamphlet and postoperative follow-up ( n = 30 ) . Data were collected through question naires at the time of admission and from day 1 to day 7 after surgery with the help of a blinded research assistant . Outcomes were pain intensity , pain interference with daily activities , patients ’ pain barriers , tendency to catastrophize in face of pain , and analgesic consumption . Results The two groups were comparable at baseline across all demographic measures . Results revealed that patients in the experimental group did not experience less intense pain , but they reported significantly less pain interference when breathing/coughing ( P = .04 ) . A severe pain interference with breathing/coughing ( pain ranked ≥ 7/10 ) was reported on day 3 after surgery by 15 % of the patients in the experimental group ( 4/27 ) , as compared to 44 % ( 7/16 ) in the control group . On day 7 after surgery , participants in the experimental group also exhibited fewer pain-related barriers as measured by the Barriers Question naire-II ( mean 10.6 , SD 8.3 ) than patients in the control group ( mean 15.8 , SD 7.3 , P = .02 ) . No difference was found for pain catastrophizing . However , in both groups , means revealed a lower tendency to catastrophize pain before surgery as measured by the Pain Catastrophizing Scale ( control group mean 1.04 , SD 0.74 ; experimental group mean 1.10 , SD 0.95 ) and after surgery ( control group mean score 1.19 , SD 0.94 ; experimental group mean score 1.08 , SD 0.99 ) . Finally , the experimental group consumed more opioid medication ( mean 31.2 mg , SD 23.2 ) than the control group ( mean 18.8 mg , SD 15.3 , P = .001 ) . Conclusions This pilot study provides promising results to support the benefits of this new Web-tailored approach that can increase accessibility to health education and promote pain relief without generating more costs . Trial Registration Clinical trials.gov NCT01084018 ; http://www . clinical trials.gov/ct2/show/NCT01084018 ( Archived by WebCite ® at http://www.webcitation.org/6CoTBkIoT The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice OBJECTIVE To provide a detailed description of post-herniorrhaphy convalescence . DESIGN Prospect i ve , descriptive , consecutive question naire case series . SETTING Public university hospital , Denmark . PATIENTS 100 consecutive patients treated for inguinal hernia . INTERVENTION Elective open inguinal herniorrhaphy under local anaesthesia . One day convalescence for light/moderate and three weeks for strenuous physical activity was recommended . MAIN OUTCOME MEASURE Duration of absence from work or main recreational activity . RESULTS Overall median absence ( including the day of operation ) was 6 days ( interquartile range 1 - 16 ) . For unemployed patients it was 1 day ( 0 - 7 ) , for patients with a light or moderate workload 6 days ( 3 - 12 ) , and for those with a heavy workload 25 days ( 21 - 37 ) . Among the 64 patients , who did not follow the recommendations , pain was contributory in 33 and advice from the general practitioner in 12 . Pain was the main cause of impairment of activities of daily living . CONCLUSION Well-defined recommendations for convalescence may , together with improved management of postoperative pain , shorten convalescence ; they are essential in the evaluation of effects of different surgical techniques of herniorrhaphy on convalescence BACKGROUND Technologic advances in communications have facilitated the development and diffusion of telemedicine . Most applications have focused on remote outpatient management of medical conditions . We assessed the impact of introducing remote video conferencing during the immediate postoperative period ( telerounds ) on patient-reported satisfaction with their hospitalization . STUDY DESIGN Between October 2002 and June 2003,85 patients undergoing elective laparoscopic or percutaneous urologic procedures were enrolled in a trial testing the impact of telerounds on patients ' satisfaction with their hospitalization . Participants were entered into one of three postoperative care arms : st and ard once-daily attending bedside rounds ; st and ard once-daily attending level bedside rounds plus one afternoon telerounding visit ; or a substitution of one daily bedside round with a robotic telerounding visit . Participants completed a vali date d patient satisfaction survey 2 weeks after hospital discharge . RESULTS Eighty-five individuals ( 100 % response rate ) completed the question naire . With responses dichotomized to " excellent " or " other , " patients in the telerounding arm demonstrated statistically substantial improvements in ratings of examination thoroughness , quality of discussion s about medical information , postoperative care coordination , and attending physician availability . Patients in the robotic telerounding arm indicated considerably higher satisfaction with regard to physician availability . After adjusting for age differences , ratings of each of the previously listed aspects of care remained notably improved in the telerounding arm . CONCLUSIONS Telerounding either as an additional visit or as a substituted bedside visit is associated with increased patient satisfaction in postoperative care . This type of interaction appears to acceptably facilitate physician communication with hospitalized patients OBJECTIVE The study objective was to examine the effect of a symptom management ( SM ) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients ( aged > 65 years ) after coronary artery bypass surgery ( CABS ) by group ( SM intervention group and usual care group ) . METHODS A r and omized clinical trial design was used . The study was conducted in 4 Midwestern tertiary hospitals . The 6-week SM telehealth intervention was delivered by the Health Buddy ( Health Hero Network , Palo Alto , CA ) . Measures included Modified  7-Day Activity Interview , RT3 accelerometer  ( Stayhealthy , Inc , Monrovia , CA ) , physical activity and exercise diary , Medical Outcomes Study Short-Form 36 , and subjects ' self-report and provider records of health care use . Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS . RESULTS Subjects ( N = 232 ) had a mean age of 71.2 ( + 4.7 ) years . There were no significant interactions using repeated- measures analyses of covariance . There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer , with the usual care group having a higher estimated energy expenditure . Both groups had significant improvements over time for role-physical , vitality , and mental functioning . Both groups had similar health care use . CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity . Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted BACKGROUND Despite known gender differences in recovery , few studies have examined symptom management ( SM ) interventions or responses by gender after coronary artery bypass surgery ( CABS ) . OBJECTIVE The purpose of this sub analysis was to describe and evaluate differences in response by gender to an SM intervention on the presence and burden of symptoms , physical activity , and physical functioning in elderly CABS patients during the early discharge period ( 3 and 6 weeks after CABS , and 3 and 6 months after CABS ) . METHODS The parent study whose data were analyzed to examine gender differences involved a two-group , r and omized clinical trial design . The 6-week early recovery SM telehealth intervention was delivered by the Health Buddy . Measures included the  Cardiac Symptom Survey , a Modified 7-Day Activity Interview , an RT3 accelerometer , an Activity Diary , and the Medical Outcomes Study Short Form 36 . This study was not powered for a gender × group analysis , and we used descriptive statistics , χ(2 ) tests , t tests , and analysis of variance for statistical analyses . RESULTS Subjects ( n = 232 ) included 192 men and 40 women , with a mean age of 71.2 SD , 7 years . The intervention group consisted of 86 men and 23 women , and the usual care ( UC ) group consisted of 106 men and 17 women . Data trends suggest that the SM intervention exerted greater impact on women than on men for symptoms such as fatigue , depression , sleep problems , and pain . Again , men exhibited higher levels of physical activity than did women . However , women in the SM group generally had higher scores than did women in the UC group . CONCLUSION Although the parent study found no effect of an early recovery SM intervention , this exploratory secondary analysis indicated that women in the intervention group demonstrated more improvement in measures of physical activity than did those in the UC group . Further study , using a larger sample , is necessary to test these preliminary results Our aim was to prove the feasibility and safety of a protocol for early and protected discharge 1 day after carotid endarterectomy ( CEA ) using a system of telemedicine ( TMD ) monitoring . Among 147 patients operated upon for 163 CEAs , we selected a group ( A ) of 36 patients fulfilling criteria for discharge 1 day after surgery . An electronic blood pressure manometer , a videophone , an antihypertensive drug ( amlodipine ) , and a customer satisfaction question naire were given to every group A patient . With a video-communication program linked to the Web , we monitored every 4 hours ( from 8:00 a.m. to 8:00 p.m. ) for 2 days the surgical wound , blood pressure , and heart frequency of the patients . Other patients were included in group B. No differences regarding demographic characteristics , risk factors , carotid lesions , operative time , postoperative complications , or blood loss were noted between group A and group B. Twenty-one patients in group A were actually discharged 1 day after surgery . No cervical hematoma developed . Three hypertensive crises were treated successfully in group A. From the question naire a feeling of insecurity at discharge emerged , but it rapidly resolved . The overall cost of video connections was 25.39 + /- 0.25 Euros per patient . CEA can be safely done as 1-day surgery using a TMD monitoring system in selected cases . Our protocol allowed early discharge safely , leading to reduced hospital costs Aim . This study determined the usefulness of an interactive , individualized online patient pathway to patients undergoing elective operation for nonmalignant disease . Methods . An exploratory double-blind , prospect i ve r and omized controlled trial was established involving consecutive patients undergoing minimally invasive radioguided parathyroidectomy ( MIRP ) .  A total of 64 patients were r and omly assigned to either a st and ard or an enhanced Web site ( interactive with detailed , personalized timeline ) . Each patient completed vali date d Hospital Anxiety and Depression Scale question naires preoperatively and pain assessment s and question naires concerning Web site usefulness postoperatively . Results . All patients found their Web site useful , although patient satisfaction was significantly higher with the enhanced Web site in regard to overall impression as well as ease , organization , usefulness , and specificity of information . There were no significant differences in mean anxiety or pain scores , in analgesia requirements , or adequacy of informed consent . Conclusion . Providing education and information through a tailored Web server is viewed positively by patients PURPOSE Patients receiving cancer-related thoracotomy  are highly symptomatic in the first weeks after surgery . This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control . PATIENTS AND METHODS We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm r and omized controlled trial ; 79 patients completed the study . After hospital discharge , patients rated symptoms twice weekly for 4 weeks via automated telephone calls . For intervention group patients , an e-mail alert was forwarded to the patient 's clinical team for response if any of a subset of symptoms ( pain , disturbed sleep , distress , shortness of breath , or constipation ) reached a predetermined severity threshold . No alerts were generated for controls . Group differences in symptom threshold events were examined by generalized estimating equation modeling . RESULTS The intervention group experienced greater reduction in symptom threshold events than did controls ( 19 % v 8 % , respectively ) and a more rapid decline in symptom threshold events . The difference in average reduction in symptom interference between groups was -0.36 ( SE , 0.078 ; P = .02 ) . Clinicians responded to 84 % of e-mail alerts . Both groups reported equally high satisfaction with the automated system and with postoperative symptom control . CONCLUSION Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery . Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery . These results should be confirmed in a larger study
Background E-health interventions have become increasingly popular , including in perioperative care .
The objective of this study was to evaluate the effect of perioperative e-health interventions on the postoperative course .