scholarly journals Improving Provision of Preanesthetic Information Through Use of the Digital Conversational Agent “MyAnesth”: Prospective Observational Trial

10.2196/20455 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e20455
Author(s):  
Fabrice Ferré ◽  
Nicolas Boeschlin ◽  
Bruno Bastiani ◽  
Adeline Castel ◽  
Anne Ferrier ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Care Pathway ◽  
Phase 1 ◽  
Real Life ◽  
Added Value ◽  
Control Group ◽  
Conversational Agent ◽  
Before And After ◽  
Perioperative Care Pathway ◽  
Time Limitations

Background Due to time limitations, the preanesthetic consultation (PAC) is not the best time for patients to integrate information specific to their perioperative care pathway. Objective The main objectives of this study were to evaluate the effectiveness of a digital companion on patients' knowledge of anesthesia and their satisfaction after real-life implementation. Methods We conducted a prospective, monocentric, comparative study using a before-and-after design. In phase 1, a 9-item self-reported anesthesia knowledge test (Delphi method) was administered to patients before and after their PAC (control group: PAC group). In phase 2, the study was repeated immediately after the implementation of a digital conversational agent, MyAnesth (@+PAC group). Patients’ satisfaction and their representations for anesthesia were also assessed using a Likert scale and the Abric method of hierarchized evocation. Results A total of 600 tests were distributed; 205 patients and 98 patients were included in the PAC group and @+PAC group, respectively. Demographic characteristics and mean scores on the 9-point preinformation test (PAC group: 4.2 points, 95% CI 3.9-4.4; @+PAC: 4.3 points, 95% CI 4-4.7; P=.37) were similar in the two groups. The mean score after receiving information was better in the @+PAC group than in the PAC group (6.1 points, 95% CI 5.8-6.4 points versus 5.2 points, 95% CI 5.0-5.4 points, respectively; P<.001), with an added value of 0.7 points (95% CI 0.3-1.1; P<.001). Among the respondents in the @+PAC group, 82% found the information to be clear and appropriate, and 74% found it easily accessible. Before receiving information, the central core of patients’ representations for anesthesia was focused on the fear of being put to sleep and thereafter on caregiver skills and comfort. Conclusions The implementation of our digital conversational agent in addition to the PAC improved patients' knowledge about their perioperative care pathway. This innovative audiovisual support seemed clear, adapted, easily accessible, and reassuring. Future studies should focus on adapting both the content and delivery of a digital conversational agent for the PAC in order to maximize its benefit to patients.

scholarly journals Improving Provision of Preanesthetic Information Through Use of the Digital Conversational Agent “MyAnesth”: Prospective Observational Trial (Preprint)

2020 ◽  
Author(s):  
Fabrice Ferré ◽  
Nicolas Boeschlin ◽  
Bruno Bastiani ◽  
Adeline Castel ◽  
Anne Ferrier ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Care Pathway ◽  
Phase 1 ◽  
Real Life ◽  
Added Value ◽  
Control Group ◽  
Conversational Agent ◽  
Before And After ◽  
Perioperative Care Pathway ◽  
Time Limitations

BACKGROUND Due to time limitations, the preanesthetic consultation (PAC) is not the best time for patients to integrate information specific to their perioperative care pathway. OBJECTIVE The main objectives of this study were to evaluate the effectiveness of a digital companion on patients' knowledge of anesthesia and their satisfaction after real-life implementation. METHODS We conducted a prospective, monocentric, comparative study using a before-and-after design. In phase 1, a 9-item self-reported anesthesia knowledge test (Delphi method) was administered to patients before and after their PAC (control group: PAC group). In phase 2, the study was repeated immediately after the implementation of a digital conversational agent, MyAnesth (@+PAC group). Patients’ satisfaction and their representations for anesthesia were also assessed using a Likert scale and the Abric method of hierarchized evocation. RESULTS A total of 600 tests were distributed; 205 patients and 98 patients were included in the PAC group and @+PAC group, respectively. Demographic characteristics and mean scores on the 9-point preinformation test (PAC group: 4.2 points, 95% CI 3.9-4.4; @+PAC: 4.3 points, 95% CI 4-4.7; <i>P</i>=.37) were similar in the two groups. The mean score after receiving information was better in the @+PAC group than in the PAC group (6.1 points, 95% CI 5.8-6.4 points versus 5.2 points, 95% CI 5.0-5.4 points, respectively; <i>P</i>&lt;.001), with an added value of 0.7 points (95% CI 0.3-1.1; <i>P</i>&lt;.001). Among the respondents in the @+PAC group, 82% found the information to be clear and appropriate, and 74% found it easily accessible. Before receiving information, the central core of patients’ representations for anesthesia was focused on the fear of being put to sleep and thereafter on caregiver skills and comfort. CONCLUSIONS The implementation of our digital conversational agent in addition to the PAC improved patients' knowledge about their perioperative care pathway. This innovative audiovisual support seemed clear, adapted, easily accessible, and reassuring. Future studies should focus on adapting both the content and delivery of a digital conversational agent for the PAC in order to maximize its benefit to patients.

scholarly journals Chiasmal herniation following treatment of pituitary macroadenoma

Pituitary ◽  
2020 ◽  
Author(s):  
Marjolein Tabak ◽  
Iris C. M. Pelsma ◽  
Mark C. Kruit ◽  
Wouter R. van Furth ◽  
Nienke R. Biermasz ◽  
...  
Keyword(s):  
Tumour Size ◽  
Severity Index ◽  
Optic Chiasm ◽  
Added Value ◽  
Control Group ◽  
Mean Deviation ◽  
Pituitary Macroadenoma ◽  
Mri Findings ◽  
Before And After ◽  
Group 2

Abstract Purpose To evaluate whether the occurrence of chiasmal herniation coincides with visual field (VF) deterioration and to compare the course of VF defects in patients with and without radiological chiasmal herniation following treatment of pituitary adenoma. Methods This retrospective cohort study included 48 pituitary macroadenoma patients with chiasm compression, divided into three groups: Group 1 (N = 12), downward displaced optic chiasm and deteriorated VFs; Group 2 (N = 16), downward displaced optic chiasm; Group 3 (N = 20), control-group matched for tumour size and follow-up VFs, in mean deviation (dB). VFs were compared over time and a severity index, Chiasm Herniation Scale (CHS), for herniation based on radiological parameters was designed. Results After treatment, all groups showed improvement of VFs (Gr1: 2.97 dB p = 0.097, Gr2: 4.52 dB p = 0.001 and Gr3: 5.16 dB p = 0.000), followed by long-term gradual deterioration. The course of VFs between patients with and without herniation was not significantly different (p = 0.143), neither was there a difference in the course before and after herniation (p = 0.297). The median time till onset of herniation was 40 months (IQR 6 month-10 years) and did not significantly differ (p = 0.172) between the groups. There was no relation between VFs and the degree of herniation (p = 0.729). Conclusion Herniation does not appear to have clinical relevance with respect to VF outcome. The newly designed CHS is the first scoring system to quantify the severity of herniation and, in the absence of alternatives, may be useful to describe MRI findings to serve future added value in larger sized outcome studies.

scholarly journals 8 Positive Distraction Entertainment System (PDES) in Paediatric Population Undergoing Day Surgery

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e3-e3
Author(s):  
Michael Chang ◽  
Alicia Fernandes ◽  
Alexandra Frankel
Keyword(s):  
Virtual Reality ◽  
Separation Anxiety ◽  
Pediatric Population ◽  
Phase 1 ◽  
Paediatric Population ◽  
Day Surgery ◽  
Control Group ◽  
Phase 2 ◽  
Before And After ◽  
Experience Survey

Abstract Background Patients undergoing procedures at hospitals may experience anxiety and such anxiety can be heightened in pediatric populations. Anxiety can invoke a physical and mental stress response leading to poorer health outcomes and in children these outcomes include: resistance to treatment, nightmares, longer recovery periods, lowered pain thresholds and separation anxiety (Biddis, 2014; Manyande 2015; Aydın 2017). Objectives This study aimed to test whether a virtual reality intervention is feasible, beneficial and effective in reducing anxiety prior to surgery in the pediatric population of Scarborough Health Network. Design/Methods Virtual Reality (VR) is a computer technology that simulates a user’s physical presence in a virtual or imaginary environment. ‘Bubble Bloom’, an underwater fishing game where participants launch bubbles to catch colourful fish, is the VR game that the children are administered in a two phased research design to explore whether the VR intervention was a beneficial tool in reducing anxiety in our pediatric population. Phase 1 was a trial phase in which participants (n=20) were administered the condensed version of the State Trait Anxiety Scale before and after the intervention to determine if anxiety levels had been reduced. Participants were also administered an experience survey to explore patient satisfaction, headset comfort, and virtual reality satisfaction. Phase 2, randomized control trial, is currently ongoing with the same measures and VR intervention being administered. In Phase 2, participants are randomized to the control group (regular play activities) or intervention (virtual reality game). Results In Phase 1, all participants indicated they enjoyed the experience of the virtual reality intervention. Sixteen of the 20 participants had pre scores that were in the mild to moderate anxiety range (80%). Of these 16 participants, 10 participants’ post scores decreased to the normal or no anxiety range (63%). Additionally, 80% of participants demonstrated a reduction in anxiety post-virtual reality intervention. Conclusion Phase 1 results were encouraging with 80% of participants experiencing a reduction in anxiety and all participants enjoying the virtual reality experience.

Assessing and preparing patients with medical conditions for major surgery

2020 ◽  
pp. 3860-3866
Author(s):  
Tom Abbott ◽  
Rupert Pearse
Keyword(s):  
Chronic Disease ◽  
Hospital Discharge ◽  
Perioperative Care ◽  
Care Pathway ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Major Surgery ◽  
Clinical Approach ◽  
Perioperative Care Pathway ◽  
Robust Evidence

The assessment of patients before surgery is complex. However, since surgery is offered to increasing numbers of patients with multiple comorbidities, the demand for comprehensive preoperative assessment is expected to increase. Perioperative medicine provides a patient-centred approach from preoperative assessment through to hospital discharge and beyond. Preoperative assessment serves to identify comorbidity that may require optimization before surgery, plan perioperative care, identify a need for a non-standard anaesthetic technique, assess functional reserve, brief patients on the perioperative care pathway, and provide an opportunity to have questions answered. There are a variety of tools for preoperative assessment and recognized approaches to managing patients with existing chronic disease during the perioperative period, but the absence of robust evidence to favour any particular clinical approach is striking.

A Multidisciplinary Perioperative Care Pathway for Interstitial Gynecologic Brachytherapy

Brachytherapy ◽  
2015 ◽  
Vol 14 (1) ◽  
pp. 91-92
Author(s):  
Alison A. Nielsen ◽  
Tehani A. Liyanage ◽  
Gary S. Leiserowitz ◽  
Jyoti S. Mayadev
Keyword(s):  
Perioperative Care ◽  
Care Pathway ◽  
Perioperative Care Pathway

Street Crossing by Typically Developed Children in Real and Virtual Environments

2008 ◽  
Vol 28 (2) ◽  
pp. 89-96 ◽  
Author(s):  
Orit Bart ◽  
Noomi Katz ◽  
Patrice L. Weiss ◽  
Naomi Josman
Keyword(s):  
Virtual Reality ◽  
Low Cost ◽  
Real Life ◽  
Training Group ◽  
After School ◽  
Control Group ◽  
The Real ◽  
Street Crossing ◽  
Before And After ◽  
Serious Injury

Independent street crossing is a necessary skill for children to have so they can engage in different occupations and complete tasks such as arriving at school or after-school activities. Without the appropriate opportunities to practice and master street crossing, children's participation will be incomplete and they will not be able to attain their physical, emotional, and intellectual potentials. Training children in safe street crossing is especially important because pedestrian injury is the second leading cause of death and serious injury among children between 5 and 14 years old. The existing methods for teaching children how to cross a street safely are difficult to transfer to real-life situations. The purpose of the current study was to evaluate the effectiveness of a virtual reality environment in teaching children how to cross a street safely. Eighty-six typical children (55 girls and 31 boys) between 7 and 12 years old participated in the study. The children who failed the virtual reality test were randomly assigned to training and control groups. The children were observed while crossing a real street and tested within the virtual environment both before and after the virtual reality training. Results indicate that children in the training group significantly improved their street crossing abilities in both the virtual reality simulation and the real street crossing in comparison to the control group. Street crossing became safer with increasing age, but no differences were found between boys and girls. This low-cost and readily available street crossing simulation had a positive effect on children's street crossing behavior in the real environment and on their self-reported satisfaction. These results provide support for the potential of training in a virtual street crossing simulation to transfer to actual street crossing.

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