The Feasibility of a Health Care Application in the Treatment of Patients Undergoing Radical Cystectomy
The Feasibility of a Health Care Application in the Treatment of Patients Undergoing Radical Cystectomy
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DOI：
10.1097/ju.0000000000000050
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发表时间：
2019-05-01
影响因子：
6.6
通讯作者：
Lee, Eugene K.
中科院分区：
文献类型：
--
作者：
Metcalf, Meredith;Glazyrine, Vassili;Lee, Eugene K.
目的：膀胱癌根治性膀胱切除术患者发生并发症和再入院的风险较高。研究表明术前教育和围手术期监测不足。本研究的目的是证明实施医疗保健应用程序的可行性，以提供更多的患者教育和更彻底的围手术期监测。材料和方法：接受根治性膀胱切除术的家庭Wi-Fi接入的参与者被招募参加这项试点试验。每位受试者获得预装m.Care （LifeScience Technologies, Leawood, Kansas）医疗保健应用程序的平板电脑、加速度计和生命体征设备。参与者被要求观看教育视频，使用提供的加速度计，并进行生命体征监测。结果：在1年的时间里，20名参与者参加了研究，15名参与者完成了研究。观看次数最多的视频是“回肠导管与新膀胱”和“综合护理途径”。所有参与者都使用了加速度计，60%的人定期同步数据。术前平均步数为5679步，反映了久坐人群。步数在住院期间减少（1,351步），并在术后期间趋于基线（3,156步）。在85%的指定天数记录生命体征，并产生33个干预触发器。虽然大多数诱因导致重复评估、教育和鼓励，但4名参与者接受了门诊治疗，包括培养、静脉输液、抗生素或大麻酚处方，而无需再次住院。结论：采用卫生保健应用程序进行围手术期教育和监护是可行的。测试是必要的，以确定在何种程度上实施将改善患者分诊和减少再入院。
Purpose: Patients who undergo radical cystectomy of bladder cancer are at high risk for complications and hospital readmissions. Studies indicate insufficient preoperative education and perioperative monitoring. The aim of this study was to demonstrate the feasibility of implementing a health care application to provide more patient education and more thorough monitoring perioperatively.Materials and Methods: Participants with home Wi-Fi access who were undergoing radical cystectomy were recruited for this pilot trial. Each subject was provided a tablet preloaded with the m.Care (LifeScience Technologies, Leawood, Kansas) health care application, an accelerometer and vital sign equipment. Participants were asked to watch educational videos, use the provided accelerometer and perform vital sign monitoring.Results: In 1 year 20 participants enrolled in the study and 15 completed it. The most frequently viewed videos were "Ileal Conduit versus Neobladder" and "Comprehensive Care Pathway." All participants used the accelerometer and 60% kept up with syncing the data regularly. The average step count preoperatively was 5,679 reflecting a sedentary population. Step counts decreased during the inpatient stay (1,351 steps) and trended toward baseline during the postoperative period (3,156 steps). Vital signs were recorded on 85% of assigned days and generated 33 triggers for intervention. While most triggers led to repeat assessment, education and encouragement, 4 participants underwent outpatient treatment, including cultures, intravenous fluids, antibiotics or dronabinol prescription, without the need for hospital readmission.Conclusions: Providing more education and monitoring perioperatively is feasible using a health care application. Testing is warranted to determine the extent to which implementation will improve patient triaging and reduce readmissions.