BackgroundInadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting.ObjectiveThe objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC).MethodsA multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group.ResultsThe technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019.ConclusionsProgress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability a...

This article takes stock of how far the field of consultation-liaison psychiatry has come since its inception in the 20th century. In order to do this, we review its past in terms of its knowledge base in psychosomatic medicine and in terms of its practice at the bedside in the general hospital setting. We also offer a contemporary account of the field and finish with a subjective view of the opportunities and pitfalls faced during the next phase of consultation-liaison psychiatry in the 21st century.

Objective: Determine average time of delivery of childbirth in pregnants with joint hypermobility and compare with the average time of delivery of childbirth in pregnants without it. Patients and Methods: One hundred ninety-one pregnants distributed in 2 groups were studied, a group included 64 pregnants with joint hypermobility (exposed group) and other of 127 pregnants without it (non exposed group), assisted in the Obstetrician service from Hospital Regional Docente de Trujillo. We applied Beighton's Test to determine joint hypermobility. T-student Test was used, assuming that the difference is significant among the groups (P Ͻ 0.05). Results: The average time of delivery total childbirth in exposed group was 7.01 Ϯ 2.15 and the non exposed group was 8.89 hours Ϯ 3.5 (P Ͻ 0.001). The average time delivery of the childbirth in active stage in the exposed group was 4.05 hours Ϯ 2.15 and in the non exposed group was 5.94 Ϯ 3.46 (P Ͻ 0.001). Conclusions:The time of childbirth work is smaller in pregnants, with joint hypermobility that in those pregnants without it, with difference highly significant statistic.Objetivos: Demostrar a través de un análisis de los costos que realizan durante el primer mes en su tratamiento, los pacientes con A.R, OAD, y RPB, el potencial encarecimiento de su presupuesto, y de la marcada disminución en la capacidad adquisitiva de servicios básicos, de salud, vivienda, alimentación, vestido, trasporte y recreación, al compararlos con el estimado gubernamental para la canasta básica mensual, que dichos costos representan en Guatemala. Metodología: Se analizan 3 grupos de pacientes con los padecimientos reumáticos más frecuentes: Artritis Reumatoide (AR), Osteo-artritis Degenerativa (OAD) y Reumatismo de partes blandas (RPB), cada grupo compuesto de 30 pacientes, de una clínica priada, clínicas AGAR y consulta externa de un hospital local.Para tal objeto se diseñó un instrumento de recolección de datos, las respuestas de los gastos realizados fueron divididas entre. Gastos Directos: todos aquellos que se relacionan propiamente con el diagnóstico y tratamiento de la patología articular. Indirectos: los que se relacionan con la vida diaria y las adaptaciones que el paciente realiza a la misma como consecuencia de la enfermedad. El sueldo mínimo fijado por el gobierno para este año para el área agrícola es de Q957.00 ($119.62) y para el área no agrícola de Q1,026.00 ($128.25); es decir $1435.44 years $1539.00 respectivamente al año (Fuente: ACUERDO GUBERNATIVO No. 459-2002 Departamento Nacional del Salario, Ministerio de Trabajo y Previsión social de Guatemala). Resultados: El 85% de los pacientes no cuentan con la capacidad económica para un adecuado control y seguimiento de su enfermedad. La dependencia familiar corresponde a 58% hijos, cónyuges 30%, padres 3%, hermanos 5%. Mensualmente los Guatemaltecos, en base a su salario pueden realizar una inversión del 5.48% en salud (Instituto Nacional de Estadística, Indice de precios al consumidor, Boletín Marzo 2004) es decir Q69.92 ($8.75) resu...

BACKGROUND Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/10938