The First National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China: Protocol for the Design, Development, and Evaluation of a WeChat Applet

Abstract

Background Malignant hyperthermia (MH) is a rare life-threatening anesthetic emergency. With respect to the high fatality rate, difficulty in early recognition, and the lack of disease-specific drug (ie, dantrolene) in China, more effort is needed to strengthen early diagnosis and effective treatment of MH emergencies. Nowadays, mobile health (mHealth) apps are changing the way of medical practice; they can serve as an accessible tool to help anesthesiologists deal with MH crises. However, no related mHealth-based emergency system is available currently. Objective The aim of this study is to outline the protocol for the development of a WeChat applet used to design a National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China, as well as the protocol for the evaluation of the user experience and perception of the system. Methods The system adopts the client-server architecture, with a custom user interface operating as clients and the back-end system operating as the server. The client-side software was developed using uni-app technology with Vue.js-based framework, which consists of 6 modules: Quick Diagnosis, Dantrolene Mobilization, Instruction on Dantrolene Use, MH Treatment, Recovery Period Treatment, and DNA Test and Biopsy. The back-end system was developed based on the Spring framework. The system will be evaluated by administrating a modified user version of the Mobile App Rating Scale. Pilot testing will be conducted in Sichuan Province, China, and a subsequent evaluation on a national scale is planned. Results The theoretical framework design of this system was completed in August 2021. The development of the system was completed in February 2022, and the refinement is currently ongoing. Pilot testing after the implementation of the system in Sichuan Province is planned to take 2 months, and the subsequent evaluation on a national scale is planned to take 2 months. Conclusions We have described a novel approach using the WeChat applet to develop the MH-NRES. Findings from the usability testing process in the current study may lead to refinements and is expected to suggest that this system is both feasible and welcomed by anesthesiologists. Depending on the availability of research funding, this system will be extended nationally across China. International Registered Report Identifier (IRRID) PRR1-10.2196/37084

The Knowledge Profile, Competence and Pending Problems of Chinese Anesthesiologists in Dealing with Malignant Hyperthermia: A Cross-Sectional Survey

“…It might imply the necessity to establish an MH website and a telephone hotline available, as well as mHealth apps to offer guidance for anesthesiologists in China. 10 , 13 , 21 , 25 In addition, we could find that less work experiences, lower levels of hospital, educations and professional titles were associated with lower competencies in managing MH. This suggests that training should focus more on anesthesiologists with less experienced, lower educations and from primary hospitals.…”

“…As mobile health (mHealth) apps are changing the ways of modern medical practice, we planned to develop the National Remote Emergency System for Malignant Hyperthermia (MH-NRES) as an applet of the WeChat app in China, 13 which is composed of six functions: quick clinical diagnosis, dantrolene mobilization, instruction on dantrolene use, MH treatment, MH genetic testing and MH case study. However, there is limited information about knowledge, capability, and problems encountered about MH among Chinese anesthesiologists.…”

A WeChat applet-based national remote emergency system for malignant hyperthermia in China: a usability study

“…We simplified the modified version of uMARS mentioned in our previous study [ 11 ] and developed a new uMARS in this study. The new uMARS comprises 20 questions using a 5-point Likert scale with higher score corresponding to good usability.…”

“…In addition, dantrolene is only stocked in a few of Chinese hospitals even after its commercially available in China after 2020 [ 8 ]. In order to solve the above problems, we developed the WeChat applet–based National Remote Emergency System for Malignant Hyperthermia (MH-NRES) [ 11 ]. This real-time emergency system can assist anesthesiologists to make rapid diagnosis, initiate dantrolene mobilization from other hospitals in China, execute effective treatment, and provide subsequent gene diagnostic services and online simulation training.…”

“…Leanne Hides and colleagues developed the user version of the Mobile App Rating Scale (uMARS) which derived from the former Mobile App Rating Scale (MARS) to classify and evaluate the quality of mHealth apps [ 18 , 19 ]. Considering the target users and the function of our system, we developed a modified usability questionnaire according to uMARS in our previous study [ 11 ] to evaluate the user experience and perception of the system.…”