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      Usability and feasibility of a digital cognitive screening tool measuring older adults’ early postoperative neurocognitive recovery: a protocol for a pilot study

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          Abstract

          Introduction

          Delayed neurocognitive recovery, also identified as early postoperative cognitive decline (POCD), is a common complication after surgery, with advanced age being the most important risk factor. As the geriatric population is increasing worldwide, and number of older adults undergoing surgery continues to rise, so will the incidence of POCD. Only a small proportion use digital cognitive tests for measuring postoperative neurocognitive performance compared with analogue tests. This study aims to evaluate a digital cognitive screening tool, Mindmore Postoperative version (Mindmore-P), in a perioperative setting to determine its feasibility and usability, and to compare preoperative cognition with early postoperative neurocognitive performance. Further, to determine associations between neurocognitive performance and perioperative factors as well as to explore patients’ experiences of early neurocognitive recovery.

          Methods and analysis

          We will include 50 patients (aged ≥60 years) undergoing elective abdominal surgery under general anaesthesia. Cognitive functions will be measured with Mindmore-P preoperatively and on postoperative day (POD) 1 or 2 as well as 2–3 weeks after surgery. Preoperatively, frailty, (Clinical Frailty Scale), depression (Geriatric Depression Scale-15), functional status (12-item WHO Disability Assessment Schedule 2.0) and pre-recovery status (Swedish web version Quality of Recovery Scale, SwQoR) will be measured. Delirium will be assessed by Nu-DESC (Nursing Delirium Screening Scale) twice a day, with start on POD 1 and until the patient is discharged from the hospital. Outcomes at 2–3 weeks postoperatively are postoperative recovery (SwQoR), depression, functional status and usability (System Usability Scale) of Mindmore-P. Postoperative recovery will also be measured POD 1 or 2. We will also explore feasibility and experience of early postoperative neurocognitive recovery with interviews approximately 1 month after surgery.

          Ethics and dissemination

          This study is approved by the Swedish Ethical Review Authority (REC Reference: 2022-03593-01) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and in social media.

          Trial registration number

          NCT05564195.

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          Most cited references32

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            Sample Size in Qualitative Interview Studies: Guided by Information Power

            Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is "saturation." Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose the concept "information power" to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning and during data collection of a qualitative study is discussed.
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              A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance

              The UK Medical Research Council’s widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                21 July 2023
                : 13
                : 7
                : e070404
                Affiliations
                [1 ]departmentNeurobiology, Care Sciences and Society , Ringgold_27106Karolinska Institutet , Stockholm, Sweden
                [2 ]departmentDepartment of Clinical Sciences Intervention and Technology , Ringgold_206106Karolinska institutet , Huddinge, Sweden
                [3 ]departmentPerioperative Medicine and Intensive Care , Ringgold_59562Karolinska Universitetssjukhuset , Stockholm, Sweden
                Author notes
                [Correspondence to ] Anahita Amirpour; anahita.amirpour@ 123456ki.se
                Author information
                http://orcid.org/0000-0002-2939-2592
                http://orcid.org/0000-0002-7510-8679
                http://orcid.org/0000-0001-5403-4183
                Article
                bmjopen-2022-070404
                10.1136/bmjopen-2022-070404
                10364180
                37479514
                44d130c8-e735-40e0-b4e5-8272cfa8aea2
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 21 November 2022
                : 10 July 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004047, Karolinska Institutet;
                Award ID: 2020-02641
                Funded by: FundRef http://dx.doi.org/10.13039/100007436, Familjen Erling-Perssons Stiftelse;
                Award ID: 20190200
                Funded by: Strategic Research Area Health Care Science;
                Award ID: 2021-01095
                Categories
                Anaesthesia
                1506
                1682
                Protocol
                Custom metadata
                unlocked

                Medicine
                adult anaesthesia,geriatric medicine,adult surgery
                Medicine
                adult anaesthesia, geriatric medicine, adult surgery

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