Adaptation and psychometric evaluation of the Swedish version of the Assessment of Inter professional Team Collaboration Scale (AITCS-S) for use in occupational health services.

Interprofessional team collaboration (ITC) in the Swedish Occupational Health Service is an important part of the service given to the customer. The Occupational Health Service (OHS) could be more competitive if they were able to show how successful is their ITC. The Assessment of Interprofessional Team Collaboration Scale (AITCS) is an instrument that measures ITC in teams working with the client as part of the team. The aim of this study was to adapt the Swedish version of the instrument for use in OHS and to evaluate the psychometric properties of the adapted version and the adapted short version. The study included 472 participants from different OHSs, all members of the trade association of occupational health care in Sweden. Face and content validity of the instrument were assessed, and floor and ceiling effects were measured. Internal consistency was measured with Cronbach's alpha and an exploratory factor analysis was conducted on the 42-item adapted instrument and the short, 24-item version. The exploratory factor analysis gave a three-factor solution with an eigenvalue >1 and explaining a total variance of 57.1% and 62.3% for the short version. The study concludes that AITCS-S-(OHS) as well as the short version, is a reliable and valid questionnaire. Further development of the AITCS-S-(OHS) needs to be undertaken and assessed by confirmatory factor analysis.

Postoperative recovery: the importance of the team.

An ageing population and rising healthcare costs are challenging cost-efficient hospital systems wanting to adapt, employing novel organisational structures designed to merge diverse skill sets. This needs not only physician and nursing leadership but also new models of care. Anaesthetists have expanded their role into the broader multidisciplinary field of peri-operative medicine, emphasising collaboration and safety in health teams. A greater focus on patient-centred care and shared decision making, along with validated metrics to quantify quality improvement activities, have emphasised the importance of comfort, patient satisfaction and quality of life after surgery. Shared decision-making is more likely to be manifest in a flat hierarchy in which each member of the team brings their own experience and skills to optimise patient care. Successful surgery is best achieved by a coordinated, multidisciplinary team, embedded in a culture of collaboration and safety.

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: patient-centred outcomes.

BACKGROUND: Patient-centred outcomes are increasingly used in perioperative clinical trials. The Standardised Endpoints in Perioperative Medicine (StEP) initiative aims to define which measures should be used in future research to facilitate comparison between studies and to enable robust evidence synthesis. METHODS: A systematic review was conducted to create a longlist of patient satisfaction, health-related quality of life, functional status, patient well-being, and life-impact measures for consideration. A three-stage Delphi consensus process involving 89 international experts was then conducted in order to refine this list into a set of recommendations. RESULTS: The literature review yielded six patient-satisfaction measures, seven generic health-related quality-of-life measures, eight patient well-being measures, five functional-status measures, and five life-impact measures for consideration. The Delphi response rates were 92%, 87%, and 100% for Rounds 1, 2, and 3, respectively. Three additional measures were added during the Delphi process as a result of contributions from the StEP group members. Firm recommendations have been made about one health-related quality-of-life measure (EuroQol 5 Dimension, five-level version with visual analogue scale), one functional-status measure (WHO Disability Assessment Schedule version 2.0, 12-question version), and one life-impact measure (days alive and out of hospital at 30 days after surgery). Recommendations with caveats have been made about the Bauer patient-satisfaction measure and two life-impact measures (days alive and out of hospital at 1 yr after surgery, and discharge destination). CONCLUSIONS: Several patient-centred outcome measures have been recommended for use in future perioperative studies. We suggest that every clinical study should consider using at least one patient-centred outcome within a suite of endpoints.

Isothiocyanates are important as haptens in contact allergy to chloroprene rubber.

BACKGROUND: Contact allergy to chloroprene rubber products is well known. Thiourea compounds are considered the cause of allergy. Diethylthiourea commonly occurs in this type of product and can decompose to the sensitizer ethyl isothiocyanate. OBJECTIVES: To investigate the clinical importance of degradation products and metabolites from organic thioureas in contact allergy to chloroprene rubber with a focus on isothiocyanates and isocyanates. METHODS: Patients with contact allergy to diphenylthiourea were patch tested with phenyl isothiocyanate and phenyl isocyanate. Patients with known contact allergy to diethylthiourea were retested with diethylthiourea, while chemical analyses of their chloroprene rubber products were performed. The stability of diethylthiourea, diphenylthiourea and dibutylthiourea in patch-test preparations was investigated. Liquid chromatography/mass spectrometry and solid-phase microextraction/gas chromatography were used for determination of organic thioureas and isothiocyanates. RESULTS: All patients allergic to diphenylthiourea reacted to phenyl isothiocyanate, two of eight reacted to phenyl isocyanate and six of eight reacted to diphenylthiourea. Four patients allergic to diethylthiourea reacted at retest; diethylthiourea was detected in all chloroprene rubber samples, with levels of 2-1200 nmol cm-2 . At 35 °C, ethyl isothiocyanate was emitted from all samples. Patch-test preparations of diethylthiourea, diphenylthiourea and dibutylthiourea all emitted the corresponding isothiocyanate, with diethylthiourea showing the highest rate of isothiocyanate emission. CONCLUSIONS: Thiourea compounds are degraded to isothiocyanates, which are generally strong or extreme sensitizers, thus acting as prehaptens. This process occurs in both chloroprene rubber products and patch-test preparations. Positive reactions to phenyl isocyanate indicate cutaneous metabolism, as the only known source of exposure to phenyl isocyanate is through bioactivation of diphenylthiourea.

Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial.

BACKGROUND: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores. METHODS: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14. RESULTS: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound. CONCLUSIONS: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care. CLINICAL TRIAL REGISTRATION: NCT02492191.

Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial.

BACKGROUND: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphone-based application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care. METHODS: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use. RESULTS: The mean cost for health-care consumption during 2 weeks after surgery was estimated at €37.29 for the intervention group and €60.96 for the control group. The mean difference was €23.66 (99% confidence interval -46.57 to - 0.76; P=0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of €4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P=0.75). The probability of the intervention being cost-effective was 71%. CONCLUSIONS: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective tool in providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery. CLINICAL TRIAL REGISTRATION: NCT02492191.

Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial skin sealant.

The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

Tri-isopropylsilyl thioglycosides as masked glycosyl thiol nucleophiles for the synthesis of S-linked glycosides and glyco-conjugates.

Tri-isopropylsilyl thio-glycosides (TIPS S-glycosides) were synthesized through base promoted SN2 substitution of glycosyl halides with TIPS-SH or by Lewis acid promoted glycosylation of TIPS-SH with glycosyl acetates or p-methoxyphenyl glycosides. Various thioglycoside derivatives were obtained in high yields by one-pot fluoride-mediated de-silylation and thiol alkylation with alkyl halides or Michael acceptors of one common TIPS S-glycoside.

Measurement of quality of recovery using the QoR-40: a quantitative systematic review.

BACKGROUND: Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain. METHODS: We undertook a quantitative systematic review of studies evaluating psychometric properties of the QoR-40. Data were combined in meta-analyses using random effects models. This resulted in a total sample of 3459 patients from 17 studies originating in nine countries. RESULTS: We confirmed content, construct, and convergent [pooled r=0.58, 95% confidence interval (CI): 0.51-0.65] validity. Reliability was confirmed by excellent intraclass correlation (pooled α=0.91, 95% CI: 0.88-0.93), test-retest reliability (pooled r=0.90, 95% CI: 0.86-0.92), and inter-rater reliability (intraclass correlation=0.86). The clinical utility of the QoR-40 instrument was supported by high patient recruitment into evaluation studies (97%), and an excellent completion and return rate (97%). The mean time to complete the QoR-40 was 5.1 (95% CI: 4.4-5.7) min. CONCLUSIONS: The QoR-40 is a widely used and extensively validated measure of quality of recovery. The QoR-40 is a suitable measure of postoperative quality of recovery in a range of clinical and research situations.

Gender differences in risk factors for airway symptoms following tracheal intubation.

BACKGROUND: A common complaint after endotracheal intubation is sore throat and hoarseness. The aim of this study was to describe gender differences and independent risk factors in the development of post-operative sore throat and hoarseness after endotracheal intubation in adults. METHODS: This prospective cross-sectional observational study was conducted at a university hospital in Sweden. A total of 495 patients were included (203 men and 292 women) and enrolled from a total of eight different surgical departments. Outcome variables were post-operative sore throat and hoarseness evaluated post-operatively in the post-anaesthesia care unit. A total of 31 variables were recorded which described the intubation process, intraoperative factors as well as the extubation process. Bivariate and multivariate analyses were performed. RESULTS: The overall incidence of post-operative sore throat was 35% and hoarseness 59%. The results show different predictors for men and women in the development of airway symptoms. The main risk factor for developing sore throat in men was intubation by personnel with < 3 months' work experience. In women, it was endotracheal tube size 7.0 and multiple laryngoscopies during intubation. The main risk factors for hoarseness were cuff pressure for both men and women, and oesophageal temperature probe in women. CONCLUSION: Post-operative sore throat and hoarseness result from several factors, and the cause of these symptoms are multifactorial and differs by gender. Identification of these factors pre-operatively may increase awareness among anaesthesia personnel and possibly reduce the incidence of these minor but distressing symptoms.

Placental expression of a novel primate-specific splice variant of sFlt-1 is upregulated in pregnancies complicated by severe early onset pre-eclampsia.

sFlt-1 is increased in the placenta and serum of women with pre-eclampsia. A novel primate-specific splice variant has recently been discovered, but its expression in severe pre-eclampsia has yet to be reported. We investigated placental expression of the previously described variant, sFlt-1/sFlt-i13, and the novel variant, sFlt-e15a, in pregnancies complicated by severe early onset pre-eclampsia (n = 14) and HELLP (haemolysis, elevated liver enzymes and a low platelet count) syndrome (n = 8). There was significant upregulation of both variants in pre-eclampsia and HELLP syndrome compared with normotensive term (n = 35) and preterm controls (n = 8). We conclude that the novel primate-specific splice variant of sFlt-1 is highly expressed in both severe pre-eclampsia and HELLP.

Oxidative stress and endothelin-1 in atherosclerotic renal artery stenosis and effects of renal angioplasty.

AIMS: To examine biomarkers of oxidative stress (oxs), and endothelin (ET)-1, in hypertensive patients with atherosclerotic renal artery stenosis (ARAS) and to evaluate the effect of percutaneous transluminal renal angioplasty (PTRA). METHODS: Baseline measurements were made immediately before renal angiography in patients with suspected ARAS (significant ARAS, n = 83, and non-RAS, n = 59) and in 20 healthy, matched controls. In patients with ARAS, analyses were repeated 4 weeks after PTRA. All patients were treated with statins and acetylsalicylic acid throughout. RESULTS: At baseline there were no significant differences between groups in biomarkers of oxs, whereas high-sensitivity C-reactive protein and blood leukocytes were significantly elevated in group ARAS versus both healthy controls and group non-RAS. Plasma levels of ET-1 and uric acid were significantly increased in group ARAS versus healthy controls prior to angiography and were significantly reduced compared to baseline 4 weeks after PTRA. PTRA had no significant effects on biomarkers of oxs, inflammation or serum creatinine concentrations. CONCLUSIONS: ARAS patients on treatment with antihypertensive agents, acetylsalicylic acid and statins showed elevated inflammatory indices but no increase in oxs. PTRA had no significant effects on inflammatory indices 4 weeks after intervention but reduced plasma ET-1 and uric acid.

Deficiency of the fifth component of complement in mice with an inherited complement defect.

The inherited complement deficiency of certain inbred strains of mice was shown to be due to an isolated lack of the fifth component of complement. The protein MuB1 (or hc'), which is present in normal mouse serum but absent from the serum of complement-deficient mice, was shown to be immunochemically related to the fifth component of human complement (C'5). C'5 hemolytic activity was specifically inhibited in human serum by mouse anti-MuB1 and in normal mouse serum by mouse antiserum to human C'5. Highly purified human C'5 reconstituted the hemolytic activity of complement-deficient mouse serum. It was, therefore, concluded that he', or MuB1, constitutes the murine analogue of the fifth component of human complement. The MuB1 concentration in normal mouse serum was found to be subject to a sex-related variation. By quantitative precipitin analysis it was demonstrated that serum from male mice contains twice as much MuB1 as that of female mice. This difference in C'5 concentration was also detected by hemolytic assay. In addition, C'6 and C'7 were also found to be subject to sex-related variations.

Endotracheal tube size and sore throat following surgery: a randomized-controlled study.

BACKGROUND: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. METHODS: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1-2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. RESULTS: After 1-2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P=0.006. This difference between the groups was also evident, P=0.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P=0.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size. CONCLUSION: Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit.

Human trophoblast requires galectin-3 for cell migration and invasion.

Invasive extravillous cytotrophoblast of the human placenta expresses galectins-1, -3, and -8 in vivo and in vitro. This study aimed to investigate the potential role of galectin-3 in cell migration and invasion, using recombinant human galectin-3 (rhgalectin-3), small molecule galectin inhibitor I47, and galectin-3 silencing. HTR-8/SVneo cell migration was stimulated by rhgalectin-3 and reduced by I47, which could be neutralised by rhgalectin-3. Inhibitor specificity and selectivity for the galectins expressed in extravillous trophoblast were validated in solid phase assays using recombinant galectin-1, -3, -8, confirming selectivity for galectin-3. HTR-8/SVneo cell migration and invasion, and invasion by isolated trophoblast cells in primary culture were significantly reduced in the presence of I47, which could be restored by rhgalectin-3. Upon HTR-8/SVneo cell treatment with galectin-3 siRNA both LGALS3 and galectin-3 protein were dramatically decreased. Silencing of galectin-3 induced significant reduction in cell migration and invasion, which was restored by rhgalectin-3. The influence on known mediators of cell invasion, MMP2 and -9, and integrins α1, α5, and ß1 was followed in silenced cells, showing lower levels of MMPs and a large reduction in integrin subunit ß1. These results show that galectin-3 acts as a pro-invasive autocrine/paracrine factor in trophoblast in vitro.

Dietary supplementation with beta-glucan enriched oat bran increases faecal concentration of carboxylic acids in healthy subjects.

BACKGROUND/OBJECTIVE: Carboxylic acids (CAs), especially butyric acid, have been suggested to counteract colonic diseases, such as ulcerative colitis and colon cancer. Colonic formation of CAs can be influenced by the diet, but the concentrations and pattern formed need to be evaluated for different food products in humans. To elucidate how the colonic concentration of CAs in healthy subjects is influenced by dietary supplementation with oat bran, and whether the concentration varies over time and during consecutive days. SUBJECTS/METHODS: Twenty-five healthy subjects (age 24+/-1.3) were recruited to the study. The subjects were given 40 g beta-glucan enriched oat bran per day, corresponding to 20 g dietary fibre, in 4 slices of bread. CAs were analysed in faeces during three consecutive days after 0, 4, 8 and 12 weeks on this diet. RESULTS: The concentration of acetic, propionic, butyric, isobutyric and isovaleric acid was higher (P<0.05-0.001) after 8 weeks on the oat bran diet as compared with values at entry, whereas that of lactic acid was lower (P<0.05). After 12 weeks, the concentrations of acetic, propionic and isobutyric acid were still higher and that of lactic acid lower. The variation between individuals was considerable, whereas in the same individuals there was little variation. CONCLUSIONS: Oat bran increased the faecal concentration of CAs after 8 weeks, indicating an increased concentration also in the distal colon. The concentration of all main acids increased, except for lactic acid, which decreased. Oat bran may therefore have a preventive potential adjunct to colonic diseases.

Validation of a HILIC/ESI-MS/MS method for the wood burning marker levoglucosan and its isomers in airborne particulate matter.

In the present study, a methodology involving hydrophilic interaction liquid chromatography (HILIC) and electrospray (ESI) tandem mass spectrometry (MS/MS) was developed for measurement of anhydrous monosaccharides as markers for wood burning in atmospheric aerosols, PM10. No extensive sample preparation, other than ultrasound-assisted solvent extraction and evaporation, was applied. A pentahydroxysilica column enabled separation of levoglucosan from mannosan and galactosan within 5 min and the quantitative performance was validated using the standard reference materials (SRM) 1649a and 1649b. The experimentally obtained results for SRMs were in agreement with values previously reported in other studies. Achieved instrumental limits of detection (LODs) were below 10 pg injected on column, corresponding to LODs in air lower than 0.10 ng/m3 for all measured isomers for 2-3 day sampling with 1.0 m-3 h-1 sampling rate. The validated method was used for the determination of levoglucosan and its isomers in atmospheric aerosols collected in three different Swedish urban areas during the winter and summer time in 2017. The total measured concentrations for levoglucosan and galactosan + mannosan were determined to be between 78 and 167 ng/m3 in January 2017, which is approximately 10-times higher compared to the levels detected in July, reflecting the higher frequency of wood burning for heating during the cold season. Calculated concentration ratios between levoglucosan and its isomers in the urban area samples indicated mostly mixed softwood/hardwood combustion in winter time; on the other hand, softwood burning was observed as the major emission in summer time.

Designing interactions by control of protein-ligand complex conformation: tuning arginine-arene interaction geometry for enhanced electrostatic protein-ligand interactions.

We investigated galectin-3 binding to 3-benzamido-2-O-sulfo-galactoside and -thiodigalactoside ligands using a combination of site-specific mutagenesis, X-ray crystallography, computational approaches, and binding thermodynamics measurements. The results reveal a conformational variability in a surface-exposed arginine (R144) side chain in response to different aromatic C3-substituents of bound galactoside-based ligands. Fluorinated C3-benzamido substituents induced a shift in the side-chain conformation of R144 to allow for an entropically favored electrostatic interaction between its guanidine group and the 2-O-sulfate of the ligand. By contrast, binding of ligands with non-fluorinated substituents did not trigger a conformational change of R144. Hence, a sulfate-arginine electrostatic interaction can be tuned by the choice of ligand C3-benzamido structures to favor specific interaction modes and geometries. These results have important general implications for ligand design, as the proper choice of arginine-aromatic interacting partners opens up for ligand-controlled protein conformation that in turn may be systematically exploited in ligand design.

Hereditary deficiency of the seventh component of complement.

Deficiency of the seventh component of complement has been found in the serum of a 42-yr-old Caucasian woman who has Raynaud's phenomenon, sclerodactyly, and telangiectasia. Partial deficiency was found in the serum of the patient's parents and children, indicating a pattern of inheritance of autosomal codominance. Transfusion experiments indicated that exogenous C7 had a 91-h halk-life in the patient. There was no evidence for C7 synthesis after transfusion. No C7 inhibitors were detected in the patient's serum. The patient's serum was found to support the activation of complement by both the classical and properdin pathways to the C7 stage. The addition of C7 to the patient's serum permitted it to support hemolytic reactions initiated by either pathway. No defects could be detected in plasma or whole blood coagulation. The patient's serum was deficient in opsonizing unsensitized yeast particles in serum and in the generation of chemotactic factor by antigen-antibody complexes and endotoxin. Both deficiencies were corrected by the addition of C7. These observations suggest a key role for C7 for in vitro yeast phagocytosis and chemotaxis generation. However, the patient's lack of infections indicates a relatively minor role for C7 in human resistance to infection.

RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies.

INTRODUCTION: Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life. METHODS AND ANALYSIS: This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A-C) at 1 and 2 weeks and (D) at 1 and 4 months. TRIAL REGISTRATION NUMBER: NCT02492191; Pre-results.