Virtual Round care model in a Covid-19 Geriatric sub intensive unit

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff.  Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units.  Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family. Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives. Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis. Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01). Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients Limitation. However, the study has some possible limitations considering its small size and that it was mono centric Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay.   More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patient

A komputer által létrehozott virtuális valóság pszichológiai mechanizmusai: téri reprezentációs sajátosságok = Psychological Mechanism in Computer Generated Virtual Reality: Spatial Representation Features

A virtuális valóságban (VR) végzett gyógyászati és oktatási tevékenység iránt megnövekedett érdeklődés szükségessé teszi a VR-re vonatkozó pszichológiai értelmezési keretek egy csoportjának bemutatását. Az összefoglalóban – szakirodalmi ismeretekre hagyatkozva – a belemerülés (immersion), valamint a jelenlét (presence) fogalmak rövid bemutatását követően a virtuális valóság mentális modelljei közül elsősorban a téri reprezentációra vonatkozó komponenseket fogom bemutatni. Az áttekintés a VR-ben megjelenő multiszenzoros koherencia, tudatos jelenlét, kapcsolat és leválás, átmeneti jelenlét és a különböző affordanciák szerepének ismertetésére koncentrál. Az alkalmazások fejezetrészben pedig néhány, az egészségügyben és az oktatásügyben alkalmazott, és várhatóan az eddigi gyakorlathoz viszonyítva szélesebb körben hazánkban is alkalmazandó VR-alapú eljárások ismertetésére kerül sor. A digitális oktatás és a pszichoterápiás ellátás iránti érdeklődés ellentmondásos. Sokan a klienssel vagy a tanulóval való személyes kapcsolat elvesztésének fenyegető veszélyétől féltik az orvosokat és a pedagógusokat. A betegek és a diákok részéről azonban egyre sürgetőbb az igény a VR-hez kötődő módszerek bevezetésére. A bemutatott összefoglaló tovább erősíti az új digitális eszközök alkalmazásával kapcsolatos igényeket, de ugyanakkor felhívja a figyelmet, hogy szükség van olyan technikai és szaktudományi infrastruktúra megteremtésére, amely kritikus elemzést követően képes elősegíteni a jelenlegi, konfliktusokkal terhes ellátási és oktatási formák fejlődését. Az új VR-módszerek bevezetése a tudomány és a gyakorlat közös feladata. The increased interest in health care- and educational activities carried out in virtual reality (VR) brought about the need to discuss certain psychological frameworks of interpretation concerning VR. My summary relies on special literature and partly on our own research work. It aims to defi ne special terms such as immersion and presence that concentrates on presenting those mental models of VR, which comprise components of spatial representation. The overview introduces the concept of multisensory coherence, conscious being there, attachment to and detachment from the digital world, and different forms of affordances. In the Application chapter I primarily present a few of those VR-based processes that may be more widely applied in the future in health care and education in Hungary as well. The interest in digital education and health service has its own contradictions. There are fears that the personal contact between medical practitioners and clients or teachers and students will be lost. On the other hand, there is an increasing demand for the introduction of new methodologies, thus dialogues are inevitable. The more reliable and effi cient application of the new processes may bear considerable mental and financial changes. I hope that my presentation will widen the demands concerning the application of digital technologies, and will draw attention on the need to establish technological and disciplinal infrastructure, which, after critical analysis, is able to alter certain – now contradictional – educational and health care processes. Introducing new VR methodologies should be a joint venture of research and practice

7 Virtual reality in palliative care: a systematic review and meta-analysis

Introduction Virtual Reality (VR) has the potential to alleviate common mental and physical health symptoms at the end-of-life. There is limited data on the efficacy of VR in palliative care. Aims To review the feasibility and effectiveness of VR intervention within a palliative care setting. Method Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to March 2021. Studies that reported on the use of VR in an adult (over 18 years) palliative population were included. The ROB-2 (for RCTs) and ROBINS tools (for non-RCTs) were used to assess risk of bias. The GRADE tool assessed the quality of the evidence. Data regarding feasibility, acceptability, and changes of psychological and physical symptoms of palliative care patients were extracted. Standardised mean differences (Hedges’ g) were calculated from the pre- post data reported on patient outcomes. A DerSimonian-Laird random effects model meta-analysis was conducted. PROSPERO (CRD42021240395, 03/03/2021) Results 524 studies were identified; 8 studies were included, 5 were included in the meta-analysis. All studies had at least some concern for risk of bias. 44% (97/219) of patients were male; the mean age ranged from 47 to 85 (years). Recruitment was feasible and retention rates ranged between 55% and 100%. Discomfort and technical issues were recorded in 4/7 studies (57%) but overall, participants reported a positive experience. The meta-analysis showed VR statistically significantly improved pain (p=0.0363), tiredness (p=0.0030), drowsiness (p=0.0051), shortness of breath (p=0.0284), depression (p=0.0091), and psychological well-being (p=0.0201). The quality of the evidence was graded as low to very low. Conclusion VR in palliative care is feasible and acceptable. Larger trials with a control arm are needed. Impact VR could be an adjuvant non-pharmacological therapy for symptoms such as anxiety, pain, or depression. Higher quality studies are needed to inform clinical recommendations

Virtual reality and live scenario simulation: options for training medical students in mass casualty incident triage

Introduction Multicasualty triage is the process of establishing the priority of care among casualties in disaster management. Recent mass casualty incidents (MCI) revealed that health personnel are unfamiliar with the triage protocols. The objective of this study is to compare the relative impact of two simulation-based methods for training medical students in mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm. Methods A prospective randomized controlled longitudinal study. Medical students enrolled in the emergency medicine course were randomized into two groups (A and B). On day 1, group A students were exposed to a virtual reality (VR) scenario and group B students were exposed to a live scenario (LS), both exercises aiming at triaging 10 victims in a limited period of time (30 seconds/victim). On day 2 all students attended a 2-hour lecture about medical disaster management and START. On day 3 group A and B students were exposed to a LS and to a VR scenario respectively. The vital signs and clinical condition of the 10 victims were identical in the two scenarios. Ability of the groups to manage a simulated triage scenario was then compared (times and triage accuracy). Results Groups A and B were composed of 25 and 28 students respectively. During day 1 group A LS triage accuracy was 58%, while the average time to assess all patients was 4 minutes 28 seconds. The group B VR scenario triage accuracy was 52%, while the average time to complete the assessment was 5 minutes 18 seconds. During day 3 the triage accuracy for group A VR simulation was 92%, while the average time was 3 minutes 53 seconds. Group B triage accuracy during the LS was 84%, with an average time of 3 minutes 25 seconds. Triage scores improved significantly during day 3 (P < 0.001) in the two groups. The time to complete each scenario decreased significantly from day 1 to day 3. Conclusions The study demonstrates that the training course generates significant improvement in triage accuracy and speed. It also reveals that VR simulation compared to live exercises has equivalent results in prompting critical decisions in mass casualty drills. In the beginning the average time to complete the VR scenario was higher than the LS. This could be due to the fact that on day 1 very detailed VR victims created a higher challenge for untaught students. However, the higher triage accuracy recorded at the end of day 3 in VR could be explained by a lower stress level compared to the LS, which could be creating a more stressful environment in taught students

Future Trends of Virtual, Augmented Reality, and Games for Health

Serious game is now a multi-billion dollar industry and is still growing steadily in many sectors. As a major subset of serious games, designing and developing Virtual Reality (VR), Augmented Reality (AR), and serious games or adopting off-the-shelf games to support medical education, rehabilitation, or promote health has become a promising frontier in the healthcare sector since 2004, because games technology is inexpensive, widely available, fun and entertaining for people of all ages, with various health conditions and different sensory, motor, and cognitive capabilities. In this chapter, we provide the reader an overview of the book with a perspective of future trends of VR, AR simulation and serious games for healthcare

Essential Considerations for Establishing Partnerships Among Agencies Addressing the Employment-Related Needs of Individuals with Disabilities

[Excerpt] The Collaboration Brief series is intended to assist both generic and disability-specific agencies to work collaboratively and enhance their capacity to serve individuals with disabilities. To help agencies become familiar with their mandated and non-mandated partners, these briefs provide information that will contribute to better understanding of the goals, eligibility criteria, and policy parameters of the respective generic and disability-specific agencies; the development of expanded and improved collaborative relationships; and the coordination of resources, services, and supports. These briefs are consistent with and reflect the overarching goal of the Workforce Investment Act (WIA)— to develop a seamless workforce investment system that includes multiple agencies and programs. The series includes briefs on the One-Stop Career Centers established under Title I of the WIA and the one disability-related mandatory partner participating in the workforce investment system (vocational rehabilitation agencies). In addition, the series includes employment-related services and supports provided by other federal, state, and local agencies and programs serving people with significant disabilities, including Mental Health, Developmental Disabilities, and Special Education. Further, the series explains the potential role the Medicaid program can play in supporting employment and the work incentive provisions in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs, and describes the Ticket to Work Program operated by the Social Security Administration. Each brief provides information on the purpose of the program, eligibility for benefits or services, funding sources, administrative structure, and resources provided to support jobseekers and employers. Further, the briefs provide considerations for assessing the respective programs in each state and suggestions for the development of collaborative relationships. The concepts and strategies of Customized Employment—a dynamic set of assessment and job development tools—will be used to contextualize the collaborative strategies discussed in each brief. Most importantly, the briefs show that no agency is alone or limited to their own resources in serving people with significant disabilities; this series should be used as a source for the basic information upon which cross-system partnerships are built. Collaborative relationships between One-Stop Career Centers, Vocational Rehabilitation, community provider organizations, and other systems that provide benefits and services will create new employment opportunities for people with significant disabilities

A Review into eHealth Services and Therapies: Potential for Virtual Therapeutic Communities - Supporting People with Severe Personality Disorder

eHealth has expanded hugely over the last fifteen years and continues to evolve, providing greater benefits for patients, health care professionals and providers alike. The technologies that support these systems have become increasingly more sophisticated and have progressed significantly from standard databases, used for patient records, to highly advanced Virtual Reality (VR) systems for the treatment of complex mental health illnesses. The scope of this paper is to initially explore e-Health, particularly in relation to technologies supporting the treatment and management of wellbeing in mental health. It then provides a case study of how technology in e-Health can lend itself to an application that could support and maintain the wellbeing of people with a severe mental illness. The case study uses Borderline Personality Disorder as an example, but could be applicable in many other areas, including depression, anxiety, addiction and PTSD. This type of application demonstrates how e-Health can empower the individuals using it but also potentially reducing the impact upon health care providers and services.Comment: Book chapte

Supporting Career Development and Employment: Benefits Planning, Assistance and Outreach (BPA&O) and Protection and Advocacy for Beneficiaries of Social Security (PABSS)

This training curriculum is dedicated to increasing knowledge and understanding of the Social Security Administration\u27s disability and return to work programs and work incentive provisions as prescribed in the Social Security Act and Ticket to Work and Work Incentives Improvement Act of 1999 as well as other federal benefit programs. These informational resources were compiled and edited to provide continuing education and print materials for benefits specialists and protection and advocacy personnel on the interplay of these benefit programs and impact or employment

State TANF Policy and Services to People With Disabilities

The intent of this study is to identify state policies and procedures that are designed to ensurethat people with disabilities and/or parents with children with disabilities are provided theopportunity to participate in state TANF programs. The intent is not to present "best practices," with quantifiable and measurable outcomes. Many state TANF programs are still in their early stages, with new programs being developed and outcomes still uncertain. The intent is to present an in-depth "snapshot" of what is occurring right now at the state level in terms of services and programs designed to assist TANF recipients with disabilities. Are states developing programs and policies specifically targeted toward people with disabilities? Are people with disabilities being served on an individual basis as part of the overall TANF population? Are states developing innovative strategies that particularly benefit TANF recipients with disabilities and, if so, what are they? By identifying these strategies, this report may assist other states in their policy development process in support of people with disabilities and parents with children of disabilities