36 research outputs found
Determinants of implementing of pet robots in nursing homes for dementia care
Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and organisational leaders. Methods: A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based on the CFIR as an a priori framework. Results: A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all five CFIR domains. Determinants relating to the characteristics of pet robots include their design, realisticness and interactivity, affordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external influences (outer setting) include national regulatory guidelines, funding and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain âcharacteristics of individualsâ, determinants were associated with individualsâ beliefs on the role of technology, desires to enhance residentsâ quality of life, and differential attitudes on the use of robots. Finally, in the domain âimplementation processâ, assessments and care planning were identified as determinants. Conclusions: Overall, while sentiments around determinants within CFIR domains of pet robotsâ characteristics, outer setting and implementation process were similar, participantsâ opinions on the determinants within the âinner settingâ and âcharacteristics of individualsâ were more varied. This could be due to different organisational structures, disciplinary differences and personal experiences of using pet robots. Many determinants in different domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation of pet robots from research into real-world practice
Adolescent Overweight and Obesity in IrelandâTrends and Sociodemographic Associations Between 1990 and 2020
Background: Overweight and obesity in adolescence is a growing issue and can have a range of both short- and long-term consequences on health.
Objectives: To analyse trends in adolescent weight status in Ireland across a 30-year period and to examine the influence of sociodemographic factors on overweight/obesity in Irish adolescents over time.
Methods: Body composition and body mass index weight status of Irish adolescents were compared using data from three nationally representative, cross-sectional Irish national food consumption surveys from 1990, 2006 and 2020. Adjusted analysis of associations between socio-demographic factors with the risk of adolescent overweight/obesity at each time point were examined.
Results: The prevalence of Irish adolescents with overweight/obesity has increased significantly in recent years, with 24% of adolescents living with overweight/obesity in 2020 compared to 18% in 2006 and 13% in 1990 (p \u3c 0.001). Of note is a substantial increase in the prevalence of obesity, with 8% of adolescents living with obesity in 2020 compared to 3% in 2006 and 0.5% in 1990 (p \u3c 0.001). A lower affluence social class was associated with 3.95 increased odds of adolescent overweight/obesity (95%CI 2.06-7.61) (p \u3c 0.001) in 2020 only, with 41% of adolescents from the lowest affluence social class affected by overweight/obesity. Parental education level was inversely associated with the risk of adolescent overweight/obesity in 2006 and 2020, with a stronger effect in 2020.
Conclusion: There is an increasing prevalence of adolescents living with overweight/obesity in Ireland, with evidence of a growing socioeconomic gradient of overweight/obesity where adolescents affected by socioeconomic disadvantage are most at risk
Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality.
Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a pre-requisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing
Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19
IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.
Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 nonâcritically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022).
INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes.
RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ supportâfree days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively).
CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570
Phase Four: Evaluating a VR social connecting space for older adults living with dementia
PAR Phase Four, Cycles Five and Six.
This evaluated a multi-user VR application's usability, feasibility and acceptability to support social connectedness
PAR Phase Two: Social Connectedness and the Role of Virtual Reality: Experiences and Perceptions of Older Adults Living with Dementia and their Caregivers
PAR Phase Two, Cycle Two
Explore people living with dementia and their support person's experiences of social connectedness and the potential role of multi-user VR
Key Stakeholdersâ Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: A Qualitative Evidence Synthesis Protocol
Background: Technology is increasingly being used in dementia care as a means of non-pharmacological intervention. One such technology, Virtual Reality (VR) has shown to be a promising vehicle to deliver interventions for people living with dementia. The views of people living with dementia and key stakeholders must be considered to inform future research. There is a lack consensus regarding VR design considerations for this population which makes it difficult for researchers and practitioners to develop meaningful VR spaces. Methods: This qualitative evidence synthesis (QES) protocol aims to explore key stakeholdersâ experiences and perceptions of VR for older adults living with dementia. A systematic search will be conducted across six electronic databases. Forward and backward citation searching, and hand searching will identify additional articles. Two authors will independently complete title and abstract, and full text screening. Quality appraisal will be conducted using the CASP qualitative checklist. Included studies will be analyzed using a thematic synthesis approach. The GRADE-CERQual will assess the researcherâs confidence in the findings. Discussion: This QES will constitute part of a larger project which aims to develop a VR social connecting space for older adults living with dementia. The findings will also add to the existing body of literature exploring VR in dementia care contexts. It is anticipated that this review will add to the momentum toward holistic design practices, resulting in usable and acceptable VR spaces for older adults living with dementia
Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers
Purpose: People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiverâs experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same. Materials and Methods: People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis. Results: The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness. Conclusions: The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers
Older Adultsâ Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis
BackgroundImmersive virtual reality (IVR) can be defined as a fully computer-generated environment shown on a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. There has been a surge in qualitative studies exploring older adultsâ experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies.
ObjectiveThis study aimed to systematically review and synthesize qualitative studies exploring older adultsâ experiences and perceptions of IVR.
MethodsA systematic review and thematic synthesis were conducted following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. In total, 2 reviewers completed title and abstract screening, full-text screening, data extraction, and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves 3 key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes, and going beyond these data to form analytical themes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach.
ResultsOverall, 13 studies were included in the final synthesis, including 224 participants across 9 countries and 5 continents. Confidence in the evidence ranged from high to moderate. Three descriptive themes were generated: practical aspects of IVR use, experiencing unique features of IVR, and perceptions of IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to facilitate older adultsâ use of this technology. However, older adultsâ responses to IVR were generally positive. Three analytical themes were generated: tolerating the bad to experience the good, buying in to IVR (donât judge a book by its cover), and âit proves to me I can do it.â The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking. There was a discrepancy between older adultsâ perceptions of IVR before useâwhich were generally negativeâand after useâwhich were generally positiveâand IVR provided a platform for older adults to access certain activities and environments more easily than in the real world because of limitations caused by aging.
ConclusionsThis review offers insights into older adultsâ experiences and perceptions of IVR and suggests how a few improvements to its existing hardware and software as well as how it is first presented could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences.
Trial RegistrationPROSPERO CRD42020200774; https://tinyurl.com/8f48w2vt
International Registered Report Identifier (IRRID)RR2-10.1177/1609406921100968
Older Adultsâ Experiences and Perceptions of Immersive Virtual Reality: A Protocol for a Systematic Review and Thematic Synthesis
Background: In the current digital age, new opportunities arise to support healthy ageing in older adults as frailty and immobility become more prominent. Immersive virtual reality, which can be defined as a fully computer-generated environment that is displayed through a headmounted display, is one of these technologies. Recently, there has been an increase in the number of qualitative studies exploring the potential for immersive virtual reality in assisting older adultsâproviding opportunities in health promotion and tackling social isolation and loneliness. With this in mind, the current review aims to explore the following research questions: (1) What are older adultsâ experiences and perceptions of immersive virtual reality? (2) What are the specific barriers and facilitators to older adultsâ use of immersive virtual reality? (3) Do older adults find immersive virtual reality acceptable? The objective of the current study is to systematically review and synthesize qualitative data exploring older adultsâ experiences and perceptions of immersive virtual reality. Methods: A systematic review and thematic synthesis will be conducted. Two reviewers will complete title and abstract screening, full-text screening and, data extraction and quality appraisal. A thematic synthesis will be conducted by the lead author, after which the research team and other key stakeholders will discuss the findings and make any necessary changes. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves three key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes and finally, going beyond the data to form novel insights and theories known as analytical themes. The following protocol has been written following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines