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Leclaire, A., and A. Fall. "Exposition par réalité virtuelle : une approche plus sereine pour nos patients ?" European Psychiatry 30, S2 (November 2015): S115. http://dx.doi.org/10.1016/j.eurpsy.2015.09.220.
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Depuis une vingtaine d’années, on assiste au développement de la réalité virtuelle dans le domaine de la psychopathologie. Elle se définit comme une application permettant à un utilisateur de naviguer et d’interagir en temps réel avec un environnement en trois dimensions généré par un ordinateur [1]. Grâce à cette technologie, les difficultés rencontrées dans les techniques d’exposition de TCC habituelles peuvent être contrées. L’environnement virtuel permet, par exemple, de contrôler les imprévus, d’être exposé à certaines peurs pouvant être difficiles à reproduire en situation réelle, et garantit une meilleure confidentialité [2]. Nous avons acquis, il y a peu un logiciel de thérapie par réalité virtuelle pour les troubles anxieux. Le patient est plongé dans un environnement virtuel relativement proche des situations anxiogènes réelles. Il est progressivement désensibilisé par une exposition virtuelle répétée, prolongée et complète. De nombreuses études ont déjà prouvé l’efficacité de ce genre d’exposition [3]. Nous pensons que cet outil permettrait aux patients d’aborder de manière plus sereine les séances d’exposition. Notre projet d’étude est de présenter à des anxieux sociaux deux techniques d’exposition : in vivo et in virtuo. Dans les deux situations, les sujets sont amenés à faire face à un groupe de personnes : « réelles » (groupe thérapeutique dans la clinique où a lieu l’étude) ou « virtuelle » (salle de classe avec des étudiants, dans l’environnement virtuel). Leur niveau d’anxiété avant chaque séance est évalué grâce à l’inventaire d’anxiété état-trait de Spielberger. Ce poster présente les premiers résultats de l’étude, qui est en cours.
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Besnar, Jeremy, Morgane Pallone, Ghislaine Aubin, Laëtitia Ferracci, Caroline Racineux, and Philippe Allain. "Phénomènes de dépendance à l’environnement et conformisme social : intérêts d’une approche interactionniste en neuropsychologie clinique." Neuropsychologie clinique et appliquée 1, Fall 2017 (2017): 98–112. http://dx.doi.org/10.46278/j.ncacn.20170913.
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Nous décrivons le cas d’un patient victime d’un traumatisme crânien, responsable de lésions frontales et temporales bilatérales. Ce patient présentait des troubles exécutifs ainsi que des perturbations comportementales, principalement sous forme d’une dépendance à l’environnement. L’objectif de la présente étude était double. D’une part, nous souhaitions évaluer la pertinence d’une interprétation socio-cognitive de la dépendance à l’environnement, au moyen d’un dispositif évaluant le conformisme social, impliquant des situations d’interaction réelle et virtuelle. D’autre part, nous souhaitions étudier l’influence du type de situation sur le conformisme social, de rares études démontrant des différences de performances selon le type d’évaluation (réel ou virtuel). Les résultats démontrent des dissociations de performance en fonction du mode d’évaluation. Le conformisme n’est constaté que lors de l’évaluation en environnement réel. L’intérêt de l’approche interactionniste pour la mise en évidence de troubles socio-comportementaux et le bénéfice des environnements virtuels pour l’évaluation neuropsychologique sont discutés.
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Petitpas, Laurent, and Frédérick Van Meer. "L’utilisation de fichiers 3D pour la création d’un clone virtuel." Revue d'Orthopédie Dento-Faciale 55, no. 1 (February 2021): 53–72. http://dx.doi.org/10.1051/odf/2021005.
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Si bon nombre de praticiens sont équipés de scanners optiques intrabuccaux pour réaliser leurs empreintes numériques 3D, plus rares sont ceux qui utilisent les fichiers 3D issus de l’Imagerie volumétrique par CBCT (Cone Beam Computed Tomography) et encore moins sont ceux qui utilisent des scans 3D de visage de leur patient. Toutes ces images 3D dont la visualisation de l’image en couleur est attirante permettent déjà une analyse immédiate intéressante du patient. Mais peut-on aller plus loin ? Est-ce que ces fichiers 3D issus des différentes technologies sont interfaçables, connectables ? Les fichiers 3D générés par les différents systèmes technologiques d’acquisition correspondent chacun à une partie virtualisée du patient, malgré des formats de fichiers quelque fois différents, il est possible de les regrouper afin d’obtenir un patient virtuel complet : le « Jumeau virtuel ». Plusieurs logiciels de modélisation graphique 3D permettent d’importer, convertir et utiliser les fichiers des différents types d’acquisition 3D. Évidemment, l’utilisation de ces logiciels nécessitent un certain apprentissage initial mais finalement les procédures numériques sont simples. De la sorte, l’objectif de cet article est de vous sensibiliser avec ces techniques d’utilisation de l’imagerie 3D numérique.
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Park, Mira, and Peter Summons. "An Efficient Virtual Patient Image Model Interview Training in Pharmacy." International Journal of Bio-Science and Bio-Technology 5, no. 6 (December 31, 2013): 137–46. http://dx.doi.org/10.14257/ijbsbt.2013.5.6.14.
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Castellanos-Ruiz, Julialba, Mónica Pinzón-Bernal, and Etni Giraldo-Samboní. "Aplicación de Realidad Virtual Para Tratamiento de la Mano Espástica en la Hemiplejía. Revisión Sistemática." Revista Ecuatoriana de Neurologia 29, no. 2 (2020): 67–77. http://dx.doi.org/10.46997/revecuatneurol29200067.
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Introducción. La realidad virtual (RV) es una representación de la realidad generada por computador, cuyo uso en pacientes neurológicos es un proceso innovador para la recuperación de la función motora. Objetivo. Determinar el efecto de la realidad virtual sobre la función motora de la mano espástica del adulto con hemiparesia. Materiales y Métodos. Se realizó búsqueda sistemática en bases de datos PubMeD, Science direct, EMBASSE, PeDro, OT Seeker, Cochrane; de ensayos clínicos controlados acorde con los estándares de calidad establecidos por la estrategia CONSORT 2010 y la calidad metodológica de los estudios fue analizada utilizando la escala de PEDro. Resultados. La terapia de realidad virtual mostró efectividad en la función de la mano espástica en actividades selectivas que implican destreza y ejecución de habilidades de la vida diaria y recuperación de la espasticidad. Conclusiones. La terapia de realidad virtual es una alternativa que puede implementarse en personas con secuelas de ECV con un compromiso leve a moderado, genera adherencia y buena capacidad de respuesta. Sin embargo, estos resultados se deben recomendar con precaución, dada que las medidas de resultado no son estadísticamente significativas, pero presentan una tendencia ligeramente a favor de la realidad virtual.
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Andal,, Elizabeth M. "Quality Virtues in Service." International Journal of Human Caring 11, no. 3 (April 2007): 30–34. http://dx.doi.org/10.20467/1091-5710.11.3.30.
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In a materialistic society where economic returns in service are necessary for organizational survival, there is a need to frame the provision of patient care in the context of values—a set of ideals. Quality Virtues in Service (QVS) is the process of care delivery using virtue-driven, quality values. Virtues shape the foundation, fundamentals of patient service utilizing tools of the patient care trade: compassion, honesty, industry, and integrity. The QVS philosophy, model of service, and essential characteristics of the QVS provider are discussed. The expected outcomes or goals of QVS are listed so that healthcare providers can facilitate patient satisfaction, enhance quality of care using the QVS guidelines for practice, and reinforce professional commitment through virtue-driven supportive work interrelationships.
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Brunner, Iris, Jan Sture Skouen, Håkon Hofstad, Jörg Aßmus, Frank Becker, Anne-Marthe Sanders, Hanne Pallesen, et al. "Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES)." Neurology 89, no. 24 (November 15, 2017): 2413–21. http://dx.doi.org/10.1212/wnl.0000000000004744.
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Objective:To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.Methods:In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.Results:Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.Conclusions:Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.ClinicalTrials.gov identifier:NCT02079103.Classification of evidence:This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.
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Webster, Laura Bentley, and Jamie L. Shirley. "No Need to Object: Ethical Obligations for Interprofessional Collaboration in Emergency Department Discharge Planning." Annual Review of Nursing Research 34, no. 1 (January 2016): 183–98. http://dx.doi.org/10.1891/0739-6686.34.183.
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Emergency departments (EDs) serve a wide range of patient needs. A crucial aspect of safe and effective care in the ED is to appropriately transition patients to the next level of care. In most EDs, this disposition planning is done exclusively by physicians, which has the potential to result in unacceptable harm. A virtue ethics approach demonstrates the need for explicit inclusion of nurses in disposition planning. In utilizing this approach, it is necessary to examine four focal virtues as they relate to the work of disposition planning and the moral character of the nurse. The virtues of prudence, trustworthiness, vigilance, and courage show that interprofessional collaboration is needed during disposition planning to promote patient safety, facilitate interprofessional relationships, and prevent moral distress. The majority of literature on disposition planning is empirical in nature; this chapter adds a normative argument and a motive for policy reform.
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Lavelock, Caroline R., Everett L. Worthington, Brandon J. Griffin, Rachel C. Garthe, Aaliah Elnasseh, Don E. Davis, and Joshua N. Hook. "Still Waters Run Deep: Humility as a Master Virtue." Journal of Psychology and Theology 45, no. 4 (December 2017): 286–303. http://dx.doi.org/10.1177/009164711704500404.
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We present two intervention studies designed to promote humility and other virtues. In Study 1, we compared the PROVE Humility workbook (Lavelock, Worthington, & Davis, 2012/2013) to alternative workbooks, each designed to promote a particular virtue (e.g., forgiveness, patience, self-control) or mood state (positivity). Participants who completed the PROVE Humility workbook reported greater increases in humility and other virtues when compared to participants in the other conditions. In Study 2, we revised the workbook and tested it against a test-retest control condition. Study 2 replicated the findings from Study 1, such that participants who completed the PROVE Humility workbook reported improvements in humility and other virtues (e.g., forgivingness and patience), as well as reductions in negative affect. These findings support the idea of humility being a master virtue, and we recommend future directions for the clinical application of humility.
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Islam, M. Kamrul, and Iris Brunner. "Cost-analysis of virtual reality training based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial." International Journal of Technology Assessment in Health Care 35, no. 5 (2019): 373–78. http://dx.doi.org/10.1017/s026646231900059x.
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AbstractObjectivesStroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important.MethodsA cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions.ResultsBased on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced.ConclusionsExtra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.
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Burdea, G. C. "Virtual Rehabilitation – Benefits and Challenges." Methods of Information in Medicine 42, no. 05 (2003): 519–23. http://dx.doi.org/10.1055/s-0038-1634378.
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Summary Objectives: To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. Methods: VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculo-skeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called “VR-augmented rehabilitation.” Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is “VR-based.” If the intervention is done at a distance, then it is called “telerehabilitation.” Simulation exercises for post-stroke patients have been developed using a “teacher object” approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. Results: VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. Conclusions: Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.
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Stamenova, Vess, Payal Agarwal, Leah Kelley, Jamie Fujioka, Megan Nguyen, Michelle Phung, Ivy Wong, Nike Onabajo, R. Sacha Bhatia, and Onil Bhattacharyya. "Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada." BMJ Open 10, no. 7 (July 2020): e037064. http://dx.doi.org/10.1136/bmjopen-2020-037064.
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ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.
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Talbot, Thomas B., Kenji Sagae, Bruce John, and Albert A. Rizzo. "Sorting Out the Virtual Patient." International Journal of Gaming and Computer-Mediated Simulations 4, no. 3 (July 2012): 1–19. http://dx.doi.org/10.4018/jgcms.2012070101.
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Since Dr. Howard Barrows (1964) introduced the human standardized patient in 1963, there have been attempts to game a computer-based simulacrum of a patient encounter; the first being a heart attack simulation using the online PLATO system (Bitzer, 1966). With the now ubiquitous use of computers in medicine, interest and effort have expended in the area of Virtual Patients (VPs). One problem in trying to understand VPs is that there are several quite distinct educational approaches that are all called a ‘virtual patient.’ This article is not a general review of virtual patients as current reviews of excellent quality exist (Poulton & Balasubramaniam, 2011; Cook & Triola, 2009). Also, research that demonstrates the efficacy of virtual patients is ample (Triola, et al., 2006). This article assesses the different kinds of things the authors call “virtual patients”, which are often mutually exclusive approaches, then analyzes their interaction structure or ‘game-play’, and considers the best use scenarios for that design strategy. This article also explores dialogue-based conversational agents as virtual patients and the technology approaches to creating them. Finally, the authors offer a theoretical approach that synthesizes several educational approaches over the course of a medical encounter and recommend the optimal technology for the type of encounter desired.
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SUGANUMA, Takeshi, Nobuhiro KAIZAWA, Yasuhiro ONO, Haruka ITO, and Kazuyoshi BABA. "Virtual Patient System." Dental Medicine Research 32, no. 2 (2012): 111–16. http://dx.doi.org/10.7881/dentalmedres.32.111.
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Oden, Dr Kristy, Dr Michelle Nelson, and Dr Marilyn Lee. "Virtual Standardized Patient." International Journal for Innovation Education and Research 6, no. 6 (June 30, 2018): 67–75. http://dx.doi.org/10.31686/ijier.vol6.iss6.1059.
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Background: Higher education nursing programs include a physical/health assessment course that prepares graduates to provide excellent care based on data collected through assessment. Finding a teaching strategy that engages students as well as educates them in health assessment techniques is a challenge that all nurse educators share.
Objectives: The objectives of this study were to determine the level of engagement and learning that occurred with undergraduate and graduate students who participated in a health assessment course that included the use of an online virtual standardized patient (VSP).
Design: Quantitative, descriptive survey research was utilized to determine student nurses’ perception of the use of VSP in a physical assessment course.
Setting/Participants: Students in a traditional on-campus BSN program and students in an online RN to BSN and MSN program were included in this study.
Methods: After receiving IRB approval, course leaders provided students a standardized questionnaire of two (2) multiple choice and six (6) Likert-style questions. The questions evaluated the participants’ ease of use, comparison of interaction between online virtual and live human patients, ability to perform an exam on a virtual patient, and ability to communicate with a virtual patient. Questionnaires were administered to volunteers in the three identified health assessment courses (BSN, RN-BSN, and MSN). Also evaluated was the participant’s perception of their ability to transfer knowledge from the VSP to the live patient. All students participated in the VSP with completion of the questionnaire optional.
Results: Findings in this study generally supported the educational value of using a virtual standardized patient in teaching both undergraduate and graduate students’ health assessment. Variations between the groups were found.
Conclusion: Use of a virtual standardized patient is a positive teaching strategy for teaching health assessment in both undergraduate and graduate nursing programs.
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NOTTE, CHRIS, and NEIL SKOLNIK. "Virtual Patient Encounters." Internal Medicine News 43, no. 5 (March 2010): 62. http://dx.doi.org/10.1016/s1097-8690(10)70296-1.
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NOTTE, CHRIS, and NEIL SKOLNIK. "Virtual Patient Encounters." Family Practice News 40, no. 4 (March 2010): 53. http://dx.doi.org/10.1016/s0300-7073(10)70371-6.
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Nystrom, Daniel T., Douglas E. Paull, Ashley N. D. Meyer, and Hardeep Singh. "Virtual Patient Simulation." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 60, no. 1 (September 2016): 533–37. http://dx.doi.org/10.1177/1541931213601123.
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Medical diagnosis has begun to draw attention as a patient safety concern that is valid, yet difficult to study. In the current study, we implement a virtual patient simulation to assess different information sampling techniques practiced by a variety of health care providers including physicians, nurses, health technicians, and pharmacists who were tasked with diagnosing a virtual patient. Results suggest there are three different information sampling approaches used to arrive at a medical diagnosis: iteration, batch, and haste. In the iterative approach, clinicians sampled a series of hypothesis-generating sources of information (e.g., patient history, physical exam, etc.) that were immediately followed by a series of diagnostic tests (e.g., X-ray, EKG, etc.) and this process was repeated for 2-4 cycles before arriving at a diagnosis. In the batch approach, hypothesis-generating sources of information were sampled in a single series or “batch” that was then followed by a single series of diagnostic tests. In the haste approach, only a few sources of hypothesis-generating information were sampled before arriving at a medical diagnosis, and none of the information sampled was tested using diagnostic tests. Results suggest virtual patient simulation is a useful format to observe the emergence of clinicians’ diagnostic process and to collect a variety of measures and outcomes associated with medical diagnosis.
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Langstrup, Henriette, Louise Bagger Iversen, Signe Vind, and Thomas Lunn Erstad. "The Virtual Clinical Encounter." Science & Technology Studies 26, no. 2 (January 1, 2013): 44–60. http://dx.doi.org/10.23987/sts.55298.
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Telemedical devices such as the Patient Suitcase for treating chronic heart failure patients at home have been suggested to foster new and empowered patients. In this paper we analyse to what extent the ‘virtual clinical encounters’ taking place through the Patient Suitcase can be said to have such effects. We find that new skills are developed for all actors involved and that the work involved in the consultation is largely shared, but the normative claims of an independent and self-managing ‘Patient 2.0’ are difficult to support. Rather than seeing this as a dismissal of the transformative effects of telemedicine, we will suggest the need to decentre the attention from the individual and include the place-making efforts and effects involved in emplacing telemedicine in the home. The technology does not move work, knowledge and power from one actor in the clinical encounter to another – rather it redistributes and transforms it among more actors and more places demanding continuous sharing of work, development of new skills and involvement of distant and at times unruly actors. This may provide more sober accounts of the ways in which telemedicine has implications for the kinds of patients we may fi nd in contemporary healthcare and awareness of the more ambiguous relations between self, place and other in emerging care infrastructures.
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Watson, Linda, Siwei Qi, Andrea Delure, Claire Link, Eclair Photitai, Lindsi Chmielewski, April Hildebrand, Dean Ruether, and Krista Rawson. "Virtual Cancer Care During the COVID-19 Pandemic in Alberta: Evidence From a Mixed Methods Evaluation and Key Learnings." JCO Oncology Practice 17, no. 9 (September 2021): e1354-e1361. http://dx.doi.org/10.1200/op.21.00144.
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PURPOSE This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. METHODS Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. RESULTS 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. CONCLUSION The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.
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Rose, Susannah, Heather McKee Hurwitz, Mary Beth Mercer, Sabahat Hizlan, Kari Gali, Pei-Chun Yu, Caroline Franke, et al. "Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions." Journal of Medical Internet Research 23, no. 6 (June 21, 2021): e18488. http://dx.doi.org/10.2196/18488.
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Background Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated. Objective This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits. Methods We conducted a large survey study with open-ended questions to comprehensively assess patients’ experiences with virtual visits in a diverse patient population. Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit. Factor analysis of the survey items revealed three factors: experience with technology, patient-clinician engagement, and overall satisfaction. Multivariable logistic regression was used to test the associations among the three factors and patient demographics, clinician type, and prior relationship with the clinician. Using qualitative framework analysis, we identified recurrent themes in survey comments, quantitatively coded comments, and computed descriptive statistics of the coded comments. Results A total of 65.7% (426/648) of the patients completed the survey; 64.1% (273/426) of the respondents were women, and the average age was 46 (range 18-86) years. The sample was geographically diverse: 70.2% (299/426) from Ohio, 6.8% (29/426) from Florida, 4.2% (18/426) from Pennsylvania, and 18.7% (80/426) from other states. With regard to insurance coverage, 57.5% (245/426) were undetermined, 23.7% (101/426) had the hospital’s employee health insurance, and 18.7% (80/426) had other private insurance. Types of virtual visits and clinicians varied. Overall, 58.4% (249/426) of patients had an on-demand visit, whereas 41.5% (177/426) had a scheduled visit. A total of 41.8% (178/426) of patients had a virtual visit with a family physician, 20.9% (89/426) with an advanced practice provider, and the rest had a visit with a specialist. Most patients (393/423, 92.9%) agreed that their virtual visit clinician was interested in them as a person, and their virtual visit made it easy to get the care they needed (383/421, 90.9%). A total of 81.9% (344/420) of respondents agreed or strongly agreed that their virtual visit was as good as an in-person visit by a clinician. Having a prior relationship with their virtual visit clinician was associated with less comfort and ease with virtual technology among patients (odds ratio 0.58, 95% CI 0.35-0.98). In terms of technology, patients found the interface easy to use (392/423, 92.7%) and felt comfortable using it (401/423, 94.8%). Technical difficulties were associated with lower odds of overall satisfaction (odds ratio 0.46, 95% CI 0.28-0.76). Conclusions Patient-clinician engagement in virtual visits was comparable with in-person visits. This study supports the value and acceptance of virtual visits. Evaluations of virtual visits should include assessments of technology and patient-clinician engagement, as both are likely to influence patient satisfaction.
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Parkes, Rebekah J., Joanne Palmer, Jennifer Wingham, and Dan H. Williams. "Is virtual clinic follow-up of hip and knee joint replacement acceptable to patients and clinicians? A sequential mixed methods evaluation." BMJ Open Quality 8, no. 1 (March 2019): e000502. http://dx.doi.org/10.1136/bmjoq-2018-000502.
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ObjectiveTo evaluate the acceptability to key stake holders of a newly introduced virtual clinic follow-up pathway for hip and knee joint replacement.DesignA service evaluation comprising a questionnaire sent electronically to 115 patients and interviews with 10 individuals.SettingA newly introduced virtual clinic follow-up pathway for hip and knee replacement patients in a district general hospital.ParticipantsThe electronic questionnaire was distributed to all patients treated under the virtual clinic service over a 5-month period (n=115). Purposive sampling from volunteers among respondents, leading to semi-structured interviews with eight patients. Two orthopaedic consultants were also interviewed.InterventionConsultant review of web-based patient reported outcome measures and digital radiographs, with feedback to patients via letter, replacing face-to-face outpatient appointments for the follow-up of hip and knee joint replacement.ResultsThe response rate to the questionnaire was 40%. 44% indicated they would prefer a virtual appointment over a face-to-face consultation in future. The most common word in the free text comments was ‘good’ (n=107).Seven main themes were identified from the patient interviews: patient understanding and expectations, patient confidence, patient voice, managing deterioration of condition, patient benefit, patient satisfaction using technology and navigating the website.Two main themes were identified from the staff interviews: the adapting patient pathway and project management.Combined analysis elucidated that patients who were doing well liked the ‘click and go’ approach but those with problems were concerned about how to report these and were therefore less satisfied.ConclusionThe virtual clinic process appears to be well accepted by both patients and clinicians. However, appropriate patient selection and clear pathways of communication to address patient concerns are pivotal to success.
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Khairat, Saif, Malvika Pillai, Barbara Edson, and Robert Gianforcaro. "Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices." Journal of Patient Experience 7, no. 5 (September 4, 2020): 665–72. http://dx.doi.org/10.1177/2374373520952975.
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Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.
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Heng, Pheng-Ann, Ping-Fu Fung, Kwong-Sak Leung, Han-Qiu Sun, and Tien-Tsin Wong. "Virtual Bronchoscopy." International Journal of Virtual Reality 4, no. 4 (January 1, 2000): 21–43. http://dx.doi.org/10.20870/ijvr.2000.4.4.2654.
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Patients potentially suffer and are exposed to danger during invasive bronchoscopic diagnosis and surgery. In order to reduce this hazardous risk, we have developed an interactive virtual environment for the simulation of bronchoscopy (in short, called "virtual bronchoscopy"). Because of this state-of-the-art application, medical doctors can now obtain pre-operative information and perform pilot examinations in a virtual environment without any invasive or needless surgery. This 3D lung volume data of the patient is first acquired from CT and/or MRI scanning, without any pain being inflicted upon the patient. Then a vessel-tracking process is used to extract the patient's bronchial tree from the data. It is important to note that while manual tracking is tedious and labor-intensive, fully automatic tracking may not be as reliable in such a critical medical application. Thus a semi-automatic tracking technique called the Intelligent Path Tracker, which provides automation and sufficient user control during the tracking process, is most useful. This methodology is applied to a virtual bronchoscopy session, where doctors can use a 3D pen input device to navigate and visualize the bronchial tree of patients in a natural and interactive manner. To support an interactive frame rate, we also propose a new volume rendering acceleration technique, named IsoRegion Leaping. Through this technique visualization is further accelerated using a distributed rendering process based upon a TCP/IP network of low-cost PCs. Combining these approaches enables a 256x256x256 volumetric data representation of a human lung to be navigated and visualized at a frame rate of over 10 Hz in our virtual bronchoscopy system.
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Asif, R., N. Elndari, and A. Negi. "POS1167 REVIEW OF THE IMPACT OF COVID-19 PANDEMIC ON RHEUMATOLOGY SERVICES AT A LARGE TERTIARY CARE CENTRE IN WALES, UK." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 862.2–863. http://dx.doi.org/10.1136/annrheumdis-2021-eular.649.
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Background:COVID-19 pandemic had an unprecedented impact on the delivery of patient care. Rheumatology services had to rapidly adapt to virtual consultations at the onset of the pandemic. However, providing a high quality and effective service in a virtual setting can be challenging and therefore its prudent to do a formal review and gain patient feedback to ensure that these clinics are fit for purpose.Objectives:To evaluate the impact of first wave of COVID-19 pandemic on patients with autoimmune rheumatic conditions, assess delivery of rheumatology outpatient care and record patient feedback.Methods:This study included patients on the Rheumatology clinic lists between 3rd and 31st August 2020. An electronic survey questionnaire was developed and the survey link was sent to patients via a text message using secure IT platform. Data was collected on patient demographics, diagnosis, comorbidities, treatments, clinical/ laboratory confirmed COVID-19 diagnosis, treatment interruption, impact on work, personal protective measures taken and views on virtual consultations.Results:307 patients responded with 287 complete responses. 73.1%(223) were female and 32.4% (99) were >65 years of age. Rheumatoid arthritis was the most common diagnosis 41.6%(127). Hypertension was the commonest comorbidity 21.4%(64) followed by Chronic lung disease 17.3%(52). 28.8%(85) were on Hydroxychloroquine, 26.7%(79) Methotrexate, 14.2%(42) Sulfasalazine and 13.2%(39) on Prednisolone. 22.3%(66) were on Biologics: Anti TNF 12.8%(38), Tocilizumab 3.7%(11) and Rituximab 3%(9). 52.6%(161) shielded, 16.9%(55) self-isolated and 30.3%(93) only maintained social distance. 197 patients self reported as being vulnerable but based on their treatment,only 167 patiemts met the clinically extremely vulnerable (CEV) criteria and all of those received government shielding letter.3.6%(11) had lab confirmed COVID-19, 3.2%(10) had clinically suspected COVID-19 infection. 14.3% (43) had their treatment interrupted. 4.6%(14) were unable to work from home or maintain social distancing at work. 59.8%(182) had face-to-face consultation changed to virtual. 63.2%(189) were satisfied, 28%(84) neutral and 8.7%(26) reported dissatisfaction with their consultation. 50.5%(153) were happy to continue with virtual consultation but with an option of face to face only if necessary.For consultations post COVID-19, 59.4%(182) preferred a mixture of face to face and virtual appointments.Conclusion:Majority of our patients seem happy with virtual consultations as long as they are assured of a face-to-face consultation if needed. A minority(8.7%) however, were dissatisfied. Some of the suggestions were, use of video consultations and improvement in communication before the virtual appointments. Our survey also shows that our patients have adapted well to virtual consultations and many are keen to have virtual consultation in the longer term. In our survey, only 6.8%(21) patients reported definite or clinically suspected COVID-19. Possible explanations for this include strict compliance with government advice on social distancing/shielding and limited testing at the onset of the pandemic. More patients assumed themselves to be clinically CEV than those who were actually CEV based on their treatment which is not surprising because of high level of anxiety among patients due to rapidly spreading pandemic and multiple sources of information.This feedback provides useful data which will help us to plan the delivery of rheumatology services post COVID-19 pandemic. While face-to-face patient contact is needed for comprehensive disease assessment, teaching and training, a model for the future is likely to include a combination of face-to-face and virtual consultations. This could allow a greater capacity to see new patients and reduce waiting lists. Patients with uncomplicated and stable disease could be followed up in virtual clinics. There is also a need to formally incorportate the virtual consultations into the curriculum for Rheumatology trainees.Disclosure of Interests:None declared.
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Arzhanik, M. B., S. I. Karas, E. V. Grakova, O. A. Vasiltseva, T. B. Korneeva, and E. E. Kara-Sal. "Methodology in cardiologists’ postgraduate education." Russian Journal of Cardiology, no. 12 (December 28, 2019): 104–8. http://dx.doi.org/10.15829/1560-4071-2019-12-104-108.
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Aim. To develop the methodological ware for distance cardiologists’ postgraduate education by virtual patients’ simulations. The article describes the first stage of the project to create a database of virtual patients. It includes the integration of text and multimedia clinical and diagnostic information about patients and software for its presentation. A virtual patient is considered as an informational model of the diagnostic and treatment processes.Material and methods. To create a database of virtual patients, a description of completed clinical cases in specially designed patterns was used. To provide distance access to information about virtual patients, the JavaScript was used. Results. When forming the database of virtual patients, two categories of case histories were used — the most common cases and rare disease variants. From archival case histories and examination data, information has been selected that plays a significant role in the diagnosis and treatment. It was decided to present the information in the form of separate portions-visits. Each visit includes the results of tests and specialty consultations necessary to make a decision on further treatment. In the template developed by doctors and analysts, patient information is broken down into blocks that included complaints; anamnesis; physical examination; provisional diagnosis; diagnostic and treatment plan; tests’ results; administrations; final diagnosis; clinical report. These blocks served as the basis for the development of relational database tables. To visualize information about the virtual patient, prototypes of screen forms were implemented. Information about different visits was placed on different marks, and the user is able to see previously available information.Conclusion. After testing, this software will be used in education to demonstrate complete clinical cases to students. In addition, by each virtual case, tasks that require students to make medical decisions can be formed. The technology of virtual patients can be used both for postgraduates (doctors) and medical students.
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Kim, Hyeon-Young, Ji-Hye Lee, and Eun-Hye Lee. "Virtual Experience of Perioperative Patients: Walking in the Patients’ Shoes Using Virtual Reality and Blended Learning." International Journal of Environmental Research and Public Health 18, no. 12 (June 15, 2021): 6457. http://dx.doi.org/10.3390/ijerph18126457.
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PURPOSE: This study examined the significance, nature, and structure of the virtual experience of perioperative patients as undergone by nursing students during their practical training through VR and blended learning. METHODS: Data were collected through a focus group interview (FGI) of 21 nursing student participants from November 2019 to December 2019 and analyzed through Colaizzi’s phenomenological method. RESULTS: Seven theme clusters were organized that described nursing students’ experiences. They are “placed in a passive position,” “facing the limits of communication,” “thinking of developing and improving competency as a nurse,” “recognizing the importance of interacting with their patients”, “learning vividly through experience”, “engaging in a new type of participatory learning”, and “designing nursing knowledge.” CONCLUSION: Patient-centered care can be achieved in the nursing school curriculum through “patient experiences.” Additionally, the feedback from research participants who have “become keenly aware of the need for patient experiences” shows that empathizing with the “patient experience” is an essential quality to acquire by prospective medical professionals before they are introduced to the nursing field. We suggest future studies that expand on nursing students’ patient experience in various teaching methods and curriculums.
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Legler, Sean, Matthew Diehl, Brian Hilliard, Andrew Olson, Rebecca Markowitz, Christopher Tignanelli, Genevieve B. Melton, Alain Broccard, Jonathan Kirsch, and Michael Usher. "Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study." Journal of Medical Internet Research 23, no. 4 (April 29, 2021): e25987. http://dx.doi.org/10.2196/25987.
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Background The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
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Little, Max, Daniel Huntley, James Morris, Felix Jozsa, John Hardman, and Raymond E. Anakwe. "The virtual fracture clinic improves quality of care for patients with hand and wrist injuries: an assessment of 3709 patients." Journal of Hand Surgery (European Volume) 45, no. 7 (June 15, 2020): 748–53. http://dx.doi.org/10.1177/1753193420930610.
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Fracture clinic services are under significant pressures to meet patients' expectations of a high-quality service. The virtual fracture clinic has shown early promise in helping to reduce such pressures. We used the virtual fracture clinic for hand and wrist injuries treated in the orthopaedic fracture clinic and used key quality indicators to measure improvement. Over the first 21 months, key patient outcome measures and satisfaction scores for patients discharged from the virtual fracture clinic with education to self-care were excellent. Our results show that a virtual fracture clinic model can be applied to provide high-quality care for hand and wrist injuries. The main advantage of the virtual fracture clinic is its ability to direct patients to the right person for timely treatment. We conclude from our 21-month experience that this model of care allows safe, effective, patient-centred, efficient and equitable care to the patients with hand and wrist fractures. Level of evidence: IV
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Raffan, Freya, Teresa Anderson, Tim Sinclair, Miranda Shaw, Sue Amanatidis, Rajip Thapa, Sarah Jane Nilsson, Dianna Jagers, Andrew Wilson, and Fiona Haigh. "The Virtual Care Experience of Patients Diagnosed With COVID-19." Journal of Patient Experience 8 (January 1, 2021): 237437352110083. http://dx.doi.org/10.1177/23743735211008310.
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Virtual models of care are seen as a sustainable solution to the growing demand for health care. This paper analyses the experience of virtual care among patients diagnosed with COVID-19 in home isolation or health hotel quarantine using a patient-reported experience questionnaire. Results found that patients respond well to virtual models of care during a pandemic. Lessons learned can inform future developments of virtual care models.
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Alcocer Alkureishi, Maria, Gena Lenti, Zi-Yi Choo, Jason Castaneda, George Weyer, Julie Oyler, and Wei Wei Lee. "Teaching Telemedicine: The Next Frontier for Medical Educators." JMIR Medical Education 7, no. 2 (April 29, 2021): e29099. http://dx.doi.org/10.2196/29099.
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The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.
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Shachak, Aviv, and Maria Alcocer Alkureishi. "Virtual care: a ‘Zoombie’ apocalypse?" Journal of the American Medical Informatics Association 27, no. 11 (September 17, 2020): 1813–15. http://dx.doi.org/10.1093/jamia/ocaa185.
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Abstract In the wake of COVID-19, clinicians took to telehealth to continue providing services to their patients, mostly via telephone or videoconferencing technology. Telehealth has many promised and proven benefits including convenience to the patient, potentially less distraction from the electronic health record (EHR), saves in travel time and expenses, and lowering patients’ wait time in the clinic. However, there could be some unintended negative consequences including increased clinician burnout due to screen fatigue, potential loss of information due to the limitations of the medium, difficulty discussing sensitive issues and impacts on patient-clinician relationship, empathy, and compassion. In this perspective, we discuss some of the positives and potential negatives of telehealth and highlight some considerations that could guide the choice of media. We submit that for telehealth to become a sustainable solution that is widely applied, it is important to take these issues into consideration in both research and implementation of telehealth solutions.
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Ferdig, Richard E., Katherine Schottke, Diego Rivera-Gutierrez, and Benjamin Lok. "Assessing Past, Present, and Future Interactions with Virtual Patients." International Journal of Gaming and Computer-Mediated Simulations 4, no. 3 (July 2012): 20–37. http://dx.doi.org/10.4018/jgcms.2012070102.
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Virtual patients have proven to be an effective educational tool for learning and applying clinical examination skills. Interactive virtual patient scenarios provide opportunities for medical students to practice and improve verbal and nonverbal communication through the use of performance feedback. This feedback helps students to understand the ways in which they are perceived by their patients which otherwise could not be analyzed by health professionals. Evidence supports that interactive VPs fill a niche in medical education and testing for scenarios that cannot be practiced outside the virtual environment or with standardized patients. Not only are virtual patients effective in medical curriculum, as evidenced by various studies, they are applicable in understanding the ways in which learning occurs and can be implemented into a number of educational settings. In this article, the authors summarize seven years of findings on the use of virtual patients. They also describe current efforts at implementing virtual patients in community scenarios. The paper concludes with avenues for future directions with virtual human patients.
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Graham, Judy M., Marcia Brinson, Lisa-Vanessa Magtibay, Brian Regan, and Eliot J. Lazar. "Virtual Patient Safety Rounds." Journal For Healthcare Quality 31, no. 5 (September 2009): 48–52. http://dx.doi.org/10.1111/j.1945-1474.2009.00047.x.
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Bond, William F., Teresa J. Lynch, Matthew J. Mischler, Jessica L. Fish, Jeremy S. McGarvey, Jason T. Taylor, Dipen M. Kumar, et al. "Virtual Standardized Patient Simulation." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 14, no. 4 (August 2019): 241–50. http://dx.doi.org/10.1097/sih.0000000000000373.
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Hamilton, Robert James, Lauren Landoni, Kopika Kuhathaas, Peter W. M. Chung, Philippe L. Bedard, Padraig Richard Warde, Aaron Richard Hansen, Tran Truong, Ezra Hahn, and Michael A. S. Jewett. "WATChmAN: A randomized trial of virtual surveillance versus standard in-person care for clinical stage I testicular cancer." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 396. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.396.
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396 Background: Most guidelines recommend active surveillance (AS) as initial management for stage I testis cancer (TC). AS entails blood work and imaging at regular intervals requiring multiple clinic visits spanning 5 years. This can be time-consuming, difficult to adhere to, dissatisfying and costly for patients and health care systems. We innovated a secure online platform, WATChmAN (Web-based virtuAl Testicular CANcer clinic) allowing asynchronous communication between patients, results, and physician team. Methods: We are conducting an RCT (NCT03360994) where patients with stage I TC on AS are randomized to virtual care (WATChmAN), or standard in-person care. Primary endpoint is safety: examining loss-to-follow-up and compliance with AS schedules, incidence of relapse, delays in detection of relapse, and burden of relapse. Non-compliance represents a) patient-derived delay in visit; or b) follow-up visit with incomplete testing. Secondary endpoints include: patient/physician satisfaction and cost savings. Results: At present, 102 of a planned 144 patients are enrolled: 51 to virtual care, and 51 to standard in-person care. More patients in the virtual arm have been compliant with AS schedules (89% vs 73%) with shorter median compliance delays (12 vs. 14 days). To date, 10 patients have relapsed: 6 virtual (11.8%) and 4 standard (7.8%). Median time to relapse was shorter for the virtual arm (8 vs. 9.5 months), with no difference in burden of disease at relapse. Response rates to 6-month surveys were 90% and 59% for virtual and standard arms respectively. When asked if satisfied with their care, on the virtual arm 67% reported “extremely satisfied”, and 33% “satisfied” compared to 50% and 45% for the standard arm. When WATChmAN patients were asked if the application is able to provide the same excellence of care as in-person appointments, 82% reported “strongly agree” or “agree”. Conclusions: Interim results suggest virtual care in stage I TC is feasible and safe with improvements in patient satisfaction. Through semi-structured interviews and cost-effectiveness analyses, we anticipate more insight into virtual care. This may serve as a potential model for virtual care for other cancers. Clinical trial information: NCT03360994.
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Dyachenko, E. V. "Simulated Patient or Patient-Robot in Teaching Doctors Professional Communication — Unity of Opposites." Virtual Technologies in Medicine 1, no. 3 (September 17, 2021): 137–38. http://dx.doi.org/10.46594/2687-0037_2021_3_1343.
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Research shows that bedside communication training (in the workplace) is more effective if trainees have mastered the doctor-patient simulation cycle. The technologies are different: virtual and simulated patients, robotic patients. What learning tasks can they solved? Is it possible to effectively train doctors in professional communication with the involvement of virtual patients and robotic patients?
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Preston, N., G. A. McHugh, E. M. A. Hensor, A. J. Grainger, P. J. O’Connor, P. G. Conaghan, M. H. Stone, and S. R. Kingsbury. "Developing a standardized approach to virtual clinic follow-up of hip and knee arthroplasty." Bone & Joint Journal 101-B, no. 8 (August 2019): 951–59. http://dx.doi.org/10.1302/0301-620x.101b8.bjj-2018-1566.r1.
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Aims This study aimed to develop a virtual clinic for the purpose of reducing face-to-face orthopaedic consultations. Patients and Methods Anonymized experts (hip and knee arthroplasty patients, surgeons, physiotherapists, radiologists, and arthroplasty practitioners) gave feedback via a Delphi Consensus Technique. This consisted of an iterative sequence of online surveys, during which virtual documents, made up of a patient-reported questionnaire, standardized radiology report, and decision-guiding algorithm, were modified until consensus was achieved. We tested the patient-reported questionnaire on seven patients in orthopaedic clinics using a ‘think-aloud’ process to capture difficulties with its completion. Results A patient-reported 13-item questionnaire was developed covering pain, mobility, and activity. The radiology report included up to ten items (e.g. progressive periprosthetic bone loss) depending on the type of arthroplasty. The algorithm concludes in one of three outcomes: review at surgeon’s discretion (three to 12 months); see at next available clinic; or long-term follow-up/discharge. Conclusion The virtual clinic approach with attendant documents achieved consensus by orthopaedic experts, radiologists, and patients. The robust development and testing of this standardized virtual clinic provided a sound platform for organizations in the United Kingdom to adopt a virtual clinic approach for follow-up of hip and knee arthroplasty patients. Cite this article: Bone Joint J 2019;101-B:951–959.
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Gilson, Sarah F., Craig A. Umscheid, Neda Laiteerapong, Graeme Ossey, Kenneth J. Nunes, and Sachin D. Shah. "Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis." JMIR Medical Informatics 8, no. 12 (December 4, 2020): e24544. http://dx.doi.org/10.2196/24544.
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Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.
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Miles, J. K. "Taking patient virtue seriously." Theoretical Medicine and Bioethics 40, no. 2 (April 2019): 141–49. http://dx.doi.org/10.1007/s11017-019-09484-x.
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Haase, Kristen R., Fay Strohschein, Virginia Lee, and Carmen G. Loiselle. "Les promesses de la navigation virtuelle dans les soins du cancer : perspectives des patients et des fournisseurs de soins de santé." Canadian Oncology Nursing Journal 26, no. 3 (July 15, 2016): 246–54. http://dx.doi.org/10.5737/23688076263246254.
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Pittman, Josh. "The Most Important Virtue?" Renascence 71, no. 1 (2019): 57–75. http://dx.doi.org/10.5840/renascence20197114.
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The narrator of the Middle English Cleanness states that God punishes sexual sin more harshly than any other sin. This essay argues that the rest of the BL Cotton Nero A.x manuscript continues to develop the virtue of temperance, which governs sexual behavior, as a central theme. Pearl uses temperance to bring home the dreamer’s sin and God’s justice, while Patience and SGGK employ the interrelation between temperance and fortitude in ways that make temperance foundational. Interrogating the interdependence of the virtues allows the poet to challenge the traditional hierarchy of virtues, in which temperance is the lowest, thus making the case that temperance is paradoxically foundational to other virtues, like justice and fortitude. In this way, the poems not only make a case for the value of temperance, but they also expose ambiguities in orthodox accounts of the virtues.
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Indelicato, Alyssa, Lauren Germain, Liliana Barros Una, Alice Krueger, Ann Ludwig, Sharon Brangman, and Telisa Stewart. "Using a Virtual Curriculum to Provide Interprofessional Student Education in Alzheimer’s Disease." Innovation in Aging 4, Supplement_1 (December 1, 2020): 4–5. http://dx.doi.org/10.1093/geroni/igaa057.013.
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Abstract As Alzheimer’s disease increases in prevalence among older adults, there is an increased need for health professionals to effectively communicate with patients and their caregivers. Interactions between providers and Alzheimer’s patients differ from a typical patient-physician encounter. The project created a virtual learning environment (VLE) to better prepare students to engage with Alzheimer's patients and their caregivers. The VLE includes a clinical space, clinical office, and a patient’s home environment for students to practice their health communication skills and to better understand the lived experience. Nursing, MD, and Physician Assistants students were recruited and assigned a virtual provider (avatar). Students engage with a virtual patient (bot) in an exam room and then are directed to engage with a virtual caregiver (bot) in a clinical office. The virtual patient and caregiver have been programmed to respond to questions respectively and provide detailed insight into their lived experiences. After these encounters, the student is asked to react on the information obtained. The student is asked to explore the virtual home environment and triangulate the home experience, the caregiver’s perspective, and the patient’s responses. We are enrolling students to participate in the project and will complete the evaluation data. Students will be assessed for knowledge, self-efficacy, and their overall satisfaction with the virtual learning environment. We anticipate students will have an increase in each of these areas and will have improved communication skills with this at-risk, older adult population.
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ÖZDEMİR, Gökhan, Berkman ALBAYRAK, Emir YÜZBAŞIOĞLU, and Yeşim ÖLÇER US. "Virtual Articulators, Virtual Occlusal Records and Virtual Patients in Dentistry." Journal of Experimental and Clinical Medicine 38, SI-2 (May 19, 2021): 129–35. http://dx.doi.org/10.52142/omujecm.38.si.dent.9.
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Digital technology is broadly used in almost every part of medicine. As tools of digital technology, augmented reality and virtual reality have been adopted in all disciplines of dentistry and dental education. In particular, virtual articulators have allowed for a full analysis of occlusion with dental models that can simulate all mandibular movements in static and dynamic positions. When combined with additional software, virtual articulators can also enhance education and practice, allow for quicker and more precise individualized diagnoses and enable discussions of dental treatment planning options with patients during their first appointment. This article reviews the requirements for virtual articulators and occlusal recordings and assesses their advantages and disadvantages in various aspects.
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Levine, Oren Hannun, Michael McGillion, and Mark Levine. "Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation." JMIR Cancer 6, no. 2 (November 24, 2020): e24222. http://dx.doi.org/10.2196/24222.
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The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon.
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Coe, Taylor M., Trevor J. McBroom, Sarah A. Brownlee, Karen Regan, Stephen Bartels, Noelle Saillant, Heidi Yeh, Emil Petrusa, and Leigh Anne Dageforde. "Medical Students and Patients Benefit from Virtual Non-Medical Interactions Due to COVID-19." Journal of Medical Education and Curricular Development 8 (January 2021): 238212052110283. http://dx.doi.org/10.1177/23821205211028343.
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Background: Patient care restrictions created by the COVID-19 pandemic constrained medical students’ ability to interact directly with patients. Additionally, organ transplant recipients faced increasing isolation due to the rise of telemedicine, the importance of social distancing and their immunosuppressed state. We created a pilot program to pair students with transplant patients for structured, virtual encounters and studied its impact on medical students and patients. Methods: In May 2020, medical students conducted virtual visits with patients via telephone or video conferencing. Patients and students were surveyed regarding their experiences and independent focus groups were conducted. The survey responses and focus group discussions were deidentified, transcribed, and analyzed for themes. Results: Ten participating students were in their first, second, or final year of medical school. The 14 patients were liver or kidney transplant recipients or kidney donors. All interactions lasted longer than 30 minutes, with 56% greater than 1 hour. Three themes emerged related to the student experience: improvement of their clinical communication skills, development of knowledge and attitudes related to organ transplantation and donation, and independent management of a patient encounter. Three themes related to the patient experience: appreciation of the opportunity to share their personal patient experience to help educate future physicians, a cathartic and personally illuminating experience and an opportunity to share the message of donation. Conclusions: This pilot program provided a novel opportunity for virtual student-patient interactions that was feasible, well-received, and mutually beneficial. The use of virtual non-medical patient experiences allowed for experiential learning during which students learned about both clinical medicine and enhanced their communication skills directly from patients. Additionally, patients were able to engage with medical students in a new way, as teachers of clinical interactions, and reported a high level of satisfaction in addition to deriving personal benefit.
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Marshall, Sophie, and Thayalan Kandiah. "Staying home: teledentistry in the delivery of paediatric dental care." Faculty Dental Journal 11, no. 4 (October 2020): 174–77. http://dx.doi.org/10.1308/rcsfdj.2020.115.
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Virtual clinics were introduced at Surrey and Sussex Healthcare NHS Trust in 2019 as an innovative way to improve access to care for patients. During the COVID-19 pandemic, these clinics have been key to the delivery of care to patients. This article discusses the applications and patient reported outcomes of the use of teledentistry before the COVID-19 pandemic, examines the applications of virtual clinics during the COVID-19 pandemic, and considers the role of teledentistry in routine care and patient management during the COVID-19 recovery phase. Applications in teaching are also considered along with limitations and considerations for setting up teledentistry services. Is ‘healing at a distance’ a viable solution? We investigate the benefits and limitations of virtual clinics in managing young patients.
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Wood, Eleanor, Alexandra Rankin, Pasquale Berlingieri, and Owen Epstein. "The junior doctor's virtual consulting room." Journal of Telemedicine and Telecare 13, no. 1_suppl (July 2007): 65–67. http://dx.doi.org/10.1258/135763307781645022.
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We assessed the usability of the Virtual Consulting Room (VCR), a Web-based guidance application providing direct access to specialist knowledge. The VCR guides the user through the patient journey from first presentation to final destination. Four pre-registration house officers (PRHOs) were informed of the availability of the VCR which was accessible from all ward computers at the Royal Free Hospital. During a six-week study, 52 patients were assessed by four PRHOs. The VCR was accessed for all 52 patients. A questionnaire was completed in 49 cases (94%). In 43 of the 49 cases (88%), the PRHOs reported that the VCR supported clinical decision-making, and in 46 cases (94%) it improved their knowledge. Use of the VCR altered the PRHOs investigations in 24 cases (49%), changed the management plan in 18 cases (37%) and the decision to refer in 10 cases (20%). The present study showed that the VCR was easy to use, educational, supported clinical decision-making and affected patient management.
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Veldhuijzen, Govert, Nienke J. M. Klaassen, Richard J. A. Van Wezel, Joost P. H. Drenth, and Aura A. Van Esch. "Virtual reality distraction for patients to relieve pain and discomfort during colonoscopy." Endoscopy International Open 08, no. 07 (June 30, 2020): E959—E966. http://dx.doi.org/10.1055/a-1178-9289.
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Abstract Background and study aims Colonoscopy is an invasive procedure that may cause patients pain and discomfort. Routine use of sedation, while effective, is expensive and requires logistical planning. Virtual reality (VR) offers immersive, three-dimensional experiences that distract the attention and might comfort patients. We performed a pilot study to investigate the feasibility of VR distraction during colonoscopy. Patients and methods Adults referred for colonoscopy were considered for inclusion and divided over two groups: with and without VR glasses. The main outcome was patient acceptance of wearing VR glasses during colonoscopy without compromising the technical success of the procedure. Secondary outcomes were patient comfort, pain, and anxiety before, during and after the procedure, using validated patient questionnaires. Patient comments were collected through a qualitative interview. Results We included 19 patients, 10 of whom were offered VR glasses. All patients accepted VR glasses without prolonging procedural time. No disadvantages of the VR glasses were reported in terms of communication or change of position of the patient. We found that patient comfort, pain, anxiety, and satisfaction in relation to the procedure were similar in both groups. Patients described a pleasant distracting effect using VR glasses. Conclusion VR glasses during colonoscopy are accepted by patients and do not compromise endoscopic technical success. Patients reported that the VR experience was pleasant and distracting.
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Briggs, Richard S. "Who Can Read Wisdom? The Implied Virtues of the Readers of Wisdom’s Narratives." Expository Times 131, no. 12 (March 2, 2020): 536–44. http://dx.doi.org/10.1177/0014524620909307.
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This article contributes to the attempt to reformulate hermeneutical questions about ‘how to read the Bible’ in terms of theological characterisations of the kind of reader best placed to read the Bible well. It is thus situated amidst renewed interest in the intersection of character ethics and biblical interpretation. It addresses two related issues, before pointing in the direction of a substantive third concern. First, it explores what is at stake in reading wisdom texts as narratives, finding it persuasive to construe wisdom in narrative terms. Secondly, it considers what virtues are presupposed in these narrative constructions. The reading of Job draws us to consider patience; from Proverbs we consider the virtue of perceptiveness; and from Ecclesiastes a virtue of honesty. Thirdly, the larger question of how one might begin to characterise the implied reader of these texts is considered, building on a canonically constructed portrait of the reader informed by the virtues considered.