Article

A Digital Health Intervention for Stress and Anxiety Relief in Perioperative Care: Protocol for a Feasibility Trial (Preprint)

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background Stress and anxiety are psychophysiological responses commonly experienced by patients during the perioperative process that can increase presurgical and postsurgical complications to a comprehensive and positive recovery. Preventing and intervening in stress and anxiety can help patients achieve positive health and well-being outcomes. Similarly, the provision of education about surgery can be a crucial component and is inversely correlated with preoperative anxiety levels. However, few patients receive stress and anxiety relief support before surgery, and resource constraints make face-to-face education sessions untenable. Digital health interventions can be helpful in empowering patients and enhancing a more positive experience. Digital health interventions have been shown to help patients feel informed about the possible benefits and risks of available treatment options. However, they currently focus only on providing informative content, neglecting the importance of personalization and patient empowerment. Objective This study aimed to explore the feasibility of a digital health intervention called the Adhera CARINAE Digital Health Program, designed to provide evidence-based, personalized stress- and anxiety-management methods enabled by a comprehensive digital ecosystem that incorporates wearable, mobile, and virtual reality technologies. The intervention program includes the use of advanced data-driven techniques for tailored patient education and lifestyle support. Methods The trial will include 5 hospitals across 3 European countries and will use a randomized controlled design including 30 intervention participants and 30 control group participants. The involved surgeries are cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacement, prostate or bladder cancer surgeries, hip and knee replacement, maxillofacial surgery, or scoliosis. The control group will receive standard care, and the intervention group will additionally be exposed to the digital health intervention program. Results The recruitment process started in January 2022 and has been completed. The primary impact analysis is currently ongoing. The expected results will be published in early 2023. Conclusions This manuscript details a comprehensive protocol for a study that will provide valuable information about the intervention program, such as the measurement of comparative intervention effects on stress; anxiety and pain management; and usability by patients, caregivers, and health care professionals. This will contribute to the evidence planning process for the future adoption of diverse digital health solutions in the field of surgery. Trial Registration ClinicalTrials.gov NCT05184725; https://www.clinicaltrials.gov/ct2/show/NCT05184725 International Registered Report Identifier (IRRID) DERR1-10.2196/38536

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Article
Background: Digital data sources have become ubiquitous in modern culture in the era of digital technology but often tend to be under-researched because of restricted access to data sources due to fragmentation, privacy issues, or industry ownership, and the methodological complexity of demonstrating their measurable impact on human health. Even though new big data sources have shown unprecedented potential for disease diagnosis and outbreak detection, we need to investigate results in the existing literature to gain a comprehensive understanding of their impact on and benefits to human health. Objective: A systematic review of systematic reviews on identifying digital data sources and their impact area on people's health, including challenges, opportunities, and good practices. Methods: A multidatabase search was performed. Peer-reviewed papers published between January 2010 and November 2020 relevant to digital data sources on health were extracted, assessed, and reviewed. Results: The 64 reviews are covered by three domains, that is, universal health coverage (UHC), public health emergencies, and healthier populations, defined in WHO's General Programme of Work, 2019–2023, and the European Programme of Work, 2020–2025. In all three categories, social media platforms are the most popular digital data source, accounting for 47% (N = 8), 84% (N = 11), and 76% (N = 26) of studies, respectively. The second most utilized data source are electronic health records (EHRs) (N = 13), followed by websites (N = 7) and mass media (N = 5). In all three categories, the most studied impact of digital data sources is on prevention, management, and intervention of diseases (N = 40), and as a tool, there are also many studies (N = 10) on early warning systems for infectious diseases. However, they could also pose health hazards (N = 13), for instance, by exacerbating mental health issues and promoting smoking and drinking behavior among young people. Conclusions: The digital data sources presented are essential for collecting and mining information about human health. The key impact of social media, electronic health records, and websites is in the area of infectious diseases and early warning systems, and in the area of personal health, that is, on mental health and smoking and drinking prevention. However, further research is required to address privacy, trust, transparency, and interoperability to leverage the potential of data held in multiple datastores and systems. This study also identified the apparent gap in systematic reviews investigating the novel big data streams, Internet of Things (IoT) data streams, and sensor, mobile, and GPS data researched using artificial intelligence, complex network, and other computer science methods, as in this domain systematic reviews are not common.
Full-text available
Article
Artificial Intelligence revolutionizes the drug development process that can quickly identify potential biologically active compounds from millions of candidate within a short span of time. The present review is an overview based on some applications of Machine Learning based tools such as GOLD, DeepPVP, LIBSVM, etc and the algorithms involved such as support vector machine (SVM), random forest (RF), decision trees and artificial neural networks (ANN) etc in the various stages of drug designing and development. These techniques can be employed in SNP discoveries, drug repurposing, ligand-based drug design (LBDD), Ligand-based Virtual Screening (LBVS) and Structure-based virtual screening (SBVS), Lead identification, quantitative structure-activity relationship (QSAR) modeling, and ADMET analysis. It is demonstrated that SVM exhibited better performance in indicating that the classification model will have great applications on human intesti-nal absorption (HIA) predictions. Successful cases have been reported which demonstrate the efficiency of SVM and RF model in identifying JFD00950 as a novel compound targeting against a colon cancer cell line, DLD-1 by inhibition of FEN1 cytotoxic and cleavage activity. Furthermore, a QSAR model was also used to predicts flavonoid inhibitory effects on AR activity as a potent treatment for diabetes mellitus (DM), using ANN. Hence, in the era of big data, ML approaches evolved as a powerful and efficient way to deal with the huge amounts of generated data from modern drug discovery in order to model small-molecule drugs, Gene Biomarkers, and identifying the novel drug targets for various diseases.
Full-text available
Article
The convergence of artificial intelligence (AI) and precision medicine promises to revolutionize health care. Precision medicine methods identify phenotypes of patients with less-common responses to treatment or unique health care needs. AI leverages sophisticated computation and inference to generate insights, enable the system to reason and learn, and empower clinician decision making through augmented intelligence. Recent literature suggests that translational research exploring this convergence will help solve the most difficult challenges facing precision medicine, especially those in which non-genomic and genomic determinants, combined with information from patient symptoms, clinical history, and lifestyles, will facilitate personalized diagnosis and prognostication.
Full-text available
Article
Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users’ feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioural change theories, which may further increase the effectiveness of their recommendations. This paper’s objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioural change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioural change determinants of the I-Change behavioural change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user profile by following the principles of the I-Change model and maintaining the benefits of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system’s design bridges the gap between health recommender systems and the use of behavioural change theories. This article presents a novel approach integrating recommender system technology, health behaviour technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.
Full-text available
Chapter
In the current study, a model-based system for predicting resilience in silico, as part of personalizing precision medicine, to better understand the needs for improved therapeutic protocols of each patient is proposed. The computational environment, which is currently under implementation within the BOUNCE EU project (“Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back”), will help clinicians and care-givers to predict the patient’s resilience trajectory throughout cancer continuum. The overall proposed system architecture contributes to clinical outcomes and patient well-being by taking into consideration biological, social, environmental, occupational and lifestyle factors for resilience prediction in women with breast cancer. Supervised, semisupervised and unsupervised learning algorithms are adopted with the inherent ability to represent the time-varying behaviour of the underlying system which allows for a better representation of spatiotemporal input-output dependencies. The in silico resilience prediction approach accommodates numerous diverse factors contributing to multi-scale models of cancer, in order to better specify clinically useful aspects of recovery, treatment and intervention.
Full-text available
Article
Background: Venipuncture is one of the most painful and distressing procedure experienced by pediatric patients. Evidence suggests that distraction combined with age-appropriate procedural information can effectively decrease procedural pain and anxiety in pediatric patients. Immersive virtual reality (IVR) can simultaneously provide complete distraction and procedural information to patients. Methods: Guided by the gate control theory and Lazarus and Folkman's theory, this study aims to examine the effects of IVR intervention on reducing the pain, anxiety and stress, the duration of venipuncture, and the satisfaction of healthcare providers for the procedure. A randomized controlled trial with repeated assessments will be conducted. A total of 200 pediatric patients aged 4-12 years will be recruited from a regional public hospital and randomly assigned to either the intervention or control group. The study will use two age-appropriate IVR modules that consist of procedural information. The intervention group will receive IVR intervention, whereas the control group will receive standard care only. The cost-effectiveness of IVR intervention will be compared with that of standard care. Outcome evaluation will be conducted at four time points: 10 min before, during, immediately after, and 30 min after the procedure. Intention to treat and generalized estimating equation model will be used to analyze the data. Discussion: This study is the first of its kind to adopt IVR intervention with age-appropriate procedural information for pediatric patients undergoing venipuncture. Findings of the proposed study may: (1) provide a novel, facile, and cost-effective intervention that can be used virtually at any time and place to manage pain and anxiety; and (2) shed light on the global trends of research and clinical development of IVR as an intervention for other painful and stressful medical procedures. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800018817 . Registered on 11 October 2018.
Full-text available
Article
In Palliative Care, the unit of care is the patient and their family. Although members of the health care team often address the family caregiver’s opinions and concerns, the focus of care remains on the needs of the patient. The readiness and willingness of the family caregiver is often overlooked as they are expected to assume a complex caregiving role. When family caregivers are not intellectually or emotionally prepared or physically capable, the caregiver is at high risk for serious health issues and cognitive, emotional, and physical decline particularly as caregiving extends over time. Family caregivers are often a neglected and at-risk population. Illustrated through the use of a case study, this article addresses the complex role of family caregivers, as both health team members and second-order patients. It emphasizes the importance of family assessment and interventions to balance the burdens and benefits of family caregiving and protect caregivers’ health and well-being.
Full-text available
Article
Objective Tailored digital health programs can promote positive health-related lifestyle changes and have been shown to be (cost) effective in trials. However, such programs are used suboptimally. New approaches are needed to optimise the use of these programs. This paper illustrates the potential of recommender systems to support and enhance computer-tailored digital health interventions. The aim is threefold, to explore: (1) how recommender systems provide health recommendations, (2) to what extent recommender systems incorporate theoretical models and (3) how the use of recommender systems may enhance the usage of computer-tailored interventions. Methods A scoping review was conducted, using MEDLINE and ScienceDirect, to identify health recommender systems reported in studies between January 2007 and December 2017. Information was subsequently extracted to understand the potential benefits of recommender systems for computer-tailored digital health programs. Titles and abstracts of 1184 studies were screened for the full-text screening, in which two reviewers independently selected articles and systematically extracted data using a predefined extraction form. Results A total of 26 articles were included for data extraction. General characteristics were reported, with eight studies reporting hybrid filtering. A description of how each recommender system provides a recommendation is described; the majority of recommender systems used messages as recommendation. We identified the potential effects of recommender systems on efficiency, effectiveness, trustworthiness and enjoyment of the digital health program. Conclusions Incorporating a collaborative method with demographic filtering as a second step to knowledge-based filtering could potentially add value to traditional tailoring with regard to enhancing the user experience. This study illustrates how recommender systems, especially hybrid programs, may have the potential to bring tailored digital health forward.
Full-text available
Article
Background Accurate assessment of surgical‐site infection (SSI) is crucial for surveillance and research. Self‐reporting patient measures are needed because current SSI tools are limited for assessing patients after leaving hospital. The Bluebelle Wound Healing Questionnaire (WHQ) was developed for patient or observer completion; this study tested its acceptability, scale structure, reliability and validity in patients with closed primary wounds after abdominal surgery. Methods Patients completed the WHQ (self‐assessment) within 30 days after leaving hospital and returned it by post. Healthcare professionals completed the WHQ (observer assessment) by telephone or face‐to‐face. Questionnaire response rates and patient acceptability were assessed. Factor analysis and Cronbach's α examined scale structure and internal consistency. Test–retest and self‐ versus observer reliability assessments were performed. Sensitivity and specificity for SSI discrimination against a face‐to‐face reference diagnosis (using Centers for Disease Control and Prevention criteria) were examined. Results Some 561 of 792 self‐assessments (70·8 per cent) and 597 of 791 observer assessments (75·5 per cent) were completed, with few missing data or problems reported. Data supported a single‐scale structure with strong internal consistency (α greater than 0·8). Reliability between test–retest and self‐ versus observer assessments was good (κ 0·6 or above for the majority of items). Sensitivity and specificity for SSI discrimination was high (area under the receiver operating characteristic (ROC) curve 0·91). Conclusion The Bluebelle WHQ is acceptable, reliable and valid with a single‐scale structure for postdischarge patient or observer assessment of SSI in closed primary wounds.
Full-text available
Article
Introduction Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. Methods Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. Results None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0–4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. Conclusions Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.
Full-text available
Article
This paper discusses challenges in utilizing findings and constructs from different (health behavior) theories. There is a multitude of theories that can be used, but the question is what to do with so many theories. As a result there is debate about the need for integrating health behavior theories. Opponents of integrating theories suggest that this may lead to a theory of everything without adding anything. Supporters, however, see advantages of such an approach. Integration is more than simply combining theories. Combining theories implies using a simple additive model. Integration, however, implies critical testing of these constructs, and constructs will only be added if they have supplementary value theoretically and empirically and will lead to developing and testing new hypotheses. This paper outlines what the advantages of critical testing and integration of theories could be, using the Integrated-Change Model as an example.
Full-text available
Article
The roles of mental health educators and professionals in the diffusion of mental health mobile apps are addressed in this viewpoint article. Mental health mobile apps are emerging technologies that fit under the broad heading of mobile health (mHealth). mHealth, encompassed within electronic health (eHealth), reflects the use of mobile devices for the practice of public health. Well-designed mental health mobile apps that present content in interactive, engaging, and stimulating ways can promote cognitive learning, personal growth, and mental health enhancement. As key influencers in the mental health social system, counselor educators and professional associations may either help or hinder diffusion of beneficial mHealth technologies. As mental health mobile apps move towards ubiquity, research will continue to be conducted. The studies published thus far, combined with the potential of mental health mobile apps for learning and personal growth, offer enough evidence to compel mental health professionals to infuse these technologies into education and practice. Counselor educators and professional associations must use their influential leadership roles to train students and practitioners in how to research, evaluate, and integrate mental health mobile apps into practice. The objectives of this article are to (1) increase awareness of mHealth and mental health mobile apps, (2) demonstrate the potential for continued growth in mental health mobile apps based on technology use and acceptance theory, mHealth organizational initiatives, and evidence about how humans learn, (3) discuss evidence-based benefits of mental health mobile apps, (4) examine the current state of mHealth diffusion in the mental health profession, and (5) offer solutions for impelling innovation diffusion by infusing mental health mobile apps into education, training, and clinical settings. This discussion has implications for counselor educators, mental health practitioners, associations, continuing education providers, and app developers.
Full-text available
Article
We conducted a systematic review of studies employing telehealth interventions which focused on family caregivers' outcomes. The Embase, CINHAL, Cochrane and PubMed databases were searched using combinations of keywords including "telehealth," "telemedicine," "telecare," "telemonitoring," "caregiver" and "family." The initial search produced 4205 articles, of which 65 articles met the inclusion criteria. The articles included 52 experimental studies, 11 evaluation studies, one case study and one secondary analysis. Thirty-three articles focused on family caregivers of adult and older patients, while 32 articles focused on parental caregivers of paediatric patients. The technologies included video, web-based, telephone-based and telemetry/remote monitoring. Six main categories of interventions were delivered via technology: education, consultation (including decision support), psychosocial/cognitive behavioural therapy (including problem solving training), social support, data collection and monitoring, and clinical care delivery. More than 95% of the studies reported significant improvements in the caregivers' outcomes and that caregivers were satisfied and comfortable with telehealth. The review showed that telehealth can positively affect chronic disease care, home and hospice care. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Full-text available
Article
Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Methods A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed. Results A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7 ± 1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief. Conclusions In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital should provide anxiety related information for patients.
Full-text available
Article
Several studies have demonstrated that exposure therapy—in which the patient is exposed to specific feared situations or objects that trigger anxiety—is an effective way to treat anxiety disorders. However, to overcome a number of limitations inherent in this approach—lack of full control of the situation, costs and time required, etc.—some therapists have started to add virtual reality (VR) to the in vivo exposure-based therapy, providing in-office, controlled exposure therapy. Compared to the in vivo exposure, VR Exposure Therapy (VRET) is completely controlled: the quality, the intensity and the frequency of the exposure are decided by the therapist, and the therapy can be stopped at any time if the patient does not tolerate it. Moreover, the flexibility of a virtual experience allows the patient to experience situations that are often much worse and more exaggerated than those that are likely to be encountered in real life. However, a critical issue underlying the use of VRET in the treatment of anxiety-related disorders is the lack of a virtual reality system in the patient’s real-life context. In this paper, we present a clinical protocol for the treatment of Generalized Anxiety Disorders (GAD) based on the ubiquitous use of a biofeedback-enhanced VR system. The protocol includes the use of a mobile exposure system allowing patients to perform the virtual experience in an outpatient setting. A between-subjects study, involving 25 GAD patients, was carried out to verify the efficacy of the proposed approach. The clinical data in this pilot study seemed to support the efficacy of the ubiquitous approach.
Full-text available
Article
There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation--or having the knowledge, skills, and confidence to manage one's health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples. To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population. Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010. A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit. The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization. In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher. This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.
Full-text available
Article
The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed to meet demand for instruments to measure mental well-being. It comprises 14 positively phrased Likert-style items and fulfils classic criteria for scale development. We report here the internal construct validity of WEMWBS from the perspective of the Rasch measurement model. The model was applied to data collected from 779 respondents in Wave 12 (Autumn 2006) of the Scottish Health Education Population Survey. Respondents were aged 16-74 (average 41.9) yrs. Initial fit to model expectations was poor. The items 'I've been feeling good about myself', 'I've been interested in new things' and 'I've been feeling cheerful' all showed significant misfit to model expectations, and were deleted. This led to a marginal improvement in fit to the model. After further analysis, more items were deleted and a strict unidimensional seven item scale (the Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS)) was resolved. Many items deleted because of misfit with model expectations showed considerable bias for gender. Two retained items also demonstrated bias for gender but, at the scale level, cancelled out. One further retained item 'I've been feeling optimistic about the future' showed bias for age. The correlation between the 14 item and 7 item versions was 0.954.Given fit to the Rasch model, and strict unidimensionality, SWEMWBS provides an interval scale estimate of mental well-being. A short 7 item version of WEMWBS was found to satisfy the strict unidimensionality expectations of the Rasch model, and be largely free of bias. This scale, SWEMWBS, provides a raw score-interval scale transformation for use in parametric procedures. In terms of face validity, SWEMWBS presents a more restricted view of mental well-being than the 14 item WEMWBS, with most items representing aspects of psychological and eudemonic well-being, and few covering hedonic well-being or affect. However, robust measurement properties combined with brevity make SWEMWBS preferable to WEMWBS at present for monitoring mental well-being in populations. Where face validity is an issue there remain arguments for continuing to collect data on the full 14 item WEMWBS.
Article
Background Health recommender systems (HRSs) offer the potential to motivate and engage users to change their behavior by sharing better choices and actionable knowledge based on observed user behavior. Objective We aim to review HRSs targeting nonmedical professionals (laypersons) to better understand the current state of the art and identify both the main trends and the gaps with respect to current implementations. Methods We conducted a systematic literature review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and synthesized the results. A total of 73 published studies that reported both an implementation and evaluation of an HRS targeted to laypersons were included and analyzed in this review. Results Recommended items were classified into four major categories: lifestyle, nutrition, general health care information, and specific health conditions. The majority of HRSs use hybrid recommendation algorithms. Evaluations of HRSs vary greatly; half of the studies only evaluated the algorithm with various metrics, whereas others performed full-scale randomized controlled trials or conducted in-the-wild studies to evaluate the impact of HRSs, thereby showing that the field is slowly maturing. On the basis of our review, we derived five reporting guidelines that can serve as a reference frame for future HRS studies. HRS studies should clarify who the target user is and to whom the recommendations apply, what is recommended and how the recommendations are presented to the user, where the data set can be found, what algorithms were used to calculate the recommendations, and what evaluation protocol was used. Conclusions There is significant opportunity for an HRS to inform and guide health actions. Through this review, we promote the discussion of ways to augment HRS research by recommending a reference frame with five design guidelines.
Article
BACKGROUND: Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display. OBJECTIVE: To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery. METHODS: A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons' hand-drawn presurgical illustrations. RESULTS: The VR session effectively enhanced surgeons' understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons' presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts. CONCLUSION: Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons' understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.
Chapter
Virtual reality (VR) is the simulation of reality where the users would be immersed in an artificial/virtual environment that isn't there but creates an illusion as if it really exists. People using this technology get a feeling that they are performing everything in real time. This gives users a sense of satisfaction. Initially, VR technology was used for gaming purposes, but now it is used in many sectors, including healthcare. There are many situations wherein, when it is expensive or impossible to do something, in reality, a probable solution is virtual reality. An important area where it is explored is healthcare for training doctors, diagnosis, and treatment of various ailments. The main objective of this chapter is to shed light on the applications of VR in healthcare and to discuss some applications showing how the medical field has already started reaping the benefits of VR.
Article
While many cancer centers suggest treating pain with medication and nondrug treatment, few include the use of virtual reality (VR) as an alternative for stress and pain relief therapy. The purpose of this research was to determine whether a nature-inspired VR simulation reduced stress and pain levels among patients in a cancer treatment center. Using a repeated measures design, 50 patients attending their regularly scheduled chemotherapy infusion were measured for pain and stress during their intravenous (IV)/port access. At the patient’s second visit, they viewed a nature-inspired VR simulation while receiving their IV/port access and were measured for pain and stress again. The paired, one-tailed t tests found significant increases in relaxation, feelings of peace, and positive distractions. While patients felt significantly less frustrated, measures for stress and pain were not significant. Future research should include additional stress and pain measures to determine the viability of VR for chemotherapy infusions.
Article
Individualizing patient treatment is a core objective of the medical field. Reaching this objective has been elusive owing to the complex set of factors contributing to both disease and health; many factors, from genes to proteins, remain unknown in their role in human physiology. Accurately diagnosing, monitoring, and treating disorders requires advances in biomarker discovery, the subsequent development of accurate signatures that correspond with dynamic disease states, as well as therapeutic interventions that can be continuously optimized and modulated for dose and drug selection. This work highlights key breakthroughs in the development of enabling technologies that further the goal of personalized and precision medicine, and remaining challenges that, when addressed, may forge unprecedented capabilities in realizing truly individualized patient care.
Chapter
Chronic pain is one of the most common health problems affecting daily activity, employment, relationships and emotional functioning. Unfortunately, the lack of specialized health care personnel, and the high heterogeneity in terms of clinical manifestation and treatment results contribute in failure to manage efficiently and effectively pain. Information and communication technology (ICT) can be a valuable tool, enabling patients and healthcare professional empowerment and better self-management of pain. To this direction, this article reports on the design of a novel technical infrastructure to support effectively and efficiently chronic pain management, based on an Intelligent Personal Health Record platform on top of already available ICT tools. The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment and providing effective communication channels between patients and healthcare professionals.
Conference Paper
In this work, we propose a novel VR s/w system aiming to disrupt the healthcare training industry with the first Psychomotor Virtual Reality (VR) Surgical Training solution. Our system generates a fail-safe, realistic environment for surgeons to master and extend their skills in an affordable and portable solution. We deliver an educational tool for orthopedic surgeries to enhance the learning procedure with gamification elements, advanced interactability and cooperative features in an immersive VR operating theater. Our methodology transforms medical training to a cost-effective, easily and broadly accessible process. We also propose a fully customizable SDK platform able to generate educational VR simulations with minimal adaptations. The latter is accomplished by prototyping the learning pipeline into structured, independent and reusable segments, which are used to generate more complex behaviors. Our architecture supports all current and forthcoming VR HMDs and standard 3D content generation.
Article
Objective: To know the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery and their parents. Design: Prospective randomized control nonblinded trial. Setting: Single-center tertiary teaching hospital. Participants: A total of 60 children aged 5 to 15 years undergoing cardiac surgery were included in the study. One of the parents, preferably the father, was selected from the respective children. Interventions: Subjects were randomized into 2 groups: noninterventional (group 1) and interventional (group 2). Intervention was in the form of toys and video games in children, and counseling and information in parents. Preoperative and postoperative anxiety in parents was measured using the State-Trait Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker faces pain scale were applied and serum cortisol was measured. Measurements and main results: Group 2 children had significantly less (p < 0.001) stress, anxiety, and pain and improved mood. Group 2 parents had a significant reduction in state anxiety (42 ± 4.4 v 54.5 ± 7.8; p < 0.001) and ICS score (68.1±9.6 v 84.2 ± 9.2; p < 0.001) and an improvement in mood (7.5 ± 0.7 v 5.9 ± 1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]). Conclusion: Providing video games and toys preoperatively reduced postoperative stress and anxiety and improved mood in children undergoing congenital cardiac surgery. Parents were relieved of anxiety and stress with proper counseling and information.
Article
Due to importantly beneficial effects on physical and mental health and strong association with many rehabilitation programs, Physical Activity Recognition and Monitoring (PARM) have been considered as a key paradigm for smart healthcare. Traditional methods for PARM focus on controlled environments with the aim of increasing the types of identifiable activity subjects complete and improving recognition accuracy and system robustness by means of novel body-worn sensors or advanced learning algorithms. The emergence of the Internet of Things (IoT) enabling technology is transferring PARM studies to open and connected uncontrolled environments by connecting heterogeneous cost-effective wearable devices and mobile apps. Little is currently known about whether traditional PARM technologies can tackle the new challenges of IoT environments and how to effectively harness and improve these technologies. In an effort to understand the use of IoT technologies in PARM studies, this paper will give a systematic review, critically examining PARM studies from a typical IoT layer-based perspective. It will firstly summarize the state-of-the-art in traditional PARM methodologies as used in the healthcare domain, including sensory, feature extraction and recognition techniques. The paper goes on to identify some new research trends and challenges of PARM studies in the IoT environments, and discusses some key enabling techniques for tackling them. Finally, this paper consider some of the successful case studies in the area and look at the possible future industrial applications of PARM in smart healthcare.
Article
Caregivers of youth with special health care needs (YSHCN) are a critical part of the health care team. It is important for pediatric providers to be cognizant of the burden and strain caregiving can create. This article will discuss the health, psychological, social, and financial effects of caregiving, as well as strategies to screen for caregiver strain among families of YSHCN. Caregivers of YSHCN, for example, are more likely to report poor health status and demonstrate higher rates of depression and anxiety. Numerous validated screens for caregiver strain have been developed to address the multi-faceted effects of caregiving. Finally, we will discuss strategies to alleviate caregiver strain among this vulnerable population. We will describe services pediatric providers can encourage caregivers to utilize, including financial support through Supplemental Security Income (SSI), benefits available through the Family Medical Leave Act (FMLA), and options for respite care. Addressing caregiver strain is an important aspect of maintaining a family centered approach to the care of YSHCN.
Article
The objective of this study was to determine sources of intraoperative stress, impact on surgical outcomes, coping strategies, and surgeon interest in stress management training. An anonymous survey was electronically distributed to surgeons at a tertiary care hospital. Respondents were asked to rate the perceived impact of 9 stressors on operative performance, identify stress coping strategies, list witnessed stress-related complications, and opine on the perceived need for stress management training. Seventy-two responses were received (76% relative risk). Complex or rarely performed cases and poor assistance were associated with the highest stress, while personal life distractions were associated with the least. Importantly, 40% of surgeons indicated that they had witnessed an intraoperative complication directly related to surgeon stress. Respondents (82%) believed that formal stress management training is needed. Several stressors affect surgical performance and contribute to complications. Surgeons use a variety of stress coping strategies. Formal stress management training is needed. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
The purpose of this project was to examine the effect of music on anxiety among preoperative patients. A convenience sample of 137 patients participated in this two-group quasi-experimental study. Participants were assigned to a music group (n = 73) or a nonmusic group (n = 64). Both groups were similar in terms of gender, age, and initial anxiety level. Clinical experts designated surgeries as invasive (n = 48) or noninvasive (n = 89), and no difference in initial anxiety level was found between these two groups. Findings showed that patients who listened to music had a small significant decrease in anxiety when compared with patients in the nonmusic group. In addition, results showed that the influence of music on changes in anxiety was related to initial anxiety level. For example, patients with high levels of anxiety in the music group had the largest change in anxiety when compared with other participants.
Article
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Article
In the course of developing a standardised, non-disease-specific instrument for describing and valuing health states (based on the items in Table 1), the EuroQol Group (whose members are listed In the Appendix) conducted postal surveys in England, The Netherlands and Sweden which indicate a striking similarity in the relative valuations attached to 14 different health states (see Table 3). The data were collected using a visual analogue scale similar to a thermometer (see Table 2). The EuroQol Instrument Is Intended to complement other quality-of-life measures and to facilitate the collection of a common data set for reference purposes. Others interested in participating in the extension of this work are invited to contact the EuroQol Group.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented.
Article
Controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients. We describe a process for conceptualizing and operationalizing what it means to be "activated" and delineate the process we used to develop a measure for assessing "activation," and the psychometric properties of that measure. We used the convergence of the findings from a national expert consensus panel and patient focus groups to define the concept and identify the domains of activation. These domains were operationalized by constructing a large item pool. Items were pilot-tested and initial psychometric analysis performed using Rasch methodology. The third stage refined and extended the measure. The fourth stage used a national probability sample to assess the measure's psychometric performance overall and within different subpopulations. Convenience samples of patients with and without chronic illness, and a national probability sample (N=1,515) are included at different stages in the research. The Patient Activation Measure is a valid, highly reliable, unidimensional, probabilistic Guttman-like scale that reflects a developmental model of activation. Activation appears to involve four stages: (1) believing the patient role is important, (2) having the confidence and knowledge necessary to take action, (3) actually taking action to maintain and improve one's health, and (4) staying the course even under stress. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor intervention and assess changes.
Article
The purpose of this study was to evaluate the psychometric properties of three versions of the Perceived Stress Scale (PSS; American Sociological Association) in adults who had survived the death of a family member or significant other by suicide. Reliability and validity were examined. Exploratory factor analysis was conducted to assess dimensionality of the underlying constructs. All three versions of the PSS demonstrated acceptable reliability. Two shorter versions retained good psychometric properties and demonstrated convergent and concurrent validity with measures of posttraumatic stress symptoms and mental health quality of life. Factor analysis provided further evidence of their usefulness as brief and valid measures of perceived stress in acutely bereaved adult survivors of suicide. In a sub-sample of closely related survivors, the psychometric properties of the 4-item version of the PSS were retained.