124 Virtual Reality for Reducing Pain and Perioperative Anxiety in Pediatric Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S83-S84 ◽  
Author(s):  
Heather J Schwartz ◽  
Shawn Fagan ◽  
Beretta Craft-Coffman ◽  
Christopher A Truelove ◽  
Robert F Mullins
Keyword(s):  
Virtual Reality ◽  
Burn Injury ◽  
Post Treatment ◽  
Improvement Project ◽  
Burn Care ◽  
Anxiety Control ◽  
Significant Difference ◽  
Scale Scores ◽  
Before And After ◽  
Pre Treatment

Abstract Introduction One of the most traumatizing and frightening experiences a child can experience is to sustain a burn injury. As a result, the child may experience excruciating pain and anxiety. The objective of this quality improvement project is use virtual reality as a nonpharmacologic intervention for pain and anxiety control and compare to traditional distractions methods. Methods There were 46 subjects ages 4 to 20 enrolled in a sample of convenience. Participants were given either virtual reality or distraction for dressing changes or minor surgical procedures. Before and after the surgical procedure or dressing change, the participants, their parent and nursing staff completed a Modified Yale Perioperative Anxiety Scale (mYPAS, Faces, Legs, Activity, Cry, and Consolability (FLACC) scale or Numeric Rating System (NRS). Results There was no significant difference in FLACC, NRS, and mYPAS scale scores pre-treatment. The post treatment NRS scores were significantly different between distraction and virtual reality (p= 0.031). FLACC scores for the distraction group increased 3.5-fold, while the virtual reality group scores decreased (p.0.0008). Mean mYPAS scores decreased again showing a significant difference between distraction and virtual reality with p= 0.004. The score increased with distraction and decreased with virtual reality with a difference of 12. In all cases virtual reality was better than distraction, when measuring pain and anxiety. Conclusions This QI project demonstrates that VR was more effective in reducing both pain and anxiety in burned pediatric patients as opposed to traditional distraction post treatment. Traditional distraction unfortunately was shown to increase both pain and anxiety post treatment. These conclusions suggest that VR may be utilized as a non-pharmacologic treatment option in conjunction with standard treatment to help decrease pain and anxiety in acutely burned children. Applicability of Research to Practice This study increases the knowledge base and advances the evidence-based practice of advanced practice registered nurses in the specialty of burn care. It suggests that a non-pharmacologic intervention such as virtual reality can be used to effectively reduce pain and anxiety in children who are undergoing treatment for their burn injury.

OCT-Angiography as a reliable prognostic tool in laser-treated proliferative diabetic retinopathy: The RENOCTA Study

2020 ◽  
pp. 112067212096345
Author(s):  
Marco Lupidi ◽  
Ramkailash Gujar ◽  
Alessio Cerquaglia ◽  
Jay Chhablani ◽  
Daniela Fruttini ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Additional Treatment ◽  
Post Treatment ◽  
Vascular Perfusion ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Pre Treatment ◽  
Induced Changes

Purpose: To quantitatively assess retinal neovascularizations (RNVs) in proliferative diabetic retinopathy (PDR) before and after photocoagulative laser treatment (PLT) using Optical Coherence Tomography Angiography (OCT-A). Methods: Consecutive patients with PDR were examined with fluorescein angiography (FA) and OCT-A before and after PLT. Baseline and after-treatment FA images were quantitatively analyzed to assess both the RNVs area and leakage area. On OCT-A RNVs area, vascular perfusion density (VPD), vessel length density (VLD) and fractal dimension were computed. VPD of the full-retina OCT-A underneath the RNV was determined to evaluate potential laser-induced changes in vascular perfusion. Results: Fifteen eyes of 13 patients with PDR were enrolled. The mean area of the RNVs was 0.47 ± 0.50 mm2 in the baseline OCT-A and 0.32 ± 0.40 mm2 in the post-treatment assessment ( p = 0.0002). The mean RNV VPD of RNV was 2% ± 4% in pre-treatment and 1% ± 1% for the post-treatment ( p = 0.0001). The mean VLD of RNV was 7.26 ± 1.53 at baseline and 6.64 ± 1.65 in the post treatment ( p = 0.0002). A significant difference in terms of mean RNVs area and VPD reduction between eyes that needed additional treatment and those that did not (~40% vs ~20%; p < 0.05), was observed. Mean VPD of full-retinal thickness OCT-angiogram was 55% ± 10% for the pre-treatment and 53% ± 8% for the post treatment scan ( p = 0.02). Conclusion: The quantitative OCT-A assessment of laser-induced changes of RNVs can be a useful non-invasive approach for determining treatment efficacy. A reduction of RNVs area or VPD ⩾ 40% might reveal those eyes that won’t require additional treatment. Retinal perfusion impairment seemed to progress independently from the treatment.

scholarly journals Pilot study quantifying muscle glycosaminoglycan using bi-exponential T1ρ mapping in patients with muscle stiffness after stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rajiv G. Menon ◽  
Preeti Raghavan ◽  
Ravinder R. Regatte
Keyword(s):  
Pilot Study ◽  
Free Water ◽  
Treatment Monitoring ◽  
Muscle Stiffness ◽  
Post Treatment ◽  
Monitoring Tool ◽  
Significant Difference ◽  
Before And After ◽  
T1ρ Mapping ◽  
Pre Treatment

AbstractPost stroke muscle stiffness is a common problem, which left untreated can lead to disabling muscle contractures. The purpose of this pilot study was to evaluate the feasibility of bi-exponential T1ρ mapping in patients with arm muscle stiffness after stroke and its ability to measure treatment related changes in muscle glycosaminoglycans (GAGs). Five patients with muscle stiffness after stroke and 5 healthy controls were recruited for imaging of the upper arm with 3D-T1ρ mapping. Patients were scanned before and after treatment with hyaluronidase injections, whereas the controls were scanned once. Wilcoxon Mann–Whitney tests compared patients vs. controls and patients pre-treatment vs. post-treatment. With bi-exponential modeling, the long component, T1ρl was significantly longer in the patients (biceps P = 0.01; triceps P = 0.004) compared to controls. There was also a significant difference in the signal fractions of the long and short components (biceps P = 0.03, triceps P = 0.04). The results suggest that muscle stiffness is characterized by increased muscle free water and GAG content. Post-treatment, the T1ρ parameters shifted toward control values. This pilot study demonstrates the application of bi-exponential T1ρ mapping as a marker for GAG content in muscle and as a potential treatment monitoring tool for patients with muscle stiffness after stroke.

Cytoprotective Effect of Tocotrienol-Rich Fraction and α-Tocopherol Vitamin E Isoforms Against Glutamate-Induced Cell Death in Neuronal Cells

2014 ◽  
Vol 84 (3-4) ◽  
pp. 0140-0151 ◽  
Author(s):  
Thilaga Rati Selvaraju ◽  
Huzwah Khaza’ai ◽  
Sharmili Vidyadaran ◽  
Mohd Sokhini Abd Mutalib ◽  
Vasudevan Ramachandran ◽  
...  
Keyword(s):  
Vitamin E ◽  
Cell Viability ◽  
Neuronal Cells ◽  
Positive Control ◽  
Post Treatment ◽  
Mitochondrial Activity ◽  
Before And After ◽  
Pre Treatment ◽  
Tocotrienol Rich Fraction ◽  
Major Mediator

Glutamate is the major mediator of excitatory signals in the mammalian central nervous system. Extreme amounts of glutamate in the extracellular spaces can lead to numerous neurodegenerative diseases. We aimed to clarify the potential of the following vitamin E isomers, tocotrienol-rich fraction (TRF) and α-tocopherol (α-TCP), as potent neuroprotective agents against glutamate-induced injury in neuronal SK-N-SH cells. Cells were treated before and after glutamate injury (pre- and post-treatment, respectively) with 100 - 300 ng/ml TRF/α-TCP. Exposure to 120 mM glutamate significantly reduced cell viability to 76 % and 79 % in the pre- and post-treatment studies, respectively; however, pre- and post-treatment with TRF/α-TCP attenuated the cytotoxic effect of glutamate. Compared to the positive control (glutamate-injured cells not treated with TRF/α-TCP), pre-treatment with 100, 200, and 300 ng/ml TRF significantly improved cell viability following glutamate injury to 95.2 %, 95.0 %, and 95.6 %, respectively (p < 0.05).The isomers not only conferred neuroprotection by enhancing mitochondrial activity and depleting free radical production, but also increased cell viability and recovery upon glutamate insult. Our results suggest that vitamin E has potent antioxidant potential for protecting against glutamate injury and recovering glutamate-injured neuronal cells. Our findings also indicate that both TRF and α-TCP could play key roles as anti-apoptotic agents with neuroprotective properties.

A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

2021 ◽  
pp. 1357633X2110098
Author(s):  
Aya Sedky Adly ◽  
Afnan Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Mohammad F Ali
Keyword(s):  
Rheumatoid Arthritis ◽  
Virtual Reality ◽  
Elderly Patients ◽  
Aerobic Exercise ◽  
Health Professionals ◽  
Post Treatment ◽  
Laser Acupuncture ◽  
Virtual Reality Training ◽  
Significant Difference ◽  
Elderly Onset

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this study was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments ( p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups ( p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

scholarly journals Low frequency of pre-treatment and post-treatment haematological abnormalities in dogs with non-infectious meningoencephalitis treated with cytosine arabinoside and prednisolone

2019 ◽  
Vol 6 (1) ◽  
pp. e000315 ◽  
Author(s):  
Sarah Keegan ◽  
Jeremy H Rose ◽  
Zohra Khan ◽  
Francois-Xavier Liebel
Keyword(s):  
Cytosine Arabinoside ◽  
Standard Dose ◽  
Low Frequency ◽  
Post Treatment ◽  
Inclusion Criteria ◽  
Presumptive Diagnosis ◽  
Prednisolone Treatment ◽  
Before And After ◽  
Pre Treatment ◽  
The Uk

BackgroundCytosine arabinoside (CA) and prednisolone are drugs commonly used together in the management of canine non-infectious meningoencephalitis (NIME). The aim of this study was to report the haematological findings before and after CA and prednisolone treatment and identify any adverse haematological events in this clinical setting, following the veterinary cooperative oncology group established common terminology criteria for recording adverse events following administration of chemotherapy or biological antineoplastic therapy.ResultsWhile 48 patients with a presumptive diagnosis of NIME had pretreatment haematology results, only 12 patients met the inclusion criteria of also having post-treatment haematology results available for review after being treated with prednisolone and CA at a standard dose (200 mg/m2) in a single referral hospital in the UK. Forty-nine post-treatment haematology results were available for these 12 patients.ConclusionsFour adverse haematological events were identified in four patients. None of these events were convincingly attributable to CA administration.

Treatment of Storm Fears Using Virtual Reality and Progressive Muscle Relaxation

2017 ◽  
Vol 46 (2) ◽  
pp. 251-256 ◽  
Author(s):  
Jessica Lima ◽  
Hanna McCabe-Bennett ◽  
Martin M. Antony
Keyword(s):  
Virtual Reality ◽  
Treatment Group ◽  
Exposure Therapy ◽  
Clinical Sample ◽  
Muscle Relaxation ◽  
Post Treatment ◽  
Progressive Muscle Relaxation ◽  
Exposure Condition ◽  
Pre Treatment

Background: The present study examined the efficacy of virtual reality (VR) exposure therapy for treating individuals with storm fears by comparing a one-session VR exposure treatment with a one-session progressive muscle relaxation (PMR) and psychoeducation session. Aims: It was predicted that there would be a reduction in storm-related fear post-treatment for individuals in both conditions, but that this reduction would be greater for those in the VR exposure condition. It was predicted that improvements would be maintained at 30-day follow-up only for those in the VR exposure condition. Method: Thirty-six participants each received one of the two treatment conditions. Those in the PMR treatment group received approximately 30 minutes of PMR and approximately 15 minutes of psychoeducation regarding storms. Those in the VR treatment group received approximately 1 hour of VR exposure. Additionally, participants were asked to complete a pre-treatment and post-treatment 5-minute behavioural approach test to assess changes in storm fears. They were also asked to complete a measure assessing storm phobia. Results: There was a significant interaction between treatment group and self-reported fear at post-treatment, such that fear decreased for both groups, although the reduction was stronger in the VR group. Results also showed that reductions in storm fear were maintained at 30-day follow-up for both groups. Conclusions: Although this study used a small non-clinical sample, these results offer preliminary support for the use of VR exposure therapy in the treatment of storm-related fear.

Urinary Steroids in Depressive Illness

1971 ◽  
Vol 16 (4) ◽  
pp. 224-227 ◽  
Author(s):  
A. Balfour Sclare ◽  
J. K. Grant
Keyword(s):  
Depressive Illness ◽  
Post Treatment ◽  
Normal Range ◽  
Mean Values ◽  
Female Patients ◽  
Significant Difference ◽  
The Mean ◽  
Pre Treatment ◽  
Depressive Patients ◽  
Source Of Information

A longitudinal study of urinary 17-OHCS in 16 depressive patients showed mean values within the accepted normal range. There were no significant differences between pre-treatment and post-treatment values; only the female patients showed a tendency to have somewhat lower post-treatment levels. 17-KS output was measured in 18 depressive patients. The mean values were within the normal range. There was no significant difference between pre-treatment and post-treatment values although the female patients displayed a tendency towards somewhat lower levels following treatment. DHA and EA excretion were measured in 9 depressive patients. There was a very wide variance in the findings. There was no significant difference between pre-treatment and post-treatment levels. The significance of the above findings is discussed. It is considered that measurements of urinary excretion of corticosteroids in affective disorders constitute a limited source of information.

scholarly journals The effect of antibiotic timing on culture yield in paediatric osteoarticular infection

2019 ◽  
Vol 13 (1) ◽  
pp. 114-119 ◽  
Author(s):  
M. van der Merwe ◽  
K. Rooks ◽  
H. Crawford ◽  
C. M. A. Frampton ◽  
M. J. Boyle
Keyword(s):  
Treatment Group ◽  
Blood Cultures ◽  
Post Treatment ◽  
Antibiotic Administration ◽  
Osteoarticular Infection ◽  
Paediatric Patients ◽  
Significant Difference ◽  
Pre Treatment ◽  
Systemic Antibiotics ◽  
Culture Yield

Purpose To assess the influence of antibiotic timing on surgical culture yield in paediatric patients with haematogenous osteoarticular infection. Methods All patients aged 0 to 15 years admitted to a National Children’s Hospital with the diagnosis of acute, haematogenous, osteoarticular infection (osteomyelitis and/or septic arthritis) between June 1997 and December 2016 were retrospectively analyzed. Only patients with positive blood cultures undergoing surgery for culture and debridement were included. Patients were allocated into pre-treatment and post-treatment groups, according to whether they received antibiotics before or after surgical cultures were obtained. Outcomes measured included baseline variables, treatment characteristics and surgical culture yield. Results A total of 131 patients were included; 107 patients in the pre-treatment group and 24 patients in the post-treatment group. There was no significant difference with respect to patient age (p = 0.870), white blood cell count (p = 0.197), ethnicity (p = 0.203) or infection multi-focality (p = 0.883) between the two groups. The administration of systemic antibiotics prior to obtaining surgical cultures had no clinically significant effect on surgical culture yield (rate of positive surgical cultures, 85% (pre-treatment) versus 54.2% (post-treatment); p = 0.002). Within the pre-treatment group, there was no significant difference in duration of pre-surgical antibiotic treatment between patients who had positive or negative surgical cultures (mean duration, 45.9 hours (positive cultures) versus 47.9 hours (negative cultures); p = 0.743). Conclusion In paediatric patients with acute, haematogenous, osteoarticular infection, antibiotic administration before surgery does not decrease surgical culture yield. Our results suggest that paediatric patients presenting with suspected osteoarticular infection should receive appropriate systemic antibiotics promptly after blood cultures are obtained. Level of Evidence Level III - retrospective case-control study

scholarly journals The comparison of on-demand caffeine consumption with squeezing technique on treating patients with premature ejaculation; a randomized clinical trial

2021 ◽  
Vol 15 (6) ◽  
pp. 2005-2010
Author(s):  
Seyyed Hassan Saadat ◽  
Khodabakhsh Ahmadi
Keyword(s):  
Sexual Satisfaction ◽  
Premature Ejaculation ◽  
Post Treatment ◽  
Common Disease ◽  
Latency Time ◽  
Caffeine Consumption ◽  
On Demand ◽  
Ejaculation Latency ◽  
Significant Difference ◽  
Pre Treatment

Background: The present study was aimed at evaluating the effect of on-demand caffeine consumption on treating patients with premature ejaculation (PE compared to squeezing technique. Methods: In this non-blind RCT, 42 otherwise healthy individuals with PE were divided into 2 groups of caffeine and squeezing technique group. The former received 100 mg of encapsulated caffeine for 3 weeks, 2 hours prior to each intercourse. Intra-vaginal ejaculation latency time and index of sexual satisfaction were calculated before and after treatment in both groups. Results: Mean age of the participants was 39.48±7.62 years. Despite the fact that there was no significant difference between pre-treatment and post-treatment values of both IELT and ISS between our 2 groups, significant difference was seen in both groups between pre-treatment and post-treatment values. Furthermore, no strong correlation was seen in pre-treatment IELT and ISS; however, statistically significant correlation was found in post-treatment values. Conclusion: Regarding the fact that caffeine is a well-known and widely-used drug in common disease, the use of this compound is highly unlikely to bear any stigma. Our study demonstrates that 100 mg of on-demand caffeine can equally increase both IELT and ISS significantly as squeezing technique. Further investigations are needed. Keywords: caffeine, premature ejaculation, squeezing technique, intra-vaginal ejaculation latency time, index of sexual satisfaction,

scholarly journals Behavioral and Magnetoencephalographic Correlates of Fear Generalization Are Associated with Responses to Later Virtual Reality Exposure Therapy in Spider Phobia

2021 ◽  
Author(s):  
Kati Roesmann ◽  
Elisabeth J. Leehr ◽  
Joscha Boehnlein ◽  
Christian Steinberg ◽  
Fabian Seeger ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Exposure Therapy ◽  
Treatment Success ◽  
Post Treatment ◽  
Spider Phobia ◽  
Virtual Reality Exposure Therapy ◽  
Fear Generalization ◽  
Spatio Temporal ◽  
Pre Treatment ◽  
Virtual Reality Exposure

As overgeneralization of fear is a pathogenic marker of anxiety disorders, we investigated whether pre-treatment levels of fear generalization in spider-phobic patients are associated with their response to exposure-based treatment, in order to identify pre-treatment correlates of treatment success. Ninety patients with spider phobia completed pre-treatment clinical and magnetoencephalography (MEG) assessments, one session of virtual reality exposure therapy, and a post-treatment clinical assessment. Based on the primary outcome (30% symptom reduction in self-reported symptoms from pre- to post-treatment) they were categorized as responders or non-responders. In a pre-treatment MEG fear generalization paradigm involving fear conditioning with two unconditioned stimuli (UCS), we obtained fear ratings, UCS-expectancy ratings, and event-related fields to conditioned stimuli (CS+, CS-) and 7 different generalization stimuli (GS) on a perceptual continuum from CS+ to CS-. Prior to treatment, non-responders showed behavioral overgeneralization indicated by more linear generalization gradients in fear ratings. Analyses of MEG source estimations revealed that non-responders showed a decline of their (inhibitory) frontal activations to safety-signaling CS- and GS compared to CS+ over time, while responders maintained these activations at early (<300ms) and late processing stages. Results provide initial evidence that pre-treatment differences of behavioral and neural markers of fear generalization are associated with later responses to behavioral exposure. Findings demonstrate the relevance of inhibitory learning functions and their spatio-temporal neural reflections in this interplay. Findings stimulate research on mechanism-based augmentation strategies for behavioral therapies.

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