ABSTRACT
Background: Transplant psychiatry and organ selection committees have a past littered with inequalities. With the growing medical advances in transplantation and the increasing number of transplants, it is the perfect time for transplant psychiatrists to adopt anti-racist practices and promote equity in marginalized communities. Method(s): Search query on PubMed: "Transplant Racism" Last 10 years Results: 42 articles, 25 after exclusion of articles not focused on transplant racism Reviewed the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), Psychosocial Assessment of Candidates for Transplant (PACT), and the Transplant Evaluation Rating Scale (TERS). Result(s): Our literature review showed many barriers that would serve to limit or diminish the candidacy for transplantation among minority groups. Specific examples include lack of healthcare, lack of cultural and linguistic aides, and racism serving as a barrier to medical care (Purnell, 2021). All three rating scales have domains referencing substance use, social support systems, and transplant literacy. (Maldonado, 2008;Olbrisch, et al. 1988;Twillman, et al., 1993). Discussion(s): Our results are consistent that there is inherent inequity in the current transplantation evaluation process. This marginalization is a result of ongoing systemic barriers and differing rates of health literacy, cohesion of social supports, and cultural differences towards nicotine and marijuana. Conclusion(s): We recommend using a holistic and flexible approach in transplant evaluations, with a focus on equity, by advocating for patients in the following ways: 1. Education of primary care and specialist providers that practice mostly within marginalized communities 2. Advocating for increased health literacy and outreach in marginalized communities 3. Adopting a more nuanced approach in applying the social support system, substance use, health literacy, and lifestyle factors of the transplant rating scales. 4. Less stringent application to absolute and relative contraindications in transplant rating scales, especially concerning drug use, social supports, housing, and health literacy 5. Advocate for abolishing eGFR race corrections 6. Promoting services to help process the effects of racism and promote increased treatment alliance References: 1. Purnell TS, Simpson DC, Callender CO, Boulware LE. Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation. Am J Transplant. 2021;21:2327-2332. 2. Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) Stanford University Medical Center. Maldonado et al, 2008;Maldonado et al, Psychosomatics 2012 3. Olbrisch, M. E., Levenson, J. L., & Hamer, R. (1989). The PACT: A rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation, 3, 164-169. 4. Twillman, R. K., Manetto, C., Wellisch, D. K., & Wolcott, D. L. (1993). The Transplant Evaluation Rating Scale: A revision of the Psychosocial Levels System for evaluating organ transplant candidates. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 34(2), 144-153. Copyright © 2022
ABSTRACT
Background: Virtual Reality (VR) is increasingly considered a valuable therapy tool for managing behavioural and psychological symptoms (BPSDs) and quality of life (QoL) in dementia (Parsons, 2013). However, rigorous studies are still needed to evaluate its impact in acute care settings (Appel, 2021). This study evaluated the impact of VR-therapy on managing BPSDs, falls, and length of stay (LoS) and QoL for inpatients with dementia admitted to an acute care hospital. Method(s): An open longitudinal interventional randomized controlled trial was conducted between April 2019 and March 2020 (ClinicalTrials.gov, ID:NCT03941119). A total of 69 participants (age >=65, diagnosis of dementia, did not meet exclusion criteria) (Figure 1) who were randomly assigned either followed standard of care (Control Arm, n = 35 or received VR-therapy every 1-3 days (Intervention Arm, n = 34) (Figure 2). VR-therapy entailed watching 360-degree-VR-films on a HMD for up to 20 minutes (Figures 3 and 4). Instances of daily BPSDs documented in EMR nursing notes were categorized based on the Neuropsychiatric Inventory (NPI). QoL measures included the Quality of Life in Late-Stage Dementia scale (QUALID) and semi-structured interviews conducted at scheduled visits. Structured observations (including the standardized "ObsRVR" tool) and interviews were used to measure treatment feasibility (Figure 5). Result(s): VR-therapy had a statistically significant effect (p =.014) in reducing aggressivity (i.e., physical aggression and loud vociferation). A sentiment analysis of patient responses to the semi-structured interviews on QoL revealed a statistically significant impact of VR therapy (p =.013). No statistically significant impact of VR therapy was found for other BPSDs (e.g., apathy), falls, or LoS or QoL as measured by the QUALID. VR-therapy was overall an acceptable and enjoyable experience for participants and no adverse events occurred as a result of VR-therapy. Conclusion(s): Immersive VR-therapy appears to have an effect on aggressive behaviours and QoL in acute care patients with dementia. Although the RCT was stopped before reaching the intended sample size due to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. Copyright © 2022 the Alzheimer's Association.