ABSTRACT
Introduction: The World Health Organization defined dementia as a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging. Currently, 55 million people live with Alzheimer's in the world. Unfortunately, there isn't any drug treatment to cure the degenerative disease although clinical trials are promising regarding the use of monoclonal antibodies. But, Alzheimer's disease and associated diseases lead to behavioral and psychological symptoms (anxiety, apathy, depression) which can be frequent in nursing homes. In the context of pandemic, these conditions are amplified because of the sanitary restrictions. Since the beginning of the sars-cov2 pandemic, residents have felt alone, sad and more anxious. Nowadays, non-drug interventions are recommended by health organizations for the treatment of behavioral and mood disorders in the elderly with cognitive disorders. Reminiscence therapy is a non drug intervention which has been shown to be effective in the treatment of mood disorders on elderly. Many nursing homes use this non pharmacological treatment for their residents. Some studies take interest in reminiscence and virtual reality. The use of new technologies is innovative in geriatric care and it can be used as a personalized support for reminiscence therapy. The "Bien Vieillir Nice 2030" Project of Nice's University Hospital supports this research on virtual reality and mood disorders in nursing homes/long term care unit. Objective(s): The objective of this study (University Hospital of Nice, CoBTeK France) is to evaluate the effects of personalized virtual reality on reduction of mood disorders in nursing homes residents with minors and moderates neurocognitive disorders. The secondary objectives are to assess the acceptability of the device, the emotional valence and the resident's quality of life. Method(s): A single case study is presented to illustrate reminiscences and emotions protocol. Participants are randomized into two groups: neutral versus personalized. The neutral videos consist of unknown places like random streets or public gardens while the personalized videos are known places that mattered to the residents. Places are filmed with a camera GoPro Fusion 360degree. The healthcare team and families are actively involved in the research protocol. Their help is invaluable in targeting memories related to the resident's life history. A clinical psychologist specializing in gerontology is in charge of the virtual reality sessions. The therapeutic alliance is central to our study. A humanistic method of person-centered approach allows communication with the resident to offer him to participate in the sessions. The sessions always start and end in the same way in order not to cause stress in the resident. The hardware is tested before the protocol starts, for familiarization purpose. Potential side effects related to virtual reality are identified using a cybermalaise questionnaire. The sessions are held in a sitting position for the participant's safety. In this paper, Mr. G, 92 years old benefits from personalized video according to his life story. He has moderate cognitive impairment as well as mood disorders. He received ten virtual reality sessions over a period of six weeks. The exposure time varies between five to ten minutes. We use an Oculus Rift S headset and a computer in partnership with C2Care. Variables were measured before and at the end of the protocol. We performed a visual analysis of the scores. Result(s): The results indicated a decrease on mood rating scales scores (Geriatric Depression Scale, Apathy Inventory, Neuropsychiatric Inventory and Hamilton Depression Rating scale). The interventions produced pleasure and alertness in connection along with the emergence of positive memories. The headset was well tolerated by the participant, but we did not observe any effect on quality of life. Conclusion(s): There is an interest in the use of reminiscence therapy using virtual reality to improve participants' mood. Future results will allow us to conclude on the method and on its indication in nursing homes after the inclusion of 30 participants. Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Introduction La pandémie COVID-19 a bouleversé le quotidien de chaque professionnel de santé (PS) dans sa vie personnelle et professionnelle, en particulier durant la 1ère vague marquée par un confinement drastique, une pénurie en équipements de protection mais aussi beaucoup de solidarité tels « les applaudissements de 20heures ». Le but fut d’évaluer la résultante de cela sur la qualité de vie (QV) perçue par les PS hospitaliers. Matériels et méthodes Étude « hors Loi Jardé », prospective, non interventionnelle, sous forme d’un auto-questionnaire anonyme proposé en mai 2020 à tous les PS d’un CHU d’une région alors de moyenne endémie SARS-CoV-2 ayant ouvert 200 lits dédiés et mobilisé 1000 PS en renfort sur 4 mois. Elaboration du questionnaire par le team d’infectiologie, validation par les instances, généralisation en ligne (Lime Survey) via Intranet et Facebook. En environ 10minutes 71 items dont 27 échelles visuelles (0 à 10) et 5 cadres libres comparant la QV personnelle et professionnelle à celle des mois antérieurs. Cotations 6 à 10 considérées comme positives. Résultats Sur 794 réponses (11 % des PS du CHU) 259 par IDE, 228 d’autres soignants, 179 de médecins et 55 de cadres de santé, dont 311 (39 %) en unités dédiées COVID (155 permanents et 156 renforts). Cohorte surtout jeune (moyenne: 41 ans), féminine (80 %), en couple (90 %), chargée d’enfant (73 %), en maison (72 %) au CHU depuis >5 ans (79 %). Retentissement sur la vie personnelle du confinement jugé acceptable sur le plan matériel et relationnel respectivement par 76 % et 56 %. QV professionnelle s’abaissant moins sur le plan matériel (58 % vs 62 avant) que relationnel (70% vs 81). Globalement engagement dans la lutte contre l’épidémie évalué important par 72%, 50% se sentant valorisé, 82 % davantage fatigué, 69% vivant la période comme plus difficile professionnellement et 68% personnellement. Chez ceux confrontés aux cas (en unité dédié ou sous forme sporadique ailleurs) 72 % se disant à l’aise dans la pratique et 71 % bien protégés. Relation patient (COVID ou non) vécue différente par 47 %. Encouragements en tant que PS exprimés à 63% surtout par la famille;stigmatisation de 19 % surtout par des quidams. Réponses libres par 147 (18 %) des répondants, riches, pointant les failles mais aussi la solidarité. Conclusion Ce questionnaire sur la QV des PS a intéressé pas seulement ceux impliqués dans la gestion d’unités COVID, soulignant que beaucoup souhaitaient témoigner sur ce temps particulier à un moment où la fin de crise pouvait être espérée prochaine. Malgré « les protocoles changeant », « le manque de matériel », « le bouleversement des habitudes et repères » mais grâce au « soutien entre équipes » « à la période riche avec les patients et entre soignants » le bilan global s’avère contrasté avec une QV finalement pas plus altérée professionnellement que personnellement. L’analyse se poursuit par une comparaison selon le métier, le lieu d’affectation (unité COVID ou non) et les modalités d’exercice (habituel ou renfort).
ABSTRACT
BACKGROUND: The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS: The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS: A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS: In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.