Use of immersive virtual reality to reduce anxiety during complex paediatric dressing changes.

In recent years, there has been an increasing interest in the practical applications of virtual reality (VR) in healthcare. One discussed application of this technology is to reduce anxiety during procedures for paediatric patients. Following skin loss in paediatric patients, careful management of the wound with appropriate dressings and frequent dressing changes is a key part of the treatment process. In children, continued dressing changes are often a source of anxiety, which complicates procedures causing distress to the child, their parents and staff members. VR systems have the potential to not only reduce anxiety but also pain in children requiring frequent dressing changes. Although our knowledge of this technology is improving, further research is needed to evaluate its full potential in this population and to establish guidelines to take advantage of the full potential of VR technology.

Scoping review of the use of virtual reality in intensive care units.

BACKGROUND: A wide range of reviews have demonstrated the effectiveness and tolerability of Virtual Reality (VR) in a range of clinical areas and subpopulations. However, no previous review has explored the current maturity, acceptability, tolerability, and effectiveness of VR with intensive care patients. AIMS: To identify the range of uses of VR for intensive care patients, classify their current phase of development, effectiveness, acceptability, and tolerability. METHODS: A scoping review was conducted. A multi-database search was undertaken (inception to January 2021). Any type of study which examined the use of VR with the target application population of intensive care patients were included. Screening, data extraction, and assessment of quality were undertaken by a single reviewer. A meta-analysis and a descriptive synthesis were undertaken. RESULTS: Six hundred and forty-seven records were identified, after duplicate removal and screening 21 studies were included (weak quality). The majority of studies for relaxation, delirium, and Post Traumatic Stress Disorder (PTSD) were at the early stages of assessing acceptability, tolerability, and initial clinical efficacy. Virtual Reality for relaxation and delirium were well-tolerated with completion rates of target treatment of 73.6%, (95% CI:51.1%-96%, I2  = 98.52%) 52.7% (95% CI:52.7%-100%, I2  = 96.8%). The majority of reasons for non-completion were due to external clinical factors. There were some potential benefits demonstrated for the use of VR for relaxation, delirium, and sleep. CONCLUSION: Virtual Reality for intensive care is a new domain of research with the majority of areas of application being in the early stages of development. There is great potential for the use of VR in this clinical environment. Further robust assessment of effectiveness is required before any clinical recommendations can be made. RELEVANCE TO CLINICAL PRACTICE: Virtual reality for ICU patients is in its infancy and is not at a stage where it should be used as routine practice. However, there is early evidence to suggest that virtual reality interventions have good acceptability and tolerability in intensive care patients for relaxation, delirium, and improving sleep.

COVID-19 - the ultimate disruptor?

This article was migrated. The article was marked as recommended. Coronavirus disease 2019 (COVID-19) has influenced undergraduate medical education in various ways already. In affected countries, educators and their teams were faced with a rapidly changing situation that made traditional ways of curriculum delivery impossible and required alternative approaches. Exams have also been affected and a cohort of students has graduated early and now joins the workforce. There is also concern for the next academic year should the pandemic last longer. In this paper we aim to describe wider implications of the pandemic beyond current curriculum delivery, exams and planning. We describe how our own clinical and educational environment has been utterly transformed within weeks and speculate how much these changes will persist after the pandemic. We also describe student concerns and introduce the thought that the pandemic may have positive long term effects as well. Finally, we speculate how COVID-19 may affect student recruitment, multi-professional learning and the current and future undergraduates' view of the profession. Our aim is to share our experience in the UK, reflect on the direction and magnitude of change seen in our own local and regional practice, and provide food for thought for educators and their teams who find themselves in a similar situation.