A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation.

BACKGROUND: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments. OBJECTIVE: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies. METHODS: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested. RESULTS: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment. CONCLUSIONS: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.

An educational video improves technique in performance of pediatric lumbar punctures.

BACKGROUND: Unsuccessful or traumatic lumbar punctures (LPs) occur commonly and contribute to patient discomfort and to challenges in medical decision making in the pediatric emergency department (ED). OBJECTIVE: We produced an instructional video demonstrating the best practices in pediatric LP technique. We hypothesized that the performance of LPs would change and the rate of successful LPs would increase after watching the video. METHODS: This was a prospective study of LPs performed in an urban, academic pediatric ED before and after an educational intervention. Lumbar punctures performed during year 1 constituted the control arm. During year 2, all medical practitioners working in the ED watched the instructional video, and this constituted the interventional arm. The practitioner performing the LP completed a standardized data collection form after each LP procedure, and medical records were reviewed. RESULTS: Data forms were collected on 668 LPs during the study period, 391 during year 1 and 277 during year 2. There was neither a significant change in overall LP success rate between the 2 years (56.8% year 1 vs 53.4% year 2) nor a significant difference in median number of LP attempts required per patient (P = 0.78). Seventy-eight percent of participants who viewed the LP video during year 2 stated that the video helped increase their comfort level with performing LPs. The odds of using the techniques endorsed in the educational video were significantly higher during year 2 compared to year 1 for use of local anesthetic, early stylet removal, and vertical patient position. CONCLUSIONS: The video increased practitioners' comfort level with the performance of pediatric LPs and adherence to evidence-based best practices. It was not associated with an increased rate of successful LPs.

Pediatric mastoiditis in the pneumococcal conjugate vaccine era: symptom duration guides empiric antimicrobial therapy.

BACKGROUND: The microbiology of acute otitis media has changed in the heptavalent pneumococcal conjugate vaccine (PCV) era. We hypothesize similar changes with pediatric mastoiditis. OBJECTIVES: To compare the etiology of mastoiditis in the pre-PCV (January 1995-December 2000) and post-PCV (January 2001- April 2005) eras to guide empiric antimicrobial therapy in the pediatric emergency department. METHODS: Retrospective chart review of all patients admitted with a diagnosis of mastoiditis from January 1995 to April 2005. RESULTS: : One hundred twenty-two charts were reviewed, 68 pre-PCV and 54 post-PCV. Etiological agents were determined by culture results in 60 patients. The most common bacterial isolates were Streptococcus pneumoniae (24), Pseudomonas aeruginosa (12), Staphylococcus aureus (12), Streptococcus pyogenes (8), and Haemophilus influenzae (2). There was no reduction in mastoiditis due to S. pneumoniae from the pre-PCV to the post-PCV eras (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.4-2.1; P = 0.77). Ceftriaxone nonsusceptibility was seen in 30% of post-PCV S. pneumoniae isolates compared with 7% of pre-PCV isolates. Acute mastoiditis was diagnosed in 93 patients, and chronic mastoiditis (defined as >or=3 wk of symptoms) was diagnosed in 29 patients. Streptococcus pneumoniae was more likely to be implicated in acute versus chronic mastoiditis (OR, 9.2; 95% CI, 1.2-52.2; P = 0.01). Pseudomonas aeruginosa was more frequently implicated in chronic versus acute mastoiditis (OR, 16.4; 95% CI, 2.1-75.8; P = 0.0003). CONCLUSIONS: There was no difference in the proportion of pediatric mastoiditis cases caused by S. pneumoniae in the pre-PCV versus post-PCV eras. Empiric antimicrobial therapy with ceftriaxone alone is not sufficient in the post-PCV era.