Search Results (21)

Background: Out-of-hospital cardiac arrest (OHCA) survivors and their relatives may face challenges following hospital discharge, relating to mood, cognition, and returning to normal day-to-day activities. Identified research gaps include a lack of knowledge around what type of intervention is needed to best navigate recovery. In this study, we investigate the feasibility and patient acceptability of a new virtual psychoeducational group intervention for OHCA survivors and their relatives and compare it to a control group receiving a digital information booklet. Methods: V-CARE is a comparative, single-blind randomized pilot trial including participants at selected sites of the STEPCARE trial, in the United Kingdom and Sweden. Inclusion criteria are a modified Rankin Scale (mRS) ≤ 3 at 30-day follow-up; no diagnosis of dementia; and not experiencing an acute psychiatric episode. One caregiver per patient is invited to participate optionally. The intervention group in V-CARE receives four semi-structured, one-hour-long, psychoeducational sessions delivered remotely via video call by a trained clinician once a week, 2–3 months after hospital discharge. The sessions cover understanding cardiac arrest; coping with fatigue and memory problems; managing low mood and anxiety; and returning to daily life. The control group receives an information booklet focused on fatigue, memory/cognitive problems, mental health, and practical coping strategies. Results: Primary: feasibility (number of patients consented) and acceptability (retention rate); secondary: satisfaction with care (Client Satisfaction Questionnaire 8 item), self-management skills (Self-Management Assessment Scale) and, where available, health-related outcomes assessed in the STEPCARE Extended Follow-up sub-study including cognition, fatigue, mood, quality of life, and return to work. Conclusions: If preliminary insights from the V-CARE trial suggest the intervention to be feasible and acceptable, the results will be used to design a larger trial aimed at informing future interventions to support OHCA recovery. Full article

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative anxiety. Commonly used pharmacological options include benzodiazepines, ketamine, or fentanyl. Antidepressants have also been shown to be effective in alleviating symptoms, but they typically require four weeks to take effect. Establishment of supportive relationships with medical staff to help patients express their feelings have been shown to have a positive impact on anxiety reduction. Other nonpharmacological methods include the provision of information through informed consent forms, video materials, virtual reality, or the use of psychotherapeutic interventions such as breathing techniques, music therapy, or cognitive–behavioural therapy. Some studies suggest that essential oils may have a role in reducing perioperative anxiety. Nonpharmacological interventions can be used in patients of different ages. An increasing number of researchers advocate for a holistic approach that integrates less invasive and cost-effective interventions with conventional medicine. While various interventions have been proposed to manage preoperative anxiety, more research is needed to establish the most effective and feasible interventions for different patient populations. Full article

Introduction: Consent-taking for surgery evolved from a historical paternalistic approach to informed consent in the mid-20th century. Modern healthcare models prioritize patient-centric care, and the use of multimedia tools may overcome challenges such as language barriers and complex medical surgical steps. This study evaluates the impact of an educational video on patient satisfaction for those undergoing percutaneous nephrolithotomy (PCNL), a procedure where explaining complexities verbally can be challenging. Materials and Methods: A randomized control trial was conducted at a tertiary care center in India from July 2022 to April 2024. A total of 232 adult patients scheduled for PCNL were randomly assigned to a study group (Group A) or a control group (Group B). Group A viewed an educational video about PCNL, while Group B provided standard written consent. The video, presented in patients’ native languages, covered procedural details, potential outcomes, and post-operative care. Patient satisfaction was assessed using a 10-question questionnaire at discharge, with scores ranging from one (poor) to five (best). Statistical analysis was performed using SPSS software to compare outcomes between the two groups. Results: The study found that Group A exhibited significantly higher satisfaction compared to Group B across all domains. Group A demonstrated a better understanding of the procedure, improved knowledge of post-operative care, reduced anxiety, and a greater awareness of potential complications. Specifically, the mean satisfaction scores for Group A were higher in understanding the procedure (13.15 vs. 10.00), post-operative care (8.46 vs. 6.84), and overall anxiety (8.65 vs. 6.96). The video also improved patients’ comprehension regarding potential complications and the need for further procedures. Complication rates and hospital stay durations were similar between both groups. Discussion: The educational video significantly enhanced patient satisfaction and the understanding of PCNL. This multimedia approach provided a consistent, clear explanation of the procedure, which improved patient comprehension and reduced anxiety, irrespective of literacy levels. These findings support the integration of video-assisted consent in pre-operative education to enhance patient engagement and satisfaction. Conclusions: The use of an educational video for consent in PCNL improves patient understanding and satisfaction. This method effectively complements traditional consent processes, providing a valuable tool for patient education in complex procedures. Full article

Background and Objectives: The objective of this study was to assess the efficient use of advanced energy devices by examining the impact of their usage frequency on surgical outcomes of total laparoscopic hysterectomies. Materials and Methods: A retrospective study was conducted between 2020 and 2023 by a single surgeon. The patients’ medical records and surgical videos were reviewed. Cases were categorized into three groups based on the frequency of usage of advanced energy devices: Group 1 (≤10 uses), Group 2 (11–20 uses), and Group 3 (≥21 uses). The differences in blood loss, surgery time, and surgical outcomes among these groups were analyzed. This study was conducted as a single-center retrospective analysis. It included 126 patients who underwent total laparoscopic hysterectomy and provided informed consent for video recording. To evaluate the usage of advanced energy devices, anonymized surgical videos were reviewed, and outcomes were analyzed based on the frequency of usage of advanced energy devices. Results: The time required for surgery differed significantly among the three groups (p = 0.006). However, no significant differences were observed in the changes in hemoglobin levels or estimated blood loss (p = 0.255 and 0.053, respectively). Additionally, the application of hemostatic agents, the need for intraoperative or postoperative transfusions, and the use of intravenous hemostatic agents postoperatively showed no notable variation. Complication rates, including rates of hematoma, urinary tract injury, gastrointestinal injury, and infections necessitating reoperation, were also comparable. Conclusions: The findings suggest that the prudent and strategic use of advanced energy devices, rather than their frequent application, may improve surgical efficiency without increasing the risk of complications. Full article

Introduction: In recent years, the integration of robotic systems into various aspects of daily life has become increasingly common. As these technologies continue to advance, ensuring user-friendly interfaces and seamless interactions becomes more essential. For social robots to genuinely provide lasting value to humans, a favourable user experience (UX) emerges as an essential prerequisite. This article aimed to evaluate the usability of the MINI robot, highlighting its strengths and areas for improvement based on user feedback and performance. Materials and Methods: In a controlled lab setting, a mixed-method qualitative study was conducted with ten individuals aged 65 and above diagnosed with mild dementia (MD) and mild cognitive impairment (MCI). Participants engaged in individual MINI robot interaction sessions, completing cognitive tasks as per written instructions. Video and audio recordings documented interactions, while post-session System Usability Scale (SUS) questionnaires quantified usability perception. Ethical guidelines were followed, ensuring informed consent, and the data underwent qualitative and quantitative analyses, contributing insights into the MINI robot’s usability for this demographic. Results: The study addresses the ongoing challenges that tasks present, especially for MD individuals, emphasizing the importance of user support. Most tasks require both verbal and physical interactions, indicating that MD individuals face challenges when switching response methods within subtasks. These complexities originate from the selection and use of response methods, including difficulties with voice recognition, tablet touch, and tactile sensors. These challenges persist across tasks, with individuals with MD struggling to comprehend task instructions and provide correct answers and individuals with MCI struggling to use response devices, often due to the limitations of the robot’s speech recognition. Technical shortcomings have been identified. The results of the SUS indicate positive perceptions, although there are lower ratings for instructor assistance and pre-use learning. The average SUS score of 68.3 places device usability in the “good” category. Conclusions: Our study examines the usability of the MINI robot, revealing strengths in quick learning, simple system and operation, and integration of features, while also highlighting areas for improvement. Careful design and modifications are essential for meaningful engagement with people with dementia. The robot could better benefit people with MD and MCI if clear, detailed instructions and instructor assistance were available. Full article

Background/Objectives: Informed consent is crucial in medical practice, especially for complex treatments such as postoperative radiotherapy for patients with breast cancer. Conventional consent procedures are often based on verbal declarations with a highly condensed but nevertheless large amount of information, which can exceed the recording capacity of patients and lead to misunderstandings. The aim of this study was to develop and test an educational video on breast cancer patients to enhance the informed consent process by improving patients’ understanding and reducing the duration of the subsequent consultation. Methods: The educational video was created after the underlying content was determined by a modified Delphi method in which a panellist of radiation oncologists, nurses, radiation therapists, and former patients participated in successive rounds of topic scoring. After achieving content consent, the video included 19 items to cover key aspects of postoperative radiotherapy in a patient-friendly manner. Fifty breast cancer patients scheduled for postoperative radiotherapy were randomised to watch the video prior to their verbal consultation (n = 25) or to the control group participating in the traditional informed consent process only (n = 25). The duration of the informed consent processes in both arms was recorded. To assess the educational effect of the video, a multiple-choice test was created. In addition, patients’ satisfaction was recorded using a separate questionnaire. Both questionnaires were completed by the patients one to two hours after signing the consent form. Results: The patients in the video group evidenced significantly higher knowledge scores than those who received standard verbal explanations (median number of correct answers 9 vs. 8 out of 10, p = 0.0039). The whole informed consent process was also completed faster in the video group (mean duration 34.7 vs. 46.2 min, p < 0.001). Median satisfaction scores were high in both groups (34 vs. 33 out of 35 points), with no significant differences observed (p > 0.05). Conclusion: The educational video effectively improved patient understanding and streamlined the informed consent process without compromising patients’ satisfaction. This approach also helps to standardise the delivery of complex medical information, and it can also be adapted to improve the informed consent process for other cancer treatments. Full article

Background/Objectives: Rhomboid intercostal block (RIB) is a new interfascial plane block. RIB is a simple and clinically effective technique. Paravertebral block (PVB) is offered as a first-line regional anesthesia technique for thoracoscopic surgeries. In this study, we aim to compare the analgesic efficacy of RIB to PVB in video-assisted thoracoscopic surgeries (VATSs). Methods: This is a prospective randomized study with 84 patients aged 18–75 and ASA I–III, undergoing VATS for primary lung cancer. The study was approved by an ethical committee and registered under clinicaltrials.org. With informed consent, patients were randomized to receive ultrasound-guided RIB or PVB at T5-level with 20 mL of %0.25 bupivacaine preoperatively. Surgeries were performed under general anesthesia. Postoperatively, patient-controlled IV fentanyl analgesia was prescribed, delivering 10 μg boluses upon request with 10 min of a lock-out period. Patients received paracetamol 1 g IV three times a day and tramadol 50 mg IV for breakthrough pain. The postoperative Numeric Rating Scale (NRS) for pain, total opioid consumption, and rescue analgesic requirements were recorded postoperatively at 1, 3, 6, 12, and 24 h. Results: There were no significant differences in 24 h total opioid consumption between the RIB and PVB groups [PVB: 48.5 (39.5–55) mcg; RIB: 48.6 (40.2–65) mcg; p = 0.258], nor in rescue analgesic requirements [PVB: seven patients (20%); RIB: seven patients (17.1%); p = 0.570]. NRS pain scores were also similar between the groups, with no significant difference in overall pain control efficacy (p = 0.833). Conclusions: RIB is comparable to PVB in analgesic efficacy for VATS and can be considered as an alternative analgesic modality. Full article

Fluorescence-guided oncology promises to improve both the detection and treatment of malignancy. We sought to investigate the temporal distribution of indocyanine green (ICG), an exogenous fluorophore in human colorectal cancer. This analysis aims to enhance our understanding of ICG’s effectiveness in current tumour detection and inform potential future diagnostic and therapeutic enhancements. Methods: Fifty consenting patients undergoing treatment for suspected/confirmed colorectal neoplasia provided near infrared (NIR) video and imagery of transanally recorded and ex vivo resected rectal lesions following intravenous ICG administration (0.25 mg/kg), with a subgroup providing tissue samples for microscopic (including near infrared) analysis. Computer vision techniques detailed macroscopic ‘early’ (<15 min post ICG administration) and ‘late’ (>2 h) tissue fluorescence appearances from surgical imagery with digital NIR scanning (Licor, Lincoln, NE, USA) and from microscopic analysis (Nikon, Tokyo, Japan) undertaken by a consultant pathologist detailing tissue-level fluorescence distribution over the same time. Results: Significant intra-tumoural fluorescence heterogeneity was seen ‘early’ in malignant versus benign lesions. In all ‘early’ samples, fluorescence was predominantly within the tissue stroma, with uptake within plasma cells, blood vessels and lymphatics, but not within malignant or healthy glands. At ‘late’ stage observation, fluorescence was visualised non-uniformly within the intracellular cytoplasm of malignant tissue but not retained in benign glands. Fluorescence also accumulated within any present peritumoural inflammatory tissue. Conclusion: This study demonstrates the time course diffusion patterns of ICG through both benign and malignant tumours in vivo in human patients at both macroscopic and microscopic levels, demonstrating important cellular drivers and features of geolocalisation and how they differ longitudinally after exposure to ICG. Full article

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being. Objective: This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy. Methods: A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants’ connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention. Results: Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy. Full article

In the age of information, new platforms are consulted by patients to acquire consciousness about medical treatments. The aim of this study was to assess the level of understanding and feasibility of video consensus (VC) administration in patients scheduled for radical prostatectomy (RP), comparing it with standard informed consensus (SIC). According to the European Association of Urology Patient Information, we set up a video content for RP that was translated in Italian and implemented with information about possible perioperative and postoperative complications, days of hospitalization etc. From 2021 to 2022, all patients undergoing RP at our institution were prospectively included in this study. Patients received an SIC and after that, a VC about RP. After two consensuses were administered, patients received a preformed Likert 10 scale and STAI questionnaires. On the RP dataset, 276 patients were selected and 552 questionnaires for both SIC and VC were evaluated. Out of these, the median age was 62 years (IQR 60–65). Patients reported a higher overall satisfaction for VC (8.8/10) compared to the traditional informed consent (6.9/10). Therefore, VC may play a role in the future of surgery, improving the consciousness and satisfaction of patients and reducing preoperative anxiety. Full article

Informed consent practices in healthcare represent a fundamental element of patient-centred care; however, the traditional use of a written, paper-based description of the medical procedure to obtain informed consent presents many limitations. This research aimed to evaluate the effects of an alternative modality of obtaining informed consent using a brief informative video for patients waiting to undergo a coronary angiography procedure in Italy. The study involved 40 participants—28 males and 12 females (mean age: 68.55, SD = 13.03)—divided equally into two groups: one group received the video-based informed consent and the other received a traditional paper-based form. Each group was asked to fill in two questionnaires; one was created by the researchers to measure the patient’s level of understanding of the given information and the perception of usefulness of the informed consent, and the other was the Depression Anxiety Stress Scales-21 (DASS-21), which evaluates levels of anxiety, depression and stress. A comparison of the results of the two groups showed that video-based informed consent allowed participants to better understand the given information, to feel more confident concerning their subjective comprehension of it and to perceive the video-based informed consent as more useful than the traditional one. The video-based informed consent did not lead to higher levels of anxiety, depression or stress among the participants. It can be hypothesized that video-based formats may represent a more useful, understandable and safe alternative to traditional paper-based informed consent in healthcare. Full article

The use of video conferencing applications has increased tremendously in recent years, particularly due to the COVID-19 pandemic and the associated restrictions on movements. As a result, the corresponding smart apps have also seen increased usage, leading to a surge in downloads of video conferencing apps. However, this trend has generated several data protection and privacy challenges inherent in the smart mobile ecosystem. This paper aims to study data protection issues in video conferencing apps by statistically and dynamically analyzing the most common such issues in real-time operation on Android platforms. The goal is to determine what these applications do in real time and verify whether they provide users with sufficient information regarding the underlying personal data processes. Our results illustrate that there is still room for improvement in several aspects, mainly because the relevant privacy policies do not always provide users with sufficient information about the underlying personal data processes (especially with respect to data leaks to third parties), which, in turn, raises concerns about compliance with data protection by design and default principles. Specifically, users are often not informed about which personal data are being processed, for what purposes, and whether these processes are necessary (and, if yes, why) or based on their consent. Furthermore, the permissions required by the apps during runtime are not always justified. Full article

Most nursing simulation programs focus on persons’ healthcare needs in hospital settings, and little is known about how to identify them in home settings. This study aims to develop and validate a virtual reality (VR) simulation program for nursing students to improve their clinical reasoning skills and confidence in assessing persons’ healthcare needs in home settings. We developed a VR simulation program based on a literature review and expert discussion. In Phase 1, home visit nurses or public health nurses will validate the program through their interviews in 2022. In Phase 2, we will conduct a pilot and main single-blinded randomized trial for nursing students to confirm the effectiveness from 2022 and 2023. Participants will be randomly allocated into an intervention group using VR simulations and a control group receiving videos regarding three kinds of community residents’ lives [1:1]. After obtaining informed consent, the students will submit their anonymous data to the researchers to prevent associating their grade evaluation. The primary outcome will be their clinical reasoning skills. The second outcome will include their satisfaction and self-confidence. This study will examine the effectiveness of improving their clinical reasoning skills and confidence in assessing persons’ healthcare needs in home settings. Full article

Background: Plasmodium knowlesi malaria is a zoonotic infection that affects rural communities in South East Asia. Although the epidemiology of the disease has been extensively researched, the voices of individuals within affected communities often go unheard. Here, we describe a study that explores the importance of gatekeepers in conducting research among rural communities, their perspectives on the challenges encountered when attempting to avoid malaria infection, and their views on participatory research. Methods: Between 1 November 2021 and 28 February 2022, we conducted a study in Kudat district, Sabah, using a multi-method design. All participants consented to the study, which included health care workers (HCWs) (n = 5), community leaders (n = 8), and faith leaders (n = 1). We conducted interviews, transect walks, and observations with gatekeepers to ensure data trustworthiness. All interviews were conducted in the Sabah Malay dialect. The sessions were audio- and video-recorded, transcribed into English and analyzed using thematic analysis. Results: Between 2017 and 2021, the number of cases of P. knowlesi malaria detected in humans ranged from 35 to 87 in villages under the care of the Lotong primary health care clinic. The challenges in controlling malaria include social norms, lifestyles, socioeconomic factors, environmental factors, and limitations of basic resources. Critical discussions regarding participation with the gatekeepers identified that face-to-face interviews were preferable to online discussions, and influenced willingness to participate in future research. Conclusion: This study was conducted among village gatekeepers during the COVID-19 pandemic and generated information to drive methodological changes, opening up new ideas by sharing perspectives on challenges in P. knowlesi malaria control among vulnerable communities. The study generated trust in the community and expanded knowledge regarding participation that is critical for future community-based studies. Full article

Obtaining valid parental informed consent for pediatric procedures in the emergency department (ED) is challenging. We compared a video-assisted informed consent intervention with conventional discussion to inform parents about pediatric procedural sedation in the ED. We conducted a prospective randomized controlled trial using a convenience sample including the parents of children in the ED in whom procedural sedation for facial laceration was recommended. The video group watched an informational video. Conventional group participants received information from physicians during conventional discussion. The primary outcome was knowledge improvement of the video intervention compared with conventional discussion. The secondary outcome was parental satisfaction. Video and conventional groups comprised 32 and 30 participants, respectively. Mean knowledge scores of parents after intervention [±standard deviation] were higher in the video group (91.67 ± 12.70) than in the conventional group (73.33 ± 19.86). Knowledge score differences were significantly bigger in the video group (coefficient: 18.931, 95% confidence interval: 11.146–26.716). Video group participants reported greater satisfaction than conventional group participants. Parents’ comprehension of and satisfaction with the informed consent process for pediatric procedural sedation may be improved with the use of an educational video. Standardized approaches should be developed by healthcare institutions to better educate parents, facilitate treatment decisions, and boost satisfaction in the ED. Full article