Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic

BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment.Moreover,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of care.Consequently,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD.However,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.AIM To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 pandemic.METHODS This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the department.The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment.After a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was developed.Guidelines for clinicians and educational materials for patients and their families were prepared.The protocol was implemented among patients with OCD attending the TMH services,and their progress was monitored.The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders.Feasibility and efficacy outcomes were examined.RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version criteria.Out of 115 patients who attended the services during the study period,37 were excluded from the final analysis.Of the remaining 78 patients,VC-ERP was initiated in 43 patients.Six patients dropped out,and three were hospitalized for inpatient ERP.Eleven patients have completed the full VC-ERP treatment.One patient completed the psychoeducation part of the protocol.VC-ERP is ongoing in 22 patients.The protocol for VC-ERP treatment was developed and upgraded online.A large proportion of the eligible patients(n=34/43;79%)actively engaged in the VC-ERP treatment.Drop-out rates were low(n=6/43;14%).Satisfaction with the treatment was adequate among patients,caregivers,and clinicians.Apart from hospitalization in 3 patients,there were no other adverse events.Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol.Therefore,the feasibility of VC-ERP treatment in terms of operational viability,service utilization,service engagement,need for additional in-person services,frequency of adverse events,and user satisfaction was adequate.The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment.Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD.The results suggest that VC-ERP can be a useful option in resource-constrained settings.

Usefulness of telepsychiatry:A critical evaluation of videoconferencing-based approaches

Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencingbased telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.

Multipoint videoconferencing with scalable video coding

We describe a system for multipoint videoconferencing that offers extremely low end-to-end delay, low cost and complexity, and high scalability, alongside standard features associated with high-end solutions such as rate matching and per- sonal video layout. The system accommodates heterogeneous receivers and networks based on the Internet Protocol and relies on scalable video coding to provide a coded representation of a source video signal at multiple temporal and spatial resolutions as well as quality levels. These are represented by distinct bitstream components which are created at each end-user encoder. Depending on the specific conferencing environment, some or all of these components are transmitted to a Scalable Video Conferencing Server (SVCS). The SVCS redirects these components to one or more recipients depending on, e.g., the available network con- ditions and user preferences. The scalable aspect of the video coding technique allows the system to adapt to different network conditions, and also accommodates different end-user requirements (e.g., a user may elect to view another user at a high or low spatial resolution). Performance results concerning flexibility, video quality and delay of the system are presented using the Joint Scalable Video Model (JSVM) of the forthcoming SVC (H.264 Annex G) standard, demonstrating that scalable coding outper- forms existing state-of-the-art systems and offers the right platform for building next-generation multipoint videoconferencing systems.

Standards for Videoconferencing

This paper analyzes three standards for videoconferencing and forecasts their development trends.It is concluded that ITU standard H.320 can only videoconferencing involving a few participants while unable to be expanded to interactive multimedia communication platform for multi-applications; H.323 is an open standard system developed under the consideration of both the traditional PSTN call procedure and the characteristics of IP network,and represents a general trend of the development of multimedia telecom services;Session Initiation Protocol (SIP) has good flexibility,scalability and cross-platform compatibility.

ZTE Launches the World's First Converged Intelligent Videoconferencing Solution at ISE 2014

February 4, 2014--ZTE Corporation has launched the world＇s first converged intelligent videoconferencing solution at Integrated Systems Europe, Amsterdam. The solution transforms existing video conferencing terminals from functional ma- chines into smart machines. Due to restrictions in system convergence, traditional videoconferencing can no longer meet the requirements of rapidly developing technologies and markets. The development of video codec technology and the extensive use of wireless technol- ogies such as LTE are also raising people＇ s expectations for higher video resolution and more flexible video communica- tions. This converged intelligent videoconferencing solution uses an open video communication interface, provides a univer- sal platform, and supports convergence with third-party applications, quickly meeting different user requirements. The sys- tem has pre-installed common conferencing software and supports plug and play USB flash disks and portable hard disks for easy sharing of electronic documents. With integrated functions such as E-whiteboard, data conferencing and muhi- touch, the system supports simple and intuitive operations.

Framework for Better Understanding a Face-to-Face Videoconferencing Using H.263 Codec

Face-to-face Videoconferencing is a popular option for many large organizations because it minimizes the need for travel. Instead of continually paying for traveling expenses, a company can either pay to set up a high speed network which has many usages （including videoconferencing） or they can rent time on an existing network. Employees will also no longer be burdened with the need to travel. While face-to-face videoconferencing performance is heavily influenced by the underlying hardware and software, a good video compression scheme can help make the best use of videoconferencing and provide a high quality picture. H.263 standard is now widely used for real-time video communications over a range of networks including the Internet. A frame work for better understanding the H.263 including the implementation of encoder and decoder for face-to-face videoconferencing is presented. This software was written in C＋＋ language, running under the Microsoft Windows operating system.

3D modeling and motion parallax for improved videoconferencing

We consider a face-to-face videoconferencing system that uses a Kinect camera at each end of the link for 3D modeling and an ordinary2 D display for output. The Kinect camera allows a 3D model of each participant to be transmitted;the(assumed static) background is sent separately.Furthermore, the Kinect tracks the receiver's head,allowing our system to render a view of the sender depending on the receiver's viewpoint. The resulting motion parallax gives the receivers a strong impression of 3D viewing as they move, yet the system only needs an ordinary 2D display. This is cheaper than a full3 D system, and avoids disadvantages such as the need to wear shutter glasses, VR headsets, or to sit in a particular position required by an autostereo display.Perceptual studies show that users experience a greater sensation of depth with our system compared to a typical 2D videoconferencing system.

Review of key telepsychiatry outcomes

AIM: To conduct a review of the telepsychiatry literature.METHODS: We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to:(1) be published in a peer-reviewed journal after the year 2000;(2) be written in English;(3) use videoconferencing technology for the provision of mental health assessment or treatment services; and(4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in Pub Med(Medline database), Ovid medline, Psych Info, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories:(1) satisfaction;(2) reliability;(3) treatment outcomes;(4) implementation outcomes;(5) cost effectiveness; and(6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion.RESULTS: Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry.CONCLUSION: A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.

Teaching by Teleconference: A Model for Distance Medical Education across Two Continents

Introduction: In Uganda, an estimated 120 obstetrician/gynecologists serve a population of 30 million people demonstrating the need to train additional skilled clinician leaders in reproductive health. In 2012, a partnership was formed with the Mbarara Regional Referral Hospital (MRRH) in southwest Uganda and the Massachusetts General Hospital (MGH) in Boston, USA, in part to increase access to specialist training. This report presents an update in the development of a teaching conference between the institutions. Methods: In June 2012, a didactic teleconference between the institutions was instituted. Various conferencing tools were tried: direct telephone connection, VentriloTM conferencing system and SkypeTM via personal computer or smart phone. In Mbarara, Internet was accessed via cellular data. In Boston, Internet was accessed via hospital network or cellular data. All lectures were HIPAA compliant. PowerPoint lectures were stored in a collective DropboxTM that could be accessed and downloaded prior to lecture dates. Results: Over 30 months, 30 lectures were given. Lecturers included faculty and fellows from maternal fetal medicine, gynecology oncology, urogynecology, family planning, psychiatry and obstetric anesthesia. A patient case pertinent to the teaching topic framed the discussion. About 20 participants attended each lecture. Internet connectivity was the biggest challenge. Ultimately audio Skype via cellular data proved the most successful modality and became the method of choice. Conclusion: A successful collaboration in medical education via teleconference is sustainable, low cost, and beneficial to both resource-rich and resource-poor institutions. Expertise can be shared bilaterally and internationally by individuals potentially unable travel.

An internet-based intervention program for supporting families with prematurely born infants

The purpose of this paper was to describe the development, planning and implementing of an internet-based intervention program for providing support to families with prematurely born infants. During the families initial stay at home with their infant;families were given access to use of videoconference system from their home to have contact with staff at the neonatal unit, via direct link, throughout twenty-four hours. This program successfully ended, and video-conferencing is incorporated as a tool to support families after coming home. Probably, a variety of factors has contributed to make this program successful, as for example user friendliness and the close collaboration between researchers and staff at the neonatal unit. In conclusion, Information and Communication Technology (ICT) must be taken into consideration in developing upcoming care, thereby making possible a program to extend accessibility to health care.

SYNCHRONOUS COMMUNICATION IN PLM ENVIRONMENTS USING ANNOTATED CAD MODELS

The connection of resources, data, and knowledge through communication technology plays a vital role in current collaborative design methodologies and Product Lifecycle Management （PLM） systems, as these elements act as channels for information and meaning. Despite significant advances in the area of PLM, most communication tools are used as separate services that are disconnected from existing development environments. Consequently, during a communication session, the specific elements being discussed are usually not linked to the context of the discussion, which may result in important information getting lost or becoming difficult to access. In this paper, we present a method to add synchronous communication functionality to a PLM system based on annotated information embedded in the CAD model. This approach provides users a communication channel that is built directly into the CAD interface and is valuable when individuals need to be contacted regarding the annotated aspects of a CAD model. We present the architecture of a new system and its integration with existing PLM systems, and describe the implementation details of an annotation-based video conferencing module for a commercial CAD application.