Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.

Risk of anemia in morbidly obese patients after bariatric surgery in Taiwan

BACKGROUND Bariatric surgery is one of most effective long-term treatments for morbid obesity.However,post-bariatric surgery anemia is identified as a common adverse effect and remains a challenge nowadays.AIM To estimate the risk of post-bariatric surgery anemia and to stratify the association between age,gender,and types of surgery.METHODS This study is a population-based cohort study.We conducted this nationwide study using claims data from National Health Insurance Research Database in Taiwan.There were 4373 morbidly obese patients in this study cohort.RESULTS Among patients who were diagnosed with morbid obesity,2864 received bariatric surgery.All obesity-associated comorbidities decreased in the surgical group.Increasing risk of post-bariatric surgery anemia among obese patients was found by Cox proportional hazards regression[adjusted hazard ratio(HR):2.36].Also,we found significantly increasing cumulative incidence rate of anemia among patients receiving bariatric surgery by log-rank test.After adjusting for age and gender,the increasing incidence of post-bariatric surgery anemia was found among women(adjusted HR:2.48),patients in the 20–29-year-old group(adjusted HR:3.83),and patients in the 30-64-year-old group(adjusted HR:2.37).Moreover,malabsorptive and restrictive procedures had significantly higher adjusted HRs,3.18 and 1.55,respectively.CONCLUSION Bariatric surgery give rise to anemia risk among obese patients,specifically in women,young-and middle-aged patients,and patients undergoing malabsorptive procedures in our population-based cohort study in Taiwan.