Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch

Patients' experiences of being touched by their general practitioner: a qualitative study

OBJECTIVE

This study aimed to explore patients' experiences and perceptions of touch, as practised by their general practitioner during their medical appointment.

DESIGN

Qualitative study using grounded theory method, based on individual interviews. Data collection and analysis occurred iteratively; themes were identified using constant comparison.

SETTING

Recruitment among general practitioners' private practices and health centres in Ile-de-France.

PARTICIPANTS

Twenty-one patients aged 19-88 years old, interviewed between June 2018 and May 2019.

RESULTS

Physical examination was described as a ritual enabling the establishment of patients' and doctors' roles, the verification of the doctor's skills and the construction of a caring experience. Touch was also a media for the doctor to exercise power that the patient authorised. Finally, it had relational and emotional value.

DISCUSSION AND CONCLUSION

Physical examination is so internalised by the patients that it becomes unquestionable. It may be inappropriate when this touch does not belong to physical examination or on the contrary represents a proof of the doctor's humanity. The patient is not necessarily aware of the relational dimension that underpins touching and, in particular, clinical examination. This raises the question of why should doctor use it and how they can communicate about it, so that it may become an active tool in favour of trust and the construction of the relationship.

Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study

To assess whether the treatment of children with oral midazolam and pediatric hypnosis techniques can improve the compliance in consecutive sessions, a retrospective longitudinal practice-based observational study was designed and carried out. A total of 311 children between 3 and 12 years of age were treated under hypnosis and sedation with midazolam (0.40 mg/kg body weight). Treatments were performed in one to a maximum of three sessions. A total of 183 children received one, 103 received two and 25 children received three treatment sessions. The behavior of the children during the sessions was examined by means of the Venham score. The self-evaluation of the children was based on the Wong−Baker Scale. Child behavior using midazolam and hypnosis techniques showed little difference and good compliance between the sessions. Venham scores did not increase significantly regarding total treatment from the first (0.99 ± 1.41) to the second (1.17 ± 1.39) and to the third session (1.27 ± 1.20) (p > 0.05). However, considering the highest Venham scores that occurred in each case, the behavior of the children worsened significantly (p < 0.01) during the three treatment sessions, from 1.37 ± 1.31 (first) to 1.87 ± 1.74 (second) to 2.32 ± 1.33 (third). In 6.11% of the children, treatment was discontinued in the first session (n = 19), 0.96% in the second (n = 3) and 0% in the third. Treatment with low-dose midazolam, combined with hypnosis techniques, showed to be an effective option for dental treatment in children. Within the limitations of the current study, and with consideration of highest possible compliance, no more than two treatment sessions for pediatric dental treatment should be performed.

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.

Representing Interpersonal Touch Directions by Tactile Apparent Motion Using Smart Bracelets

We present a novel haptic interaction to vibro-tactually connect an interpersonal touch using bracelet devices. A pair of bracelet devices identifies the user who is actively touching and the other who is passively touched, defining the direction as being from the former to the latter. By controlling the vibrational feedback, the pair induces a tactile apparent motion representing the direction between two hands. The bracelets are comprised of our developed interpersonal body area network module, an acceleration sensor, and a vibrator. The devices communicate with each other through electrical current flowing along the hands to identify the direction by sharing accelerations just before a touch and to synchronize the feedback in less than ten milliseconds. Experiment 1 demonstrates that the vibration propagated from a bracelet device to the wearer's hand is perceivable by another. Experiment 2 determines sets of optimal actuation parameters, stimulus onset asynchrony, and duration of vibration to induce the tactile apparent motion based on a psychophysical approach. In addition, vibration propagation between hands is observed. Experiment 3 demonstrates the capability of the developed device to present the haptic interaction.

Social Touch Technology: A Survey of Haptic Technology for Social Touch

This survey provides an overview of work on haptic technology for social touch. Social touch has been studied extensively in psychology and neuroscience. With the development of new technologies, it is now possible to engage in social touch at a distance or engage in social touch with artificial social agents. Social touch research has inspired research into technology mediated social touch, and this line of research has found effects similar to actual social touch. The importance of haptic stimulus qualities, multimodal cues, and contextual factors in technology mediated social touch is discussed. This survey is concluded by reflecting on the current state of research into social touch technology, and providing suggestions for future research and applications.

Friendly touch increases gratitude by inducing communal feelings

Communion among people is easily identifiable. Close friends or relatives frequently touch each other and this physical contact helps identifying the type of relationship they have. We tested whether a friendly touch and benefits elicit the emotion of gratitude given the close link between gratitude and communal relations. In Study 1, we induced a communal mindset and manipulated friendly touch (vs. non-touch) and benefit to female participants by a female confederate. We measured pre- and post-benefit gratitude, communal feelings, and liking toward the toucher, as well as general affect. In Study 2, we manipulated mindset, friendly touch and benefit, and measured the same variables in female pairs (confederate and participants). In both studies the results showed a main effect of touch on pre-benefit gratitude: participants who were touched by the confederate indicated more gratitude than those not touched. Moreover, benefit increased gratitude toward a confederate in the absence of touch, but not in the presence of touch. Additionally, perceiving the relationship as communal, and not merely liking the confederate, or a positive mood mediated the link between touch and gratitude. The results further support a causal model where touch increases communal feelings, which in turn increase gratitude at the end of the interaction, after having received a benefit from the interaction partner. These results support a broader definition of gratitude as an emotion embodied in communal relationship cues.