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Keramati H, Lu X, Cabanag M, Wu L, Kushwaha V, Beier S. Applications and advances of immersive technology in cardiology. Curr Probl Cardiol 2024; 49:102762. [PMID: 39067719 DOI: 10.1016/j.cpcardiol.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Different forms of immersive technology, such as Virtual Reality (VR) and Augmented Reality (AR), are getting increasingly invested in medicine. Advances in head-mounted display technology, processing, and rendering power have demonstrated the increasing utility of immersive technology in medicine and the healthcare environment. There are a growing number of publications on using immersive technology in cardiology. We reviewed the articles published within the last decade that reported case studies or research that uses or investigates the application of immersive technology in the broad field of cardiology - from education to preoperative planning and intraoperative guidance. We summarized the advantages and disadvantages of using AR and VR for various application categories. Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance. Despite the limitations and gaps that have inhibited us from benefiting from immersive technologies' full potential in cardiology settings to date, its promising, impactful future for standard cardiovascular care is undoubted.
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Affiliation(s)
- Hamed Keramati
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia.
| | - Xueqing Lu
- Learning and Digital Environments, Deputy Vice-Chancellor Education and Student Experience, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Matt Cabanag
- School of Art and Design, Faculty of Arts, Design and Architecture, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Liao Wu
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Virag Kushwaha
- Eastern Heart Clinic, Prince of Wales Hospital, Barker Street Randwick, NSW 2031, Australia; Faculty of Medicine, The University of New South Wales, Kensington, Sydney 2033, NSW, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia
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Lareyre F, Mialhe C, Nasr B, Poggi E, Lorenzo GD, Rajhi K, Chaudhuri A, Raffort J. Extended and augmented reality in vascular surgery: Opportunities and challenges. Semin Vasc Surg 2024; 37:321-325. [PMID: 39277348 DOI: 10.1053/j.semvascsurg.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/17/2024]
Abstract
Extended reality has brought new opportunities for medical imaging visualization and analysis. It regroups various subfields, including virtual reality, augmented reality, and mixed reality. Various applications have been proposed for surgical practice, as well as education and training. The aim of this review was to summarize current applications of extended reality and augmented reality in vascular surgery, highlighting potential benefits, pitfalls, limitations, and perspectives on improvement.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France
| | - Claude Mialhe
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Bahaa Nasr
- Univ Brest, Institut National de la Santé et de la Recherche Médicale, L'Institut Mines-Télécom-Atlantique, UMR1011 Laboratoire de Traitement de L'information Médicale, Vascular and Endovascular Surgery Department, Centre Hospitalier Universitaire, Cavale Blanche, Brest, France
| | - Elise Poggi
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Gilles Di Lorenzo
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Khalid Rajhi
- Department of Vascular and Endovascular Surgery, Jazan Specialist Hospital, Jazan, Saudi Arabia
| | - Arindam Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals, National Health Service Foundation Trust, Bedford, United Kingdom
| | - Juliette Raffort
- Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France; Department of Clinical Biochemistry, Hôpital Pasteur, Pavillon J, 30, Avenue de la Voie Romaine, 06001 Nice Cedex 1, France.
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Kanschik D, Haschemi J, Heidari H, Klein K, Afzal S, Maier O, Piayda K, Binneboesssel S, Oezaslan G, Bruno RR, Antoch G, Lichtenberg A, Fleissner F, Scherner M, Kelm M, Zeus T, Jung C. Feasibility, Accuracy, and Reproducibility of Aortic Valve Sizing for Transcatheter Aortic Valve Implantation Using Virtual Reality. J Am Heart Assoc 2024; 13:e034086. [PMID: 39041603 DOI: 10.1161/jaha.123.034086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/18/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Detailed visualization and precise measurements of aortic valve dimensions are critical for the success of transcatheter aortic valve implantation and for the prevention of complications. Currently, multislice computed tomography is the gold standard for assessment of the aortic annulus and surrounding structures to determine the prosthesis size. New technologies such as virtual reality (VR) not only enable 3-dimensional (3D) visualization with the potential to improve understanding of anatomy and pathology but also allow measurements in 3D. This study aims to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in preprocedural sizing for transcatheter aortic valve implantation. METHODS AND RESULTS Based on the preprocedural multislice computed tomography data, 3mensio measurements and 3D visualizations and measurements using VR software were performed retrospectively on 60 consecutive patients who underwent transcatheter aortic valve implantation at our heart center. There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software. Furthermore, excellent or good intra- and interobserver reliability could be demonstrated for all values. In a structured questionnaire, users reported that VR simplified anatomical understanding, improved 3D comprehension of adjacent structures, and was associated with very good self-perceived depth perception. CONCLUSIONS The use of VR for preprocedural transcatheter aortic valve implantation sizing is feasible and has precise and reproducible measurements. In addition, 3D visualization improves anatomical understanding and orientation. To evaluate the potential benefits of 3D visualization for planning further cardiovascular interventions, research in this field is needed.
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Affiliation(s)
- Dominika Kanschik
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Jafer Haschemi
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Houtan Heidari
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Kathrin Klein
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Shazia Afzal
- Heartcenter Trier Krankenhaus der Barmherzigen Brueder Trier Germany
| | - Oliver Maier
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Kerstin Piayda
- Department of Cardiology and Angiology University Hospital Giessen und Marburg Giessen Germany
| | - Stephan Binneboesssel
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Goeksen Oezaslan
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Raphael R Bruno
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty Heinrich-Heine University Duesseldorf Germany
| | - Felix Fleissner
- Department of Cardiac Surgery, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Maximillian Scherner
- Department of Cardiac Surgery, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty Heinrich-Heine University Duesseldorf Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Hospital and Heinrich-Heine University Duesseldorf Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty Heinrich-Heine University Duesseldorf Germany
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Levit T, Grzela P, Lavoie DCT, Wang L, Agarwal A, Couban RJ, Shanthanna H. The Effectiveness of Virtual and Augmented Reality in Surgical Pain Management: A Systematic Review of Randomized Controlled Trials. Anesth Analg 2024:00000539-990000000-00888. [PMID: 39088374 DOI: 10.1213/ane.0000000000007051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Satisfactory management of postoperative pain remains challenging. Nonpharmacological modalities such as virtual and augmented reality (VR/AR) offer potential benefits and are becoming increasingly popular. This systematic review evaluates the effectiveness and safety of VR/AR interventions on postoperative pain and recovery. METHODS MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL databases were searched from inception to July 27, 2023, for randomized controlled trials (RCTs), published in English, evaluating the use of VR/AR interventions for surgical pain relief. Study selection and data extraction were performed by pairs of reviewers independently and in duplicate, and potential risk of bias was determined using the Risk of Bias-version 2 (RoB 2) tool. Our outcomes included pain relief, reduction of anxiety, satisfaction, and adverse effects. Due to substantial heterogeneity, a narrative synthesis without meta-analysis was performed. RESULTS We included 35 trials among 2257 citations, categorized as surgery (n = 12), minor procedures (n = 15), and postoperative physiotherapy (n = 8). Surgical group included various surgeries, with 11 using immersive VR predominantly in the postoperative period, and most reporting no differences in pain, but potential for reduced anxiety and sedation requirements. In the minor procedures group, most studies reported decreased pain and anxiety during the procedural performance. Two studies reported increased heart rate, while 2 others reported better hemodynamic stability. Home-based AR physiotherapy achieved (n = 6) similar pain and functional outcomes after knee replacement, with 1 large study (n = 306) reporting reduction of mean costs by $2745 for provision of 12 weeks physiotherapy. There were some concerns around potential bias for most studies, as the nature of interventions make it challenging to blind assessors and participants. No important adverse effects were noted using VR/AR technology. CONCLUSIONS Evidence from RCTs indicates that the use of immersive VR during minor procedures may reduce procedural pain, decrease anxiety, and improve satisfaction. However, small studies, inconsistent effect, and variation in the application of interventions are important limitations. Evidence to support the application of AR/VR for major surgeries is limited and needs to be further investigated. Use of home-based physiotherapy with AR likely has economic advantages, and facilitates virtual care for appropriate patients who can access and use the technology safely.
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Affiliation(s)
- Tal Levit
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Grzela
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Declan C T Lavoie
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Aashna Agarwal
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel J Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
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Amonoo HL, Newcomb R, Lorenz KA, Psenka R, Holmbeck K, Farnam EJ, Tse A, Desai S, Vassev N, Waldman LP, El-Jawahri A. A novel psychosocial virtual reality intervention (BMT-VR) for patients undergoing hematopoietic stem cell transplantation: Pilot randomized clinical trial design and methods. Contemp Clin Trials 2024; 142:107550. [PMID: 38685401 PMCID: PMC11180582 DOI: 10.1016/j.cct.2024.107550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Although patients undergoing hematopoietic stem cell transplantation (HSCT) must cope with psychological distress and isolation during an extended transplant hospitalization, psychosocial interventions to address these unmet needs are lacking. Virtual reality offers an innovative modality to deliver a patient-centered psychosocial intervention to address psychosocial needs of patients undergoing HSCT. However, there are currently no supportive care interventions leveraging virtual reality in patients undergoing HSCT. OBJECTIVE To describe the methods of a randomized clinical trial (RCT) to assess the feasibility and preliminary efficacy of a self-administered, virtual reality-delivered psychosocial intervention (BMT-VR) to improve psychological distress and quality of life (QOL) for patients hospitalized for HSCT. METHODS This study entails a single-center RCT of BMT-VR compared to usual transplant care in 80 patients hospitalized for HSCT. Adult patients with hematologic malignancies hospitalized for autologous or allogeneic HSCT are eligible. BMT-VR includes psychoeducation about the HSCT process, psychosocial skill building to promote effective coping and acceptance, and self-care and positive psychology skills to promote post-HSCT recovery. The primary aim is to assess the feasibility defined a priori as ≥60% of eligible patients enrolling in the study, and of those enrolled and randomized to the BMT-VR, ≥ 60% completing 4/6 BMT-VR modules. Secondary objectives include assessing the preliminary effects on psychological distress and QOL. DISCUSSION This is the first RCT of a virtual reality-delivered psychosocial intervention for the HSCT population. If deemed feasible, a future larger multi-site clinical trial can evaluate the efficacy of BMT-VR on outcomes for patients hospitalized for HSCT.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Richard Newcomb
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Karl A Lorenz
- Division of Primary Care and Population Health, Section of Palliative Care, Palo Alto VA Health Care System, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Riley Psenka
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Emelia J Farnam
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Alexandra Tse
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Lauren P Waldman
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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Micheluzzi V, Burrai F, Casula M, Serra G, Al Omary S, Merella P, Casu G. Effectiveness of virtual reality on pain and anxiety in patients undergoing cardiac procedures: A systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024; 49:102532. [PMID: 38503359 DOI: 10.1016/j.cpcardiol.2024.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Cardiac procedures often induce pain and anxiety in patients, adversely impacting recovery. Pharmachological approaches have limitations, prompting exploration of innovative digital solutions like virtual reality (VR). Although early evidence suggests a potential favourable benefit with VR, it remains unclear whether the implementation of this technology can improve pain and anxiety. We aimed to assess by a systematic review and meta-analysis the effectiveness of VR in alleviating anxiety and pain on patients undergoing cardiac procedures. METHODS Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024504563. The search was carried out in the PubMed, Web of Science, Scopus, and the Cochrane Library databases in January 2024. Four randomized controlled trials were included (a total of 382 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect. RESULTS The results showed that VR, when compared to the standard of care, had a statistically significant impact on anxiety (SMD = -0.51, 95 % CI: -0.86 to -0.16, p = 0.004), with a heterogeneity I2 = 57 %. VR did not show a significant difference in terms of pain when compared to standard care (SMD= -0.34, 95 % CI: -0.75 to -0.07, p = 0.10). The included trials exhibited small sample sizes, substantial heterogeneity, and variations in VR technology types, lengths, and frequencies. CONCLUSIONS VR effectively lowers anxiety levels in patients undergoing cardiac procedures, however, did not show a statistically significant difference on pain.
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Affiliation(s)
| | - Francesco Burrai
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Marta Casula
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Serra
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Shadi Al Omary
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Pierluigi Merella
- Clinical and interventional cardiology, University Hospital, Sassari, Italy
| | - Gavino Casu
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
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Micheluzzi V, Navarese EP, Merella P, Talanas G, Viola G, Bandino S, Idini C, Burrai F, Casu G. Clinical application of virtual reality in patients with cardiovascular disease: state of the art. Front Cardiovasc Med 2024; 11:1356361. [PMID: 38633842 PMCID: PMC11021579 DOI: 10.3389/fcvm.2024.1356361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Virtual reality offers a multisensory experience to patients, allowing them to hear, watch, and interact in a virtual environment. Immersive virtual reality is particularly suitable for the purpose of completely isolating patients from the external environment to transport them away from the suffering related to the disease. On this state of the art, we summarize the available literature on the effectiveness of virtual reality on various physical and psychological outcomes in patients with atherosclerotic cardiovascular disease. Virtual reality has been employed in the cardiovascular field in various settings such as cardiac rehabilitation, interventional cardiology, and cardiac surgery. This technology offers promising opportunities to improve several outcomes related to cardiovascular disease, but further research is needed to entirely capture its benefits and to standardize the intervention.
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Affiliation(s)
- Valentina Micheluzzi
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Eliano Pio Navarese
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Pierluigi Merella
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Talanas
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
| | - Graziana Viola
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
| | - Stefano Bandino
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
| | - Chiara Idini
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Francesco Burrai
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Gavino Casu
- Clinical and Experimental Cardiology, Clinical and Interventional Cardiology, University Hospital, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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Narayan SM, Wan EY, Andrade JG, Avari Silva JN, Bhatia NK, Deneke T, Deshmukh AJ, Chon KH, Erickson L, Ghanbari H, Noseworthy PA, Pathak RK, Roelle L, Seiler A, Singh JP, Srivatsa UN, Trela A, Tsiperfal A, Varma N, Yousuf OK. Visions for digital integrated cardiovascular care: HRS Digital Health Committee perspectives. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:37-49. [PMID: 38765620 PMCID: PMC11096652 DOI: 10.1016/j.cvdhj.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | | | | | | | | | - Ki H Chon
- University of Connecticut, Storrs, Connecticut
| | | | | | | | | | - Lisa Roelle
- Washington University School of Medicine, Saint Louis, Missouri
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Anthony Trela
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Angela Tsiperfal
- Stanford Arrhythmia Service, Stanford Healthcare, Palo Alto, California
| | | | - Omair K Yousuf
- Inova Heart and Vascular Institute; Carient Heart and Vascular; and University of Virginia Health, Fairfax, Virginia
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Bashir ZS, Misquith C, Has P, Bukhari SM. The Effectiveness of Virtual Reality on Anxiety and Pain Management in Patients Undergoing Cardiac Procedures: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57557. [PMID: 38707015 PMCID: PMC11068510 DOI: 10.7759/cureus.57557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Cardiac procedure-related anxiety and pain can adversely affect outcomes and lead to patient dissatisfaction. Virtual reality (VR) offers a promising alternative to traditional therapies for improving patient experience. Our objective is to synthesize evidence and assess the effectiveness of VR in reducing cardiac procedure-related anxiety and pain compared to standard of care. We conducted a comprehensive search across various online databases, including MEDLINE, EMBASE, CINAHL, Web of Sciences, and COCHRANE, to identify relevant randomized controlled trials (RCTs) focusing on VR, cardiac procedures, anxiety, and pain. We utilized a random-effect model to generate effect estimates reported as standardized mean differences (SMD) with a 95% confidence interval. Our review comprised 10 studies with a total of 621 participants (intervention arm: 301, control arm: 320). Overall, among the seven studies evaluating anxiety outcomes, no significant difference in anxiety reduction was observed between the intervention and control groups (standardized mean difference (SMD) -0.62, 95% CI -1.61, 0.37, p=0.22). However, studies using the same anxiety assessment tool demonstrated a significant improvement in the VR arm (SMD -1.01, 95% CI -1.98, -0.04, p=0.04). Conversely, the narrative synthesis of four studies examining pain revealed mixed results. Our findings suggest no significant difference in anxiety reduction between the VR and control groups. Future studies should employ standardized tools for assessing and reporting anxiety and pain to better understand the potential of VR in enhancing patient experience during cardiac procedures.
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Affiliation(s)
- Zubair S Bashir
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | | | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Brown University, Providence, USA
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10
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Boyce L, Jordan C, Egan T, Sivaprakasam R. Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials. Pain 2024; 165:741-752. [PMID: 37870233 DOI: 10.1097/j.pain.0000000000003086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/16/2023] [Indexed: 10/24/2023]
Abstract
ABSTRACT Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies ("endoscopic") and interventions that involved a skin incision in 7 studies ("incision"). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the "incision" and "endoscopic" subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.
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Affiliation(s)
| | | | | | - Rajesh Sivaprakasam
- Nephrology and Renal Transplant, the Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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11
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Heidari H, Kanschik D, Maier O, Wolff G, Brockmeyer M, Masyuk M, Bruno RR, Polzin A, Erkens R, Antoch G, Reinartz SD, Werner N, Kelm M, Zeus T, Afzal S, Jung C. A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure. Front Cardiovasc Med 2024; 11:1328906. [PMID: 38596690 PMCID: PMC11002144 DOI: 10.3389/fcvm.2024.1328906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background Understanding complex cardiac anatomy is essential for percutaneous left atrial appendage (LAA) closure. Conventional multi-slice computed tomography (MSCT) and transesophageal echocardiography (TEE) are now supported by advanced 3D printing and virtual reality (VR) techniques for three-dimensional visualization of volumetric data sets. This study aimed to investigate their added value for LAA closure procedures. Methods Ten patients scheduled for interventional LAA closure were evaluated with MSCT and TEE. Patient-specific 3D printings and VR models were fabricated based on MSCT data. Ten cardiologists then comparatively assessed LAA anatomy and its procedure relevant surrounding structures with all four imaging modalities and rated their procedural utility on a 5-point Likert scale questionnaire (from 1 = strongly agree to 5 = strongly disagree). Results Device sizing was rated highest in MSCT (MSCT: 1.9 ± 0.8; TEE: 2.6 ± 0.9; 3D printing: 2.5 ± 1.0; VR: 2.5 ± 1.1; p < 0.01); TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT (MSCT: 3.3 ± 1.4; TEE: 2.2 ± 1.3; 3D printing: 2.2 ± 1.4; VR: 1.9 ± 1.3; all p < 0.01). The major strength of VR and 3D printing techniques was a superior depth perception (VR: 1.6 ± 0.5; 3D printing: 1.8 ± 0.4; TEE: 2.9 ± 0.7; MSCT: 2.6 ± 0.8; p < 0.01). The visualization of extracardiac structures was rated less accurate in TEE than MSCT (TEE: 2.6 ± 0.9; MSCT: 1.9 ± 0.8, p < 0.01). However, 3D printing and VR insufficiently visualized extracardiac structures in the present study. Conclusion A true 3D visualization in VR or 3D printing provides an additional value in the evaluation of the LAA for the planning of percutaneous closure. In particular, the superior perception of depth was seen as a strength of a 3D visualization. This may contribute to a better overall understanding of the anatomy. Clinical studies are needed to evaluate whether a more comprehensive understanding through advanced multimodal imaging of patient-specific anatomy using VR may translate into improved procedural outcomes.
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Affiliation(s)
- Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Sebastian Daniel Reinartz
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Nikos Werner
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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12
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Squara F, Bateau J, Scarlatti D, Bun SS, Moceri P, Ferrari E. Virtual Reality for the Management of Pain and Anxiety in Patients Undergoing Implantation of Pacemaker or Implantable Cardioverter Defibrillator: A Randomized Study. J Med Syst 2024; 48:28. [PMID: 38441786 DOI: 10.1007/s10916-024-02039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The Virtual Reality Headset (VRH) is a device aiming at improving patient's comfort by reducing pain and anxiety during medical interventions. Its interest during cardiac implantable electronic devices (CIED) implant procedures has not been studied. METHODS We randomized consecutive patients admitted for pacemaker or Implantable Cardioverter Defibrillator (ICD) at our center to either standard analgesia care (STD-Group), or to VRH (VRH-Group). Patients in the STD-Group received intra-venous paracetamol (1 g) 60 min before the procedure, and local anesthesia was performed with lidocaine. For patients of the VRH-Group, VRH was used on top of standard care. We monitored patients' pain and anxiety using numeric rating scales (from 0 to 10) at the time of sub-cutaneous pocket creation, and during deep axillary vein puncture. Patient comfort during the procedure was assessed using a detailed questionnaire. Morphine consumption was also assessed. RESULTS We randomized 61 patients to STD-Group (n = 31) or VRH-Group (n = 30). Pain and anxiety were lower in the VRH-Group during deep venous puncture (3.0 ± 2.0 vs. 4.8 ± 2.2, p = 0.002 and 2.4 ± 2.2 vs. 4.1 ± 2.4, p = 0.006) but not during pocket creation (p = 0.58 and p = 0.5). Morphine consumption was lower in the VRH-Group (1.6 ± 0.7 vs. 2.1 ± 1.1 mg; p = 0.041). Patients' overall comfort during procedure was similar in both groups. CONCLUSION VRH use improved pain and anxiety control during deep venous puncture compared to standard analgesia care, and allowed morphine consumption reduction. However, pain and anxiety were similar at the time of sub-cutaneous pocket creation.
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Affiliation(s)
- Fabien Squara
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France.
| | - Jules Bateau
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France
| | - Didier Scarlatti
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France
| | - Sok-Sithikun Bun
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France
| | - Pamela Moceri
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France
| | - Emile Ferrari
- Cardiology department, Pasteur University Hospital, 30 voie Romaine, Nice, France
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13
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Micheluzzi V, Casu G, Sanna GD, Canu A, Iovino P, Caggianelli G, Vellone E. Improving adherence to rehabilitation for heart failure patients through immersive virtual reality (VIRTUAL-HF): A protocol for a randomized controlled trial. Contemp Clin Trials 2024; 138:107463. [PMID: 38302011 DOI: 10.1016/j.cct.2024.107463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND To improve symptoms and reduce poor outcomes related to heart failure (HF), international guidelines recommend cardiac rehabilitation (CR), particularly for those with a reduced ejection fraction. Unfortunately, patient adherence to rehabilitation programs remains suboptimal, with dropouts ranging from 15.4 to 63.3%. An innovative and promising intervention that could improve adherence to rehabilitation is virtual reality (VR). This study aims to evaluate the effects of VR in patients with HF who undergo CR using this technology in terms of adherence (primary outcome), functional capacity, perceived exertion, angina, quality of life, heart rate, oxygen saturation, blood pressure, maximum oxygen uptake, minute ventilation/carbon dioxide production slope, oxygen pulse, blood values of NT-proBNP and HF related rehospitalization rates (secondary outcomes). METHODS A randomized controlled trial will be conducted in a sample of 80 patients referred to CR. Participants will be enrolled in a cardiological rehabilitation unit of a large university hospital in Italy and randomized (1:1) to the experimental intervention consisting of CR performed with high-quality immersive VR with PICO 4® Head Mounted Display headset and TREADMILL XR® software (Arm 1) or standard CR (Arm 2). Patients, according to guidelines, will perform 30-min of CR sessions with moderate intensity, twice a week for one month. RESULTS Significant improvements in primary and secondary outcomes are expected in patients in the intervention group. CONCLUSIONS If proven to be effective, VR could be an innovative, safe, and easy digital health intervention to improve adherence to CR in patients with HF, as well as important clinical outcomes.
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Affiliation(s)
- Valentina Micheluzzi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Gavino Casu
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy; Department of Medicine, and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Antonella Canu
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
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14
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el Mathari S, Hoekman A, Kharbanda RK, Sadeghi AH, de Lind van Wijngaarden R, Götte M, Klautz RJ, Kluin J. Virtual Reality for Pain and Anxiety Management in Cardiac Surgery and Interventional Cardiology. JACC. ADVANCES 2024; 3:100814. [PMID: 38939386 PMCID: PMC11198628 DOI: 10.1016/j.jacadv.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 06/29/2024]
Abstract
Pain and anxiety are common in patients undergoing cardiac surgery and percutaneous cardiac interventions. Virtual reality (VR) is an emerging non-pharmacological tool for pain and anxiety management. However, its application around cardiac procedures remains relatively unexplored. In this review, we perform a targeted non-systematic literature review to assess the current state-of-the-art of VR for pain and anxiety management in patients undergoing cardiac procedures. Contexts of interest were preprocedural, periprocedural, and postprocedural applications. Existing trials show inconsistent results. The majority of studies in the preprocedural (7 studies, n = 302), periprocedural (1 study, n = 99), and postprocedural stage (4 studies, n = 214) demonstrate significant reduction of pain and anxiety through VR distraction therapy or VR patient education. However, larger-scale trials (2 preprocedural studies [n = 233], 1 periprocedural study [n = 32], 2 postprocedural studies [n = 300]) report no effect. Current literature on effectiveness of VR for pain and anxiety management in cardiac surgery and interventional cardiology remains inconclusive.
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Affiliation(s)
- Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anne Hoekman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rohit K. Kharbanda
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Marco Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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15
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Parco C, Kreuels V, Kelm M, Jung C, Wolff G. Robotic-assisted early mobilization and virtual reality: a perspective on innovative support strategies for critically ill patients. Intensive Care Med Exp 2023; 11:86. [PMID: 38052739 DOI: 10.1186/s40635-023-00571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Affiliation(s)
- Claudio Parco
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Vanessa Kreuels
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, CARID, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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16
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Gökçe E, Arslan S. Effects of virtual reality and acupressure interventions on pain, anxiety, vital signs and comfort in catheter extraction processes for patients undergoing coronary angiography: A randomized controlled trial. Int J Nurs Pract 2023; 29:e13176. [PMID: 37403339 DOI: 10.1111/ijn.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Pain and anxiety management in patients undergoing medical and surgical procedures is an important competence area for nurses. AIM This study aimed to determine and compare the effects of virtual reality and acupressure interventions on pain, anxiety, vital signs and comfort levels in the process of femoral catheter extraction for patients undergoing coronary angiography. METHODS The study was a single-blind, three-group, randomized controlled trial conducted in the cardiology clinics of a university hospital in 2021. A total of 153 patients (51 virtual reality, 51 acupressure, 51 control) participated in the study. Data were collected using a Visual Analogue Scale, the State-Trait Anxiety Inventory, a vital signs follow-up form and the Perianesthesia Comfort Scale. RESULTS Both intervention groups had significantly lower pain and anxiety scores, as well as higher comfort scores, compared to the control group (p < 0.001). The virtual reality group had lower systolic blood pressure, respiratory rate and pulse rate than the control group (p < 0.05). The acupressure group had lower systolic and diastolic blood pressure and respiratory rate than the control group (p < 0.05). CONCLUSIONS While neither intervention group was found to be superior to the other, both interventions improved vital signs and comfort levels by reducing pain and anxiety.
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Affiliation(s)
- Esma Gökçe
- Vocational School of Health Services, Toros University, Mersin, Turkey
| | - Sevban Arslan
- Department of Surgical Nursing, Çukurova University Faculty of Health Sciences, Adana, Turkey
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17
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Sedhom R, Megaly M. It might be virtual, but the effect is real. Int J Cardiol 2023; 390:131207. [PMID: 37495188 DOI: 10.1016/j.ijcard.2023.131207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Michael Megaly
- Division of Cardiology, Willis Knighton Heart Institute, Shreveport, LA, USA.
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18
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Lind A, Ahsan M, Totzeck M, Al-Rashid F, Haddad A, Dubler S, Brenner T, Skarabis A, El Gabry M, Rassaf T, Jánosi RA. Virtual reality-assisted distraction during transcatheter aortic valve implantation under local anaesthesia: A randomised study. Int J Cardiol 2023; 387:131130. [PMID: 37355243 DOI: 10.1016/j.ijcard.2023.131130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND A minimal approach, using local anaesthesia alone, has been advocated to promote faster transcatheter aortic valve replacement (TAVR) procedures in intermediate-risk patients. Pre- and periprocedural anxiety and pain remain a concern. Virtual reality (VR) is a form of non-pharmacological distraction that can potentially modulate pain and anxiety. This randomised study explored whether VR reduces pain and anxiety during TAVR without sedation and compared the effects of VR with those of standard care. METHODS AND RESULTS Between June 2022 and March 2023, 207 patients underwent transfemoral TAVR (TF-TAVR). Of these, 117 (56.5%) patients were willing to participate in the study and met the educational background and mental status criteria for assessment. Fifty-nine patients underwent TF-TAVR with VR glasses (VR group). Fifty-eight patients underwent standard TF-TAVR without VR (control group; CG). Post-interventional anxiety scores (STAI-S) (31.5 ± 13.4 vs. 38.5 ± 19.2, p = 0.02) and the perceived duration of the procedure (60.1 ± 32.3 vs. 73.0 ± 32.4, p = 0.04) were lower in the VR than in the CG. Procedure time, pain, and anxiety scores (visual analogue scale) were similar between the groups. The complication rate was low and not associated with VR. Post-interventional delirium occurred in nine patients, and was similar between the groups (VR: 4 [6.8%] vs. CG: 5 [8.6%], p = 0.71). No periprocedural strokes were observed. CONCLUSION VR for TAVR is feasible and safe and expands the non-drug spectrum of therapy for anxiety and pain in patients undergoing TAVR with a minimalistic approach.
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Affiliation(s)
- Alexander Lind
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Majid Ahsan
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ali Haddad
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Simon Dubler
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Annabell Skarabis
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Heart Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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19
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Tsai TY, Onuma Y, Złahoda-Huzior A, Kageyama S, Dudek D, Wang Q, Lim RP, Garg S, Poon EKW, Puskas J, Ramponi F, Jung C, Sharif F, Khokhar AA, Serruys PW. Merging virtual and physical experiences: extended realities in cardiovascular medicine. Eur Heart J 2023; 44:3311-3322. [PMID: 37350487 PMCID: PMC10499546 DOI: 10.1093/eurheartj/ehad352] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.
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Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Xitun District, Taichung 40705, Taiwan
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Adriana Złahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, al. A. Mickiewicza 30, 30-059 Kraków, Poland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
- Center of Digital Medicine and Robotics, Jagiellonian University Medical College, Świętej Anny 12, 31-008 Kraków, Poland
| | - Qingdi Wang
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Ruth P Lim
- Department of Radiology and Surgery (Austin), Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 161 Barry St, Carlton VIC 3010, Australia
- Department of Radiology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn BB1 2RB, UK
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Fabio Ramponi
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London W12 0HS, UK
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
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20
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Bruining N. Robotics in interventional cardiology: a new era of safe and efficient procedures. EUROINTERVENTION 2023; 18:e1300-e1301. [PMID: 37025089 PMCID: PMC10068858 DOI: 10.4244/eij-e-23-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Nico Bruining
- Digital Cardiology, Department of Clinical Epidemiology and Innovation, Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
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21
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Affiliation(s)
- Rogier Barendse
- Digital Cardiology, Department of Clinical Epidemiology and Innovation, Thoraxcenter, Department of Cardiology, Erasmus MC, Room Na-312, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Nico Bruining
- Corresponding author. Tel: +31651733542, E-mail address:
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22
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Ma X, Chu H, Han K, Shao Q, Yu Y, Jia S, Wang D, Wang Z, Zhou Y. Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:646-660. [PMID: 36419366 DOI: 10.1111/jgs.18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/19/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Abstract
AIMS To perform an updated systematic review and meta-analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). METHODS We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. RESULTS A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%-11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%-23.7%). According to the level of evidence and results of meta-analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non-transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79-2.71; pooled adjusted RR: 1.62, 95% CI: 1.25-2.10), particularly long-term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91-4.23; pooled adjusted HR: 1.88, 95% CI: 1.30-2.73). CONCLUSIONS POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.
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Affiliation(s)
- Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huijun Chu
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Kangning Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiaoyu Shao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dunliang Wang
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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23
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Hitching R, Hoffman HG, Garcia-Palacios A, Adamson MM, Madrigal E, Alhalabi W, Alhudali A, Sampaio M, Peterson B, Fontenot MR, Mason KP. The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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Affiliation(s)
- Rita Hitching
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Hunter G. Hoffman
- Department of Mechanical Engineering HPL, University of Washington, Seattle, WA 98195, USA
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Azucena Garcia-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, 12071 Castellon de la Plana, Spain
| | - Maheen M. Adamson
- WRIISC-WOMEN and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Esmeralda Madrigal
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Wadee Alhalabi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Computer Science, School of Engineering, Computing and Informatics, Dar Al-Hekma University, Jeddah 21589, Saudi Arabia
| | - Ahad Alhudali
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mariana Sampaio
- Department of Psychology, University of Coimbra, 3000-115 Coimbra, Portugal
- Department of Social Work, Catholic University of Portugal, 1649-023 Lisbon, Portugal
| | | | - Miles R. Fontenot
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA
| | - Keira P. Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, Boston, MA 02115, USA
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24
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Bruno RR, Wolff G, Wernly B, Masyuk M, Piayda K, Leaver S, Erkens R, Oehler D, Afzal S, Heidari H, Kelm M, Jung C. Virtual and augmented reality in critical care medicine: the patient's, clinician's, and researcher's perspective. Crit Care 2022; 26:326. [PMID: 36284350 PMCID: PMC9593998 DOI: 10.1186/s13054-022-04202-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) are aspiring, new technologies with increasing use in critical care medicine. While VR fully immerses the user into a virtual three-dimensional space, AR adds overlaid virtual elements into a real-world environment. VR and AR offer great potential to improve critical care medicine for patients, relatives and health care providers. VR may help to ameliorate anxiety, stress, fear, and pain for the patient. It may assist patients in mobilisation and rehabilitation and can improve communication between all those involved in the patient's care. AR can be an effective tool to support continuous education of intensive care medicine providers, and may complement traditional learning methods to acquire key practical competences such as central venous line placement, cardiopulmonary resuscitation, extracorporeal membrane oxygenation device management or endotracheal intubation. Currently, technical, human, and ethical challenges remain. The adaptation and integration of VR/AR modalities into useful clinical applications that can be used routinely on the ICU is challenging. Users may experience unwanted side effects (so-called "cybersickness") during VR/AR sessions, which may limit its applicability. Furthermore, critically ill patients are one of the most vulnerable patient groups and warrant special ethical considerations if new technologies are to be introduced into their daily care. To date, most studies involving AR/VR in critical care medicine provide only a low level of evidence due to their research design. Here we summarise background information, current developments, and key considerations that should be taken into account for future scientific investigations in this field.
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Affiliation(s)
- Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Paracelsusstraße 37, 5110 Oberndorf, Salzburg Austria ,grid.21604.310000 0004 0523 5263Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Maryna Masyuk
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Kerstin Piayda
- grid.411067.50000 0000 8584 9230Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Giessen, Germany
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Ralf Erkens
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel Oehler
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Shazia Afzal
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Houtan Heidari
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany ,CARID, Cardiovascular Research Institute Duesseldorf, 40225 Düsseldorf, Germany
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
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25
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Bruno RR, Bruining N, Jung C. Virtual reality in intensive care. Intensive Care Med 2022; 48:1227-1229. [PMID: 35816236 PMCID: PMC9272874 DOI: 10.1007/s00134-022-06792-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Raphael R Bruno
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225, Düsseldorf, Germany
| | - Nico Bruining
- Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Christian Jung
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225, Düsseldorf, Germany.
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26
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Coulibaly I, Cardelli LS, Duflos C, Moulis L, Mandoorah B, Nicoleau J, Placide L, Massin F, Pasquié JL, Granier M. Virtual Reality Hypnosis in the Electrophysiology Lab: When Human Treatments Are Better than Virtual Ones. J Clin Med 2022; 11:jcm11133913. [PMID: 35807198 PMCID: PMC9267480 DOI: 10.3390/jcm11133913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: Virtual reality hypnosis (VRH) has been used successfully in various clinical settings to decrease anxiety and the sensation of pain. We aimed to investigate the feasibility and safety of VRH in patients undergoing electrophysiology and pacing procedures under conscious sedation. Methods: During a two-month period, VRH support was proposed and accepted by 25 patients undergoing electrophysiological procedures. Data were compared with a control group (n = 61) enrolled during the following three-month period. Both groups underwent the measurement of the duration of intervention, the consumption of analgesics and hypnotics, and their pain and comfort using a validated visual analogue scale (VAS 0−10). Results: The baseline characteristics were comparable in both groups, including age. There were no differences in procedure duration (46 (±29) vs. 56 (±32) min, p = 0.18) or in hypnotic/antalgic consumption (midazolam 1.95 (±1.44) vs. 2.00 (±1.22) mg, p = 0.83; sufentanyl 3.78 (±2.87) vs. 3.58 (±2.48) μg, p = 0.9) between the control and VRH groups. In a multivariate analysis, the use of VRH was independently associated with lower comfort during the procedure assessed by postoperative visual analogue scale (OR 15.00 [95% CI 4.77−47.16], p < 0.01). There was no influence of VRH use on pain or drug consumption. Conclusions: In our experience, compared with VRH, human care is preferable during procedures in electrophysiology lab to improve the comfort of the patient. VRH has no influence on pain or drug consumption.
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Affiliation(s)
- Iklo Coulibaly
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | | | - Claire Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, 34090 Montpellier, France; (C.D.); (L.M.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, CHU Montpellier, 34090 Montpellier, France; (C.D.); (L.M.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Bara Mandoorah
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Jean Nicoleau
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Leslie Placide
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - François Massin
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Jean-Luc Pasquié
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Mathieu Granier
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
- Correspondence:
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27
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Rudzinski PN, Leipsic JA, Schoepf UJ, Dudek D, Schwarz F, Andreas M, Zlahoda-Huzior A, Thilo C, Renker M, Burt JR, Emrich T, Varga-Szemes A, Amoroso NS, Steinberg DH, Pukacki P, Demkow M, Kepka C, Bayer RR. CT in Transcatheter-delivered Treatment of Valvular Heart Disease. Radiology 2022; 304:4-17. [PMID: 35638923 DOI: 10.1148/radiol.210567] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Minimally invasive strategies to treat valvular heart disease have emerged over the past 2 decades. The use of transcatheter aortic valve replacement in the treatment of severe aortic stenosis, for example, has recently expanded from high- to low-risk patients and became an alternative treatment for those with prohibitive surgical risk. With the increase in transcatheter strategies, multimodality imaging, including echocardiography, CT, fluoroscopy, and cardiac MRI, are used. Strategies for preprocedural imaging strategies vary depending on the targeted valve. Herein, an overview of preprocedural imaging strategies and their postprocessing approaches is provided, with a focus on CT. Transcatheter aortic valve replacement is reviewed, as well as less established minimally invasive treatments of the mitral and tricuspid valves. In addition, device-specific details and the goals of CT imaging are discussed. Future imaging developments, such as peri-procedural fusion imaging, machine learning for image processing, and mixed reality applications, are presented.
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Affiliation(s)
- Piotr Nikodem Rudzinski
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jonathon A Leipsic
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Dariusz Dudek
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Florian Schwarz
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Martin Andreas
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Adriana Zlahoda-Huzior
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Christian Thilo
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Matthias Renker
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jeremy R Burt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Nicholas S Amoroso
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Daniel H Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Piotr Pukacki
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Marcin Demkow
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Cezary Kepka
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Richard R Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
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Jung C, Wolff G, Wernly B, Bruno RR, Franz M, Schulze PC, Silva JNA, Silva JR, Bhatt DL, Kelm M. Virtual and Augmented Reality in Cardiovascular Care: State-of-the-Art and Future Perspectives. JACC Cardiovasc Imaging 2021; 15:519-532. [PMID: 34656478 DOI: 10.1016/j.jcmg.2021.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
Applications of virtual reality (VR) and augmented reality (AR) assist both health care providers and patients in cardiovascular education, complementing traditional learning methods. Interventionalists have successfully used VR to plan difficult procedures and AR to facilitate complex interventions. VR/AR has already been used to treat patients, during interventions in rehabilitation programs and in immobilized intensive care patients. There are numerous additional potential applications in the catheterization laboratory. By using AR, interventionalists could combine visual fluoroscopy information projected and registered on the patient body with data derived from preprocedural imaging and live fusion of different imaging modalities such as fluoroscopy with echocardiography. Persistent technical challenges to overcome include the integration of different imaging modalities into VR/AR and the harmonization of data flow and interfaces. Cybersickness might exclude some patients and users from the potential benefits of VR/AR. Critical ethical considerations arise in the application of VR/AR in vulnerable patients. In addition, digital applications must not distract physicians from the patient. It is our duty as physicians to participate in the development of these innovations to ensure a virtual health reality benefit for our patients in a real-world setting. The purpose of this review is to summarize the current and future role of VR and AR in different fields within cardiology, its challenges, and perspectives.
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Affiliation(s)
- Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Georg Wolff
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology and Intensive Care, Paracelsus Medical University of Salzburg, Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Medical Faculty, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Medical Faculty, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - Jennifer N Avari Silva
- Pediatric Cardiology Division, Department of Pediatrics, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA; SentiAR, Saint Louis, Missouri, USA
| | - Jonathan R Silva
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA; SentiAR, Saint Louis, Missouri, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/DLBHATTMD
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany; Cardiovascular Research Institute Duesseldorf, Düsseldorf, Germany
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Roxburgh T, Li A, Guenancia C, Pernollet P, Bouleti C, Alos B, Gras M, Kerforne T, Frasca D, Le Gal F, Christiaens L, Degand B, Garcia R. Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study. J Med Internet Res 2021; 23:e26349. [PMID: 34042589 PMCID: PMC8193475 DOI: 10.2196/26349] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 05/04/2021] [Indexed: 01/02/2023] Open
Abstract
Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. Methods All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. Results The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. Conclusions We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.
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Affiliation(s)
- Thomas Roxburgh
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Anthony Li
- Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | | | - Patrice Pernollet
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Claire Bouleti
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Benjamin Alos
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Gras
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Thomas Kerforne
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - François Le Gal
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Luc Christiaens
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Bruno Degand
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Rodrigue Garcia
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
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Chen C, Chen L, Shen N, Luo C, Wang R, Fang H, Zhang Q, Hei Z. The use of virtual reality to reduce stress among night-shift anesthesiologists: study protocol for a crossover trial. Trials 2021; 22:257. [PMID: 33827653 PMCID: PMC8025449 DOI: 10.1186/s13063-021-05222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the lack of anesthesia workforce, anesthesiologists are forced to work overtime and more night shifts, which can disturb their biological rhythm and cause severe stress and depression, potentially leading to negative and even devastating outcomes for both themselves and patients. Virtual reality (VR), a new method to reduce stress and pain for patients, has been widely used in biomedical fields. The purpose of this study is to evaluate the potential effectiveness of VR technology in reducing stress among night-shift anesthesiologists. METHODS In this randomized controlled, crossover, single-center clinical trial, a total of 30 anesthesiologists will be enrolled and randomized in a 1:1 allocation to either the VR immersion group (intervention group) or the routine night-shift group (control group) with a washout of 1 week. Anesthesiologists in the intervention group will undergo VR immersion twice, while anesthesiologists in the control group will not watch VR videos during the night shift. The primary outcome will be the difference in the NASA Task Load Index (NASA-TLX) score between the two groups. Secondary outcomes will include the Chinese Perceived Stress Scale (CPSS), perceived stress scores (visual analogue scale (VAS)), and Multidimensional Fatigue Inventory (MFI-20) scores; levels of satisfaction among the participants; incidence of arrhythmia; and incidence of chest tightness, headache, and palpitations. DISCUSSION It is unknown whether the use of VR technology during the night shift can reduce stress among anesthesiologists. With the widespread use of VR technology, a positive result in this trial could spur hospitals to apply VR technology to reduce stress among night-shift doctors in every department and provide a relatively relaxed working environment. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000031025 . Registered on 21 March 2020.
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Affiliation(s)
- Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
- Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Liubing Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Ning Shen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Chenfang Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Ren Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Hongyi Fang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Qi Zhang
- Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
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31
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Bruining N, Cummins PA, de Jaegere PP. Addressing interventional periprocedural anxiety with virtual reality. EUROINTERVENTION 2020; 16:e963-e965. [DOI: 10.4244/eijv16i12a177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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