Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study

BACKGROUND

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit.

AIM

This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff.

STUDY DESIGN

A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes.

RESULTS

In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention.

CONCLUSIONS

This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement.

RELEVANCE TO CLINICAL PRACTICE

This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

A user evaluation of speech/phrase recognition software in critically ill patients: a DECIDE-AI feasibility study

OBJECTIVES

Evaluating effectiveness of speech/phrase recognition software in critically ill patients with speech impairments.

DESIGN

Prospective study.

SETTING

Tertiary hospital critical care unit in the northwest of England.

PARTICIPANTS

14 patients with tracheostomies, 3 female and 11 male.

MAIN OUTCOME MEASURES

Evaluation of dynamic time warping (DTW) and deep neural networks (DNN) methods in a speech/phrase recognition application. Using speech/phrase recognition app for voice impaired (SRAVI), patients attempted mouthing various supported phrases with recordings evaluated by both DNN and DTW processing methods. Then, a trio of potential recognition phrases was displayed on the screen, ranked from first to third in order of likelihood.

RESULTS

A total of 616 patient recordings were taken with 516 phrase identifiable recordings. The overall results revealed a total recognition accuracy across all three ranks of 86% using the DNN method. The rank 1 recognition accuracy of the DNN method was 75%. The DTW method had a total recognition accuracy of 74%, with a rank 1 accuracy of 48%.

CONCLUSION

This feasibility evaluation of a novel speech/phrase recognition app using SRAVI demonstrated a good correlation between spoken phrases and app recognition. This suggests that speech/phrase recognition technology could be a therapeutic option to bridge the gap in communication in critically ill patients.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC

Communication can be attempted using visual charts, eye gaze boards, alphabet boards, speech/phrase reading, gestures and speaking valves in critically ill patients with speech impairments.

WHAT THIS STUDY ADDS

Deep neural networks and dynamic time warping methods can be used to analyse lip movements and identify intended phrases.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE AND POLICY

Our study shows that speech/phrase recognition software has a role to play in bridging the communication gap in speech impairment.

Using experience-based co-design to prioritise areas for improvement for patients recovering from critical illness

OBJECTIVES

Critical illness recovery is a journey; from intensive care unit to hospital ward to home. However, evidence is limited on how best to enable recovery from critical illness. This study aimed to prioritise areas for improvement in care and services for patients recovering from critical illness.

RESEARCH DESIGN

This study used experience-based co-design. Service users and providers worked in partnership to identify and prioritise service improvements for patients who had survived an episode of critical illness.

METHOD

Qualitative interviews were carried out with patients (n = 10) who had experienced critical illness, and staff (n = 9) who had experienced caring for patients in the intensive care unit. Key patient touchpoints were identified and used to produce a film, reflecting the critical illness journey. A patient feedback event incorporated an emotional mapping exercise, to identify key points during the recovery journey. A joint patient/family (n = 10) and staff (n = 10) event was held to view the film and identify priorities for improvements.

FINDINGS

Emotional mapping highlighted areas where services were not synchronised with patients' needs. Four patient-focussed priorities for service improvement emerged 1. Improving the critical care experience, 2. Addressing patients' emotional and psychological needs, 3. Positioning patients at the centre of services and 4. Building a supportive framework for recovery.

CONCLUSION

Evidence-based co-design was used successfully in this study to identify priorities for improvements for patients recovering from critical illness. This approach positions patients at the centre of service improvements and realigns care delivery around what matters most to patients. Person-centred care provision underpins all identified priorities.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care unit staff should get to know patients and their families by talking more to patients and families about their care and engaging in more non-medical conversations. Emotional and psychological support should be provided to aid rehabilitation and recovery from critical illness in the intensive care unit, on general wards, and in the community. Information and services should be available when patients need them, rather than at fixed time points or settings. Recovery services should focus on enabling and building the self-efficacy of patients to empower them to be in control of their recovery journey.

Magnonic Einstein-de Haas Effect: Ultrafast Rotation of Magnonic Microspheres

Magnons, collective spin excitations in magnetic crystals, have attracted much interest due to their ability to couple strongly to microwaves and other quantum systems. In compact magnetic crystals, we show that there are magnonic modes that can support orbital angular momentum and that these modes can be driven by linearly polarized microwave fields. Because of conservation of angular momentum, exciting such magnon modes induces a mechanical torque on the crystal. We study a levitated magnetic crystal, a yttrium iron garnet (YIG) microsphere, where such orbital angular momentum magnon modes are driven by microwaves held in a microwave high-Q microwave cavity. We find that the YIG sphere experiences a mechanical torque and can be spun up to ultralarge angular speeds exceeding 10 GHz.

Intensive Cavity-Magnomechanical Cooling of a Levitated Macromagnet

We describe microwave cavity-magnomechanical center-of-mass cooling of a levitated magnetic sphere. The standing magnetic component of the electromagnetic wave within a microwave cavity exerts a dynamical force on a magnonic crystalline sphere and dissipates the mechanical energy through scattering into the magnon mode. The coupling is established by the magnetic dipole interaction and enriched by the collective spin motion. We find that the final cooled phonon occupation achieved is an intensive property independent of the mass and size of the sphere, in contrast to standard optomechanical couplings. This is of particular importance for testing quantum mechanics with macroscopic objects.

Scoping review of the use of virtual reality in intensive care units

BACKGROUND

A wide range of reviews have demonstrated the effectiveness and tolerability of Virtual Reality (VR) in a range of clinical areas and subpopulations. However, no previous review has explored the current maturity, acceptability, tolerability, and effectiveness of VR with intensive care patients.

AIMS

To identify the range of uses of VR for intensive care patients, classify their current phase of development, effectiveness, acceptability, and tolerability.

METHODS

A scoping review was conducted. A multi-database search was undertaken (inception to January 2021). Any type of study which examined the use of VR with the target application population of intensive care patients were included. Screening, data extraction, and assessment of quality were undertaken by a single reviewer. A meta-analysis and a descriptive synthesis were undertaken.

RESULTS

Six hundred and forty-seven records were identified, after duplicate removal and screening 21 studies were included (weak quality). The majority of studies for relaxation, delirium, and Post Traumatic Stress Disorder (PTSD) were at the early stages of assessing acceptability, tolerability, and initial clinical efficacy. Virtual Reality for relaxation and delirium were well-tolerated with completion rates of target treatment of 73.6%, (95% CI:51.1%-96%, I²  = 98.52%) 52.7% (95% CI:52.7%-100%, I²  = 96.8%). The majority of reasons for non-completion were due to external clinical factors. There were some potential benefits demonstrated for the use of VR for relaxation, delirium, and sleep.

CONCLUSION

Virtual Reality for intensive care is a new domain of research with the majority of areas of application being in the early stages of development. There is great potential for the use of VR in this clinical environment. Further robust assessment of effectiveness is required before any clinical recommendations can be made.

Exploring the quantum critical behaviour in a driven Tavis-Cummings circuit

Quantum phase transitions play an important role in many-body systems and have been a research focus in conventional condensed-matter physics over the past few decades. Artificial atoms, such as superconducting qubits that can be individually manipulated, provide a new paradigm of realising and exploring quantum phase transitions by engineering an on-chip quantum simulator. Here we demonstrate experimentally the quantum critical behaviour in a highly controllable superconducting circuit, consisting of four qubits coupled to a common resonator mode. By off-resonantly driving the system to renormalize the critical spin-field coupling strength, we have observed a four-qubit nonequilibrium quantum phase transition in a dynamical manner; that is, we sweep the critical coupling strength over time and monitor the four-qubit scaled moments for a signature of a structural change of the system's eigenstates. Our observation of the nonequilibrium quantum phase transition, which is in good agreement with the driven Tavis–Cummings theory under decoherence, offers new experimental approaches towards exploring quantum phase transition-related science, such as scaling behaviours, parity breaking and long-range quantum correlations.

Quantum phase transitions are a discontinuous change in a property of the ground state or the structure of the excited states as a system parameter traverses a critical point. Here, the authors recreate analogous effects with laboratory-achievable light-matter coupling in an on-chip superconducting circuit

Quantum magnetomechanics: ultrahigh-Q-levitated mechanical oscillators

Engineering nanomechanical quantum systems possessing ultralong motional coherence times allows for applications in precision quantum sensing and quantum interfaces, but to achieve ultrahigh motional Q one must work hard to remove all forms of motional noise and heating. We examine a magneto-meso-mechanical quantum system that consists of a 3D arrangement of miniature superconducting loops which is stably levitated in a static inhomogeneous magnetic field. The motional decoherence is predominantly due to loss from induced eddy currents in the magnetized sphere which provides the trapping field ultimately yielding Q∼10(9) with motional oscillation frequencies of several hundreds of kilohertz. By inductively coupling this levitating object to a nearby driven flux qubit one can cool its motion very close to the ground state and this may permit the generation of macroscopic entangled motional states of multiple clusters.

High-dynamic-range magnetometry with a single nuclear spin in diamond

Sensors based on the nitrogen-vacancy defect in diamond are being developed to measure weak magnetic and electric fields at the nanoscale. However, such sensors rely on measurements of a shift in the Lamor frequency of the defect, so an accumulation of quantum phase causes the measurement signal to exhibit a periodic modulation. This means that the measurement time is either restricted to half of one oscillation period, which limits accuracy, or that the magnetic field range must be known in advance. Moreover, the precision increases only slowly (as T(-0.5)) with measurement time T (ref. 3). Here, we implement a quantum phase estimation algorithm on a single nuclear spin in diamond to combine both high sensitivity and high dynamic range. By achieving a scaling of the precision with time to T(-0.85), we improve the sensitivity by a factor of 7.4 for an accessible field range of 16 mT, or, alternatively, we improve the dynamic range by a factor of 130 for a sensitivity of 2.5 µT Hz(-1/2). Quantum phase estimation algorithms have also recently been implemented using a single electron spin in a nitrogen-vacancy centre. These methods are applicable to a variety of field detection schemes, and do not require quantum entanglement.

Observation and control of blinking nitrogen-vacancy centres in discrete nanodiamonds

Nitrogen-vacancy colour centres in diamond can undergo strong, spin-sensitive optical transitions under ambient conditions, which makes them attractive for applications in quantum optics, nanoscale magnetometry and biolabelling. Although nitrogen-vacancy centres have been observed in aggregated detonation nanodiamonds and milled nanodiamonds, they have not been observed in very small isolated nanodiamonds. Here, we report the first direct observation of nitrogen-vacancy centres in discrete 5-nm nanodiamonds at room temperature, including evidence for intermittency in the luminescence (blinking) from the nanodiamonds. We also show that it is possible to control this blinking by modifying the surface of the nanodiamonds.

Dynamical properties of the delta-kicked harmonic oscillator

We propose an efficient procedure for numerically evolving the quantum dynamics of delta-kicked harmonic oscillator. The method allows for longer and more accurate simulations of the system as well as a simple procedure for calculating the system's Floquet eigenstates and quasienergies. The method is used to examine the dynamical behavior of the system in cases where the ratio of the kicking frequency to the system's natural frequency is both rational and irrational.