Efficacy of virtual reality assisted guided imagery (VRAGI) in a home setting for pain management in patients with advanced cancer: protocol for a randomised controlled trial.

INTRODUCTION: Patients with advanced cancer often experience high levels of debilitating pain and pain-related psychological distress. Although there is increasing evidence that non-pharmacological interventions are needed to manage their pain, pharmacologic modalities remain the preferred treatment . Guided imagery is a form of focused relaxation that helps create harmony between the mind and body and has been shown to significantly improve cancer pain. Our study presents Virtual Reality Assisted Guided Imagery (VRAGI) as a complementary treatment modality to manage chronic pain in patients with cancer. We will conduct a randomised controlled trial to test its impact on patients with advanced cancer in a home setting. METHODS AND ANALYSIS: We will recruit 80 patients from Prisma Health, a tertiary-level healthcare centre based in Greenville, South Carolina, USA. The prospective 2×2 randomised controlled trial will randomise participants into four groups: (1) VRAGI, (2) laptop-assisted guided imagery, (3) VR (no guided imagery) and (4) laptop (no guided imagery). Patients allocated to VR groups will be trained to use a head-mounted display that immerses them in 3D audio-video content. The non-VR group will use a laptop displaying 2D video content. We will collect measures before and during the 3-week intervention as well as 3 weeks after the intervention ends. Measures will include patient-reported outcomes of pain, anxiety, depression and fatigue in addition to opioid use. The primary objective of the current study is to assess the efficacy of VRAGI on pain in the home setting. The secondary objective is to assess the efficacy of VRAGI on opioid use, anxiety, depression and fatigue. ETHICS AND DISSEMINATION: This study was approved by the Prisma Health Institutional Review Board (#Pro00114598) in November 2021. All participants enrolled in the study will provide written informed consent. Dissemination will be through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT05348174, clinicaltrials.gov.

Development of the iCubate Molecular Diagnostic Platform Utilizing Amplicon Rescue Multiplex Polymerase Chain Reaction.

We utilized Amplicon-Rescue Multiplex PCR (ARM-PCR) and microarray hybridization to develop and validate the iC-GPC Assay, a multiplexed, in vitro diagnostic test that identifies five of the most common gram positive bacteria and three clinically relevant resistance markers associated with bloodstream infections (BSI). The iC-GPC Assay is designed for use with the iC-System™, which automates sample preparation, ARM-PCR, and microarray detection within a closed cassette. Herein, we determined the limit of detection for each of the iC-GPC Assay targets to be between 3.0 × 105-1.7 × 107 CFU/mL, well below clinically relevant bacterial levels for positive blood cultures. Additionally, we tested 106 strains for assay inclusivity and observed a target performance of 99.4%. 95 of 96 non-target organisms tested negative for cross-reactivity, thereby assuring a high level of assay specificity. Overall performance above 99% was observed for iC-GPC Assay reproducibility studies across multiple sites, operators and cassette lots. In conclusion, the iC-GPC Assay is capable of accurately and rapidly identifying bacterial species and resistance determinants present in blood cultures containing gram positive bacteria. Utilizing molecular diagnostics like the iC-GPC Assay will decrease time to treatment, healthcare costs, and BSI-related mortality.

Pre- and post-shunting observations in adult sheep with kaolin-induced hydrocephalus.

BACKGROUND: The objective of this study was to examine host-shunt interactions in sheep with kaolin-induced hydrocephalus. METHODS: Forty-two sheep (29-40 kg) were utilized for this study. In 20 animals, various kaolin doses were injected into the cisterna magna including 10 and 50 mg/kg as well as 2-4 ml of a 25% kaolin suspension. Based on animal health and hydrocephalus development, 3 ml of a 25% kaolin suspension was chosen. In 16 animals, kaolin was administered and 6-8 days later, the animals received a custom made ventriculo-peritoneal shunt. In 8 animals ventricular CSF pressures were measured with a water manometer before kaolin administration and 7-8 days later. The sheep were allowed to survive for up to 9-12 weeks post-kaolin or until clinical status required euthanasia. Brains were assessed for morphological and histological changes. Ventricle/cerebrum cross sectional area ratios (V/C) were calculated from photographs of the sliced coronal planes immediately anterior to the interventricular foramina. RESULTS: Intraventricular pressures increased from 12.4±1.1 cm H2O to 41.3±3.5 cm H2O following kaolin injection (p < 0.0001, n = 8). In all animals, we observed kaolin on the basal surface of the brain and mild (V/C 0.03-0.10) to moderate (V/C >0.10) ventricular expansion. The animals lost weight between kaolin administration and shunting (33.7±1.2 kg versus 31.0±1.7 kg) with weights after shunting remaining stable up to sacrifice (31.6±2.2 kg). Of 16 shunted animals, 5 did well and were sacrificed 9-12 weeks post-kaolin. In the remainder, the study was terminated at various times due to deteriorating health. Hydrocephalus was associated with thinning of the corpus callosum, but no obvious loss of myelin staining, along with reactive astroglial (glial fibrillary acidic immunoreactive) and microglial (Iba1 immunoreactive) changes in the white matter. Ventricular shunts revealed choroid plexus ingrowth in 5/16, brain tissue ingrowth in 1/16, problems with shunt insertion in 3/16, occlusion by hemorrhagic-inflammatory material in 5/16, or no obstruction in 2/16. Free flowing CSF indicated that the peritoneal catheter was patent. CONCLUSIONS: Cerebrospinal fluid shunts in hydrocephalic sheep fail in ways that are reminiscent of human neurosurgical experience suggesting that this model may be helpful in the development of more effective shunt technology.