Virtual reality as complementary pain therapy in hospitalized patients with sickle cell disease.

OBJECTIVE: Due to incomplete management of vaso-occlusive pain episodes (VOE) in patients with sickle cell disease (SCD), we sought to determine if immersive VR would be feasible for inpatients. Secondarily, we hypothesized that a single VR session would improve the VOE pain experience. PROCEDURES: Consecutive patients with SCD eight years and older admitted for VOE were offered one 15-minute VR session, utilizing a relaxing underwater world specifically created for pediatric patients and to minimize potential simulator side effects. Safety and acceptability were evaluated with a brief survey before and after the session. Pain was evaluated utilizing the validated adolescent pediatric pain tool (APPT). Survey data and pain scores were analyzed using Wilcoxon signed-rank test as the data were nonnormally distributed. RESULTS: Thirty patients, 21 female, with a median age of 16 years were enrolled, the majority having hemoglobin SS disease. The VR session had no reported side effects; all patients requested VR again in the future. Median pain intensity (pre-VR 7.3 [interquartile range, IQR, 6.1, 8.8], post-VR 5.8 [4.7, 7.9]), number of affected body areas (pre-VR 3.0 [2.0, 7.8], post-VR 2.0 [0, 4.8]), and qualitative measures including sensory, affective, evaluative, and temporal pain domains were all statistically reduced (i.e., P ≤0.01). CONCLUSIONS: VR therapy was feasible in a cohort of patients with SCD admitted for VOE. In addition to standard therapies, VR may help reduce the pain experience with SCD VOE. Further study is required to determine the impact of VR therapy on opioid usage and length of stay in hospital.

Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10).

BACKGROUND AND OBJECTIVES: Dysphagia is a common disability with different etiologies. In order to measure dysphagia symptom severity and effects on quality of life, the Eating Assessment Tool (EAT-10) was developed and validated in the English language. We aimed to develop a Hebrew version of the EAT-10 and to evaluate its internal consistency, test-retest reliability, and validity in Hebrew-speaking adults with dysphagia. SUBJECTS AND METHODS: The Hebrew EAT-10 (H-EAT-10) questionnaire was completed by 132 patients: 56 patients with dysphagia and 76 controls. Internal consistency analysis was calculated using Cronbach α, and test-retest reliability was calculated using intraclass correlation coefficient in order to assess clinical validity. RESULTS: Internal consistency and test-retest reliability were found to be high in the H-EAT-10 (Cronbach α = 0.955 and intraclass correla tion = 0.98). In addition, H-EAT-10 scores in the dysphagia group were found to be significantly higher than those in the control group (p < 0.001). CONCLUSION: This study demonstrated that H-EAT-10 is a reliable and valid tool that may be implemented for clinical practice and research on dysphagia in a Hebrew-speaking population.

Streamlining Communication: "Resident Huddle" on General Medicine Wards at a Veterans Affairs Hospital.

Background Orienting medical trainees to new practice environments is essential. Huddles have been shown to improve communication and safety outcomes. However, their use in orienting trainees to systems processes and changes on inpatient general medicine (GM) wards remains unexplored. Objective Implement a weekly inpatient huddle between residents and hospital leaders to improve dissemination of information around health system operations. Methods In 2019, we established "Resident Huddle," a weekly 20-minute huddle for senior internal medicine residents rotating on GM wards at a US Department of Veterans Affairs Hospital led by the site leads. Resident Huddle content included system updates, rotation updates, process reminders, performance feedback, and systems and patient safety concerns raised by trainees. Reactions to the huddle were assessed via survey. Behavioral change was assessed by rates of complete trainee admission medication reconciliation documentation before and after huddle implementation. Results Resident Huddle started in October 2019 and continues to this day. Between October 2019 and June 2022, 136 of 205 participants completed surveys (66% response rate). Respondents agreed or strongly agreed that the huddle provided useful information for care delivery (94%, 128 of 136), improved work engagement (73%, 99 of 136), provided feedback on practice patterns (90%, 121 of 135), and that issues they experienced were acknowledged and acted upon (86%, 114 of 133). Retrospective medical record analysis demonstrated improvement in admission medication reconciliation completion rate by trainees from pre-intervention (32%, 19 of 60) to post-intervention (73%, 44 of 60). Conclusions A weekly huddle between hospital leaders and residents strengthened communication and equipped trainees with operational health systems knowledge to enhance patient care outcomes while fostering a greater sense of engagement with their work environment.

Risk of Cardiovascular Events After COVID-19.

We aimed to determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular (CV) events and all-cause mortality. We conducted a retrospective double cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection (COVID-19+ cohort) and its documented absence (COVID-19- cohort). The study investigators drew a simple random sample of records from all patients under the Oregon Health & Science University Healthcare (n = 65,585), with available COVID-19 test results, performed March 1, 2020 to September 13, 2020. Exclusion criteria were age <18 years and no established Oregon Health & Science University care. The primary outcome was a composite of CV morbidity and mortality. All-cause mortality was the secondary outcome. The study population included 1,355 patients (mean age 48.7 ± 20.5 years; 770 women [57%], 977 White non-Hispanic [72%]; 1,072 ensured [79%]; 563 with CV disease history [42%]). During a median 6 months at risk, the primary composite outcome was observed in 38 of 319 patients who were COVID-19+ (12%) and 65 of 1,036 patients who were COVID-19- (6%). In the Cox regression, adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk for primary composite outcome (hazard ratio 1.71, 95% confidence interval 1.06 to 2.78, p = 0.029). Inverse probability-weighted estimation, conditioned for 31 covariates, showed that for every patient who was COVID-19+, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19-: average treatment effect on the treated -65.5 (95% confidence interval -125.4 to -5.61) days, p = 0.032. In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.