The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers.

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.

Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic.

PURPOSE: Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). PATIENTS AND METHODS: All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. RESULTS: Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49-68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61-80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8-17.7] mg/L). CONCLUSION: The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.