A Randomized Study Using Telepresence Robots for Behavioral Health in Interprofessional Practice and Education.

Virtual worlds (VWs) present a viable, low-cost delivery mechanism for telehealth services. Although preliminary reports support the effectiveness of VWs in terms of health metrics, few studies have examined the perceived benefits and learning potential for military service members and veterans. Trust is integral to any interaction and may be even more important, and problematic to establish, during virtual interactions than in-person (IP) communications. The purpose of this study was to compare active duty and veteran U.S. Military service members' (n = 92) self-reported trust, class satisfaction, and didactic learning after completing either an 8-week training course in mindfulness-based stress reduction (MBSR) delivered IP or an 8-week mindfulness meditation class based on MBSR via the VW of Second Life. Results showed that learning performance was not significantly different between the IP and VW groups (p > 0.05). Although overall trust was high for both groups, participants in the IP group reported greater trust and class satisfaction compared with the VW group (p < 0.05). Trust, satisfaction, and learning were significantly correlated with one another, and trust in the instructor significantly predicted trust-in-classmates, trust-in-self, and class satisfaction for both groups (p < 0.05). In this study, IP group training was superior to VW training in terms of self-reported greater trust in the instructor, classmates, and self, and higher satisfaction with the training. Trust in the instructor is particularly important for group training, whether IP or in a VW. This study reiterates the arduous task of establishing trust in a VW setting and suggests that creating trust between the instructor and participants is high priority as a leading objective for VW communications. Suggestions for building trust are tight collaboration and clear communication, along with supporting and advocating for one another.

BackgroundHead-Mounted-Displays which have mixed reality capabilities have a range of functions which may improve medical training and address certain challenges facing universities worldwide. Devices such as the Microsoft HoloLens 2 device can facilitate provision of procedural tutorials from remote locations, provide tutors with a first-person perspective of a student’s field of view, and allow the insertion of holographic artefacts which can replicate in-person tutorials and facilitate vertical integration of curriculum elements. This study aimed to evaluate the feasibility, efficacy and usability of the Microsoft HoloLens 2 device in providing tutorials to medical students on peripheral intravenous cannulation from a remote location.MethodsMedical student volunteers were randomly allocated to an In-Person (IP) group and HoloLens (HL) group. Students in the IP group received a tutorial on intravenous cannulation in-person, the HL group received the tutorial remotely via the HoloLens. Both groups completed an initial metric- based competency assessment, received a period of metrics-based feedback which informed a period of deliberate practice, followed by a second competency assessment. Students in the HL group received a familiarisation session with the device, completed a Mental Rotations Test, provided feedback, completed a System Usability Scale (SUS) questionnaire and three students completed interviews. One additional student completed a Think Aloud session. ResultsSeventeen student volunteers were recruited. Sixteen students underwent block randomisation. One additional student completed the Think Aloud session. Baseline characteristics of the two groups were similar. Mean initial competency scores were similar for the HL and IP groups, both groups showed significant improvements in performance, and there was no significant difference between the groups’ post-feedback scores, (p= 0.11). Students SUS scores were mean 79.4 (Standard Deviation 13.1). Quantitative and qualitative feedback was relatively positive, but identified several usability and technological limitations, including the development of headaches and visual fatigue.ConclusionsThis study demonstrates that tutorials on intravenous cannulation which are delivered remotely using the HoloLens 2 device are feasible, show a similar improvement in student performance to in-person tutorials, and are relatively well received by students and tutors. The ability to deliver procedural tutorials to a remote location has the potential to be a significant asset to medical educators. However, it also highlights several usability issues, including the development of “cybersickness” symptoms which may be limiting factors in its widespread adoption by educational institutions, and warrants further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-026-08648-3.

Physician organizations recommend screening for health care behaviors. Despite these recommendations, health care providers worry that questions on sensitive topics may not be accepted by their patients. To determine if there is a relationship between health care screening by providers and acceptance of that screening by patients, a survey of female patients was analyzed. Two telephone surveys were conducted two years apart. Each was a cross-sectional sample of female patients over the age of 18 years who had been seen by their primary care provider (PCP) in the previous 12 months. Patients were asked if they had been screened for eight different health behaviors (exercise, smoking, use of alcohol or drugs, excessive stress, sexual functioning concerns, safety or violence in the home, guns in the home) in the past year. They were also asked about their attitudes toward screening for those behaviors by health care providers. Odds ratios were calculated for patients who both agreed that screening should occur and reported having been screened in the last year. 3,175 women were surveyed. There was high acceptance of routine screening for exercise (75%), smoking (72%), alcohol/drugs (68%), and stress (62%), but less for sexual functioning (40%), safety/violence (40%), or guns (23%). There was a higher likelihood of agreeing with routine screening if the patient reported having been screened in the past year: exercise (OR 2.3, 95% CI 1.8-2.9), smoking (OR 1.6, 95% CI 1.3-1.9), alcohol/drugs (OR 2.3, 95% CI 1.9-2.7), stress (OR 1.7, 95% CI 1.4-1.9), sexual functioning (OR 2.7, 95% CI 2.2-3.4), safety/violence (OR 3.4, 95% CI 2.8-4.2), and guns (OR 4.4, 95% CI 3.4-5.8). Only women in established relationships with primary care providers were surveyed. The cross-sectional nature of the survey prevents determination of the causality of the relationship. Women who had been screened for a health behavior had greater acceptance of routine screening for that behavior. Although further research is needed to determine the casual relationship, providers should not worry about offending their patients when screening for sensitive health behaviors.

MP41-16 EVALUATION OF MIXED REALITY (MR) TECHNOLOGIES FOR REMOTE GUIDANCE DURING TRANSRECTAL ULTRASOUND BIOPSY (TRUS-BX) SIMULATION: A PROSPECTIVE, RANDOMIZED COMPARATIVE TRIAL

As the world becomes older, sustainable healthy aging becomes an important goal of social development. Robotic technologies have been widely considered an effective solution to reduce the labor demand and cost in aged care, thus providing satisfiable services to the elderly while keeping the cost low. The global outbreak of corona virus disease 2019 (COVID-19) has strengthened this trend when it impacted the elderly most because (1) the elderly was generally the most vulnerable population group to pandemics, and (2) the resources available to the elderly significantly declined due to lockdown and quarantines. The observations and experience from COVID-19 inspired us to consider the impact of pandemics on sustainable healthy aging, which was largely missing in existing work, leading to the study of the use of robots in general and telepresence robots in specific to aid sustainable healthy aging. The methodology of systematic review is applied to retrieve and analyze the articles published in nine databases between 2010 and 2020. Based on the review, the paper classifies the applications of robots in pandemics into four main categories, including healthcare, social support, education, and manufacturing. Further analysis of these applications revealed the missing features and challenges in applying them to healthy aging. The discoveries and findings in this paper provide practical guidelines for the future design and development of (telepresence) robots.

Background: In addition to the physical effects caused by coronavirus disease 2019 (COVID-19), the disease is also associated with various psychological problems that have required research and clinical attention. Objectives: The purpose of this study was to compare the effectiveness of in-person and telehealth cognitive-behavioral therapy (CBT) in people who have recovered from COVID-19. Methods: This study was a randomized controlled trial with a pre-post design, a control group, and a three-month follow-up. The statistical population consisted of patients who had recovered from COVID-19 in Tehran between 2022 and 2023. From this population, 45 patients were selected using a convenience sampling method and randomly divided into three groups: An in-person CBT group, a telehealth CBT group (15 patients in each), and a control group (15 patients). The in-person CBT group received 11 sessions, while the telehealth CBT group received 12 sessions. Research instruments included the Depression, Anxiety, and Stress Scale (DASS-21) and the Resilience Scale (RS). The data were analyzed using repeated measures analysis of variance. Results: The results showed that although both treatments led to improvements in psychological distress (P &lt; 0.01) and resilience (P &lt; 0.01), the effectiveness of in-person CBT was greater and statistically significant. The effect sizes for depression, anxiety, stress, and resilience were 0.37, 0.38, 0.44, and 0.64, respectively. Conclusions: The results indicate that both in-person and virtual CBT lead to improvements in psychological distress and resilience in patients with a history of COVID-19, compared to the control group. However, the improvement rate was higher for in-person CBT compared to the virtual group. In-person CBT led to significant improvements in both psychological distress and resilience.

AimsTo investigate the mental workload level of nurses aiding the most affected area during the Coronavirus disease 2019 (COVID‐19) pandemic and explore the subtypes of nurses regarding their mental workload.DesignCross‐sectional study.MethodsA sample of 446 frontline nurses participated from March 8 to 19, 2020. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of the National Aeronautics and Space Administration Task Load Index. The differences among the classes and the variables including sociodemographic characteristics, psychological capital and coping style were explored.ResultsThe level of mental workload indicates that the nurses had high self‐evaluations of their performance while under extremely intensive task loads. The following three latent subtypes were identified: ‘low workload & low self‐evaluation’ (8.6%); ‘medium workload & medium self‐evaluation’ (35.3%) and ‘high workload & high self‐evaluation’ (56.1%) (Classes 1, 2, and 3, respectively). Nurses with shared accommodations, fewer years of practice, junior professional titles, lower incomes, nonmanagement working positions, lower psychological capital levels and negative coping styles had a higher likelihood of belonging to Class 1. In contrast, senior nurses with higher psychological capital and positive coping styles were more likely to belong to Classes 2 and 3.ConclusionThe characteristics of the ‘low workload & low self‐evaluation’ subtype suggest that attention should be paid to the work pressure and psychological well‐being of junior nurses. Further research on regular training program of public health emergency especially for novices is needed. Personnel management during public health events should be focused on the allocation between novice and senior frontline nurses.ImpactThis study addresses the level of mental workload of frontline nurses who aid in the most severe area of the COVID‐19 pandemic in China and delineates the characteristics of the subtypes of these nurses.

The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study. In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002). After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62% female) accessing a university health center. Each semester, 9-13% of students screened positive for depression, 2.5-3% for suicidal ideation, and 33-38% for alcohol misuse, while 10% wanted help with smoking cessation and 12-13% with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.

To adapt the National Aeronautics and Space Administration Task Load Index scale into Turkish, to determine the nurses' mental workload using subjective methods and to identify the factors affecting the mental workloads of nurses. As the concept of safety gains prominence in healthcare services, the determination of employees' mental workloads using subjective methods is considered important in preventing errors caused by employees. Methodological and descriptive design. The population of the study consisted of a total of 1900 nurses working at three hospitals and a dentistry faculty hospital affiliated with a public university in Istanbul. The sample of the study consisted of 1266 nurses who agreed to participate in the study (the rate of return was 66·6%). Language and content validity and reliability measurements were performed to adapt the National Aeronautics and Space Administration Task Load Index into Turkish, which was used as the data collection tool. It was found that the mean total mental workload score of the nurses was 80·48 (SD 11·76), and the weighted score of mental workload was 83·7. While the highest mean score was obtained on the subscale of mental demand (88·08, SD 16·12), the lowest mean score was obtained on the subscale of frustration (54·52, SD 29·96). The mean total mental workload score of the nurses showed a significant difference according to the units in which the nurses worked. The mean mental workload scores of nurses working at hospitals within the scope of the study were higher than the results of other studies. It is recommended that nurse managers perform mental workload measurements of nurses and compare the results with the quality indicators observed in units to determine and employ a labour force that is qualified for the profession and that may benefit more effectively from human resources.

Aims & Objectives: Rapid Cycle Deliberate Practice (RCDP) is a simulation debriefing methodology that has been compared to post simulation debriefing (PsD) in simulation based medical education (SBME) studies, mostly focused on resuscitations and procedure skills. The aim of this study is to compare the RCDP versus PsD training as methods for experiential learning in the pediatric intensive care unit (PICU) interprofessional SBME sessions. We also measure PICU team workload perception during the simulation scenario using the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire. We hypothesize the RCDP will be more effective than PsD in improving team performance and minimizing cognitive load of learners and facilitators. Methods: Pediatric Critical Care attending physicians, Nurses, Pharmacists and Respiratory Therapists will participate in a 3-hour simulation workshop. Workshops are being conducted from October 2019 - March 2020, and include 5 workshops covering two medical sepsis scenarios. Each session will schedule 1 physician, 2-3 nurses, 1 pharmacist and 1 RT. The first part of the SBME workshop will be PsD and the second half will be RCDP with hard stops and soft stops. The learners complete pre and post-test crew resource knowledge assessments and cognitive load assessments (NASA Task Load Index). Facilitators complete the validated teamwork assessment tool (TEAM Assessment) andNASA Task Index. Results: Raw scores of crew resource knowledge test, TEAM Assessment and NASA Task Load Index between the two studies will be examined. Conclusions: RCDP during interporfessional SBME is feasible and needs to be designed differently in a trainee versus non trainee environment.

The aim of this study was to examine the physiological and psychological responses to an on-sight lead in comparison to an on-sight top rope ascent in elite level rock climbers. Fifteen (14 male, 1 female) rock climbers took part in the study, and were included based on having a self reported on-sight ability of ≥ 25 (Ewbank). Climbers attended three separate testing sessions; a maximum oxygen uptake test (VO2max), baseline session, and an attempt at one randomly assigned climb (lead or top rope) at the limit of their ability on an indoor artificial climbing wall. Before climbing perception of anxiety (Revised Competitive State Anxiety Inventory-2), blood lactate and plasma cortisol concentration were measured. Climb time, heart rate, oxygen consumption (VO2), blood lactate, plasma cortisol concentration and task load (National Aeronautics and Space Administration Task Load Index) were measured in response to the climb. Results indicated there were no significant differences in levels of somatic or cognit...

INTRODUCTION: Endoscopic Submucosal Dissection (ESD) is utilized for the treatment of large gastrointestinal tract lesions or lesions not amenable to standard endoscopic mucosal resection. Insulated tip (IT-ESD) knife is a commonly used knife for ESD. A recent axially paralleled ESD (AP-ESD) knife has shown promising results in tissue resection. The primary aim of this study was to compare the efficacy, safety, physical and mental workload of AP-ESD knife to IT-ESD knife in ex-vivo models. METHODS: This was a randomized-controlled, pilot study comparing IT-ESD to AP-ESD knife in ex-vivo porcine models. AP-ESD knife is a single use, electrocautery enhanced knife that allows for safe dissection and low risk of perforation given the parallel orientation of the knife to the mucosa [s]. A total of 18 participants divided into two groups (novices, n = 9 and experts n = 9) without prior experience with AP-ESD knife were randomized 1:1 into two groups (group 1: AP-ESD followed by IT-ESD; group 2: IT-ESD followed by AP-ESD). A standard template was used to create 2 × 2 cm gastric lesions. The primary outcome was complete en-bloc resection. Secondary outcomes included differences in procedure time, perforation rate, and National Aeronautical and Space Administration Task Load Index (NASA-TLX) to assess physical and mental workload. RESULTS: 18 participants each performed 2 tissue resections (1 AP-ESD and 1 IT-ESD), for a total of 36 procedures. Complete en-bloc resection was achieved in 33 models (resection rate 91.6%). No differences were observed in complete resection or perforation rate between IT-ESD and AP-ESD (88.2% vs 94.4%, P = 0.51 and 11.8 vs 11.1%, P = 0.95, respectively). Participants had a longer time with AP-ESD (1045 +/- 779 vs 783+/-532 seconds, P = 0.04) however there was no difference in demand using total NASA TLX (33 +/- 11 vs 39 +/- 9, P = 0.07). While experts (N = 9) had longer time with AP-ESD (895 +/- 649 seconds vs 595 +/- 383, P = 0.05), there was no difference in resection rate, perforation rate or NASA TLX demand. On the other hand, Novices (N = 9) showed no difference in resection rate, perforation rate or procedure time, however did have higher demand with AP-ESD (45 +/- 9 vs 37 +/- 11, P = 0.05). CONCLUSION: AP-ESD knife yielded similar rates of resection and perforation compared to a standard IT-ESD knife. Experts endoscopists required more time for dissection, likely due to an undefined learning curve with this new device and extensive familiarity with conventional knives.Figure 1.: Novel Axially Paralleled Endoscopic Submucosal Dissection (AP-ESD) Knife.

In this study, I examined the effects of sleep loss, time pressure, and workload on performance in a dynamic air traffic control (ATC) task. Participants performed the ATC task following 8, 16, and 24 hr of sleep loss under conditions of low and high time pressure and workload. In general, the findings revealed that ATC performance was susceptible to the effects of time pressure and workload. However, there was only partial support for the assumption that the effects of sleep loss on performance are dependent on the level of cognitive challenge posed by a task. Furthermore, I observed a dissociation between ATC performance and subjective assessments of workload (i.e., the National Aeronautics and Space Administration Task Load Index; Hart & Staveland, 1988), suggesting that the cognitive processes responsible for performance are not identical to those processes responsible for subjective assessments of workload.

Is the “sterile cockpit” concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass