Effectiveness of Immersive Virtual Reality in Alleviating Pain and Anxiety in Children during Immunization in Primary Care: A Pilot Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Zi Ying Chang ◽  
Gary Chun-Yun Kang ◽  
Eileen Yi Ling Koh ◽  
Rodney Jin Kai Fong ◽  
Jiasheng Tang ◽  
...  
Keyword(s):  
Primary Care ◽  
Virtual Reality ◽  
Response Rate ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Rank Test ◽  
Control Group ◽  
Immersive Virtual Reality ◽  
Childhood Immunization ◽  
Care Clinic

BACKGROUND Paediatric immunization is often associated with significant fear and anxiety among the older children and their parents. Their distress may potentially affect their adherence to the childhood immunization schedule and the acceptance of other recommended vaccines by physicians. OBJECTIVE The study primarily aimed to assess the feasibility of using immersive virtual reality (VR) during immunization in children in primary care. The secondary aim was to determine the effectiveness of immersive VR in alleviating pain and anxiety among children, reduction of anxiety of their parents and attending nurses during immunization compared to usual care without VR. METHODS A pilot open-label randomized control trial was conducted at a public primary care clinic in Singapore. Thirty children, aged 4-10 years were randomised to an intervention group (n=15) using VR and a control group (n=15) without VR during immunization. Feasibility was assessed by the response rate to the use of VR. The Faces Pain Scale-Revised (FPS-R) and the Children’s Fear Scale (CFS) were used to determine their pain and anxiety respectively before and after the immunization. The anxiety level of their accompanying parents and attending nurses were evaluated using Visual Analogue Scale (VAS) prior and post-immunization of these children. Change in FPS-R and CFS scores, and anxiety assessment for parents and nurses were assessed using Mann-Whitney U test. Wilcoxon signed rank test was used to assess the difference in the nurses’ experience of using the VR application. RESULTS One child refused to use the VR equipment, constituting a rejection rate of 6.7% (1/15) but no adverse event occurred in the intervention arm. The overall response rate of 88% (30/34) when the parents were approached to participate in the study, indicating feasibility of using VR in childhood immunization. In the intervention group compared to the control group, the change in scores for CFS (median -1, IQR -2 to 0; P=.04), parental VAS (median -4, IQR -5 to -1; P=.04) were significantly decreased. After immunization, nurses scored favourably for VR, in terms of simplicity (median 9.5, IQR 5.72 to 10; P=.01), acceptability (median 10, IQR 5 to 10; P=.005) and willingness to use VR in the future (median 10, IQR 5 to 10; P=.02). CONCLUSIONS Immersive VR is feasible, safe and effective in alleviating anxiety among the children, parents and their attending nurses. Nurses viewed the application of VR in childhood immunization favorably. CLINICALTRIAL ClinicalTrials.gov NCT04748367 ; https://clinicaltrials.gov/ct2/show/NCT04748367

scholarly journals Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial

10.2196/16266 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16266 ◽  
Author(s):  
Yeoree Yang ◽  
Eun Young Lee ◽  
Hun-Sung Kim ◽  
Seung-Hwan Lee ◽  
Kun-Ho Yoon ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile Phone ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Glucose Monitoring ◽  
Feedback System ◽  
Control Group ◽  
Care Clinic ◽  
Cluster Randomized

Background Recent evidence of the effectiveness of mobile phone–based diabetes management systems is generally based on studies conducted in tertiary hospitals or professional diabetes clinics. Objective This study aimed to evaluate the clinical efficacy and applicability of a mobile phone–based glucose-monitoring and feedback system for the management of type 2 diabetes mellitus (T2DM) in multiple primary care clinic settings. Methods In this multicenter, cluster-randomized controlled, open trial, 13 primary care clinics in Seoul and other large cities in South Korea were voluntarily recruited. Overall, 150 (9 clinics) and 97 (4 clinics) participants with T2DM were assigned to the intervention and control groups, respectively (2:1 allocation). Every month, participants in both groups attended face-to-face physicians’ consultation for the management of diabetes in the clinic. For the intervention group, participants were required to upload their daily self-monitoring of blood glucose (SMBG) results using the mobile phone app in addition to outpatient care for 3 months. The results were automatically transmitted to the main server. Physicians had to check their patients’ SMBG results through an administrator’s website and send a short feedback message at least once a week. At baseline and 3 months, both groups had anthropometry and blood tests, including hemoglobin A1c (HbA1c), and responded to questionnaires about treatment satisfaction and compliance. Results At 3 months, participants in the intervention group showed significantly more improvement in HbA1c (adjusted mean difference to control −0.30%, 95% CI −0.50 to −0.11; P=.003) and fasting plasma glucose (−17.29 mg/dL, 95% CI −29.33 to −5.26; P=.005) than those in the control group. In addition, there was significantly more reduction in blood pressure, and the score regarding treatment satisfaction and motivation for medication adherence increased more in the intervention group than in the control group. In the subgroup analyses, the effect on glycemic control was more significant among younger patients and higher baseline HbA1c levels. Conclusions The mobile phone–based glucose-monitoring and feedback system was effective in glycemic control when applied in primary care clinic settings. This system could be utilized effectively with diverse institutions and patients. Trial Registration Clinical Research Information Service (CRIS) https://tinyurl.com/tgqawbz

Effectiveness of the 5A’s Model for Changing Physical Activity Behaviors in Rural Adults Recruited From Primary Care Clinics

2019 ◽  
Vol 16 (12) ◽  
pp. 1138-1146
Author(s):  
Jill R. Reed ◽  
Paul Estabrooks ◽  
Bunny Pozehl ◽  
Kate Heelan ◽  
Christopher Wichman
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Well Being ◽  
Text Messages ◽  
Future Research ◽  
Control Group ◽  
Care Clinic ◽  
Rural Adults

Background: Most rural adults do not meet current guidelines for physical activity (PA). A 12-week feasibility study tested the effectiveness of using the 5A’s model for PA counseling on rural adults’ PA behaviors. Methods: Inactive rural adults recruited from a primary care clinic were randomized to an intervention (n = 30) or control (n = 29) group. All subjects wore a Fitbit to track steps and active minutes. The intervention group completed action plans to improve self-regulatory PA strategies and received weekly motivational text messages to improve PA behaviors. Theory of planned behavior constructs and self-regulatory strategies of planning, goal setting, and tracking (steps and active minutes) were measured with both groups. The control group received the Fitbit only. Results: All individuals became more physically active; however, no significant differences between groups in active minutes or steps were found. All subjects, regardless of group, increased steps (P > .05). There were no statistically significant differences between groups on any of the theoretical variables. Conclusions: It is vitally important to continue to find ways to make PA a priority to improve the overall health and well-being of rural adults. Future research warrants adjusting the intervention dose and strategies to increase PA that can be maintained long term.

FACT effectiveness in primary care; a single visit RCT for depressive symptoms

2021 ◽  
pp. 009121742110105
Author(s):  
B Arroll ◽  
H Frischtak ◽  
R Roskvist ◽  
V Mount ◽  
F Sundram ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Psychosocial Assessment ◽  
Care Practice ◽  
Control Group ◽  
Number Needed To Treat ◽  
Care Clinic ◽  
The Mean

Background Patients with depressive symptoms are common in primary care. Brief, simple therapies are needed. Aim Is a focussed acceptance and commitment therapy (FACT) intervention more effective than the control group for patients with depressive symptoms in primary care at one week follow up? Design and setting: A randomised, blinded controlled trial at a single primary care clinic in Auckland, New Zealand. Methods Patients presenting to their primary care practice for any reason were recruited from the clinic waiting room. Eligible patients who scored ≥2 on the PHQ-2 indicating potential depressive symptoms were randomised using a remote computer to intervention or control groups. Both groups received a psychosocial assessment using the “work-love-play” questionnaire. The intervention group received additional FACT-based behavioural activation activities. The primary outcome was the mean PHQ-8 score at one week. Results 57 participants entered the trial and 52 had complete outcome data after one week. Baseline PHQ-8 scores were similar for intervention (11.0) and control (11.7). After one week, the mean PHQ-8 score was significantly lower in the intervention group (7.4 vs 10.1 for control; p<0.039 one sided and 0.078 two sided). The number needed to treat to achieve a PHQ-8 score ≤6 was 4.0 on intention to treat analysis (p = 0.043 two sided). There were no significant differences observed on the secondary outcomes. Conclusion This is the first effectiveness study to examine FACT in any population. The results suggest that it is effective compared with control, at one week, for patients with depressive symptoms in primary care.

Pharmacist Review to Simplify Medication Regimens in a VAMC Primary Care Clinic

1996 ◽  
Vol 12 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Paul V Laucka ◽  
Will B Webster ◽  
Jeffrey Kuch
Keyword(s):  
Primary Care ◽  
Clinical Pharmacist ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Pharmacist Intervention ◽  
Control Group ◽  
Care Clinic ◽  
Before And After ◽  
Clinical Pharmacist Intervention ◽  
Clinic Visits

Objective: To assess the effect of a clinical pharmacist's prospective medication review of patients receiving multiple drug therapy, using the pharmaceutical care process, as determined by the number of concurrent medications the patient is receiving before and after clinic visits. Design: Assigned groups. Setting: Outpatient primary care clinic of a tertiary healthcare Veterans Affairs (VA) medical facility. Patients: Seven hundred twenty-seven patients who had eight or more active medication orders were selected. Four hundred forty-one patients (aged 67.2 ± 10.4 y) were in the intervention group; 286 others (aged 66.6 ± 11.9 y), whose medical records were not available, were assigned to the control group and received no clinical pharmacist intervention. Intervention: Medication regimens of VA ambulatory patients with eight or more active medications were reviewed by a clinical pharmacist, and a written communication to the prescriber was attached to the medical record. Main Outcome Measures: The number of active concurrent medications before and after clinic visits was measured. Results: There was a decrease in the medications in the intervention group from an average of 12.1 ±4 to 11.5 ± 4.2 (p < 0.05). The medications in the control group rose from an average of 11.8 ± 4.44 to 12.2 ± 4 (p = NS). A decrease of 0.6 prescriptions per patient was highly significant (p < 0.05). During the study, 1,336 recommendations were made to practitioners. From this group, 41% of the recommendations were accepted, and 477 medications were discontinued, the quantity dispensed or dosage was reduced, or an alternative medication was prescribed. Conclusions: These data suggest that clinical pharmacist intervention in an ambulatory care setting can affect practitioner prescribing habits and significantly decrease the number of medications prescribed.

scholarly journals Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Yeoree Yang ◽  
Eun Young Lee ◽  
Hun-Sung Kim ◽  
Seung-Hwan Lee ◽  
Kun-Ho Yoon ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile Phone ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Glucose Monitoring ◽  
Feedback System ◽  
Control Group ◽  
Care Clinic ◽  
Cluster Randomized

BACKGROUND Recent evidence of the effectiveness of mobile phone–based diabetes management systems is generally based on studies conducted in tertiary hospitals or professional diabetes clinics. OBJECTIVE This study aimed to evaluate the clinical efficacy and applicability of a mobile phone–based glucose-monitoring and feedback system for the management of type 2 diabetes mellitus (T2DM) in multiple primary care clinic settings. METHODS In this multicenter, cluster-randomized controlled, open trial, 13 primary care clinics in Seoul and other large cities in South Korea were voluntarily recruited. Overall, 150 (9 clinics) and 97 (4 clinics) participants with T2DM were assigned to the intervention and control groups, respectively (2:1 allocation). Every month, participants in both groups attended face-to-face physicians’ consultation for the management of diabetes in the clinic. For the intervention group, participants were required to upload their daily self-monitoring of blood glucose (SMBG) results using the mobile phone app in addition to outpatient care for 3 months. The results were automatically transmitted to the main server. Physicians had to check their patients’ SMBG results through an administrator’s website and send a short feedback message at least once a week. At baseline and 3 months, both groups had anthropometry and blood tests, including hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>), and responded to questionnaires about treatment satisfaction and compliance. RESULTS At 3 months, participants in the intervention group showed significantly more improvement in HbA<sub>1c</sub> (adjusted mean difference to control −0.30%, 95% CI −0.50 to −0.11; <i>P</i>=.003) and fasting plasma glucose (−17.29 mg/dL, 95% CI −29.33 to −5.26; <i>P</i>=.005) than those in the control group. In addition, there was significantly more reduction in blood pressure, and the score regarding treatment satisfaction and motivation for medication adherence increased more in the intervention group than in the control group. In the subgroup analyses, the effect on glycemic control was more significant among younger patients and higher baseline HbA<sub>1c</sub> levels. CONCLUSIONS The mobile phone–based glucose-monitoring and feedback system was effective in glycemic control when applied in primary care clinic settings. This system could be utilized effectively with diverse institutions and patients. CLINICALTRIAL Clinical Research Information Service (CRIS) https://tinyurl.com/tgqawbz

Use of short message service (SMS) reminders to improve the attendance rate of diabetes-related multidisciplinary services in a primary care clinic a randomized controlled trial

2019 ◽  
Author(s):  
Man Chi DAO ◽  
Sau Nga FU ◽  
Carlos King Ho WONG ◽  
Wan LUK
Keyword(s):  
Controlled Trial ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Control Group ◽  
Short Message ◽  
Attendance Rates ◽  
Care Clinic ◽  
Message Service ◽  
Sms Reminder ◽  
Sms Reminders

Abstract Background: Non-attendance of various non-physician-led multidisciplinary (NPLM) services causes wastage of health care resources. This study determined whether using mobile phone text message reminders by Short Message Service (SMS) in patients with type II diabetes attending a primary care clinic resulted in higher attendance rates of NPLM services when compared with those without SMS reminders. Method: A single centre randomized-controlled trial included adult subjects with type II diabetes who could read Chinese or English, possessed an SMS-capable phone and booked at least NPLM service appointments in study site. The main outcomes were comparing attendance rates between the control group and the intervention group of various NPLM services including nurse complication screening, nurse individual counselling, multidisciplinary group education, dietitian counselling, physiotherapist service, retinopathy screening by optometrist and blood taking sessions Results: 297 eligible subjects were approached, 15 were excluded and 11 refused to participate. 271 subjects were recruited (response rate 96%). Their mean (± standard deviation) age was 63.3±11.3. Their mean duration of DM was 6.9±5.3 years with mean HbA1c 7.37±1.32%. They were randomly assigned to intervention (N=135) or control (N=136) group. The Intervention groups received a standard SMS reminder included appointment name, date and time 24-72 hours prior to the scheduled appointment. The Control groups received no reminder. 733 appointments (intervention N=372, control N=361) were analysed. More subjects used smartphone (82.2%) than mobile phone without internet access (17.8%). All SMS were successfully delivered for the 372 appointments with no adverse event reported. The overall attendance rates were 92.7% in the intervention group and 83.1% in the control group (Odds ratio, OR 2.60, 95% confidence interval, CI 1.61-4.19, p<0.001). In subgroup analysis, SMS reminders were particularly useful in reminding nurse clinic (OR 3.06, 95% CI 1.22-7.66, p=0.017) and optometrist clinic (OR 2.73, 95% CI 1.07-7.01, p=0.037). Conclusion: SMS reminder is a reliable method to increase overall attendance rates and health service utilization of NPLM DM services in outpatient setting.

scholarly journals Neuromuscular Exercise for Chronic Musculoskeletal Pain in Older People: A Randomized Clinical Trial

2020 ◽  
pp. bjgp20X714053
Author(s):  
Regina Wing-shan Sit ◽  
Shirley Yue Kwan Choi ◽  
Bo Wang ◽  
Dicken Chan ◽  
Daisy, Dexing Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Self Efficacy ◽  
Primary Care Physicians ◽  
Short Form ◽  
Handgrip Strength ◽  
Controlled Trial ◽  
Primary Care Clinic ◽  
Control Group ◽  
Care Clinic

Abstract Background: Exercise therapy is commonly prescribed by primary care physicians (PCPs) in the management of chronic musculoskeletal (MSK) pain. Aims: We evaluated the clinical effectiveness of a supervised neuromuscular (NM) exercise program in older people with chronic MSK pain. Design: A 12-week, two-arm randomized controlled trial comparing 6 weeks supervised NM exercise versus waiting list control. Setting: We enrolled 72 participants with chronic MSK pain in a primary care clinic. Methods: Participants were randomly allocated (block size of 12) in 1:1 ratio to the NM (N=36) and control group (N=36). Data were collected at baseline, 6 and 12 weeks. The primary outcome was the Brief Pain Inventory (BPI) score at 6 weeks (post-intervention). Secondary outcomes included the Pain Self-Efficacy Questionnaire (PSEQ), Short form of Health Survey (SF-12), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scores, and functional measurement using the Timed-Up-and-Go test and handgrip strength. Results: Compared with the control group at 6 weeks, the NM group demonstrated a significantly greater improvement in the BPI-severity pain (between-group difference -1.27, 95% CI = -2.08 to -0.45, P = 0.002) and PSEQ (between-group difference 6.50, 95% CI = 2.022 to 10.77, P = 0.003). Participants who complied to the protocol also demonstrated statistical significant improvement in the SF-12-physical score and PHQ-9 score. Conclusion and implications: NM exercise has the potential of reducing pain, improving self-efficacy, physical function and mood in older people with chronic MSK pain. It can be an option to PCPs in exercise prescriptions.

Single-centre study on the use of virtual reality in the reduction of pain after the administration of vaccines in children aged 3 to 6 years in primary care centres in Central Catalonia: randomized clinical trial (Preprint)

2021 ◽  
Author(s):  
Mercedes de la Cruz Herrera ◽  
Aïna Fuster Casanovas ◽  
Queralt Miró Catalina ◽  
Mireia Cigarrán Mensa ◽  
Pablo Alcántara Pinillos ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Virtual Reality ◽  
Intervention Group ◽  
Third Party ◽  
Primary Care Centre ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Care Centre ◽  
Reduction Of Pain

BACKGROUND Pain and anxiety caused by vaccination and other medical procedures in childhood can cause discomfort for both the patient and their parents. Virtual reality (VR) is a technology capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions. OBJECTIVE Reduction of pain and anxiety after the administration of two vaccines in children aged 3 to 6 years. METHODS Randomized, parallel, controlled clinical trial with two assigned groups. The intervention group will wear virtual reality goggles during the administration of two vaccines, while the control group will receive standard primary care centre care for the procedure. Randomization will be carried out using the "RandomizedR" computer system, a randomization tool of the R Studio program. This is an open or unblinded trial, both the subject and the investigator will know the assigned treatment group. Due to the nature of the VR intervention, it is impossible to blind patients, caregivers or observers. However, a blind third party assessment will be carried out. The study population focuses on children aged 3 to 6 years, included in the patient registry and cared for in the primary care centre of the region of Central Catalonia, who will receive the following vaccines during the well child check-up: triple viral + varicella at 3 years of age and hepatitis A + Diphtheria-Tetanus-Pertussis at 6 years of age. RESULTS The study is scheduled to begin in January 2022 and is scheduled to end in January 2023 when the statistical analysis will begin. CONCLUSIONS Virtual reality can be a useful tool in paediatric procedures that generate pain and anxiety. CLINICALTRIAL The clinical trial has been approved by the IDIAP Jordi Gol i Guirna ethics committee with code 4R21/061.

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic
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