Video games in psychotherapy.

Video games have found their way into the clinical care of youth in most medical fields, and academic interest in their use is increasing steadily. The popularity of video games among youth may qualify them as a useful tool in psychotherapy for children and adolescents. Limited literature on use of video games in mental health care suggests that they can help young patients become more cooperative and enthusiastic about psychotherapy. Recent experience suggests that video games may facilitate therapeutic relationships, complement the psychological assessment of youth by evaluating cognitive skills, and elaborate and clarify conflicts during the therapy process. Concerns about video game content, perceived effects on youth, and lack of familiarity with this medium may form a barrier in their use in therapy offices. Further research on the benefits of video game use in psychotherapy, including patient characteristics that may moderate outcomes, is needed. Finally, future collaborations between clinicians and video game developers may produce specific games to be used in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Telestroke" : the application of telemedicine for stroke

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.     

The education of depressed primary care patients: what do patients think of interactive booklets and a video?

BACKGROUND: Clinicians, policy makers, and health care administrators are attempting to improve depression outcomes in the primary care setting. Despite positive evidence about the efficacy of self-help materials and psychoeducational interventions, use of educational materials designed for the primary care patient are receiving little attention in present depression initiatives. The present study describes the use and evaluation of three educational materials by depressed primary care patients. METHODS: As a part of a randomized control trial, depressed primary care patients were identified by primary care physicians and randomized to a clinical trial exploring a new method of treating depression. Patients assigned to the new method of treatment received a package of educational materials at the time of the baseline interview. These materials included two brief interactive booklets (medication booklet, behavioral health booklet) and a short video. The present analysis concerns data obtained from 108 intervention patients in a telephone survey conducted 1 week after they received the package of educational materials. RESULTS: Approximately three quarters of the subjects reported that they read or viewed all of the educational products. The majority rated the products as somewhat to significantly helpful: medication booklet 81%; behavioral health booklet 82%; and video 69%. Previously reported results include findings of significantly better medication adherence and improved clinical outcomes by patients with major depression who received a primary care intervention that included the educational products discussed in this paper. CONCLUSIONS: Educational materials may play a significant role in improving depression treatment outcomes in the primary care setting.     

Video games in health care: Closing the gap.

Although a great deal of media attention has been given to the negative effects of playing video games, relatively less attention has been paid to the positive effects of engaging in this activity. Video games in health care provide ample examples of innovative ways to use existing commercial games for health improvement or surgical training. Tailor-made games help patients be more adherent to treatment regimens and train doctors how to manage patients in different clinical situations. In this review, examples in the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors are summarized. There is a history of using video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus on making tailor-made games for different disease groups, which have been evaluated in scientific trials more recently. Commercial video games have been of interest regarding their impact on surgical skill. More recently, some basic computer games have been developed and evaluated that train doctors in clinical skills. The studies presented in this article represent a body of work outlining positive effects of playing video games in the area of health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's motivations for video game play in the context of normal development.

Electronic games are now an everyday part of childhood and adolescence. The debate has moved from whether children should play video games to how to maximize potential benefits and to identify and minimize potential harms. To do this, we must understand what motivates children to play electronic games and what needs the games meet. Drawing on a survey of 1,254 middle school children, focus groups with boys and their parents, and findings from other quantitative and qualitative research, the author describes a variety of motivations for video game play (including games with violent content) and how these may vary based on factors such as mood, environment, personality, and developmental stage. The findings are put into the context of normal development, and suggestions are given for parents, educators, and researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telemedicine for diabetes care: the DIABTel approach towards diabetes telecare

Telemedicine is modifying classical health care by providing effective solutions to an increasing number of new situations. This article summarizes the potential benefits made available by this technology in diabetes care, and describes in detail how the new DIABTel Telemedicine Service complements the daily care of diabetic patients. The basic functions of the telemedicine system include telemonitoring of patient's blood glucose data and self-management actions, and remote care from doctors to diabetic patients. The system's architecture comprises two main components: the Medical Workstation, a PC-based system to be used by physicians and nurses in Diabetes Day Centre units in hospitals, and the Patient Unit, a palmtop-computer to be used by patients in their day to day activities. Both components, in an integrated approach, offer tools to doctors and patients for data collection and management, viewing and interpretation modules, data/message exchange services and an interactive glucose/insulin simulator for educational purposes. The DIABTel telemedicine diabetes care procedure aims: (1) to improve communication of the patient with the hospital-based diabetologist, in between the patient's visits to the clinic; (2) to allow doctors to assess the patient's condition on a frequent basis (every week); (3) to help patients with management in the daily care of diabetes, and (4) to provide patients with a service of 'supervised autonomy', to increase patient's independence without decreasing the necessary continual support and supervision from the doctor. Finally, we discuss the practical problems, limitations and vital issues regarding implementation of the telemedicine service.     

Blazing angels or resident evil? Can violent video games be a force for good?

Violent video games have been a source of controversy in the United States and elsewhere for several decades. Considerable concern has been raised in the public and scientific communities about the alleged deleterious effects of violent games. These concerns may coincide with periodic moral panics about media's influence, particularly on youth. This paper argues that the negative effects of violent games have been exaggerated by some elements of the scientific community, fitting with past cycles of media-focused moral panics. By contrast, potential positive effects of violent video game play have been ignored in the debate on violent games. The current paper considers research in several areas, including aggression, but also the nascent research fields of visuospatial cognition, social networking, and use as educational tools. It is argued that the debate on video game violence should be broadened to include both potential negative and positive effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing Observational Research Methods to Study Team Performance in Construction Management

The evolution of research in the area of construction engineering and management has moved toward the use of quantitative metrics and research methods for identifying and evaluating the impact of events or procedures on the construction process. While quantitative research methods can be very important for answering certain research questions, there are important reasons for adopting qualitative or mixed methodology studies to gain a better understanding of complex phenomena. This paper explores the use of observational studies and their potential use within the field of construction research. Observational studies can provide answers to “what” phenomena occurred, particularly when people are involved in a process, along with gaining insights into “why” the phenomena occurred. This paper discusses two types of observational studies, structured and unstructured, and provides a procedure for their implementation within construction research. To clearly demonstrate the methodology, a case study focused on the investigation of two different versions of an educational simulation application, the virtual construction simulator (VCS), is used to illustrate the benefits and challenges of implementing mixed methodology observational studies. The case study involved the video recording and analysis of interactions between student team members when using the VCS application for a construction sequencing task. The video recordings were analyzed, and important insights were identified, both qualitative and quantitative. Through content analysis, it was determined that the improvements made in a new version of the VCS application were beneficial, and the detailed observational studies identified insights into why the revisions in the application yielded improved results. This case study details the steps and considerations involved in planning an observational study, as well as the benefits and challenges that researchers may encounter when using observational research methodologies.     

Telecommunications and rural health care

Telehealth has many applications, including the education and training of health professionals. This article describes the use of advanced telecommunications technology to educate family nurse practitioners in rural areas of Kansas. Four Kansas universities use compressed video technology (an interactive audio and video system) to offer five common core courses in primary care to students enrolled in FNP programs at the respective institutions. Using technology to educate FNPs in rural communities has resulted in a greater percentage of graduates (approximately 67% of 258 graduates) going to work in rural underserved communities. In addition to learning the course content, students learn to use technology as a tool to access telehealth information and services Knowing how to use these technologies provides greater opportunities to rural health care providers, as well as the recipients of health care.     

A motivational model of video game engagement.

More Americans now play video games than go to the movies (NPD Group, 2009). The meteoric rise in popularity of video games highlights the need for research approaches that can deepen our scientific understanding of video game engagement. This article advances a theory-based motivational model for examining and evaluating the ways by which video game engagement shapes psychological processes and influences well-being. Rooted in self-determination theory (Deci & Ryan, 2000; Ryan & Deci, 2000a), our approach suggests that both the appeal and well-being effects of video games are based in their potential to satisfy basic psychological needs for competence, autonomy, and relatedness. We review recent empirical evidence applying this perspective to a number of topics including need satisfaction in games and short-term well-being, the motivational appeal of violent game content, motivational sources of postplay aggression, the antecedents and consequences of disordered patterns of game engagement, and the determinants and effects of immersion. Implications of this model for the future study of game motivation and the use of video games in interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potential economic benefits of lower-extremity amputation prevention strategies in diabetes

OBJECTIVE: To estimate the potential economic benefits of selected strategies from published literature--educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes--to reduce the incidence of lower-extremity amputation among individuals with diabetes. RESEARCH DESIGN AND METHODS: We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years. RESULTS: The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged > or = 70 years. CONCLUSIONS: Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.     

The relativity and geodiversity of medico-economic realities

The economic gestion of health care is difficult to handle. It covers several aspects which cannot pride to be accurate sciences. It strikes difficulties such as the geodiversity of problems to be solved and the nuances in the application of principles of social equity and medical ethics. The health-care analysis is also exposed to some politician interpretations biased by doctrinal a priori. Most often, a confrontation ensues between the political cenacle and the professionals directly involved in health-care.     

Diabetes intervention in the information age

Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus. We have designed and evaluated an electronic information system which facilitates this task. The system is voice-interactive, physician directed and affords, to remote patients, 24 h access via touch-tone telephone. Accordingly, patients access the system each day to report self-measured blood glucose levels or hypoglycaemic symptoms together with dietary changes, planned exercise, stress, illness or other lifestyle events. In turn they receive immediate advice with respect to medication dosing changes, and other pertinent feedback. Preliminary system beta-testing for safety and efficacy was performed for one year in an open study of 204 patients derived from two independent, health-care environments. Among the two testing centres, over 60,000 telephone cells were received by the computer systems during the start-up year. Safety and efficacy expectations were met. In addition, prevalence of diabetes related crises (hyperglycaemia or hypoglycaemia) fell approximately 3-fold. Glycated haemoglobin fell significantly (1.0-1.3%) in patients actively using the system. In control groups of patients not actively using the system, there were no improvements in metabolic control while body weights were stable in all groups. The new system was safe and effective in our hands and empowered our health professionals to provide improved diabetes care.     

What do survivors of congenital diaphragmatic hernia look like when they grow up?

Health professionals in rural and remote areas of Australia are disadvantaged when accessing continuing education. Their geographical isolation influences attendance at seminars, workshops and even informal discussions with colleagues. This paper describes the strategies adopted to meet the continuing education needs of a group of health professionals working in diabetes education and discusses how other specialist areas can provide similar educational opportunities. The education programs for isolated health professionals involved in diabetes care in South Australia were created by a team, and the resources of their associated institutions. Formal working agreements were established to achieve the aim of relevant continuing education for rural health professionals and to ensure ongoing ventures. All programs have been positively received, and evaluations identify the need to develop other, related subjects. Future developments will further utilise advances in technology to extend access and add to the current modes of education delivery. It is the intention of this group to continue to develop practice-based subjects capable of meeting rural health practitioners' needs and thus enhance the quality of care in rural and remote communities.     

Roles of advanced practice nurses in oncology

Managed care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care's rapid transformation of specialty practices, such as oncology, is redirecting classic nursing functions toward market initiatives that value the design of care/case management systems and the implementation of multidisciplinary "patient-centered" care models. As health-care systems continue to evolve, advanced practice nurses (APNs) are redefining their roles and enhancing their skills to meet the demands of the marketplace. Advanced practice nurses are defined as registered nurses who have met advanced educational and practice requirements and are prepared at the graduate level. This paper will identify the four established APN roles: nurse practitioner (NP), nurse anesthetist, nurse midwife, and clinical nurse specialist (CNS), as well as highlight the nurse practitioner and clinical nurse specialist as the leadership APN roles within oncology practice. The adaption to managed care has identified new functions and created opportunities for these APN specialties that are being viewed both competitively by other oncology health-care providers and creatively by managed-care organizations. The integration of these emerging roles within the new advanced nursing market and their contributions to oncology care are also discussed.     

Cognitive/attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy.

Two studies were conducted to investigate the use of cognitive/attentional distraction (via commercially available video games) to control conditioned nausea in pediatric cancer patients receiving chemotherapy. The first study compared the nausea severity in children who played video games during chemotherapy-related procedures with that of control-group children who did not play video games. The second study used a combined ABAB withdrawal and repeated measures analysis of variance design that incorporated baseline and intervention assessments within a single session. In both studies, video game-playing resulted in significantly less nausea. The introduction and withdrawal of the opportunity to play video games produced significant changes (reduction and exacerbation, respectively) in nausea. Although video games also reduced self-reported anxiety, the effects were weaker than those for nausea. Pulse rate and systolic/diastolic blood pressure were not consistently affected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue on video games.

Video games are fast becoming one of the most popular media of choice among children and young adults. They are one of the newest media forms to find themselves under scientific scrutiny. To date, much of the attention has been negative, focusing on potential harm related to addiction, aggression, and lowered school performance. Scientists increasingly are examining the potential to use this immensely popular media for positive purposes, in education, in health, for students with disabilities, and to foster visuospatial cognition. This special issue concerns itself mainly with these issues: refocusing the discussion of video games away from fears that may have been exaggerated in the past, to examining whether video games may be put to some good use or are just games in the end. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Video games and spatial cognition.

Video game enthusiasts spend many hours at play, and this intense activity has the potential to alter both brain and behavior. We review studies that investigate the ability of video games to modify processes in spatial cognition. We outline the initial stages of research into the underlying mechanisms of learning, and we also consider possible applications of this new knowledge. Several experiments have shown that playing action games induces changes in a number of sensory, perceptual, and attentional abilities that are important for many tasks in spatial cognition. These basic capacities include contrast sensitivity, spatial resolution, the attentional visual field, enumeration, multiple object tracking, and visuomotor coordination and speed. In addition to altering performance on basic tasks, playing action video games has a beneficial effect on more complex spatial tasks such as mental rotation, thus demonstrating that learning generalizes far beyond the training activities in the game. Far transfer of this sort is generally elusive in learning, and we discuss some early attempts to elucidate the brain functions that are responsible. Finally, we suggest that studying video games may contribute not only to an improved understanding of the mechanisms of learning but may also offer new approaches to teaching spatial skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perception of the role and potential side effects of inhaled corticosteroids among asthmatic patients

BACKGROUND: Misunderstanding of the role of asthma medication and fear of untoward side effects may reduce compliance to therapy, potentially resulting in poor asthma control and increased risk of severe asthma events. METHODS: We report the results of a recent Canadian survey of 603 asthmatic patients recruited from the general population, aimed at determining their perception of the role and potential side effects of inhaled corticosteroids (ICS). RESULTS: The survey revealed that a large proportion of asthmatic patients do not understand the role of their medications and have many misconceptions and fears in regard to ICS, reducing their willingness to use them. Among the most common fears are those concerning troublesome side effects, particularly in regard to corporeal image, bone density, and a reduction in efficacy of medication over time. More than half of the population said they were very or somewhat concerned using ICS on a regular basis; two thirds of patients had not discussed their concerns about ICS with their physicians or other health-care professionals. Finally, in a large number of asthma patients, asthma was not adequately controlled, according to recent asthma consensus guidelines. CONCLUSIONS: These observations stress the importance for those involved in asthma care of questioning patients about their understanding of the role of asthma medications, particularly ICS, their fears and misconceptions, and what they consider to be adequate asthma control, in order to provide appropriate education and counseling.