Extending the reach of health care for obesity and diabetes using virtual worlds

Today's epidemic of obesity and diabetes poses challenges to health care similar to those facing soldiers who return with postdeployment mental health issues. These include geographic barriers, social stigma, and the need for behavioral change. Researchers at University of Southern California's Institute for Creative Technologies are adapting their extensive experience in technological solutions for training to techniques that can aid veterans in need. These techniques show promise for concerns in the growing crisis of "diabesity." Virtual reality (VR) has already demonstrated itself as an impactful treatment method for several behavioral and mental health domains. Virtual worlds, the successor technology of original VR, inherited many of its predecessor's strengths but also presents the new affordances of accessibility, social connectivity, and avatar usage, which pave the way toward future treatment options on a broader scale.     

Virtual reality technologies for research and education in obesity and diabetes: research needs and opportunities

The rising rates, high prevalence, and adverse consequences of obesity and diabetes call for new approaches to the complex behaviors needed to prevent and manage these conditions. Virtual reality (VR) technologies, which provide controllable, multisensory, interactive three-dimensional (3D) stimulus environments, are a potentially valuable means of engaging patients in interventions that foster more healthful eating and physical activity patterns. Furthermore, the capacity of VR technologies to motivate, record, and measure human performance represents a novel and useful modality for conducting research. This article summarizes background information and discussions for a joint July 2010 National Institutes of Health - Department of Defense workshop entitled Virtual Reality Technologies for Research and Education in Obesity and Diabetes. The workshop explored the research potential of VR technologies as tools for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR in fostering more effective utilization of diabetes- and obesity-related nutrition and lifestyle information. Virtual reality technologies were considered especially relevant for fostering desirable health-related behaviors through motivational reinforcement, personalized teaching approaches, and social networking. Virtual reality might also be a means of extending the availability and capacity of health care providers. Progress in the field will be enhanced by further developing available platforms and taking advantage of VR's capabilities as a research tool for well-designed hypothesis-testing behavioral science. Multidisciplinary collaborations are needed between the technology industry and academia, and among researchers in biomedical, behavioral, pedagogical, and computer science disciplines. Research priorities and funding opportunities for use of VR to improve prevention and management of obesity and diabetes can be found at agency websites (National Institutes of Health: http://grants.nih.gov/grants/guide/index.html; Department of Defense: www.tatrc.org).     

Uses of a dedicated 3D reconstruction software with augmented and mixed reality in planning and performing advanced liver surgery and living donor liver transplantation (with videos)

The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics, virtual surgery simulation and using the created scenarios in real-time surgery using mixed reality. In this article, we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver transplantation. Furthermore, we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.     

Video games for diabetes self-management: examples and design strategies

The July 2012 issue of the Journal of Diabetes Science and Technology includes a special symposium called "Serious Games for Diabetes, Obesity, and Healthy Lifestyle." As part of the symposium, this article focuses on health behavior change video games that are designed to improve and support players' diabetes self-management. Other symposium articles include one that recommends theory-based approaches to the design of health games and identifies areas in which additional research is needed, followed by five research articles presenting studies of the design and effectiveness of games and game technologies that require physical activity in order to play. This article briefly describes 14 diabetes self-management video games, and, when available, cites research findings on their effectiveness. The games were found by searching the Health Games Research online searchable database, three bibliographic databases (ACM Digital Library, PubMed, and Social Sciences Databases of CSA Illumina), and the Google search engine, using the search terms "diabetes" and "game." Games were selected if they addressed diabetes self-management skills.     

脊柱疾病虚拟手术系统的初步研究

目的 建立基于64排CT图像数据的计算机辅助三维立体脊柱手术模拟系统,为术前进行精确设计手术方案及达到术后良好效果提供真实可靠依据.方法 对人体64排CT切片数据进行感兴趣区域图像分割和边缘提取,采用面绘制技术对提取的轮廓序列进行三维数据生成,建立适用于虚拟手术的脊柱三维重建模型,采用Freeform虚拟手术软件和Phantom力反馈系统,初步以腰椎间盘突出后路减压椎间盘摘除术为例,进行虚拟手术,并且以动态动画形式演示.结果 初步建立了脊柱疾病虚拟手术系统,完成了腰椎后路椎间盘摘除虚拟手术模型,以动态形式成功演示了椎间盘突出手术仿真模拟,手术过程真实逼真,立体可视化效果好,并可进行反复演练,预测手术效果.结论 腰椎三维立体可视化模拟手术系统的建立,为腰椎术前手术方案制定提供实用有效的技术手段和全新的科学方法 .     

虚拟现实技术辅助胸部战创伤分级救治模式

基于现代战争胸部外伤伤情特点和战伤分级救治理论,本文提出利用虚拟现实技术(virtual reality,VR)辅助建立胸部战伤分级救治模式.VR具有提供沉浸式和交互式体验、规避安全风险等优势,利用VR设计个性化胸部战伤案例,在分级救治不同的阶段对伤情评估、诊断和处置进行培训和考核,更有利于提高野战条件下战士及卫生人员...     

New directions in the use of virtual reality for food shopping: marketing and education perspectives

Virtual reality is used in marketing research to shape food selection and purchase decisions. Could it be used to counteract the marketing of less-nutritious foods and teach healthier food selection? This article presents interviews with Raymond Burke, Ph.D., of Indiana University Bloomington, and Rachel Jones, M.P.H., of the University of Utah College of Health. Topics covered include new marketing research technologies, including virtual reality simulations; retailing and shopper behavior; and the use of virtual grocery stores to help students explore quality of diet and food/nutrient relationships. The interviewees discuss how the technologies they have developed fit into research and behavior change related to obesity and diabetes.     

Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities

BackgroundVirtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans’ access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act impact how the VHA provides care. Research on ways to refine virtual care delivery models to meet the needs of veterans, clinicians, and VHA stakeholders is needed.ObjectiveGiven the importance of virtual approaches for increasing access to high-quality VHA care, in December 2019, we convened a Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to consider challenges to virtual care research and practice across the VHA, discuss novel approaches to using and evaluating virtual care, assess perspectives on virtual care, and develop priorities to enhance virtual care in the VHA.MethodsWe used a participatory approach to develop potential priorities for virtual care research and activities at the VHA. We refined these priorities through force-ranked prioritization and group discussion, and developed solutions for selected priorities.ResultsThink Tank attendees (n = 18) consisted of VHA stakeholders, including operations partners (e.g., Office of Rural Health, Office of Nursing Services, Health Services Research and Development), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers. We identified an initial list of fifteen potential priorities and narrowed these down to four. The four priorities were (1) scaling evidence-based practices, (2) centralizing virtual care, (3) creating high-value care within the VHA with virtual care, and (4) identifying appropriate patients for virtual care.ConclusionOur Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within the VHA. We brought together research and operations stakeholders and identified possibilities, partnerships, and potential solutions for virtual care.KEY WORDS: telemedicine, implementation science, health services research, delivery of health care     

Interview: Lessons from a Leader in Telehealth Diffusion: A Conversation with Adam Darkins of the Veterans Health Administration

The Veterans Health Administration (VHA) is one of the world leaders in using telehealth to promote independent living for its patient population. The VHA’s model uses a care coordinator who supports and monitors a panel of 100–150 patients, with a focus on empowering patients to take roles in self-management. VHA’s telehealth program has resulted in successful outcomes including patient satisfaction and reductions in bed days of care and hospital admissions. Adam Darkins, M.D., MPMH, FRCS, identifies key drivers that have led to the organization’s successful implementation of telehealth for patients with chronic illnesses: dedicated senior leadership, the presence of an electronic health record, operational innovation, and a desire to avoid higher-cost institutional care for patients. Looking forward, Dr. Darkins expects that telehealth will continue to create an environment in which people are motivated, engaged, and feel responsible for their own health. Dr. Darkins stresses that the opportunity is not in making more advanced technological breakthroughs, but rather in consolidating what is currently available and developing a coherent strategic vision for the future of health care. The VHA’s success in telehealth implementation is a result of the organization’s ability to connect its vision, strategy, and technology; this success can serve as a blueprint for the nation as it moves forward on health technology adoption.     

Digital Connectivity: The Sixth Vital Sign

Digital health and telehealth connectivity have become important aspects of clinical care. Connected devices, including continuous glucose monitors and automated insulin delivery systems for diabetes, are being used increasingly to support personalized clinical decisions based on automatically collected data. Furthermore, the development, demand, and coverage for telehealth have all recently expanded, as a result of the COVID-19 pandemic. Medical care, and especially diabetes care, are therefore becoming more digital through the use of both connected digital health devices and telehealth communication. It has therefore become necessary to integrate digital data into the electronic health record and maintain personal data confidentiality, integrity, and availability. Connected digital monitoring combined with telehealth communication is known as virtual health. For this virtual care paradigm to be successful, patients must have proper skills, training, and equipment. We propose that along with the five current vital signs of blood pressure, pulse, respiratory rate, temperature, and pain, at this time, digital connectivity should be considered as the sixth vital sign. In this article, we present a scale to assess digital connectivity.     

Virtual and Augmented Reality in Cardiovascular Care: State-of-the-Art and Future Perspectives

Applications of virtual reality (VR) and augmented reality (AR) assist both health care providers and patients in cardiovascular education, complementing traditional learning methods. Interventionalists have successfully used VR to plan difficult procedures and AR to facilitate complex interventions. VR/AR has already been used to treat patients, during interventions in rehabilitation programs and in immobilized intensive care patients. There are numerous additional potential applications in the catheterization laboratory. By using AR, interventionalists could combine visual fluoroscopy information projected and registered on the patient body with data derived from preprocedural imaging and live fusion of different imaging modalities such as fluoroscopy with echocardiography. Persistent technical challenges to overcome include the integration of different imaging modalities into VR/AR and the harmonization of data flow and interfaces. Cybersickness might exclude some patients and users from the potential benefits of VR/AR. Critical ethical considerations arise in the application of VR/AR in vulnerable patients. In addition, digital applications must not distract physicians from the patient. It is our duty as physicians to participate in the development of these innovations to ensure a virtual health reality benefit for our patients in a real-world setting. The purpose of this review is to summarize the current and future role of VR and AR in different fields within cardiology, its challenges, and perspectives.     

Using virtual reality to improve walking post-stroke: translation to individuals with diabetes

Use of virtual reality (VR) technology to improve walking for people post-stroke has been studied for its clinical application since 2004. The hardware and software used to create these systems has varied but has predominantly been constituted by projected environments with users walking on treadmills. Transfer of training from the virtual environment to real-world walking has modest but positive research support. Translation of the research findings to clinical practice has been hampered by commercial availability and costs of the VR systems. Suggestions for how the work for individuals post-stroke might be applied and adapted for individuals with diabetes and other impaired ambulatory conditions include involvement of the target user groups (both practitioners and clients) early in the design and integration of activity and education into the systems.     

Disease prevention and the CDC. Interview by C. Burns Roehrig

As director of the Centers for Disease Control (CDC) in Atlanta, William L. Roper, MD, leads the agency of the U.S. Public Health Service responsible for promoting health and preventing disease, injury and premature death. Before coming to CDC in March of 1990, Dr. Roper, a pediatrician, served as a health care adviser for two presidents throughout the 1980s and as head of the Health Care Financing Administration (HCFA) from 1986 to 1989. Reflecting recently on the various roles he has played, Dr. Roper spoke with C. Burns Roehrig, MD, editor of The Internist: Health Policy in Practice about the CDC and its efforts to prevent the spread of AIDS, hepatitis and other diseases.     

Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare

Racial–ethnic minorities receive lower quality and intensity of health care compared with whites across a wide range of preventive, diagnostic, and therapeutic services and disease entities. These disparities in health care contribute to continuing racial–ethnic disparities in the burden of illness and death. Several national medical organizations and the Institute of Medicine have issued position papers and recommendations for the elimination of health care disparities. However, physicians in practice are often at a loss for how to translate these principles and recommendations into specific interventions in their own clinical practices. This paper serves as a blueprint for translating principles for the elimination of racial–ethnic disparities in health care into specific actions that are relevant for individual clinical practices. We describe what is known about reducing racial–ethnic disparities in clinical practice and make recommendations for how clinician leaders can apply this evidence to transform their own practices. Funding: Drs. Washington (#RCD-00-017), Saha (#RCD-00-028), and Moody (#RCD-03-183) are supported by grants from the Department of Veterans Affairs, Health Services Research and Development Service. Dr. Saha is supported by a Generalist Physician Faculty Scholar award from the Robert Wood Johnson Foundation. Drs. Horowitz (#P60 MD00270) and Brown (#P20MD00148) are supported by grants from the National Center on Minority Health and Health Disparities. Dr. Brown also received support from the University of California, Los Angeles, Resource Center in Minority Aging Research (#AG02004) and the Beeson Career Development Award (#AG26748). Dr. Cooper is supported by a grant from the National Heart, Lung, and Blood Institute (K24HL083113).     

Virtual reality and interactive digital game technology: new tools to address obesity and diabetes

The convergence of the exponential advances in virtual reality (VR)-enabling technologies with a growing body of clinical research and experience has fueled the evolution of the discipline of clinical VR. This article begins with a brief overview of methods for producing and delivering VR environments that can be accessed by users for a range of clinical health conditions. Interactive digital games and new forms of natural movement-based interface devices are also discussed in the context of the emerging area of exergaming, along with some of the early results from studies of energy expenditure during the use of these systems. While these results suggest that playing currently available active exergames uses significantly more energy than sedentary activities and is equivalent to a brisk walk, these activities do not reach the level of intensity that would match playing the actual sport, nor do they deliver the recommended daily amount of exercise for children. However, these results provide some support for the use of digital exergames using the current state of technology as a complement to, rather than a replacement, for regular exercise. This may change in the future as new advances in novel full-body interaction systems for providing vigorous interaction with digital games are expected to drive the creation of engaging, low-cost interactive game-based applications designed to increase exercise participation in persons at risk for obesity.     

Political and economic aspects of the transition to universal health coverage

Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care--in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.     

Development of and Feedback on a Fully Automated Virtual Reality System for Online Training in Weight Management Skills

Virtual reality (VR) technology can provide a safe environment for observing, learning, and practicing use of behavioral weight management skills, which could be particularly useful in enhancing minimal contact online weight management programs. The Experience Success (ES) project developed a system for creating and deploying VR scenarios for online weight management skills training. Virtual environments populated with virtual actors allow users to experiment with implementing behavioral skills via a PC-based point and click interface. A culturally sensitive virtual coach guides the experience, including planning for real-world skill use. Thirty-seven overweight/obese women provided feedback on a test scenario focused on social eating situations. They reported that the scenario gave them greater skills, confidence, and commitment for controlling eating in social situations.     

Incorporating TechQuity in Virtual Care Within the Veterans Health Administration: Identifying Future Research and Operations Priorities

BackgroundThe Covid-19 pandemic dramatically changed healthcare delivery, driving rapid expansion of synchronous (i.e., real-time) audio-only and video telehealth, otherwise known as virtual care. Yet evidence describes significant inequities in virtual care utilization, with certain populations more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policies and processes to counteract current inequities in access and health outcomes.ObjectiveGiven the importance of incorporating equity into virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused on achieving equitable implementation of virtual care within the VHA.MethodsWe used participatory activities to engage clinicians, researchers, and operational partners from across the VHA to develop priorities for equitable implementation of virtual care. We refined priorities through group discussion and force-ranked prioritization and outlined next steps for selected priorities.Key ResultsThink Tank participants included 43 individuals from the VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified their associations primarily as operations (n = 9), research (n = 28), or both (n = 6). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priority areas: (1) measure inequities in virtual care, (2) address emerging inequities in virtual care, (3) deploy virtual care equitably to accommodate differently abled veterans, and (4) measure and address potential adverse consequences of expanded virtual care. We discuss related information, data, key partners, and outline potential next steps.ConclusionsThis Think Tank of research and operational partners from across the VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Although much work remains, the priorities identified represent important steps toward achieving this vital goal.KEY WORDS: delivery of healthcare, telemedicine, health equity, veterans, health services research     

The Brazilian health system: history, advances, and challenges

Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unified Health System. A defining characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unified Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined.     

To diet or not if you have inflammatory bowel disease

Liver surgery remains a difficult challenge in which preoperative data analysis and strategy definition may play a significant role in the success of the procedure. Medical image processing led to a major improvement of patient care by guiding the surgical gesture. From this initial data, new technologies of virtual reality and augmented reality can increase the potential of such images. The 3D modeling of the liver of patients from their CT scan or MRI thus allows an improved surgical planning. Simulation allows the procedure to be simulated preoperatively and offers the opportunity to train the surgical gesture before carrying it out. These three preoperative steps can be used intraoperatively thanks to the development of augmented reality, which consists of superimposing the preoperative 3D modeling of the patient onto the real intraoperative view of the patient and his/her organs. Augmented reality provides surgeons with a transparent view of the patient. This facilitated the intraoperative identification of the vascular anatomy and the control of the segmental arteries and veins in liver surgery, thus preventing intraoperative bleeding. It can also offer guidance due to the virtual improvement of their real surgical tools, which are tracked in real-time during the procedure. During the surgical procedure, augmented reality, therefore, offers surgeons a transparent view of their patient, which will lead to the automation of the most complex maneuvers. The new ways of processing and analyzing liver images have dramatically changed the approach to liver surgery.