The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.
- Klíčová slova
- Cold River,
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- mladý dospělý MeSH
- pacienti psychologie MeSH
- popálení * ošetřování psychologie terapie MeSH
- postoj zdravotnického personálu MeSH
- senioři MeSH
- terapie pomocí virtuální reality * metody přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- lidé MeSH
- management bolesti ekonomika metody MeSH
- popálení * ošetřování terapie MeSH
- terapie pomocí virtuální reality * ekonomika metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
INTRODUCTION: Patients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries. MATERIAL AND METHODOLOGY: A prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period. MEASUREMENTS AND MAIN RESULTS: Daily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change -33 [95 % CI: -292;+227] kcal .24 h-1, p = 0.79), nitrogen balance (+2.0 [95 % CI: -3.1;+7.1] g N .1.73 m-2 BSA .24 h-1), or insulin sensitivity (mean change of insulin-mediated glucose disposal -0.33 [95 % CI: -1.18;+0.53] mmol.h-1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected. CONCLUSIONS: Compared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.
- MeSH
- dospělí MeSH
- energetický metabolismus * fyziologie MeSH
- fyzioterapie (techniky) MeSH
- inzulinová rezistence fyziologie MeSH
- klinické křížové studie * MeSH
- kosterní svaly * metabolismus patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nepřímá kalorimetrie MeSH
- popálení * metabolismus terapie rehabilitace patofyziologie komplikace MeSH
- povrch těla MeSH
- propriocepce fyziologie MeSH
- prospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Klíčová slova
- Abilar,
- MeSH
- dekubity terapie MeSH
- dermatologické látky * MeSH
- hojení ran * MeSH
- lidé středního věku MeSH
- masti MeSH
- péče o kůži metody MeSH
- popálení terapie MeSH
- rostlinné pryskyřice MeSH
- senioři MeSH
- smrk MeSH
- Check Tag
- lidé středního věku MeSH
- senioři MeSH
- Publikační typ
- inzerce MeSH
- kazuistiky MeSH
Termický úraz je jedno z najzávažnejších zranení v traumatológii. Popáleniny nesú so sebou veľa rizík, z ktorých najzávažnejšie je ohrozenie života a v neposlednom rade trvalé následky. Hlavnou klasifikáciou popálenín je rozdelenie na dve skupiny podľa hĺbky poranenia. Hĺbka určuje aj následný spôsob ošetrenia popálenej plochy. Povrchové popáleniny ošetrujeme konzervatívnym postupom, hlboké popáleniny si vyžadujú často chirurgický prístup. Špecifickou skupinou sú detskí pacienti. Liečba popálenín v Českej republike pozostáva zo siete tvorenej tromi špecializovanými popáleninovými centrami (Praha, Brno, Ostrava), ktoré hospitalizujú pacientov s najzávažnejšími termickými úrazmi z celej ČR i zahraničia. Menej závažné prípady popálených pacientov môžu byť ošetrované cestou spádových chirurgických ambulancií.
Thermal injuries belong to the most severe ones in traumatology. Burn injuries pose numerous risks, the most critical ones are life-threatening and potentially resulting in permanent damage. The main classification of burn injuries is based on the depth of the injury, which determines the appropriate treatment method. Superficial burns are typically treated conservatively, while deep burns often require surgical intervention. Children represent a very specific group of burn patients. In the Czech Republic, burn injury treatment is centralized in three specialized burn centres (Prague, Brno, Ostrava) that hospitalize patients with the most severe thermal injuries from the whole country and abroad. Less serious thermal burns can be treated at local surgery departments.
Virtuálna realita (VR) predstavuje zlom v pediatrickej starostlivosti o popáleniny, poskytujúc inovatívne riešenia nielen v akútnej liečbe, ale aj v rehabilitácii. Distrakčná terapia, osvedčený psychologický fenomén, tvorí základ účinnosti VR. Vedecké štúdie neustále potvrdzujú, že pohlcujúce zážitky VR dokážu odvrátiť pozornosť dieťaťa od bolestivých procedúr, čím sa znižuje vnímaná intenzita bolesti. VR je tiež dôležitým nefarmakologickým doplnkom, ktorý je v súlade s prístupmi založenými na dôkazoch a poskytuje vedecky podloženú alternatívu a doplnkovú liečbu k farmakologickým stratégiám zvládania bolesti. Vedecké štúdie u detí podstupujúcich rehabilitáciu popálenín ukazujú, že cvičenia s podporou VR prispievajú k zlepšeniu rozsahu pohybu, koordinácie a funkčných výsledkov. Prispôsobivosť aplikácií VR umožňuje vytváranie personalizovaných rehabilitačných plánov, ktoré sú prispôsobené individuálnym potrebám každého dieťaťa. Našim cieľom bolo primárne predstaviť recentné práce týkajúce sa využitia VR v starostlivosti o popálených pacientov a to najmä pri starostlivosti o rany a v rehabilitácii po popáleninách a poukázať na to, čo z nich vyplýva v kontexte vplyvu VR ako doplnku farmakologickej liečby na zníženie bolesti.
Virtual reality (VR) represents a breakthrough in pediatric burn care, providing in- novative solutions not only in acute treatment, but also in rehabilitation. Distractive therapy, a proven psychological phenomenon, underlies the effectiveness of VR. Scientific studies have consistently confirmed that immersive VR experiences can divert a child's attention from painful procedures, thus reducing the perceived intensity of pain. VR also serves as an important non-pharmacological adjunct that is aligned with evidence-based approaches and provides sci- entifically-based alternative and complementary treatment to pharmacological pain management strategies. Scientific studies in children undergoing burn rehabilitation demonstrate that VR-supported exercises contribute to improving range of motion, coordination, and functional outcomes. The adaptability of VR applications allows the creation of personalized rehabilitation plans tailored to the individual needs of each child. Our goal was primarily to introduce recent works regarding the use of VR in the care of patients with burns, particularly in wound care and rehabilitation after burns, and to highlight their implications in the context of the impact of VR as an adjunct to pharmacological treatment for pain reduction.
- MeSH
- akutní bolest etiologie klasifikace psychologie terapie MeSH
- bolest klasifikace psychologie MeSH
- dítě MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- management bolesti metody MeSH
- pediatrie metody MeSH
- popálení * diagnóza klasifikace psychologie terapie MeSH
- rány a poranění klasifikace psychologie terapie MeSH
- rehabilitace metody psychologie MeSH
- virtuální realita * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American and European adults, specifically mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. In total, 54 studies were included, pooling 60 269 adult patients. A total of 53 896 patients were in North America (NA, 89.4%), and 6373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI, 8%-19%) for moderate burns, 20% (95% CI, 12%-29%) for severe burns in the NA region, and 22% (95% CI, 16%-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for patients with moderate and severe burns at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs 37%) and shock (29% vs 35%) were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for patients with severe burns in Europe and 31.02 days for patients with severe burns in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.
- MeSH
- lidé MeSH
- popálení * mortalita terapie MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
- Geografické názvy
- Evropa MeSH
- Severní Amerika MeSH
- MeSH
- dermatologické látky terapeutické užití MeSH
- dospělí MeSH
- hojení ran * MeSH
- komorbidita MeSH
- lidé MeSH
- neurochirurgické výkony MeSH
- péče o kůži metody MeSH
- popálení * terapie MeSH
- spondylóza chirurgie MeSH
- synoviální cysta chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- Abilar,
- MeSH
- dekubity terapie MeSH
- dermatologické látky * terapeutické užití MeSH
- hojení ran * MeSH
- lidé středního věku MeSH
- lidé MeSH
- masti terapeutické užití MeSH
- péče o kůži metody MeSH
- popálení terapie MeSH
- rostlinné pryskyřice terapeutické užití MeSH
- senioři MeSH
- smrk MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- inzerce MeSH
- kazuistiky MeSH
