The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

• MeSH
• COVID-19 * epidemiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Pandemics * MeSH
• Delivery of Health Care organization & administration   MeSH
• Surveys and Questionnaires MeSH
• Interviews as Topic MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Telemedicine * organization & administration   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: This study examines the perspectives of individuals with coronary heart disease (CHD) on a nurse-led eHealth cardiac rehabilitation (NeCR) program, which included a website, tele-monitoring device, and social media chatroom. METHODS: Using a descriptive qualitative approach, semi-structured interviews were conducted with 18 participants to capture their feedback and experiences with the NeCR program. RESULTS: Participants found the NeCR program valuable in addressing gaps in cardiac rehabilitation services in China, empowering them to make behavioral changes and enhancing their social motivation. However, they also highlighted the need for a more user-friendly website, better symptom management during exercise, and stronger privacy protections in the peer networking chatroom. The study concludes that the NeCR program is feasible in providing accessible rehabilitative services at home post-discharge. Recommendations include improving the self-monitoring platform for ease of use, incorporating immediate symptom management guidance during exercise, and ensuring a secure environment for online peer support. CONCLUSIONS: These findings offer crucial insights for developing patient-centered eHealth cardiac rehabilitation services, emphasizing the importance of user-friendly design, effective symptom management features, and privacy protection in promoting participant engagement with e-platforms. TRIAL REGISTRATION: ChiCTR1800020411 (http://www.chictr.org.cn/showprojen.aspx?proj=33906).

• MeSH
• Adult MeSH
• Cardiac Rehabilitation * methods   MeSH
• Coronary Disease rehabilitation   nursing   MeSH
• Qualitative Research * MeSH
• Middle Aged MeSH
• Humans MeSH
• Interviews as Topic MeSH
• Aged MeSH
• Telemedicine * MeSH
• Feedback MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• China MeSH

Navrhovaná studie proveditelnosti využívá aplikaci „OCD dům“, vytvořenou v prostředí virtuální reality (VR) pro expoziční terapii u pacien- tů s obsedantně-kompulzivní poruchou (OCD). Metoda byla vyvinuta na základě dimenzionálního přístupu k symptomatologii OCD, který vyčleňuje čtyři podtypy: „kontaminace/čištění“, „symetrie/uspořádání“, „strach z poškození/kontrola“ a „hromadění“. Cílem probíhající studie proveditelnosti je ověřit účinnosti již dříve validované expoziční metody ve spojení s čichovou stimulací. Předpokládáme, že čichová stimulace během expozice ve VR zvýší vnímanou realističnost a potenciálně také intenzitu symptomů vyvolaných touto čichově obohacenou simulací.

The proposed feasibility study uses the application "OCD house" created in a virtual reality (VR) environment for exposure therapy in pati- ents with obsessive-compulsive disorder (OCD). The method was designed based on a dimensional approach to OCD symptomatology, which distinguishes four subtypes: 'contamination/cleaning', 'symmetry/ordering', 'fear of harm/checking' and 'hoarding'. An ongoing feasibility study aims to test the previously validated exposure method in combination with olfactory stimulation. We hypothesize that olfactory stimu- lation during exposure in VR will increase the perceived level of immersion in the environment and potentially also the assessed intensity of symptoms induced by this olfactory-enriched simulation.

PURPOSE: Extranodal extension (ENE) increases the risk of recurrence and death in head and neck squamous cell carcinoma (HNSCC) patients and is an indication for treatment escalation. Histopathology forms the mainstay of diagnosing ENE. There is substantial variation in the diagnosis of ENE and related terminology. Harmonising the diagnostic criteria for ENE was identified as a priority by the Head and Neck Consensus Language for Ease of Reproducibility (HN CLEAR) Steering Committee and its global stakeholders. METHODS: An international working group including 16 head and neck pathologists from eight countries across five continents evaluated whole slide images of haematoxylin and eosin-stained sections depicting potential diagnostic problems through nine virtual meetings to develop consensus guidelines. RESULTS: ENE should be diagnosed only when viable carcinoma extends through the primary lymph node (LN) capsule and directly interacts with the extranodal host environment with or without desmoplastic stromal response. Identifying the original LN capsule and reconstruction of its contour can assist in the detection and assessment of ENE. The term matting is recommended for confluence of two or more nodes due to histologically identifiable tumour extending from one LN to another. Matting constitutes major form of ENE. On the other hand, the terms fusion/adhesion/confluence/conglomeration and other synonyms of adhesion should be limited to confluence due to fibrosis or inflammation without histologically identifiable tumour between involved lymph nodes. Tumour extension along narrow needle tracks or spillage of cyst contents following an FNA do not constitute ENE. CONCLUSIONS: The consensus recommendations encompassing the definition of ENE, macroscopic and histologic examination of lymph nodes (LN) and practical guidelines for handling challenging cases are provided.

• MeSH
• Squamous Cell Carcinoma of Head and Neck * pathology   diagnosis   MeSH
• Extranodal Extension * pathology   MeSH
• Consensus MeSH
• Humans MeSH
• Head and Neck Neoplasms * pathology   diagnosis   MeSH
• Terminology as Topic * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Letter MeSH

INTRODUCTION: Upper limb (UL) impairment is common in people with multiple sclerosis (pwMS), and functional recovery of the UL is a key rehabilitation goal. Technology-based approaches, like virtual reality (VR), are increasingly promising. While most VR environments are task-oriented, our clinical approach integrates neuroproprioceptive 'facilitation and inhibition' (NFI) principles. To advance this, we developed immersive VR software based on NFI principles targeting UL function and sit-to-stand ability. This study aims to evaluate the effectiveness of this VR therapy compared with conventional NFI-based physical therapy in pwMS. Our study uniquely applies advanced imaging techniques, along with biological molecular assessments, to explore adaptive processes induced by VR rehabilitation. METHODS AND ANALYSIS: This double-arm, randomised, assessor-blinded, controlled trial runs over 2 months (1 hour, 2 times per week). PwMS with mild to severe disability will receive either VR therapy or real-world physical therapy. Primary outcomes include the nine-hole peg test, box and block test, handgrip strength, tremor and five times sit-to-stand test. Secondary measures include the Multiple Sclerosis Impact Scale, the 5-level EQ-5D questionnaire and kinematic analysis. Adaptive processes will be monitored using imaging techniques (functional MRI and tractography), molecular genetic methods (long non-coding RNAs) and immune system markers (leukocytes, dendritic cells). The International Classification of Functioning, Disability and Health brief set for MS will map the bio-psycho-social context of participants. ETHICS AND DISSEMINATION: This project and its amendments were approved by the Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital (1983/21+4772/21 (G-21-02) and the Ethics Committee of Kralovske Vinohrady University Hospital (EK-VP/38/0/2021) in Prague, Czechia (with single enrolment). The findings of this project will be disseminated through scientific publications, conferences, professional networks, public engagement, educational materials and stakeholder briefings to ensure a broad impact across clinical, academic and public domains. TRIAL REGISTRATION NUMBER: clinicaltrials.gov (NCT04807738).

• MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Upper Extremity * physiopathology   MeSH
• Quality of Life * MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Posture MeSH
• Randomized Controlled Trials as Topic MeSH
• Multiple Sclerosis * diagnostic imaging   MeSH
• Hand Strength MeSH
• Physical Therapy Modalities * MeSH
• Virtual Reality Exposure Therapy methods   MeSH
• Virtual Reality MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial Protocol MeSH

Immersive Virtual Reality (iVR) presents a promising avenue for treating acrophobia through Virtual Reality Exposure Therapy (VRET). This paper explores the current state of VRET for acrophobia, identifying significant technological and practical barriers that limit its effectiveness and hinder widespread adoption. Key challenges include the need for more advanced and realistic user experiences, and for the integration of biofeedback mechanisms. Additionally, the role of therapists remains crucial, as therapist-led VRET sessions demonstrate better outcomes compared to automated interventions. The potential of Collaborative Immersive Virtual Environments (CIVEs) to enhance VRET by simulating real-life interactions and improving patient-therapist engagement is also discussed. Future research should focus on developing comprehensive guidelines for CIVE design and evaluating integrated VRET and CIVE systems for treating phobias, including acrophobia. Addressing these issues will enhance the therapeutic experience, making VRET a more effective and accessible tool for treating acrophobia.

• Publication type
• Journal Article MeSH

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.

• Keywords
• Cold River,
• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Pain Management methods   MeSH
• Young Adult MeSH
• Patients psychology   MeSH
• Burns * nursing   psychology   therapy   MeSH
• Attitude of Health Personnel MeSH
• Aged MeSH
• Virtual Reality Exposure Therapy * methods   instrumentation   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Over the past 25 years, the development of multiuser applications has seen considerable advancements and challenges. The technological development in this field has emerged from simple chat rooms through videoconferencing tools to the creation of complex, interactive, and often multisensory virtual worlds. These multiuser technologies have gradually found their way into mental health care, where they are used in both dyadic counseling and group interventions. However, some limitations in hardware capabilities, user experience designs, and scalability may have hindered the effectiveness of these applications. OBJECTIVE: This systematic review aims at summarizing the progress made and the potential future directions in this field while evaluating various factors and perspectives relevant to remote multiuser interventions. METHODS: The systematic review was performed based on a Web of Science and PubMed database search covering articles in English, published from January 1999 to March 2024, related to multiuser mental health interventions. Several inclusion and exclusion criteria were determined before and during the records screening process, which was performed in several steps. RESULTS: We identified 49 records exploring multiuser applications in mental health care, ranging from text-based interventions to interventions set in fully immersive environments. The number of publications exploring this topic has been growing since 2015, with a large increase during the COVID-19 pandemic. Most digital interventions were delivered in the form of videoconferencing, with only a few implementing immersive environments. The studies used professional or peer-supported group interventions or a combination of both approaches. The research studies targeted diverse groups and topics, from nursing mothers to psychiatric disorders or various minority groups. Most group sessions occurred weekly, or in the case of the peer-support groups, often with a flexible schedule. CONCLUSIONS: We identified many benefits to multiuser digital interventions for mental health care. These approaches provide distributed, always available, and affordable peer support that can be used to deliver necessary help to people living outside of areas where in-person interventions are easily available. While immersive virtual environments have become a common tool in many areas of psychiatric care, such as exposure therapy, our results suggest that this technology in multiuser settings is still in its early stages. Most identified studies investigated mainstream technologies, such as videoconferencing or text-based support, substituting the immersive experience for convenience and ease of use. While many studies discuss useful features of virtual environments in group interventions, such as anonymity or stronger engagement with the group, we discuss persisting issues with these technologies, which currently prevent their full adoption.

• MeSH
• Mental Disorders therapy   MeSH
• Mental Health MeSH
• Humans MeSH
• Mental Health Services * MeSH
• Telemedicine MeSH
• Videoconferencing MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Systematic Review MeSH

There is growing interest in virtual reality (VR) training among competitive athletes and casual sports players alike as a tool to supplement real-life play within a highly controlled, intellectually stimulating environment. We examined data from a commercially available, recently released VR software for tennis for changes in and correlates of performance. Two most frequently used tasks were evaluated-Baseline Center and Quick Volley, which include Efficiency (both), Concentration (both), and Reaction Time (Quick Volley only) subtasks. In all, 1,124 (Baseline Center) and 745 (Quick Volley) users met inclusion criteria (completed more than four trials; active sometime between November 2022 and July 2023). We found that most users were male adults and were about evenly split between advanced/pro users and intermediate/beginner users. Two or three trajectories emerged across the subtasks. Performance gains were most pronounced on movement efficiency, especially early on. Adult users generally exhibited more improvement than junior users. Additionally, women and right-handed users improved more on Baseline Center subtasks, and advanced/pro users did better than intermediate/beginner users on Quick Volley subtasks. We discuss that, despite strong performance gains within VR environment, VR training may still reflect in better real-world performance, may increase confidence and accuracy of relevant movement, lower risk of injury, and present a welcome diversion from a potential monotony of performing sport-related tasks in purely real-world settings. Future research should explore the extent to which VR training transfers to real-world performance.

• MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Psychomotor Performance physiology   MeSH
• Athletic Performance * physiology   MeSH
• Tennis * MeSH
• Virtual Reality * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH