Virtual Reality and Social Work

Virtual reality in social work education and practice is relatively new. There is not a large literature on it—note that several of the resources below are authored by the same colleagues. Given the rapid evolution of the technologies, there are limited resources in terms of works within the last fifteen years. Juried resources published by recognized experts are provided. There are basically two distinct forms. First, we have virtual worlds such as Second Life where controlled avatars explore simulated environments. Virtual worlds can be quite varied and rich in visual content. Complete creation of hospitals, service agencies, schools, and places of worship are possible. Support groups for a variety of problems and ability challenges can regularly meet “in world.” Participation is usually synchronous. Most virtual worlds are accessible via personal computers. Participation costs are generally absent. Virtual worlds are not “games” but instead are platforms in which games may be played, role plays may be staged, classes and seminars held. The second virtual reality technology is generally found in laboratory settings. Participants don 3D helmets or goggles and explore environments that are computer-based. Purposes for creating and establishing these environments vary. For example, people suffering from PTSD can explore and relive traumatic events with therapeutic guidance towards symptom relief. As in the case of virtual worlds, lab-based simulations are usually synchronous. Just as avatars may interact with each other, lab-based experiences can include multiple participants. Each of these technologies offers promise for social work education and practice. Students in distance education can work together even when separated by oceans. Students can engage in service evaluation in virtual worlds. Students can learn about addiction triggers through creating the 3D environments that have modeled them. Both formats may be termed multi-user virtual environments (MUVEs) though terms vary. Of interest, if one looks at this bibliography as a data sample, educational uses tend to be through virtual worlds while practice uses may tend to be more in laboratory settings. The opening section discusses critical professional issues that may apply to using virtual reality innovations in social work. The next sections take up educational and practice applications. Articles that predominantly address research issues follow. Finally, resources for developing virtual world experiences are provided.

A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services

Aims and method This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Results Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. Clinical implications New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19

Background Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Results 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction ( p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusions In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.

A service evaluation examining the requirement for Level 2 critical care in a major trauma centre

Critical care provision is fundamental in all developed health systems in which severe disease and injury is managed. This is especially true in major trauma centres and high-acuity establishments, where acutely unstable patients can be admitted at any time, requiring clinical monitoring and interventions appropriate for their burden of illness. This single-centre, prospective service evaluation applied validated scoring systems to a surgical population, sampling and following those considered “high-risk” through to discharge or death, alongside all intensive care unit (ICU) admissions during 2019. Primarily we aimed to quantify the number of patients objectively suitable for Level 2 critical care, conventionally provided in a high-dependency unit (HDU) setting. Secondary outcome measures included ICU readmission rate, in-hospital mortality, and delays to ICU admission and discharge. Of the “high-risk” surgical patients, more than eight per week were found to have peri-operative Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) scores that would advocate critical care admission. Only one individual received scheduled peri-operative critical care. Post-operative mortality in this group was 6.1%, though none of these patients was admitted to ICU prior to death. There were 605 ICU admissions in 2019, with 32.1% of admitted days spent at the equivalent of Level 2 critical care, which could have been administered in a HDU if one was available. The ICU readmission rate was 6.45%. This data demonstrates substantial unmet critical care needs, with patients not uncommonly managed in clinically inappropriate areas for extended periods due to delays accessing ICU. A designated HDU may mitigate clinical risk from this subgroup, reducing morbidity and in-hospital mortality, and this methodology for assessing requirements could be used in other similar institutions.

A single centre service evaluation of the pre-biopsy mpMRI pathway for prostate cancer diagnosis

Aim: To study the efficacy and impact of the local pre-biopsy multiparametric magnetic resonance imaging (mpMRI) pathway for prostate cancer diagnosis. Methods: In this tertiary centre, 570 patients had prostate mpMRI across a 6-month period in 2019. A total of 511 patients met inclusion criteria for retrospective analysis. MRI reporting used the Prostate Imaging-Reporting and Data System (PI-RADS) v2.1. These were assessed alongside histological outcomes and diagnostic times. PI-RADS ⩾ 3 were recommended for biopsy consideration. Gleason scoring ⩾ 3 + 4 and 3 + 3 were used to define clinically and non-clinically significant prostate cancer (csPCa and nsPCa), respectively. Results: Overall prostate cancer prevalence was 40% (204/511, csPCa in 31.1%) with an overall biopsy avoidance of 32.1% (164/511). Around 69.7% (356/511) scored PI-RADS ⩾ 3 and 30.3% (155/511) scored PI-RADS 1–2. About 22.6% (35/155) of PI-RADS 1–2 patients proceeded to biopsy, demonstrating a negative predictive value of 91.43% for csPCa. For PI-RADS ⩾ 3 patients, 63.4% (197/312) of those biopsied had cancer (Gleason ⩾ 3 + 3), with 50% (156/312) demonstrating csPCa. Around 76.7% (102/133) of PI-RADS 5, 35.3% (48/136) of PI-RADS 4, 14.0% (6/43) of PI-RADS 3 and 8.6% (3/35) of PI-RADS 1–2 scores demonstrated csPCa. Overall median prostate-specific antigen (PSA) density was 0.15 ng/mL2 (IQR: 0.10–0.27/mL2). PSA density were significantly different across PI-RADS cohorts ( H = 118.8, p < 0.0001) and across all three biopsy outcomes ( H = 99.72, p < 0.0001). Only 34.3% (119/347) of biopsied patients met the NHS 28-day standard. MRI acquisition and reporting met the 14-day local standard in 96.1% (491/511). The biopsy was the most delayed component with a median of 20 days (IQR: 8–43). Conclusion: Pre-biopsy mpMRI with PI-RADS scoring safely avoided biopsy in almost one-third (32.1%) of patients. The use of PSA-density in risk stratifying PI-RADS 3 lesions has informed local practice in the period 2020–2021, with implementation of a PSA-density threshold of 0.12 ng/mL2. Biopsy scheduling issues and anaesthetic requirements need to be overcome to improve diagnostic waiting times. Level of evidence: 2

The Terms of “You(s)”: How the Term of Address Used by Conversational Agents Influences User Evaluations in French and German Linguaculture

Background: Conversational agents (CAs) are a novel approach to delivering digital health interventions. In human interactions, terms of address often change depending on the context or relationship between interlocutors. In many languages, this encompasses T/V distinction—formal and informal forms of the second-person pronoun “You”—that conveys different levels of familiarity. Yet, few research articles have examined whether CAs' use of T/V distinction across language contexts affects users' evaluations of digital health applications.Methods: In an online experiment (N = 284), we manipulated a public health CA prototype to use either informal or formal T/V distinction forms in French (“tu” vs. “vous”) and German (“du” vs. “Sie”) language settings. A MANCOVA and post-hoc tests were performed to examine the effects of the independent variables (i.e., T/V distinction and Language) and the moderating role of users' demographic profile (i.e., Age and Gender) on eleven user evaluation variables. These were related to four themes: (i) Sociability, (ii) CA-User Collaboration, (iii) Service Evaluation, and (iv) Behavioral Intentions.Results: Results showed a four-way interaction between T/V Distinction, Language, Age, and Gender, influencing user evaluations across all outcome themes. For French speakers, when the informal “T form” (“Tu”) was used, higher user evaluation scores were generated for younger women and older men (e.g., the CA felt more humanlike or individuals were more likely to recommend the CA), whereas when the formal “V form” (“Vous”) was used, higher user evaluation scores were generated for younger men and older women. For German speakers, when the informal T form (“Du”) was used, younger users' evaluations were comparable regardless of Gender, however, as individuals' Age increased, the use of “Du” resulted in lower user evaluation scores, with this effect more pronounced in men. When using the formal V form (“Sie”), user evaluation scores were relatively stable, regardless of Gender, and only increasing slightly with Age.Conclusions: Results highlight how user CA evaluations vary based on the T/V distinction used and language setting, however, that even within a culturally homogenous language group, evaluations vary based on user demographics, thus highlighting the importance of personalizing CA language.

National Webinar on Philosophy and Psychological Review of Thinking Disposition

In addition to the ability to think, students need a thinking disposition to succeed in learning. However, the results of preliminary research indicate that the knowledge of prospective teachers, teachers, and lecturers is still low on thinking dispositions. Therefore, this problem can be solved by conducting a national webinar on dispositions of thinking. Thus, the purpose of this service is to provide participants with an understanding of the philosophical and psychological dispositions of thinking. This service method is in the form of a national webinar, which is a seminar held online. This webinar activity is divided into three stages, namely the material presentation stage, the question and answer stage, and the community service evaluation stage. The results of this community service evaluation show that the percentage of the results of filling out the questionnaire is 81% which means that it is in the very high category. This means that this national webinar activity was very successful in understanding the participants towards a philosophical and psychological review of thinking dispositions. This success is supported by the availability of material, internet signals, and the ability of the presenters to convey the material. Apart from that, there are also inhibiting factors in this seminar activity, namely inadequate material delivery time, signal constraints, and too many presenters.

Clinical Outcomes of a Primary Care Liaison Psychiatry Service for Patients with Complex Persistent Physical Symptoms.

Background: Patients with Persistent Physical Symptoms (PPS) may have chronic physical disorders such as diabetes, COPD, Crohn’s, MS and/or ongoing medically unexplained symptoms, and in either case there can be both physical and [psychiatric aetiologies combined. Such co-morbidity tends to be chronic and hard to manage in any healthcare setting and therefore frequent attendance in healthcare settings is present for these patients. We rolled out a primary care based integrated multidisciplinary liaison psychiatry team to 3 CCG areas in Nottinghamshire in October 2019 to see this patient group and have taken patient reported outcome measures from baseline up to 15 months later as part of normal service evaluation. Results: We show here that there are clinically relevant and statistically significant improvements in depressive symptoms (PHQ-9), anxiety symptoms (GAD-7) and physical symptoms (PHQ-15). The improvements in the EQ-5D-5L shows that in a whole health measure there are significant improvements over all and specifically in the anxiety/depression and usual activity domains. Conclusion: This is clinically very relevant especially when seen in the context that these results were achieved despite a pandemic affecting the whole population. This model is scalable and integrated providers should look to implement it.