Ellen Y. Wang

Background: Virtual reality (VR) reduces pain and anxiety, but influencing factors remain ambiguous. This study evaluated the effect of interactivity within a VR experience on heat pain threshold (HPT), pressure pain threshold (PPT), and immediate and recalled pain and anxiety.Methods: The Stanford Chariot Program conducted this prospective, randomized, crossover clinical trial at Stanford Children’s Hospital Stanford, Stanford Hospital, and Stanford Medical School. Healthy adult participants meeting inclusion criteria were randomized by hand dominance and condition sequence and underwent standardized pain threshold tests with a heat thermode or pressure algometer during active and passive VR conditions. The primary outcome was the impact of active VR on HPT. Secondary outcomes evaluated its effects on PPT, immediate and recalled pain, and immediate and recalled anxiety.Results: 163 total participants were included, 81 who underwent HPT testing and 82 who underwent PPT testing. Active VR increased pain thresholds for both HPT (P = 0.0001) and PPT (P ≤ 0.0001). There was no difference in initial pain scores between VR conditions for HPT (P = 0.63), though there was for PPT (P = 0.006). There was no difference in recalled pain scores for HPT (P = 0.13) or PPT (P = 0.39). Active VR reduced initial and recalled anxiety scores for HPT (P = 0.012, P = 0.002; respectively) and initial anxiety scores for PPT (P = 0.04). Recalled anxiety scores for PPT did not differ (P = 0.32).Conclusions: Active VR improved pain tolerance and anxiety more than passive VR.

Background: In recent years, health systems worldwide have increasingly expanded patient and guardian access to clinical records. While adult patient perspectives on anesthetic records have been explored, little is known about how pediatric guardians interpret and engage with their child's anesthetic documentation. Aims: To explore how guardians of pediatric patients engage with their child's anesthetic record and to identify elements they perceive as meaningful, confusing, or emotionally impactful. Methods: We conducted a qualitative study using semi‐structured video conference interviews between April 2023 and August 2024 with guardians of pediatric patients undergoing outpatient surgery under general anesthesia at a quaternary academic pediatric hospital. Twenty English‐speaking guardians of children classified as American Society of Anesthesiologists Physical Status I–II and receiving anesthesia via endotracheal tube or supraglottic airway were recruited using a semi‐purposive convenience sampling approach. During interviews, guardians reviewed their child's record via screen share and provided real‐time feedback. Interviews were audio‐recorded, transcribed verbatim, and analyzed using inductive and deductive thematic coding until thematic saturation was reached. Results: Guardians identified several elements of the anesthetic record as meaningful, including medications administered, provider involvement, event timelines, and their child's reactions to anesthesia. However, they reported confusion due to unexplained abbreviations, medical jargon, non‐chronological data presentation, unclear visual formatting, and perceived inaccuracies. Interpretation was influenced by guardians' comfort level with health information, emotional state, and considerations unique to pediatric care. Emotional responses ranged from reassurance to anxiety; while some guardians found the record useful for future care planning, others described elements as distressing or difficult to interpret. Conclusions: Guardians face substantial barriers when interpreting pediatric anesthetic records. As patient‐accessible records become increasingly common across health systems globally, improving anesthetic record design is essential. Plain‐language summaries, visual annotations, and pediatric‐specific contextual guidance could improve comprehension, reduce misinterpretation, and facilitate better collaboration between guardians and clinicians during perioperative care.

Introduction: Despite advancements in pharmacological and non-pharmacological strategies, pain and anxiety during needle-related procedures affect most patients. Through activation of large diameter nerve fibers, vibration therapy has been proposed to alleviate pain by minimizing perception of concomitant painful stimuli. This study investigated the effectiveness of a Bluetooth-enabled haptic device (BHD) in reducing pain sensitivity and improving patient satisfaction during needle procedures. Given the frequency of vascular access procedures, from IV catheter placements to phlebotomy, improving patient experience during these encounters is essential. Non-pharmacologic tools like the BHD may enhance vascular access by improving patient cooperation and reducing procedure-related distress. Methods: This was a prospective crossover study conducted at an academic hospital in Northern California. Participants included healthy adults with no history of chronic pain, who underwent a series of pinprick stimuli and different vibration patterns (A, B, C, and D) applied by the BHD. The primary outcome investigated mechanical pain sensitivity, and secondary outcomes explored mechanical pain threshold and satisfaction. Mechanical pain sensitivity was assessed using numerical pain ratings, while pain threshold and satisfaction were measured through standardized thresholds and survey responses, respectively. Data were analyzed using mixed-effect linear and logistic regression models. Results: A total of 199 participants were enrolled. All vibration patterns reduced perceived pain compared to the control condition, with Pattern D achieving the greatest reduction ( p < 0.001). Regarding mechanical pain threshold, Pattern A increased the odds of pain detection (odds ratio: 1.63, p = 0.019), while other patterns showed no differences. Approximately 77% of participants recommended the BHD. Discussion: The BHD reduced procedural pain, supporting use of vibration therapy as a non-pharmacological strategy to improve patient comfort during needle procedures. Future studies should explore vibration patterns with clinical procedures and assess the device’s impact across diverse populations.

Pediatric inpatient caregivers often experience significant anxiety. Although improving caregiver anxiety is critical for improving patient outcomes, inpatient interventions targeting patients’ families are rarely implemented. This study assessed the effectiveness of a language-concordant, virtual reality (VR)-guided meditation on inpatient caregiver anxiety. Using a prospective, pragmatic, randomized study, the primary aim assessed caregiver anxiety using the Visual Analog Scale for Anxiety (VAS-A). Secondary aims explored state and trait anxiety using the State-Trait Anxiety Inventory (STAI), differences in anxiety reduction between English- and Spanish-speaking participants, and satisfaction. With 200 participants included in the final analysis, VAS-A scores in the VR group were lower compared to the standard of care (SOC) group ( p  = 0.0005), with a greater reduction for Spanish-speaking participants ( p  = 0.005). After controlling for baseline trait anxiety, the STAI found a greater reduction in state anxiety in the VR group ( p  ≤ 0.0001). VR-guided meditation effectively reduced caregiver anxiety in pediatric inpatient settings. VR's immersive and versatile nature offers diverse therapeutic options to improve caregiver and patient health, including marginalized populations with previously limited interventions.

Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model’s reliability within specialties in different geographic locations.

Background: Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals’ facility with immersive technologies. Objective: This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods: We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results: Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions: Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings.

BACKGROUND Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of healthcare settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. OBJECTIVE The primary aim of this study was to apply a hybrid technology acceptance model (TAM)/United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM/UTAUT. METHODS Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence adoption of new technologies. RESULTS 202 of 1540 GME trainees participated. 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment, social influence and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated good fit. All domain measurements demonstrated acceptable reliability. CONCLUSIONS This TAM/UTAUT demonstrated validity and reliability for predicting GME trainees’ behavioral intentions to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model’s reliability within specialties in different geographic locations.