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okay well thank you so much my french is very pour so i apologise
rise up to speak in english i speak spanish with that will help
so i wanna thank you for inviting me and for repartee to visit
your beautiful country beautiful value really enjoyed my two days here
and i'm pleased to present today our experience using virtual reality
to treat patients in our hospital in los angeles
our cost was the largest hospital in the western united states we
have about a nine hundred and thirty beds in a hospital
and we have virtual reality treatments everyday right now
i have probably four five people not possible using virtual reality
yeah we've treated over five hundred patients so far today i want to
share some of our experiences using virtual reality what works and
also what doesn't work for managing these patients so wanna start by
showing you a picture of one of our hospital rooms
and this is a nice room to private room we have over nine hundred of these rooms
but being in a room like this is not a place
of healing this is not a place of rest
our patience in these rooms are suffering they supper seriously they stuff for
physically based stuff for emotionally they suffer socially socially isolated and stigma
ties to this is not a good place to be this is like a jail cell for patients who are in the hospital
so i took a picture what it looks like to be a patient and our hospital in the bed
and as the patients look up this is what they see all their base your television
and they see the ceiling and there's two things on the ceiling there's that one right there and then there's that one and then there's that
one and all day long people look back and forth at things on the ceiling that's in every so often something like this will happen
and you'll notice that i'm not smiling staring at the patient
and talking interrogating questioning and then we disappear and
come back again all day long back and forth this is what life is like in the hospital
whether you're in los angeles or in switzerland or anywhere in the world this is what life is like in the hospital
so we thought for starters there must be a way that
we can improve experience of our patients just experience
and then later determine if it improves clinical outcomes
could we use virtual reality to provide our patients with the opportunity to escape the four walls possible
to go on a tour of iceland to stand on the stage of circus
away and watch the performers or to go away and leave the hospital
and that's what we've been doing and this is a picture of one of my patients this particular young man
is experiencing severe pain because he has sickle cell and nina
very severe disease very very painful he's hospital lies he's
on o. p. o. it's narcotics pain medicines
but you can't tell that right now because at this moment he's in a helicopter over fjords in iceland
and i wanna show you know the idea of him and i'll show you a video of him and one other patient
uh these are two patients that are among the five hundred we've treated the
first man i told you about the second is an older woman
who has liver disease very severe psoriasis she's dying
she's in severe pain but you also won't be able to tell that from
what you'll see in second since this video was may this patients died
as many of our patients unfortunately due in virtual reality i don't know if it saves lives yet
but you'll see that they can improve people's self we can improve the way
people feel and i say this video now and you can save yourself
oh well
so you can see i don't know how you were able to hear that um but you
can see the experiences patients are having so what we've been interested in is studying
rigorously with a control research trials whether these
interventions are proving pain or other clinical
outcomes and uh this is i'll show you what would the patients are seeing
this is one of many visualisation is that we use we use about forty different visualisation is
and we have a pharmacy virtual reality pharmacy and we pick
and choose which visualisation to use for which patient
this is one of them this is a program called anxiety reliever
and you sit on the beach you interact with the environment
and there's a voice over in that your phones which is a mindful
meditation patients meditate they breathe slowly relax and uh it's extremely powerful
we're doing a study right now to see what impact this has
on pain and anxiety and also on hormone levels court is all stress hormone levels in the blow
so we're doing a study right now i understand how this is working but this is one of the experiences that they see
so we just published this paper which you can see find online it's open access free paper
and in this study we had two groups the first group was a group of fifty patients like the ones
i showed you and we gave them a ten minutes
of virtual reality we measured pain before and afterwards
and there was a drop in pain but then we have a control group and the control group watch
this video very relaxing high definition video on a two
dimensional screen in close proximity to the patient
and we show that for ten minutes as well and then we looked at the pain reduction in that group
and that work to that also work to reduce pain but the virtual reality work
more than the two dimensional screen is statistically significantly better at pain reduction
so this is one of the first controlled trials uh a virtual
reality in a diverse group of patients in the hospital
with pain scores of three or greater on a ten point scale
right now we're doing a new study with samsung
electronics it's a large prospective randomised control trial
two groups and we keep the virtual reality in the room the entire hospital stay
and we're looking at pain and we're looking at pain medications sleep
and how long they're in the hospital and their satisfaction with their stay in the hospital
and we will recruit a hundred and forty patients in that study we have a hundred and ten
so far so we will be reporting those data open the next four to six months
when we look at this more closely we looked at whether the
patient tell better or not which is an important consideration
and there's a sixty five percent response and b. r. verses forty
percent in control that's a difference of twenty five percent
one way of thinking about that is the statistical the number
needed to treat and and t. number needed to treat
how many people do we needed she would be our instead
of a control in order to provide one benefit
the numbers for if you do the calculation that better than pain medicines much better it's better than most
former pro therapies that we haven't that's so that's important finding and you can read more in it
this is the cover of the january edition of clinical neuroscience
and this is the paper that we just published a review systematic
review of the literature evaluating randomised control trials in virtual reality
and this also isn't open access paper if you're interested you can you can read this
this is a summary of what we found in this review we look throughout
the entire published medical literature and we found there are uh leaven studies
that are a randomised control trial in in patients in hospital based patients
comparing virtual reality versus control and these are mainly in a burn injuries
like the work work a pointer hoffman and others but also an obesity in cancer
pain physical trauma stroke course you know you're with my name is here
dramatic brain injury now the main thing i wanna point out is that in
these studies virtual reality is almost always a factor and well tolerated however
the studies need to be better we need better
studies higher quality studies better methyl logically
larger studies the studies we have are not good enough in general
so that's why we're trying to do larger prospective randomised control trials
with an active control and we'll be reporting that's it
i wanna show this to you 'cause this is an important lesson what you're looking at here is the c. t. scan
of the abdomen it's looking at the major blood vessels in the abdomen this is a eighteen year old one
who i was asked to evaluate for abdominal pain i'm aghast rounder our just wanna click and i
was asked to evaluate this one and for abdominal pain eight months of severe abdominal pain
the doctor said that every test they could think of every test was negative no reason for about
opening very severe abdominal pain she's losing weight and the doctors thought that she they psychiatric problem
i thought she had your double bowel syndrome and anorexia and was losing weight because she had psychiatric problem
so i evaluated her and i agreed i couldn't find an explanation
so i decided to use virtual reality and we thought virtual reality would help her
it did not help or not one bit in fact she target after the virtual reality i said what did you think and she said
nothing i still have pain in faxes that i had pain through the entire experience the entire time
and it's so unusual to have no benefit zero benefit that we wondered are we missing
something here are we missing a problem because there's no response to virtual reality
so we did the only task to laugh that we can find and this is that what you're looking at here
is a black stripe that does not belong or diaphragm
has crashed or major blood vessels and she has
no blood flow to her abdomen she has a serious problem and she needed surgery to fix it
the reason we found that was a negative response to virtual reality so in digital health
in general we always wanted positive response but we should always think when somebody
does not respond to an intervention that also
has clinical relevance that too can be
clinically important and in this case the fact that she did not respond
was extremely important and this is not repeated itself many times
i use virtual reality in some regards the diagnostic test
to help me understand the degree to which the mind and the body are communicating and whether
painting is more in the mind or more in the bar you're somewhere in between
and in this instance she did not need virtual reality she needed surgery of picture problem
i've said this that a virtual reality is the therapy we need a virtual reality pharmacy
we need a way to pick what is the right visualisation for the right patient
virtual reality is just like a syringe right medicine going through it it's not
about the syringe it's about what medicine do you put through the search
so virtual reality it's it's just a platform what matters is what are we putting through
that platform what experiences what visualisation is that what matters so what we're doing now
is creating a new uh tasks a cycle matcher
profile the computer program second helpless profile
each patient individually and then use the results to map to the right prescription
how frequently how for how long what kind of intensity just
like i'm a doctor i write a prescription for medicine
i need to be able to write a prescription for virtual reality and that's what we're working on that
i wanna show you another example of how we're using virtual reality
this is the samsung three sixty a cure or um camera
it fits in the palm of your hand i don't know if anyone hears used it very small
what we're doing now is we're taking a summer giving it to the family of the patient
patients in the hospital and the family takes it home to the house
they then turn it on and the patient could be transported directly
from the hospital bed to their home to the park to
be with their family so wanna show your video now we'll see how the sound is what happens when we do this
or patient a young man he's been in the hospital almost a hundred days
and in this case he wants to go home but he cannot go
so we bring him home this was during christmas last december and
you'll see the christmas tree in the back around and he gets to go home to be with his family in the house
and we then bring him to the park where he starts to meditate but
it all happens from his hospital bed so first to introduce himself
we'll see if you can hear it and then you'll see what happens when we use the camera to bring him back to his house
oh well
if so i don't know how you heard that but you can see the pictures at
least this is a man who has severe disease and is in severe pain
but again at that moment you can't tell that and we keep that in the room
and if he comes back to the hospital every month in when he comes back
we give him the virtual reality for the entire time that he's in the hospital you can go wherever he wants to go
and he is reported that it's improved his symptoms and troops is i'm experiencing hostile
to the point where he thinks he gets out of a possible faster
as a result of using the headsets gets better sleep is more comfortable
this is an example of what uh we're trying to do
where the walls of the possible can be turned into
any vision but you want even if you don't have the
headsets uh accept this is actually a television show
call up your genius i think some of you for me last night you've seen the
show there's a show that we developed in united states that the t. v. show
and this is actually not a real possible this is a seven million dollars set at universal studios
so universal studios we build entire hospital and tried to demonstrate
what the hospital should look like in the future
and this is this a t. v. show we use virtual reality uh throughout the
t. v. show these are the actors learning how to use virtual reality
uh in our laboratory at cedars sinai and uh this is the scene where we
use virtual reality for a patient with um a phobia and expose sam
uh to his worst fears which is something we hear about later today and
that research is what we tried to depict in this t. v. show
no this is a very online that um we n. b.
c. news and united states posted and what's amazing
to me is there are almost four and a half a million people who have watched this video
and underneath it there are two and a half thousand comments
so we decided to do a research study by just allies inc those
two and a half thousand comments in my graduate students got together
and they used a computer program and they analysed be comments that
we're receiving from the public about the uh the virtual reality
and this is hard for you to see but it demonstrates a variety of different sentiments in pots that people half
people think that they should be used for women undergrad delivering a baby in a brain stand
uh elderly people who can't move or travel as a distraction
for boredom uh for cancer chemotherapy for kidney dialysis
they also have worries and concerns could could uh okay the patient fall a bad because they
can't see is gonna cause cancer in the rice all sorts of concerns so for the
virtual reality research community for the therapeutic the our community this is a blueprint for what we
need to study next and what we need to answer in terms of consumer sentiment
this paper will be published sometime in the next six months or so so you can i can send the slides out
alright so i'm gonna finish now uh this one last example is we're
going into the community now using virtual reality this is very important
because we're on this room we like digital hell we like virtual reality we talk to each other but what about the rest of the world
what about people in community this is in the church and selfless stanza less
and we've you were using virtual reality to treat high blood
pressure we've created a virtual reality treatment for hypertension
where people go in the kitchen and they'll learn about what to to you and then they can
travel through their body and see what happens to their body if they eat too much salt
how it affects their brain the blood vessels are are and we're doing a study right now to see if we can reduce blood pressure
okay well i mean and because another time but i wanna show you this this is amazing
to me you may have heard of the web the awards this is for the best
of the internet every year the web awards are given out and we were nominated for
the best technology and the internet up against in gadget in wired magazine and nike
and then uh s. which i couldn't believe and just last week
or two weeks ago we won the best technology on
the internet and the web your words i don't even know what the web you word as i'm not research doctor
but apparently this matters to some people so there's just demonstrates a that's
a virtual reality squarely very important and has tremendous opportunity and growth
so since i'm from los angeles and from hollywood i'm showing you my closing
credits like this is a movie 'cause there are many many people
involved in this research we have sciences social scientists computer scientists we have
clinicians we have nurses doctors uh from all sorts of different departments
from oncology from surgery or or therapeutics from urology
uh from almost every department in the hospital is involved in this and the study
so up and finish their ah saw thing i thank you very much again for uh the opportunity and you can't call
that number because this is an interstate so that's amateur move that so sorry i can't take your patients in switzerland
uh but otherwise thank you very much appreciate your attention yeah
mm thank you very much for having troops who these experiences in
and so on the um the question
i think you were mentioned vernon speech um i was wondering
or mid to focus uh some units uh of maturity
um maybe some some patient would be we'll oh this is much
better than my real life so please send me away right
well that's a concern not just for patients but for gamers for the read the
book ready player one some of you may have read that book you've
no this to stop in future where people are no longer interested in real reality
but are only living in virtual reality from my standpoint of
the doctor or patience are suffering cancer severe pain
i'm not yet is concerned about that considering some of the other things we do the patients that are much more harmful
like giving opiate waves which causes suicide alley and death and thirty thousand people
per year in united states just from over dosing on mccain medicines
so it's a little early for me to get too concerned about that to still be in future
but it's still very much in my mind and yeah so there's always a concern that we can use too
much virtual reality uh or could be used responsibly uh but that's a very big important ethical question
read digits
with my i think integrated on the potential with yellow eyes huge one of the problems up with you know
something's emotions a semi uh_huh i was happy t. who
is it that you patients what'll rated the dimension
would you comment on yeah motions in this problem yeah motion sickness is usually consequence of that d. r.
what i mean by that is b. r. with for a graphical
will processing speed from you know it's is the latency
between the head movement and the visual uh than the visual a scene
uh however yes there's still that ten percent of people
that have some degree of transients of vertigo
and could get nauseous our patients have not generally experience that however we are not
using it in people who have not as yet or vomiting or very sick
so we not trying it in those patients 'cause we don't wanna make them worse so we've excluded those patients but
for the most part well tolerated if they feel sick they take a headset often get better quickly uh yeah
question concerning the o. o. p. h. present in the beginning
and the control group now the you know the uh it was a huge video or a
picture that you showed is this if they don't yeah alright p. in their names engine
with the actual there is this to their pain therapy is giving people pain medicines
and that's um unfortunate but um we don't have sort of a standardised um visualisation and
what that's like their you're alright therapy yeah absolutely not be there for sure
so all all sorts of non medical highly effective adjunct slippage interesting to
compare preacher yelling these kind of intervention yes it would yes
it words so this was a ten minute intervention so something like art therapy is hard to standardise over ten minute you could
uh we have to start somewhere so this is how we started but i agree that it would be
very helpful look against a variety of other interventions which there are many and the pain literature
i mean 'cause to with with them
okay the question the boat the pain reduction oh experiments you didn't
so what was the time window to beat was not during o. decision
that you mention these pain or you had effects that plastic tsunami needs or even longer yes
yeah so that's what unclear uh so for the study we did it uh before
and then usually uh was about ten minutes after the end of therapy and we
did the same protocol on both arms the question that comes up is okay
is that pain reduction sustained there's a continue hours later days later and
that's what we're studying now but what we have definitely seeing
is that the pain reduction can be sustained even after the virtual reality is discontinued
it is somehow in some patients change their mind set in a way that we don't yet fully understand
uh we need more basic science understand why but we do
see that there's a reduction pain many patients that persists
for hours in some cases even days but we need a booster effect so we're treating three
times a day ten minutes per session ten to twelve minutes three times a day
um during the hospital stay and for breakthrough pain if somebody continues to have pain
uh but our current study will answer your question more uh better with evidence that we're doing right now
we're going through
uh the most will you mention ye ah zero um i'll call does all differences
so we do have so the right now and i don't have any data yet to present to you
but uh i think i said let but we're actually measuring saliva a seller very
uh of course all levels and we're in the middle of doing that right now and
i haven't actually seen any of the data so i'll report back when we know

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Conference program

Mot d'introduction
Sébastien Mabillard, Coordinateur projets e-health, Fondation The Ark
8 juin 2017 · 6:05 après-midi
Les Technologies Cognitives ou l'Homme Augmenté
Jérôme De Nomazy, IBM Suisse
8 juin 2017 · 6:09 après-midi
Les Technologies Cognitives ou l'Homme Augmenté - Questions du public
Jérôme De Nomazy, IBM Suisse
8 juin 2017 · 6:41 après-midi
Mot de bienvenue
Sébastien Mabillard, Coordinateur projets e-health, Fondation The Ark
9 juin 2017 · 9:04 matin
Présentation de Swiss Digital Health
Frédéric Bagnoud, CimArk
9 juin 2017 · 9:07 matin
Présentation des instituts de recherche HES-SO Valais-Wallis
Laurent Sciboz, Directeur des Instituts informatiques
9 juin 2017 · 9:11 matin
Virtually Better: How Virtual Reality is Easing Pain, Calming Nerves and Improving Health the Drug-Free Way
Brennan Spiegel, Director of Health Services Research, Cedars-Sinai Health System
9 juin 2017 · 9:21 matin
Augmented Reality-assisted surgery
Luc Soler, Directeur de la R&D et Professeur PAST, IRCAD, IHU
9 juin 2017 · 11:22 matin
Réalité virtuelle dans le traitement des troubles mentaux
Eric Malbos, Psychiatre et spécialiste du traitement en réalité virtuelle, CHU Conception
9 juin 2017 · 11:56 matin
La Simulation Numérique pour les Professionnels de Santé
Xavier Abadie, Directeur du Développement International, SimforHealth
9 juin 2017 · 12:28 après-midi
AR for different medical use cases
Antoine Widmer, Professeur HES & co-fondateur d'Adventures Lab
9 juin 2017 · 2:04 après-midi
Augmented reality for medical applications
Henrique Galvan Debarba, Chercheur senior, Fondation Artanim
9 juin 2017 · 2:15 après-midi
Virtual reality solutions for stroke rehabilitation
Andrea Serino, Responsable de la recherche en neurosciences, Mindmaze
9 juin 2017 · 2:34 après-midi
Virtual Reality combined with haptic robotics for rehabilitation
Aurélien Fauquex, Directeur Exécutif et co-fondateur, Lambda Health System
9 juin 2017 · 2:48 après-midi
Creating a valuable user experience for nursing home inhabitants
Roel Smolders, Directeur Exécutif, Active84Health
9 juin 2017 · 3:05 après-midi
TABLE RONDE : Quelle innovation pour la santé du futur en Suisse?
Eric Beer, Henning Müller, Pascal Detemmerman, Victor Fournier, Resp: Head of Customer Engagement e-Health (Swiss Post), Professeur en informatique médicale HES-SO Valais-Wallis, Directeur Exécutif SwissEnov, Chef du service de la santé publique du Canton du Valais
9 juin 2017 · 3:20 après-midi