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By Dr. Liji Thomas, MD Feb 1 2024 Reviewed by Danielle Ellis, B.Sc.

Palliative care is necessary to ensure comfort and an improved quality of life towards the end of one’s life when enduring chronic or fatal diseases. With the graying of the population in many developed countries, the importance of this segment of healthcare is growing rapidly. Study: Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Image Credit: Chinnapong/Shutterstock.com

In this context, a new study published in Frontiers in Virtual Reality explored the effectiveness of a psychological strategy called Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT)® in helping people cope with their symptoms and achieve relaxation at the end of life. Background

While earlier studies that compared the use of virtual reality (VR) in palliative therapy have been reported, none have been randomized controlled trials (RCTs), driving the current experimental study.

It is known from prior research that palliative care leaves multiple areas of need unsatisfied, including pain relief, psychological distress over loss of autonomy, and limited opportunity for social interactions. This impacts the quality of life and promotes the progression of the illness.

Both pharmacological and non-pharmacological interventions are used in palliative care. Psychotherapy and other psychological tools are extensively used as they do not have the potential for adverse effects that medications have. Moreover, these are inexpensive and practical, especially when focused on helping the patient relax.

Most studies on relaxation in the field of palliative medicine look only at traditional techniques, largely ignoring the potential for VR to ease pain and facilitate relaxation. However, VR creates an immersive experience that makes patients feel they are present in another environment.

VR thus prevents the consciousness of the present, miserable surroundings while promoting a sense of being in a virtual environment that is controlled. This leads to distraction, a known cognitive-behavioral tool for pain relief. Moreover, this is improved by the chance for the patient to choose the preferred environment, even using this platform to fulfill deeply cherished longings.

This ability to virtually fulfill their wishes to travel to a relaxing destination or environment could bring happiness and relieve the discomfort and sadness of the terminal condition.

Building on earlier feasibilty and pilot studies, the current study seeks to document the impact of VR on patient symptoms in palliative care by simulating activities that are meaningful for the patient. The researchers built a structured psychological program for palliative care patients.

Called FLOW-VRT Relaxation, this is built upon various psychological theories, including flow theory (“completely absorbed in activity without reflective self-consciousness but with a deep sense of control”), self-determination theory (autonomy and a sense of control), stress coping theory, and the attention restoration theory that attributes renewed cognitive ability and greater wellbeing to exposures to natural environments. It is one form of the broader FLOW-VRT intervention, modified for relaxation, allowing patients to choose their relaxing experience. What did the study show?

The study included 128 patients recruited from a palliative care unit over ten months. About 93% completed the study, the mean age being 67 years, and 70% being female. The participants were administered the Chinese version of the Edmonton Symptom Assessment System (CESAS), consisting of a questionnaire exploring nine typically encountered symptoms among cancer patients. This was first done at baseline, followed by randomization and post-test assessment. Related StoriesUK Biobank research reveals significant impact of type 2 diabetes on COVID-19 outcomesNew research highlights regional variations in COPD prevalence according to diagnostic criteriaStudy shows how social media fuels unhappiness and materialism

At baseline, total, physical, and emotional subscale scores on the CESAS were comparable for test and control groups. After the Flow-VRT Relaxation intervention, total, physical, and emotional scores changed in both groups, those exposed to the FLOW-VRT –Relaxation therapy and those who underwent traditional relaxation therapy.

However, the scale of reduction in all three subscale scores was significantly greater with FLOW-VRT Relaxation, indicating that this intervention produced superior symptom improvement compared to traditional measures. This may be due to the individual’s freedom to choose meaningful content for the VR experience, promoting self-determination by supporting the person’s autonomy rather than forcing the individual to embrace an experience chosen by someone else.

The use of immersive VR technology could be another reason for the improved symptom control, as this induces flow, which is linked to physical and mental wellbeing. In addition, it may allow patients to explore and learn to use stress management strategies when going through stressful physical and emotional symptoms. Such emotion-focused coping is more easily managed for many patients undergoing the trauma of end-of-life after a terminal illness and are unable to exercise problem-focused coping strategies. What are the implications?

“Our results showed that following a FLOW-VRT-Relaxation session, the symptoms of distress that patients in palliative care have to endure significantly reduced.” Both physically and emotionally, patients reported that they did not feel the same level of distress. These promising results could point to the extending potential of this approach for elderly patients in long-term care homes and rehabilitation centers.

This sheds light on the scope for the use of this intervention in this area, considering its relatively low cost, scalability, and personalization potential. The use of this approach is especially suitable for those with terminal illnesses who are often bedridden or confined to hospital wards, unable to find pain relief, or suffering from the adverse effects of required medical therapy. Moreover, they are emotionally vulnerable as they have unfulfilled wishes of traveling or escaping their pain.

Further studies are required to follow up on the effects of FLOW-VRT Relaxation over time. However, this is not an essential feature in palliative care, where patient survival is typically expected to be short. In fact, against a background of unfulfilled wishes and a short lifespan, FLOW-VRT Relaxation provides a meaningful impact on the patient’s wellbeing as it can virtually satisfy some of these longings and provide a sense of control.

At the same time, the study brought out some potential risks of such technology, which may engender a greater sense of loss of past abilities or skills in contrast to the patient’s current situation. Further research should look at how VR content may be made still more personalized to have meaning for each individual and design training protocols to make sure the intervention is delivered as intended. Journal reference: Woo, O. K. L. et al. (2024). Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Frontiers in Virtual Reality. doi: https://doi.org/10.3389/frvir.2023.1304155. https://www.frontiersin.org/articles/10.3389/frvir.2023.1304155/full. 

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Jury shown CCTV and bodycam footage of brothers allegedly assaulting police at Manchester Airport

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Jury shown CCTV and bodycam footage of brothers allegedly assaulting police at Manchester Airport

CCTV and police bodycam footage allegedly showing three police officers being assaulted at Manchester Airport has been played to jurors.

Mohammed Fahir Amaaz, 20, and his brother, Muhammad Amaad, 26, are said to have struck out after police were called to the airport on 23 July last year, following Amaaz allegedly headbutting a customer at a Starbucks in Terminal 2.

Minutes later, three police officers approached the defendants at the paystation in the terminal’s car park.

A jury at Liverpool Crown Court today watched CCTV footage from opposite angles, which captured what the prosecution says was a “high level of violence” being used by the siblings.

The prosecution says Amaaz resisted as officers tried to move him to arrest him, and Amaad then intervened.

Junior counsel Adam Birkby suggested Amaaz threw 10 punches, including one to the face of PC Lydia Ward, which knocked her to the floor.

His brother Amaad is then said to have aimed six punches at firearms officer PC Zachary Marsden.

Amaaz also allegedly kicked PC Marsden and struck firearms officer PC Ellie Cook twice with his elbow.

He is said to have punched PC Marsden from behind and had a hold of him, before PC Cook discharged her Taser.

Human Rights lawyer Aamer Anwar (centre) arrives with Mohammed Fahir Amaaz (left) and Muhammed Amaad (right) at Liverpool Crown Court, where
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Mohammed Fahir Amaaz (left) and Muhammed Amaad (right) arrive at the court with their lawyer. Pic: PA

The bodycam and CCTV footage, submitted as evidence by the prosecution, allegedly shows the officers’ arrival in the Terminal 2 car park and their attempts to arrest the siblings, as well as their exchanges with them.

PC Ward can be heard saying “Oi, you b*****d” in footage from her bodycam, the prosecution evidence appears to show.

She then appears to fall to the floor and screams.

PC Cook, who is pointing her Taser at one of the defendants, then allegedly says: “Stay on the floor, stay on the floor whatever you do.”

“Get back, get back,” PC Ward appears to say.

The bodycam footage, shown to the jury by the prosecution, shows PC Marsden, who is also pointing his Taser, appear to approach the defendant who is lying on the ground and kick out at him.

Mr Birkby said: “Mr Amaaz, while prone, lifts his head towards the officers. PC Marsden kicks Mr Amaaz around the head area.

“PC Marsden stamps his foot towards the crown of Mr Amaaz’s head area but doesn’t appear to connect with Mr Amaaz.”

Amaaz denies three counts of assault occasioning actual bodily harm to the three police officers and one count of assault to Abdulkareem Ismaeil, the customer at Starbucks.

Amaad denies one count of assault occasioning actual bodily harm to PC Marsden.

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Stephen Doohan: Paramedic who secretly gave pregnant woman abortion drug jailed for more than 10 years

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Stephen Doohan: Paramedic who secretly gave pregnant woman abortion drug jailed for more than 10 years

A paramedic who secretly gave a pregnant woman an abortion drug during sex has been jailed for more than 10 years. 

Stephen Doohan, 33, was married when he met the woman on holiday in Spain in 2021 and began a long-distance relationship.

The High Court in Glasgow heard how the victim travelled to Edinburgh in March 2023 to visit Doohan after learning she was pregnant.

During consensual sex, Doohan twice secretly administered the tablets which led to the woman suffering a miscarriage.

In May, Doohan pleaded guilty to sexual assault and causing the woman to have an abortion. He returned to the dock on Monday where he was jailed for 10 years and six months.

Lord Colbeck said Doohan caused “long-term psychological injury” to his victim.

The judge said: “You put her through considerable pain over a number of days and left her facing a lifetime of pain and loss.”

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The court heard how the woman found tablets hidden under the mattress after she became suspicious over Doohan’s behaviour in bed.

Lord Colbeck said: “The complainer then carried out an internet search for abortion tablets and confronted you over your actions.”

After the woman fell ill, Doohan convinced her to lie to medics at the Royal Infirmary of Edinburgh amid fears he would be arrested if she told the truth.

The victim later attended another hospital with her sister and was told she was having a miscarriage.

The Crown Office and Procurator Fiscal Service (COPFS) said Doohan sent the woman gifts including perfume, socks, facial cleansing oil, money to get her hair done and bought tickets for them to attend a football match.

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The woman complained to the Scottish Ambulance Service in May 2023, sparking an investigation.

The court heard that on 14 March 2023, the day the woman told Doohan she was pregnant, the paramedic used a work intranet to search for abortion drugs.

Lord Colbeck said: “You planned out what you did to your victim using resources available to you as a paramedic.”

In addition to his prison sentence, Doohan was also added to the sex offenders’ register and banned from contacting his victim.

Fiona Kirkby, procurator fiscal for high court sexual offences, said: “Stephen Doohan’s calculated and heinous actions caused the loss of the victim’s pregnancy, robbing her of plans she had for the future.

“He has now been held accountable for this fundamental breach of trust.

“While offences like this are thankfully rare, I hope this prosecution sends a clear message to all those who seek to inflict sexual harm towards women.

“Our thoughts remain with the victim, who must be commended for reporting her experience and seeking justice.

“We recognise that reporting sexual offending can be difficult but would urge anyone affected to come forward and seek support when they feel ready to do so.”

The Scottish Ambulance Service branded it an “appalling case”.

A spokesperson added: “We recognise the courage it must have taken for the victim to come forward and speak out.

“As soon as we learned of these very serious allegations and charges, we immediately took action, providing ongoing support to her whilst liaising with Police Scotland throughout the investigation.

“We know nothing will change what has happened to the victim and all we can hope is this sentence provides some comfort to them.”

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UK farmers have ‘nothing more to give’ as they fear govt will compromise welfare in US-UK trade deal

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UK farmers have 'nothing more to give' as they fear govt will compromise welfare in US-UK trade deal

UK farmers have “nothing more to give” as they fear the government will use agriculture to further reduce US tariffs in a trade deal with the White House.

The UK is trying to reduce steel tariffs to zero, from a current reduced rate of 25%, but Downing Street refused to confirm if it was confident ahead of Donald Trump’s deadline of 9 July.

Tom Bradshaw, president of the National Farmers’ Union (NFU), said UK agriculture had already been used to reduce Trump-imposed tariffs on cars but any other concessions would have serious repercussions for farmers, food security and the UK’s high animal welfare standards.

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He told Sky News: “It just feels like we, as the agricultural sector, had to shoulder the responsibility to reduce the tariffs on cars from 25%.

“We can’t do it anymore, we have nothing more to give.

“It’s clear the steel quotas and tariffs aren’t sorted yet, so we just want to be very clear with the government: if they’re sitting around the negotiating table – which we understand they are – they can’t expect agriculture to give any more.”

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Tom Bradshaw, the head of the NFU, speaking to Sky News
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Tom Bradshaw, the head of the NFU, said farmers cannot give any more

‘Massively undermine our standards’

Since 30 June, the US has been able to import 13,000 tonnes of hormone-free British beef without tariffs under a deal made earlier this year, which farmers feel was to reduce the car import levy Mr Trump imposed.

The UK was also given tariff-free access to 1.4bn litres of US ethanol, which farmers say will put the UK’s bioethanol and associated sectors under pressure.

Allowing lower US food standards would “massively undermine our standards” and would mean fewer sales to the European Union where food standards are also high, Mr Bradshaw said.

It would leave British farmers competing on a playing field that is “anything but fair”, he said, because US food can be produced – and sold – much cheaper due to low welfare which could see a big reduction in investment in UK farms, food security and the environment.

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‘The US will push hard for more access’

He said the US narrative has always suggested they want access to British agriculture products “as a start and they’ll negotiate for more”.

“The narrative from the White House on 8 May, when a US-UK trade deal was announced, was all about further access to our agriculture products – it was very different to what our government was saying,” he added.

“So far, the UK has stood firm and upheld our higher welfare standards, but the US will push very hard to have further access.

“No country in the world has proved they can reduce the 10% tariffs further.”

US poultry welfare is lower than the UK, with much more intensive farming that means the meat has to be washed with antimicrobials. Pic: AP
Image:
US poultry welfare is lower than the UK, with much more intensive farming that means the meat has to be washed with antimicrobials. Pic: AP

US ‘will target poultry and pork’

The Essex farmer said he expects the US to push “very hard” to get the UK to lower its standards on poultry and pork, specifically.

US poultry is often washed with antimicrobials, including chlorine, in an attempt to wash off high levels of bacteria caused by poor hygiene, antibiotic use and low animal welfare conditions not allowed in UK farming.

US pig rearing methods are also quite different, with intensive farming and the use of feed additive ractopamine legal, with both banned in the UK.

A government spokesperson told Sky News: “We regularly speak to businesses across the UK to understand the impact of tariffs and will only ever act in the national interest.

“Our Plan for Change has delivered a deal which will open up exclusive access for UK beef farmers to the US market for the first time ever and all agricultural imports coming to the UK will have to meet our high SPS (sanitary and phytosanitary) standards.”

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