VTNE reality - Veterinary Technician National Examination (VTNE) Updated: 2023

Virtual Reality (VR) and Augmented Reality (AR) are being utilized in daily life around the globe. From the entertainment and gaming industry to assisting in healthcare and education, both technologies are altering how the world operates.

Enhancing Gaming Experiences With Virtual Reality

Virtual reality (VR) has revolutionized the gaming industry by providing immersive and interactive experiences. Today, players can step into a virtual world and engage with games in a way never before experienced.

One of the key benefits of VR gaming is the level of immersion it offers. By wearing a VR headset, players are transported into a 3D environment surrounding them, making them feel like they are truly inside the game. A heightened sense of presence allows players to feel more connected to the virtual world. 

In addition to immersion, VR also introduces a new level of interactivity and enables players to feel part of the game from the comfort of their homes. 

Players who know what signs to watch out for after reading a guide to online poker will be able to track opponents exactly as they would in a physical in-person game. With motion tracking technology, players can use their body movements and gestures to control the game, which offers an advantage in a game like online poker, where it is important to read the signals given by your opponent.

It’s estimated there are 100 million registered online poker players around the world, and the pursuit continues to grow in popularity. Games like PokerStars VR have boosted the appeal of online poker as it gives players the ability to sit down at a virtual poker table, where they can chat and interact in real-time in the same way they would at a physical, land-based casino. 

What’s more, VR gaming provides a sense of exploration and discovery. With the ability to freely move and explore within the virtual environment, players can uncover hidden secrets, navigate challenging obstacles, and discover new worlds.

Augmented reality (AR) has emerged as a useful tool in the retail industry, changing the way customers shop and the overall experience. By blending the physical and digital worlds, AR technology allows retailers to provide immersive and interactive experiences to their customers. 

AR in retail offers consumers the chance to try before they buy. Customers can virtually try on clothing, accessories, or even makeup, eliminating the need for physical fitting rooms or samples. This not only saves time but also provides a more personalized and convenient shopping experience. 

AR enables retailers to showcase their products in a more engaging and informative way. Customers can use their smartphones or AR devices to scan products and instantly access detailed information, such as product specifications, customer reviews, or styling suggestions. 

This helps customers make more informed purchasing decisions.

AR can also be used to create virtual showrooms or try-on experiences at home. Customers can visualize how furniture or home decor items would look in their own space. This not only reduces the risk of buyer’s remorse but also increases customer confidence and trust in the brand. 

How VR and AR Could Change the Future

Virtual Reality (VR) and Augmented Reality (AR) have the potential to revolutionize even more aspects of our lives in the future. 

In the field of entertainment, VR and AR can provide immersive experiences like never before. This technology has the potential to transform the way we consume media, play games, and even watch sports or concerts. 

In the realm of education, VR and AR can offer new and engaging ways of learning. Students can virtually visit historical sites, explore the depths of the ocean, or even travel to outer space, all from the comfort of their classrooms. AR can provide real-time information and interactive elements, making learning more interactive and hands-on. 

In the healthcare industry, VR and AR can also have significant impacts. Surgeons can use VR to practice complex procedures in a safe and controlled environment, reducing the risk of errors during real surgeries. AR can assist doctors by overlaying patient information and medical images during examinations, improving diagnosis and treatment. 

Overall, virtual reality has the potential to enhance gaming experiences by providing more immersive, interactive, and exploratory gameplay. As technology continues to advance, we can expect even more exciting developments in the world of VR gaming, offering gamers a whole new level of excitement and enjoyment.

Our experts answer readers' insurance questions and write unbiased product reviews (here's how we assess insurance products). In some cases, we receive a commission from our partners; however, our opinions are our own.

Medical exams are among the top reasons people hesitate to buy life insurance. You imagine sitting in a doctor's waiting room, doing blood draws, standing on a scale, and many other things that make us uncomfortable. But it's easy to understand why life insurance medical exams remain an industry stap — an insurer must gauge its risk before it grants you a policy. Ironically, medical exams lower insurance premiums for the average life insurance customer.

Of course, medical exams may sound overwhelming, especially if you've abandoned a life insurance application or been denied. This is where no medical exam life insurance comes in. The stereotypical no medical exam policy includes no medical data of any kind. Many buyers also expect coverage in days, or at least that's the idea. Despite what you might hear, it isn't quite that simple.

Who should buy a no medical exam life insurance policy?

Many shoppers are misinformed about the target audience for no medical exam life insurance. "Who should buy a no medical exam life insurance" should be rephrased as "who will qualify for no medical exam life insurance coverage?" These policies eliminate the inconvenience of a medical exam for healthy buyers who don't use tobacco in most cases. However, it comes with higher premiums, and underwriting can be extended as insurers gather medical data from other sources.

Some small funeral cost policies are more flexible, especially if you invest in workplace life insurance. However, more sizable policies not connected to your workplace can only accept limited risk. Seniors, buyers with preexisting health conditions, tobacco users, and other high-risk buyers may not qualify.

How do insurance companies know who presents a more considerable risk? First, no medical exam doesn't mean medical records-free. Applications still include basic medical questions, and companies can rescind life insurance policies if you get caught lying on your application. More importantly, life insurance companies may still order a copy of your medical records. So, companies would go off your last blood tests or appointment notes if you have a history of high cholesterol, heart disease, diabetes, etc.

College students and young working adults with no significant medical issues may be ideal candidates for a no medical exam life insurance policy. Another thing to note is companies will only issue small life insurance policies without an exam, and premiums are higher. So if you're looking for a $1 million policy or retirement planning options, you should make time for a short medical exam.

What if I don't qualify for a no medical exam life insurance policy?

Some companies only offer small life insurance policies with no medical exam required. However, most insurers offer a range of permanent and term life insurance policies. If you don't qualify for a no medical exam policy, licensed insurance agents can help you apply for a medical exam life insurance policy.

While many companies are going online, we recommend working with a licensed insurance agent, especially for no medical exam policies. Any time your application is denied, it creates an alert for other life insurance companies you might try to buy from, reducing your chance of getting a policy elsewhere. An agent can help you avoid this by stopping short of denial if you need to switch to a medical exam plan.

Types of no medical exam life insurance

Life insurance companies sell four life insurance policies without a medical exam. Coverage, pricing, and the application process are a few of the things that vary widely. So what are your no medical exam life insurance options?

Simplified issue life insurance

Simplified issue life insurance looks to streamline the approval process. No blood tests or medical exams are required, but applicants answer basic health questions. If the answers given meet underwriting guidelines (the company uses electronic medical records to verify), you may qualify for a policy. Generally, these policies cover non-smokers with minimal known risk factors. However, premiums are higher, and benefits tend to be lower to account for the elevated risk.

Guaranteed issue life insurance

Guaranteed issue is also commonly referred to as guaranteed acceptance. These whole life insurance plans require no medical exam or health surveys. Age limits are imposed, with most policies issued to seniors. But if you're within the stated age range, you are guaranteed a life insurance policy. Guaranteed issue life insurance offers death benefit policies topping out around $20,000 to $30,000, depending on the company. The company does not guarantee the death benefit or premiums, only the policy. So the same policy may or may not be budget-friendly.

The company may also utilize a waiting period, during which beneficiaries would get a refund of premiums. However, the full benefit would only apply once the waiting period passes.

Accelerated underwriting life insurance

Accelerated underwriting uses everything except the medical exam. Underwriters access applicants' public medical records and credit data. Typically, companies take applicants between the ages of 18 and 60. Regular life insurance underwriting could take weeks or even months. Simplified underwriting life insurance policies can be issued the same day with some online insurance providers. It is not guaranteed issuance, and licensed agents may refer some customers for a medical exam life insurance policy. However, death benefits could be higher than other no-medical exam policies.

Group life insurance

Group life insurance is part of many employer benefit packages. No medical exam is required, and death benefits are typically small. More importantly, it's tied to your employment. So if you separate from your employer, the policy will lapse. You can invest in higher death benefits by increasing your monthly deductions, but this is not required.

Pros and cons of no medical exam life insurance

Pros:

• No blood tests or other medical exams required
• Quick approval, sometimes even the same day
• Guaranteed issue available within set age limits

Cons:

• More expensive than a medical exam-based life insurance policy
• Death benefits are lower, and waiting periods may apply
• Insurance companies may base your approval on health questionnaires and medical records
• Underwriting may be less tolerant of prior health issues, including things that would otherwise be non-problematic

No medical exam life insurance is sometimes mistaken for a fast and easy solution for older adults or those with preexisting health conditions. In reality, it's just the opposite in many cases. Guaranteed issue policies may only be sold through life insurance companies for seniors. You also pay more to get less coverage across the board.

Life insurance companies can still access medical records. So applicants aren't hiding a history of heart disease, diabetes, or other chronic conditions. The only difference is you don't have to meet with a medical professional for a formal exam. If in doubt, non-guaranteed policies may be harder to get.

How to shop for a no medical exam life insurance policy

A workplace policy will be issued based on your employment and yearly benefit elections. If you want the best life insurance companies for no medical life insurance that's all yours, remember a few key things:

• Work with a qualified life insurance agent
• Choose a company or brokerage with medical exam options
• Compare quotes and coverage to ensure you understand what you're getting
• Be prepared for higher prices with limited death benefits
• Be honest on any health questionnaires

A no medical exam life insurance policy's simplicity may be deceiving. It takes one element out of the application process, but underwriters may pull medical records and be stricter about smoking, preexisting conditions, age, and other common risk factors. Unfortunately, being denied by a life insurance company could make it harder to get life insurance coverage in the future.

Your agent can get a soft underwrite if you're working with a broker or company offering medical exam policies. If it looks like your application can be denied, your agent could run a medical exam life insurance application instead. A great thing about no medical exam policies is that many companies offer online estimates. So you can compare pricing based on age, smoking status, desired coverage amount, etc., before you start the application process.

The most important thing to remember is underwriters still consider medical history. So if answering medical questions, answer honestly. If discrepancies come up later, leaving out details about your health may cause significant problems.

FAQs

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Some of the former military men and women marking Veterans Day on Saturday might not be here had it not been for the lifesaving care provided by a combat medic.

While not physicians, these members of the armed forces are trained to rapidly respond to those injured in service to our country. Often, they attend to patients under the grimmest of conditions.

Patients may have suffered grievous wounds from bullets or bombs. Medics themselves may be under fire while operating in the field with just the medical equipment and drugs they can carry.

It's easy to see how those who have proven themselves in these conditions could make excellent physicians. That's why a pioneering new University of Minnesota Medical School program to help medics become doctors as they re-enter civilian life is both commendable and deserving of Minnesotans' support.

The new initiative is known as the "Medic to Medical School Pathway." The inspiration for it came from the experience abroad of Dr. Greg Beilman, a critical care surgeon, U medical school professor and associate dean of Department of Defense research and partnerships.

In 2022, Beilman was in Ukraine with the Global Surgical and Medical Support Group, a nonprofit "dedicated to providing medical relief to communities in conflict zones, austere environments and disaster areas around the world."

On that mission trip, Beilman worked with combat medics and was impressed. The Minnesota surgeon told one standout medic to apply to medical school. The medic replied that he intended to and was working with a program elsewhere that steers veterans with this experience into an M.D. program.

Beilman liked the idea so much that upon his return, he recommended the U set up something similar. While institutions the size of the U often move slowly, this proposal swiftly became reality. That reflects well on Dr. Jakub Tolar, the medical school's dean, and the rest of the medical school's leadership.

The program, which appears to be among the first nationally, is now accepting applicants. The aim is to get the first medics into the classroom in 2024 to complete prerequisite coursework and prepare for the medical school entry exam. And then, in 2025, into the medical school itself. (To learn more, go to tinyurl.com/MedicToMedicalSchool).

One of the program's key components is the support, advising and mentorship provided to participants to smooth their entry into medical school and civilian medicine. While there is no scholarship money for participants, Beilman and other officials hope donors will come forward who would like to help fund this assistance. (Contact information for Beilman and other program leaders is at the Medic To Medical School link above.)

In an interview, Beilman said that medics' talent, experience and maturity are qualities that will not only serve them well in the classroom but enhance the education of other students learning alongside them. The pathway program — which will accept between three and five students in its first group — has other potential benefits.

Historic workforce shortages plague health care in Minnesota and elsewhere. The pandemic left providers burned out. Looming physician retirements are also a serious concern. "The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years," according to the American Medical Association.

The problem is especially acute in rural areas, as a Star Tribune editorial noted earlier this year. The median age for doctors practicing outside the metro is a decade higher than their urban counterparts — 58 vs. 48.

New solutions are sorely needed. Students with medic backgrounds not only have a running start on a medical education but may be especially suited to practicing in rural areas, which can require more self-reliance. Medics' experience with trauma injuries in combat zones will also serve them well. Helping patients hurt in farming or hunting accidents is part of the critical care physicians provide outstate.

The new U program is receiving a warm welcome.

Gov. Tim Walz, a National Guard veteran, said: "If you worked as a combat medic on a battlefield, we should be able to find a position for you within our medical system in Minnesota. Our veterans are a highly skilled and, in many cases, untapped workforce. I applaud the U for this program, as we continue to create opportunities for veterans in our state."

The Minnesota National Guard also praised the initiative.

"This is an exciting opportunity for military members to become physicians and continue to provide service to their communities. Their experience as combat veterans provides a unique bond with patients who also served in the military," Army Lt. Col. Jason Eggers, Deputy Commander of the Minnesota National Guard's Medical Detachment, said in a statement.

The Medic to Medical School program exemplifies the innovation needed to sustain and Excellerate medical care in Minnesota. Hopefully, other medical schools will follow the U's lead, allowing veterans to continue serving their country after they return to civilian life.

Donna Davis, Ph.D., the director of the Oregon Reality Lab in Portland, Oregon, and an expert in virtual reality therapy (VRT), explains that VRT is used in a computer-generated or 3-D environment. She explains that VRT is completely different from teletherapy. While teletherapy is talk therapy performed virtually (such as over Zoom), VRT revolves around the use of a virtual world, such as a computer game or headset. It’s also important to note that a licensed therapist must be involved for it to be considered therapy. Apps or YouTube videos that are meant for relaxation or to enhance meditation are not technically VRT since a therapist is not involved.

There is a specific type of VRT called virtual reality exposure therapy (VRET), which immerses someone in a 3-D environment that feels extremely real. Often, but not always, this is done using a headset. One example of this type of therapy is that if someone is afraid of heights, the 3-D environment may depict a glass elevator, and can be used to help them conquer their fear. VRET is also used to help individuals with other types of phobias, as well as post-traumatic stress disorder (PTSD) and victims of violence.

But VRT is not always immersive to this level. Dr. Davis says that another form of VRT is talking to a therapist under the guise of an avatar in a computer-generated environment. For example, Dr. Davis has worked with a virtual reality support group for people with Parkinson’s disease on the online platform Second Life, in which users can create a 3-D character in an alternate universe. The group has been “meeting” regularly for over 10 years. “People in the group create an avatar and they feel more comfortable opening up while their true physical identity is not revealed,” she says.

Since VRT is still new, there are not as many therapists trained in using it as there are for more common forms of therapy. Because of this, it can be hard to access. Dr. Davis’s advice is to do a Google search for clinical therapists in your area and see if the providers have VRT or VRET training. Virtual Reality International is another helpful resource with a database of VRT therapists.

How Successful Is Virtual Reality Therapy?

Lucy Dunning, a licensed professional counselor in Marietta, Georgia, who uses VRET in her counseling practice, says because the concept is relatively new, the data is still emerging in terms of how successful it is long-term. But early research points to promising results. “It has especially been shown to be successful for people with PTSD, anxiety and chronic pain,” she says.

Virtual reality therapy in the form of VRET has a reported success rate of between 66% and 90% for those with PTSD when used to enhance cognitive behavioral therapy (CBT), according to 2022 research in JMIR Serious Games . It has also been shown to significantly help with pain relief in place of medications. In one study in Annals of Behavioral Medicine, burn victims were transported to a snowy world, interacting with snowmen and throwing snowballs. This reduced their physical pain between 35% and 50% . Scientific studies have also shown success for overcoming fear of spiders and positive results for treatment for people with eating disorders.

Most existing research on VRT focuses on VRET; there is less known about how successful therapy using avatars in a virtual world is. One scientific article in Frontiers in Psychiatry found that using CBT in a virtual reality setting is an effective way to treat people experiencing depression, who may be reluctant to seek traditional therapy . Another in JMIR Mental Health highlights that VRT could be used as an alternative form of treatment to in-person therapy for people with social anxiety .

Lazarus is an adjunct professor of psychiatry.

The future of medical students appears promising and challenging at the same time. While there will be abundant opportunities for medical students to explore various fields of medicine, they will be challenged by high stress levels, financial burden, and unprecedented competition for prestigious residencies. How will they fare? In what ways will tomorrow's medical students be different than past generations? Here is a brief overview of what medical school applicants can expect, and how their training will provide an advantage over previous graduates, in my opinion.

A main advantage comes from training prior to matriculation into medical school. Many of the standards for acceptance into medical school by which my generation (Baby Boomers) and others were judged are no longer relevant. The soft sciences -- as opposed to the hard sciences -- now have standing in premedical curricula, especially courses in psychology and sociology. At Philadelphia area medical schools, for example, calculus is required at only one of eight MD or DO granting institutions (Penn State).

The Association of American Medical Colleges (AAMC) added a psychology-sociology ("psych-sosh") section to its MCAT standardized admissions exam in 2015. The revised MCAT reflects the importance of learning how to think and solve problems, with more questions requiring that future doctors use analytical skills rather than simply memorize material. Prerequisite courses in the social sciences may also yield students who are emotionally intelligent as well as clinically competent.

It's telling that in a survey of physicians trained in my era -- those graduating college between 1955 and 1982 -- the greatest unmet need was "skill with people," and my peers wished they had taken more courses in art, history, literature, and music while in college. Nowadays, some of those subjects are expected if students want to earn a spot in medical school, even if they reserve the right to "fall asleep in [their] seats during lectures," writes acclaimed physician-author Chris Adrian, MD.

After decades of welcoming science nerds, medical educators have finally placed more emphasis on the humanities in medicine. Medical students need to be competent in the humanities in order to converse intelligently with a heterogeneous health-conscious public. Once accepted into medical school, students can augment their literary competence through narrative medicine programs, now offered at roughly 80% of medical schools. These programs aim to teach medical students sensitive interviewing and empathic listening skills, combined with storytelling and writing skills to acknowledge the struggles of their patients, as well as their own.

The AAMC has also created an optional exam to evaluate the "situational judgment" of students applying to medical school. The Professional Readiness Exam, formerly known as the AAMC Situational Judgment Test, consists of 30 hypothetical scenarios and 186 related questions that test the effectiveness of students' remedies to hypothetical situations encountered in the classroom and practice. The appropriateness of students' responses is a proxy for their readiness to enter medical school, as determined across eight core competencies such as service orientation, cultural competence, and teamwork.

Typical dilemmas presented to students include: (1) how to deal with a classmate who violates patient privacy on social media; (2) how to ensure a patient's cultural customs are respected in the event something unexpected occurs following surgery; (3) how to seek help when the stress of a clerkship in emergency medicine is beginning to affect sleep and judgment; (4) how to address a lecturer who is quick to dismiss multiple valid perspectives on a subject; and (5) how to deal with a classmate who has assumed a deceased immigrant was "undocumented," or a person's stomach pain was fabricated because they were homeless.

Another similar test, made by Toronto-based Acuity Insights, is called Casper. This assessment evaluates aspects of students' social intelligence and professionalism such as ethics, empathy, problem-solving, and collaboration. The evaluation offers admissions assessments that give each applicant the opportunity to showcase their attributes beyond their grades and to differentiate themselves from other applicants.

The removal of affirmative action admission policies by the Supreme Court of the U.S. (SCOTUS) this past June has not deterred medical schools from efforts to select diverse students, deemed necessary to reduce health disparities. Conducting holistic reviews of applicants and searching for unique personal characteristics complies with the SCOTUS ruling and supports diversity. In addition, some medical schools have instituted community outreach and "pipeline" programs to attract a more diverse applicant pool. The University of California Davis School of Medicine has maintained a remarkably diverse class of students by assessing their socioeconomic status rather than their race and ethnicity (affirmative action admissions have been banned in California public colleges since 1996). A heterogeneous workforce has been shown to Excellerate patient outcomes and increase trust in the doctor-patient relationship. Furthermore, teaching diversity, equity, and inclusion across medical school campuses fosters a sense of belonging among staff and faculty and the patients they serve.

Tomorrow's medical students will be vastly different from their predecessors not only due to their premedical training and selective screening for admission, but also due to changes in medical education methods, evolving technological advancements, and the continuously shifting healthcare landscape.

With the rise of digital health technologies such as telemedicine, artificial intelligence (AI), and machine learning, future medical students will be better technologically equipped. They will be trained in using advanced tools to diagnose, treat, and communicate with patients. In addition, improvements in virtual and augmented reality will provide students access to cutting edge learning tools. This will make their education more interactive and practical, potentially facilitating better understanding and knowledge retention.

AI in particular holds significant promise for medical students, training them to operate at a higher cognitive level and reducing time gathering data and information from multiple sources. According to Harvard Medical School educator Bernard Chang, MD, MMSc, "students ought to be able to move further along the developmental progression of reporter, interpreter, manager, and educator earlier in their training, reaching functional levels at which their cognitive talents will be most valuable in an AI-assisted clinical environment."

Future medical students will increasingly learn to work within and lead multidisciplinary teams. As the healthcare system shifts focus from treatment to prevention, medical students will pay closer attention to the social determinants of health and emphasize preventive care.

The COVID-19 pandemic has shown the importance of adaptability in healthcare. By virtue of having lived through the pandemic, medical students will show resilience and flexibility to changes in the healthcare environment, including changes in the way medicine is practiced and health systems achieve their goals. The whims of private equity and the business of medicine will become second-nature to them. With the rise of healthcare startups and new medical ventures, future medical students will learn entrepreneurial skills to innovate and Excellerate the healthcare system. In fact, approximately 80 medical schools in the U.S. offer a combined MD/MBA program.

Clearly, tomorrow's medical students will be unlike any cohort of doctors in my time.

Arthur Lazarus, MD, MBA, is a member of the editorial board of the American Association for Physician Leadership, an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, and a former Doximity fellow. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

A new study has found that incorporating virtual reality into therapy for hoarding disorder, allowing people to virtually dispose of clutter, reduced symptoms and increased real-life discarding of objects. It suggests the technology could provide an effective treatment for this often-distressing condition.

Characterized by persistent difficulty discarding or parting with possessions due to a perceived need to save them regardless of their value, hoarding disorder is a common and debilitating psychiatric condition. More prevalent in people over 60, the condition can cause problems in relationships, social and work activities.

Not much is known about what causes hoarding disorder. Previously thought to be a subtype of obsessive-compulsive disorder (OCD), it’s only recently, since 2013, been included in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. It’s also frequently underdiagnosed.

While the first-line treatment is cognitive behavioral therapy (CBT), a substantial number of people still remain impaired by their hoarding symptoms after treatment. Now, a new study by Stanford Medicine has examined the effectiveness of incorporating virtual reality (VR) into the treatment of people with hoarding disorder.

“Some people are in such dire need, but we can’t go into their homes,” said Carolyn Rodriguez, a senior author of the study. “The clutter is stacked so high that it’s dangerous for our team to go inside. Yet, practicing letting go of items is such a useful skill that we wanted to create a virtual and safe environment.”

Nine participants, aged over 55 and diagnosed with hoarding disorder, took photos and videos of the most cluttered room in their home and 30 possessions. The photos and videos were transformed into custom navigable 3D virtual environments in which participants could manipulate their possessions.

All participants attended a 16-week online facilitated group therapy session that provided peer support and cognitive behavioral skills related to hoarding. For weeks seven to 14, they also received individual clinician-guided VR sessions in which they practiced placing their ‘objects’ into recycling, donation, or trash bins – the latter was removed by a virtual garbage truck.

The researchers say using VR enabled participants to better understand their attachment to the objects they hoarded and presented a less threatening version of real-life discarding.

“It’s nice to be able to titrate in a virtual space for people who experience considerable distress even attempting to part with possessions,” Rodriguez said.

Seven of the nine participants self-reported improved hoarding symptoms, with an average decrease of 25%. Eight of them also had less clutter in their homes, confirmed by visual assessment by clinicians, with an average decrease of 15%. Although the results were comparable to those who received group therapy without VR, the researchers say this small initial trial demonstrated that the inclusion of VR therapy was feasible, even for older adults.

“I actually thought it might not work because these were older patients, and maybe they would not like the technology, or they would be dizzy – but they thought it was fun,” said Rodriguez.

Most participants reported that VR helped them part with their possessions in real life, though some found the experience unrealistic. The researchers hope that newer technology will Excellerate the VR experience and perhaps lead to the use of augmented reality (AR), where virtual objects are overlaid in the patient’s real home.

Regardless, the researchers say their study goes some way to removing the stigma associated with hoarding disorder.

“People tend to have a lot of biases against hoarding disorder and see it as a personal limitation instead of a neurobiological entity,” Rodriguez said. “We just really want to get the word out there that there’s hope and treatment for people who suffer from this. They don’t have to go it alone.”

The study was published in the Journal of Psychiatric Research.

Source: Stanford Medicine

Many people who dream of an organized, uncluttered home à la Marie Kondo find it hard to decide what to keep and what to let go. But for those with hoarding disorder—a mental condition estimated to affect 2.5% of the U.S. population—the reluctance to let go can reach dangerous and debilitating levels.

Now, a pilot study by Stanford Medicine researchers suggests that a virtual reality therapy that allows those with hoarding disorder to rehearse relinquishing possessions in a simulation of their own home could help them declutter in real life. The simulations can help patients practice organizational and decision-making skills learned in cognitive behavioral therapy—currently the standard treatment—and desensitize them to the distress they feel when discarding.

The study was published in the October issue of the Journal of Psychiatric Research.

A hidden problem

Hoarding disorder is an under-recognized and under-treated condition that has been included in the Diagnostic and Statistical Manual of Mental Disorders—referred to as the DSM-5—as a formal diagnosis only since 2013. People with the disorder, who tend to be older, have persistent difficulty parting with possessions, resulting in an accumulation of clutter that impairs their relationships, their work and even their safety.

"Unfortunately, stigma and shame prevent people from seeking help for hoarding disorder," said Carolyn Rodriguez, MD, Ph.D., professor of psychiatry and behavioral sciences and senior author of the study. "They may also be unwilling to have anyone else enter the home to help."

Sometimes the condition is discovered through cluttered backgrounds on Zoom calls or, tragically, when firefighters respond to a fire, Rodriguez said. Precarious piles of stuff not only prevent people from sleeping in their beds and cooking in their kitchens, but they can also attract pests; block fire exits; and collapse on occupants, first responders and clinicians offering treatment.

Clinicians like Rodriguez occasionally make home visits to help patients practice parting with possessions, but some homes are off limits.

"Some people are in such dire need, but we can't go into their homes. The clutter is stacked so high that it's dangerous for our team to go inside," Rodriguez said. "Yet, practicing letting go of items is such a useful skill that we wanted to create a virtual and safe environment."

Virtual stepping stone

In the study, Rodriguez's team asked nine participants, over the age of 55 and with diagnosed hoarding disorder, to take photos and videos of the most cluttered room in their home along with 30 possessions. With the help of a VR company and Stanford University engineering students, the photos and videos were transformed into custom 3D virtual environments. The participants navigated around their rooms and manipulated their possessions using VR headsets and handheld controllers.

All participants attended 16 weeks of online facilitated group therapy that provided peer support and cognitive behavioral skills related to hoarding. In weeks seven to 14, they also received individual VR sessions guided by a clinician. In these one-hour sessions, they learned to better understand their attachment to the objects and practiced placing them in recycling, donation or trash bins—the latter of which was taken away by a virtual garbage truck. They were then assigned the task of discarding the real item at home.

As with many mental health disorders, the causes of hoarding disorder are not well understood, Rodriguez said, but could involve difficulty processing information, making decisions, sustaining attention or regulating emotions. People with the disorder may fear a loss of security or identity giving up their treasured possessions.

The virtual experience can serve as "a kind of stepping stone," a less intense version of real-life discarding, Rodriguez said. "It's nice to be able to titrate in a virtual space for people who experience considerable distress even attempting to part with possessions."

Seven of the nine participants improved in self-reported hoarding symptoms, with an average decrease of 25%. Eight of nine participants also had less clutter in their homes based on visual assessment by clinicians, with an average decrease of 15%. These improvements are comparable to those from group therapy alone, so it's still unclear whether VR therapy can add value, Rodriguez said. But importantly, this small initial trial demonstrated that VR therapy for hoarding disorder is feasible and well-tolerated, even in older patients.

"I actually thought it might not work because these were older patients and maybe they would not like the technology or they would be dizzy—but they thought it was fun," she said.

Most participants said VR decluttering helped them part with possessions in real life, though some found the VR experience unrealistic. The researchers hope that newer technology will Excellerate the VR experience and perhaps allow augmented reality, in which virtual objects are overlaid in the patient's real home.

"People tend to have a lot of biases against hoarding disorder and see it as a personal limitation instead of a neurobiological entity," Rodriguez said. "We just really want to get the word out that there's hope and treatment for people who suffer from this. They don't have to go it alone."

CNN  — 

Reproductive health experts are updating how they define “infertility” to be more inclusive.

The new definition, issued last week by the American Society for Reproductive Medicine (ASRM) Practice Committee, has been expanded to include anyone needing medical interventions “in order to achieve a successful pregnancy either as an individual or with a partner.”

The updated definition will be published as a report in the society’s journal Fertility and Sterility in about a week or 10 days, Sean Tipton, ASRM’s chief advocacy and policy officer, said Monday.

In the new definition, “we made it explicit that lack of access to the kind of gametes you need is a condition deserving of treatment,” Tipton said, referring to how some people who are single or in same-sex couples would fall into that category.

“That is, the reason you may need medical assistance to build your family, it can be because your fallopian tubes don’t work, or it could be because your sperm don’t swim right. But it could also be because you’re single, or because you are in a relationship with a person who doesn’t have the kind of gametes you need. Those are legitimate causes of infertility, and they need to be treated accordingly,” Tipton said. “It is our hope that this definition removes one of the excuses that insurance companies have attempted to use to deny patients coverage for the medical care they need to have children.”

The ASRM previously defined infertility as the failure to get pregnant within a year of having regular, unprotected intercourse or therapeutic donor insemination in women younger than 35 or within six months in women older than 35. That diagnostic and treatment guideline remains unchanged for heterosexual couples trying to have a baby.

But the updated definition now expands beyond that to also state that infertility is characterized by the “inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing,” or “the need for medical intervention,” such as donor eggs or sperm.

“This revised definition reflects that all persons, regardless of marital status, sexual orientation, or gender identity, deserve equal access to reproductive medicine. This inclusive definition helps ensure that anyone seeking to build a family has equitable access to infertility treatment and care,” Dr. Jared Robins, CEO of ASRM, said in a news release last week.

The new definition “acknowledges the reality of all seeking infertility care,” Robins said, and ASRM looks forward to “working with our members, policymakers, and others to normalize this definition.”

While infertility generally has been defined as not being able to conceive after a year or longer of unprotected sex for heterosexual couples, the US Centers for Disease Control and Prevention has said on its website that “these definitions of infertility are used for data collection and monitoring,” and “they are not intended to guide recommendations about the provision of fertility care services. Individuals and couples who are unable to conceive a child should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility.”

Overall, the new ASRM definition addresses two groups. It maintains a definition of infertility for heterosexual couples – being a year of trying but not conceiving for women younger than 35 and six months of trying but not conceiving for those 35 and older – and it includes patients who are single or in same-sex couples, said Dr. Rachel Ashby, director of the Donor Egg and Gestational Carrier Program at Brigham and Women’s Hospital, who was not involved in the new ASRM definition.

On one hand, “infertility is a disease state. It’s a condition that needs treatment,” Ashby said. “Then the other thing that stands out is the idea that for many people, they can’t get pregnant without the use of donor gametes. If I’m a single woman, if I’m in a same-sex relationship as a woman, or if I’m two men, I need donor gametes. This is another tenet of infertility that’s inclusive of the LGBT community.”

Dr. Aimee Eyvazzadeh, a San Francisco-based reproductive endocrinologist, called the new ASRM definition a positive step forward.

“By adopting a more inclusive and accurate definition of infertility, the medical community can better serve and support those in need of reproductive assistance. It not only promotes transparency but also helps reduce the stigma often associated with fertility problems,” Eyvazzadeh, who was not involved in the updated definition, said in an email.

“There are doctors who feel compelled to tell patients that insurance won’t cover a service because they don’t meet a ‘definition’ even if it’s unrelated to insurance coverage,” Eyvazzadeh said in the email. “The definition means a lot to fertility doctors and patients and I’m thrilled to see this change.”

Reproductive health experts are updating how they define “infertility” to be more inclusive.

The new definition, issued last week by the American Society for Reproductive Medicine (ASRM) Practice Committee, has been expanded to include anyone needing medical interventions “in order to achieve a successful pregnancy either as an individual or with a partner.”

The updated definition will be published as a report in the society’s journal Fertility and Sterility in about a week or 10 days, Sean Tipton, ASRM’s chief advocacy and policy officer, said Monday.

In the new definition, “we made it explicit that lack of access to the kind of gametes you need is a condition deserving of treatment,” Tipton said, referring to how some people who are single or in same-sex couples would fall into that category.

“That is, the reason you may need medical assistance to build your family, it can be because your fallopian tubes don’t work, or it could be because your sperm don’t swim right. But it could also be because you’re single, or because you are in a relationship with a person who doesn’t have the kind of gametes you need. Those are legitimate causes of infertility, and they need to be treated accordingly,” Tipton said. “It is our hope that this definition removes one of the excuses that insurance companies have attempted to use to deny patients coverage for the medical care they need to have children.”

The ASRM previously defined infertility as the failure to get pregnant within a year of having regular, unprotected intercourse or therapeutic donor insemination in women younger than 35 or within six months in women older than 35. That diagnostic and treatment guideline remains unchanged for heterosexual couples trying to have a baby.

But the updated definition now expands beyond that to also state that infertility is characterized by the “inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing,” or “the need for medical intervention,” such as donor eggs or sperm.

“This revised definition reflects that all persons, regardless of marital status, sexual orientation, or gender identity, deserve equal access to reproductive medicine. This inclusive definition helps ensure that anyone seeking to build a family has equitable access to infertility treatment and care,” Dr. Jared Robins, CEO of ASRM, said in a news release last week.

The new definition “acknowledges the reality of all seeking infertility care,” Robins said, and ASRM looks forward to “working with our members, policymakers, and others to normalize this definition.”

While infertility generally has been defined as not being able to conceive after a year or longer of unprotected sex for heterosexual couples, the US Centers for Disease Control and Prevention has said on its website that “these definitions of infertility are used for data collection and monitoring,” and “they are not intended to guide recommendations about the provision of fertility care services. Individuals and couples who are unable to conceive a child should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility.”

Overall, the new ASRM definition addresses two groups. It maintains a definition of infertility for heterosexual couples – being a year of trying but not conceiving for women younger than 35 and six months of trying but not conceiving for those 35 and older – and it includes patients who are single or in same-sex couples, said Dr. Rachel Ashby, director of the Donor Egg and Gestational Carrier Program at Brigham and Women’s Hospital, who was not involved in the new ASRM definition.

On one hand, “infertility is a disease state. It’s a condition that needs treatment,” Ashby said. “Then the other thing that stands out is the idea that for many people, they can’t get pregnant without the use of donor gametes. If I’m a single woman, if I’m in a same-sex relationship as a woman, or if I’m two men, I need donor gametes. This is another tenet of infertility that’s inclusive of the LGBT community.”

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