USF College of Nursing professor, John Clochesy, PhD, collaborates with engineers on virtual technology to help patients manage their own health.

Dr. Clochesy teamed up with researchers and engineers at University of Central Florida and Case Western University to design an interactive video game technology to help improve patient care.

John Clochesy, PhD, professor and senior assistant dean of the PhD program at the USF College of Nursing.

“The virtual support technology helps patients and caregivers become members of the team that manages their own health,” said Dr. Clochesy, who is also the senior assistant dean of the PhD program at the USF College of Nursing. “Interactions with health care providers are sometimes difficult, but if we give people a chance to practice in the virtual world without putting themselves at risk, maybe they would do better. The technology allows people to experience, learn from that experience and take whatever they learn into the clinical setting.”

Dr. Clochesy and his team created several virtual support technologies. The most recent versions are being evaluated in two different randomized controlled trials.

For the first study, Dr. Clochesy teamed up with Vicki Loerzel PhD, associate professor at UCF, to create a virtual game to help older adults manage their cancer symptoms. The study helps cancer patients better manage chemotherapy-induced nausea and vomiting. This trial, which studies 66 participants, will be completed in 2018.

This version of the virtual game helps older adults manage their cancer symptoms.

For the second study, Dr. Clochesy partnered with Ronald L. Hickman, Jr., PhD, associate professor at the Case Western Reserve University, to help educate caregivers of chronically critically ill patients. This trial aims to help caregivers make informed decisions about critically ill patients at the end of life. This study is planned to be completed in 2020.

This version of the game aims to educate caregivers of the chronically critically ill patients.

The virtual support is developed using an avatar-based decision support technology fit for various digital platforms and devices. The risk-free technology helps improve self-management of chronic illness and health outcomes.

“Patients can learn in a virtual reality focusing on real-life events,” Dr. Clochesy said. “The game goes through different situations in various locations and settings where patients and caregivers can learn and practice at the same time. For example, after cancer patients go through chemotherapy, they are presented scenarios where patient-like avatars go into a drug store to get their medication or interact with pharmacists. The game also presents questions on the screen and asks the patients if they’re thirsty or if they need to take their medication – allowing the patient to not only watch but also interact.”

The two studies are funded by grants from National Institute of Nursing Research (NINR), a part of the National Institutes of Health. The researchers have also previously received funding from American Nurses’ Foundation, a program created by Sigma Theta Tau International.

The virtual support technology is not new. Dr. Clochesy and his team of interdisciplinary researchers initially developed the technology in 2009. Their previous studies were focused on an electronic self-management resource training platform called eSMART to help teach people how to better communicate with their health care providers.

The various adaptations of eSMART have shown significant improvements for people suffering with depression and high blood pressure. Since these studies began, Dr. Clochesy and his team have published more than 10 studies in major publications nationwide.

Dr. Clochesy hopes the new version of the virtual game shows similar improvements on cancer patents and decision makers for critically ill patients.

“Chronic illness is costing a fortune in this country,” Clochesy said. “The majority of the care is done by patients and families themselves. But, if they don’t do it well, they end up in the hospital — spending a lot of money. So, if we can teach people to better take care of themselves, we can have better health outcomes and we can also control health care costs.”

The technology appears promising. So, Dr. Clochesy hopes to eventually take the virtual support game to health facilities or home health agencies to help improve patients’ quality of life and help reduce health care costs.

Story and photos by Vjollca Hysenlika, USF Health Communications. 

The NIA-funded study focuses on those who care for people with dementia and Alzheimer’s disease at home

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Tampa, FL (July 9, 2013) – The University of South Florida College of Nursing is conducting research to improve sleep in those caring for people with dementia and Alzheimer’s disease, with the aim of determining if better sleep affects heart health. The $1.9-million, four-year study funded by National Institute on Aging (NIA), “Improving Dementia Caregiver Sleep and the Effect on Heart Disease Biomarkers,” is led by USF College of Nursing Professor and Endowed Chair Meredeth Rowe, RN, PhD, FGSA, FAAN.

Fifteen million Americans provided an estimated 17.5 billion hours of unpaid care to people with Alzheimer’s disease and other dementias in 2012, according to the Alzheimer’s Association. Recent studies indicate that caregivers, unpaid family members or friends who assist people with Alzheimer’s with daily activities, may experience sleep loss from the constant demands of caregiving.

The College of Nursing study tests the relationship between caregiver sleep and heart disease to help understand what negatively affects caregiver health.

USF College of Nursing’s Dr. Meredeth Rowe places one of the monitoring device’s sensors beneath the mattress. The sensor detects movement and sounds an alarm to alert the caregiver if the person with Alzheimer’s disease starts to get out of bed.

“Caregiving and lack of sleep each separately increase the risk of heart disease,” Dr. Rowe said. “We want to discover whether improving sleep in caregivers lowers that risk.”

According to the 2006 Institute of Medicine (IOM) report “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem,” the cumulative effects of sleep loss and sleep disorders have been associated with a wide range of adverse health consequences including increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.

“The College of Nursing at the University of South Florida is transforming lives through research to improve the health of patients and their caregivers,” said Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president of USF Health and dean of the College of Nursing. “We’re making life better by transforming the health care of the family members who provide essential home care for persons with dementia. These caregivers fill an often unrecognized role in the healthcare system.”

The primary focus of Dr. Rowe’s research is finding an effective and easy-to-use treatment that can improve sleep in Alzheimer’s caregivers to increase their overall health and reduce the nursing home placement of people with dementia.

“When I was working on ways to provide caregivers better quality of sleep, I looked for technologies that might help and there were none,” Dr. Rowe said. “I realized that unless I invented a system that allowed them to sleep well, I was never going to have an impact on improving their sleep.”

Dr. Rowe explains to a caregiver how the integrated nighttime monitoring system tracks the bed occupancy and movement patterns around the house of a loved one with dementia. The goal is to allow the caregiver to rest easier through the night while maintaining the safety of the person with dementia.

A number of sensors can be placed around the house, including doorways, to analyze movement patterns and provide customized, specific alerts.

CareAlert, a new night monitoring system designed by Dr. Rowe and Caregiver Watch, LLC, provides reliable alerts to caregivers whenever a person with dementia leaves the bed and wanders through the house. The system helps the caregiver rest easier through the night, and improves the overall safety of the person with dementia. The findings of a study testing the effectiveness of CareAlert were published by Dr. Rowe and colleagues in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, in 2009. The researchers reported that use of CareAlert reduced nighttime injuries and unattended home exits by 85 percent over a period of 12 months.

“Dr. Rowe’s research seeks not only to improve caregiver sleep, but also to better understand the relationships between sleep and changes in heart health,” said Cindy L. Munro, PhD, RN, ANP-BC, FAAN, professor and associate dean for research and innovation at the USF College of Nursing.

In the latest research, Dr. Rowe is evaluating whether a combined intervention using  CareAlert and cognitive-behavioral therapy for insomnia improves sleep in individuals who care for people with dementia and Alzheimer’s who wake up at night. The study, conducted in the USF College of Nursing Caregiving Laboratory, will include as many as 100 participants. All will receive the CareAlert device and one of two sleep therapies assigned at random.

Dr. Rowe, a national expert in caregiver-related issues, worked with a company to design an evidence-based monitoring system with technology responsive to caregiver needs.

Rita F. D’Aoust, PhD, ACNP, ANP-BC, CNE, FAANP, FNAP, associate professor and associate dean of academic affairs and interprofessional initiatives at the USF College of Nursing, and Maureen E. Groer, RN, PhD, FAAN, Gordon Keller professor, are study co-investigators. Dr. D’Aoust studies the associations between vigilance and sympathetic nervous system activity, and Dr. Groer leads the design and analysis of biologic markers for heart disease. Others contributing to this research project include Brandi Mallek, research project manager; Taujihana Brown, research assistant; Glenna Brewster, predoctoral fellow; Milora Morley, undergraduate public health honors student.

The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency and the leading supporter of biomedical research in the world. NIA, one of the 27 institutes and centers at NIH, helps understand the nature of aging and supports the health and well-being of older adults. Dr. Rowe has received many NIH grants throughout her research career to study people with Alzheimer’s disease or dementia and their caregivers. The USF College of Nursing ranks first in Florida and 24th in the nation in NIH funding, for both public and private schools of nursing.

Dr. Maureen Groer, a co-investigator for the caregiver sleep and heart disease risk study, watches as research lab technician Nicole Williams drops processed blood into a machine that will identify biomarkers of heart disease.

Dr. Rowe is currently enrolling participants for this study. For more information, contact USF College of Nursing Research Project Manager Brandi Mallek, at (813) 974-1827 or bmallek@health.usf.edu.

USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu.

Media contact:
Ashlea Bailey, College of Nursing Communications 
(813)396-9642 or  ahudak@health.usf.edu

All photos with Dr. Rowe taken at the USF Health Byrd Alzheimer’s Institute’s Center for Memory C.A.R.E  by Eric Younghans, USF Health Communications
Video by Andy Faza, USF College of Nursing Communications & Marketing