Virtual and Augmented Reality Applications in Medicine: Analysis of the Scientific Literature

A Novel Training Modality for Providers in the Emergency Department Using a Computer-Based Scenario: A Pilot Study

OBJECTIVES

Individuals with substance use disorders (SUDs) are increasingly admitted in emergency departments (EDs) nationwide. However, ED providers often have limited knowledge about and lack confidence in treating SUDs. This limited knowledge often results in poor treatment outcomes among patients with SUD in the ED setting. The aims of this pilot study were to (a) assess the desirability, applicability, and acceptability of a computer-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) education scenario and (b) examine changes in SUD knowledge scores among ED providers before and after engaging in the computer-based SBIRT education scenario.

METHODS

A tailored computer-based education scenario was developed based on the SBIRT framework for ED providers in an academic medical center. Participants (N = 15) evaluated the desirability, applicability, and acceptability of the education tool. Also, a single-group pre-/post-design was used to examine changes in participants' SUD knowledge and proficiency scores.

RESULTS

Participants rated the computer-based SBIRT education scenario as desirable, applicable, and acceptable based on 4.0/5.0 or greater evaluation scores for each component. Overall knowledge scores increased from 3.5 to 3.8, albeit non-significantly. Proficiency score percentages increased by 25%.

CONCLUSION

Computer-based SBIRT education scenario training may be acceptable by ED providers and may improve proficiency in addressing SUD for patients. Future studies should evaluate this training method with a larger sample size.

Apple Vision Pro-guided Laparoscopic Radio Frequency Ablation for Liver Tumors: The Pioneer Experience

Background: This study evaluates the feasibility of Apple Vision Pro goggles as an augmented reality (AR) surgical navigation tool for laparoscopic-assisted ultrasound-guided radiofrequency ablation (RFA) of liver tumors. Traditional RFA is effective but challenging due to the integration of multiple imaging modalities.Purpose: The primary aim of this research is to assess how Vision Pro goggles can enhance the surgical navigation process during RFA, improving tumor localization and the overall effectiveness of the procedure.Research Design: A feasibility study design was used to analyze the implementation of AR technologies in surgical navigation, focusing specifically on their application in laparoscopic surgeries.Study Sample: Participants included patients undergoing laparoscopic-assisted ultrasound-guided RFA, with pre-operative imaging workups involving CT and MRI scans followed by intraoperative laparoscopic sonography.Data Collection and/or Analysis: Data were collected through observations during surgical procedures using the Vision Pro goggles, which displayed various imaging inputs (MRI, 3D reconstruction, and laparoscopic sonography) in the surgeon's field of view. Image manipulation was assessed based on accuracy and effectiveness of tumor ablation.Results: The goggles enhanced tumor localization accuracy and facilitated real-time image manipulation, resulting in effective tumor ablation. Initial results show promising outcomes in the precision and efficiency of the RFA procedure.Conclusions: While the initial results are promising, larger studies are necessary to validate the technology's efficacy and safety. Future research should compare outcomes with traditional methods and explore its applicability to other surgeries, aiming to refine the system further. The Vision Pro goggles potentially represent a significant advancement in surgical technology by improving RFA precision and efficiency.

TMJ pericapsular guided injection with visual-inertial odometry (Augmented/mixed reality): A novel pilot clinical approach for joint osteoarthrosis drug delivery

INTRODUCTION

Temporomandibular joint (TMJ) osteoarthrosis often requires pericapsular injections for symptom management. Image-guided techniques have demonstrated superior outcomes compared to traditional manual palpation. Augmented reality (AR) integrates digital images into the clinical scenario in real time and proved to be an efficient surgical guide. This pilot study evaluated the outcomes of AR-assisted versus manual palpation for polynucleotides (PN) pericapsular injections in subjects with TMJ osteoarthrosis.

MATERIALS AND METHODS

20 condyles (10 patients) with bilateral TMJ osteoarthrosis were randomly assigned to either the test (N = 10 condyles - 5 patients; 53 years old SD 13; 4 female - 6 male) or the control group (N = 10 condyles - 5 patients; 58 years old SD 15; 5 female - 5 male): AR-guided or standard injection site localization following manual palpation. AR-guided injections employed custom visual-inertial odometry (VIO) algorithm, using the condyle's segmented images for precise injection site estimation. Mouth opening, lateral movements, and pain intensity were assessed at baseline (T0), 2 weeks (T1), 6 weeks (T2), 12 weeks (T3) post-injection. Statistical analysis included non-parametric Mann-Whitney test between groups for all the outcomes assessed.

RESULTS

AR-guided and manual palpation groups showed improvements in VAS scores and mandibular kinematics over time. The AR-guided group demonstrated significant pain reduction and increased lateral movement. There was no statistically significant difference between the two groups in terms of overall efficacy. The AR-guided procedure took approximately 120 s longer compared to manual palpation (mean time 343.8 s and 211.2 s).

CONCLUSION

The new technique showed clinical efficacy and improvement trends in some clinical parameters such as VAS and laterality, with a reasonable increase in timing compared to the standard practice. This first application of AR can be considered for guided TMJ injections, but further research is needed.

CLINICAL SIGNIFICANCE

AR-assisted TMJ injections offered improvements trends in VAS scores and lateral movements, making it a promising digitally guided approach for daily practice without the need of direct palpation.

Enhancing lower-limb rehabilitation: a scoping review of augmented reality environment

BACKGROUND

Lower-limb rehabilitation is crucial for restoring motor function in individuals with physical impairments; however, traditional rehabilitation approaches often encounter challenges such as limited resources and reduced patient motivation. Augmented reality (AR) offers an innovative approach by enriching rehabilitation with interactive and engaging experiences, thereby enhancing both motivation and treatment outcomes. AR environments enable patients to practice exercises in an immersive setting that emulates real-life scenarios, potentially increasing adherence and improving functional recovery.

METHODS

This scoping review analyzed 25 peer-reviewed studies on the use of AR within the "Environment" component of the Human-Computer-Environment system for lower-limb rehabilitation. We present a taxonomy of existing AR systems, categorizing them by rehabilitation tasks (content) and interaction modes (form), which identify both physical and virtual elements that contribute to a supportive AR environment.

DISCUSSION

The findings suggest that well-designed AR environments offer a flexible and cost-effective approach to various rehabilitation tasks. Customization is essential for addressing specific rehabilitation stages, including muscle strengthening, balance improvement, and gait training. The integration of multisensory feedback, such as visual, auditory, and haptic cues, enhances patient engagement and provides real-time performance monitoring. Effective AR environments must also account for the distinct needs of each limb, particularly for bilateral impairments, and ensure sufficient space for safe movement. By providing an individualized rehabilitation experience, AR environments have the potential to significantly improve patient motivation and outcomes. Future research should explore the integration of AR environments with assistive technologies, such as wearable devices and exoskeletons, to further enhance rehabilitation possibilities.

Virtual reality for menopause symptom management: opportunities, challenges, and next steps

IMPORTANCE AND OBJECTIVE

Menopause is the natural cessation of ovarian function, typically occurring at a mean age of 52 years in the United States. Vasomotor symptoms (VMS; hot flashes and night sweats) affect over 75% of midlife women and typically last 7 to 9 years, with only 54% seeking medical attention. Although hormone therapy is the most effective treatment for VMS, <4% of women currently use it, primarily due to safety concerns. There is evidence that cognitive behavioral therapy (CBT) is an effective management strategy for VMS. Virtual reality (VR) has shown promise in delivering an immersive form of CBT for various medical conditions, including acute and chronic pain, sleep, and mood disorders, potentially overcoming barriers such as access and cost while improving quality of life. This narrative review aims to summarize the existing literature on VR for managing menopause symptoms.

METHODS

A comprehensive literature review was conducted through PubMed and Medline databases. The search focused on keyword combinations related to VR, artificial intelligence, and menopause symptoms.

DISCUSSION AND CONCLUSION

The search yielded one study specifically targeting symptoms related to menopause. A pilot study (n = 42) evaluating an immersive VR and artificial intelligence intervention based on CBT and mindfulness techniques for managing hot flashes in women with breast or ovarian cancer demonstrated a significant reduction in frequency of hot flashes ( P  < 0.01) and improvements in sleep quality, mood, anxiety, stress, and overall quality of life. However, these women experienced hot flashes that might have been associated with their cancer diagnosis or treatment rather than relating specifically to menopause, potentially limiting the generalizability of the findings to women with menopause symptoms. Although VR has shown effectiveness in delivering CBT for other conditions, there remains a significant gap in research on its specific use for menopause-related symptoms.

Examining the effect of virtual reality application on pain and anxiety in the care of chronic wounds on the leg

BACKGROUND

In recent years, virtual reality applications have begun to be used in many areas of the healthcare (education, treatment, etc.). It has been observed that it reduces pain and anxiety by distracting individuals during painful procedures.

MATERIAL AND METHODS

The study was conducted in a wound care clinic between September 2022 and 2024 with a randomized controlled experimental design. 71 patients with chronic wounds on their legs who came to the clinic for care were randomly divided into two groups. While virtual reality glasses were applied to the patients in the experimental group during wound care, patients in the control group received standard care. Pain and anxiety levels of both groups were evaluated before and after dressing. The symptoms of patients using virtual reality glasses were examined.

RESULTS

The data of 71 patients who had chronic wounds on their legs and came to the clinic for dressing were analyzed. The majority of the patients were male patients with an average age in their sixties. Most of the patients had diabetes for a long time (intervention group 19,85 ± 12,31, control group 18,96 ± 12,38) and their wounds were diabetic feet. There was no statistically significant difference in pain (Z = -,857∗∗∗; p = ,391) and anxiety levels (t = 1,94; p = ,057) between the groups before and after the procedure.

CONCLUSSION

It was determined that the use of virtual reality application during dressing of patients with chronic wounds on their legs did not have a significant effect on pain and anxiety. However, no serious symptoms were observed in the patients regarding the use of virtual reality glasses.

Feasibility of a virtual safety officer in detecting PPE donning and doffing violations

A safety officer (SO) can assist healthcare workers in minimizing respiratory transmission of communicable diseases through verification of compliance with safety protocols, such as appropriately donning and doffing personal protective equipment (PPE). This project sought to determine if observation of PPE donning and doffing for detection of protocol violations by a virtual safety officer (VSO) was a feasible option to improve the safety of the workplace. Five healthcare workers with experience serving as safety officers were enrolled in a feasibility study in which they observed actors donning and doffing PPE in-person and noted errors using a curated checklist for documentation. One month later, the same participants viewed recordings of the in-person sessions and again recorded errors for seven trials. Five hundred and twenty-three responses recorded from the SOs across the in-person and virtual trials aligned 88.7% of the time. SOs were more accurate in the virtual setting than in the in-person setting (87.6% vs. 82.4%, respectively). However, Cohen's kappa showed lower inter-rater reliability when observing virtually than in-person, especially in the doffing steps of the protocol. A VSO may be a feasible option when assessing whether participants can correctly follow PPE donning and doffing protocols. Future work includes incorporating real-time observation, 360-degree cameras, virtual reality (VR), and augmented reality (AR) to increase visualization, thereby increasing inter-rater reliability.

Virtual reality simulation for high-risk neonatal emergency nursing training: a mixed-methods study on nurse competency and outcomes

BACKGROUND

Nurses in neonatal intensive care units face critical challenges in managing emergencies where timely, accurate interventions are essential for survival. Traditional nursing education often lacks the hands-on, immersive training required to build complex emergency skills, contributing to persistent neonatal mortality globally. Virtual reality (VR) simulation, grounded in Kolb's Experiential Learning Theory, offers a promising solution by replicating realistic and repeatable clinical scenarios. While VR has shown potential in nursing education, its specific impact on high-risk neonatal emergencies remains underexplored.

AIM

To evaluate the effectiveness of a VR simulation program in enhancing nurse competency and improving neonatal outcomes during emergency care, grounded in Kolb's Experiential Learning Theory.

METHODS

A concurrent triangulation mixed-methods design was implemented over two weeks across four pediatric hospitals. Through stratified random sampling, 128 NICU nurses were allocated to VR simulation (n = 64) or traditional training (n = 64) groups. Quantitative data were collected using validated instruments (OSCE: CVI = 0.92, MCQ: α = 0.86) measuring clinical skills, knowledge retention, and decision-making accuracy. Qualitative data were gathered through semi-structured interviews (n = 24) exploring experiential aspects.

RESULTS

The VR group showed significant improvements in clinical skills (OSCE: +16.1 points, p < 0.001, d = 1.58), decision-making accuracy (+ 16.7%, p < 0.001), and reduced stabilization times (-6.2 min, p < 0.001). Patient safety events decreased by 52% (p < 0.001). Thematic analysis revealed enhanced professional competence (83%), reduced clinical anxiety (75%), and positive learning experiences (88%), despite minor technical challenges.

CONCLUSION

VR simulation demonstrates superior effectiveness for neonatal emergency training, significantly improving both nurse competency and patient outcomes. While geographic specificity and brief follow-up duration limit generalizability, findings support VR's potential for enhancing emergency preparedness. Future research should address longitudinal outcomes and implementation across diverse healthcare settings.

CLINICAL TRIAL NUMBER

Not applicable.

Augmented reality guided versus computed tomography guided percutaneous lung nodule localization: a noninferiority randomized clinical trial

HYPOTHESIS

This study hypothesized that augmented reality (AR) technology has comparable accuracy and safety to conventional CT localization in guiding percutaneous transthoracic lung puncture (PTLP) to localize small pulmonary nodules.

METHODS

This study was a prospective, non-inferiority randomized clinical trial. Patients were randomly assigned between 23 May 2023, and 26 September 2023. Patients with small peripheral lung nodules (≤2 cm) were recruited. Patients were randomly assigned to either the CT-guided PTLP group or the AR-guided PTLP group, with a 1:1 allocation ratio. The primary outcome was the accuracy of lung nodule localization measured by localization error. The secondary outcomes included procedure duration, radiation exposure dosage and complications.

RESULTS

A total of 70 patients underwent either CT- or AR-guided lung nodule localization and subsequent surgeries. Localization error was smaller in the AR-guided group than in the CT-guided group (mean ± SD, 3.1 ± 4.0 mm vs. 5.4 ± 4.2 mm, P = 0.026). The mean difference of localization errors was -2.3 mm (95% CI: - 4.2 to -0.3 mm, P < 0.001 for non-inferiority). Compared to the CT-guided group, the AR-guided group demonstrated significantly lower radiation exposure (mean ± SD, 421 ± 168 vs. 694 ± 229 mGy × cm, P < 0.001) and shorter localization procedure duration (mean ± SD, 8.8 ± 2.3 vs. 14.1 ± 1.8 minutes, P < 0.001), with no statistical difference in complications.

CONCLUSIONS

The accuracy of the AR-guided approach is comparable to that of the CT-guided approach in localizing small lung nodules. Furthermore, the utilization of AR technology has been demonstrated to reduce procedural time and minimize radiation exposure for patients.

Descriptive observational study on the use of virtual reality in patients with inflammatory bowel disease undergoing biological treatment

BACKGROUND

Virtual reality (VR) is a neurosensory experience in which simulated spaces a person has the sensation of being able to function within them. Some patients with inflammatory bowel disease (IBD) receive intravenous biological treatments in an Adult Day Hospital (ADH) regime. VR has been used in some fields of medicine, demonstrating its usefulness in reducing negative symptoms. However, we do not have any literature showing the applicability in real clinical practice of VR in IBD.

METHODS

Descriptive observational pilot study based on an initial cohort of 87 patients that were obtained from the ADH of the IBD Unit. Satisfaction and acceptance of VR through the use of 3D glasses and the reduction of negative symptoms during intravenous biological treatment in patients with IBD in ADH have been assessed.

RESULTS

43 patients (52.4%) used VR and completed the study. In the comparative analysis of the results of the questionnaires before and after the use of VR, a statistically significant improvement was observed in the patients' view on the ability of VR to achieve a reduction in stress (65% patients improve; p: 0.0021) and pain (VAS, 54% p. improve; p<0.05) during treatment. Likewise, with the applicability of VR in other areas of medicine (53%; p: 0.05) and with the possibility of improving well-being during the stay in the ADH (56%; p: 0.0014). No side effects were reported with the use of the 3D glasses.

CONCLUSIONS

VR is a useful complementary tool to improve the stay of patients with IBD on ADH during intravenous treatment.

Simulator training for enhanced interventional radiology education

To address the challenges of staff shortages and the need to gain practical experience in interventional radiology by increasing attention in the medical curriculum, especially in combination with the opportunity to successfully gain hands-on experience, can help influence medical students' career decisions in favor of IR. Regular training on VR simulators can reduce the amount of X-ray radiation needed to adequately care for patients. Ten medical students underwent five angiographic training sessions using an endovascular simulator. Virtual fluoroscopy time was recorded during each session to measure skill development. Pre- and post-training questionnaires were conducted to assess changes in subjective proficiency and career interests. The median virtual fluoroscopy time decreased from 19.3 min initially to 9.3 min (p = 0.007), indicating enhanced procedural proficiency. Post-training questionnaires revealed a notable increase in interest in interventional radiology among participants. Additionally, participants reported improvements in practical skills, understanding of interventional radiology, and readiness for real-world interventions. Simulator-based training significantly enhances procedural proficiency and could impact career interests in interventional radiology. Despite the small sample size, the findings support the efficacy of VR training in medical education, highlighting the need for further research to optimize the implementation of simulation technology in medical training.

The use of extended reality in anesthesiology education: a scoping review

PURPOSE

Extended reality, an umbrella term for virtual, augmented, and mixed reality, is increasingly used in health care education as it requires fewer human and logistical resources and offers reduced costs compared with high-fidelity simulations. Nevertheless, the impact of extended reality on education and training in anesthesiology is largely unknown. We aimed to explore the existing extended reality tools and applications in anesthesiology, identify current knowledge gaps, and highlight future research needs in anesthesiology education.

METHODS

We conducted a scoping review of studies published from January 2010 to December 2023 that focused on extended reality training in anesthesiology and included comparative analyses with other methods. We excluded publications investigating topics unrelated to anesthesiology or not involving interaction with extended reality.

RESULTS

After screening 5,419 studies, we included 62 manuscripts in the final analysis. The definitions and uses of extended reality in anesthesiology education were very heterogeneous. Thirty-seven studies compared extended reality with other forms of training. Neuraxial procedures, peripheral blocks, central venous catheters, and bronchoscopy were primarily investigated. Extended reality improved technical skills, knowledge retention, confidence, and student satisfaction. Six studies reported at least one negative result related to learning, sense of realism, and usefulness.

CONCLUSION

The results of this scoping review highlight the increasing interest of extended reality in anesthesiology education. Nevertheless, many studies lack objective outcome measures and relevant comparisons with existing standards. In addition, extended reality needs to be consistently defined in anesthesiology education to derive optimal benefit and impact. Future studies should also focus on defining extended reality's learning objectives and clinical assessments of trainees' performance, which are commonly missing compared with high-fidelity simulation teaching.

STUDY REGISTRATION

Open Science Framework ( https://doi.org/10.17605/OSF.IO/PDT2F ); first submitted 28 June 2023.

Virtual Reality and Augmented Reality Use Cases in Gastroenterology

PURPOSE OF REVIEW

Virtual reality (VR) and augmented reality (AR) are emerging technologies with significant potential in medical education and therapeutic interventions, particularly within gastroenterology. This review aims to explore the current applications of VR and AR in enhancing endoscopy training, procedural skills, and patient comfort, while also identifying their role in non-pharmacological pain management and pre-procedure education.

RECENT FINDINGS

Extensive research has been conducted on the use of VR and AR in surgical and neurological fields, but their application in gastroenterology is still evolving. VR simulators provide realistic training environments, contributing to improved procedural skills and patient care. Additionally, VR has been shown to reduce patient discomfort and serve as an alternative to sedation during procedures like colonoscopies. AR, specifically in colonoscopies, has demonstrated potential in enhancing polyp detection by overlaying real-time digital information, leading to better diagnostic accuracy. Studies also suggest that VR can improve patient outcomes in functional gastrointestinal disorders and enhance pre-procedure education, increasing patient satisfaction. VR and AR hold significant promise in gastroenterology by advancing both educational and procedural practices. These technologies offer cost-effective, patient-friendly solutions that improve diagnostic accuracy and patient outcomes. Continued research is essential to fully realize the benefits of VR and AR in gastroenterology, as these tools become more prevalent in clinical practice.

Virtual reality modulating dynamics of neuroplasticity: Innovations in neuro-motor rehabilitation

Virtual reality (VR) technology has emerged as a ground-breaking tool in neuroscience, revolutionizing our understanding of neuroplasticity and its implications for neurological rehabilitation. By immersing individuals in simulated environments, VR induces profound neurobiological transformations, affecting neuronal connectivity, sensory feedback mechanisms, motor learning processes, and cognitive functions. These changes highlight the dynamic interplay between molecular events, synaptic adaptations, and neural reorganization, emphasizing the potential of VR as a therapeutic intervention in various neurological disorders. This comprehensive review delves into the therapeutic applications of VR, focusing on its role in addressing multiple conditions such as stroke, traumatic brain injuries, phobias, and post-traumatic stress disorder. It highlights how VR can enhance motor recovery, cognitive rehabilitation, and emotional resilience, showcasing its potential as an innovative and effective tool in neurological rehabilitation. Integrating molecular neuroscience with VR technology allows for a deeper understanding of the molecular mechanisms underlying neuroplasticity, opening doors to personalized interventions and precise treatment strategies for individuals with neurological impairments. Moreover, the review emphasizes the ethical considerations and challenges that come with implementing VR-based interventions in clinical practice, stressing the importance of data privacy, informed consent, and collaborative interdisciplinary efforts. By leveraging advanced molecular imaging techniques, VR-based research methodologies, and computational modelling, the review envisions a future where VR technology plays a central role in revolutionizing neuroscience research and clinical neurorehabilitation, ultimately providing tailored and impactful solutions for individuals facing neurological challenges.

Metaverse Clinic for Pregnant Women With Subclinical Hypothyroidism: Prospective Randomized Study

BACKGROUND

Health care is experiencing new opportunities in the emerging digital landscape. The metaverse, a shared virtual space, integrates technologies such as augmented reality, virtual reality, blockchain, and artificial intelligence. It allows users to interact with immersive digital worlds, connect with others, and explore unknowns. While the metaverse is gaining traction across various medical disciplines, its application in thyroid diseases remains unexplored. Subclinical hypothyroidism (SCH) is the most common thyroid disorder during pregnancy and is frequently associated with adverse pregnancy outcomes.

OBJECTIVE

This study aims to evaluate the safety and effectiveness of a metaverse platform in managing SCH during pregnancy.

METHODS

A randomized controlled trial was conducted at Fujian Provincial Hospital, China, from July 2022 to December 2023. A total of 60 pregnant women diagnosed with SCH were randomly assigned into two groups: the standard group (n=30) and the metaverse group (n=30). Both groups received levothyroxine sodium tablets. Additionally, participants in the metaverse group had access to the metaverse virtual medical consultations and metaverse-based medical games. The primary outcomes were adverse maternal and offspring outcomes, and the secondary outcomes included the neurobehavioral development of offspring and maternal psychological assessments.

RESULTS

Of the 30 participants in each group, adverse maternal outcomes were observed in 43% (n=13) of the standard group and 37% (n=11) of the metaverse group (P=.60). The incidence of adverse offspring outcomes was 33% (n=10) in the standard group, compared to 7% (n=2) in the metaverse group (P=.01). The Gesell Development Scale did not show significant differences between the two groups. Notably, the metaverse group demonstrated significantly improved scores on the Self-Rating Depression Scale and the Self-Rating Anxiety Scale scores compared to the standard group (P<.001 and P=.001, respectively).

CONCLUSIONS

The use of metaverse technology significantly reduced the incidence of adverse offspring outcomes and positively impacted maternal mental health. Maternal adverse outcomes and offspring neurobehavioral development were comparable between the two groups.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300076803; https://www.chictr.org.cn/showproj.html?proj=205905.

Extended reality technology for alleviating adult dental anxiety: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

To assess the effectiveness of extended reality (XR) technology in reducing dental anxiety in adults, through a systematic review and meta-analysis.

METHODS

Comprehensive electronic and manual searches were conducted to identify randomized controlled trials published up to November 23, 2024, with no restrictions on publication year or language. Key outcomes included changes in anxiety and pain levels and cardiovascular indicators, such as blood pressure, heart rate, and oxygen saturation (SpO2). A random-effects model was used to evaluate the combined effects, with subgroup analyses exploring potential influencing factors. The updated Cochrane Risk of Bias 2 tool was used to assess the risk of bias. Meta-analysis was performed using RevMan 5.4.

RESULTS

Of 1,207 screened records, 52 were retrieved for full-text evaluation, resulting in 10 studies meeting the inclusion criteria. The meta-analysis revealed that XR technology significantly reduced anxiety (mean difference [MD]:3.22, 95 % confidence interval [CI]:3.83 to -2.61; I² = 85 %), pain (MD:1.30, 95 % CI:2.07 to -0.53; I² = 84 %), and blood pressure scores (MD:3.34, 95 % CI:4.76 to -1.92; I² = 2 %). For cardiovascular indicators (heart rate, pulse, and SpO₂), the overall effect size was -3.83 (95 % CI:5.54 to -2.13; I² = 83 %).

CONCLUSIONS

Our findings suggest that XR technology effectively alleviates dental anxiety in adults. However, larger, rigorously designed trials to better understand its impact.

CLINICAL SIGNIFICANCE

XR technology reduces patients' blood pressure, heart rate, pain, and anxiety during dental treatments. Rigorous, large-scale trials are needed to confirm its clinical effectiveness.

Effects of Virtual Reality on Pain, Stress, and Affect in an Outpatient Chemotherapy Infusion Clinic: A Randomized Controlled Trial

BACKGROUND

Virtual reality (VR) is a useful therapeutic tool in various patient populations. Patients with cancer may benefit from VR during chemotherapy to address concerns like negative affect, stress, and physical side effects.

OBJECTIVES

The aim of this study was to evaluate the effects of VR on pain, stress, and affect in patients with cancer receiving chemotherapy.

METHODS

Ninety patients were randomized into control and study groups. The study group received a 12-minute VR session while undergoing chemotherapy. Participants took surveys measuring stress, pain, affect, cybersickness, and satisfaction, and heart rates were measured before and halfway through.

FINDINGS

There were statistically significant decreases in stress and pain among patients using VR. Positive affect was significantly elevated, and negative affect was significantly reduced. Heart rate measurements indicated reduced stress. Most patients reported high satisfaction with VR and experienced no feelings of cybersickness.

Metaverse-Aided Rehabilitation: A Perspective Review of Successes and Pitfalls

Background: The evolution of technology has continuously redefined the landscape of rehabilitation medicine. Researchers have long incorporated virtual reality (VR) as a promising intervention, providing immersive therapeutic environments for patients. The emergence of the metaverse has recently further expanded the potential applications of VR to augment the possibilities in rehabilitation. Rehabilitation is a crucial aspect of healthcare, and technological advancements have allowed new approaches to aid in this process. One such approach is the metaverse, a virtual world where users can interact with each other and their surroundings in a simulated environment. This comprehensive review aimed to analyze the scientific evidence using the term "metaverse" in rehabilitation and its potential patient benefits. Methods: We conducted a comprehensive literature search from the inception to September 2024 in PubMed, Scopus, Web of Science, and Cochrane Database to identify studies investigating the term "metaverse" and its role in rehabilitation. We then assessed these studies based on their methodology, patient population, technology used, and therapeutic outcomes. Results: Out of 81 articles, 55 remained after removing duplicates. After screening the title, abstract, and full text, we included five articles. Conclusions: Results from these studies suggested potential benefits in various rehabilitative areas, such as cerebral palsy, intellectual disabilities, pain management, and physical performance improvement among the elderly. The metaverse presents promising avenues for enhancing rehabilitation outcomes. While VR's effectiveness is well established, the metaverse, being a newer concept, necessitates further studies for a more comprehensive understanding.

Use of Virtual Reality Glasses During Healthcare: An Integrative Review

Integrating technology into healthcare services has direct implications for the efficacy and performance of client care. In view of this, the aim was to identify the possibilities of using virtual reality glasses in healthcare. An integrative literature review was conducted in October 2024, searching in MEDLINE, LILACS, BDENF, Scopus, Web of Science, EMBASE, and Science Direct. Original articles were included without restriction on publication period or language, whereas duplicates and those not addressing the guiding question were excluded. The level of evidence was evaluated following Melnyk and Fineout-Overholt's method. Data were synthesized in tables, figures, and in narrative form. The 47 studies in the final sample were published between 2007 and 2024, with most conducted in Turkey and predominantly clinical trials. Various models of glasses were used, with VRBox being the most cited, and video interventions were prominent. Main focuses of use included areas such as rehabilitation, invasive procedures, preoperative care, obstetrics, examinations, dentistry, and wound care. The use of virtual reality glasses has proven effective for distraction, pain reduction, and anxiety management across various health domains. Experimental studies indicate a high level of scientific evidence, which is essential for evidence-based practices; however, more objective investigations are still needed.

User Experience of a Semi-Immersive Musical Serious Game to Stimulate Cognitive Functions in Hospitalized Older Patients: Questionnaire Study

Background

Reminiscence therapy through music is a psychosocial intervention with benefits for older patients with neurocognitive disorders. Therapies using virtual or augmented reality are efficient in ecologically assessing, and eventually training, episodic memory in older populations. We designed a semi-immersive musical game called "A Life in Songs," which invites patients to immerse themselves in a past era through visuals and songs from that time period. The game aspires to become a playful, easy-to-use, and complete tool for the assessment, rehabilitation, and prevention of neurocognitive decline associated with aging.

Objective

This study aimed to assess the user experience (UX) associated with the newly designed serious game.

Methods

After one or several sessions of the game guided by the therapist, patients of the geriatric wards were asked to answer questions selected from 2 widely known UX scales (AttrakDiff and meCUE [modular evaluation of the components of user experience]) with the therapist's help. The internal consistency of the UX dimensions was assessed through Cronbach α to verify the validity of the dimensions. The level of engagement of the patient throughout the experimental session was also assessed following an internally developed scale, which included 5 levels (interactive, constructive, active, passive, and disengaged behaviors). UX mean scores were computed and presented graphically. Verbal feedbacks were reported to support the quantitative results.

Results

Overall, 60 inpatients with a mean age of 84.2 (SD 5.5) years, the majority of whom were women (41/60, 68%), were included. Their score on the Mini-Mental State Examination (MMSE) ranged between 12 and 29. A majority of patients (27/56, 48%) had no major neurocognitive disorder (MNCD), 22/56 (39%) had mild MNCD, and 7/56 (13%) had moderate MNCD. The results revealed very positive UX with mean values beyond the neutral values for every UX dimension of both scales. The overall mean (SD) judgment was rated 3.92 (SD 0.87) (on a scale of -5 to 5). Internal consistency was acceptable to good for the emotional dimensions of the meCUE. Questionable to unacceptable consistency was found for the other UX dimensions. Participants were mostly active (23/60, 38%) and constructive (21/60, 35%).

Conclusions

These findings demonstrated a very good appreciation of the game by geriatric inpatients. Participants' and health care professionals' verbal comments strongly aligned with the quantitative results. The poor internal consistency in the UX dimensions reflected the high heterogeneity among the included patients. Further studies are needed to evaluate the potential benefits of clinical factors such as neurocognitive functions, mood, depression, or quality of life.

The Role of 3D Printing and Augmented Reality in the Management of Hepatic Malignancies

Introduction: 3-dimensional (3D) printing and augmented reality (AR) are emerging technologies that are used in a wide variety of scientific fields. Among them, medicine is one of the most promising fields of application since these technologies can benefit not only surgeons, but also medical/surgical trainees, patients and can potentially benefit health care systems with better educated staff working on personalized solutions for the patients. Thus, potentially reducing intra-operative and post operative complications and overall costs for the health care systems. Hepatic malignancy surgeries are some of the most demanding surgeries that could a general surgeon perform. The intra-operative and post-operative risks and complications render them demanding. In literature there are cases of research studies including applications of 3D printing and augmented reality in hepatic malignancies. Methods: For this, a comprehensive literature search was conducted on Scopus and Pubmed databases (latest search September 5, 2024). Research studies that included applications of 3D printing and AR in hepatic malignancies were eligible for the review. Results: Herein, twelve papers have been included and presented, which either include the use of 3D printing or the use of AR. There are some cases where both technologies were used simultaneously. 3D printing technology and AR can be used alone or in combination together to aid in the management of hepatic malignancies. Conclusion: Encouraging results (eg, efforts to reduce cost of 3D printing, proper surgical pre-planning, usefulness in education of medical personnel and patients) from the use of these technologies, not only qualitatively but also quantitatively, show that the medical staff can help patients and improve their part of the health system. Yet much more studies need to validate whether the use of these two technologies provides positive results on the surgeries or not.

Trends in patient safety education research for healthcare professional students over the past two decades: a bibliometric and content analysis

Research and practice in patient safety education have garnered widespread attention; however, a comprehensive bibliometric analysis is lacking. This study aimed to provide a comprehensive understanding of the research focus and research trends in the globalization of the field of patient safety education and to describe the general characteristics of publications. Data on articles and reviews about student safety education were extracted from Web of Science. Microsoft Excel 2019, CiteSpace 6.1.R3, VOSviewer 1.6.18, SATI 3.2, Scimago Graphica, and Pajek were used for quantitative analysis. Collaboration networks of countries, institutions, journals, authors, and keywords were visualized based on publications from January 2000 to September 2022. A total of 573 papers were published between 2000 to 2022, showing an overall increasing trend. The USA, England, and Australia are the top three most prolific countries; Johns Hopkins University, the University of Technology Sydney, and the University of Toronto are the top three most productive institutions; Nurse Education Today, Journal of Nursing Education, and BMC Medical Education are the most productive journals; Based on content analysis five research hotspots focused on: (1) Quality Improvement of Patient safety Teaching and Learning; (2) Patient safety Teaching Content; (3)Specialized Teaching in Patient Safety; (4) Integrating Patient Safety and Clinical Teaching; (5)Patient Safety Teaching Assessment Content. Through keyword clustering analysis, five research hotspots and relevant contents were identified. According to this study, simulation, communication, collaboration, and medication may attract more attention from researchers and educators, and could be the major trend for future study.

Integrating digital technologies into teaching embodied knowledge in the context of physical examination

BACKGROUND

There is a growing presence of digital technologies in clinical learning environments. However, there is little research into how such technologies shape embodied teaching and learning for health professional students. This study aims to explore current teaching practices in health disciplines to illuminate how digital technologies are used to facilitate the development of embodied knowledge during student learning of physical examination.

METHODS

A qualitative interpretive approach was undertaken, sensitised by body pedagogics as a theoretical frame. In-depth interviews with 18 clinical educators across the disciplines of medicine, physiotherapy, midwifery and nursing were held. These interviews explored their current practices for teaching physical examination. The data was analysed using reflexive thematic analysis combined with a 'thinking with theory' approach, in which the theoretical framework of body pedagogics was central to guiding the reflexive and interpretative process.

RESULTS

We interpreted a framework of five approaches where digital technologies are used to develop bodily knowledge: for sensate knowing; for modelling; for rehearsing; for guiding practice and for providing feedback information.

CONCLUSION

Findings suggest that in current teaching practices, digital technology may be used to facilitate multiple essential elements of physical examination instruction. We conceptualised a framework that extends body pedagogics, where we recognise the multiple roles of digital technology for developing bodily knowledge in the context of physical examination.

Effectiveness of virtual reality in cardiac rehabilitation patients for exercise capacity and negative emotions: A systematic review and meta-analysis

BACKGROUND

The significance of virtual reality (VR) technology as an alternative or complementary modality to traditional cardiac rehabilitation is of increasing interest. Numerous studies have examined the effects of virtual reality technology in cardiac rehabilitation patients, but the results have been inconsistent.

METHODS

We conducted a systematic search of the Cochrane Library, Web of Science, PubMed, Embase, Scopus, ProQuest, OVID, CINAHL, SinoMed, CNKI, WanFang, VIP Database, and ReadShow databases following the Program for Systematic Review and Meta-Analysis guidelines. The search included studies published up until June 30, 2024. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (version 5.3). Otherwise, narrative summaries were performed.

RESULTS

A total of 11 studies with 1093 patients were included. The results of systematic review and meta-analysis showed that virtual reality technology improved patients' exercise capacity (mean difference: 53.26, 95% confidence interval [CI]: 45.14-61.37; P < .00001); anxiety (standardized mean difference [SMD]: -0.39, 95% CI: -0.69, -0.08, P = .01); depression (SMD: -0.48, 95% CI: -0.79, -0.17; P = .003); stress (SMD: -0.72, 95% CI: -1.03, -0.40; P < .00001); emotional tension (SMD: -0.81, 95% CI: -1.15, -0.47; P < .00001); emotional tension (SMD: -0.64, 95% CI: -0.98, -0.30; P = .0002), and intrapsychic stress (SMD: -0.56, 95% CI: -0.90, -0.23; P = .0009).

CONCLUSION

Virtual reality-based interventions can be effective in improving patients' exercise capacity and negative emotions. However, further research is needed to determine the efficacy of VR for other clinical outcomes.

Reporting Guidelines for the Early-Phase Clinical Evaluation of Applications Using Extended Reality: RATE-XR Qualitative Study Guideline

BACKGROUND

Extended reality (XR), encompassing technologies such as virtual reality, augmented reality, and mixed reality, has rapidly gained prominence in health care. However, existing XR research often lacks rigor, proper controls, and standardization.

OBJECTIVE

To address this and to enhance the transparency and quality of reporting in early-phase clinical evaluations of XR applications, we present the "Reporting for the early-phase clinical evaluation of applications using extended reality" (RATE-XR) guideline.

METHODS

We conducted a 2-round modified Delphi process involving experts from diverse stakeholder categories, and the RATE-XR is therefore the result of a consensus-based, multistakeholder effort.

RESULTS

The guideline comprises 17 XR-specific (composed of 18 subitems) and 14 generic reporting items, each with a complementary Explanation & Elaboration section.

CONCLUSIONS

The items encompass critical aspects of XR research, from clinical utility and safety to human factors and ethics. By offering a comprehensive checklist for reporting, the RATE-XR guideline facilitates robust assessment and replication of early-stage clinical XR studies. It underscores the need for transparency, patient-centeredness, and balanced evaluation of the applications of XR in health care. By providing an actionable checklist of minimal reporting items, this guideline will facilitate the responsible development and integration of XR technologies into health care and related fields.

Immersive interfaces for clinical applications: current status and future perspective

Digital immersive technologies have become increasingly prominent in clinical research and practice, including medical communication and technical education, serious games for health, psychotherapy, and interfaces for neurorehabilitation. The worldwide enthusiasm for digital health and digital therapeutics has prompted the development and testing of numerous applications and interaction methods. Nevertheless, the lack of consistency in the approaches and the peculiarity of the constructed environments contribute to an increasing disparity between the eagerness for new immersive designs and the long-term clinical adoption of these technologies. Several challenges emerge in aligning the different priorities of virtual environment designers and clinicians. This article seeks to examine the utilization and mechanics of medical immersive interfaces based on extended reality and highlight specific design challenges. The transfer of skills from virtual to clinical environments is often confounded by perceptual and attractiveness factors. We argue that a multidisciplinary approach to development and testing, along with a comprehensive acknowledgement of the shared mechanisms that underlie immersive training, are essential for the sustainable integration of extended reality into clinical settings. The present review discusses the application of a multilevel sensory framework to extended reality design, with the aim of developing brain-centered immersive interfaces tailored for therapeutic and educational purposes. Such a framework must include broader design questions, such as the integration of digital technologies into psychosocial care models, clinical validation, and related ethical concerns. We propose that efforts to bridge the virtual gap should include mixed methodologies and neurodesign approaches, integrating user behavioral and physiological feedback into iterative design phases.

Benefits of Virtual Reality Training for Cardiopulmonary Resuscitation Skill Acquisition and Maintenance

OBJECTIVES

To investigate the benefits of virtual reality (VR) first-aid training in acquiring cardiopulmonary resuscitation (CPR) skills.

METHODS

A total of 100 non-medical professional volunteers from Nanchang were selected in March 2021 using the convenience sampling method. They were randomly divided into two groups: the VR training group (VR group) and the traditional simulation scenario training group (traditional group). The VR Group underwent immersive virtual reality CPR training with interactive feedback, while the Traditional Group received standard simulation-based CPR training using mannequins and instructor guidance. After training, relevant data were collected for comparative analysis.

RESULTS

The study revealed that the VR group consistently outperforming the traditional group in theoretical knowledge test (cardiac arrest recognition, chest compressions, airway management, and artificial respiration) scores at 1, 3, 6, and 12 months post-training (p < 0.05). Similarly, the VR group showed superior performance in overall skills test scores and individual CPR quality metrics at all post-training assessments. The VR group scored higher in total skills, assessment, post-resuscitation assessment, chest compressions (at 1, 3, and 6 months), airway opening, and artificial respiration compared to the traditional group (p < 0.05). Despite these findings, both groups exhibited a gradual decrease in skills test scores over time.

CONCLUSIONS

Virtual reality training can significantly improve non-medical professional volunteers' CPR knowledge and skill levels, helping them master and maintain these competencies. However, a decrease in CPR knowledge and skills among the participants over time was observed after VR training, suggesting the need for further retraining sessions.

The First Surgery Experienced Through Virtual Reality: A Knee Surgery Case Report

The decision to undergo surgery and the significance of the operating theater environment are influenced by several factors, which vary from person to person. Negative perceptions of the operating room environment can influence the decision to undergo surgery and the process of treatment. Virtual reality (VR) technology offers the potential to alter individuals' environmental encounters through the provision of diverse environmental perceptions. This case study evaluates the results of a VR simulation applied during surgery to an individual with no previous surgical experience. A male patient scheduled for arthroscopic meniscus surgery was the subject of a VR simulation. The patient's perception of the simulated environment was transmitted through VR goggles from the time he entered the operating room until he left. However, the VR application was terminated during the administration of anesthesia, and no premedication was administered to the patient. The VR application included nature walks in various regions, including forests, lakeshores, and meadows, accompanied by the sound of birds. Data were collected using a visual analog scale to assess pain levels and a walking test form. The patient, a 35-year-old male, is a high school graduate and is undergoing his first surgical procedure. The patient expressed concerns and fears regarding the decision to undergo surgery. The patient's preoperative anxiety was rated at 9 out of 10 but subsequently decreased to 1 out of 10 following the surgical procedure. The patient rated his satisfaction with the surgical experience as 9 out of 10. The patient did not require sedatives or analgesics during the intraoperative period or for the first 10 hours following the operation. The patient was successfully mobilized at the 15-hour mark following surgery. The patient was highly satisfied with the application. The utilization of VR during surgical procedures has the potential to reduce the necessity for premedication and enhance postoperative compliance among patients.

Extrarenal Visceral Arteries Injuries during Left Radical Nephrectomy: A 50-Year Continuing Problem

Due to their proximity to the left renal hilum, injuries to the superior mesenteric artery and celiac trunk are still reported during left radical nephrectomy, whether performed via open, laparoscopic, or robotic methods. The aim of this 50-year narrative review is to emphasize the anatomical and pathophysiological bases, risk factors, and strategies for the prevention, diagnosis, and treatment of such injuries.

Virtual Loupes: A Pilot Study on the Use of Video Passthrough Augmented Reality in Plastic Surgery

BACKGROUND

Plastic surgeons use loupes or operative microscope to aid in tissue dissection and anastomosis of structures. These devices have their own limitations in areas of visualization and weight. Current uses of augmented and virtual reality in surgery have been limited to operative planning and simulation. We present a proof of concept that harnesses video passthrough AR technology to augment the capabilities of loupes.

METHODS

We first evaluated methods of gaze-based eye tracking to enable digital magnification. Using the Varjo XR-1 mixed reality headset, we compared discrete zoom through displayed pop-up menu vs continuous zoom through eye winking. Six participants were recruited to perform skin suturing simulation and completed a survey and interview. Next we assessed the performance and limitations of AR digital magnification. Varjo XR-3 was utilized to address the hardware limitations. Participants performed anastomotic suturing tasks with progressively finer suture, then completed a survey and interview.

FINDINGS

There was no strong preference between zoom methods, although participants felt the discrete zoom was easier to use. Participants had difficulty determining depth and visualizing the suture due to limitations of digital magnification. Using Wilcoxon rank sum test to examine differences in system usability scale, the Phase 2 user experience had significant difference in percentile distribution (P 0.0390).

CONCLUSION

Virtual loupes may be a valuable tool for plastic surgeons, with potential for variable magnification and advanced visualization. Improvements in the hardware yielded higher ratings of system usability and user experience. Further development is needed to address the limitations of existing devices.

Virtual reality gaming for rehabilitation of patients with urinary incontinence: A systematic review and meta-analysis

BACKGROUND

Urinary Incontinence (UI) is a global health issue that mainly affects the female population worldwide. Different approaches have been sought for the management of UI including Pelvic floor muscle training (PFMT) using Virtual Reality (VR) gaming. We conducted this study to evaluate the effectiveness of VR gaming for rehabilitation of pelvic floor muscles (PFM) and improving urinary symptoms in patients with UI.

METHOD

We've included studies that contain any type of VR in all geographic locations and settings with no restrictions on the date of publication, age, or gender. Our exclusion criteria include reviews, case series, case reports, unextractable data, unavailable full text, abstract only articles, and studies don't show the effects of VR as a treatment for UI. A pre-specified search term was used and modified according to the requirements of each of the following databases: PubMed, Web of Science, Scopus, Cochrane, Google scholar, and ScienceDirect. For risk of bias assessment, two assessment tools have been used: ROB 2.0 for RCTs and NIH for single arm studies.

RESULTS

Of 915 papers identified from 6 databases, 341 papers were assigned for screening after removing duplicates, 11 papers were eligible for full text screening, and 4 papers were finally included. The qualitative analysis of the results identifies six outcomes grouped into three primary categories: PFM, urinary symptoms, and quality of life. Only urinary loss outcome was eligible for meta-analysis. The net effect between Game therapy + PFMT and PFMT reached MD = -5.49, 95% CI [-12.36:1.38] (heterogeneity; I2 = 95%, p < 0.01).

CONCLUSION

Our research underscores the potential of VR gaming as a valuable adjunctive therapy for pelvic floor muscle rehabilitation in patients with UI. However, further studies are needed to explore its long-term effectiveness, optimal therapy parameters, and cost-effectiveness.

REGISTRATION

Our protocol has been registered in PROSPERO (CRD42022384500).

Knowledge mapping of induced membrane technique: a scientometric study from 2004 to 2023

BACKGROUND

The induced membrane technique (IMT) is a two-step procedure used for reconstructing segmental bone defects in the limbs. The osteogenic mechanism after bone grafting using IMT remains unclear, and efforts to modify the original techniques are limited to the investigative phase. Therefore, reviewing existing knowledge and identifying hotspots and new trends in IMT is critical.

METHODS

We retrieved reviews and articles associated with IMT published between 2004 and 2023 from the Web of Science Core Collection (WoSCC). The keywords included induced membrane technique, guided bone regeneration, bone defect reconstruction, bone graft, stem cells, Masquelet technique, management of bone defects, and scaffold. HistCite, VOSviewer, CiteSpace, and R-bibliometrics were used for scientometric analysis.

RESULTS

A total of 1019 publications from 374 academic journals with 33,995 co-cited references by 2,331 institutions from 65 countries or regions were included. China (n = 235) and the United States (n = 215) were the most productive countries, with Shanghai Jiao Tong University producing the most number of publications (n = 18). Journal Injury [co-citations = 1774; impact factor (IF) 2022 = 2.5] published the most manuscripts, while Masquelet AC and Giannoudis PV published literature with a significant influence on IMT, showing more co-citations (n = 727; n = 355). Two preface hotspots of IMT focused on investigating the microscopic mechanism (such as the membrane supporting graft-to-bone union and the role of inflammatory cells) and developing new techniques to improve IMT (such as bone tissue engineering and new drugs).

CONCLUSION

This study comprehensively reviewed the literature about IMT published in the last 20 years using qualitative and quantitative methods, providing valuable information for researchers investigating IMT.

Research Interest in Copper Materials for Caries Management: A Bibliometric Analysis

This study examined research interest in copper materials for caries management. We conducted an exhaustive literature search of English publications on copper materials for caries management. We removed duplicate publications and screened the titles and abstracts to identify relevant publications. Then, we analyzed the bibliometric data of the publications using the Bibliometrix and VOSviewer programs. This study included 75 laboratory studies, six clinical trials, and 17 reviews. Most of the original research studied copper or copper oxide nanoparticles (45/81, 56%). The materials could be doped into topical agents, restorative fillers, dental adhesives, dental implants, and orthodontic appliances. Since the first paper was published in 1980, publication counts gradually increased and surged in 2019. Among publications on copper materials for caries management, the publication counts and citations from 2019 to 2024 accounted for 65% (64/98) and 74% (1677/2255) over the last 45 years. Cocitation analysis revealed that the two main keywords were nanoparticles and antibacterial activity, and their burst strengths (period) were 3.84 (2021-2024) and 2.21 (2020-2021). The topics of the top two publications with the highest citation burst strength (period) are the antimicrobial effect of copper oxide nanoparticles (3.14, 2021-2022) and the dental application of copper nanoparticles (2.84, 2022-2024). In conclusion, this study revealed a growing interest in copper materials for caries management.

The metaverse in nuclear medicine: transformative applications, challenges, and future directions

The metaverse, a rapidly evolving virtual reality space, holds immense potential to revolutionize nuclear medicine by enhancing education, training, diagnostics, and therapeutics. This review explores the transformative applications of the metaverse in nuclear medicine, where immersive virtual learning environments, simulation-based training, artificial intelligence (AI)-powered decision support systems integrated into interactive three-dimensional (3D) visualizations, and personalized dosimetry using realistic patient-specific virtual models are seamlessly incorporated into the metaverse ecosystem, creating a synergistic platform for healthcare professionals and patients alike. However, the responsible and sustainable adoption of the metaverse in nuclear medicine requires a multidisciplinary approach to address challenges related to standardization, accessibility, data security, and ethical concerns. The formation of cross-disciplinary consortia, increased research and development (R&D) investment, and the strengthening of data governance and cybersecurity measures are crucial steps in ensuring the safe and effective integration of the metaverse in healthcare. As the metaverse continues to evolve, researchers, practitioners, and policymakers must collaborate and explore its potential, navigate the challenges, and shape a future where technology and medicine seamlessly integrate to enhance patient care and outcomes in nuclear medicine. Further research is needed to fully understand the implications of the metaverse in clinical practice, education, and research, as well as to develop evidence-based guidelines for its responsible implementation. By embracing responsible innovation and collaboration, the nuclear medicine community can harness the power of the metaverse to transform and improve patient care.

Effect of virtual reality-based visual training for myopia control in children: a randomized controlled trial

BACKGROUND

To assess the efficacy and safety of virtual reality-based visual training (VRVT) in myopia control among children.

METHODS

The randomized, parallel-group, single-blind clinical trial conducted at the Department of Ophthalmology of Shanghai Tenth People's Hospital enrolled 65 low-myopic children (aged 8 to 13 years) with cycloplegic spherical equivalent (SE) between - 0.50 and - 3.00 diopters (D), astigmatism less than - 1.00 D, anisometropia less than 1.50D, and best corrected visual acuity (BCVA) more than 0.0 logarithm (LogMAR) of the minimum angle of resolution. The participants were enrolled in December 2020, and the follow-up of this study concluded on August 2021. Children were assigned randomly to the intervention group (VRVT plus single-vision spectacle [SVS]) and the control group (only SVS without receiving VRVT). The intervention group was administered for 20 min per day with VRVT under parental supervision at home. The primary outcome was changes in axial length (AL) at 3 months. Macular choroidal thickness (mCT) was regarded as a key secondary outcome.

RESULTS

Among 65 participants (mean age: 10.8 years, 52.3% male), 60 children (92.3%) who completed the 3-month intervention and 6-month follow-up were included in the analysis (30 in the intervention group and 30 in the control group). The changes of AL were 0.063 ± 0.060 mm (95% confidence interval [CI], 0.074 to 0.119 mm) in the intervention group and 0.129 ± 0.060 mm (95% CI, 0.107 to 0.152 mm) and in the control group at 3 months (t = - 2.135, P = 0.037), and the mean difference between the two groups was 0.066 mm. The change of mCT were 22.633 ± 36.171 μm (95% CI, 9.127 to 36.140 μm) in the intervention group and - 3.000 ± 31.056 μm (95% CI, - 14.597 to 8.597 μm) in the control group at 3 months (t = 2.945, P = 0.005). VR vertigo was the most common adverse event which was occurred in two children (2/30, 6.67%) in the intervention group.

CONCLUSIONS

VRVT is a promising method for myopia control in children with good user acceptability. Among children aged 8 to 13 years with low-myopia, nightly use of VRVT resulted in slowing myopia progression.

TRIAL REGISTRATION

This protocol was registered with ClinicalTrials.gov (NCT06250920), retrospectively registered on 01 February 2024.

Metaverse and its impact on medical education and health care system: A narrative review

Background and Aims

The metaverse has enormous potential in health care, continuously developing and offering innovative solutions by combining artificial intelligence (AI), augmented reality (AR)/virtual reality (VR), Internet of Medical Devices, and quantum computing technologies. In addition to using virtual platforms to help and boost medical education, familiarity with this platform is necessary to strengthen medical skills and communication with patients in medical sciences in the future.

Methods

We conducted a comprehensive search using keywords and their MeSH synonyms, including "metaverse," "medical education," and "health care," across PubMed, Scopus, and Web of Science. After screening the results, relevant articles were selected to inform the writing of this manuscript.

Results

The metaverse is shaping the future of medical sciences, offering new opportunities for health education, advocacy training, and patient outcome improvement. The combination of real and virtual worlds may advance international relations, facilitate data sharing, increase medical care speed, and reduce infectious diseases. The metaverse, despite its benefits, has some limitations. Only 37% of 15-24-year-olds have internet access, and AR/VR glasses are expensive and may cause eye discomfort. It is also a potential risk for medical students, who may need help understanding the limitations of simulations and develop unrealistic expectations. Considering the metaverse as a supplement to clinical practice, not a replacement for supervised training, is crucial. Ethical concerns, data security, privacy, and lack of instructions for education are also issues. However, providing information about the metaverse can increase health care workers' attribution to use it for patient examinations, students' education, and tests.

Conclusion

This paper explores the impact of the metaverse on medical science education and underscores the need to integrate the metaverse into all areas of medical sciences as a supplement to existing evidence.

Global research on emerging trends of obstetrics during the COVID-19 pandemic: A bibliometric analysis

Coronavirus disease-2019 (COVID-19) has caused continuous effects on the global public, especially for susceptible and vulnerable populations like pregnant women. COVID-19-related studies and publications have shown blowout development, making it challenging to identify development trends and hot areas by using traditional review methods for such massive data. Aimed to perform a bibliometric analysis to explore the status and hotspots of COVID-19 in obstetrics. An online search was conducted in the Web of Science Core Collection (WOSCC) database from January 01, 2020 to November 31, 2022, using the following search expression: (((TS= ("COVID 19" OR "coronavirus 2019" OR "coronavirus disease 2019" OR "SARS-CoV-2" OR "2019-nCoV" OR "2019 novel coronavirus" OR "SARS coronavirus 2" OR "Severe Acute Respiratory Syndrome Coronavirus-2" OR "SARS-COV2")) AND TS= ("obstetric*" OR "pregnancy*" OR "pregnant" OR "parturition*" OR "puerperium"))). VOSviewer version 1.6.18, CiteSpace version 6.1.R6, R version 4.2.0, and Rstudio were used for the bibliometric and visualization analyses. 4144 articles were included in further analysis, including authors, titles, number of citations, countries, and author affiliations. The United States has contributed the most significant publications with the leading position. "Sahin, Dilek" has the largest output, and "Khalil, Asma" was the most influential author with the highest citations. Keywords of "Cov," "Experience," and "Neonate" with the highest frequency, and "Systematic Review" might be the new research hotspots and frontiers. The top 3 concerned genes included ACE2, CRP, and IL6. The new research hotspot is gradually shifting from the COVID-19 mechanism and its related clinical research to reviewing treatment options for pregnant women. This research uniquely delves into specific genes related to COVID-19's effects on obstetrics, a focus that has not been previously explored in other reviews. Our research enables clinicians and researchers to summarize the overall point of view of the existing literature and obtain more accurate conclusions.

Application of three-dimensional printing in plastic surgery: a bibliometric analysis

Recent years have seen the publication of numerous papers on the application of three-dimensional (3D) printing in plastic surgery. Despite this growing interest, a comprehensive bibliometric analysis of the field has yet to be conducted. To address this gap, we undertook a bibliometric study to map out the knowledge structure and identify research hotspots related to 3D printing in plastic surgery. We analyzed publications from 1995 to 2024, found in the Web of Science Core Collection (WoSCC), utilizing tools such as VOSviewer, CiteSpace, and the R package "bibliometrix". Our analysis included 1,057 documents contributed by 5,545 authors from 1,620 organizations across 71 regions, and these were published in 400 journals. We observed a steady growth in annual publications, with Europe, Asia, North America, and Oceania leading in research output. Notably, Shanghai Jiao Tong University emerged as a primary research institution in this domain. The Journal of Craniofacial Surgery and Journal of Oral and Maxillofacial Surgery have made significant contributions to the field, with Thieringer, Florian M being the most prolific and frequently cited author. Key areas of focus include medical education and surgical procedures, with "3D printing", "virtual surgical planning" and "reconstructive/orthognathic surgery" highlighted as future research hotspots. Our study provides a detailed bibliometric analysis, revealing the evolution and progress of 3D printing technologies in plastic surgery. As these technologies continue to advance, their impact on clinical practice and patient lives is expected to be profound.

Omentoplasty in Surgical Interventions: A Comprehensive Review of Techniques and Outcomes

Omentoplasty, a surgical technique utilizing the omentum's unique properties, has become a pivotal intervention across various surgical fields. This comprehensive review explores the historical evolution, techniques, applications, outcomes, and complications associated with omentoplasty. With its rich vascular supply, lymphatic tissue, and remarkable immunological properties, the omentum has proven invaluable in enhancing wound healing, controlling infections, and providing mechanical support in complex surgical scenarios. The review delves into the anatomy and physiology of the omentum, elucidating its role in promoting angiogenesis and combating infections. Different omentoplasty techniques, including open, laparoscopic, and robotic-assisted approaches, are compared with regard to indications, procedural steps, and outcomes. The applications of omentoplasty span general surgery, cardiothoracic surgery, neurosurgery, gynecologic surgery, and urologic surgery, highlighting its versatility and broad clinical relevance. Short-term and long-term outcomes of omentoplasty, including postoperative recovery, complication rates, recurrence rates, and quality of life, are thoroughly analyzed. The review addresses common and rare complications, emphasizing prevention and management strategies to optimize patient outcomes. Innovations in surgical techniques, the use of biomaterials, and the potential for synthetic or bioengineered omentum are discussed, underscoring the future directions and research opportunities in this field. By providing a detailed examination of omentoplasty, this review aims to enhance understanding, guide clinical practice, and inspire future research to further improve surgical outcomes and patient care.

Mixed reality in interventional radiology: a focus on first clinical use of XR90 augmented reality-based visualization and navigation platform

INTRODUCTION

Augmented reality (AR) and virtual reality (VR) are emerging tools in interventional radiology (IR), enhancing IR education, preprocedural planning, and intraprocedural guidance.

AREAS COVERED

This review identifies current applications of AR/VR in IR, with a focus on studies that assess the clinical impact of AR/VR. We outline the relevant technology and assess current limitations and future directions in this space. We found that the use of AR in IR lags other surgical fields, and the majority of the data exists in case series or small-scale studies. Educational use of AR/VR improves learning anatomy, procedure steps, and procedural learning curves. Preprocedural use of AR/VR decreases procedure times, especially in complex procedures. Intraprocedural AR for live tracking is accurate within 5 mm live patients and has up to 0.75 mm in phantoms, offering decreased procedure time and radiation exposure. Challenges include cost, ergonomics, rapid segmentation, and organ motion.

EXPERT OPINION

The use of AR/VR in interventional radiology may lead to safer and more efficient procedures. However, more data from larger studies is needed to better understand where AR/VR is confers the most benefit in interventional radiology clinical practice.

Artificial intelligence empowering public health education: prospects and challenges

Artificial Intelligence (AI) is revolutionizing public health education through its capacity for intricate analysis of large-scale health datasets and the tailored dissemination of health-related information and interventions. This article conducts a profound exploration into the integration of AI within public health, accentuating its scientific foundations, prospective progress, and practical application scenarios. It underscores the transformative potential of AI in crafting individualized educational programs, developing sophisticated behavioral models, and informing the creation of health policies. The manuscript strives to thoroughly evaluate the extant landscape of AI applications in public health, scrutinizing critical challenges such as the propensity for data bias and the imperative of safeguarding privacy. By dissecting these issues, the article contributes to the conversation on how AI can be harnessed responsibly and effectively, ensuring that its application in public health education is both ethically grounded and equitable. The paper's significance is multifold: it aims to provide a blueprint for policy formulation, offer actionable insights for public health authorities, and catalyze the progression of health interventions toward increasingly sophisticated and precise approaches. Ultimately, this research anticipates fostering an environment where AI not only augments public health education but also does so with a steadfast commitment to the principles of justice and inclusivity, thereby elevating the standard and reach of health education initiatives globally.

Potential Applications of New Headsets for Virtual and Augmented Reality in Urology

Virtual and augmented reality (VR/AR) technologies hold great promise in various medical fields. The release of a new generation of headsets for medical enhanced VR/AR (MER) opens new possibilities for applications in medicine, particularly in urology, to improve accessibility to everyone. These innovative headsets offer deep immersion without requiring a controller, which represents a novel approach to VR/AR engagement. The potential of these headsets applies to all aspects of urology, including surgical training, virtual meetings, communication between health care providers, patient counseling, telemedicine, delivering patient advice, and pain control. MER has the potential to improve operative planning and enhance intraoperative navigation and spatial awareness. The surgeon's visualization and overall experience can be significantly enhanced via improved guidance and visualization, ultimately leading to greater precision and safety. This cutting-edge technology has the potential to reshape urology practice, communication methods, and medical procedures, and ultimately to improve patients' experience of their urological condition. PATIENT SUMMARY: This mini review explores how a new generation of headsets for medical enhanced virtual reality could revolutionize urology by improving surgical planning, assistance during procedures, and medical education. Patients can benefit from better pain management and a deeper understanding of their conditions. However, challenges such as costs, accuracy, and ethical concerns must be addressed. This technology holds promise for transforming urological practice and patient care.

A novel psychosocial virtual reality intervention (BMT-VR) for patients undergoing hematopoietic stem cell transplantation: Pilot randomized clinical trial design and methods

BACKGROUND

Although patients undergoing hematopoietic stem cell transplantation (HSCT) must cope with psychological distress and isolation during an extended transplant hospitalization, psychosocial interventions to address these unmet needs are lacking. Virtual reality offers an innovative modality to deliver a patient-centered psychosocial intervention to address psychosocial needs of patients undergoing HSCT. However, there are currently no supportive care interventions leveraging virtual reality in patients undergoing HSCT.

OBJECTIVE

To describe the methods of a randomized clinical trial (RCT) to assess the feasibility and preliminary efficacy of a self-administered, virtual reality-delivered psychosocial intervention (BMT-VR) to improve psychological distress and quality of life (QOL) for patients hospitalized for HSCT.

METHODS

This study entails a single-center RCT of BMT-VR compared to usual transplant care in 80 patients hospitalized for HSCT. Adult patients with hematologic malignancies hospitalized for autologous or allogeneic HSCT are eligible. BMT-VR includes psychoeducation about the HSCT process, psychosocial skill building to promote effective coping and acceptance, and self-care and positive psychology skills to promote post-HSCT recovery. The primary aim is to assess the feasibility defined a priori as ≥60% of eligible patients enrolling in the study, and of those enrolled and randomized to the BMT-VR, ≥ 60% completing 4/6 BMT-VR modules. Secondary objectives include assessing the preliminary effects on psychological distress and QOL.

DISCUSSION

This is the first RCT of a virtual reality-delivered psychosocial intervention for the HSCT population. If deemed feasible, a future larger multi-site clinical trial can evaluate the efficacy of BMT-VR on outcomes for patients hospitalized for HSCT.

The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials

BACKGROUND

As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative.

OBJECTIVE

This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature.

METHODS

In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery.

RESULTS

Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies.

CONCLUSIONS

Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes.

TRIAL REGISTRATION

PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.

Enhancing surgical planning for abdominal tumors in children through advanced 3D visualization techniques: a systematic review of future prospects

Introduction

Preoperative three-dimensional (3D) reconstruction using sectional imaging is increasingly used in challenging pediatric cases to aid in surgical planning. Many case series have described various teams' experiences, discussing feasibility and realism, while emphasizing the technological potential for children. Nonetheless, general knowledge on this topic remains limited compared to the broader research landscape. The aim of this review was to explore the current devices and new opportunities provided by preoperative Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI).

Methods

A systematic review was conducted to screen pediatric cases of abdominal and pelvic tumors with preoperative 3D reconstruction published between 2000 and 2023.

Discussion

Surgical planning was facilitated through virtual reconstruction or 3D printing. Virtual reconstruction of complex tumors enables precise delineation of solid masses, formulation of dissection plans, and suggests dedicated vessel ligation, optimizing tissue preservation. Vascular mapping is particularly relevant for liver surgery, large neuroblastoma with imaging-defined risk factors (IDRFs), and tumors encasing major vessels, such as complex median retroperitoneal malignant masses. 3D printing can facilitate specific tissue preservation, now accessible with minimally invasive procedures like partial nephrectomy. The latest advancements enable neural plexus reconstruction to guide surgical nerve sparing, for example, hypogastric nerve modelling, typically adjacent to large pelvic tumors. New insights will soon incorporate nerve plexus images into anatomical segmentation reconstructions, facilitated by non-irradiating imaging modalities like MRI.

Conclusion

Although not yet published in pediatric surgical procedures, the next anticipated advancement is augmented reality, enhancing real-time intraoperative guidance: the surgeon will use a robotic console overlaying functional and anatomical data onto a magnified surgical field, enhancing robotic precision in confined spaces.

[Recent advances in the virtual reality technology for treating children with autism spectrum disorder]

Autism spectrum disorder (ASD) is one of the neurodevelopmental disorders in children, and there are currently no specific treatments, with the main interventions focusing on educational training and behavioral correction. Virtual reality, as an emerging technology, is a computer-based environmental simulation system that achieves interactive dynamics and immersive experiences by integrating information from multiple sources. In recent years, it has been gradually applied in intervention training for children with ASD. This paper reviews the recent studies on the effects of virtual reality intervention on emotional cognition, social skills, daily living skills, motor skills, and specific phobias in children with ASD, offering a new direction for ASD intervention training.

Mixed reality based teleoperation and visualization of surgical robotics

Surgical robotics has revolutionized the field of surgery, facilitating complex procedures in operating rooms. However, the current teleoperation systems often rely on bulky consoles, which limit the mobility of surgeons. This restriction reduces surgeons' awareness of the patient during procedures and narrows the range of implementation scenarios. To address these challenges, an alternative solution is proposed: a mixed reality-based teleoperation system. This system leverages hand gestures, head motion tracking, and speech commands to enable the teleoperation of surgical robots. The implementation focuses on the da Vinci research kit (dVRK) and utilizes the capabilities of Microsoft HoloLens 2. The system's effectiveness is evaluated through camera navigation tasks and peg transfer tasks. The results indicate that, in comparison to manipulator-based teleoperation, the system demonstrates comparable viability in endoscope teleoperation. However, it falls short in instrument teleoperation, highlighting the need for further improvements in hand gesture recognition and video display quality.