Non-pharmacological pain interventions for sickle cell crisis in pediatrics: A scoping review.

PROBLEM: Sickle cell crises (SCC) are recurrent, severe pain episodes experienced by people living with sickle cell disease (SCD). Non-pharmacological interventions have been recommended for SCC pain management however, little is known about the impact of these interventions on SCC pain. This scoping review aims to systematically identify evidence on the use and effectiveness of non-pharmacological interventions for pain management during SCC in the pediatric population. ELIGIBILITY CRITERIA: Studies were eligible if they are published in English and focusing on the use of any non-pharmacological interventions on pain during SCC in pediatric patients. Nine databases were searched including Medline, CINAHL and PsychInfo. Also, the reference lists of relevant studies were searched. SAMPLE: The database searching yielded 1517 studies. After the title and abstract screening, 1348 studies were excluded, and 169 full texts were retrieved and screened. One study was identified through handsearching. Finally, 27 articles were included in this scoping review. RESULTS: Across all studies, 27 different non-pharmacological interventions were identified. There were inconsistent results regarding the effectiveness of virtual reality, guided imagery, and cognitive-behavioral interventions in experimental studies. The most common interventions used at home were prayer, massage, and distraction. The main interventions used in hospitals were prayer and fluid intake, but this was explored by a few studies. CONCLUSION: Pediatric SCD patients use numerous non-pharmacological interventions to manage pain during SCC. However, the impact of many interventions on SCC pain has not been empirically investigated. IMPLICATIONS: Further research is necessary to establish the effectiveness of non-pharmacological interventions on SCC pain.

Immersive virtual reality health games: a narrative review of game design.

BACKGROUND: High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games. METHODS: We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design. FINDINGS: We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies. CONCLUSION: HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Divinity in nursing: The complexities of adopting a spiritual basis for care.

In this paper, the historical alignment of nursing with divinity-based perspectives and modern New Age nursing theories are explored. The nature of divinity in nursing is examined, together with the complexities and issues that arise in adopting a spiritual basis for care. The work of the key theorists in this area (Rogers, Newman, Parse, Watson, Dossey) is reconsidered and fundamental epistemological problems inherent in this approach reviewed. Specific concerns with the interpretation of holistic care, adoption of doxastic logic, faith-based rationales, influence of Caucasian Judeo-Christian and New Age values, misappropriation of science, use of pseudoscience and development of divinity as social consumer product are discussed. Practical problems with using a spiritual basis in contemporary nursing practice are also explored and the alignment of divinity-based nursing theories with the modern antiscience movement is examined. Overall, the re-emergence of divinity-based nursing and spiritual basis for care may be problematic, and would seem to counter the development of an inclusive profession. Additionally, the alignment of nursing with antiscience movements rejecting biomedicine has significant public health implications. This is argued as a regressive step for the advancement of the profession.

Validation of the brief version of the Susceptibility to Persuasion-II scale and evaluation of measurement invariance across age and gender in the Canadian general population.

Measurement tools that can assess personality traits rendering people more susceptible to engagement with and compliance in scams can help identify at-risk populations. The brief, 30-item version of the Susceptibility to Persuasion-II (StP-II-B) scale is a recently developed instrument for assessing 10 personality traits that play a role in scam compliance; however, psychometric evidence supporting the use of this scale is limited. This study aimed to validate the StP-II-B by examining its internal consistency reliability, factor structure, as well as age- and gender-related measurement invariance with a sample of 1287 Canadians aged 16 years and older. Confirmatory factor analysis supported a 10-factor structure identified in previous research. Good internal consistency reliability was obtained for each of the 10 subscales. This 10-factor structure was found to be invariant across age and gender at configural, metric, and scalar levels, suggesting that the StP-II-B was conceptualized in the same way across age and gender and that meaningful comparisons of factor scores could be made. Age and gender differences were found in most factors, with younger individuals and men scoring higher than older individuals and women. This study supports the use of the StP-II-B as a valid and reliable scale for measuring personality traits associated with scam compliance in the Canadian general population and offers insights into age and gender cohorts that may be at higher risk of scam victimization.

Conducting Patient-Oriented Research in Low-Income and Middle-Income Countries: A Scoping Review.

BACKGROUND: Patient-oriented research involves extensive collaboration with patients, their families, caregivers, clinicians and other relevant stakeholders to identify and investigate problems and outcomes relevant to patients. Patient-oriented research can help develop effective patient-centred interventions. Patient-oriented research is an increasingly used approach in high-income countries, but it is unclear how patients are engaged in research in low-income and middle-income countries (LMICs). OBJECTIVES: The aim of this scoping review was to explore how patient-oriented research is conducted in LMICs. The objectives were to determine the levels of involvement of patients in the research, how studies have impacted healthcare and patient outcomes in these countries, the reported benefits of patient-oriented research on the research process and the reported challenges of conducting patient-oriented research in LMICs. METHODS: A scoping review was conducted using the methodological framework suggested by Arksey and O'Malley and the Joanna Briggs Institute guidelines for conducting scoping reviews. The eligibility criteria were any healthcare research using any research design that involved patients of any age group in the research process. Six databases were searched from their inception till January 4, 2022: MEDLINE, Embase, Cumulated Index to Nursing and Allied Health Literature, PsychInfo, Cochrane Central Register of Controlled Trials and EBM Reviews. The reference lists of relevant articles and Google Scholar were combed as well. Data extraction was performed with a self-developed data extraction guide. The findings were narratively summarised. RESULTS: Thirteen articles were included in this scoping review, representing eight LMICs in Africa and Asia. The majority of studies (38%, n = 5) focused on patients living with human immunodeficiency virus. More than half of the studies (n = 8, 62%) were conducted in the adult population, 31% (n = 4) of the studies involved children and/or adolescents. For most of the studies (92%, n = 12), the participants served as consultants; for one study, the authors identified the participants as co-researchers. Across the studies, information regarding patient-oriented research activities was not consistently reported in the same manner (i.e. different locations in the article), with very limited information in some cases. None of the studies used a patient-oriented research framework and the majority did not report on how patient-oriented research impacted healthcare and patient outcomes. Patient-oriented research was beneficial in identifying relevant patients' needs and improving collaboration among stakeholders, but it also led to extended research timelines and increased financial costs for the researchers and patients. CONCLUSIONS: Researchers in LMICs are incorporating patient-oriented research in their research; however, there is a need for improved reporting practices in published articles, and the use of frameworks to guide patient-oriented research in LMICs. In LMICs, patient-oriented research enhances collaboration across stakeholders and gives patients a sense of ownership over the interventions and research process. Future work should focus on developing contextually relevant conceptual frameworks and further studies should explore the impact of patient-oriented research on healthcare and patient outcomes in the LMIC context.

Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours.

This paper builds on prior work exploring the use of risk-associated alternative healthcare (RAAH) in Canada. RAAH uptake was surveyed to explore the characteristics of adult RAAH users and the value of established psychometric instruments previously used in alternative healthcare studies in predicting RAAH behaviours: the Control Beliefs Inventory (CBI), the Reward Responsiveness Behavioural Activation System (RBAS) scale, the Positive Attitudes to Science (PAS) scale, the Satisfaction with Orthodox Medicine (SOM) scale, and the brief version of the Susceptibility to Persuasion-II (StP-II-B) scale. Findings suggest RAAH is influenced by gender, age, income, education, employment, chronic illness status, and ethnicity. Engagement in some form of RAAH was common (around 40%) and the most common types of RAAH use reported were physical manipulation and herbal/nutritional supplement use. Other higher-risk AH activities (such as use of toxins and physically invasive procedures) were also reported by about 5% of respondents. The StP-II-B and PAS instruments were predictive of the likelihood of engagement in RAAH behaviours, as illustrated by higher risk tolerance, desire for novelty, positive attitude to advertising and social influence, and positive beliefs about science. The CBI, RBAS, and SOM instruments were not predictive overall. However, the CBI and SOM instruments were predictive of engagement with physical manipulative RAAH activities, while the RBAS was predictive of herbal/nutritional RAAH engagement. These findings can help inform health professionals' understanding of public health-seeking behaviours with respect to risk.

A taxonomy of risk-associated alternative health practices: A Delphi study.

Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.

Flipped Classroom Versus Classroom Lecture: A Content Mapping Study in Undergraduate Nursing.

BACKGROUND: Educators face the ongoing difficulty of managing finite class time and limited instructor-student interactions to balance discourse and active learning. Complicating this is the growing expectation to incorporate technology into nursing curriculum. This study explored the differences of the traditional classroom lecture (TL) with the flipped classroom (FC) format and the effects on higher-order thinking. METHOD: A content analysis was performed on previous work. Concept maps were used to evaluate data from transcripts of undergraduate nursing students' case study discussions in either a TL or FC format. RESULTS: FC groups had a more complex concept map morphology and identified more subcategories and links. They exhibited a greater number of higher-order thinking concepts compared with the TL groups. The emergence of discussion tangents across both the FC and the TL groups was unexpected. CONCLUSION: The FC approach enhances student learning and aids in the development of higher-order thinking. [J Nurs Educ. 2021;60(11):629-632.].

A rapid evidence assessment of recent therapeutic touch research.

AIM: To synthesize the most recent evidence investigating the effectiveness and safety of therapeutic touch as a complementary therapy in clinical health applications. DESIGN: A rapid evidence assessment (REA) approach was used to review recent TT research adopting PRISMA 2009 guidelines. METHODS: CINAHL, PubMed, MEDLINE, Cochrane databases, Web of Science, PsychINFO and Google Scholar were screened between January 2009-March 2020 for studies exploring TT therapies as an intervention. The main outcome measures were for pain, anxiety, sleep, nausea and functional improvement. RESULTS: Twenty-one studies covering a range of clinical issues were identified, including 15 randomized-controlled trials, four quasi-experimental studies, one chart review study and one mixed methods study including 1,302 patients. Eighteen of the studies reported positive outcomes. Only four exhibited a low risk of bias. All others had serious methodological flaws, bias issues, were statistically underpowered and scored as low-quality studies. No high-quality evidence was found for any of the benefits claimed.

Virtual Reality-Guided Meditation for Chronic Pain in Patients With Cancer: Exploratory Analysis of Electroencephalograph Activity.

BACKGROUND: Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)-guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation. OBJECTIVE: This exploratory study is designed to explore the potential for recording and analyzing EEG during VR experiences in terms of the power of EEG waveforms, topographic mapping, and coherence. We examine how these measures changed during a VR-guided meditation experience in participants with cancer-related chronic pain. METHODS: A total of 10 adult patients with chronic cancer pain underwent a VR-guided meditation experience while EEG signals were recorded during the session using a BioSemi ActiveTwo system (64 channels, standard 10-20 configuration). The EEG recording session consisted of an 8-minute resting condition (pre), a 30-minute sequence of 3 VR-guided meditation conditions (med), and a final rest condition (post). Power spectral density (PSD) was compared between each condition using a cluster-based permutation test and across conditions using multivariate analysis of variance. A topographic analysis, including coherence exploration, was performed. In addition, an exploratory repeated measures correlation was used to examine possible associations between pain scores and EEG signal power. RESULTS: The predominant pattern was for increased ß and γ bandwidth power in the meditation condition (P<.025), compared with both the baseline and postexperience conditions. Increased power in the δ bandwidth was evident, although not statistically significant. The pre versus post comparison also showed changes in the θ and α bands (P=.02) located around the frontal, central, and parietal cortices. Across conditions, multivariate analysis of variance tests identified 4 clusters with significant (P<.05) PSD differences in the δ, θ, ß, and γ bands located around the frontal, central, and parietal cortices. Topographically, 5 peak channels were identified: AF7, FP2, FC1, CP5, and P5, and verified the changes in power in the different brain regions. Coherence changes were observed primarily between the frontal, parietal, and occipital regions in the θ, α, and γ bands (P<.0025). No significant associations were observed between pain scores and EEG PSD. CONCLUSIONS: This study demonstrates the feasibility of EEG recording in exploring neurophysiological changes in brain activity during VR-guided meditation and its effect on pain reduction. These findings suggest that distinct altered neurophysiological brain signals are detectable during VR-guided meditation. However, these changes were not necessarily associated with pain. These exploratory findings may guide further studies to investigate the highlighted regions and EEG bands with respect to VR-guided meditation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00102401; http://clinicaltrials.gov/ct2/show/NCT00102401.

Public perceptions of Internet-based health scams, and factors that promote engagement with them.

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet as a mass communication medium. However, little is known about the nature of this phenomena. Building on previous work exploring the nature of Internet health scams (IHS), this project sought to better understand the reasons why people engaged with IHS, and if contemporary psychosocial theory can help explain IHS engagement. A mixed-methods study, involving a web-based survey incorporating qualitative questions and the Susceptibility to Persuasion-II Brief psychometric scale (STP-II Brief), were administered (N = 194) in British Columbia, Canada, in 2017. Results (n = 156) demonstrated that 40% of participants had ever engaged with IHS, but only 1% reported to have actually lost money to a deceptive product/service. Associations between scam engagement, participant demographics and STP-II Brief scores were explored, with Sex and Employment Status both found to have a significant effect on odds of IHS engagement. STP-II Brief scores were positively correlated with a likelihood of engagement with IHS, even when adjusting for demographic characteristics. The types of IHS most frequently engaged with were those related to body image products, and social influence appeared to be a dominant psychosocial factor promoting engagement. Participants reported that claims of products being 'natural', the result of scientific breakthroughs, use of pseudoscientific language, use of testimonials, and celebrity or professional endorsement could lead them to engage with a product. These findings can help inform health professionals' understanding of public health-seeking behaviours with respect to deceptive marketing.

Internet health scams-Developing a taxonomy and risk-of-deception assessment tool.

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet. However, little is known about the nature of this phenomena. This study sought to methodically identify and categorise Internet-based Health Scams (IHS) currently active in Canada, creating an initial taxonomy based on systematic Internet searches. A five-step Delphi approach, comprised of a multidisciplinary panel of health professionals from the University of British Columbia, in Vancouver, Canada, was used to establish consensus. The resulting taxonomy is the first to characterise the nature of IHS in North America. Five core areas of activity were identified: body image products, medical products, alternative health services, healthy lifestyle products, and diagnostic testing services. IHS purveyors relied on social expectations and psychological persuasion techniques to target consumers. Persuasion techniques included social engagement, claims of miraculous effects, scarcity, and the use of pseudoscientific language. These techniques exploited personality traits of sensation seeking, needing self-control, openness to taking risks, and the preference for uniqueness. The data gathered from the taxonomy allowed the Delphi panel to develop and pilot a simple risk-of-deception tool. This tool is intended to help healthcare professionals educate the public about IHS. It is suggested that, where relevant, healthcare professionals include a general discussion of IHS risks and marketing techniques with clients as a part of health promotion activities.

Virtual Reality Clinical Research: Promises and Challenges.

BACKGROUND: Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. OBJECTIVE: This work aims to highlight key issues in the implementation of clinical research for VR technologies. METHODS: A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers' own experiences in conducting VR clinical research with chronic pain patients. RESULTS: Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. CONCLUSIONS: Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.

Virtual Reality as an Adjunct Home Therapy in Chronic Pain Management: An Exploratory Study.

BACKGROUND: Virtual reality (VR) therapy has been successfully used as an adjunct therapy for the management of acute pain in adults and children, and evidence of potential efficacy in other health applications is growing. However, minimal research exists on the value of VR as an intervention for chronic pain. OBJECTIVE: This case series examined the value of VR to be used as an adjunctive therapy for chronic pain patients in their own homes. METHODS: An exploratory approach using a case series and personal interviews was used. Ten chronic pain patients received VR therapy for 30 min on alternate days for 1 month. Pre- and postexposure (immediately afterwards, 3 h, and at 24 h) pain assessment was recorded using the Numerical Rating Scale (NRS), and weekly using the Brief Pain Inventory (BPI) and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). Terminal semistructured personal interviews with the patients were also undertaken. RESULTS: Of the 8 patients who completed the study, 5 of them reported that pain was reduced during the VR experience but no overall treatment difference in pain scores postexposure was observed. VR was not associated with any serious adverse events, although 60% of patients reported some cybersickness during some of the experiences. CONCLUSIONS: Of note is that the majority of these study participants reported a reduction in pain while using the VR but with highly individualized responses. One patient also reported some short-term improved mobility following VR use. Some evidence was found for the short-term efficacy of VR in chronic pain but no evidence for persistent benefits.

Canadian Nurses' Perspectives on Prostate Cancer Support Groups: A Survey Study.

BACKGROUND: Prostate cancer support groups (PCSGs) are community-based organizations that offer information and psychosocial support to men who experience prostate cancer and their families. Nurses are well positioned to refer men to a range of psychosocial resources to help them adjust to prostate cancer; however, little is known about nurses' perspectives on PCSGs. OBJECTIVE: The aim of this study was to describe nurses' views about PCSGs as a means to making recommendations for advancing the effectiveness of PCSGs. METHODS: A convenience sample of 101 Canadian nurses completed a 43-item Likert-scale questionnaire with the additional option of providing comments in response to an open-ended question. Univariate descriptive statistics and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS: Participants held positive views about the roles and potential impact of PCSGs. Participants strongly endorsed the benefits of support groups in disseminating information and providing support to help decrease patient anxiety. Online support groups were endorsed as a practical alternative for men who are reluctant to participate in face-to-face groups. CONCLUSIONS: Findings suggest that nurses support the value of Canadian face-to-face and online PCSGs. This is important, given that nurses can help connect individual patients to community-based sources providing psychosocial support. IMPLICATIONS FOR PRACTICE: Many men benefit from participating in PCSGs. Aside from positively endorsing the work of PCSGs, nurses are important partners for raising awareness of these groups among potential attendees and can directly contribute to information sharing in face-to-face and online PCSGs.

Prostate cancer support groups: Canada-based specialists' perspectives.

To understand prostate cancer (PCa) specialists' views about prostate cancer support groups (PCSGs), a volunteer sample of Canada-based PCa specialists (n = 150), including urologists (n = 100), radiation oncologists (n = 40), and medical oncologists (n = 10) were surveyed. The 56-item questionnaire used in this study included six sets of attitudinal items to measure prostate cancer specialists' beliefs about positive and negative influences of PCSGs, reasons for attending PCSGs, the attributes of effective PCSGs, and the value of face-to-face and web-based PCSGs. In addition, an open-ended question was included to invite additional input from participants. Results showed that PCSGs were positively valued, particularly for information sharing, education and psychosocial support. Inclusivity, privacy, and accessibility were identified as potential barriers, and recommendations were made for better marketing PCSGs to increase engagement. Findings suggest prostate cancer specialists highly valued the role and potential benefits of face-to-face PCSGs. Information provision and an educational role were perceived as key benefits. Some concerns were expressed about the ability of web-based PCSGs to effectively engage and educate men who experience prostate cancer.

The slippery slope of nursing regulation: challenging issues for contemporary nursing practice in Canada.

This paper provides readers with an overview of some contemporary issues associated with nursing regulation and scope of practice in Canada. Issues with the current organizational structure of nursing regulation and its impact on nursing advocacy in Canada are explored. An argument is presented that nursing regulation needs more consistency and collaboration in Canada. Several examples are used to illustrate this. Fragmentation of regulation is explored and regulatory disciplinary processes are examined in relation to some countries with similar professional structures. The impact of changes in the regulatory status of complementary and alternative health practitioners on nursing is also critiqued. We provide recommendations for future policy and practice to better pave the way for nursing scope and regulatory clarity.

Integrating mobile devices into nursing curricula: opportunities for implementation using Rogers' Diffusion of Innovation model.

OBJECTIVES: To identify studies reporting mobile device integration into undergraduate and graduate nursing curricula. To explore the potential use of Rogers' Diffusion of Innovation model as a framework to guide implementation of mobile devices into nursing curricula. DESIGN: Literature review and thematic categorization. DATA SOURCES: Literature published up until June 2013 was searched using EBSCO, PubMed, and Google Scholar. REVIEW METHOD: The literature was reviewed for research articles pertaining to mobile device use in nursing education. Research articles were grouped by study design, and articles were classified by: 1) strategies for individual adopters and 2) strategies for organizations. Rogers' Diffusion of Innovation theory was used to categorize reported implementation strategies. RESULTS: Fifty-two research studies were identified. Strategies for implementation were varied, and challenges to integrating mobile devices include lack of administrative support and time/funding to educate faculty as well as students. Overall, the use of mobile devices appears to provide benefits to nursing students; however the research evidence is limited. CONCLUSION: Anticipating challenges and ensuring a well laid out strategic plan can assist in supporting successful integration of mobile devices.

A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice.

OBJECTIVES: Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. METHODS: A rapid evidence assessment (REA) strategy was used. CINAHL, Medline, Web of Science, IEEE Xplore Digital Library, and the Cochrane Library databases were screened in from December 2012 to March 2013 to identify studies exploring IVR therapies as an intervention to assist in the management of pain. Main outcome measures were for acute pain and functional impairment. RESULTS: Seventeen research studies were included in total including 5 RCTs, 6 randomized crossover studies, 2 case series studies, and 4 single-patient case studies. This included a total of 337 patients. Of these studies only 4 had a low risk of bias. There was strong overall evidence for immediate and short-term pain reduction, whereas moderate evidence was found for short-term effects on physical function. Little evidence exists for longer-term benefits. IVR was not associated with any serious adverse events. DISCUSSION: This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.

Nursing instructors' and male nursing students' perceptions of undergraduate, classroom nursing education.

Attrition rates of male nursing students exceed those of females yet the experiences of male students in nursing school are poorly understood. This interpretive ethnographic study explored the experiences of male nursing students and female nursing instructors in the context of classroom education. Data collection consisted of participant observation of classroom teaching sessions followed by interviews with six male nursing students who were participants in the classes and six female nursing instructors who taught the classes. Themes resulting from data analysis addressed men's roles in the nursing classroom and the culture of nursing education. The theme of "nursing like a real man" was characterized by men's reliance on roles and behaviours associated with traditional masculinities including leadership, assertiveness and risk-taking. The theme of "masculinities in a feminine place" captured the gendered culture of nursing education which manifested in stereotypes and a sexualized identity, where men saw themselves as accommodated but not integrated. "Diversity between masculine and feminine" communicated the incongruity between men's educational preferences and the techniques that predominate in nursing education. These findings suggest that nursing instructors need to consider gender in their teaching practice, avoid parody or stereotypes of masculinities, and reject assumptions that male students are homogeneous.