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.

360° video recording inside a GI endoscopy room: Technical feasibility and its potential use for the acquisition of gastrointestinal endoscopy skills. Pilot experience.

New advances in video processing, 3-dimensional designs, and augmented/virtual reality are exciting and evolving fields. These new tools can facilitate the learning phase of basic or advanced endoscopic procedures. Herein, we explain our initial experience, creating an immersive virtual reality (IVR) by using 360-degree recording videos from an interventional endoscopy room. Some common terms used around this technology, such as Augmented reality (AR), Virtual Reality (VR), Three hundred sixty videos, and Mixed Reality (MR), are discussed below. Three examples of VR 360 endoscopic room videos are included in this article.

[Virtual reality for therapeutic purposes in stroke: A systematic review]. / Realidad virtual con fines terapéuticos en pacientes con ictus: revisión sistemática.

INTRODUCTION: Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients' functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. DEVELOPMENT: The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. DISCUSSION AND CONCLUSIONS: Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable.

Use of virtual reality systems as proprioception method in cerebral palsy: clinical practice guideline.

INTRODUCTION: The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions. DEVELOPMENT: All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait. CONCLUSIONS: The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.

Digital imaging, virtual and augmented reality.

The sensorial perception of what is captured is what we know as "image" and consists of a static component and a dynamic process. This continuous process of images capture is essential in surgery. The image is crucial for the surgeon, who requires it for the diagnosis, for the therapeutic process and for postoperative follow-up. In minimally invasive surgery the sequence of images is essential and promotes the appearance of digital video. Digital video is the representation of moving images in the form of encoded digital data, unlike classic analog video, with continuous analog signals. Beyond what we can consider the "real image" (what we see as part of the existing reality) other realities appear in these decades; the Virtual Reality and Augmented Reality. With these realities we refer in the medical ambitus to the creation or superposition, respectively, of a three-dimensional virtual environment to support healthcare and teaching or research processes. Today, these technologies have already begun to be integrated into various surgical specialties, with predictive surgical planning and intraoperative navigation us their main applications. When using these digital environments, it is difficult to completely separate virtual reality from augmented reality, often being Mixed Reality. The current developments offer an environment that mixes the best aspects of both, unifying the simulation and requiring a single helmet or glasses to enjoy the sensorial experience. In this fusion of realities it will be possible to simultaneously create a virtual world from scratch to which we can add virtual elements from our real environment.

Usefulness of virtual reality in the management of pain associated with venepuncture: a multicentre randomized clinical trial.

OBJECTIVE: To assess the efficacy of virtual reality (VR) in reducing pain and anxiety associated with scheduled blood draws. MATERIAL AND METHODS: We conducted multicentre randomized clinical trial in both primary care and hospital settings. The study included children aged 7-12 years undergoing blood extraction procedures between March and October 2022. The intervention group used headsets, and the control group received usual care. Pain was assessed using the visual analogue scale and anxiety using the Groningen Distress Scale. The anxiety of the nursing staff and family satisfaction were assessed with numerical scales ranging from 1 to 10. RESULTS: The study included 83 patients: 40 in the control group and 43 in the VR group. The median age was 10 years (range, 7-12 years). In the VR group, 83.7% of the children reported mild pain, compared to 57.5% in the control group (P = .012). Also, 93% of children in the VR group showed calm or mild anxiety (score, 1-2), compared to 72% of the control group, a difference that was not statistically significant (P = .08). Family satisfaction was higher in the RV group (score ≥ 9/10: 93% of RV group vs 72.5% of control group; P = .026). The nursing staff anxiety score was less than 5 in more than 90% of cases, with no differences between groups (P = .13). CONCLUSION: The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.

The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review.

New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.

[Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]. / Efecto del entrenamiento con realidad virtual inmersiva en el riesgo de caída de personas mayores: una revisión sistemática.

Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.

Clinical trial on nurse training through virtual reality simulation of an operating room: assessing satisfaction and outcomes.

INTRODUCTION: Virtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures. METHODS: This is an open parallel-group randomized clinical trial. One group received basic formation followed by an assessment module. The experimental group received the same basic formation, followed by thoracic surgery training and an assessment module. RESULTS: Fifty-six nurses participated in the study (51 females), with a mean age of 41.6 years. Participants achieved a median evaluation mode score of 480 points (IQR = 32 points). The experimental group (520 points) achieved an overall higher score than the control group (440 points; P = .04). Regarding age, women in the second quartile of age among the participants (35-41 years) achieved significantly better results than the rest (P = .04). When we evaluated the results based on the moment of practice, exercises performed in the last 10 min obtained better results than those performed in the first 10 min (1064 points versus 554 points; P < .001). Regarding adverse effects blurred vision was the most frequent. The overall satisfaction rating with the experience was 8.5 out of 10. CONCLUSION: Virtual reality is a useful tool for training operating room nurses. Clinical trial with ISRCTN16864726 registered number.

Continuous innovation in precision radio-guided surgery.

Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare.

The surgical metaverse.

Recent developments have seen acceleration in the development of virtual reality (VR) and augmented reality (AR) technology. Through these developments, the metaverse has emerged. Within the metaverse, users create an avatar to experience an immersive, interactive extended reality. Current front-runners in its implementation are the financial, communication and entertainment sectors. This technology, however, is receiving greater recognition in the medical world, with national and international surgical bodies acknowledging the benefits that VR and the metaverse will have on surgical training and patient care. Its versatility means that we are likely to see VR related technology become intimately woven into the fabric of surgery in the next two decade. In this article, the impact of the metaverse on the surgical field will be discussed.

Augmented reality in hepatobiliary-pancreatic surgery: a technology at your fingertips.

Augmented reality is a technology that opens new possibilities in surgery. We present our experience in a hepatobiliary-pancreatic surgery unit in terms of preoperative planning, intraoperative support and teaching. For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler. At an intraoperative level, it provides for remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides. In teaching, new lessons include sharing live video of surgery with the support of virtual elements for a better student understanding. As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.

Usage of immersive virtual reality as a relaxation method in an intensive care unit.

INTRODUCTION: The usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. METHODS: Analytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS -1/+1) and without delirium (negative CAM-ICU). Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 min with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish "Cuestionario de Ansiedad Estado-Rasgo (STAI-e)" and they were analysed using T samples coupled (statistical significance when p-value was <0.05). RESULTS: Incorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change -2.68 (SD = 2.75), p = 0.000; second session mean change -1.86 (SD = 1.57), p = 0.021; third session mean change -1.67 (SD = 1.63), p = 0.054. CONCLUSION: The usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that "digital therapies" can be effective to improve the emotional state during their stay in the ICU.

The objective structured clinical examination (OSCE): Main aspects and the role of imaging.

The objective structured clinical examination (OSCE) is a format of examination that enables students to be evaluated in a uniform, standardized, reliable, and objective way. It is carried out in different clinical stations that simulate real clinical situations and scenarios. Numerous universities in Spain and other countries employ this approach for the final examination for medical school students. This update describes the organization, design, and fundamentals for the OSCE, proposing that radiology should form part of multidisciplinary OSCEs to the extent that it forms part of clinical practice. Moreover, it is interesting and opportune to introduce the OSCE in undergraduate and postgraduate training in radiology. Online platforms enable bidimensional OSCEs that are cost-effective in terms of staff, resources, and physical space, although this approach has certain limitations. Virtual world technologies make it possible to reproduce OSCE stations in three-dimensional scenarios; recent experiences in radiology have shown that this approach interests and motivates students and is widely accepted by them.

Therapeutic intervention with virtual reality in patients with Parkinson's disease for upper limb motor training: A systematic review.

To analyze the scientific evidence regarding changes in upper extremities in patients with Parkinson's disease who use virtual reality as part of their neurological rehabilitation treatment. The search was carried out in the following databases: MEDLINE, Cochrane Library, PEDROs and SCOPUS. The following inclusion criteria were applied to a total of 106 articles: Randomized clinical trials with an age of 5 years, the sample had to be of patients with PD (regardless of their state of involvement) and who had performed RV in the treatment of limbs superiors. A total of n=7 articles were used, in which the variables corresponding to upper limb motor control were measured, such as: fine motor dexterity, gross motor dexterity, strength, tremor, functionality and speed. Virtual Reality as tool in neurorehabilitation in patients with Parkinson's disease shows positive effects in all measurements related to upper limb motor control.

[Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review]. / Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática.

INTRODUCTION: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. RESULTS: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual-perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.

[Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]. / Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto.

BACKGROUND AND OBJECTIVES: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. MATERIAL AND METHODS: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. RESULTS: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.

Improvements in planning lacrimal surgery using DICOM Horos® viewer 3D images.

INTRODUCTION AND OBJECTIVE: The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies. METHODS: Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs. RESULTS: The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P < .0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications. CONCLUSIONS: Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided. Another great advantage is that the programme is free.

Improvements in planning lacrimal surgery using DICOM Horos® viewer 3D images. / Mejora de la planificación de las cirugías lagrimales a partir de imágenes tridimensionales con el visualizador DICOM Horos®.

INTRODUCTION AND OBJECTIVE: The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies. METHODS: Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs. RESULTS: The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P<.0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications. CONCLUSIONS: Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided. Another great advantage is that the programme is free.

The effect of gaming on accommodative and vergence facilities after exposure to virtual reality head-mounted display.

BACKGROUND: To investigate the change between accommodative and vergence facilities before and after exposure to gaming in a virtual reality (VR) device amongst participants with normal binocular visual function. METHODS: 62 participants between the ages of 18-30 years with normal binocular visual function and inter-pupillary distances between 51 and 70 mm were selected for the study. Spectacle and contact lenses users were excluded. The experimental group (n = 42) was exposed to gaming using Samsung Gear VR(SM -R323) whilst the control group (n = 20) watched a television film projected on a two-dimensional screen at 1 m. Pre-test and post-test binocular amplitude-scaled facilities and vergence facilities were obtained for both groups after exposures of 25 min. RESULTS: Binocular accommodative facilities for the experimental group had a mean pre-test and post-test facility of 11.14 ± 3.67 cpm and 13.38 ± 3.63 cpm, respectively, after gaming using VR device. The vergence facilities for the experimental group had a mean pre-test and post-test facility of 11.41 ± 3.86 cpm and 15.28 ± 4.93 cpm, respectively, after gaming using a VR device. Binocular accommodative facilities for the control group had a mean pre-test and post-test facility of 11.70 ± 3.2 cpm and 11.95 ± 3.4 cpm, respectively. Vergence facilities for the control group had a mean pre-test and post-test facility of 11.55 ± 6.4 cpm and 11.70 ± 4.9 cpm, respectively. The mean change for binocular accommodative facilities was 2.24 ± 3.43 cpm and 0.25 ± 1.25 cpm for the experimental and control group, respectively. The mean change for vergence facilities was 3.81 ± 3.09 cpm and 0.15 ± 2.72 cpm for the experimental and control group, respectively. Binocular accommodative facilities and vergence facility showed a statistically significant mean increase greater than the control group after gaming using a VR device using an independent t-test (p < 0.05). CONCLUSION: The results showed that binocular accommodative facilities and vergence facilities increased after 25 min of VR gaming in emmetropic participants under 30 years of age with inter-pupillary distances between 51 mm and 70 mm.