Enhancing Men's Awareness of Testicular Diseases (E-MAT) using virtual reality: A randomised pilot feasibility study and mixed method process evaluation.

Background: Testicular cancer (TC) is among the most commonly diagnosed cancers in men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders, such as testicular torsion and epididymitis, can lead to testicular ischemia, sepsis, and infertility if left untreated. This updated systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular disorder symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsycINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and Clinicaltrials.gov were searched for studies published between April 2018 and August 2023. Methodological quality was assessed and results were synthesised meta-narratively. Results: Five studies were included. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination, including a PowerPoint presentation, an online educational brochure, video-assisted teaching, a motivational video, and a virtual reality game. Only one study addressed help-seeking for testicular symptoms and promoted men's awareness of benign as well as malignant testicular diseases. Conclusions: This review highlights the importance of evaluating innovative educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular disorder symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The protocol of the previous version of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

Introduction: Menopause is a natural aging process that occurs due to decreased production of testosterone. As the population ages, andropause is becoming a serious health problem. Due to the limited studies on andropause in Iran and the unfamiliarity of men with this concept, a study was conducted to investigate the knowledge and attitudes of men over 40 years old in Meybod about andropause. Methods: This descriptive cross-sectional study was performed on 400 men over 40 years of age. Sampling was cluster sampling and data were collected through a researcher-made questionnaire, and then analyzed by analysis of variance, Pearson correlation test and regression test in SPSS software version 18. Results: Based on the results of the study, men's knowledge about andropause was low and their attitude was negative and the mean score of participants' knowledge about andropause by age groups (P <0.05), education (P <0.05) and occupation (P <0.05 was significant and the mean score of their attitude towards andropause was significant in terms of age groups (P <0.05) and occupation (P <0.05) but in terms of education (P> 0.05). ) did not make sense. According to Pearson correlation coefficient, there is a statistically significant relationship between the mean score of knowledge and the score of attitude. Conclusion: The knowledge of men in Meybod about andropause is low and their attitude is negative and they need more education about andropause.

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

Computer-Based Social Anxiety Regulation in Virtual Reality Exposure Therapy

Introduction: Patients, oral health care staff anddentists are exposed to infections and infectious microorganisms during dental imaging. The aim of this study was to evaluate the knowledge and practice of general dentists in Yazd City about infection control during the preparation of intraoral radiographs. Methods: This analytical cross-sectional study, examined the knowledge and practice of 81 active dentists in Yazd City who were selected based on convenience sampling method through a questionnaire. To analyze the data, SPSS 16 ,and Pearson's correlation coefficient as well as One-way ANOVA were used. Results: The mean age of the participants was 36.45 ± 9.66 and their mean work experience was 10.03±8.28 years. The mean score of knowledge about infection control during intraoral radiographs was more than 50% and it was evaluated as moderate. There was no statistically significant difference between the mean score of dentists' knowledge in terms of gender (P=0.623), age (P=0.849), work experience (P=0.824) and the year of their graduation (P=0.860), but there was a statistically significant difference between the mean score of dentists' knowledge according to their university of study (P=0.015), so that Yazd School of Dentistry graduates had significantly less knowledge than graduates of other faculties. Conclusion: Considering the importance of infection control in dental radiology and the mean score of dentists' knowledge in the present study, which was moderate, therefore, the need to improve dentists' awareness in this field is emphasized.

The use of virtual reality (VR) technology to improve health among older adults has been receiving increased attention. VR technology has many applications and can produce benefits for people with various medical conditions such as symptom reduction or improving the diagnostic process. Despite the increase in the number of research studies of VR technology, little is known about how it has been used to improve health-related outcomes among people with dementia. This systematic review aimed to synthesize research evidence regarding the scope and impact of VR based interventions among people with dementia. Five databases, CINAHL, Embase, PsychINFO, PudMed, and Web of Science were searched to identify studies leveraging VR to facilitate interventions designed for people with dementia. Multiple keywords were used in combination including: dementia, Alzheimer’s, VR, virtual reality, and Virtual Reality Exposure Therapy. Articles were screened if they were published between 2000 through 2020. Fifteen studies met the criteria, with ten utilizing a randomized controlled trial. The VR based interventions in those studies included virtual physical exercises, virtual forests or natural landscapes, and virtual basic living activities. The results of these studies show that VR as a display medium can greatly improve decision-making, hearing, vision, motor ability, and memory in people with dementia residing either in the community or in long term care settings. Our review demonstrated that VR showed positive benefits through various applications for people with dementia. Future research is needed to make VR interventions more customized toward effectively meeting the needs of people with dementia.

Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (P < 0.05). Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject's attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Tinnitus is the sensation of hearing a "ringing" or "buzzing" in the ears without any external stimuli. Possible causes of tinnitus include hyperactivity in central auditory nuclei, 1 tonotopic reorganization in the auditory cortex, 2 noise exposure, 3 underlying conditions, 4 and use of certain medications. 5 Between 5% and 30% of adults suffer from tinnitus, 6 with about 50% having idiopathic tinnitus. 7www.Shutterstock.com, virtual reality, artificial intelligence, tinnitus.Patients' emotional well-being is affected by tinnitus, 8 including increased anxiety levels. 9 The amygdala and other nonauditory structures in the brain may be involved in tinnitus maintenance by mediating the emotional response in tinnitus patients. 10,11 Novel techniques like the use of vagus nerve implants have been explored for tinnitus mitigation. 12 Although there is no cure for tinnitus yet, effective management techniques include relaxation/mindfulness training, 13 amplification, 14 and sound therapy for both hearing aid users 15 as well as cochlear implant recipients. 16 Sweetow and Sabes 17 evaluated the effects of combining amplification and sound therapy for tinnitus management. The sound therapy included white noise and fractal tones from Widex Zen Therapy. 18 Participants reported a significant reduction in tinnitus annoyance after listening to both sounds but reported feeling more relaxed when hearing the fractal tones. Stress reduction is a significant component in managing chronic health conditions. Distressed patients may turn to social media or mobile applications to explore solutions. 19–22 Techniques for reducing stress can decrease the impact of tinnitus. 23 A randomized controlled trial (RCT) discovered that 16 hours of therapy over two months led to significant reductions in tinnitus measures and reactions to tinnitus. 13 Therapy techniques using virtual reality (VR) have been shown to reduce anxiety in patients with chronic conditions. 24 VR uses specialized equipment that presents visual and auditory information to create specific simulated environments. The use of VR has proven to aid in acute pain management of patients receiving routine and invasive medical procedures. 25 VR also has proven to have significant effects on all affective domains mediated by the limbic system, 26 which is also involved in the perpetuation of tinnitus. 27 Therefore, VR therapy may lessen the engagement of the limbic system in tinnitus perception by delivering relaxation and sound therapy components. The aim of the present study 28 was to explore whether the use of VR combined with conventional sound therapy helped in mitigating tinnitus and reactions to tinnitus as compared to conventional sound therapy alone. STUDY PARTICIPANTS Adults with continuous, chronic, subjective tinnitus were sought as study participants. Adults with hearing aids were recruited if they did not have tinnitus management features programmed into their hearing aids. Twenty adults with both unilateral and bilateral tinnitus (11 males, nine females) between the ages of 18 and 76 years were enrolled in the study. PROCEDURES This study was an RCT with a crossover design. Each participant received two sessions, one week apart. The control intervention provided sound therapy alone, while the experimental intervention provided sound therapy with VR. The sound therapy component used the Zen Aqua program from Widex. The sounds were played for 15 minutes through a computer loudspeaker at a comfortable volume level. The experimental intervention included 15-minute viewings of natural scenes, including flowing streams, lakes, and gorges, presented via VR goggles, while listening to the Zen sounds. Ten participants received the control intervention followed by the experimental intervention and 10 received the experimental intervention followed by the control intervention. Participants' tinnitus loudness, tinnitus functional index (TFI), 29 and minimum masking level (MML) scores were recorded before and after each intervention. RESULTS A multilevel mixed-effects linear regression model accounting for confounding variables revealed that the mean tinnitus loudness and TFI scores reduced significantly (p=0.015 and p=0.043, respectively) after the experimental intervention compared to the control intervention. The MML differences were not statistically significant, but mean values were reduced after the experimental intervention than after the control intervention (p=0.090). DISCUSSION Tinnitus loudness, MMLs, and TFI scores have been used to portray the effectiveness of tinnitus management strategies. 30–32 In the present study, since tinnitus loudness levels and TFI scores improved significantly after receiving the experimental intervention, it can be concluded that these factors are positively affected by combining VR with sound therapy in a controlled setting. While there was no significant improvement in MMLs after the experimental intervention, this could be due to the study procedures causing participants' attention to be focused on their tinnitus. Many tinnitus therapy techniques recommend having an active lifestyle to redirect attention from tinnitus. 33 Previous research has demonstrated that sound therapy, especially fractal tones, can be used to induce relaxation and manage tinnitus. 34,35 In the Sweetow and Sabes study, 17 86% of participants reported feeling relaxed after listening to the wind-chime-like fractal tones. Simonetti et al. 36 discovered a significant reduction in tinnitus handicap inventory (THI) 37 scores after studying the effects of fractal tones on patients with chronic tinnitus. In the present study, participants listened to fractal tones either standalone or with a VR video. Following these interventions, reductions in tinnitus loudness, MMLs, and TFI were present. The emotional and auditory effects of sound therapy can partially explain this trend. For more than two decades, VR has been used to treat conditions such as phobias, 38 anxiety disorders, 24 eating disorders, 39 and intractable pain. 40 A systematic review of 20 studies found VR to be an effective treatment for decreasing acute pain. In 2010, a theoretical framework for the use of VR to manage chronic subjective tinnitus was proposed. 41 Malinvaud et al.42 applied this framework to assess the differences in tinnitus attributes between those receiving VR and those receiving cognitive behavioral therapy (CBT). Without significant differences found between interventions, both interventions showed improvement on THI scores, subjective tinnitus severity scale, and the hospital anxiety and depression scale. 43 The Malinvaud 44 study concluded that VR can be at least as effective as CBT when managing tinnitus. The present study showed significant reductions in tinnitus loudness and TFI for the experimental intervention as compared to the control intervention, supporting these results. LIMITATIONS AND FUTURE DIRECTIONS The present study was conducted in a laboratory setting. Future studies could explore the effects of VR on tinnitus in more natural settings, such as at home. Stimuli can also be presented for a longer duration with more sessions. A longitudinal study would be able to analyze the long-term effects of VR on tinnitus. Future studies could also use a larger participant group. Genetic risk modeling can be used to investigate the biological mechanisms underlying tinnitus. In the present study, participants benefitted from using VR combined with sound therapy for 15 minutes in a laboratory setting. After this intervention, tinnitus loudness levels, MMLs, and TFI scores were reduced when compared to receiving sound therapy alone. Therefore, VR combined with sound therapy is a promising potential technique for managing tinnitus. Future studies could alter the stimuli, mode of delivery, number of sessions, total therapy duration, and number of participants. More trials will be needed before confirming the use of VR and sound therapy to manage tinnitus in a clinical setting.

Among military personnel who participated in combat, the prevalence of post-traumatic stress disorder ranges from 3 % to 11 %. Up to 40 % of patients with post-traumatic stress disorder may not respond to classical treatments such as pharmacotherapy or psychotherapy. Therefore, it is extremely important to develop neurobiological non-drug rehabilitation methods that will more accurately target the neural mechanisms of sensorimotor integration. In this regard, we consider it advisable to analyze whether exposure therapy in virtual reality will effectively address a wide range of symptoms in post-traumatic stress disorder. We conducted a search for articles on the Medline (PubMed) website up to and including March 3, 2025. The search bar was a query for (VR OR virtual reality) AND (PTSD OR post-traumatic stress disorder). We found 25 articles. After deleting the articles that did not meet the criteria, 7 articles remained. Patients with post-traumatic stress disorder report a high degree of immersion when using exposure therapy in virtual reality, and studies show that increased emotional engagement can improve treatment outcomes. Exposure therapy in virtual reality may be particularly useful in the treatment of resistant post-traumatic stress disorder, as it allows the patient to activate traumatic memory more intensively, which is necessary for the extinction of conditioned fear. Exposure therapy in virtual reality had a positive effect on a range of post-traumatic stress disorder symptoms in combat veterans, and all treatment outcomes persisted for 3, 6, and 12 months, although the clear cost advantage and clinical benefits of exposure therapy in virtual reality compared to traditional exposure therapy have not yet been demonstrated.

X-ray usage in medical diagnosis could have hurtful effects for both patient and medical imaging wards' personnel as a result of failure to follow radiation protection (RP) principles (shielding, distance and time) by radiographers. This cross-sectional descriptive-analytical study was carried out by valid and reliable online questionnaire, which was completed by 103 radiographers. Data were analyzed by using descriptive statistics (mean, standard deviation and frequency) and analytical statistics (Pearson's correlation coefficient test, Student's independent t-test and analysis of variance test) in the Statistical Package for Social Sciences version 20 (sig: P<0.05). The study's response rate was 67.32%. The mean scores of participants' total, RP and device knowledge were 42.76, 42.86 and 42.72 out of 100, respectively. Work experience and age of participants were significantly related to device and total knowledge (P<0.01). Results revealed an undesirable level of participants' awareness, indicating the necessity of holding training courses, especially for less experienced radiographers.

Virtual reality (VR) therapy has gained attention as a promising intervention in stroke rehabilitation, particularly for its potential to enhance motor function and promote neuroplasticity. However, its specific effects on balance, mobility, and gait remain underexplored. This review aims to provide a comprehensive evaluation of the effectiveness of VR therapy on the recovery of lower limb function in stroke survivors. Randomized controlled trials comparing VR therapy with conventional therapy were eligible for inclusion. All studies were identified through databases, such as MEDLINE, Embase, PubMed, Cochrane Library, Web of Science, and PsycINFO (up to July 2024). The primary outcomes included balance, assessed using the Berg Balance Scale (BBS), and mobility, measured with the Timed Up and Go Test (TUG) and 10-Meter Walk Test (10-MWT). Secondary outcomes included gait parameters (stride length and step length), the Functional Reach Test (FRT), the Dynamic Gait Index (DGI), and the Falls Efficacy Scale-International (FES-I). RevMan version 5.4 (The Cochrane Collaboration) software was used for the meta-analysis. A total of 2145 studies were screened, and 24 randomized controlled trials that met the inclusion criteria were included, involving 768 participants. Meta-analysis results showed that VR therapy, compared to conventional therapy, significantly improved BBS (mean difference [MD] 3.29, 95% CI 0.52-6.06; P=.02), TUG (MD -1.67, 95% CI -2.89 to -0.46; P=.007), and step length (MD 3.59, 95% CI 0.50-6.69; P=.02). However, no significant difference was observed between the 2 groups in 10-MWT (MD -0.91, 95% CI -3.33 to 1.50; P=.46), stride length (MD 5.63, 95% CI -0.73 to 11.99; P=.08), FRT (MD 2.68, 95% CI -0.30 to 5.67; P=.08), DGI (MD 1.08, 95% CI -0.41 to 2.58; P=.16), and FES-I (MD 0.16, 95% CI -2.92 to 3.24; P=.92). In the subgroup analyses, significant improvements in balance and mobility were observed in patients receiving greater than or equal to 20 sessions, with BBS improved by 5.14 points (95% CI 0.43-9.85; P=.03) and TUG reduced by 1.98 seconds (95% CI -3.33 to -0.63; P=.004). In addition, patients who received VR therapy more than 6 months after stroke showed greater improvements in BBS (MD 1.64, 95% CI 0.14-3.14; P=.03), compared to those who received VR therapy between 7 days and 6 months after stroke. Long-term VR-based therapies are more effective in improving functional ability after stroke. VR therapy has demonstrated significant potential for enhancing lower limb recovery, especially when applied with frequencies of ≥20 sessions.

BackgroundHemiplegia resulting from a stroke frequently causes considerable difficulties in hand function. Virtual reality (VR) therapy has evolved as an innovative and engaging method to facilitate sensorimotor rehabilitation.ObjectiveThis meta-analysis assessed the efficacy of VR-based therapies on hand function in post-stroke hemiplegic patients. The study evaluated the impact of treatment duration, type of VR (immersive, semi-immersive, non-immersive), and stroke stage (subacute versus chronic) on outcomes.MethodsA comprehensive search of six databases until September 2024 identified randomized controlled trials (RCTs) that compared VR therapy with conventional rehabilitation or sham control. The primary outcomes consisted of validated, hand-specific performance metrics, including the Fugl-Meyer upper extremity subscale, Action Research Arm Test, Box and Block Test, Jebsen-Taylor Hand Function Test and Box and Block Test.ResultsTwenty-five RCTs involving 844 participants were evaluated. VR therapy significantly enhanced hand function (SMD = 0.68; 95% CI: 0.41-0.95; p < 0.00001), while there was considerable heterogeneity (I2 = 71%). Subgroup analysis indicated that semi-immersive VR had the most significant benefit (SMD = 1.03), whereas interventions with a cumulative training duration beyond 12 h, along with those administered to subacute patients, demonstrated greater effect size in hand function relative to shorter interventions (pooled SMD for >12 h = 0.94; 95% CI: 0.66-1.23).ConclusionThis meta-analysis suggests that semi-immersive VR therapy improves hand function in post-stroke patients, especially when the total cumulative treatment duration exceeds 12 h. Future research should determine the principal treatment elements, establish uniform dosing methods, and evaluate long-term results, including activities of daily living and quality of life.

The exploration of space will require ever-increasing exposure to microgravity environments. The human response to this exposure has been categorized and mitigated via countermeasures, principally exercise. However, additional constraints to future mission design minimizes the allotted space and modalities for exercise, creating a risk for psychological fatigue, a reduction in motivation, and a suite of other categorical factors that could, taken together, present a risk for reduced adherence to the countermeasures and/or mission performance. Thus, the current study will examine the effects of a virtual reality (VR) intervention on spaceflight-validated exercise protocols using a prototype rowing ergometer designed to operate within the constraints of future long-duration exploration missions (LDEM). The Integrated Resistance and Aerobic Training (dubbed “SPRINT”) protocol will be used in conjunction with a combination flywheel and resistance training device (M-MED) utilized in prior bedrest studies. The SPRINT protocol trades exercise duration for intensity, providing similar benefits to existing countermeasures while reducing time spent on exercise. The M - MED permits resistance training on the muscles most effected by microgravity exposure on the same device used to train cardiovascular function, thus reducing the volume and weight requirements of the exercise countermeasure. It is upon this framework that we will add the VR rowing simulation. VR has shown to be a lightweight, reliable, and enjoyable technology in numerous studies, while exergaming has been shown to improve measures of motivation and adherence. We will create a rowing simulation that can integrate with a rowing ergometer and any exercise protocol, and then implement it on the M-MED with SPRINT. The simulation will feature virtual teammates, virtual competitors, and other gaming mechanisms that encourage a user to maintain a prescribed heart rate intensity in a way that aims to maximize factors associated with enjoyment and adherence. We plan to conduct a within-subjects experiment on an astronaut-like population. Subjects will be randomly assigned to VR or non-VR in their initial experiment, complete the SPRINT protocol on the M-MED, break for a one-month minimum washout period, then return to complete the protocol again in the other group. As a pilot study, dependent variables have been selected broadly. Physical and psychological outcomes are to be measured alongside adherence to and motivation toward this very challenging protocol. Additional measures are to be made of virtual presence, preexisting bias toward or against VR, and personality traits, which may influence a preference for or against VR. Preliminary data on non-VR subjects shows increasing measures of state-trait anxiety, negative feelings toward the exercise, and amotivation from the start to the end of the protocol. It is hypothesized that overall attitudes toward the protocol will improve with the VR intervention as indicated by metrics of adherence, motivation, affect, and mood restoration. The results of this study will inform future designs of exercise combined with VR applications for implementation during LDEM.

Background Vestibular rehabilitation therapy is a safe, effective and non-invasive treatment for the uncompensated peripheral vestibular lesions. Virtual reality can be utilized in vestibular rehabilitation. There are no standardized guidelines settled in the literature involving virtual reality settings for the treatment of the peripheral vestibular lesions. Aim of the Work To study the efficacy of virtual reality (VR) interventions in vestibular rehabilitation in patients with peripheral vestibular disorders. Methods The following databases were examined: PubMed, Google scholar andEmbase. The following search terms were utilized: (Virtual reality – video games – Vestibular rehabilitation – peripheral vestibular dysfunction). Results Based on the inclusion and exclusion criteria, four studies were selected for inclusion in this study. Statistical analysis was done using outcome measures as Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence questionnaire (ABC). This study found that virtual reality interventions can improve balance function in patients with peripheral vestibular disorders. Conclusions This study suggests that virtual reality has potential clinical benefit for vestibular rehabilitation in peripheral vestibular dysfunction compared with conventional vestibular rehabilitation.