Exploring the Potential of Virtual Reality-Based Procedural Skill Training in Reducing Medical Errors: A Pilot Study

BackgroundLifestyle changes and physical activity can make an important contribution to reducing the risk factor for high blood pressure (BP). Whether virtual reality (VR) exergames are also appropriate and make a positive contribution to the reduction of BP has not yet been sufficiently investigated. Therefore, the aim of the study was to gain knowledge of the load intensities to be achieved during a VR exergame and to examine the short-term effects on BP.MethodsFor the preliminary study, 22 participants with hypertension over the age of 65 years were analyzed. The study took place in a mobile laboratory truck. All participants visited on two occasions. During visit 1, VR strength endurance training (VR-SET) and during visit 2, VR endurance training (VR-ET) was performed. Each VR session lasted approximately 25 min and was of a moderate intensity. Heart rate (HR) was measured across the entire session, as well as BP before and after the VR exergame. The Rating of Perceived Exertion (RPE) and task load using NASA Task Load Index were determined after each VR session. Included in the statistical analysis were the Shapiro–Wilk test, the paired t-test, the Wilcoxon test and ANOVA for repeated measures.ResultsDuring the “main part” (p < .001), at the “end” (p = .002) and for the “maximum HR” (p < .001), significant load differences between both VR sessions could be determined. In addition, significantly more participants in the VR-SET group achieved a moderate load intensity of at least 40% of heart rate reserve (p = .014). Regarding RPE, participants rated their subjectively perceived exertion significantly higher in the VR-SET than in the VR-ET (p = .028). Systolic BP decreased significantly in both VR sessions when compared before VR session and 5 min after VR session (p = .015; p = .003), as well as before VR session and 10 min after VR session (p = .018; p < .001).ConclusionsAn individual moderate load intensity of 40% can be reached during VR-SET. In addition, a positive short-term effect of the VR exergame on BP behavior (postexercise hypotension) was observed after both VR sessions. The preliminary results indicate that a VR exergaming could lead to blood pressure lowering effects for older people with hypertension.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00022881, 07/09/2020, https://drks.de/search/de/trial/DRKS00022881).

BackgroundElectrocardiography (ECG) is now proposed as a simple and cost‐effective tool to determine the location of arrhythmias before ablation. We aimed to examine the value of the QRS onset of outflow tract PVC in V1 and V2 leads recorded in fourth, third, and second intercostal spaces to differentiate two main origins for premature ventricular contraction (PVC) including right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT).MethodsIn this prospective cohort study, a total of 58 patients were studied, from whom a surface ECG was obtained using V1 and V2 leads in the fourth, third, and second intercostal spaces. ECG and Electrophysiology studie (EPS) data were then recorded and compared to determine the sensitivity and specificity of QRS onset in locating arrhythmias. The reciever operating characterictic (ROC) curve analysis was applied to test diagnostic performance.ResultsBased on the time of PVC initiation in each of the V1 and V2 leads in the fourth intercostal space, if PVC is recorded earlier in the V1 lead, its source in 95.8% of the patients is RVOT and if PVC preceded the V2 lead, 70.59% of the patients had PVC from LVOT. Comparing of QRS onset in V1 and V2 leadsrecorded from third% and and second intercostal spaces had considerable sensitivity and specificity to determine the origin of the outflow tract PVC (81.82 and 94.12%, respectively)ConclusionSimultaneous recording of outflow tract PVCs from second third and fourth intercostal spaces and comparing their onset can determine the left and right outflow tract PVCs with high sensitivity and specificity.

Impact of virtual reality with or without hypnosis before oocyte retrieval: A randomised study.

Autologous free flap breast reconstruction using the internal mammary artery is common; however, its use may compromise treatment of occult coronary artery disease. The authors investigated whether internal mammary artery harvest for breast reconstruction is compatible with future use for coronary bypass. An anatomic analysis of 10 preserved female cadavers was performed. Internal mammary artery measurements, including the length from its origin to the third, fourth, and fifth intercostal spaces, were taken, and the minimum length required to reach the left anterior descending coronary artery was determined. The left internal mammary artery reached the left anterior descending target at a mean length of 10.0 cm. The mean lengths to the left third, fourth, and fifth intercostal spaces were 8.2 cm, 11.3 cm, and 13.7 cm, respectively, on the left, and 7.6 cm, 10.7 cm, and 13.2 cm, respectively, on the right. The right internal mammary artery reached the left anterior descending target at a mean of 12.0 cm. The left internal mammary artery was found to reach the estimated coronary target by the level of the fourth intercostal space consistently, while the right was more variable and required a greater length. If the fourth intercostal space was used to harvest the internal mammary artery, the length necessary for in situ coronary bypass surgery is preserved on the left, and may still be used as a free graft on the right.

Objective: To describe the anatomical features of the perforating branches of the internal thoracic artery through Multidetector row computed tomography. Subjects and method: A cross-sectional and prospective descriptive study on 100 healthy individuals whose perforating branches of the internal thoracic artery from intercostal space I to intercostal space VI were examined at the Department of Diagnostic Imaging, Military Hospital 103, from January 2023 to December 2024. Result: Distance from the point of skin penetration to the sternal edge on the same side as the penetrating branch of the internal thoracic artery: The average distances between the right and left first intercostal space are 0.42 ± 0.16cm and 0.42 ± 0.18cm, respectively; between the right and left second intercostal space are 0.76 ± 0.37cm and 0.74 ± 0.38cm, respectively; between the right and left third intercostal space are 0.68 ± 0.39cm and 0.75 ± 0.39cm, respectively; between the right and left fourth intercostal space are 0.95 ± 0.62cm and 1.13 ± 0.6cm, respectively; and between the right and left fifth intercostal space are 2.12 ± 1.49cm and 2.42 ± 1.31cm, respectively. Length of the perforating branch of the internal thoracic artery to the point of skin penetration: The average length of the perforating branch of the internal thoracic artery to the point of skin penetration at the right and left intercostal space I is: 7.86 ± 2.47 and 7.94 ± 2.55cm; at the right and left intercostal space II is: 10.08 ± 3.07 and 10.07 ± 2.94cm; at the right and left intercostal space III is: 8.8 ± 2.82 and 9.8 ± 3.13cm; at the right and left intercostal space IV is: 8.38 ± 2.56 and 8.24 ± 2.1cm; at the right and left intercostal space V is: 7.19 ± 1.52 and 7.26 ± 1.82cm. Distance from origin to lateral sternal edge: The average distance from origin to lateral sternal edge at the right and left intercostal space I is: 0.43 ± 0.21 and 0.42 ± 0.19cm; at the right and left intercostal space II is: 0.63 ± 0.4 and 0.75 ± 0.45cm; at the right and left intercostal space III is: 0.54 ± 0.52 and 0.89 ± 0.81cm; at the right and left intercostal space IV is: 0.43 ± 0.21 and 1.07 ± 0.97cm; at the right and left intercostal space V is: 1.34 ± 1.11 and 1.81 ± 2.06cm. Diameter of the perforating branches of the internal thoracic artery: The average diameter of the perforating branches of the internal thoracic artery in the first intercostal space on the right and left is: 1.43 ± 1.22 and 1.56 ± 1.44mm; in the second intercostal space on the right and left is: 1.44 ± 1.59 and 1.83 ± 1.62mm; in the third intercostal space on the right and left is: 1.27±1.12 and 2.19 ± 1.29mm; in the fourth intercostal space on the right and left is: 1.17 ± 0.84 and 1.03 ± 0.57mm; in the fifth intercostal space on the right and left is: 0.89 ± 0.68 and 0.52 ± 0.8mm. Origin diameter of the perforating branches of the internal thoracic artery: The average origin diameter of the perforating branches of the internal thoracic artery in the first intercostal space on the right and left is: 1.98 ± 1.78 and 2 ± 1.64mm; in the second intercostal space on the right and left is: 1.67 ± 1.59 and 1.72 ± 1.63mm; in the third intercostal space on the right and left is: 1.45 ± 1.49 and 1.56 ± 1.45; in the fourth intercostal space on the right and left is: 0.73 ± 1.39 and 1.45 ± 1.4 mm; in the fifth intercostal space on the right and left is: 0.59 ± 1.26 and 0.84 ± 1.4 mm. Conclusion: Number of perforating branches in rib spaces, distance from the point of skin penetration to the sternal edge on the same side as the penetrating branch of the internal thoracic artery, length of the perforating branch of the internal thoracic artery to the point of skin penetration, distance from origin to lateral sternal edge, diameter of the perforating branches of the internal thoracic artery, origin diameters of the perforating branches of the internal thoracic artery vary depending on their location.

BackgroundHigh-quality cardiopulmonary resuscitation (CPR) training, including both technical and non-technical skills, is essential for medical students. Virtual reality (VR) offers immersive learning environments that may enhance traditional teaching methods. This study investigates the impact of a single VR session prior to an Advanced Life Support (ALS) course on knowledge and performance of basic life support skills among medical students.MethodsIn this single blind randomized controlled trial, 126 fourth-year medical students with prior Basic Life Support (BLS) training were assigned to either an intervention group (n = 66) with an additional 3-part immersive VR session covering BLS theory and practice or a control group (n = 60) receiving standard preparation. All participants underwent a seminar based on advanced life support principles as dictated by the European Resuscitation Council (ERC) and International Liaison Committee on Resuscitation (ILCOR) guidelines. Theoretical knowledge was assessed via multiple-choice questionnaires at three time points (baseline, post-course, 12 weeks later). Practical skills were evaluated through an Objective Structured Clinical Examination (OSCE). Data were analyzed using Wilcoxon tests, repeated-measures ANOVA, and linear mixed models. Student evaluations were used to gauge subjective satisfaction with the scenario during teaching,ResultsNo significant differences were observed between groups at baseline. The intervention group demonstrated significantly greater gains in knowledge at both post-course (p < 0.01) and follow-up (p = 0.04). However, no significant differences were found in OSCE performance. The VR group’s improvement over time was significantly higher, suggesting a positive effect of VR on knowledge retention. Students were satisfied with the addition of a VR scenario in the teaching format.ConclusionA single VR session prior to ALS training enhanced theoretical knowledge but did not significantly affect practical performance. Students were open to integration of the technology into training, so that VR may serve as a valuable adjunct in CPR education. Further research is needed to evaluate its long-term impact and the optimal integration method into curricula.

Common source of miscalculation and misclassification of P-wave negativity and P-wave terminal force in lead V1

Background:Virtual Reality can help alleviate symptoms in a non-palliative care population. Personalized therapy can further alleviate these symptoms. There is little evidence in a palliative care population.Aim:To understand the feasibility of repeated personalized virtual reality sessions in a palliative care population.Design:A feasibility randomized control trial. Intervention: personalized virtual reality, Control: non-personalized virtual reality. All participants completed a 4-minute virtual reality session for 4 weeks. At each point, the Edmonton Symptom Assessment System-Revised (scored 0 = none up to 100 = worst) was completed pre- and post- each session. A time-series regression analysis was completed for the overall effect.Setting/Participants:The research took place in one hospice. The main inclusion criteria was: (1) under the care of the hospice (2) advanced disease (3) over 18 years (4) physically able to use virtual reality set (5) capacity (6) proficient English.Results:Twenty-six participants enrolled, of which 20 (77%) completed all sessions. At baseline, the intervention group had a mean pre- score of 26.3 (SD 15.1) which reduced to 11.5 (SD 12.6) after the first session. At the same time point, the control group had a mean pre- score of 37.9 (SD 21.6) which reduced to 25.5 (SD 17.4) post-session. The mean scores dropped following each session, however this was not significant (mean difference = −1.3, 95% CI: −6.4 to 3.7, p = 0.601).Conclusions:It is feasible to complete repeated virtual reality sessions within a palliative care population. Future research should explore the structure and effectiveness of virtual reality in a fully powered trial.

Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposure can be too anxiety-provoking to allow treatment to take place, and imaginal exposure can be problematic. To address this, we developed an intervention that combines cognitive behavioral therapy (CBT) with immersive virtual reality (VR) exposure to reduce anxiety. Following successful trials of this intervention with young people on the autism spectrum, we report a pilot study using the same intervention with autistic adults. Eight adults (aged 18–57 years) received one psychoeducation session and then four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant completed all sessions showing that the intervention is feasible and acceptable. Outcomes were monitored at 6 weeks and 6 months postintervention. Five of the eight participants were classified as intervention responders and at 6 months after the end of intervention were experiencing real-life functional improvements. These preliminary findings show that VR-graded exposure alongside CBT may be an effective treatment for autistic people with phobias.Lay SummaryWhy was this study done?Anxiety is common in autistic adults. For some people, fears and phobias regarding everyday objects and situations occur frequently affecting everyday life. The main method to treat fears and phobias for people without autism is gradual exposure to the situation that causes anxiety. However, this method may be challenging for people on the autism spectrum. We wanted to test a new method of treatment that uses cognitive behavioral therapy (CBT) delivered with gradual exposure in a fully immersive virtual reality (VR) environment.What was the purpose of this study?We have already delivered this treatment successfully with autistic children. We wanted to test if this treatment would work for autistic adults. Changing traditional psychological treatments, such as CBT, to make it more suitable for autistic people is recommended by the National Institute for Health and Care Excellence.What did the researchers do?We recruited eight autistic adults (aged 18–57 years) with a fear/phobia and their supporter (parent/friend/support worker). Each adult had one session with a therapist to learn anxiety management techniques. They then had four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant had a computer-generated scene designed for their specific anxiety-provoking situation. After four sessions, the participant tried real-life exposure with their supporter. We measured progress at 6 weeks and 6 months after the last VR session.What were the results of this study?Each participant completed all four sessions. This shows that the intervention was possible to deliver and acceptable to autistic people and therapists. Participants completed assessments at 6 weeks and 6 months after the VR sessions. Five of the eight participants were “responders” to the intervention. This means that 6 months after the last VR session, they still had real-life day-to-day improvements in relation to their phobia.What do these findings add to what was already known?We had not delivered this intervention to autistic adults previously. The findings show that this VR intervention has the potential to be an effective treatment for anxiety in autistic adults.What are the potential weaknesses in the study?This is a small study and future work will be a larger trial of this treatment—comparing results from people who get the intervention with people who do not. We would also want to have an outcome assessor who did not know whether people had received the intervention or not.How will these findings help autistic adults now or in the future?This new intervention has the potential to help autistic adults manage their anxiety in stressful situations and therefore may improve their quality of life.

BackgroundCurrent electrocardiographic (ECG) devices built into cardiovascular magnetic resonance (CMR) scanners have a narrow bandwidth (0.5–60Hz) and signals suffer from distortion due to magnetic field gradient artefact and magnetohydrodynamic effects,...

Virtual reality (VR) has been identified as a means of bridging the gap between theorytaught at university and its practical applications in industry. Recent technologicaladvancements in the gaming industry has allowed for the development of low-cost,high performance VR systems. Mining education stands to benefit significantly fromthese advancements.This thesis focuses on the development of a large-screen, semi-immersive VRsimulation which monitors a potential slope failure at an open cut coal mine over theperiod of a week and its use in a paired-data observational study. The simulation wasdesigned to compress a week of monitoring into a one and a half hour simulation. Theobservational study was conducted in the UQ course “Mine Management” with fourthyear undergraduate mining students. Students, in groups of four, were given a weekto complete a written assignment which provided them with relevant information for ahypothetical open cut coal mine, at which a potential slope failure was being monitored.Students were asked to develop a Trigger Action Response Plan (TARP) to managethe potential slope failure using monitoring triggers with appropriate trigger levels. Afterthey had submitted their TARP they were taken through a one and a half hour VRsession with the developed simulation which allowed them to explore the virtual minesite and monitor the slope displacement and rate of movement which was providedthrough an in-game slope monitoring system. This slope monitoring system updatedevery hour according to the defined timescale. Students were then asked to re-developor edit their TARP in the VR session and submit it for assessment. The results of thetwo TARPs provided two data sets which could be analysed using a paired t-test.The results of the paired t-test for the nineteen groups that completed the assessmentdetermined that an absolute difference of 19% in the mean assessment result wasobserved between the written and VR assignment results. The relative increase in theresults from written to VR was calculated to be 32%. As the P-value for the paired ttestwas found to be 0.000 (<0.05), the mean difference and relative increase can beconsidered statistically significant and provide strong evidence for the benefits of usinga VR simulation to enhance mining education.

This study presents a software technology to transform paper-based 12-lead electrocardiography (ECG) examination into (1) 12-lead ECG electronic diagnoses (e-diagnoses) and (2) mobile diagnoses (m-diagnoses) in emergency telemedicine. While Digital Imaging and Communications in Medicine (DICOM)-based images are commonly used in hospitals, the development of computerized 12-lead ECG is impeded by heterogeneous data formats of clinically used 12-lead ECG instrumentations, such as Standard Communications Protocol (SCP) ECG and Extensible Markup Language (XML) ECG. Additionally, there is no data link between clinically used 12-lead ECG instrumentations and mobile devices. To realize computerized 12-lead ECG examination procedures and ECG telemedicine, this study develops a DICOM-based 12-lead ECG information system capable of providing clinicians with medical images and waveform-based ECG diagnoses via Picture Archiving and Communication System (PACS). First, a waveform-based DICOM-ECG converter transforming clinically used SCP-ECG and XML-ECG to DICOM is applied to PACS for image- and waveform-based DICOM file manipulation. Second, a mobile Structured Query Language database communicating with PACS is installed in physicians' mobile phones so that they can retrieve images and waveform-based ECG ubiquitously. Clinical evaluations of this system indicated the following. First, this developed PACS-dependent 12-lead ECG information system improves 12-lead ECG management and interoperability. Second, this system enables the remote physicians to perform ubiquitous 12-lead ECG and image diagnoses, which enhances the efficiency of emergency telemedicine. These findings prove the effectiveness and usefulness of the PACS-dependent 12-lead ECG information system, which can be easily adopted in telemedicine.

Objective The Lewis lead configuration is an alternative bipolar chest lead and it can help detect atrial activity. The utility of the Lewis lead to distinguish orthodromic atrioventricular reentrant tachycardia (AVRT) from typical atrioventricular nodal reentrant tachycardia (AVNRT) by visualizing the apparent retrogradely conducted P waves was investigated. Methods Forty-four patients with paroxysmal supraventricular tachycardia (PSVT) were included in this study. All patients had PSVT documented by an electrocardiogram (ECG) and underwent an electrophysiological study (EPS). During tachycardia, an ECG recording was performed using a Lewis lead with the electrode on the right aspect of the sternum at the second intercostal space instead of the right arm and the electrode on the fourth intercostal space instead of the left arm. The ECG parameters during tachycardia were compared between AVRT and AVNRT. Results Fourteen patients were diagnosed with AVRTs and 30 with typical AVNRTs on EPS. The positive P wave could be seen in the Lewis lead configuration in 9 of 14 patients with AVRTs and 21 of 30 patients with AVNRTs. P waves were more often visible in the Lewis lead configuration than in the standard leads (66% vs. 45%). The RP interval was significantly longer for AVRTs than for AVNRTs (88±17 vs. 154±34 ms, p<0.001), which yields 89% sensitivity and 71% specificity for distinguishing these 2 tachyarrhythmias with a cut-off point of 100 ms. Conclusion A Lewis lead configuration may help to make an accurate diagnosis among the reentrant supraventricular tachycardias prior to procedures, owing to its ability to locate P waves.

BackgroundNeuropathic pain is a complex chronic pain condition often accompanied by affective symptoms such as anxiety and depression. This comorbidity is associated with increased pain severity, disability, and diminished quality of life, complicating treatment. Virtual reality (VR) is an innovative non-pharmacological intervention that is gaining attention for its potential to alleviate pain and anxiety through immersive distraction. The Protocol Committee of the University of Salamanca (Spain) has approved the study protocol (approval code: ID.1243)ObjectiveWe aimed to evaluate the efficacy of VR in reducing pain and anxiety in patients with persistent neuropathic pain.MethodsThis randomized, controlled, multicenter, open-label trial involves two groups: an intervention group receiving VR sessions and a control group receiving standard pharmacological treatment. Participants are adults aged 30‐61 years diagnosed with neuropathic pain, unresponsive to flexible doses of gabapentin. Pain and anxiety levels are assessed using the Pain Detect Questionnaire, Visual Analog Scale (VAS), and Goldberg Anxiety Scale at baseline and follow-up points. VR sessions are conducted weekly for 3 weeks, each lasting 30‐35 minutes. Perceived time during VR sessions is recorded as an indirect measure of distraction effectiveness. The primary outcome is the reduction in pain intensity and anxiety levels post-intervention compared to baseline. A sample size of 30 patients (15 per group) was calculated to achieve 80% statistical power, considering a 2-point mean difference in VAS scores.ResultsA preliminary pilot study was completed with 16 patients, including 9 who received the virtual reality intervention. Initial findings showed reduced pain perception in 3 patients and decreased anxiety in 4 patients. These results informed the current protocol, which is scheduled to begin in 2025 and is currently in the preparatory phase.ConclusionsThis study hypothesizes that VR will significantly reduce pain and anxiety in patients with persistent neuropathic pain. By providing new insights into non-pharmacological pain management strategies, this research aims to enhance the quality of life for these patients. The findings could support the broader application of VR in clinical pain management.

BACKGROUND Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. OBJECTIVE This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. METHODS This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants’ experiences. RESULTS The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. CONCLUSIONS It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. CLINICALTRIAL ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/54180