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Journal of Medical Internet Research Jun 2023Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The least common lesion is when all nerve roots are affected (C5-T1), which has the worst prognosis. Virtual reality (VR) is commonly used in neurological rehabilitation for the evaluation and treatment of physical deficits.
OBJECTIVE
This systematic review aims to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP.
METHODS
A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines in several scientific databases-PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL-without language or date restrictions and including articles published up to April 2023. The inclusion criteria were established according to the population, intervention, comparison, outcome, and study (PICOS) design framework: children aged <18 years diagnosed with OBP, VR therapy used in addition to conventional therapy or isolated, VR therapy compared with conventional therapy, outcomes related to OBP rehabilitation therapy, and randomized controlled trials (RCTs). The PEDro scale was used to assess the methodological quality of the RCTs, and the Cochrane Collaboration tool was used to assess the risk of bias. The Review Manager statistical software (version 5.4; The Cochrane Collaboration) was used to conduct the meta-analysis. The results were synthesized through information extraction and presented in tables and forest plots.
RESULTS
In total, 5 RCTs were included in this systematic review, with 3 (60%) providing information for the meta-analysis. A total of 138 participants were analyzed. All the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed no favorable results for all outcomes except for the hand-to-mouth subtest of the Mallet scoring system (functional activity; standardized mean difference -0.97, 95% CI -1.67 to -0.27; P=.007).
CONCLUSIONS
The evidence for the use of VR therapy for upper limb rehabilitation outcomes in patients with OBP was insufficient to support its efficacy and strongly recommend its use. Nevertheless, scientific literature supports the use of VR technologies for rehabilitation as it provides several advantages, such as enhancing the patient's motivation, providing direct feedback, and focusing the patient's attention during the intervention. Thus, the use of VR for upper limb rehabilitation in patients with OBP is still in its first stages. Small sample sizes; limited long-term analysis; lack of testing of different doses; and absence of International Classification of Functioning, Disability, and Health-related outcomes were present in the included RCTs, so further research is needed to fully understand the potential of VR technologies as a therapeutic approach for patients with OBP.
TRIAL REGISTRATION
PROSPERO CRD42022314264; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264.
Topics: Child; Female; Pregnancy; Humans; Randomized Controlled Trials as Topic; Medicine; Upper Extremity; Hand; Paralysis
PubMed: 37389922
DOI: 10.2196/47391 -
European Journal of Radiology Oct 2022Ultrasound and magnetic resonance imaging are the imaging modalities of choice for placenta accrete spectrum (PAS) disorders assessment. Radiomics could further increase... (Review)
Review
PURPOSE
Ultrasound and magnetic resonance imaging are the imaging modalities of choice for placenta accrete spectrum (PAS) disorders assessment. Radiomics could further increase the value of medical images and allow to overcome the limitations linked to their visual assessment. Aim of this systematic review was to identify and appraise the methodological quality of radiomics studies focused PAS disorders applications.
METHOD
Three online databases (PubMed, Scopus and Web of Science) were searched to identify original research articles on human subjects published in English. For the qualitative synthesis of results, data regarding study design (e.g., retrospective or prospective), purpose, patient population (e.g., sample size), imaging modalities and radiomics pipelines (e.g., segmentation and feature extraction strategy) were collected. The appraisal of methodological quality was performed using the Radiomics Quality Score (RQS).
RESULTS
10 articles were finally included and analyzed. All were retrospective and MRI-powered. The majority included more than 100 patients (6/10). Four were prognostic (focused on either the prediction of bleeding volume or the prediction of needed management) while six diagnostic (PAS vs not PAS classification) studies. The median RQS was 8, with maximum and minimum respectively equal to 17/36 and - 6/36. Major methodological concerns were the lack of feature stability to multiple segmentation testing and poor data openness.
CONCLUSIONS
Radiomics studies focused on PAS disorders showed a heterogeneous methodological quality, overall lower than desirable. Furthermore, many relevant research questions remain unexplored. More robust investigations are needed to foster advancements in the field and possibly clinical translation.
Topics: Female; Humans; Magnetic Resonance Imaging; Placenta Accreta; Pregnancy; Prognosis; Prospective Studies; Retrospective Studies
PubMed: 36030661
DOI: 10.1016/j.ejrad.2022.110497 -
Frontiers in Bioengineering and... 2023This systematic review offers an overview on clinical and technical aspects of augmented reality (AR) applications in orthopedic and maxillofacial oncological surgery....
This systematic review offers an overview on clinical and technical aspects of augmented reality (AR) applications in orthopedic and maxillofacial oncological surgery. The review also provides a summary of the included articles with objectives and major findings for both specialties. The search was conducted on PubMed/Medline and Scopus databases and returned on 31 May 2023. All articles of the last 10 years found by keywords augmented reality, mixed reality, maxillofacial oncology and orthopedic oncology were considered in this study. For orthopedic oncology, a total of 93 articles were found and only 9 articles were selected following the defined inclusion criteria. These articles were subclassified further based on study type, AR display type, registration/tracking modality and involved anatomical region. Similarly, out of 958 articles on maxillofacial oncology, 27 articles were selected for this review and categorized further in the same manner. The main outcomes reported for both specialties are related to registration error (i.e., how the virtual objects displayed in AR appear in the wrong position relative to the real environment) and surgical accuracy (i.e., resection error) obtained under AR navigation. However, meta-analysis on these outcomes was not possible due to data heterogenicity. Despite having certain limitations related to the still immature technology, we believe that AR is a viable tool to be used in oncological surgeries of orthopedic and maxillofacial field, especially if it is integrated with an external navigation system to improve accuracy. It is emphasized further to conduct more research and pre-clinical testing before the wide adoption of AR in clinical settings.
PubMed: 38076427
DOI: 10.3389/fbioe.2023.1276338 -
JMIR Mental Health Nov 2023Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%.... (Review)
Review
BACKGROUND
Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment.
OBJECTIVE
This systematic review investigated the novel technology's efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia.
METHODS
An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022.
RESULTS
A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object.
CONCLUSIONS
The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET's cost-effectiveness and examine its efficacy in other populations and anxiety conditions.
PubMed: 38032710
DOI: 10.2196/51318 -
Bipolar Disorders Nov 2013This comprehensive review examined the prevalence and progression of disturbances in reality testing (DRT), defined as psychotic symptoms, cognitive disruptions, and... (Review)
Review
OBJECTIVES
This comprehensive review examined the prevalence and progression of disturbances in reality testing (DRT), defined as psychotic symptoms, cognitive disruptions, and thought problems, in offspring of parents with bipolar disorder (O-BD). Our approach was grounded in a developmental psychopathology perspective and considered a broader phenotype of risk within the bipolar-schizophrenia spectrum as measured by categorical and dimensional assessments of DRT in high-risk youth.
METHODS
Relevant studies were identified from numerous sources (e.g., PubMed, reference sections, and colleagues). Inclusion criteria were: (i) family risk studies published between 1975 and 2012 in which O-BD were contrasted with a comparison group (e.g., offspring of parents who had other psychiatric disorders or were healthy) on DRT outcomes and (ii) results reported for categorical or dimensional assessments of DRT (e.g., schizophrenia, psychotic symptoms, cluster A personality traits, or thought problems), yielding a total of 23 studies.
RESULTS
Three key findings emerged: (i) categorical approaches of DRT in O-BD produced low incidence base rates and almost no evidence of significant differences in DRT between O-BD and comparison groups, whereas (ii) many studies using dimensional assessments of DRT yielded significant group differences in DRT. Furthermore, (iii) preliminary evidence from dimensional measures suggested that the developmental progression of DRT in O-BD might represent a prodrome of severe psychological impairment.
CONCLUSIONS
Preliminary but promising evidence suggests that DRT is a probable marker of risk for future impairment in O-BD. Methodological strengths and weaknesses, the psychometric properties of primary DRT constructs, and future directions for developmental and longitudinal research with O-BD are discussed.
Topics: Bipolar Disorder; Child of Impaired Parents; Databases, Factual; Humans; Psychopathology; Reality Testing
PubMed: 24034419
DOI: 10.1111/bdi.12115 -
Journal of AAPOS : the Official... Aug 2023Strabismus is a dynamic condition for which simulation-based training is valuable, given the variable complexity and relatively reduced exposure compared with other... (Review)
Review
BACKGROUND
Strabismus is a dynamic condition for which simulation-based training is valuable, given the variable complexity and relatively reduced exposure compared with other ophthalmic presentations. This study assessed the performance of simulation models available for medical training in the assessment and management of strabismus.
METHODS
A systematic review of relevant peer-reviewed academic databases was conducted, without publication date restrictions. English-language publications evaluating the performance of simulation models for education on strabismus were included. Risk of bias was assessed using the Cochrane RoB-2 tool and CLARITY Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Validity of evidence was evaluated using the Kirkpatrick framework.
RESULTS
Of the total 3,298 citations exported for title and abstract screening, 54 advanced to full-text screening, and 7 were included in final review. Model types were either dry (2), wet (4), or virtual reality (1). All models were deemed to be successful, but few standardized parameters were specified. Costs of models ranged from a few dollars (ball and wood), to moderate (non-cadaveric), to costly (virtual reality). All studies scored a moderate or high risk of bias, and the majority (4/7) of studies scored level 1 on the Kirkpatrick scale.
CONCLUSIONS
Research on simulation for strabismus assessment and management is limited and varied for model fidelity and testing audiences. All models were deemed individually successful compared to non-simulation-based teaching methodologies, although no direct comparisons were made. The limited evidence available suggests that low-fidelity and low-cost models can be used for trainees without sacrificing educational quality.
Topics: Humans; Cross-Sectional Studies; Simulation Training; Strabismus
PubMed: 37490980
DOI: 10.1016/j.jaapos.2023.05.011 -
Frontiers in Digital Health 2024This umbrella review aims to ascertain the extent to which immersive Virtual Reality (VR) and Augmented Reality (AR) technologies improve specific competencies in...
OBJECTIVE
This umbrella review aims to ascertain the extent to which immersive Virtual Reality (VR) and Augmented Reality (AR) technologies improve specific competencies in healthcare professionals within medical education and training, in contrast to traditional educational methods or no intervention.
METHODS
Adhering to PRISMA guidelines and the PICOS approach, a systematic literature search was conducted across major databases to identify studies examining the use of VR and AR in medical education. Eligible studies were screened and categorized based on the PICOS criteria. Descriptive statistics and chi-square tests were employed to analyze the data, supplemented by the Fisher test for small sample sizes or specific conditions.
ANALYSIS
The analysis involved cross-tabulating the stages of work (Development and Testing, Results, Evaluated) and variables of interest (Performance, Engagement, Performance and Engagement, Effectiveness, no evaluated) against the types of technologies used. Chi-square tests assessed the associations between these categorical variables.
RESULTS
A total of 28 studies were included, with the majority reporting increased or positive effects from the use of immersive technologies. VR was the most frequently studied technology, particularly in the "Performance" and "Results" stages. The chi-square analysis, with a Pearson value close to significance ( = 0.052), suggested a non-significant trend toward the association of VR with improved outcomes.
CONCLUSIONS
The results indicate that VR is a prevalent tool in the research landscape of medical education technologies, with a positive trend toward enhancing educational outcomes. However, the statistical analysis did not reveal a significant association, suggesting the need for further research with larger sample sizes. This review underscores the potential of immersive technologies to enhance medical training yet calls for more rigorous studies to establish definitive evidence of their efficacy.
PubMed: 38550715
DOI: 10.3389/fdgth.2024.1365345 -
Journal of Central Nervous System... 2018Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However,... (Review)
Review
BACKGROUND
Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established.
METHOD
We present a systematic review which was conducted according to (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were "neurorehabilitation" AND "Virtual Reality" AND "devices."
RESULTS
We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function.
CONCLUSIONS
The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.
PubMed: 30515028
DOI: 10.1177/1179573518813541 -
Journal of Medical Internet Research Nov 2020Virtual reality is increasingly being utilized by clinicians to facilitate analgesia and anxiolysis within an inpatient setting. There is however, a lack of a clinically...
BACKGROUND
Virtual reality is increasingly being utilized by clinicians to facilitate analgesia and anxiolysis within an inpatient setting. There is however, a lack of a clinically relevant review to guide its use for this purpose.
OBJECTIVE
To systematically review the current evidence for the efficacy of virtual reality as an analgesic in the management of acute pain and anxiolysis in an inpatient setting.
METHODS
A comprehensive search was conducted up to and including January 2019 on PubMed, Ovid Medline, EMBASE, and Cochrane Database of Systematic reviews according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included virtual reality, vr, and pain. Primary articles with a focus on acute pain in the clinical setting were considered for the review. Primary outcome measures included degree of analgesia afforded by virtual reality therapy, degree of anxiolysis afforded by virtual reality therapy, effect of virtual reality on physiological parameters, side effects precipitated by virtual reality, virtual reality content type, and type of equipment utilized.
RESULTS
Eighteen studies were deemed eligible for inclusion in this systematic review; 67% (12/18) of studies demonstrated significant reductions in pain with the utilization of virtual reality; 44% (8/18) of studies assessed the effects of virtual reality on procedural anxiety, with 50% (4/8) of these demonstrating significant reductions; 28% (5/18) of studies screened for side effects with incidence rates of 0.5% to 8%; 39% (7/18) of studies evaluated the effects of virtual reality on autonomic arousal as a biomarker of pain, with 29% (2/7) demonstrating significant changes; 100% (18/18) of studies utilized a head mounted display to deliver virtual reality therapy, with 50% being in active form (participants interacting with the environment) and 50% being in passive form (participants observing the content only).
CONCLUSIONS
Available evidence suggests that virtual reality therapy can be applied to facilitate analgesia for acute pain in a variety of inpatient settings. Its effects, however, are likely to vary by patient population and indication. This highlights the need for individualized pilot testing of virtual reality therapy's effects for each specific clinical use case rather than generalizing its use for the broad indication of facilitating analgesia. In addition, virtual reality therapy has the added potential of concurrently providing procedural anxiolysis, thereby improving patient experience and cooperation, while being associated with a low incidence of side effects (nausea, vomiting, eye strain, and dizziness). Furthermore, findings indicated a head mounted display should be utilized to deliver virtual reality therapy in a clinical setting with a slight preference for active over passive virtual reality for analgesia. There, however, appears to be insufficient evidence to substantiate the effect of virtual reality on autonomic arousal, and this should be considered at best to be for investigational uses, at present.
Topics: Acute Pain; Anxiety; Humans; Pain Management; Virtual Reality Exposure Therapy
PubMed: 33136055
DOI: 10.2196/17980 -
International Journal of Environmental... Jan 2022Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their... (Review)
Review
Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family's adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research.
Topics: Child; Family; Genetic Counseling; Genetic Testing; Humans; Neoplastic Syndromes, Hereditary; Risk
PubMed: 35162625
DOI: 10.3390/ijerph19031603