Virtual Reality Improves the Patient Experience during Wide-Awake Local Anesthesia No Tourniquet Hand Surgery: A Single-Blind, Randomized, Prospective Study.

Wide-awake local anesthesia no tourniquet surgery has been shown to decrease cost and hospital length of stay. The authors studied the use of virtual reality during wide-awake local anesthesia no tourniquet outpatient upper extremity surgery to assess its effect on patient pain, anxiety and fun. Patients undergoing wide-awake local anesthesia no tourniquet surgery were randomized to use (virtual reality) or not use (non-virtual reality) virtual reality during their procedures. Pain, fun, and anxiety were measured with a Likert scale at several time points, as were blood pressure and heart rate. A postoperative questionnaire was used to assess overall satisfaction. Virtual reality patients exhibited lower anxiety scores during injection, during the procedure, and at the end of the procedure. There were no differences in blood pressure, heart rate, or pain scores. Compared with non-virtual reality patients, virtual reality patients' fun scores were higher. Virtual reality patients felt the experience helped them to relax, and they would recommend virtual reality-assisted wide-awake local anesthesia no tourniquet surgery. Among patients with self-reported preexisting anxiety, virtual reality patients had lower pain and anxiety scores during injection of local anesthesia compared with non-virtual reality patients. This study demonstrates that readily available virtual reality hardware and software can provide a virtual reality experience that reduces patient anxiety both during the injection of local anesthesia and during the surgical procedure. (Plast. Reconstr. Surg. 144: 408, 2019.) CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, II.

Epiphyseal union sequencing: aiding in the recognition and sorting of commingled remains.

The presence of accessory osseous material within a seemingly single individual assemblage has the potential to result in misidentification of the remains. Detection of nonrelated material relies on the anthropologist being able to recognize incongruities among the elements. Inconsistencies in developmental status provide evidence to suggest that commingling may have occurred. Analyzing the sequence in which the various epiphyses unite can help to identify outlying elements that do not match the predicted developmental pattern of the remaining skeleton, thus indicating that the element may not belong to that individual. This paper considers the sequence in which 21 various epiphyses of the body unite to serve as a reference for identifying incongruent fusing patterns within a commingled assemblage. Two hundred and fifty-eight male individuals of Bosniak (Bosnian Muslim) descent between the ages of 14 and 30 years were included for analysis. Sequence order was determined for both "beginning" and "complete" union by comparing the fusing status of each epiphysis with each of the other 21 epiphyses. Considering both sequence patterns provides a wider spectrum of evidence from which to recognize incongruities than either sequence pattern could provide in isolation. Variations to the majority sequence pattern were also included to ensure that skeletons displaying less popular but acceptable sequence patterns would not be mistakenly considered as two individuals when using this research as a reference. Although substantial variation in the order in which epiphyses initiate and complete union was discovered within the sample, most epiphyseal relationships did not display any variable patterns. These "unvaried" relationships will be most useful in recognizing the presence of incongruent material if the pattern within an assemblage does not conform to the pattern documented in this study. Figures demonstrating the two sequence patterns are provided for easy application in the field.

Comparison of ages of epiphyseal union in North American and Bosnian skeletal material.

The accurate determination of age at death is a critical component in the analysis of human skeletal remains. Population specific techniques are often used without due consideration of the provenance of the material being studied. This communication considers the ages at which epiphyseal union occur in young Bosnian males and compares those findings to data published by McKern and Stewart on young North American soldiers killed during the Korean War. Of the ten epiphyses considered in this study, all elements were observed to be at least two years in advance in the Bosnian sample compared to the American sample. This article demonstrates that whilst standards based on an American sample produce broadly applicable age ranges for use on forensic work in the Balkans, the age ranges generated produce an upper age limit that is often two or more years older than the chronological age. Therefore, it is desirable, that wherever possible, appropriate standards should be devised for more accurate aging reflecting population specific profiles.