[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.

Realidad virtual y biomarcadores digitales: una herramienta clínica para el diagnóstico del autismo / Virtual reality and digital biomarkers: a clinical tool for early autism diagnosis

Resumen Introducción : El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo, y sus procedimien tos tradicionales de evaluación encuentran ciertas li mitaciones. El actual campo de investigación sobre TEA está explorando y respaldando métodos innovadores para evaluar el trastorno tempranamente, basándose en la detección automática de biomarcadores. Sin embargo, muchos de estos procedimientos carecen de validez ecológica en sus mediciones. En este contexto, la reali dad virtual (RV) presenta un prometedor potencial para registrar objetivamente bioseñales mientras los usuarios experimentan situaciones ecológicas. Métodos : Este estudio describe un novedoso y lúdi co procedimiento de RV para la evaluación temprana del TEA, basado en la grabación multimodal de bio señales. Durante una experiencia de RV con 12 esce nas virtuales, se midieron la mirada, las habilidades motoras, la actividad electrodermal y el rendimiento conductual en 39 niños con TEA y 42 compañeros de control. Se desarrollaron modelos de aprendizaje automático para identificar biomarcadores digitales y clasificar el autismo. Resultados : Las bioseñales reportaron un rendimien to variado en la detección del TEA, mientras que el modelo resultante de la combinación de los modelos de las bioseñales demostró la capacidad de identificar el TEA con una precisión del 83% (DE = 3%) y un AUC de 0.91 (DE = 0.04). Discusión : Esta herramienta de detección pue de respaldar el diagnóstico del TEA al reforzar los resultados de los procedimientos tradicionales de evaluación.

Abstract Introduction : Autism Spectrum Disorder (ASD) is a neurodevelopmental condition which traditional as sessment procedures encounter certain limitations. The current ASD research field is exploring and endorsing innovative methods to assess the disorder early on, based on the automatic detection of biomarkers. How ever, many of these procedures lack ecological validity in their measurements. In this context, virtual reality (VR) shows promise for objectively recording biosignals while users experience ecological situations. Methods : This study outlines a novel and playful VR procedure for the early assessment of ASD, relying on multimodal biosignal recording. During a VR experience featuring 12 virtual scenes, eye gaze, motor skills, elec trodermal activity and behavioural performance were measured in 39 children with ASD and 42 control peers. Machine learning models were developed to identify digital biomarkers and classify autism. Results : Biosignals reported varied performance in detecting ASD, while the combined model resulting from the combination of specific-biosignal models demon strated the ability to identify ASD with an accuracy of 83% (SD = 3%) and an AUC of 0.91 (SD = 0.04). Discussion : This screening tool may support ASD diagnosis by reinforcing the outcomes of traditional assessment procedures.

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.

El metaverso en el mundo de la salud: el futuro presente. Desafíos y oportunidades / The metaverse in the world of health: The present future. Challenges and opportunities

La Organización Mundial de la Salud define la salud digital como la incorporación de tecnologías de información y comunicación para mejorar la salud. En los últimos años, se vio una fuerte aceleración en la adopción de estas herramientas digitales, lo que impactó de lleno en los modelos asistenciales tradicionales. Actualmente, estamos observando el surgimiento de un gran entorno virtual inmersivo llamado metaverso. Su aparición genera nuevas y desafiantes oportunidades en la salud. En este artículo se exploran algunos conceptos relacionados con este campo, se dan ejemplos concretos de su aplicación en pediatría, se mencionan algunas experiencias en el ámbito hospitalario para finalmente adentrarse en los desafíos y oportunidades que emergen.

The World Health Organization has defined "digital health" as the use of information and communication technologies to improve health. In recent years, there has been a strong acceleration in the adoption of these digital tools, which has had a major impact on traditional healthcare models. We are currently witnessing the emergence of a large immersive virtual environment called the "metaverse." Its emergence creates new and challenging opportunities in health care. This article explores some metaverse-related concepts, provides specific examples of its use in pediatrics, describes experiences in the hospital setting, and finally delves into the resulting challenges and opportunities.

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.

Innovación continuada en cirugía radioguiada de precisión / Continuous innovation in precision radio-guided surgery

Desde sus inicios, la medicina nuclear se ha enfrentado a cambios tecnológicos que la han obligado a modificar sus modos operativos y a adecuar sus protocolos. En el campo de la cirugía radioguiada (CRG), la incorporación de la imagen gammagráfica preoperatoria y la detección intraoperatoria con la sonda gamma proporcionó un impulso definitivo a la biopsia del ganglio centinela (GC) para convertirse en el procedimiento estándar de aplicación en el melanoma y el cáncer de mama. Las diversas innovaciones tecnológicas y la adaptación consiguiente de protocolos confluyen en lo disruptivo y lo gradual. Como ejemplos evidentes tenemos la introducción de la tomografía por emisión de fotón único/tomografía computarizada (SPECT/TC) en el campo preoperatorio y las sondas Drop-in (Lightpoint Medical Ltd; Crystal photonics, Eurorad) en el intraoperatorio. Otros aspectos innovadores con posible aplicación en la CRG se basan en la utilización de la inteligencia artificial (IA), navegación y teleasistencia (AU)

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 (AU)

Can Virtual Reality be Used for the Prevention of Peer Sexual Harassment in Adolescence? First Evaluation of the Virtual-PRO Program / [¿Puede utilizarse la realidad virtual para prevenir el acoso sexual entre iguales en la adolescencia? Primera evaluación del programa Virtual-PRO]

Objective: The present study analyzed the Virtual-PRO program’s efficacy in preventing peer sexual harassment by promoting the bystanders’ active intervention and incorporating a virtual reality (VR) component. The impact of the program on sexist attitudes, moral disengagement, the intention to intervene as bystanders, and the involvement in sexual aggression and victimization was tested. Method: Virtual-PRO is a VR-enhanced sexual harassment curricular prevention program of six one-hour sessions. The evaluation comprised a pre-test, a post-test after the intervention, and a follow-up measure at three months. In the study, 579 Spanish adolescent students aged between 12 and 17 years (M = 14.76, SD = 0.88; 47.1% boys) were randomly grouped into experimental (n = 286) and control (n = 293) conditions. Results: The Virtual-PRO program effectively controlled participants’ levels of sexism and reduced moral disengagement in the experimental group compared to the control group three months after the intervention. The program also showed positive results in changing bystander behavior, increasing the intention to intervene when the victim was not a friend. Finally, visual/verbal and online victimization decreased in the experimental group and increased in the control group. No differences were found for physical sexual victimization and sexual aggression. Conclusions: The first trial of the Virtual-PRO program is promising and highlights the use of VR as a sexual harassment prevention tool. Follow-up measures are essential to determine the impact of interventions accurately.(AU)

Objetivo: El presente estudio analiza la eficacia del programa Virtual-PRO en la prevención del acoso sexual entre iguales promoviendo la intervención activa de los espectadores mediante el uso de la realidad virtual (RV). Se comprobó el impacto del programa en las actitudes sexistas, la desconexión moral, la intención de intervenir como espectadores y la implicación en agresión y victimización sexual. Método: Virtual-PRO es un programa curricular compuesto por seis unidades que incorpora la RV para mejorar la prevención del acoso sexual. La evaluación incluyó una medida pre-test, un post-test después de la intervención y una medida de seguimiento a los tres meses. En el estudio participaron 579 estudiantes españoles de entre 12 y 17 años (M = 14.76, DT = 0.88, 47.1% chicos), agrupados aleatoriamente en grupo experimental (n = 286) y control (n = 293). Resultados: El programa Virtual-PRO controló eficazmente los niveles de sexismo y redujo la desconexión moral en el grupo experimental en comparación con el grupo de control tres meses después de la intervención. También mostró resultados positivos en el cambio del comportamiento de los espectadores, mejorando la intención de intervenir cuando la víctima no era amigo o amiga. Por último, la victimización visual/verbal y online disminuyó en el grupo experimental y aumentó en el grupo control. No se encontraron diferencias en victimización sexual física y agresión sexual. Conclusiones: El primer ensayo del programa Virtual-PRO es prometedor y pone de relieve el uso de la RV como herramienta eficaz para la prevención del acoso sexual. Las medidas de seguimiento son esenciales para determinar con precisión el efecto de las intervenciones.(AU)

Utilidad de la realidad virtual en el manejo del dolor asociado a venopunción: ensayo clínico aleatorizado multicéntrico / Usefulness of virtual reality in the management of pain associated with venepuncture: A multicentre randomized clinical trial

Objetivo: Comprobar la eficacia de la realidad virtual (RV) en la disminución del dolor y ansiedad asociados a extracciones sanguíneas programadas. Material y métodos: Ensayo clínico aleatorizado multicéntrico realizado en atención primaria y hospitalaria. Se incluyeron los pacientes de 7 a 12 años que acudieron entre marzo y octubre de 2022 a realizarse una extracción sanguínea programada. En el grupo intervención se utilizaron gafas de RV y en el grupo control cuidados habituales. Se evaluó el dolor mediante la escala visual analógica y la ansiedad mediante la Groningen Distress Scale. Se evaluó la ansiedad de enfermería y la satisfacción de los familiares, mediante escala numérica del 1 al 10. Resultados: Se incluyeron 83 pacientes: 40 en el grupo control y 43 en el grupo RV. La mediana de edad fue de 10 años (rango de 7 a 12); 83,7% de los niños en el grupo RV refirió dolor leve, frente a 57,5% del grupo control (p = 0,012). Del grupo RV, 93% mostró calma o ansiedad leve (puntuación 1-2), frente a 72% del grupo control, aunque sin diferencias estadísticamente significativas (p = 0,08). La satisfacción de los familiares fue mayor en el grupo RV (≥ 9/10: 93% de RV vs. 72,5% de controles, p = 0,026). La ansiedad de enfermería fue < 5 en más del 90% de los casos, sin diferencias entre grupos (p = 0,13). Conclusiones: El uso de RV durante la venopunción disminuye el dolor percibido por los niños y aumenta la satisfacción de sus familiares.(AU)

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). Conclusions: The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.(AU)

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.

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.

Miedo a las alturas en mareo postural perceptual persistente en ambientes arquitectónicos simulados por realidad virtual

Introducción: El mareo postural perceptual persistente (MPPP) es una de las causas más frecuentes de vértigo crónico. Si bien, los pacientes con MPPP tienen alteraciones de la percepción espacial, se desconoce si presentan alteraciones en el miedo a las alturas. Para no exponer a pacientes con MPPP a ambientes reales con altura, nos propusimos utilizar la realidad virtual para estudiar el miedo a las alturas. Objetivo: Cuantificar el miedo a las alturas en pacientes con MPPP y controles mediante ambientes simulados con realidad virtual. Material y Método: Estudio transversal, prospectivo de casos y controles pareados por edad y sexo. Se reclutaron pacientes con MPPP del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile entre los años 2020 y 2021. Se midió presencia subjetiva de miedo y taquicardia. Los escenarios se desarrollaron con el programa Blender 2.8 y Oculus Link para equipo Oculus Quest. Se utilizaron cinco escenarios a diferentes alturas (pisos 1, 3, 6, 12, 19). Resultados: Se reclutaron 20 sujetos (12 mujeres, 47 años en promedio), incluyendo 10 pacientes con MPPP y 10 controles sin síntomas vestibulares. Ningún sujeto del grupo control presentó miedo en los escenarios presentados, mientras que siete pacientes del grupo MPPP tuvieron miedo subjetivo a una altura menor a 40 metros virtuales (Fischer, p < 0,05). Conclusión: Los pacientes con MPPP presentan, con mayor frecuencia, miedo subjetivo a las alturas que los controles, pero se requiere de nuevos estudios para determinar si este miedo es específico de MPPP, o es general a otras causas de vértigo crónico.

Introduction: Persistent Postural Perceptual Dizziness (PPPD) is one of the most common causes of chronic vertigo. While patients with PPPD have spatial perception alterations, it is unknown whether they present alterations in fear of heights. To avoid exposing patients with PPPD to high places, we aimed to use virtual reality to quantify fear of heights. Aim: To quantify fear of heights in patients with PPPD and controls using simulated environments with virtual reality. Material and Method: A prospective cross-sectional study of age- and sex-matched case-control pairs. PPPD patients were recruited from the Otolaryngology Service of the Clinical Hospital of the University of Chile between 2020 and 2021. Presence of subjective fear and tachycardia were measured. The scenarios were developed using Blender 2.8 and Oculus Link for the Oculus Quest. Five scenarios at different heights (floors 1, 3, 6, 12, 19) were used. Results: Twenty subjects were recruited (12 women, average age of 47 years), including 10 PPPD patients and 10 controls without vestibular symptoms. None of the control group subjects presented fear in the presented scenarios, while seven patients in the PPPD group had subjective fear at a height lower than virtual 40 meters (Fischer, p < 0.05). Conclusion: Patients with PPPD present a greater proportion of subjective fear to heights than controls, but further studies are required to determine if this fear is specific to PPPD or is general to other causes of chronic vertigo.

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.

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

Introducción: La parálisis cerebral (PC) es una condición de salud secundaria a daños no progresivos que ocurren durante el desarrollo del cerebro en la etapa fetal o infantil. Evaluar la efectividad de la tecnología robótica y la realidad virtual de la función motora en pacientes con PC en comparación con estrategias convencionales de rehabilitación como fisioterapia, terapia ocupacional, intervención de neurodesarrollo y estimulación transcraneal. Se llevó a cabo una revisión de ensayos controlados aleatorizados de los últimos 5 años. Para la evaluación de la calidad metodológica de los estudios incluidos se utilizó la escala PEDro, con evaluación del nivel de evidencia y grado de recomendación según la clasificación de Oxford. Resultados: Diecisiete artículos cumplieron con los criterios de elegibilidad. La tecnología robótica y la realidad virtual demostraron ser efectivas para la mejora de la función motora, las habilidades manuales y las destrezas perceptivo-visuales de los pacientes con PC, en comparación con el uso de estrategias convencionales de rehabilitación.(AU)

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.(AU)

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.

Niveles de aprobación de ESFUNO entre los años 2019 y 2020. Facultad de Enfermería Udelar / Approval levels of ESFUNO between the years 2019 and 2020. Faculty of Nursing Udelar / Níveis de aprovação do ESFUNO entre os anos de 2019 e 2020. Faculdade de Enfermagem da Udelar

El presente trabajo muestra los resultados de un estudio de carácter diagnóstico sobre el efecto de la aplicación de una metodología de enseñanza totalmente virtual para el curso ESFUNO de Facultad de Enfermería en el marco de la pandemia por Covid-19. Se realizó un estudio observacional descriptivo y analítico comparando el desempeño académico entre las generaciones del año 2019 y 2020 mediante contraste de proporciones. Se sistematizaron los datos de desempeño estudiantil para la exoneración del curso ESFUNO y los dos primeros períodos de exámenes a partir de la finalización del curso desarrollados desde la implementación del Plan 2016. A partir de los datos obtenidos se pudo observar que predominó la exoneración del curso con un porcentaje para el año 2019 de 56 % y para el año 2020 de 79 % siendo este un aumento significativo (p<0.05). Se observó un aumento significativo de la desvinculación en el año 2020 con respecto al año 2019 (27 % y 19 % respectivamente) (p<0.05). La proporción de estudiantes que salvaron el examen de ESFUNO aumento significativamente en el segundo periodo para el año 2019 (p<0.05) pero no así para el año 2020 (p>0.05). Al comparar la proporción de aprobación del primer periodo entre la generación que cursó en 2019y la generación que cursó en 2020 se observó un aumento significativo para el año 2020 (p<0.05). Finalmente se observó que en el año 2020 hubo una asociación positiva entre aquellos alumnos que sin exonerar tuvieron una nota media (5) y un mayor porcentaje de aprobación del examen. Se concluye que la utilización de la total virtualidad aplicada en el año 2020 en el curso ESFUNO no tuvo un impacto negativo sobre los niveles de aprobación del mismo ya sea a nivel de exoneración como a nivel de aprobación en el primer y segundo periodo de examen.

This work shows the results of a diagnostic study on the effect of the application of a totally virtual teaching methodology for the ESFUNO course of the School of Nursing, in the frame work of the Covid-19 pandemic. A descriptive and analytical observational study was carried out to compare academic performances between the 2019 and 2020 class by comparing proportions. Student performance data were systematized for the ESFUNO exam exemption and the first two exam periods immediately after the end of the course, for all the years since the implementation of the 2016 Plan. From the data obtained, it was observed that the exam exemption prevailed with a 56 % for the 2019 class and for a 79 % for the2020 class, this being a significant increase (p<0.05). A significant increase in disengagement was observed in 2020compared to 2019 (27 % and 19 % respectively) (p<0.05). The proportion of students who saved the ESFUNO exam in the second period, increased significantly for 2019 (p<0.05) but not for 2020 class (p>0.05). When comparing the passing rate during the first period between the 2019 and 2020 classes, a significant increase was observed for 2020 (p<0.05). Finally, it was observed that in 2020 there was a positive association between those students who, without exam exemption, had an average grade (5) and a higher percentage of students passing the exam. It is concluded that the use of the total virtuality applied in the year 2020 for the ESFUNO course did not have a negative impact on the approval rate, either at the exemption level or at the approval level in the first and second period of exam.

O presente trabalho mostra os resultados de um estudo diagnóstico sobre o efeito da aplicação de uma metodologia de ensino totalmente virtual para o curso ESFUNO da Faculdade de Enfermagem no contexto da pandemia Covid-19. Realizou-se um estudo observacional descritivo e analítico comparando o desempenho acadêmico entre as gerações de 2019 e 2020 através da comparação de proporções. Se sistematizaram os dados do desempenho estudantil para aprovação direta do curso ESFUNO e os dois primeiros períodos das provas a partir da finalização do curso desenvolvidos após a implementação do Plano 2016. Pelos dados obtidos, observou-se que houve predomínio da aprovação direta do curso, com uma porcentagem de 56% para o ano de 2019 e de 79 % para o ano de 2020, sendo este um aumento significativo (p<0.05). Observou-se, ainda, no ano de 2020 um aumento significativo da desvinculação do curso quando comparado ao ano de 2019 (27 % e 19 %, respectivamente) (p<0.05). A proporção de estudantes que passaram na prova de ESFUNO aumentou significativamente no segundo período para o ano de 2019 (p<0.05), porém não se observou o mesmo no ano de 2020 (p>0.05). Ao comparar a taxa de aprovação no primeiro período de recuperação entre a geração que cursou no ano de 2019 com a geração que cursou no ano de 2020, se observou um aumento significativo para o ano de 2020 (p<0.05). Finalmente, foi observado que no ano de 2020 houve uma associação positiva entre aqueles alunos que não obtiveram aprovação direta, mas tiveram nota média (5) e maior percentual de aprovação. Conclui-se que a utilização da modalidade totalmente virtual aplicada no ano de 2020 para realização do curso ESFUNO não teve um impacto negativo sobre os níveis de aprovação do mesmo, seja no nível de aprovação direta, como no nível de aprovação no primeiro e segundo períodos de provas.

Efecto de la retroalimentación (feedback) remota vs. presencial en el proceso de adquisición de destreza manual en un simulador de realidad virtual háptico: un estudio piloto / Effect of remote vs. face-to-face feedback on the manual dexterity acquisition process in a haptic virtual reality simulator: a pilot study / Efeito do feedback remoto versus feedback presencial no processo de aquisição de destreza manual em um simulador de realidade virtual háptica: um estudo piloto

RESUMEN Los simuladores de realidad virtual háptico (RVH) están tomando cada vez más alcance en la educación clínica moderna. En este proceso se evidencia la importancia de la retroalimentación que el instructor brinda a los estudiantes, que puede darse de manera presencial o remota, esta última con ayuda de un sistema de audio y micro individualizado. No obstante, existe poca literatura que haya explorado y evidenciado las ventajas y desventajas de estas dos formas. Objetivo: Determinar el efecto que tiene la retroalimentación remota vs. presencial en el proceso de adquisición de destreza manual utilizando un simulador de RVH en estudiantes de primer año de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia. Material y Métodos: Se realizó un estudio en 37 participantes (X = 18,2 años; DS = 3,2 años), sin entrenamiento dental previo. Fueron asignados aleatoriamente en tres grupos (n1 = 17; n2 = 10; n3 = 10). El grupo 1 recibió solo retroalimentación presencial; el grupo 2 recibió solo retroalimentación remota; y el grupo 3 no recibió ningún tipo de retroalimentación. Los tres grupos debían completar el mismo ejercicio durante el mismo tiempo asignado. Resultados: Se encontraron diferencias significativas entre los grupos en el rendimiento general, incluyendo intentos fallidos y exitosos; sin embargo, no hubo diferencia entre el tiempo y el número de intentos realizados durante la práctica. Conclusiones: La adquisición de destreza manual utilizando ejercicios básicos dentales por estudiantes novatos es optimizada a través de una retroalimentación remota con el uso de un simulador de RVH.

ABSTRACT Haptic Virtual Reality (HVR) simulators are increasingly crucial in modern clinical education. Within this context, the significance of feedback provided by instructors to students is evident. This feedback can be delivered either face-to-face or remotely, the latter facilitated by an individualized audio and microphone system. However, there is limited literature exploring and illustrating the advantages and disadvantages of these two approaches. Objective: To determine the impact of remote vs. face-to-face feedback on the process of acquiring manual dexterity using an HVR simulator among first-year students at the School of Stomatology of Universidad Peruana Cayetano Heredia. Material and methods: A study was conducted involving 37 participants (mean age = 18.2 years; SD = 3.2 years) without prior dental training. They were randomly assigned to three groups (n1 = 17; n2 = 10; n3 = 10). Group 1 received only face-to-face feedback; Group 2 received exclusively remote feedback; and Group 3 received no feedback. All three groups were required to complete the same exercise within the same designated time frame. Results: Significant differences were observed among groups in overall performance, encompassing both unsuccessful and successful attempts. However, there was no distinction in terms of the time taken or the number of attempts made during practice. Conclusions: The acquisition of manual dexterity among novice dental students through basic exercises is optimized by utilizing remote feedback in conjunction with an HVR simulator.

RESUMO Os simuladores de realidade virtual háptica (RVH) estão ganhando crescente relevância na educação clínica moderna. Nesse contexto, torna-se cada vez mais evidente a importância do feedback fornecido pelos instrutores aos alunos, seja de forma pessoal ou remota. No segundo caso, a utilização de um sistema de áudio e microfone individualizado auxilia nesse processo. No entanto, é notável a escassez de literatura que tenha explorado e evidenciado as vantagens e desvantagens dessas duas abordagens. Objetivo: O presente estudo tem como objetivo determinar o impacto do feedback remoto em comparação com o feedback presencial no processo de aquisição de destreza manual utilizando um simulador de RVH. O estudo foi conduzido com alunos do primeiro ano da Faculdade de Estomatologia da Universidad Peruana Cayetano Heredia. Material e métodos: Participaram do estudo 37 alunos (média de idade = 18,2 anos; desvio padrão = 3,2 anos), sem experiência prévia em odontologia. Os participantes foram distribuídos aleatoriamente em três grupos: Grupo 1 (n1 = 17) recebeu somente feedback presencial; Grupo 2 (n2 = 10) recebeu exclusivamente feedback remoto; e o Grupo 3 (n3 = 10) não recebeu nenhum tipo de feedback. Todos os três grupos realizaram o mesmo exercício no mesmo período de tempo determinado. Resultados: Foram encontradas diferenças significativas entre os grupos no desempenho geral, incluindo tanto tentativas fracassadas quanto bem-sucedidas. No entanto, não foram observadas diferenças significativas em relação ao tempo e ao número de tentativas realizadas durante a prática. Conclusões: Os resultados deste estudo indicam que a aquisição de destreza manual por parte de alunos novatos, ao executarem exercícios odontológicos básicos, é otimizada por meio do uso de feedback remoto proporcionado por um simulador de RVH.

La digitalización en la formación odontológica

La implementación de herramientas tecnológicas en la educación odontológica a lo largo de los años ha permitido al estudiante mejorar su desempeño en el ámbito preclínico de su formación, desarrollando habilidades motoras finas; en la actualidad este tema cobra relevancia debido a la coyuntura de salubridad del COVID-19. El objetivo de esta revisión fue describir la digitalización en la formación odontológica, las herramientas tecnológicas que se emplean y la percepción de estudiantes frente a la educación digital en Odontología. Se realizó una revisión electrónica en las bases de datos PubMed, SciELO, LILACS y ScienceDirect, en búsqueda de artículos publicados en inglés y español en el periodo 2015 al 2022. Se revisaron 156 artículos seleccionándose 50 directamente relacionados al tema de estudio. Se concluye que existen diversas herramientas digitales que pueden utilizarse en la formación de profesionales en Odontología; además, el aprendizaje mixto genera mejores resultados que el aprendizaje tradicional, y el aprendizaje en on-line, que fue utilizado durante el confinamiento por la pandemia de la COVID-19, demostró un alto grado de insatisfacción en los estudiantes.

The implementation of technological tools in dental education over the years has allowed the student to improve their performance in the preclinical field of their training, developing fine motor skills, currently this issue has become relevant due to the health situation of COVID-19. The objective was to describe digitalization in dental training, the technological tools used and the students´ perception of digital education in dentistry. An electronic review of the PubMed, SciELO, LILACS and ScienceDirect databases was carry out in search of articles published in English and Spanish in the period 2015 to 2022. One hundred fifty-six articles were reviewed, selecting 50 directly related to the subject of study. It is concluded that there are various digital tools that can be used in the training of professionals in dentistry; furthermore, exclusive online learning generates better results than traditional learning; and exclusive online learning, which was used during the COVID-19 pandemic lockdown, demonstrated a high degree of student dissatisfaction.

O uso de realidade virtual no cateterismo intravenoso periférico em crianças/adolescentes: relato de experiência / The use of virtual reality in peripheral intravenous catheterization in children/adolescents: experience report / El uso de la realidad virtual en el cateterismo intravenoso periférico en niños/adolescentes: reporte de experiencia

Conclusão: a realidade virtual é um recurso que pode ser utilizado como distração durante o cateterismo intravenoso periférico. Para os discentes, houve reflexão sobre o tratamento adequado de enfermagem em pediatria, além do desenvolvimento de habilidades de comunicação e senso crítico

Conclusion: virtual reality is a resource that can be used as a distraction during peripheral intravenous catheterization. For the learners, this experience prompted reflection on appropriate pediatric nursing care, in addition to fostering the development of communication skills and critical thinking

Conclusión: la realidad virtual es un recurso que se puede utilizar como distracción durante la cateterización intravenosa periférica. Para los aprendices, esta experiencia llevó a una reflexión sobre la atención de enfermería pediátrica adecuada, además de fomentar el desarrollo de habilidades de comunicación y pensamiento crítico

Therapeutic intervention with virtual reality in patients with Parkinson's disease for upper limb motor training: A systematic review / Intervención terapéutica con realidad virtual en pacientes con enfermedad de Parkinson para entrenamiento motor del miembro superior: revisión sistemática

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.(AU)

Analizar la evidencia científica relativa a los cambios en las extremidades superiores en pacientes con enfermedad de Parkinson que utilizan realidad virtual como parte de su tratamiento de rehabilitación neurológica. La búsqueda se realizó en las bases de datos siguientes: MEDLINE, Cochrane Library, PEDROs y SCOPUS. Se aplicaron los siguientes criterios de inclusión a un total de 106 artículos: ensayos clínicos aleatorizados con edad de 5 años, muestra que incluyera pacientes con EP (independientemente de su estado de compromiso), y que hubieran realizado RV para el tratamiento de los miembros superiores. Se utilizó un total de n=7 artículos, en los que se midieron las variables correspondientes al control motor de los miembros superiores, tales como: destreza motora fina, destreza motora bruta, fuerza, temblor, funcionalidad y velocidad. La realidad virtual como herramienta de neurorehabilitación en los pacientes con enfermedad de Parkinson muestra efectos positivos en todas las medidas relacionadas con el control motor de las extremidades superiores.(AU)