Virtual reality exposure therapy using a virtual Iraq: case report

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.     

Incidence of greater trochanteric pain syndrome in active duty US military servicemembers

Although greater trochanteric pain syndrome is thought to be a common musculoskeletal disorder, little has been reported on the incidence rates of the disorder. The purpose of this study was to determine the incidence and demographic risk factors of greater trochanteric pain syndrome in a United States military population. Multivariate Poisson regression analysis was used to estimate the rate of greater trochanteric pain syndrome per 1000 person-years, controlling for sex, race, age, rank, and branch of service. The overall unadjusted incidence rate of greater trochanteric pain syndrome was 2.03 per 1000 person-years. Women had a significantly increased adjusted incidence rate ratio for greater trochanteric pain syndrome of 5.03 (95% confidence interval [CI], 4.91-5.16). The adjusted incidence rate ratio for White servicemembers compared with Black servicemembers was 1.36 (95% CI, 1.32-1.40). The adjusted incidence rate ratio for the 40+ age group compared with the 25 to 29 age group was 2.81 (95% CI, 2.68-2.95). Compared with junior officers, junior and senior enlisted ranks had an increased adjusted incidence rate ratio of 1.94 (95% CI, 1.84-2.04) and 1.17 (95% CI, 1.12-1.23), respectively. Compared with the Navy, each branch of service had an increased adjusted incidence rate ratio, with the Army at 2.90 (95% CI, 2.80-3.01), the Marines at 1.96 (95% CI, 1.87-2.07), and the Air Force at 1.33 (95% CI, 1.27-1.38). Female servicemembers had a five-fold greater incidence of greater trochanteric pain syndrome. Increasing age, enlisted rank groups, and service in the Army, Marines, or Air Force were also significant risk factors.     

Bone scintigraphic findings of os trigonum: a prospective study of 100 soldiers on active duty

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty. PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated. RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum. CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.     

Multiple trauma and mental health in former Ugandan child soldiers

The present study examines the effect of war and domestic violence on the mental health of child soldiers in a sample consisting of 330 former Ugandan child soldiers (age: 11-17 years, female: 49%). All children had experienced at least 1 war-related event and 78% were additionally exposed to at least 1 incident of domestic violence. Prevalences of posttraumatic stress disorder and major depressive disorder were 33%, and 36%, respectively. Behavioral and emotional problems above clinical cutoff were measured in 61%. No gender differences were found regarding mental health outcomes. War experience and domestic violence were significantly associated with all mental health outcomes. The authors' findings point to the detrimental effects of domestic violence in addition to traumatizing war experiences in child soldiers.     

Documented combat-related mental health problems in military noncombatants

Although combat-related posttraumatic stress disorder (PTSD) has been documented for military combatants, little is known about PTSD in noncombatants. Active-duty U.S. Air Force noncombatants (N = 5,367) completed a Post-Deployment Health Assessment upon return from combat zones in Iraq (n = 4,408) or a noncombat zone in Qatar (n = 959). Those deployed to Iraq were significantly more likely to report exposure to someone who was wounded or killed (20.8% vs. 6.3%), feeling in great danger of being killed at some point during deployment (18.9% vs. 3.5%), symptoms of PTSD (4.1% vs. 0.7%), and symptoms of major depression (9.9% vs. 5.4%). These findings suggest that deployment to a war zone is associated with increased mental health problems, even for noncombatants.     

From planes to brains: parallels between military development of virtual reality environments and virtual neurological surgery

Military explorations of the practical role of simulators have served as a driving force for much of the virtual reality technology that we have today. The evolution of 3-dimensional and virtual environments from the early flight simulators used during World War II to the sophisticated training simulators in the modern military followed a path that virtual surgical and neurosurgical devices have already begun to parallel. By understanding the evolution of military simulators as well as comparing and contrasting that evolution with current and future surgical simulators, it may be possible to expedite the development of appropriate devices and establish their validity as effective training tools. As such, this article presents a historical perspective examining the progression of neurosurgical simulators, the establishment of effective and appropriate curricula for using them, and the contributions that the military has made during the ongoing maturation of this exciting treatment and training modality.     

个体认知刺激疗法对痴呆患者心理健康干预效果的系统评价

目的 系统评价个体认知刺激疗法对痴呆患者心理健康的干预效果.方法 按照循证医学的原则和方法,计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Embase、CINAHL、Web of Science、Cochrane Library和APA PsycNet数据库,查找关于个体认知刺激疗法对痴呆患者心理健康干预效果的随机对照试验,检索时限自建库至2021年4月.由2名研究人员按照纳入和排除标准独立文献筛选、资料提取和质量评价,采用RevMan5.3软件对纳入的数据进行分析.结果 共纳入8篇RCT研究,共1324例研究对象.Meta分析结果显示,与对照组相比,个体认知刺激能够减轻痴呆患者精神行为症状(P＜0.01).亚组分析显示,与家庭照顾者实施3～6个月的个体认知刺激相比较,专业照顾者实施3个月以内的个体认知刺激对痴呆患者精神行为症状的改善更显著(P＜0.01).结论 由专业照顾者实施的个体认知刺激较家庭照顾者更能有效缓解痴呆患者的精神行为症状.     

Use of a virtual reality simulator for ureteroscopy training

PURPOSE: Virtual reality surgical simulators may shorten operative time and reduce the potential for iatrogenic injury by providing training outside the operating room. We hypothesized that training on a virtual ureteroscopy (VU) simulator would allow novice endoscopists to overcome the initial learning curve before entering the operating room. MATERIALS AND METHODS: We evaluated 16 medical students on their ability to perform specific ureteroscopic tasks on a VU simulator. The students trained on the simulator for a total of 5 hours over multiple sessions using different training modules and then were retested on the initial module. Likewise, 16 urology residents with varying degrees of endoscopic experience were assessed on the same test module twice, without additional simulator training. RESULTS: The students improved task completion time from 17.4 to 8.7 minutes (p <0.05), while the residents performed the task in 7.6 minutes at baseline and 6.7 minutes at the second trial. Stratification of residents by years of urology training revealed that the mean completion time for the students after training did not differ statistically from that of first year residents who had performed a median of 14 clinical ureteroscopies. Furthermore, the subjective performance scores of the students were comparable to those of the first year residents. CONCLUSIONS: Novice medical students trained on a VU simulator improved task completion time by 50% after training, and performed comparably to residents who had completed nearly 1 year of urology training. VR training may allow beginning urology residents to shorten the initial learning curve associated with ureteroscopy training, although this hypothesis requires further validation.     

虚拟现实技术对结肠镜检查患者疼痛和焦虑的影响

目的 探讨减轻结肠镜检查患者疼痛和焦虑的有效方法。方法 将接受结肠镜检查的60例患者随机分为对照组、虚拟现实组和清醒镇静组各20例。对照组接受常规结肠镜检查;虚拟现实组患者在检查过程中佩戴虚拟现实一体机无线头盔眼镜,视听自选视频;清醒镇静组在检查时接受镇静药物处理。评价患者检查各阶段生命体征,疼痛及焦虑评分。结果 检查中清醒镇静组、虚拟现实组疼痛评分显著低于对照组,检查后患者焦虑评分显著低于对照组（均P＜0.05）。结论 虚拟现实技术可减轻患者结肠镜检查过程中的疼痛,并改善患者的焦虑状态。     

Investigating the effects of suicide exposure among a clinical sample of active duty service members

Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.     

Functional outcomes in young, active duty, military personnel after submuscular ulnar nerve transposition

PURPOSE: The purpose of this study was to report on the results of submuscular ulnar nerve transposition (SMUNT) for treatment of cubital tunnel syndrome in a young, active duty, military population. METHODS: Twenty patients (20 extremities) were evaluated retrospectively a minimum of 12 months after surgery. Outcome analyses were performed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Bishop-Kleinman rating scales, physical examination, return-to-work analysis, evaluation of complication rate, and overall patient satisfaction. RESULTS: At an average follow-up evaluation of 24 months (range, 12-38 mo), 19 patients had returned to full military active duty work status. The average duration of limited work capacity after surgery was 4.8 months (range, 3-7 mo). The DASH scores improved from an average of 32.5 points before surgery to 6.2 points after surgery. In 19 patients the functional outcome evaluated with the Bishop-Kleinman rating system was excellent. There were no poor outcomes using this rating score. Statistically significant improvements in both key pinch and grip strength were noted. Complications included one permanent and 2 transient neuropraxias of the medial antebrachial cutaneous nerve. Overall 19 of 20 patients were satisfied with the procedure and would have the surgery again if required. CONCLUSIONS: Submuscular ulnar nerve transposition for cubital tunnel syndrome provides a reliable rate of return to full active duty work in military personnel with good patient satisfaction and minimal complications.     

The contribution of prior psychological symptoms and combat exposure to post Iraq deployment mental health in the UK military

This study assessed the contribution of baseline psychological symptoms, combat exposure, and unit support in the etiology of posttraumatic stress disorder (PTSD), and psychological distress. From 2004–2006, 67% of a random sample of 2,820 participants who had been assessed for psychological symptoms in 2002 were reassessed. Baseline psychological symptoms, combat exposure, and unit support factors were associated with the outcomes and the effect sizes for combat exposure were marked for PTSD symptoms. Adjustment for baseline psychological symptoms did not modify the pattern of association of group cohesion and combat exposures. The authors concluded that combat exposure and group cohesion have an effect on mental health outcomes independent of previous mental health status, which explains why screening prior to deployment is ineffective.     

Development of a structured virtual reality curriculum for laparoscopic appendicectomy

BackgroundLaparoscopic appendicectomy (LA) is a common surgical emergency procedure mainly performed by trainees. The aim was to develop a step-wise structured virtual reality (VR) curriculum for LA to allow junior surgeons to hone their skills in a safe and controlled environment.MethodsA prospective randomized study was designed using a high-fidelity VR simulator. Thirty-five novices and 25 experts participated in the assessment and their performances were compared to assess construct validity. Learning curve analysis was performed.ResultsFive of the psychomotor tasks and all appendicectomy tasks showed construct validity. Learning was demonstrated in the majority of construct-valid tasks. A novel goal-directed VR curriculum for LA was constructed.ConclusionsA step-wise structured VR curriculum for LA is proposed with a framework which includes computer generated metrics and supports deliberate practice, spacing intervals, human instruction/feedback and assessment. Future study should test the feasibility of its implementation and transferability of acquired skill.     

Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer: a randomized controlled trial

Background The first step toward increasing the level of patient safety in endoscopic surgery is for all endoscopic surgeons to acquire fundamental skills, including psychomotor skills, in the preoperation stage of training. The current study aimed to evaluate the effectiveness of virtual reality (VR) simulator training and box training for training the fundamental skills of endoscopic surgery. Methods For this study, 35 medical students at Kyushu University were divided into three groups: simulator (SIM) group (n = 20), box trainer (BOX) group (n = 20), and control group (n = 15). None of the students had any experience assisting with endoscopic surgery or any previous training for endoscopic surgery. The students in the SIM group underwent training using a VR simulator, the Procedicus MIST, 2 h per day for 2 days. The students in the BOX group underwent training using a box trainer 2 h per day for 2 days. The students in the control group watched an educational video for 30 min. The endoscopic surgical skills of all the students were evaluated before and after training with a task of suturing and knot tying using a box trainer. Results Although no significant differences were found between the three groups in the total time taken to complete the evaluation task before training, there were significant improvements in the SIM and BOX groups after training compared with the control group. Box training increased errors during the task, but simulator training did not. Conclusion The findings showed that box training and VR training have different outcomes. The authors expect that the best curriculum for their training center would involve a combination that uses the merits of both methods.     

沉浸式虚拟现实技术在肺癌患者肺康复健康教育中的应用

目的 探讨沉浸式虚拟现实技术在早期肺癌患者肺康复健康教育中的应用效果,促进患者术后康复。方法 将120例早期肺癌患者随机分为对照组与干预组各60例。对照组实施常规健康教育;干预组在常规健康教育基础上,采用沉浸式虚拟现实技术进行肺康复健康教育。结果 干预组健康教育内容掌握率、肺康复训练依从性、6 min步行距离、Barthel指数及健康教育满意度显著高于对照组,Borg气促与劳累评分显著低于对照组（均P＜0.05）。结论 沉浸式虚拟现实技术用于早期肺癌患者肺康复健康教育,有助于患者对健康教育内容的掌握,提高肺康复训练的依从性及健康教育满意度,促进患者康复。