The use of virtual simulation-based training continues to expand, as organizations explore alternative methods to reduce the cost of training. While virtual simulation has been empirically validated to be effective in the transfer of skills to the live environment, what is still unknown is what effect, if any, that an individual's sense of presence in the simulation has on their performance. In this paper, we examine the relationship between presence and performance while performing a psychomotor task in a virtual environment. The independent variables were visual display and expertise level. The dependent variables were presence and performance. We found evidence of a moderate relationship between the degree of presence experienced in the simulation and an individual's performance over three training trials. Results of this study may inspire future research to investigate whether higher presence in virtual simulation results in higher performance.

Military organizations worldwide continue to invest heavily in research, development, and fielding of virtual and mixed reality simulations and simulators for training. However, the future fiscal environment will be challenging for both simulation as well as the US Army as a whole. Thus, wise design decisions must be made when developing virtual simulations for training. In order to optimize the effectiveness of these simulations, developers must employ trade-off analysis and scientific methods to derive empirical evidence, in order to ensure that the simulation under development is optimized to meet the training requirements, while still adhering to cost and schedule constraints. This paper specifically focuses on the task of employing the optimal visual modality in virtual and mixed reality simulations. This paper reviews the literature on training simulation benefits and taxonomy, and examines the training efficacy of virtual and mixed reality simulation. Major concepts and applications of virtual and mixed reality simulation training efficacy are discussed. A key component of virtual simulation, visual modality, is examined through a literature review and recommendations for visual display design parameters are provided.

Introduction Immune-related adverse events are complications of immune checkpoint inhibitors which require robust patient education and proactive follow-up to ensure timely identification and management. Oncology pharmacist practice models with other anticancer modalities have been well documented, but there is limited evidence assessing the spectrum of pharmacist interventions in patients receiving immune checkpoint inhibitor(s) and the impact of these interventions on patient outcomes. Methods Patients initiated on immune checkpoint inhibitor(s) from 1 January 2016 to 31 August 2019 were included for data collection and analysis. Part 1 featured an intensive pharmacist follow-up cohort (study cohort) and summarized pharmacist interventions. Part 2 compared patient outcomes between the study cohort and a standard of care cohort (control cohort) from a different oncology centre. Patient outcomes included emergency department visits not resulting in admission, hospitalizations due to immune-related adverse event(s), immune checkpoint inhibitor cycles received, treatment discontinuation due to immune-related adverse event(s), completion of finite programmed death-1/death-1 ligand treatment course and completion of ipilimumab. Clinical outcomes were compared using a retrospective, matched cohort design based on age, cancer diagnosis and immune checkpoint inhibitor(s). Results A total of 143 patients were included in Part 1 encompassing 1664 pharmacist recommendations across 11 categories. The matched cohort yielded 92 matches (n = 184) with a higher odds of immune checkpoint inhibitor discontinuation due to immune-related adverse event(s) in the control cohort (odds ratio (OR) (95% confidence interval (CI)) = 5.5 (1.2−24.8); p = 0.022). Conclusion Intensive immune-related adverse event education, proactive follow-up and immune-related adverse event management by pharmacists result in clinically meaningful interventions which correlate to improved patient outcomes, namely lower odds of treatment discontinuation due to immune-related adverse event(s).

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