Virtual reality goggles may be a feasible, noninvasive alternative to traditional pharmacologic treatment. The cost of any intervention would need to be considered. Virtual reality should be researched and adapted to benefit patients in appropriate settings.

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Study design: Retrospective cohort study.Background: Several studies focus on the long-term results of anterior cervical discectomy and fusion (ACDF) surgeries, but little information exists regarding how various patient-related, procedure-related, and payer-related variables may affect postoperative hospital length of stay (LOS).Objective: To determine what factors, if any, contribute to increased hospital LOS in patients who have had an ACDF.Methods: Retrospective cohort study of 108 consecutive patients who underwent elective ACDF at a Midwest academic medical center. Extensive preoperative, intraoperative, and postoperative data were abstracted and analyzed to identify prognostic factors for an increased LOS. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on hospital LOS.Results: 103 patients met inclusion and exclusion criteria. The mean LOS for patients undergoing ACDF was 1.98 (±1.6) days. Only 29% of patients had one level fused. The mean blood loss during surgery was 87.4 ± 99.6 mL. One subject lost 700 mL of blood. Complications, though rare, included uncontrolled postoperative pain (13%), cardiac (6%), pulmonary (4%), and urinary (3%). Covariates included in the final model were age, sex, cardiac complication, urinary complication, and pulmonary complication. Factors that contributed to increased LOS and their associated adjusted mean days were: ≥50 years of age (2.5 ± 1.2 days), female gender (2.3 ± 1.2 days), and three particular types of complications. The complications that had the largest effect on increased LOS from least to most severe were cardiac (3.5 ± 1.3 days), urinary (4.7 ± 1.3 days), and pulmonary (5.3 ± 1.3 days).Conclusions: The information presented in this study may be useful for patients, clinicians, and insurance companies, including precertification and case-management services. Our results can be instrumental in designing future prospective studies using more detailed analyses with more patients, more surgeons, and multiple institutions.Final class of evidence (CoE)-treatmentYesStudy design: Prospective cohort Retrospective cohort• Case control Case seriesMethods Patients at similar point in course of treatment• Follow-up ≥85%• Similarity of treatment protocols for patient groups• Patients followed-up long enough for outcomes to occur• Control for extraneous risk factors•Overall class of evidenceIIThe definiton of the different classes of evidence is available on page 59.

There is limited information on how military women manage feminine hygiene practices in combat and noncombat environments. The purpose of this study was to describe feminine hygiene practices of military women in deployed and noncombat (normal) environments. A nonexperimental descriptive research design was used. The study used a survey questionnaire, the Deployed Female Health Practice Questionnaire, which was developed specifically for military women to report their experiences with hygiene issues. Significant differences between deployed and normal environments were found in the areas of types of menses management products used and in douching and handwashing practices. Continuing education about safe feminine hygiene practices will help military women cope better in deployed (field) environments. Recommendations suggest further study on intervention strategies for hygiene management practices.

This article describes a focused ethnography of a group of chronically mentally ill clients who were involved in a client-run drop-in center. Spradley's (1979) Developmental Research Sequence guided the research. Data were obtained from interviews, participant-observation and documents review. The qualitative analysis identified the major theme of empowerment, which had four process domains: participating, choosing, supporting and negotiating. These domains represented four levels of empowerment for this group. From the client's perspective, empowerment meant they participated more in the community, their choices were increased, they provided support for each other and they negotiated on a more equal basis with staff. A fifth domain, personal significance, described the effects of empowerment for each individual.