1.0 INTRODUCTION:

There has recently been a rise of global interest in one of the most significant technical achievements that the world has witnessed yet, the metaverse.¹The metaverse promises a new digital reality predicted to revolutionize many aspects of our day to day life, including healthcare.²This new reality has accelerated the adoption of innovative technology in a lot of aspect of everyday life, from daily social interactions all the way to medical services^.³ With the aid of artificial intelligence (AI), you can collaborate more effectively with data scientists to create models that will enhance patient care ⁴. A multiuser environment that blends physical reality and digital virtuality, the metaverse is a post-reality universe.

It is founded on the integration of technologies like virtual reality (VR) and augmented reality (AR), which enable multimodal interactions with digital items, people, and virtual environments.⁵ It is utilized in the field of medicine's diagnosis and treatment plans as well as virtual reality simulations.⁶ The outcome is the metaverse, a web of socially networked immersive experiences on platforms with ongoing multiuser participation.² The introduction of this would drastically transform the world of healthcare, The most recent epidemic has called into question the link and physical encounter between patient and doctor, separating the patient from healthcare providers, and raising concerns about the quality of patient treatment.⁷As the technology underlying the metaverse develops further, it is anticipated to play a bigger part in the healthcare sector, improving patient outcomes and altering how healthcare professionals provide care.⁸

Recently, the metaverse has even transformed economies, whereby the United Arab Emirates Government issues the Dubai Metaverse Strategy, the strategy represents the next revolution in the sphere of technology and economics that will have an impact on all facets of life over the next two decades.⁹The program intends to multiply the metaverse by five times and the number of blockchain businesses by two.⁹Those certain technological advances are expected to revolutionize health system, making it more efficient, cost-effective, and accessible to a larger population.¹⁰As the metaverse market expands, technology giants in numerous industries, including healthcare, have begun to establish their presence in this new platform.¹¹From virtual immersive treatment experiences to digitally analyzing medication interactions, the metaverse has several potential uses in healthcare.¹²

2.0 MATERIALS AND METHODS:

A comprehensive literature review was conducted by electronically searching scholarly databases including Web of Science, PubMed, and Scopus. In addition, manual searches of reference sections in relevant studies and systematic reviews were carried out to identify potential publications. To gather a broad range of literature on the topic, the review aimed to address specific research questions, including the areas covered by metaverse technology in clinical care, common metaverse strategies employed in medical education, and the current context and reasons for implementing metaverse approaches in medicine.

3.0 Metaverse and clinical care:

The metaverse concept has a great deal of potential since it offers an entirely new way of connecting and interacting with people. Medicine has traditionally been an intimate scientific profession in which physicians may notice both emotional and physical reactions. The outbreak, on the other hand, has expedited the development of remote care technology. For instance, just 43% of healthcare facilities could offer telemedicine prior to the pandemic; by 2020, that percentage had increased to 95%.⁸ The most significant and valuable aspect of the metaverse in medicine for clinical care is the merging of humans and computers together with the connection between virtuality and reality. ¹³The clinical possibilities of metaverse on healthcare are shown in (Figure 1)

Figure 1: Clinical possibilities of the metaverse in the healthcare

3.1 Surgical operations:

The use of the metaverse in surgical intervention has enormous potential. Using immersive surgical experiences, real-time guidance in the surgeon's field of view can be provided. AR improves surgical accuracy and flexibility by allowing access to information within the operating room's sterile field. The metaverse facilitates medical procedure teaching, training, concurrent planning, and sharing.⁴ The metaverse will first be utilized for medical management, patient care management, diagnostic imaging, and surgical simulations. ¹⁴Intuitive Surgical, recognized for its robotic surgical devices, has a lot of promise to change the way people think about virtual reality. Several small manufacturers are engaged in implementing the digital healthcare, whether it's through augmented reality to improve the telemedicine experience or by offering extra options to make a more efficient and convenient healthcare experience that is more secure for patients .¹⁵

3.2 Virtual Reality and Augmented Reality:

These innovations aid patients in gaining a faster understanding of their ailments and recommended treatments. Using AR and VR together in a clinical setting may make it possible to teach medical professionals how to treat and care for patients. When augmented reality and radiography are used together, doctors can project images from CT (computed tomography) scans onto the patient's body while they are moving, allowing the doctor to see the inside anatomy of the body clearly.⁴The development of associated hardware, such as brain-computer interfaces (BCI) and extended reality (XR) technologies, will be inextricably linked to the development of the metaverse, a virtual parallel universe. Mixed reality, virtual reality, and augmented reality are just a few of the technologies that XR incorporates. Virtual reality (VR) will be able to continue offering patients and clinicians a completely interactive medical qualification as digital medical settings grow extraordinarily close to natural medical surroundings and reach the point of holographic structure and modeling. In the healthcare sector, VR and AR present special technological obstacles. The development of accurate physical objects and surgical interfaces in a computer-generated environment, modeling relationships between objects, and processing signals for complex actions during operations are some of these challenges.¹

3.3 Cardiovascular diseases:

The cardiovascular sector is continually researching effective ways to integrate contemporary and successful technology breakthroughs in medical care.¹⁶Healthcare would undergo a meaningful change if it were possible for highly qualified cardiac surgeons and interventionalists to operate globally while also training the next generation of physicians.¹⁶A cardiologist and cardiac surgeon can follow up and consult with patients virtually to monitor disease development and go through the test results.¹⁷ The metaverse can increase the capability to significantly minimize the risk of problems while improving effectiveness and precision in several types of cardiovascular interventional procedures. Adopting such a technique would improve the dependability of real-time guidance by integrating with surgical navigation systems and combining data from multiple imaging sources, as well as provide more depth in seeing heart cavities, coronary architecture, and the vascular system. ¹⁸

3.4 Mental Health:

In addition, another clinical application of the metaverse would be its integration within mental health management.¹⁹ The advantage of VR simulations is that they may simulate real-life circumstances that are hard to replicate in the real life. The deficit of mental health professionals might manageas we conduct VR which can decrease to require doctors being present in person for the patient, allowing them to engage virtually from distant regions.²⁰ Metaverse is effective in the management of the following mental illnesses: conditions like: Alzheimer’s disease, Autism, Anxiety, phobias, and post-traumatic stress disorder.

3.4.1 Alzheimer’s disease:

Virtual reality is used to study navigation skills and improve learning and memory in people with Alzheimer's disease. On the other hand, however, one of the limitations of working with elderly patients is that some patients reported boredom, worry, and anxiety upon implementing the VR app.²¹

3.4.2 Autism:

Cognitive counselling utilizing VR for autistic patients has also showed promising outcomes. Trials employing VR programs that use avatars to replicate employment interviews and meetings have been successfully conducted at the University of Texas and North-western University's Department Of psychiatry. They have been shown to be effective in boosting life skills as well as general focus, cognition, and memory, this kind of therapy enable autistic patients to familiarize themselves with real life situations.²¹ For children , In order to improve affective recognition and interaction for autistic people, a Collaborative Virtual Environment was created by developing a three-dimensional avatar that could express feelings like anger,happiness, sadness and surprise through body language.²²

3.4.3 Anxiety, and post-traumatic stress disorder:

A VR social skills training session notably benefited socially nervous persons since it enables them to engage and gain communication skills.¹⁷ VR-based interaction counseling for post-traumatic stress disorder (PTSD) empowers the provider to customize the virtual environment to replicate war experiences most appropriate to the trauma experienced by specific soldiers. It has shown promise in lowering suicidal thoughts, despair, and aggression.²³

4.0 Radiological Imaging:

A technology called virtual reality (VR) enables users to interact with digitally created worlds. This technology is often used in video games or movies. However, VR can also be used for research purposes. For example, VR can be used to study how the brain responds to different types of stimuli.²⁴With the aid of image visualization and manipulation, diagnosticians will be able to examine more images with features that can aid in better diagnosis. Radiologists in different countries would be able to work on medical pictures in 3D. ²⁵Radiologists have typically relied on two-dimensional imaging, but VR can augment slice-based imaging. It has been demonstrated that VR platforms may give immersive three-dimensional experiences that help in diagnosis.²⁶ The development of VR might allow doctors and other healthcare professionals to collaborate in a virtual space.

People in the metaverse can use a special visualization to share medical information with one another. This visualization allows people to see and interact with the data in front of them. This is a sentence about the metaverse. The metaverse is a place where people can collaborate across faraway locations.²⁶Immersive technology is also used to place patients in imaging and interventional radiology suites, which helps patients understand interventional radiology procedures and reduces anxiety.²⁷

5.0 Emergency Medicine:

Metaverse in Emergency Medicine enhances the real-time emergency medicine experience by providing deeper expertise in clinical education and training, hospital and disaster medicine, diagnostic and therapeutic programs and management.²⁸ Virtual reality will be a potential method for information transfer and communication in emergency healthcare regarding disease knowledge, medical procedures, and health concept teaching. We can expect augmented reality to have more potential and applied utility in the future because of its ability to integrate with real-world stimuli and the existing world in clinical practice. So far, the impact on clinical care has been minimal, although some strategies appear to aid clinicians, albeit greater application and proof are required in the future.²⁹

6.0 Cancer Care:

An estimated 30 million people worldwide are affected by the global pandemic of cancer³⁰.Various potential uses for the metaverse exist in the treatment of cancer.³¹ More specifically, surgical treatment and cancer rehabilitation could be areas where the metaverse is used to cancer care. One case involved the removal of a malignant tumor from a patient's spine by Johns Hopkins neurosurgeons using Augmedics headsets.³²The Metaverse can also enable avatar-based patient-physician interaction in a virtual space, whatever the location opening a new dimension of telemedicine services in the field of cancer care. ³³

7.0 - Medical education and training:

To accommodate the increased need for distance learning and remote education, instructional approaches utilizing the "metaverse" are starting to be implemented within the medical field. A key example of the success of using metaverse in medical training is when The Asian Thoracic Surgery Education Group oversaw an outreach initiative employing an extended reality (XR) technology platform during the Asian Heart and Thoracic Surgery Society's 29th Online Conference. More than 200 Asian thoracic surgeons participated in the Outreach program and received training.²⁹Participants created their own avatars and entered a virtual classroom where they watched lectures on various surgical procedures and virtual and mixed technologies trends. The metaverse is divided into so many different types and has different applications, according to the metaverse roadmap, the metaverse is divided into four categories: lifelogging, virtual reality, augmented reality, and mirror world.³⁴ These categories tend to serve different purposes according to use in medical education. The use of the metaverse in healthcare education are shown in (figure 2)

These advancements in medical education not only improve the understanding and comprehension of medical topics but also add quality and value to the future of healthcare and treatment. A research team that collaborated with university labs at a Seoul hospital has developed a spinal surgery platform employing augmented reality technology. This platform uses an overlay image based on augmented reality to project a pedicle screw used for spinal fixation on a human body structure in real-time.³⁴This technology will be used to build an effective education system that can be applied to actual surgery, including a spinal surgery education program. This serves as further evidence of the influence the metaverse has already had on medical education.³⁴

The following table (Table 1) displays examples and unique ways in which different medical fields such as pharmacy, dentistry, nursery, emergency healthcare and surgery have utilized the metaverse in enhancing and enriching medical training.

Figure 2 – The use of the metaverse in healthcare education

Table 1 – The utilization of the metaverse in different types of Healthcare Training

Healthcare Training

Metaverse Implementation

Outcome

Reference

Dental Education

Using haptic gloves so that dentistry students might practice suturing or performing a neve block while feeling virtual items.

This can gradually enhance the students' skill and provide them with rapid feedback, for instance, while inserting needle points.it has the potential to revolutionize dental education and improve the quality of care provided to patients.

35 ,

Pharmaceutical Training

Students are able to utilize head-mounted devices and assume the role of the patients, caretakers, and healthcare professionals in the cases in virtual reality movies enabling pharmacy students to practice their patient evaluation and counselling skills. Students can speak with patients and their caregivers in interviews to gather information, and they can collaborate with othermedical experts to improve treatment strategies.

The use of VR examples helped students better grasp the course material and develop their problem solvingskills. Also it Can provide a realistic and safe environment for trainees to practice complex procedures and protocols.

37,38

Nursing Skills

Educational models using 3D animation, text, audio, and augmented reality, create. A virtual environment is also available for the deployment of critical skill training and evaluation in the nursing sector.

While enabling students to train in a secure environment from any place, these immersive and interactive experiences serve as a medium for the dissemination of knowledge and the instillation of best practice procedures across a variety of subject areas.

30,31

Surgical Training

Virtual reality cameras with high resolution used for surgery instruction relay every surgical situation at 360 degrees. To build a virtual environment and high-quality voice chats, the platform employs 3D XR immersive sound technology. Participants may also examine the surgeon, the nurses' distribution of surgical instruments, the motion of the forceps, and even the sweat while the incision is patched.

Observers and students are able to analyze human details and learn in a safer environment before entering the operating room which widens their perspective.

39, 40

Medical Emergency (paramedic) Training

In a secure, replicable, immersive, and interactive context, the virtual world enables the repetition of several life-threatening clinical scenarios and cases using VR technology.

Studies showed its benefit in overcoming the drawbacks of practical education, which benefits learner happiness and capacity for learning.

28,29

8.0 - Metaverse in digital therapeutics:

The merging of physical and virtual space-time is the most striking element of the metaverse, which differs from the standard digital medical approach.⁴¹The Federal Drug Agency (FDA) in the USA is starting to acknowledge digital therapeutics as a treatment that is effective enough to be recommended and even supported.⁴²The application of digital technologies to promote health and wellness is known as "digital therapeutics. ⁴³It functions as a virtual representation of the actual thing or process it represents, allowing for remote monitoring and assessment that is almost real-time.⁴⁴ As shown in the following figure (Figure 3) The types of digital therapeutic are shown in figure 3.

8.1.Blockchain:

Metaverse in Emergency Care enhances the relatively close time emergency medicine practices by successfully delivering unique environments in clinical degree and diploma education, preclinical and crisis medicine, diagnostic and therapeutic approaches, and administrative operations.⁴⁵ Blockchain is an important factor of the metaverse in healthcare, according to specialists, since it provides a fragmented community managed collectively by digital currencies, as well as a record of digital "property" of surroundings or even products in the digital world.The most notable use case for blockchain in healthcare is the management and protection of our very important health data.⁴⁶In addition to the potential benefits of blockchain technology in the healthcare , there are a few difficulties in implementing it like Information sharing, data standardization, and compliance.⁴⁷

Figure 3: Types of digital therapeutics

8.2. Big Data:

The effectiveness of COVID-19 safety measures and people tracking can be considerably increased with the use of big data and artificial intelligence. Machine learning models can be created by gathering real-time data from sources including mobile heat maps, mobile phones, mobile payment apps, and social media in order to forecast the spread of SARS-CoV-2, help with border inspections and surveillance, and help with drug delivery. In the battle against COVID-19, these instruments have shown to be crucial.^48,49

8.3. Digital Twin:

A technical twin model is a virtual or simulation model like any object, process, or system produced using actual data to learn about its meaningful digital counterpart. In the metaverse, the patient's digital doppelganger can be the patient itself.⁴⁶

8.4. Telemedicine:

Among the most important and useful components is connectivity and communication with currently offered hospital equipment, that will help to expand the metaverse through expanding on prior beneficial advances.¹² Telemedicine enables patients to connect with healthcare professionals remotely, eliminating the need for in-person visits. This telepresence in healthcare allows patients to have virtual consultations with doctors using VR technology. The results of these consultations can be easily shared with physicians worldwide, while any necessary follow-up care, such as medical scans or testing, can be scheduled and completed at a nearby facility. This innovative approach to healthcare allows patients to receive the medical attention they need, regardless of their physical location.⁵⁰ by using teleservices, it makes treatment accessible for a patient who need it in remote areas.⁵¹

8.5. Wearable Technologies:

Wearable devices in the Metaverse send the patient’s data and rebuild it into three-dimensional virtual entities for medical practitioners to analyze. Instead of needing doctors to be online 24 hours a day, clinicians' AI virtual entities should be widely employed to connect with patients in the health Metaverse.⁵²

The digital revolution of healthcare is all around us. Consider telemedicine, which makes it simpler to obtain specialist care, wearables, which assist us in taking a more proactive part in monitoring our health and attaining wellness goals, or AI embedded into imaging technology, which assists physicians in providing more accurate treatment.⁵³ In the metaverse, real, meaningful connections with patients and consumers will be important.⁵⁴Physicians in Health Metaverse can communicate with the following people: They can remotely control patients and turn patient health data into a digital virtual environment. They can gradually explain the patient's situation and therapy to the patient or the patient's family. The ability to convert biological signals from medical equipment into digital form allows clinicians to care for patients in emergency medicine.⁵⁵ Overall, wearable technology has the potential to improve user experience in the metaverse, but more research and development is required to overcome challenges and make these devices more accessible to a wider audience.⁵⁶

9.0 The ethical and legal challenges of the metaverse in healthcare:

Although the metaverse will enable us to make huge advancements in various domains within healthcare, it still has its drawbacks which must be analyzed and kept to a minimum in order to truly reap the benefits of this technological breakthrough. Privacy and security are very important factors since the metaverse collects activity and data that is more particular than user interactions and internet history. Protection of transmitted data and two-factor authentication for avatars are crucial, and we need to be more watchful of potential criminal activity in the metaverse.⁵⁵Malicious users can track and gather real-time biometrics (such as facial expressions and voice inflections) and metaverse users' behavior (such as interactions with other users and purchasing activities), which might be used to identify the user.⁵⁶ The metaverse is technically a virtual environment which gives rise to a digital footprint, as a result, our digital footprint is recorded and can expose a variety of information about us, including our identity, age, location, and medical history. In the worst-case scenario, such surveillance may result in hostile parties learning about you, identifying you and tracking you down, giving rise to crime and discomfort.⁵⁷ Healthcare is a sensitive and important field therefore the security and privacy shouldn't be optional consideration. They are essential and important elements that must be continually controlled throughout the whole service process in a metaverse setting. That is, from the time of first deployment until the time of decommissioning, security and privacy should be taken into account and managed.

10.0 CONCLUSION:

In conclusion, the use of the metaverse in the healthcare industry can support creative medical training, better surgical techniques, medical treatment, and improved online health management. Innovative thinkers are turning health education into engaging microsessions that can be delivered online to anybody, anywhere. The ability for clinicians to practice with greater accuracy, collaborate globally, and use augmented reality to their advantage opens the prospect of conquering medical obstacles. The prospect of rewarding the public, patients, and experts for their efforts to advance health creates a completely new market and avenue for revenue. This is a brand-new reality that is always developing, and we are learning more about it along with the innovators who are forging these fresh metaverses. In order to reduce risks, handle ethical and legal issues, and optimize benefits, a sustainable and affordable health-care system can be developed. Health leaders must be involved in this process.

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Received on 18.02.2023 Modified on 20.07.2023

Research J. Pharm. and Tech 2023; 16(11):5506-5513.

DOI: 10.52711/0974-360X.2023.00891