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Aims: This systematic review and meta-analysis aimed to evaluate the association between β-blocker use and neuropsychiatric adverse events, specifically focusing on short-term outcomes., Methods: A comprehensive literature search identified studies reporting neuropsychiatric outcomes in patients using β-blockers, including randomized controlled trials and observational studies. Relative risks (RR) and 95% confidence intervals (CIs) were calculated for outcomes such as dizziness, insomnia, nightmares, drowsiness and delirium., Results: Our analysis revealed that β-blocker use was significantly associated with an increased risk of dizziness (RR 1.72, 95% CI [1.39-2.14]; I 2  = 1%, 14 studies) compared to placebo. Lipophilic β-blockers, especially propranolol, showed an even greater risk of dizziness (RR 3.13, 95% CI [1.44-6.84]; I 2  = 0%, three studies). Propranolol was also associated with increased insomnia risk compared to placebo (RR 1.13, 95% CI [1.00-1.28]; I 2  = 0%, five studies). Our data did not show statistically significant increases in the reports of nightmares and somnolence. Other adverse effects, including drowsiness, sleep disturbances, hallucinations and delirium, were noted., Conclusions: Our findings suggest a significant association between β-blocker use and an increased risk of neuropsychiatric adverse events, particularly insomnia and dizziness with higher risks associated with lipophilic β-blocker use. Given the ambiguity surrounding dizziness and its classification as a neuropsychiatric effect, our findings are exploratory, and we cannot exclude a potential cardiovascular origin for dizziness. Most studies (75%) were published before the CONSORT statement in 1996, indicating potential reporting limitations and a lack of recent research. Additionally, 60% of studies had a high risk of bias, underscoring the need for more rigorous and contemporary investigations into the neuropsychiatric implications of β-blocker use., (© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Background: The concept of the metaverse is a virtual world that immerses users, allowing them to interact with the digital environment. Due to metaverse's utility in collaborative and immersive simulation, it can be advantageous for medical education in high-stakes care settings such as emergency, critical, and acute care. Consequently, there has been a growth in educational metaverse use, which has yet to be characterized alongside other simulation modalities literature. This scoping review aims to provide a comprehensive overview of all research describing metaverse use in education for emergency, critical, and acute care., Methods: We used Arksey and O'Malley's framework with the Levac et al. modifications to conduct a scoping review by searching these five databases (MEDLINE, EMBASE, ERIC, Web of Science, and Education Source). The framework comprises six steps: (1) identifying the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting data; and (6) consultation with key informants. Relevant themes and trends were extracted and mapped for reporting., Results: The search yielded 8175 citations, which ultimately led to data extraction from 65 articles. Studies evaluated metaverse programs for the learning and assessment of both technical skills (management of code blue, sepsis, stroke, etc.) and nontechnical skills (e.g., interprofessional collaboration, communication, critical decision making). Barriers to metaverse implementation include technical challenges and difficulty evaluating educational effectiveness., Conclusions: The results of this scoping review highlight the current applications of metaverse as an educational tool, its identified strengths and weaknesses, and further comparison between metaverse and other educational modalities such as high-fidelity simulation. This work provides direction for future primary and secondary research that can aid educational programmers and curriculum planners in maximizing metaverse potential in emergency, critical, and acute medical education., Competing Interests: TMC reports salary from Toronto Metropolitan University for her role as Dean of the School of Medicine and Vice‐President Medical Affairs. She also receives travel funding from her work with the McMaster Education Research, Innovation, and Theory (MERIT) group and teaching stipends for her role of associate dean via the McMaster Faculty of Health Sciences Office of Continuing Professional Development. TMC also discloses that she has received various unrelated research grants, teaching honoraria, and speakership fees from academic institutions (Harvard Medical School, International Association of Medical Sciences Educators, Ontario College of Family Physicians), physician organizations (Association of American Medical Colleges, Canadian Association of Emergency Physicians, Society for Academic Emergency Medicine, the Royal College of Physicians and Surgeons of Canada, Medical Council of Canada), Tri‐Council funding sources (CIHR, SSHRC) and governmental sources (Government of Ontario, Virtual Learning Strategy eCampus Ontario program)., (© 2025 The Author(s). AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)