JMIR Serious Games最新文献

Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios.

Objective: This study aimed to compare an MR-based tele-supervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors.

Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the tele-supervision group (TG; n = 20) or direct supervision group (DG; n = 20). Participants received a 15-min video lecture, conducted ultrasound on a phantom, and had 18 images scored by two blinded experts. Additionally, the TG received five minutes of training on basic operation of a head-mounted display (HMD). Communication between doctors in the TG and supervisors was facilitated through an HMD, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using NASA-Task load index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and post-surveys.

Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 ± 10.3 vs DG: 66.8 ± 10.4, P = .844; TG: 23.8 ± 8.0 min vs DG: 24.0 ± 8.1 min, P = .946). However, the TG engaged in more educational interventions (TG: 4.0 ± 2.5 vs DG: 0.8 ± 1.1, P <.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 ± 24.8 vs 60.6 ± 22.4, P = .03), effort (43.1 ± 22.9 vs 67.9 ± 17, P < .001), and frustration (26.9 ± 20.3 vs 45.2 ± 27.8, P = .022), indicating a reduced cognitive load compared the DG. The mean SUS score was also higher in the TG (66.6 ± 9.1 vs 60.2 ± 10.4, P =.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (Pre-education ━ TG: 1.6 ± 0.9 vs DG: 1.7 ± 0.9, P =.728; Post-education ━ TG: 3.8 ± 0.9 vs DG: 2.8 ± 1.0, P =.006).

Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform's potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning.

Clinicaltrial: ClinicalTrials.gov, NCT06171828.

Background: Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change.

Objective: This pilot study aims to (1) compare the social game-based program Storm-Heroes to a nonsocial program regarding adolescents' personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use.

Methods: In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45/74, 61% retained). Repeated measures mixed effects models were conducted.

Results: A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=-0.37; P<.001) were related to higher tobacco knowledge.

Conclusions: The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program's goals of improving participants' awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents' initiation of tobacco use.

Trial registration: ClinicalTrials.gov NCT02703597; https://clinicaltrials.gov/study/NCT02703597.

Background: Many studies have shown a direct relationship between physical activity and health. It has also been shown that the average fitness level in Western societies is lower than recommended by the World Health Organization. One tool that can be used to increase physical activity for individual people is exergaming, that is, serious games that motivate players to do physical exercises.

Objective: This scoping review of recent studies regarding exergame efficacy aims to evaluate which sensing modalities are used to assess exergame efficacy as well as motion quality. We also analyze how the collected motion sensing data is being leveraged with respect to exergame efficacy and motion quality assessment.

Methods: We conducted 2 extensive and systematic searches of the ACM Digital Library and the PubMed database, as well as a single search of the IEEE Xplore database, all according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Overall, 343 studies were assessed for eligibility by the following criteria: The study should be peer-reviewed; the year of publication should be between 2015 and 2023; the study should be available in English or German; the study evaluates the efficacy of at least 1 exergame; sensor data is recorded during the study and is used for evaluation; and the study is sufficiently described to extract information on the exergames, sensors, metrics, and results.

Results: We found 67 eligible studies, which we analyzed with regard to sensor usage for both efficacy evaluation and motion analysis. Overall, heart rate (HR) was the most commonly used vital sign to evaluate efficacy (n=52), while the Microsoft Kinect was the most commonly used exergame sensor (n=26). The results of the analysis show that the sensors used in the exergames and the sensors used in the evaluation are, in most cases, mutually exclusive, with motion quality rarely being considered as a metric.

Conclusions: The lack of motion quality assessment is identified as a problem both for the studies and the exergames themselves since incorrectly executed motions can reduce an exergame's effectiveness and increase the risk of injury. Here we propose how to use the same sensors both as input for the exergame and to assess motion quality by presenting recent developments in motion recognition and sensing.

Background: Effective interprofessional teamwork is vital for ensuring high-quality patient care, especially in emergency medicine. However, interprofessional education often fails to facilitate meaningful interaction among health care disciplines. It is therefore imperative to afford early opportunities for cultivating interprofessional teamwork skills. While in-person simulation-based training has been shown to improve performance, this is resource-intensive, especially if it involves multiple professions. Virtual reality (VR)-based training is an innovative instructional approach that demands fewer resources and offers the flexibility of location-independent learning.

Objective: This study aimed to develop and evaluate the acceptance, learning outcome, and feasibility of an interprofessional team (INTEAM) training course that included a VR simulation of a neurological emergency case.

Methods: This 1-group study used a pre- and posttest design to evaluate the 2-hour INTEAM training course for nursing and medical students. The course included an e-learning part, VR simulation, and debriefing. The main learning objectives were derived from the entrustable professional activity 6, namely to handle a common problem in emergency medicine (headache due to subarachnoid hemorrhage and epileptic seizure) that requires interprofessional collaboration, including a structured handover. We used validated and self-constructed questionnaires, pre- and posttests, and open questions to assess the acceptance, learning outcome, and feasibility of the course.

Results: The data of 42 students (21 nursing and 21 medical students) were analyzed and showed good usability in the System Usability Scale (median 72.5, IQR 65-80). The perception of usefulness (median 6, IQR 5.8-6.9) and ease of use (median 5.9, IQR 5.1-6.3) was good among all students. There was a significant increase in the handover performance from pre- (median 8, IQR 6-9) to posttraining (median 8, IQR 7-9; z=-2.01; P=.045; r=0.33) and of the confidence in caring for patients with seizures (median 3, IQR 2-3 and median 3.5, IQR 3-4, respectively; z=-3.8; P<.001; r=0.60). In 67% (14/21) of the simulations, technical issues occurred, but all simulations could be carried out completely.

Conclusions: The new INTEAM training course was well received by nursing and medical students. The handover skills and confidence in caring for patients with seizures were improved after the course. Despite technical challenges with the VR simulations, none required termination, and this demonstrates that our approach is feasible. These promising results encourage the use of VR simulations for team training in the education of nursing and medical students.

Background: Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation.

Objective: This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training.

Methods: A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention.

Results: The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F_2,85=76.77; P<.001) and on parent-rated self-control (F_2,85=18.77; P<.001), initiative (F_2,85=11.93; P<.001), and emotional control (F_2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05).

Conclusions: The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits.

Trial registration: ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526.

International registered report identifier (irrid): RR2-10.2196/48208.

Background: This study explores gamification in the design of virtual patients (VPs) to enhance the training of Swedish military medics in trauma care. The challenges related to prehospital trauma care faced on the battlefield require tailored educational tools that support military medics' education and training.

Objective: The aim of the study is to investigate how to design VPs with game elements for Swedish military medics to support learning in military trauma care. By understanding the reasoning and perceptions of military medics when interacting with VPs, this study aims to provide insights and recommendations for designing VPs with game elements that are specifically tailored to their needs.

Methods: The study involved 14 Swedish military medics of the Home Guard-National Security Forces participating in a tactical combat care course. Participants interacted with 3 different VP cases designed to simulate military trauma scenarios. Data were collected through think-aloud sessions and semistructured interviews. The data were analyzed using interaction analysis, structured by the unawareness, problem identification, explanation, and alternative strategies or solutions (uPEA) framework, and reflexive thematic analysis to explore participants' reasoning processes and perceptions and identify possible game elements to inform the VP design.

Results: Mapping the military medics' reasoning to the uPEA framework revealed that study participants became more creative after making a mistake followed by feedback and after receiving a prompt to make a new decision. The thematic analysis revealed 6 themes: motivation, "keep on trying"; agency in interaction with VPs; realistic tactical experience; confidence, "I know that the knowledge I have works"; social influence on motivation; and personalized learning. Participants suggested that game elements such as scoring; badges; virtual goods; progress bars; performance tables; content unlocking; hints; challenge; control; imposed choice; narrative; avatars; sensation; randomness; difficulty adapting; competition; leaderboards; social pressure; progression; and renovation can promote engagement, motivation, and support confidence in decision-making.

Conclusions: Gamification in the design of VPs represents a promising approach to military medical training, offering a platform for medics to practice medical and tactical decision-making in a risk-free environment. The insights gained by the study may encourage designing VPs with game elements, as well as including possibly wrong decisions, their consequences, and relevant feedback, that may support military medics' reflections and decision-making.