Educational Games in Geriatric Medicine Education: A Systematic Review

OBJECTIVE: To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. METHODS: We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) and excluded single arm studies. Population of interests included members (practitioners or students) of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. RESULTS: We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. CONCLUSION: The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly.Society of General Internal Medicin

Monitoring Slope Failure at Kadoorie Agricultural Research Centre with a 3D Laser Scanner

A loosely compacted fill slope with an angle of 33° was constructed at the Kadoorie Agricultural Research Centre of The University of Hong Kong. The height and width were 4.75 m and 9 m respectively. It was constructed by end-tipping method and resulted in a loose state with an initial dry density of 70% of the maximum dry density. Two rows of grouted nails were installed at a grid of 1.5 m x 1.5 m at an inclination of 20° from the horizontal. The slope was brought to failure by subjecting it to surcharge at the slope crest in combination with induced rise in groundwater table and precipitation. Heavy instrumentation comprised in-place inclinometer, vibrating wire piezometers, vibrating wire extensometer, earth pressure cell, tensiometer and strain gauges along soil nails and they had been monitored throughout the test. Surface movement was monitored using a GPS system and a 3D laser scanner. This paper focuses on the use of 3D laser scanner in capturing the formation of cracks and surface movement during the failure. It is found that by overlapping the point clouds generated from the scanner at different time intervals, the surface movement of the slope can be accurately recorded without the need of physically accessing the slope surface. When the slope reaches failure, the use of laser scanning can safely and quickly record the movement and dimension of washout and cracks, providing advantages over conventional survey method. This study shows that the movement obtained from the scanner agrees very well with that from conventional inclinometer reading at the surface. The travel distance of the surcharge block can be easily measured and point cloud can be easily modeled into geometrical shape for further rendering.published_or_final_versio

Assessing and presenting summaries of evidence in Cochrane Reviews

Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care. The goal of the Cochrane Applicability and Recommendation Methods Group (ARMG) is to develop approaches, strategies and guidance that facilitate the uptake of information from Cochrane Reviews and their use by a wide audience with specific focus on developers of recommendations and on healthcare decision makers. This paper is part of a series highlighting developments in systematic review methodology in the 20 years since the establishment of The Cochrane Collaboration, and its aim is to present current work and highlight future developments in assessing and presenting summaries of evidence, with special focus on Summary of Findings (SoF) tables and Plain Language Summaries. A SoF table provides a concise and transparent summary of the key findings of a review in a tabular format. Several studies have shown that SoF tables improve accessibility and understanding of Cochrane Reviews. The ARMG and GRADE Working Group are working on further development of the SoF tables, for example by evaluating the degree of acceptable flexibility beyond standard presentation of SoF tables, developing SoF tables for diagnostic test accuracy reviews and interactive SoF tables (iSoF). The plain language summary (PLS) is the other main building block for dissemination of review results to end-users. The PLS aims to summarize the results of a review in such a way that health care consumers can readily understand them. Current efforts include the development of a standardized language to describe statistical results, based on effect size and quality of supporting evidence. Producing high quality PLS and SoF tables and making them compatible and linked would make it easier to produce dissemination products targeting different audiences (for example, providers, health policy makers, guideline developers). Current issues of debate include optimal presentation formats of SoF tables, the training required to produce SoF tables, and the extent to which the authors of Cochrane Reviews should provide explicit guidance to target audiences of patients, clinicians and policy-makers

Reclamation Ground Settlement Monitoring by Using GPS and Other Positioning Technologies at ShenZhen Airport.

Hong Kong is a small territory of about 1070 km2 . There is an ever-increasing demand for land to cope with her increasing development. Typical geology in Hong Kong under the seabed comprises a layer of soft marine deposit of variable thickness of up to 20 m, overlying alluvium, residual soil, decomposed rock and bedrock. However, the marine deposit is too soft to support any structures. Conventional reclamation practice in Hong Kong is to dredge the marine deposit, build the seawalls and fill the enclosed space by sand. This conventional approach has many shortcomings. A research project was undertaken by The University of Hong Kong to develop a vacuum preloading technique that is environmentally safe to improve the engineering properties of the thick layer of soft marine deposits so that they can be kept in place during land reclamation. As a result, the environmental problems relating to dredging can be completely eliminated. A vacuum preloading test near the Shenzhen Airport was carried out as part of a very large research program. Sub-surface field instrumentation comprised piezometers, inclinometers, extensometers and pressure cells to monitor the performance of the vacuum system and the physical changes of the marine deposit during vacuum preloading. Surface settlement was monitored using 3 units of high precision GPS equipment throughout the test for checking against the sub-surface monitored movement. It is necessary to use a fully automatic system like GPS for replacing conventional survey because the test was carried out over water, which was difficult to access and the test was carried out over a very long period of 4 months. This paper reports the use of GPS for reclamation ground settlement monitoring and demonstrates cm-level positioning results through experimental trials. The results also agree very well with the sub-surface settlement readings.published_or_final_versio

An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability

<p>Abstract</p> <p>Background</p> <p>Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability.</p> <p>Methods</p> <p>We developed the Guide-O-Game^©in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game^©consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process.</p> <p>Results</p> <p>The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable.</p> <p>Conclusion</p> <p>We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.</p

Development and Testing of an Implantable Perfusion and Oxygenation Sensor for Liver Transplant Monitoring

Since the first successful liver transplant in 1968 the surgery has become very common and 6,291 patients received liver transplants in 2010 in the United States. However, the monitoring methods used post-surgery, in the recovery phase, are still very basic and rely mainly on blood tests and looking for unusual symptoms. Complications are usually detected after the organ is substantially damaged which poses a risk to the patients’ life. This dissertation presents the development and testing of an implantable sensor that can potentially be used to monitor the transplant continuously and transmit the information wirelessly to the medical staff for timely intervention. Such a sensor could have a great effect on survival and reduction of retransplantation rates. The presented sensor employs near infrared spectroscopy to measure perfusion changes, arterial oxygenation and venous oxygenation in the parenchyma of the liver tissue and the supplying vessels. Light at three different wavelengths (735-, 805- and 940-nm) is shined on the tissue and the diffuse reflectance is collected via a photodetector. The collected signals can be transmitted wirelessly to an external unit for processing and display. In this dissertation, different perfusion and oxygenation monitoring techniques are reviewed and the instrumentation of an NIRS based wireless sensor is introduced. A phantom that mimics the anatomy of the liver and its optical and mechanical properties is presented. The processing methods to extract the information of interest from the diffuse reflectance are described in details. Finally, results from in vitro phantom experiments, ex vivo perfused livers and in vivo porcine studies are presented. The first in vivo wireless monitoring of hepatic perfusion and oxygenation levels is reported. The studies show that the sensor can track perfusion changes with a resolution of 0.1 mL/min/g of tissue. The possibility of tracking oxygen saturation changes is also shown as well as the ability to separate them from perfusion changes. Combining results from the pulsatile wave and DC levels, venous and arterial oxygen saturation changes were tracked with a resolution of 1.39% and 2.19% respectively. In conclusion, optical spectroscopy is shown to track perfusion, and arterial and venous oxygenation in tissue. In particular, the method was tested on hepatic and intestinal tissue

Stakeholders' perceptions of rehabilitation services for individuals living with disability:A survey study

Background: The World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders' perceptions are an essential factor to take into account in the guideline development process. The aim of this study was to assess stakeholders' perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes.   Methods: We disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale.   Results: Two hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, 'Increasing access' and 'Optimizing utilization' were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. 'Fewer hospital admissions', 'Decreased burden of care' and 'Increasing longevity' were the services rated as least critical (57 %, 63 % and 58 % respectively). In terms of services, 'Community based rehabilitation' and 'Home based rehabilitation' were found to be both definitely feasible and acceptable (75 % and 74 % respectively). 'Integrated and decentralized rehabilitation services' was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for 'Task shifting', most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively).   Conclusion: The majority of stakeholder's perceived 'Increasing access' and 'Optimizing utilization' as most critical amongst rehabilitation outcomes. The feasibility of the 'Integrated and decentralized rehabilitation services' was perceived to be less than their acceptability. The majority of stakeholders found 'Task shifting' as neither feasible nor acceptable

Children and their parent&#039;s perceptions of overweight and obesity in Kuwait children

Background: The prevalence of overweight and obesity among children are a major public health concern internationally. Recognition of overweight and obesity status is an important step to prevent unhealthy weight. This study was designed to assess the prevalence and to explore the perceptions of children and their parents towards overweight and obesity in children. Methods: A cross-sectional study approach was utilized surveying 635 children aged 11 to 14 years (males and females) in 12 randomly selected public schools in Kuwait. Trained nurses performed measurements of children&#039;s height and weight to determine their Body Mass Index.Valid questionnaire were used to assess children and their parent perception of child&#039;s weight. Results: One quarter of the surveyed children 25.5% (N = 162) were overweight. Over one third of the participants 36.5% (N = 232) were classified as obese. The nurses&#039; measurements did not coincide with the children&#039;s perceptions but were better aligned with parents&#039; perceptions of overweight and obesity. Conclusion: The results indicated that there is high prevalence of overweight and obesity among Kuwaiti children. Furthermore, both the children and their parents underestimate the child weight status. Health education programs are highly recommended

Factors associated with female genital mutilation : A systematic review and synthesis of national, regional, and community-based studies.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgment We would like to acknowledge the assistance of Ms. Sandra Kahwaji and Ms. Jana Abu Ayash for their help in the title and abstract screening of articles. We thank Dr. Sawsan Abdulrahim for insightful comments and edits on preliminary drafts.Peer reviewedPublisher PD