What is the impact of Apps in medical education? A study of CAPSULE, a case-based learning App

Introduction - Mobile applications (Apps) are popular in medical education; yet, the actual benefits for students are yet to be formally researched. Clinical And Professional Studies Unique Learning Environment (CAPSULE) is an App created by Brighton and Sussex Medical School. The App provides 650 cases offered to students in their final two years of the undergraduate programme. The App performed consistently well in student feedback, and therefore, a study into the educational benefits of the App was constructed. Methods - A cross-sectional study was performed following two years of use by students to investigate the relationship between App usage and decile ranking. Results - The study found that the students who completed more cases tended to score higher per case (p value=0.0037). The study also found a trend between having higher case scores and being part of a stronger decile (p value=0.019). Conclusions - Greater App usage was linked with performing better in the App itself and this was further associated with being in a stronger decile rank. From a user perspective, the data generated from the App could help with identifying students who are underperforming or help students to recognise areas on which they need to focus

Online versus in-person comparison of Microscale Audit of Pedestrian Streetscapes (MAPS) assessments: reliability of alternate methods

Abstract Background An online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions. Methods In-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation. Results Online and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [−0.12, 0.24] to 0.27, 95% CI [0.10, 0.43]. Conclusions Results support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial

Abstract Background About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a “stretch and tone” control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health. Methods Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable. Results Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control). Conclusions This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial. Trial registration ClinicalTrials.gov. NCT02925481 . Registered 10–04-16.http://deepblue.lib.umich.edu/bitstream/2027.42/173441/1/12906_2020_Article_2926.pd

Patterns of walkability, transit, and recreation environment for physical activity

Introduction: Diverse combinations of built environment (BE) features for physical activity (PA) are understudied. This study explored whether patterns of GIS-derived BE features explained objective and self-reported PA, sedentary behavior, and BMI. Methods: Neighborhood Quality of Life Study participants (N=2,199, aged 20–65 years, 48.2% female, 26% ethnic minority) were sampled in 2001–2005 from Seattle / King County WA and Baltimore MD / Washington DC regions. Their addresses were geocoded to compute net residential density, land use mix, retail floor area ratio, intersection density, public transit, and public park and private recreation facility densities using a 1-km network buffer. Latent profile analyses (LPAs) were estimated from these variables. Multilevel regression models compared profiles on accelerometer-measured moderate to vigorous PA (MVPA) and self-reported PA, adjusting for covariates and clustering. Analyses were conducted in 2013–2014. Results: Seattle region LPAs yielded four profiles, including low walkability/transit/recreation (L-L-L); mean walkability/transit/recreation (M-M-M); moderately high walkability/transit/recreation (MH-MH-MH); and high walkability/transit/recreation (H-HH). All measures were higher in the HHH than the LLL profile (difference of 17.1 minutes/day for MVPA, 146.5 minutes/week for walking for transportation, 58.2 minutes/week for leisure-time PA, and 2.2 BMI points; all p < 0.05). Baltimore region LPAs yielded four profiles, including L-L-L; M-M-M; high land use mix, transit, and recreation (HLU-HT-HRA); and high intersection density, high retail floor area ratio (HID-HRFAR). HLU-HT-HRA and L-L-L differed by 12.3 MVPA minutes/day; HID-HRFAR and L-L-L differed by 157.4 minutes/week for walking for transportation (all p < 0.05). Conclusions: Patterns of environmental features explain greater differences in adults’ PA than the four-component walkability index

Smartphone-based meditation for myeloproliferative neoplasm patients: Feasibility study to inform future trials

© 2020 JMIR Publications. Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P\u3c.001 d=-0.43), depression (P=.02; d=-0.38), sleep disturbance (P=.01; d=-0.40), total symptom burden (P=.13; d=-0.27), and fatigue (P=.06; d=-0.30), and moderate effects on physical health (P\u3c.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=-0.22), depression (P=.09; d=-0.29), sleep disturbance (P=.002; d=-0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=-0.27), and fatigue (P=.13; d=-0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P\u3c.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs

Patterns of neighborhood environment attributes in relation to children's physical activity

Characterizing neighborhood environments in relation to physical activity is complex. Latent profiles of parents’ perceptions of neighborhood characteristics were examined in relation to accelerometer-measured moderate-to-vigorous physical activity (MVPA) among 678 children (ages 6–12) in two US regions. Neighborhood environment profiles derived from walkability, transit access, aesthetics, crime and traffic safety, pedestrian infrastructure, and recreation/park access were created for each region. The San Diego County profile lowest on walkability and recreation/park access was associated with an average of 13 fewer min/day of children's out-of-school MVPA compared to profiles higher on walkability and recreation/park access. Seattle/King County profiles did not differ on children's MVPA. Neighborhood environment profiles were associated with children's MVPA in one region, but results were inconsistent across regions