iPad Game Research Articles

Contextual Variables Associated with Challenging Behaviors in Adolescents with Fragile X Syndrome.

Our purpose was to report on a novel method of identifying variables associated with challenging behaviors in natural interactions between mothers and their adolescents with Fragile X syndrome (FXS). Videotaped interactions of 47 dyads interacting with an iPad game, completing a puzzle, and making a snack and were coded for challenging behaviors by adolescents with FXS, and maternal behaviors that preceded these behaviors. We described the frequencies of adolescent challenging behaviors, then used sequential and survival analyses to identify maternal and adolescent behaviors that preceded self-injurious behavior (SIB) and aggression. Across all the dyads, 109 instances of SIB and 79 instances of aggression were identified during the 30min of recorded interaction. Most of these challenging behaviors occurred during the iPad activity. The sequential analysis indicated that maternal requests for behavioral compliance frequently preceded both SIB and aggression. Survival analyses revealed that the likelihood of SIB or aggression was increased if the mothers requested behavioral compliance after the child engaged in another challenging behavior. Challenging behaviors including SIB and aggression were frequently observed in many participants. The sequential and survival analyses were useful for identifying precursors to these behaviors. Further research is needed to investigate preventative strategies based on the results of sequential and survival analyses.

Virtual Reality Video Game Improves Memory in Older Adults

The ability to remember detailed information is called high-fidelity long-term memory. We use high-fidelity long-term memory to remember the details of our favorite stories and how to track which family member a green pair of socks belongs to. As we age, the ability to remember these details declines as the health of the brain changes. We created a virtual reality video game called Labyrinth-VR, with the aim to restore memory. When playing Labyrinth-VR, participants practice figuring out where they want to go using the shortest route to get there. In Labyrinth-VR, participants learned a virtual neighborhood and then had to find their way around to run errands. In our study, 49 older adults played either 12 h of Labyrinth-VR or 12 h of iPad games. The results of tests of high-fidelity long-term memory showed that playing Labyrinth-VR, but not iPad games, led to improvements in participants’ scores.

Transactional relationships between maternal requesting and responsivity, adolescent compliance, and task demands in fragile X syndrome

BackgroundMales with fragile X syndrome (FXS) may have difficulty with social communication and language in addition to behavioral concerns such as noncompliance to maternal requests. Mothers vary in how they pose requests to their children, and contextual demands may also be a factor in compliance. This study examined the relationships between maternal requesting behaviors, maternal responsivity, child compliance, and task demands in adolescent males with FXS. Methods35 mother-son dyads completed three interactive tasks during in-home visits (puzzle, iPad games, snack). The adolescents also completed assessments of language and autism symptoms. The three interactive tasks were video-recorded, and behavior-by-behavior coding and transcription was completed. ResultsComparing between tasks, mothers requested a behavior most often during the snack task and used a higher proportion of indirect requests during the iPad task. Adolescents were largely compliant across tasks, with average compliance equal to 70%. Adolescent compliance was predicted by maternal request frequency such that mothers who used more requests had adolescent sons who were less compliant. Maternal responsivity was higher for mothers of adolescents with FXS-only compared to those with FXS and high autism symptoms. Conclusions and implicationsTask demands may have influenced maternal requesting, which in turn may have impacted adolescent compliance. Compliance with requests is important for both social and educational aspects of life, and further study of requesting and compliance in FXS is needed to identify effective teaching and behavioral intervention methods.

Utility of online cognitive test in cognitive neurology unit

AbstractBackgroundDelirium is one of the most common complications in hospitalized elders and corresponds with a higher risk of cognitive decline and death. Numerous test batteries exist to assist clinicians in detecting delirium, but it continues to be undiagnosed in up to 88% of patients, particularly those with AD where “confusion” is mistakenly attributed to impaired baseline (1). This pilot study investigated the utility of a digital cognitive assessment (D‐Cog), in the form of an iPad game, which would allow for rapid and routine baseline testing in patients with AD so that delirium‐induced changes can be easily detected.MethodWhile collecting traditional vital signs, medical assistants in the Beth Israel Deaconess Center (BIDMC) Cognitive Neurology Unit (CNU) prompted 67 willing patients to complete the D‐Cog assessment, an adaptive visuospatial span task, on an iPad. We then retrospectively reviewed the medical records of each patient to collect diagnosis, demographics, and pen‐and‐paper neuropsychological scores (e.g., MoCA or MMSE). Of the 67 patients (mean age 67, 29 female), 22 were clinically diagnosed with mild cognitive impairment (MCI) or varying severities of AD.ResultThe assessment was successfully completed by 52 participants. 15 participants, including 5 participants with moderate AD, experienced great difficulty during the task and were subsequently excluded. The 17 included participants with AD (mean age 75, 6 female) averaged a D‐Cog score of 4.1 and a MMSE score of 23.1. In comparison, a control group with no cognitive concerns (n = 16, mean age 60, 9 female) garnered a 6.7 average D‐Cog score and 29.3 MMSE score. The difference in D‐Cog scores was significantly different at p = 0.001.ConclusionThe D‐Cog assessment is feasible in clinical practice for patients with a wide range of cognitive impairments. These scores can act as an attentional baseline to compare against later testing in the event of suspected delirium. While the D‐Cog is derived from traditional pen‐and‐paper testing, its digital framework offers new opportunities for adaptive and remote testing.ReferenceFong TG, Davis D, Grodon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neruol. 2015; 14(8): 823–32

A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.

Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.

International Study of Movement Behaviors in the Early Years (SUNRISE): Results from SUNRISE Sweden's Pilot and COVID-19 Study.

The International Study of Movement Behaviors in the Early Years (SUNRISE) was initiated in response to the 2019 WHO guidelines for physical activity, sedentary behavior, and sleep in children aged 0–5 years. This Swedish pilot study aimed to: (i) assess the proportion of preschoolers meeting the guidelines, (ii) evaluate the feasibility of the methods for the SUNRISE study, and (iii) assess how movement behaviors have been affected in preschoolers during the COVID-19 pandemic. Physical activity and sleep (waist-worn ActiGraph); screen time and movement behaviors (parental questionnaire); motor skills (Ages and Stages Questionnaire); and executive functions (3 iPad games) were assessed in 100 Swedish preschoolers (n = 58 boys). There were 19.4% of preschoolers (n = 14) who met the WHO guidelines. The motor skill and executive function assessments were feasible; however, 20% refused to wear the ActiGraph overnight. Additionally, during the pandemic Swedish children’s physical activity, time spent outside on weekdays and weekend days, and screen time significantly increased (+53; +124; +68; +30min/day, respectively, all p-values ≤ 0.001). Methods for the SUNRISE study were feasible in a Swedish context; however, considerations to switch to a wrist-worn accelerometer should be made. Furthermore, children’s physical activity increased during the pandemic, which is likely due to how the rules/restrictions were implemented in Sweden.

A pilot randomized trial of contrast-rebalanced binocular treatment for deprivation amblyopia

Binocular neural architecture may be preserved in children with deprivation amblyopia dueto unilateral cataract. The purpose of this study was to investigate whether a contrast-rebalanced binocular treatment, recently used with success to treat the interocular suppression and amblyopia in strabismic and anisometropic children, can contribute to rehabilitation of visual acuity in children with deprivation amblyopia secondary to monocular cataract. In a pilot randomized trial, 15 children (4-13years of age) were enrolled and randomized to continue with their current treatment only (n=7) or to continue with their current treatment and add contrast-rebalanced binocular iPad game play 5hours/week for 4weeks (n=8). The primary outcome was change in visual acuity at 4weeks. Although 10 of 15 participants were patching, there was little change in visual acuity during the 3months prior to enrollment. At the 4-week primary outcome visit, the mean improvement in visual acuity for the binocular game group was significantly greater than that for the current-treatment group (0.08±0.10 logMAR vs -0.03±0.05 logMAR [t10.2=2.53, P=0.03]). None of the children who had dense congenital cataract achieved improved visual acuity with binocular treatment. In this study cohort, visual acuity improved over 8weeks in children with unilateral deprivation amblyopia who played a binocular contrast-rebalanced binocular iPad game.

Measurement of the Impact on the Usability of an iPad Game Developed with a Design Guide Built by Children

Aim/Purpose: This research is a comparative test between two Human Computer Interaction (HCI) design approaches - Apple versus one informed by child users. Background: There are studies concerning the creation of graphical interfaces for kids, however, they do not involve them in the design process. On the other hand, operating systems such as Apple or Android impose their graphic guidelines designed only for a general outlook. Methodology: The research has a scope of exploratory nature, with a mixed approach. For the measurement of usability, tests were developed to determine the degree of efficiency, effectiveness, and satisfaction generated in two versions of the same game. Children between six and eight years of age were targeted for this test. Contribution: This research compares two design guides to determine which one is better to develop games for children. Findings: This study concluded that the design guide elaborated by children allowed the building a more efficient, effective, and satisfactory game because the total usability percentage was 89.84%. This percentage was much higher than that obtained using the generic Apple guide, where the percentage of total usability obtained was 78.72%. Recommendations for Practitioners: Using design guides to develop games for children helps to increase the level of usability for them. Recommendation for Researchers: These design guides can be used for other devices that have different operating systems as guidelines to develop games for children. Impact on Society: The future generations of game developers that focus on games for children can take into account the following guidelines to create games that children will enjoy more. Future Research: Perform usability tests with users of different ages, for example children, adolescents, and adults. It is also suggested to take into account mobile devices with Android operating system.

A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years

To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone. Multicenter randomized clinical trial. One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment. Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n= 69) or continued spectacle correction alone if needed (n= 69). Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P= 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively. In children aged 7 to 12 years who have received previous treatment for amblyopia otherthan spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.

A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia

To compare visual acuity (VA) improvement in teenagers with amblyopia treated with a binocular iPad game vs part-time patching. One hundred participants aged 13 to <17 years (mean 14.3 years) with amblyopia (20/40 to 20/200, mean ∼20/63) resulting from strabismus, anisometropia, or both were enrolled into a randomized clinical trial. Participants were randomly assigned to treatment for 16weeks of either a binocular iPad game prescribed for 1 hour per day (n= 40) or patching of the fellow eye prescribed for 2 hours per day (n= 60). The main outcome measure was change in amblyopic eye VA from baseline to 16weeks. Mean amblyopic eye VA improved from baseline by 3.5 letters (2-sided 95% confidence interval [CI]: 1.3-5.7 letters) in the binocular group and by 6.5 letters (2-sided 95% CI: 4.4-8.5 letters) in the patching group. After adjusting for baseline VA, the difference between the binocular and patching groups was-2.7 letters (95% CI:-5.7 to 0.3 letters, P= .082) or 0.5 lines, favoring patching. In the binocular group, treatment adherence data from the iPad device indicated that only 13% of participants completed >75% of prescribed treatment. In teenagers aged 13 to <17 years, improvement in amblyopic eye VA with the binocular iPad game used in this study was not found to be better than patching, and was possibly worse. Nevertheless, it remains unclear whether the minimal treatment response to binocular treatment was owing to poor treatment adherence or lack of treatment effect.

Desirable difficulties during the development of active inquiry skills

This study explores developmental changes in the ability to ask informative questions, hypothesizing a link between the ability to update beliefs in light of evidence and the ability to ask informative questions. Five- to ten-year-old children played an iPad game asking them to identify a hidden insect. Learners could either ask about individual insects, or make a series of feature queries (e.g., “Does the hidden insect have antenna?”) that could more efficiently narrow the hypothesis space. Critically, the task display either helped children integrate evidence with the hypothesis space or required them to perform this operation themselves. Our prediction was that assisting children with belief updating would help them formulate more informative queries. This assistance improved some aspects of children’s active inquiry behavior; however, despite making some updating mistakes, children required to update their own beliefs asked questions that were more context-sensitive and thus informative. The results show how making a task more difficult can improve some aspects of children’s active inquiry skills, thus illustrating a type of “desirable difficulty” for reasoning.

PAtient Safety in Surgical EDucation (PASSED): A Pilot Study Using iPad Game to Teach Patient Safety in Undergraduate Medical Curriculum

PAtient Safety in Surgical EDucation (PASSED): A Pilot Study Using iPad Game to Teach Patient Safety in Undergraduate Medical Curriculum

People with dementia playing casual games on a tablet

Objective: Preserving clients’ quality of life (QoL) has become increasingly important in dementia care. Engagement in pleasant and meaningful activities may influence this QoL. We studied people with dementia’s experiences and views of independent tablet games in a practice-based study, conducted at two day-care centres and five small-scale living facilities for people with dementia in the city of Rotterdam. Method: The participants were 54 clients (24 men, 30 women; mean age 83 years) who participated in a total of 177 game-playing sessions. Ten existing iPad games and three new game prototypes were evaluated. Written informed consent was obtained from the clients or the clients’ representatives prior to the study. Data collection included epidemiological and game playing characteristics. Observers took note of the specific game(s) offered, the clients’ mood and engagement, and the duration of game playing. Immediately after each participant finished playing,a short 4-question interview was conducted to discover their opinion on the game. The participants’ answers were recorded verbatim. Qualitative content analysis was used to explore their experiences and views of the games. Results: This study revealed positive experiences related to people’s need for achievement, self-esteem, sense of connection and belonging, identity, having something to do, and admiration for the game. Negative experiences included failure (low self-esteem), annoyance and a sense of insecurity. Conclusions: This study shows there is potential for people with dementia to play casual games on a tablet as a pleasant and meaningful activity. It is important, however that there is a match between the game, the touchscreen skills of the person with dementia, and their ambitions or interests. It is challenging to find the right game for the right person. An interactive tool to support the choice of the game that is most suitable and a database of dementia-friendly tablet games may support the use of these games by people with dementia, in health care organisations as well as at home.

Novel binocular iPad game treatment for amblyopia

Novel binocular iPad game treatment for amblyopia

Mobile Gaming and Student Interactions in a Science Center: the Future of Gaming in Science Education

This article explores the impact of an augmented reality iPad-based mobile game, called The Great STEM Caper, on students’ interaction at a science center. An open-source, location-based game platform called ARIS (i.e. Augmented Reality and Interactive Storytelling) was used to create an iPad-based mobile game. The game used QR scan codes and a challenge-based game structure to encourage engagement in science. Participants wore head-mounted GoPro cameras to record interactions within the physical and social environment. The purpose of this research was to study the impact of a mobile game on student interactions in a science center. Gender differences in gameplay behaviors and perceptions were compared. The study included a quasi-experimental design with two groups: one group that played the iPad mobile game during their science center visit, and one group that explored the science center in a traditional free exploration manner. Video data from the GoPro cameras provided examination of the different ways students interacted with the science center. The female students outperformed the male students on every measure of the iPad game achievement. Lazzaro’s (2004) four types of fun was used to describe the gender differences in game perceptions and interactions. Females tended to enjoy hard fun and collaborative people fun, while males enjoyed easy fun and competitive people fun. The females tended to be more goal-oriented, persistent in the face of difficulty, and appreciative of hard fun. The results of this study have implications for the design of mobile-based gaming technology to encourage interaction in an informal science center setting.

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia. To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care. This investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment. Binocular game and patching as amblyopia treatments. The primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit. Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P < .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73). A binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia. clinicaltrials.gov Identifier: NCT02365090.

Effect of a Binocular iPad Game vs Part-time Patching in Children Aged 5 to 12 Years With Amblyopia

A binocular approach to treating anisometropic and strabismic amblyopia has recently been advocated. Initial studies have yielded promising results, suggesting that a larger randomized clinical trial is warranted. To compare visual acuity (VA) improvement in children with amblyopia treated with a binocular iPad game vs part-time patching. A multicenter, noninferiority randomized clinical trial was conducted in community and institutional practices from September 16, 2014, to August 28, 2015. Participants included 385 children aged 5 years to younger than 13 years with amblyopia (20/40 to 20/200, mean 20/63) resulting from strabismus, anisometropia, or both. Participants were randomly assigned to either 16 weeks of a binocular iPad game prescribed for 1 hour a day (190 participants; binocular group) or patching of the fellow eye prescribed for 2 hours a day (195 participants; patching group). Study follow-up visits were scheduled at 4, 8, 12, and 16 weeks. A modified intent-to-treat analysis was performed on participants who completed the 16-week trial. Binocular iPad game or patching of the fellow eye. Change in amblyopic-eye VA from baseline to 16 weeks. Of the 385 participants, 187 were female (48.6%); mean (SD) age was 8.5 (1.9) years. At 16 weeks, mean amblyopic-eye VA improved 1.05 lines (2-sided 95% CI, 0.85-1.24 lines) in the binocular group and 1.35 lines (2-sided 95% CI, 1.17-1.54 lines) in the patching group, with an adjusted treatment group difference of 0.31 lines favoring patching (upper limit of the 1-sided 95% CI, 0.53 lines). This upper limit exceeded the prespecified noninferiority limit of 0.5 lines. Only 39 of the 176 participants (22.2%) randomized to the binocular game and with log file data available performed more than 75% of the prescribed treatment (median, 46%; interquartile range, 20%-72%). In younger participants (aged 5 to <7 years) without prior amblyopia treatment, amblyopic-eye VA improved by a mean (SD) of 2.5 (1.5) lines in the binocular group and 2.8 (0.8) lines in the patching group. Adverse effects (including diplopia) were uncommon and of similar frequency between groups. In children aged 5 to younger than 13 years, amblyopic-eye VA improved with binocular game play and with patching, particularly in younger children (age 5 to <7 years) without prior amblyopia treatment. Although the primary noninferiority analysis was indeterminate, a post hoc analysis suggested that VA improvement with this particular binocular iPad treatment was not as good as with 2 hours of prescribed daily patching. http://www.clinicaltrials.gov Identifier: NCT02200211.

Innovative Patient Safety Curriculum Using iPAD Game (PASSED) Improved Patient Safety Concepts in Undergraduate Medical Students.

While healthcare outcomes have improved significantly, the complex management of diseases in the hospitals has also escalated the risks in patient safety. Therefore, in the process of training medical students to be proficient in medical knowledge and skills, the importance of patient safety cannot be neglected. A new innovation using mobile apps gaming system (PAtient Safety in Surgical EDucation-PASSED) to teach medical students on patient safety was created. Students were taught concepts of patient safety followed by a gaming session using iPad games created by us. This study aims to evaluate the outcome of patient safety perception using the PASSED games created. An interactive iPad game focusing on patient safety issues was created by the undergraduate education team in the Department of Surgery, Yong Loo Lin School of Medicine at the National University of Singapore. The game employed the unique touched-screen feature with clinical scenarios extracted from the hospital sentinel events. Some of the questions were time sensitive, with extra bonus marks awarded if the student provided the correct answer within 10s. Students could reattempt the questions if the initial answer was wrong. However, this entailed demerit points. Third-year medical students posted to the Department of Surgery experienced this gaming system in a cohort of 55-60 students. Baseline understanding of the students on patient safety was evaluated using Attitudes to Patient Safety Questionnaire III (APSQ-III) prior to the game. A 20min talk on concept of patient safety using the WHO Patient Safety Guidelines was conducted. Following this, students downloaded the apps from ITune store and played with the game for 20-30min. The session ended with the students completing the postintervention questionnaire. A total of 221 3rd year medical students responded to the survey during the PASSED session. Majority of the students felt that the PASSED game had trained them to understand the processes of medical error (p<0.001), that their understanding on patient safety issues improved (p=0.007), and the training prepared them to prevent medical errors (p<0.001). Many students also recognized the importance of error reporting, where they felt comfortable reporting errors committed by themselves (p<0.001) or by other people (p<0.001). They also felt comfortable discussing with the supervisor on medical errors (p<0.001). Students responded that better teamwork will reduce medical errors (p=0.003), and teaching teamwork skills will reduce medical errors (p=0.002). After the PASSED session, students felt that patients could play an important role in preventing medical errors (p<0.001). They felt that patient safety should be emphasized in undergraduate training (p=0.024). The level of understanding about concepts of patient safety was also found to improve progressively from the 2nd posting to the 5th posting for both the pre-PASSED and post-PASSED intervention. The pre-PASSED scores for Posting 2 (3.59±1.931), Posting 3 (4.11±1.833), Posting 4 (4.84±1.653), and Posting 5 (4.88±1.642) were significantly higher than the post-PASSED scores for Posting 2 (4.46±2.020), Posting 3 (5.17±1.845), Posting 4 (5.88±1.843), and Posting 5 (5.80±1.843), respectively (p<0.001). Using iPad game (PASSED) to enhance the patient safety teaching has successfully improved the awareness and understanding of patient safety in clinical practice. This training model can be used to teach more senior medical students on the complexity of patient safety issues in medicine.

Influences of short-term iPAD game on accommodative response and microfluctuation in adolescent myopia patients

Background Using tablet computer at a short distance is one of the risk factors resulting to pathogenesis and progression of myopia.Studying the effect of such device on accommodative system of human eyes can provide further insights into myopia control. Objective This study was to explore the influences of playing iPAD game for a short duration on accommodative response, accommodative microfluctuation and pupil diameter in adolescent myopia patients. Methods Sixty adolescent myopic patients were included in Peking University People's Hospital from August 2014 to April 2015, with the mean age (11.6±2.6) years and mean spherical equivalent refraction (SER) (-2.38±1.08)D.The patients were randomly divided into 3 groups according to different playing duration of iPAD game, including 3-minute group, 5-minute group and 10-minute group.An open-field infrared refractometer was used to record pupil diameter and accommodation-associated data before and after playing iPAD game.Accommodative response was defined as the difference between the recorded value and theoretical accommodative response, and root mean square (RMS) was used to describe the amplitude of accommodative microfluctuation.One-dimension discrete Fourier transformation was used to analyze spectral characteristic of accommodative response curve.Paired t tests were used to compare these accommodative parameters before and after playing game, while Wilcoxon signed-rank tests were applied for analyzing high frequency component of accommodative microfluctuation.This research conforms to the declaration of Helsinki, and was approved by Peking University People's Hospital Ethics Committee, all the subjects and their guardian signed informed consent. Results The accommodative response values before and after playing iPAD game in 10-minute group were (0.81±0.29)D and (0.74±0.27)D, respectively, with significant difference between them (t=2.263, P=0.036), and no significant differences were found in the accommodative response values before and after playing iPAD game in the 3-minute group and 5-minute group (both at P>0.05). The RMS after playing iPAD game was (0.31±0.08)D in the 10-minute group, which was significantly higher than (0.27±0.09)D before playing iPAD game (t=-2.259, P=0.036). The high-frequency spectral power of accommodative response curves in all the three groups were increased after playing iPAD game in comparison with before playing iPAD game, with significant differences in the 5-minute group and 10-minute group (Z=-2.213, -2.016; both at P<0.05), and the pupil diameters were significantly decreased after playing iPAD game in comparison with before playing iPAD game, with significant differences in the 5-minute group and 10-minute group (t=2.428, P=0.026; t=2.515, P=0.021). Conclusions Short-term exposure to iPAD does not deteriorate accommodative lag in adolescent myopic patients.However, the increase of amplitude and high-frequency spectral power of accommodative microfluctuation, together with accommodation lag will result in blurred images and may bring adverse effects on myopic eyes. Key words: Accommodation, ocular/physiology; Adolescent; Myopia/prevention & control; Refraction, ocular/physiology; Humans

Pilot Development of an Electronic Pediatric Inflammatory Bowel Disease Quiz Game.

Data suggest physicians poorly assess disease-specific literacy and transition readiness in pediatric patients with inflammatory bowel disease (IBD). We piloted an electronic, interactive iPad quiz game that could be used in a clinical setting, with the aims of measuring IBD-related knowledge, and concomitant mood and quality of life (QOL) in a pediatric population. Two pediatric IBD clinics developed and tested 2 versions of "Emma." Patients between 10 and 18 years of age played Emma during an office visit. Each patient answered 12 randomly selected disease-related questions and 4 mood-related questions. Sites 1 and 2 tested Emma v1 between May and August 2013. Emma v2 was tested from November 2013 to January 2014 and from September 2013 to January 2014. A total of 56 patients played Emma v1, whereas 60 played Emma v2. In Emma v2, 73.1% of questions were answered correctly. Patients recognized signs of IBD (88%), causes of diarrhea in addition to IBD (79.4%), and could define lactose intolerance (95.8%), but fewer patients understood serological testing used for disease monitoring (68%) or knew that magnetic resonance enterography did not involve radiation (22.9%). Patients tended to report good functioning in the areas of energy, mood, anxiety, and school-related QOL. Patients with Crohn disease, however, reported higher stress levels compared with patients with ulcerative colitis; older patients reported lower energy levels, and postsurgical patients reported lower QOL. The Emma iPad game has the potential to evaluate gaps in IBD knowledge, assess emotional functioning, and increase patient engagement as a transition tool in the clinical setting.