BACKGROUND: Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users\' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results.
OBJECTIVE: This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use.
METHODS: We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient\'s walking time and distance and is connected to a virtual database that stores the collected data.
RESULTS: Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3% (SD 12.1%, range 41.7%-100%), and ambulation data were obtained for 60 (92.3%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app\'s usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10).
CONCLUSIONS: MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program.

BACKGROUND: Traditional surgical training and further education has historically involved long working hours and hands-on experience within the framework of a teacher-apprentice relationship; however, changes in regulatory policy in the USA and subsequently in Switzerland and the European Union from 2003, led to restrictions in the working hours of medical residents. As a result the traditional method of surgical training \"see one, do one, teach one\" has come under scrutiny, prompting a search for alternative training methods beyond the confines of the operating theater.
OBJECTIVE: This publication highlights the possibilities and limitations associated with the use of virtual reality (VR) and gamification in surgical training and further education. It examines the ability of these technological resources to enhance the effectiveness and engagement of medical residents and the feasibility of incorporating them into the surgical training curriculum.
METHODS: The study was based on a literature search for current developments in surgical training, VR and gamification. Furthermore, various studies and projects that investigated the use of VR and gamification in medical training and further education were analyzed.
CONCLUSIONS: In this investigation it could be shown that the use of VR reduces the perioperative risks and improves the training environment and learning. The use of gamification also increases the motivation and engagement of the medical residents. As a result the quality of medical education can be improved by the fusion of VR and gamification.
UNASSIGNED: HINTERGRUND: Die traditionelle chirurgische Aus- und Weiterbildung war durch lange Arbeitszeiten und eine praktische Ausbildung im Rahmen eines Lehrer-Lehrling-Verhältnisses gekennzeichnet. Gesetzesänderungen in den Vereinigten Staaten und der Europäischen Union führten ab 2003 zu einer Reduzierung der Arbeitszeiten für Assistenzärztinnen und Assistenzärzte. In der Folge wurde der konventionelle Ausbildungsansatz „see one, do one, teach one“ aus Zeitgründen infrage gestellt und nach alternativen Ausbildungsstrategien jenseits des Operationssaals gesucht.
UNASSIGNED: Die vorliegende Arbeit stellt Möglichkeiten und Grenzen des Einsatzes von Virtual Reality (VR) und Gamification in der chirurgischen Aus- und Weiterbildung dar. Im Fokus steht die Frage, inwiefern der Einsatz solcher Technologien die Effizienz und die Motivation von Assistenzärztinnen und Assistenzärzten steigert und inwiefern eine Integration in den chirurgischen Lehrplan möglich ist.
METHODS: Die Arbeit basiert auf einer Literaturrecherche zu aktuellen Entwicklungen in der chirurgischen Aus- und Weiterbildung sowie zu VR und Gamification. Darüber hinaus werden verschiedene Studien und Projekte analysiert, welche den Einsatz von VR und Gamification in der medizinischen Aus- und Weiterbildung untersuchen.
UNASSIGNED: Im Rahmen dieser Untersuchung konnte nachgewiesen werden, dass der Einsatz von VR perioperative Risiken reduziert und die Trainingsumgebung sowie das Lernen verbessert. Der Einsatz von Gamification steigert wiederum die Motivation und das Engagement der Assistenzärztinnen und Assistenzärzte. Folglich lässt sich die Qualität der medizinischen Aus- und Weiterbildung sowohl durch den Einsatz von VR als auch durch Gamification steigern.

Gamification is emerging as an active learning innovation in medical education to enhance student engagement and promote life-long learning in a unique and collaborative environment. Clinical enzymology in biochemistry is one of the core topics in the medical curriculum. However, students face challenges in comprehension and retention of information. Hence, CARd & Board GAmes in Medical Education (CARBGAME) was introduced and evaluated for its effectiveness in enhancing learning, application, and retention of knowledge in clinical enzymology via gamification context. This mixed-method study involved 150 first-year undergraduate medical students. Before the game, students completed a pre-test in clinical enzymology. Later they were divided into 25 small groups to compete in the board game designed for enzymology in biochemistry. The students took turns throwing the dice and answering the questions on the game board to continue moving forward. The first team to reach 100 and solve the case-based question was deemed the winner. Following the board game, the students took up the post-test to compare the educational impact of the innovation. Also, the subsequent internal assessment scores were compared with previous batch who were not implemented with this intervention. Then students evaluated the effectiveness of CARBGAME-Clinical Enzymology using a 32-item questionnaire on 5-point Likert scale. The feedback obtained on a 10-point rating scale and for qualitative analysis, students\' and faculty perceptions were recorded in small groups. CARBGAME received overwhelmingly positive feedback from both students and faculty. It was perceived well by students for being fun, relevant, consistent, motivating, collaborative, and promoting experiential learning. The game\'s low-stakes approach, effective feedback, and sense of accomplishment were highly appreciated, making it a valuable tool for education. A significant improvement in knowledge was recorded, from a mean score of 8.37 ± 1.126 on a 20-point scoring scale before the game to 16.53 ± 1.219 after with a p-value of 0.0001. The comparison of the internal assessment scores between the intervention and non-intervention group of students also showed a significant improvement among those implemented with CARBGAME (p < 0.0001). The CARBGAME innovation has achieved the intended outcome of promoting active learning and enhanced performance in clinical enzymology. Highly positive responses from faculty and students also indicate the exigent need to introduce innovative components like games into curricula to achieve student engagement and promote a meaningful learning experience.

BACKGROUND: Digital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts.
OBJECTIVE: This study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program.
METHODS: Data from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants\' characteristics were included in multilevel models to test the study objectives.
RESULTS: Participants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants\' initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect.
CONCLUSIONS: In real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants\' initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants.

暂无摘要。

BACKGROUND: Gamification and augmented reality (AR) are innovative teaching modalities. Research on the effects of combining these two strategies in nursing education is scarce.
OBJECTIVE: To examine the effect of the combined use of gamification and AR in teaching mechanical ventilation (MV) on nurse students\' knowledge, motivation, self-efficacy, and satisfaction.
METHODS: Randomized controlled trial.
METHODS: A conveniently selected faculty of nursing in Egypt.
METHODS: A total of 410 nurse students.
METHODS: Participants were randomly assigned to the intervention or control group (205 in each). Kahoot games and AR were used in the intervention group, whereas a traditional lecture was applied in the control group. The outcomes included levels of students\' knowledge, learning motivation, self-efficacy, and satisfaction.
RESULTS: Mixed design repeated-measures ANOVA test revealed a statistically significant difference in knowledge test scores within-subject over time (p-value [effect size]: <0.001 [0.515]), between-subject due to the main effect of interventions (<0.001 [0.146]), and within-between interaction effect of group and time (<0.001 [0.515]). After using Kahoot and AR, the total mean self-efficacy score was significantly higher in the intervention group than in the control group (<0.001 [0.662]). The total median motivation score was significantly higher for the Kahoot and the AR groups compared with the traditional lecture (<0.001 [0.558]).
CONCLUSIONS: Kahoot games and AR significantly increased nurse students\' knowledge, motivation, and self-efficacy compared with traditional MV learning classes. Nursing educators need to incorporate Kahoot and AR in their pedagogies to enhance nurse students\' satisfaction and development.

Surgical techniques in amputation medicine did not change for a long time, while prosthesis technology underwent rapid development. The focus shifted to optimising the residual limb for prostheses use. At the same time, digital technologies such as gamification, virtual and mixed reality revolutionised rehabilitation. The use of gamification elements increases motivation and adherence to therapy, while immersive technologies enable realistic and interactive therapy experiences. This is particularly useful in the context of controlling modern prostheses and treating phantom pain. In addition, digital applications contribute to optimised documentation of symptoms and therapy successes. Overall, these technologies open up new, effective and personalised therapeutic approaches that can significantly improve the quality of life of amputation patients.
UNASSIGNED: Die chirurgischen Techniken in der Amputationsmedizin unterlagen über einen langen Zeitraum keiner Veränderung, während die Prothesentechnik eine rasante Weiterentwicklung erfuhr. Der Fokus verlagerte sich auf die Optimierung des Amputationsstumpfes für Prothesen. Gleichzeitig führten digitale Technologien wie Gamification, Virtual und Mixed Reality zu einer Revolutionierung der Rehabilitation. Die Anwendung von Gamification-Elementen steigert die Motivation und Adhärenz hinsichtlich der Therapie, während immersive Technologien realistische und interaktive Therapieerfahrungen ermöglichen. Dies ist insbesondere im Kontext der Steuerung moderner Prothesen sowie der Behandlung von Phantomschmerzen von Nutzen. Darüber hinaus tragen digitale Anwendungen zu einer optimierten Dokumentation von Symptomen und Therapieerfolgen bei. Insgesamt eröffnen diese Technologien neue, effektive und personalisierte Therapieansätze, die die Lebensqualität von Amputationspatienten erheblich verbessern können.

The effectiveness of game-based learning strategies lies in the ability of these strategies to engage learners and enhance their motivation to learn. This is particularly important for today\'s younger generations, which are known to respond better to visual rather than textual information. Gamified education provides stimulating, realistic, and enjoyable learning experiences, helping students understand complex nursing knowledge and skills. The diversity of game-based learning tools, including based board games, escape room games, digital games, simulation games, mobile serious games, and virtual reality games, not only enhances students\' learning effectiveness and skills but also improves their problem-solving abilities, communication skills, and ability to cope with various challenges in clinical care. In general, game-based learning is a strategy with great potential and importance. This strategy not only has profound implications for modern nursing education and clinical practice but also, through its promotion of innovative thinking and diversified applications, can effectively promote the learning motivation of nursing professionals, improve teaching effectiveness, and enhance professional abilities and self-directed learning capabilities. In an era in which medical knowledge is constantly evolving, game-based learning should be promoted and utilized to cultivate nursing professionals\' capabilities effectively.
BACKGROUND: 悅趣化教學之多元化發展與臨床運用.
悅趣化學習是一個具有潛力和重要性的教學策略，對於現代護理教育和臨床實務具有深遠的影響，透過悅趣化教學的創新思維和多元化應用，可以促進學生的學習動機，提高教學效果，並有效培養護理人員的專業能力和自主學習能力。悅趣化學習策略的有效性在於其能夠吸引學習者並提升其學習動機，這對於現今偏好視覺性資訊的年輕世代尤其重要，悅趣化教學通過提供刺激性、真實性和樂趣性的學習體驗，有助於護理人員理解複雜的護理知識與技能。悅趣化教學具有多樣性，包括桌上型遊戲、密室逃脫遊戲、數位互動教學工具、模擬遊戲、行動嚴肅遊戲和虛擬實境遊戲等，這些工具不僅可以增強學生的學習成效和技能，還能夠提升其問題解決能力、溝通技巧，並幫助他們應對臨床照護中的各種挑戰。.

With the recent rapid changes in the medical environment and technology, traditional teaching methods are no longer sufficient to meet current professional needs. There is an increasing demand for emerging technologies in higher education, necessitating more interactive and personalized educational approaches. Hence, educators are exploring innovative teaching interventions, including digital simulations and gamified learning, to enhance motivation and engagement in learning. In this article, the concept and core elements of gamified learning are introduced and related methods applicable to nursing education such as digital simulations, virtual reality, tabletop games, and escape rooms are described. In addition, gamification teaching techniques that enhance student learning motivation as well as improve learning outcomes in theory and practice are discussed. Gamified learning enables nursing students to practice in rich and diverse interactive simulated environments. Using appropriate teaching strategies, the gamified approach to learning can strengthen critical thinking, problem-solving abilities, and communication confidence in students. Designing game mechanisms and methods that align with educational objectives and mastering the key principles of gamified teaching is an effective approach to diversifying and enhancing the effectiveness of learning activities in the classroom.
BACKGROUND: 遊戲化教學運用在護理教育.
隨著醫療環境與技術的迅速變遷，傳統教學模式已不足以滿足當前的專業需求，高等教育中對新興技術的需求日益增加，迫切需要更互動性和個性化的教育模式。是以教學上探索著包括數位模擬和遊戲化學習在內的創新教學介入方法，以提升學習動機和參與度。本文介紹遊戲化學習的概念和核心元素，列舉運用於護理教學包括數位模擬、虛擬實境、桌上遊戲以及密室逃脫等方式，以及遊戲化教學技巧，這些策略不僅增強學生的學習動機，也提升了理論與實務技能的學習效果。遊戲化學習使護理學生能在豐富且多元互動的模擬環境中練習，搭配合宜教學的策略安排，能夠強化學生的批判性思考、問題解決能力和溝通的信心。設計能符合教學目標的遊戲機制與方法，掌握遊戲化教學的關鍵原則，讓教室裡的學習活動多樣貌與具效益。.

OBJECTIVE: The use of electromyogram (EMG) signals recorded from the wrist is emerging as a desirable input modality for human-machine interaction (HMI). Although forearm-based EMG has been used for decades in prosthetics, there has been comparatively little prior work evaluating the performance of wrist-based control, especially in online, user-in-the-loop studies. Furthermore, despite different motivating use cases for wrist-based control, research has mostly adopted legacy prosthesis control evaluation frameworks.
METHODS: Gaining inspiration from rhythm games and the Schmidt\'s law speed-accuracy tradeoff, this work proposes a new temporally constrained evaluation environment with a linearly increasing difficulty to compare the online usability of wrist and forearm EMG. Compared to the more commonly used Fitts\' Law-style testing, the proposed environment may offer different insights for emerging use cases of EMG as it decouples the machine learning algorithm\'s performance from proportional control, is easily generalizable to different gesture sets, and enables the extraction of a wide set of usability metrics that describe a users ability to successfully accomplish a task at a certain time with different levels of induced stress.
RESULTS: The results suggest that wrist EMG-based control is comparable to that of forearm EMG when using traditional prosthesis control gestures and can even be better when using fine finger gestures. Additionally, the results suggest that as the difficulty of the environment increased, the online metrics and their correlation to the offline metrics decreased, highlighting the importance of evaluating myoelectric control in real-time evaluations over a range of difficulties.
CONCLUSIONS: This work provides valuable insights into the future design and evaluation of myoelectric control systems for emerging HMI applications.