Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Virtual Reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional (3D) multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of virtual reality (VR) for educating health professions and improving their knowledge, cognitive skills, attitudes and satisfaction. Methods: We performed a systematic review of the effectiveness of virtual reality in pre- and post-registration health professions education following the gold standard Cochrane methodology. We searched seven databases from the year 1990 up to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data and assessed risk of bias, then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. We used the GRADE approach to rate the quality of the body of evidence. Results: Thirty-one studies (N = 2407) were included. Meta-analysis of eight trials found that VR slightly improves post-intervention knowledge scores when compared with traditional learning (SMD = 0.44, 95% CI: 0.18, 0.69, I2 = 49%, N = 603) or to other types of digital education such as online or digital education (SMD = 0.43, 95% CI: 0.07, 0.79, I2 = 78%, N = 608, low certainty evidence). Another meta-analysis of four trials found that VR improves health professions cognitive skills when compared with traditional learning (SMD = 1.12, 95% CI: 0.81, 1.43, I2 = 0%, N = 235). Two studies compared VR to other forms of digital education on skills, favoring the VR group (SMD = 0.50, 95% CI: 0.32, 0.69, I2 = 0%, N = 467, moderate effect size, low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. No studies reported patient-related outcomes, behavior change or unintended/adverse effects of the VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of the evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that virtual reality improves post-intervention knowledge and skills outcomes of health professions when compared to traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate more on the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness and clinical practice or behavior change.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: There is a worldwide shortage of health workers, requiring innovative education solutions. Serious gaming and gamification education has the potential to provide a quality, cost-effective, novel approach, which is flexible, portable, enjoyable, and allows interaction with tutors and peers. Objective: The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education , or other serious gaming/gamification interventions, in terms of patient outcomes, knowledge, skills, professional attitudes and satisfaction (primary outcomes) and education economics outcomes and adverse events (secondary outcomes). Methods: A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO and CINAHL from 1990 to August 2017 was conducted. Randomized controlled trials (RCTs) and cluster RCTs (cRCTs) were eligible for inclusion. Two reviewers independently searched, screened, assessed study quality and extracted data. Meta-analysis was not deemed appropriate due to heterogeneity of populations, interventions, comparisons and outcomes and a narrative synthesis is presented. Results: Twenty-seven RCTs and 3 cRCTs with 3634 participants were included. One study reported a small statistically significant difference between serious gaming and digital education for primary care physicians in time to blood pressure control among a subgroup of their patients already taking antihypertensive medications. There was evidence of moderate to large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of small to large magnitude of effect from ten studies for improved skills compared with traditional learning. Two and four studies respectively suggested equivalence between interventions and controls. Evidence suggested serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence measuring effects on professional attitudes. Serious gaming/gamification may improve satisfaction but evidence was again limited. Evidence was low or very low quality for all outcomes. Quality of evidence was downgraded due to imprecision, inconsistency and study limitations. Conclusions: Serious gaming/gamification appears to be at least as effective as controls, and in many studies more effective, for improving knowledge, skills and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory driven research.

Background: Cybersecurity is increasingly becoming a prominent concern among healthcare providers in adopting digital technologies for improving the quality of care delivered to patients. The recent reports on cyber attacks, such as ransomware and WannaCry, have brought to life the destructive nature of such attacks upon healthcare. In complement to cyberattacks, which have been targeted against the vulnerabilities of information technology (IT) infrastructures, a new form of cyber attack aims to exploit human vulnerabilities; such attacks are categorised as social engineering attacks. Following an increase in the frequency and ingenuity of attacks launched against hospitals and clinical environments with the intention of causing service disruption, there is a strong need to study the level of awareness programmes and training activities offered to the staff by healthcare organisations. Objective: The objective of this systematic review is to identify commonly encountered factors that cybersecurity postures of a healthcare organisation, resulting from the ignorance of cyber threat to healthcare. The systematic review aims to consolidate the current literature being reported upon human behaviour resulting in security gaps that mitigate the cyber defence strategy adopted by healthcare organisations. Additionally, the paper also reviews the organisational risk assessment methodology implemented and the policies being adopted to strengthen cybersecurity. Methods: The topic of cybersecurity within healthcare and the clinical environment has attracted the interest of several researchers, resulting in a broad range of literature. The inclusion criteria for the articles in the review stem from the scope of the five research questions identified. To this end, we conducted seven search queries across three repositories, namely (i) PubMed^®/MED-LINE; (ii) Cumulative Index to Nursing and Allied Health Literature (CINAHL); and (iii) Web of Science (WoS), using key words related to cybersecurity awareness, training, organisation risk assessment methodologies, policies and recommendations adopted as counter measures within health care. These were restricted to around the last 12 years. Results: A total of 70 articles were selected to be included in the review, which addresses the complexity of cybersecurity measures adopted within the healthcare and clinical environments. The articles included in the review highlight the evolving nature of cybersecurity threats stemming from exploiting IT infrastructures to more advanced attacks launched with the intent of exploiting human vulnerability. A steady increase in the literature on the threat of phishing attacks evidences the growing threat of social engineering attacks. As a countermeasure, through the review, we identified articles that provide methodologies resulting from case studies to promote cybersecurity awareness among stakeholders. The articles included highlight the need to adopt cyber hygiene practices among healthcare professionals while accessing social media platforms, which forms an ideal test bed for the attackers to gain insight into the life of healthcare professionals. Additionally, the review also includes articles that present strategies adopted by healthcare organisations in countering the impact of social engineering attacks. The evaluation of the cybersecurity risk assessment of an organisation is another key area of study reported in the literature that recommends the organisation of European and international standards in countering social engineering attacks. Lastly, the review includes articles reporting on national case studies with an overview of the economic and societal impact of service disruptions encountered due to cyberattacks. Discussion: One of the limitations of the review is the subjective ranking of the authors associated to the relevance of literature to each of the research questions identified. We also acknowledge the limited amount of literature that focuses on human factors of cybersecurity in health care in general; therefore, the search queries were formulated using well-established cybersecurity related topics categorised according to the threats, risk assessment and organisational strategies reported in the literature.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of healthcare professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions’ education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy–making, we need to determine the effectiveness of mLearning. Objective: The primary objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre-registration and post-registration health professions’ education Methods: We performed a systematic review of the effectiveness of mLearning in health professions’ education using standard Cochrane methodology. We searched seven major bibliographic databases from January 1990 to August 2017, and included randomized controlled trials (RCTs) or cluster RCTs. Results: Twenty–nine studies, including 3175 learners, met the inclusion criteria. Twenty-five studies were RCTs and four were cluster RCTs. Interventions consisted of tablet/smartphone applications, personal digital assistants (PDA), basic mobile phones, iPods and mp3 player devices to deliver learning content. Twenty studies assessed knowledge (N=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (SMD = 0.43, 95% CI: 0.05, 0.80, N=11 studies, low quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD = 0.20, 95% CI: -0.47, 0.86, N=6 studies, low quality evidence). Fourteen studies assessed skills (N=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD = 1.12, 95% CI: 0.56, 1.69, N=5 studies, moderate quality evidence) and blended learning (SMD = 1.06, 95% CI: 0.09, 2.03, N=7 studies, low quality evidence) over traditional learning for skills. Five and four studies, assessed attitudes (N=440) and satisfaction (N=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as “high” in 16 studies. Conclusions: The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Whilst acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professionals’ education using mobile devices in order to help tackle the global shortage of healthcare workers.

Background: Effective prevention at a young enough age is critical to halt the obesity epidemic. Mobile health (mHealth) apps would potentially reach large numbers at low-cost. While there is already a profusion of lifestyle apps, they are mostly non-evidence-based and evidently ineffective against rising obesity prevalence. Objective: The aim of this study was to explore preferences and usage of lifestyle apps among young people in 6 countries. Methods: A mixed methods study was conducted among young people aged 13 to 24 years residing in the United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand. Participants were recruited from Web advertisements on Facebook, asking for volunteers interested in mobile apps in general, not specific to lifestyle or health, to complete a short survey comprising 18 questions on demographics, weight gain, and mobile app preferences and then to join English-language online focus groups, which were held during 2017, in password-protected Web rooms, moderated by an experienced researcher. Descriptive statistics were carried out for the survey, and thematic analysis was applied to transcripts. Results: A total of 2285 young people (610 adolescents aged 13-17 years and 1675 young adults aged 18-24 years) responded and completed the survey, with 72.0% (1645) reported being concerned about weight gain for themselves or friends. Later, 807 young people (376 adolescents and 431 young adults) were selected based on age and country to participate in 12 online focus groups, with 719 young people completing. Analysis revealed 4 main themes: (1) feelings toward personal weight; (2) perception of lifestyle apps and desired content for weight gain prevention; (3) social media apps, lifestyle apps, and motivation for downloading and retaining; and (4) data safety and data usage and confidentiality. Young people are interested in evidence-based advice in programs incorporating their preferences. Conclusions: Young people are commonly, and consistently across 6 countries, concerned about weight gain and obesity and would welcome evidence-based mHealth programs, provided the views of young people themselves are incorporated in the program content.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre‐registration and post‐registration healthcare professional education. We will primarily assess the impact of these interventions on students’ knowledge, skills, professional attitudes and satisfaction.