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 Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn.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.

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: The use of digital education in problem-based learning, i.e. digital problem-based (DPBL) learning is increasingly employed in healthcare professions’ education. DPBL includes purely digitally delivered as well as blended problem-based learning, in which digital and face-to-face learning are combined. Objective: The aim of this review is to evaluate the effectiveness of digital problem-based learning (DPBL) in improving healthcare professionals (HCPs)' knowledge, skills, attitudes and satisfaction. Methods: We used gold standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). Results: Nine RCTs involving 890 pre-registration HCPs were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was fully delivered online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysis of seven studies comparing digital PBL to traditional PBL reported little or no difference in post-intervention knowledge outcomes (SMD = 0.19, 95% CI: 0.00-0.38). The pooled analysis of three studies comparing DPBL to traditional learning favored of DPBL (SMD = 0.67, 95% CI: 0.14-1.19). For skills, the pooled analysis of two studies comparing DPBL to traditional learning favored DPBL (SMD = 0.30, 95% CI: 0.07-0.54). Findings on attitudes and satisfaction outcomes were mixed. Conclusions: Our findings suggest that DPBL is as effective as traditional PBL and more effective than traditional learning in improving knowledge. DPBL may be more effective than traditional learning in improving skills. Further studies should evaluate the use of digital technology for delivery of other PBL components as well as PBL overall.

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: In the past five decades, digital education has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, the sharing of information and knowledge with other learners; and aiding support from peers and instructors regardless of geographic distance. Objective: This review synthesises findings from qualitative or mixed methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education. Methods: A systematic search was conducted across a range of databases. Studies were selected on the basis that they were examining mLearning in medical and nursing education, employed a mixed methods or qualitative approach, and were published in English after 1995. Findings were synthesised using a framework approach. Results: A total of 1946 citations were screened, resulting in 47 studies being selected for inclusion. Most studies evaluated pilot mLearning interventions. Synthesis identified views on: valued aspects of mobile devices in terms of efficiency and personalisation, but concerns over vigilance and poor device functionality; emphasis on the social aspects of technology, especially in a clinical setting; the value of interaction learning for clinical practice; mobile learning as a process, including learning how to use a device; and the importance of institutional infrastructure and policies. Conclusions: The portability of mobile devices can enable interactions between learners and educational material, fellow learners and educators in the health professions. However, devices need to be incorporated institutionally and learners and educators need additional support to fully comprehend device or app functions. The strategic support of mLearning is likely to require both procedural guidance for practice settings, and device training and maintenance services on campus.

Our aims were to evaluate critically the evidence from systematic reviews as well as narrative reviews of the effects of melatonin (MLT) on health and to identify the potential mechanisms of action involved. An umbrella review of the evidence across systematic reviews and narrative reviews of endogenous and exogenous (supplementation) MLT was undertaken. The Oxman checklist for assessing the methodological quality of the included systematic reviews was utilised. The following databases were searched: MEDLINE, EMBASE, Web of Science, CENTRAL, PsycINFO and CINAHL. In addition, reference lists were screened. We included reviews of the effects of MLT on any type of health-related outcome measure. Altogether, 195 reviews met the inclusion criteria. Most were of low methodological quality (mean -4.5, standard deviation 6.7). Of those, 164 did not pool the data and were synthesised narratively (qualitatively) whereas the remaining 31 used meta-analytic techniques and were synthesised quantitatively. Seven meta-analyses were significant with P values less than 0.001 under the random-effects model. These pertained to sleep latency, pre-operative anxiety, prevention of agitation and risk of breast cancer. There is an abundance of reviews evaluating the effects of exogenous and endogenous MLT on health. In general, MLT has been shown to be associated with a wide variety of health outcomes in clinically and methodologically heterogeneous populations. Many reviews stressed the need for more high-quality randomised clinical trials to reduce the existing uncertainties.