The Effects of Serious Games on Cardiopulmonary Resuscitation Training and Education: Systematic Review With Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Serious games have emerged as an innovative educational strategy with the potential to significantly enhance the quality and effectiveness of cardiopulmonary resuscitation (CPR) training. Despite their promise, there remains a degree of controversy when comparing the advantages of serious games with traditional CPR training methods. This study seeks to provide a comprehensive assessment of the impact of serious games on CPR training and education by systematically analyzing the results of previous research. OBJECTIVE: This study aimed to assess the effect of serious games on CPR training and education by summarizing and pooling the results of previous studies. METHODS: We conducted a thorough and systematic search across 9 prominent web-based databases, encompassing the period from the inception of these databases until April 1, 2023. The databases included in our search were PubMed, Cochrane Library, Wiley Online Library, EBSCO (PsycInfo), SpringerLink, Chinese Biology Medicine Disc, Vip Journal Integration Platform, Wanfang Database, and Chinese National Knowledge Infrastructure. The studies selected adhered to the following criteria: (1) being a randomized controlled trial comparing serious games and traditional methods for CPR training; (2) having participants aged 12 years or older in CPR; (3) having an experimental group using serious games and a control group using nongame methods for CPR instruction; and (4) having outcomes including theoretical and skill assessments, compression depth, and rate. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. Data analysis was performed using RevMan (version 5.3; Cochrane Training), and mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. RESULTS: A total of 9 articles were included, involving 791 study participants, of whom 395 in the experimental group taught CPR training using serious games and 396 in the control group taught CPR training using traditional methods. The results of our meta-analysis indicate that the use of serious games in CPR training yields outcomes that are comparable in effectiveness to traditional training methods across several key areas. Specifically, serious games demonstrated equivalence to traditional formats in theory assessment (SMD -0.22, 95% CI - 0.96 to 0.51; P=.55), skill assessment (SMD -0.49, 95% CI -1.52 to 0.55; P=.36), compression depth (MD -3.17, 95% CI -0.18 to 6.53; P=.06), and compression rate (MD -0.20, 95% CI -7.29 to 6.89; P=.96). CONCLUSIONS: In summary, serious games offer a viable and effective CPR education approach, yielding results comparable to traditional formats. This modality is a valuable addition to CPR training methodologies. However, caution is warranted in interpreting these findings due to limited controlled trials, small sample sizes, and low-quality meta-analyzed evidence.

Dynamic network characteristics of adolescents with major depressive disorder: Attention network mediates the association between anhedonia and attentional deficit.

Attention deficit is a critical symptom that impairs social functioning in adolescents with major depressive disorder (MDD). In this study, we aimed to explore the dynamic neural network activity associated with attention deficits and its relationship with clinical outcomes in adolescents with MDD. We included 188 adolescents with MDD and 94 healthy controls. By combining psychophysics, resting-state electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) techniques, we aimed to identify dynamic network features through the investigation of EEG microstate characteristics and related temporal network features in adolescents with MDD. At baseline, microstate analysis revealed that the occurrence of Microstate C in the patient group was lower than that in healthy controls, whereas the duration and coverage of Microstate D increased in the MDD group. Mediation analysis revealed that the probability of transition from Microstate C to D mediated anhedonia and attention deficits in the MDD group. fMRI results showed that the temporal variability of the dorsal attention network (DAN) was significantly weaker in patients with MDD than in healthy controls. Importantly, the temporal variability of DAN mediated the relationship between anhedonia and attention deficits in the patient group. After acute-stage treatment, the response prediction group (RP) showed improvement in Microstates C and D compared to the nonresponse prediction group (NRP). For resting-state fMRI data, the temporal variability of DAN was significantly higher in the RP group than in the NRP group. Overall, this study enriches our understanding of the neural mechanisms underlying attention deficits in patients with MDD and provides novel clinical biomarkers.

Association of Beta-2-Microglobulin With Coronary Heart Disease and All-Cause Mortality in the United States General Population.

Few prospective studies explored the association of beta-2-microglobulin (B2M) with coronary heart disease (CHD) mortality. The primary objective of this study was to examine the association of serum B2M with CHD and all-cause mortality. This is a prospective cohort study of a nationally representative sample of 4,885 adults, aged 40-85 years, who participated in the National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994. The relationships between B2M and CHD and all-cause mortality were estimated using Cox proportional hazards regression models. During a median follow-up of 15.5 years, 845 CHD and 3,388 all-cause deaths occurred among 4,885 participants [2,568 women (55.7%); mean (S.D.) age, 66.4 (12.5) years], respectively. In the unadjusted model, B2M concentration was strongly linearly associated with CHD and all-cause mortality (p-trend < 0.001). After adjusting multivariable factors, a positive linear association between B2M and all-cause mortality was still observed (H.R. for Q4 vs. Q1 5.90; 95% CI: 5.31-6.57; p-trend < 0.001). In the multivariable adjustment model, B2M was significantly associated with an increased risk of CHD mortality (H.R. for Q4 vs. Q1 2.72; 95% CI: 2.07-3.57; p-trend < 0.001). In the stratified analyses, the associations of B2M with CHD and all-cause mortality varied by risk factors, such as age, smoking status, and history of hypertension. The findings suggest a significant relationship between the higher serum B2M concentration and increased risk for CHD and all-cause mortality. Further large-scale follow-up studies are also needed to validate this association.

Patients' experiences across the trajectory of atrial fibrillation: A qualitative systematic review.

AIM: This study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management? DESIGN: In this study, qualitative evidence synthesis was performed using the Thomas and Harden method. DATA SOURCES: Electronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021. REVIEW METHODS: Two researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis. RESULTS: A total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: 'Diagnosing AF'; 'The impact of AF on the patients'; 'Self-reorientation in the therapeutic process'; 'Living with AF and QoL'; and 'External support to facilitate coping strategies.' CONCLUSIONS: Our findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF. IMPACT: Understanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services. PATIENT OR PUBLIC CONTRIBUTION: This paper presents a review of previous studies and did not involve patients or the public.

Effects of High-Intensity Interval Training on Pulmonary Function and Exercise Capacity in Individuals with Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review.

INTRODUCTION: This study aimed to examine the effectiveness of high-intensity interval training (HIIT) on pulmonary function and exercise capacity in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Ten databases (PubMed, the Cochrane Library, Web of Science, EMBASE, MEDLINE, CINAHL, CNKI, Wanfang, Weipu, and CBM) were searched for relevant articles published from inception to 30 June 2020. Studies were included if they were randomized controlled trials (RCTs) comparing a HIIT group with usual care or other training groups. Quality was assessed using the Physiotherapy Evidence Database (PEDro) scale, and the overall quality of evidence was assessed using the GRADE approach. The primary outcomes were peak VO2 and FEV1% predicted, and the secondary outcomes were FEV1/FVC, peak VE, peak WR, 6MWD, dyspnea, health-related quality of life, and adverse event. RESULTS: Twelve articles (689 patients) were included. HIIT was shown to have a positive effect on exercise capacity (peak WR, 6MWD), pulmonary function (FEV1% pred, peak VE), dyspnea, and quality of life. However, sensitivity analyses for dyspnea were unstable, and the result changed from positive to negative after removing one study (SMD = - 0.13, 95% CI [- 0.44, 0.17], P = 0.40). CONCLUSIONS: HIIT could improve pulmonary function, exercise capacity, and quality of life but may not decrease dyspnea in patients with COPD. It can be recommended as a safe and effective exercise modality in rehabilitation programs. Given that the overall results were based on a limited number of studies with significant heterogeneity and some of the results were based on low GRADE rating evidence, more high-quality, larger sample size, multicenter, and long-term follow-up RCTs are needed to confirm the clinical efficacy of HIIT in patients with COPD. PROSPERO REGISTRATION: CRD42020165897.

Comparative effectiveness of exercise training program in patients with heart failure: protocol for a systematic review of randomised controlled trials and network meta-analysis.

INTRODUCTION: Heart failure (HF) is an end-stage of numerous heart diseases including hypertension, coronary heart disease and arrhythmia, in which the heart is unable to perform its circulatory function with sufficient efficiency due to structural or functional dysfunction (systolic or diastolic alterations). Strategies such as exercise rehabilitation may improve cardiac function, exercise capacity and health-related quality of life and reduce anxiety and depression in patients with HF. However, the relative effectiveness as well as the hierarchy of exercise interventions have not been well established, although various exercise options are available. Therefore, this protocol proposes to conduct a network meta-analysis (NMA) aiming to compare the effectiveness of different types of exercise training in patients with HF. METHODS AND ANALYSIS: PubMed, Embase and the Cochrane Library will be searched from inception to March 2021 for relevant randomised controlled trials. Other resources, such as Google Scholar and Clinical Trials.gov will also be considered. Studies assessing exercise rehabilitation in patients with HF will be selected. Two independent reviewers will identify eligible trials. The PEDro risk of bias assessment tool will be used to assess the quality of the included studies. Bayesian NMA will be used when possible to determine the comparative effectiveness of the different exercise interventions. The mean ranks and surface will estimate the ranking probabilities for the optimal intervention of various treatments under the cumulative ranking curve. Subgroup, sensitivity and meta-regression will be conducted to explain the included studies' heterogeneity if possible. We will also use the Grading of Recommendations, Assessment, Development, and Evaluation system to assess the strength of evidence. ETHICS AND DISSEMINATION: This systematic review and NMA will synthesise evidence on the effectiveness of the different exercises in patients with HF. The results will be submitted to a peer-reviewed journal. No ethical approval will be required because the data used for the review will be exclusively extracted from published studies. PROSPERO REGISTRATION NUMBER: CRD42020165870.