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Objectives With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education. Methods We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions. Results We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap. Conclusions Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.

BackgroundResearch gaps refer to unanswered questions in the existing body of knowledge, either due to a lack of studies or inconclusive results. Research gaps are essential starting points and motivation in scientific research. Traditional methods for identifying research gaps, such as literature reviews and expert opinions, can be time consuming, labor intensive, and prone to bias. They may also fall short when dealing with rapidly evolving or time-sensitive subjects. Thus, innovative scalable approaches are needed to identify research gaps, systematically assess the literature, and prioritize areas for further study in the topic of interest. ObjectiveIn this paper, we propose a machine learning–based approach for identifying research gaps through the analysis of scientific literature. We used the COVID-19 pandemic as a case study. MethodsWe conducted an analysis to identify research gaps in COVID-19 literature using the COVID-19 Open Research (CORD-19) data set, which comprises 1,121,433 papers related to the COVID-19 pandemic. Our approach is based on the BERTopic topic modeling technique, which leverages transformers and class-based term frequency-inverse document frequency to create dense clusters allowing for easily interpretable topics. Our BERTopic-based approach involves 3 stages: embedding documents, clustering documents (dimension reduction and clustering), and representing topics (generating candidates and maximizing candidate relevance). ResultsAfter applying the study selection criteria, we included 33,206 abstracts in the analysis of this study. The final list of research gaps identified 21 different areas, which were grouped into 6 principal topics. These topics were: “virus of COVID-19,” “risk factors of COVID-19,” “prevention of COVID-19,” “treatment of COVID-19,” “health care delivery during COVID-19,” “and impact of COVID-19.” The most prominent topic, observed in over half of the analyzed studies, was “the impact of COVID-19.” ConclusionsThe proposed machine learning–based approach has the potential to identify research gaps in scientific literature. This study is not intended to replace individual literature research within a selected topic. Instead, it can serve as a guide to formulate precise literature search queries in specific areas associated with research questions that previous publications have earmarked for future exploration. Future research should leverage an up-to-date list of studies that are retrieved from the most common databases in the target area. When feasible, full texts or, at minimum, discussion sections should be analyzed rather than limiting their analysis to abstracts. Furthermore, future studies could evaluate more efficient modeling algorithms, especially those combining topic modeling with statistical uncertainty quantification, such as conformal prediction.

The purpose of this study is to analyze the level and influence of awareness, trial, preference, devotion and fanaticism of Indomie customers in Jabodetabek. The research was carried out using an online questionnaire given to respondents who were consumers of Indomie products in Jabodetabek. Based on the descriptive analysis of Indomie consumers in Jabodetabek, the level of awareness is very good, the level of trial is good, the level of preference is good, the level of devotion and fanaticism tends to be quite good. As for purchase intention, purchase decision and repurchase intention, they are included in the fairly good criteria. Judging from the results of the hypothesis testing, it is known that The results indicate that awareness significantly influences both purchase intention and purchase decision. Similarly, trial positively impacts purchase intention and purchase decision. Furthermore, preference has a significant effect on purchase intentions but not on purchase decisions. The findings also reveal that preference does significantly affect repurchase intention. Devotion significantly influences the repurchase decision. But contrary to expectations, devotion does not affect repurchase intentions. Similarly, fanaticism has no significant effect on purchase decisions. Lastly, the study confirms that fanaticism influences repurchase intention, purchase intention influences purchase decision, and purchase decision positively affects repurchase intention. That highlights the importance of the initial purchase decision in shaping future repeat purchases.

BackgroundBreast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. ObjectiveThis study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. MethodsSimilar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: سرطان الثدي – فحص سرطان الثدي – علاج سرطان الثدي – مرض سرطان الثدي – أعراض سرطان الثدي – فحص الثدي (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google’s search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. ResultsOnly 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. ConclusionsThe limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps.

BackgroundAround the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait. ObjectiveThe purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait’s health care system for diabetes care and management. MethodsThe research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The “diffusion of innovation” model was used as a perspective to interpret the findings. ResultsA total of 20 participants were included in this study—10 HCPs and 10 patients with diabetes—all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety. ConclusionsThe results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.

The integration of large language models (LLMs), such as those in the Generative Pre-trained Transformers (GPT) series, into medical education has the potential to transform learning experiences for students and elevate their knowledge, skills, and competence. Drawing on a wealth of professional and academic experience, we propose that LLMs hold promise for revolutionizing medical curriculum development, teaching methodologies, personalized study plans and learning materials, student assessments, and more. However, we also critically examine the challenges that such integration might pose by addressing issues of algorithmic bias, overreliance, plagiarism, misinformation, inequity, privacy, and copyright concerns in medical education. As we navigate the shift from an information-driven educational paradigm to an artificial intelligence (AI)–driven educational paradigm, we argue that it is paramount to understand both the potential and the pitfalls of LLMs in medical education. This paper thus offers our perspective on the opportunities and challenges of using LLMs in this context. We believe that the insights gleaned from this analysis will serve as a foundation for future recommendations and best practices in the field, fostering the responsible and effective use of AI technologies in medical education.

Abstract Artificial intelligence (AI) has been successfully exploited in diagnosing many mental disorders. Numerous systematic reviews summarize the evidence on the accuracy of AI models in diagnosing different mental disorders. This umbrella review aims to synthesize results of previous systematic reviews on the performance of AI models in diagnosing mental disorders. To identify relevant systematic reviews, we searched 11 electronic databases, checked the reference list of the included reviews, and checked the reviews that cited the included reviews. Two reviewers independently selected the relevant reviews, extracted the data from them, and appraised their quality. We synthesized the extracted data using the narrative approach. We included 15 systematic reviews of 852 citations identified. The included reviews assessed the performance of AI models in diagnosing Alzheimer’s disease (n = 7), mild cognitive impairment (n = 6), schizophrenia (n = 3), bipolar disease (n = 2), autism spectrum disorder (n = 1), obsessive-compulsive disorder (n = 1), post-traumatic stress disorder (n = 1), and psychotic disorders (n = 1). The performance of the AI models in diagnosing these mental disorders ranged between 21% and 100%. AI technologies offer great promise in diagnosing mental health disorders. The reported performance metrics paint a vivid picture of a bright future for AI in this field. Healthcare professionals in the field should cautiously and consciously begin to explore the opportunities of AI-based tools for their daily routine. It would also be encouraging to see a greater number of meta-analyses and further systematic reviews on performance of AI models in diagnosing other common mental disorders such as depression and anxiety.

Abstract Background Nowadays, patients have access to all types of health information on the internet, influencing their decision-making process. The Middle East and North Africa (MENA) region consists of 22 countries with an estimated population of around 600 million. Breast cancer is the highest diagnosed cancer in this region. Websites are commonly the go-to cancer information sources. A large population of the MENA region is only fluent in the Arabic language, thus access to Arabic websites is in more demand. However, little is known about breast cancer websites that cater to an Arabic-speaking audience. This study aims at evaluating Arabic breast cancer websites and offering recommendations to improve engagement and access to health information. Methods This study employed a cross-sectional analysis approach. Google trends was used to reveal the top searched topics across the MENA region, which in turn were used as search terms to identify the websites. To be included, a website had to be active, available in Arabic, and contain breast cancer information. The evaluation was based on a combination of automated and expert-based evaluation methods through five dimensions: Availability, Accessibility, Readability, Quality, and Popularity. Results Overall most of the websites performed poorly in the five dimensions and require careful reassessment concerning design, content, and readability levels; Only one website performed well in all dimensions, except for readability. Generally, the readability scores indicated that the websites were above the recommended level of reading. None of the websites passed the automated accessibility tests. The expert evaluation using the “Health on the Net” checklist showed good results for most websites. Conclusions Breast cancer rates are rising in the MENA region, therefore having comprehensive, accurate, trustworthy, and easy-to-understand health information in their native language is a must. The results from this study show a need for improving the accessibility to breast cancer information websites available to Arabic speakers. The search was limited to three search engines yielding 10 websites and only one tool was used per dimension. Future work is needed to overcome these limitations. Collaboration between multiple stakeholders is necessary to develop websites that contain easy-to-read and understand high-quality information.

BackgroundArtificial intelligence (AI)–driven serious games have been used in health care to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs. ObjectiveThis study aimed to explore the features of AI-driven serious games in health care as reported by previous research. MethodsWe conducted a scoping review to achieve the abovementioned objective. The most popular databases in the information technology and health fields (ie, MEDLINE, PsycInfo, Embase, CINAHL, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched using keywords related to serious games and AI. Two reviewers independently performed the study selection process. Three reviewers independently extracted data from the included studies. A narrative approach was used for data synthesis. ResultsThe search process returned 1470 records. Of these 1470 records, 46 (31.29%) met all eligibility criteria. A total of 64 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games were used for rehabilitation in most of the studies. The most common genres of serious games were role-playing games, puzzle games, and platform games. Unity was the most prominent game engine used to develop serious games. PCs were the most common platform used to play serious games. The most common algorithm used in the included studies was support vector machine. The most common purposes of AI were the detection of disease and the evaluation of user performance. The size of the data set ranged from 36 to 795,600. The most common validation techniques used in the included studies were k-fold cross-validation and training-test split validation. Accuracy was the most commonly used metric for evaluating the performance of AI models. ConclusionsThe last decade witnessed an increase in the development of AI-driven serious games for health care purposes, targeting various health conditions, and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. Although the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

BackgroundElectronic health record (EHR) has emerged as a backbone health care organization that aims to integrate health care records and automate clinical workflow. With the adoption of the eHealth care system, health information communication technologies and EHRs are offering significant health care advantages in the form of error reduction, improved communication, and patient satisfaction. ObjectiveThis study aimed to (1) investigate factors associated with physicians’ EHR adoption status and prevalence of EHRs in Kuwait and (2) identify factors predicting physician satisfaction with EHRs in public hospitals in Kuwait. MethodsThis study was conducted at Kuwait’s public Al-Jahra hospital from May to September 2019, using quantitative research methods. Primary data were gathered via questionnaires distributed among 295 physicians recruited using convenience sampling. Data were analyzed in SPSS using descriptive, bivariate, and multivariate linear regression, adjusted for demographics. ResultsResults of the study revealed that the controlled variable of gender (β=–.197; P=.02) along with explanatory variables, such as training quality (β=.068; P=.005), perception of barriers (β=–.107; P=.04), and effect on physician (β=.521; P

Abstract Background and Aims Diabetes is among the most prevalent noncommunicable chronic diseases globally and carries a substantial expense in worldwide health care. Pharmaceutical supplies related to diabetes management account for 20%–40% of the disease's management cos, and this percentage continues to increase. This study examines the pharmaceutical expenses associated with one of the most common chronic diseases: diabetes. Specifically, we measure the extent to which patient health and demographic factors drive the annual cost of pharmaceutical supplies for diabetes management. Second, the study applied a procurement‐centric classification scheme to pharmaceutical items involved in diabetes treatment. Methods Data on 98,648 pharmaceutical‐dispensing transactions (related to 2828 patients) over 1 year were collected from a specialized diabetes health center. Pharmaceutical prices from the sample were compared internationally to ensure that the findings apply to other countries. The association between the item cost and the number of unique patients prescribed pharmaceutical products was estimated at the category and subcategory levels. Results Approximately 80% of total pharmaceutical expenditures were attributed to 20% of patients. Two of 20 pharmaceutical categories—anti‐diabetes drugs and insulin—accounted for 34% of products dispensed and 57% of total pharmaceutical expenditures. Age, body mass index, and diabetes type were essential factors in predicting supply cost per patient. Conclusion Applying the portfolio purchasing model also suggested that some clinically similar items, like insulin types, are best procured through divergent procurement strategies or vendors for optimal cost efficiency. A better understanding of the diverse array of diabetes supplies can reveal opportunities for better strategic supply management. This supply classification approach can also be applied in other supply‐intensive specialties, such as orthopedics.

BackgroundMemory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated. ObjectiveThis study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment. MethodsA systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate. ResultsOf the 618 citations retrieved, 18 (2.9%) met the eligibility criteria for this review. Of these 18 studies, 15 (83%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95% CI −0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=−0.19, 95% CI −0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95% CI −0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95% CI −0.21 to 1.54), nonverbal memory (P=.94; SMD=−0.01, 95% CI −0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95% CI −0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95% CI −0.02 to 0.37). ConclusionsSerious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment.

BackgroundExecutive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses. ObjectiveThis study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment. MethodsA systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. ResultsOf 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59). ConclusionsSerious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment. Trial RegistrationPROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757

BackgroundMost diabetes management involves self-management. Effective self-management of the condition improves diabetes control, reduces the risk of complications, and improves patient outcomes. Mobile apps for diabetes self-management (DSM) can enhance patients’ self-management activities. However, they are only effective if clinicians recommend them, and patients use them. ObjectiveThis study aimed to explore the determinants of DSM apps’ use by patients and their recommendations by health care professionals (HCPs). It also outlines the future research agenda for using DSM apps in diabetes care. MethodsWe systematically reviewed the factors affecting the adoption of DSM apps by both patients and HCPs. Searches were performed using PubMed, Scopus, CINAHL, Cochrane Central, ACM, and Xplore digital libraries for articles published from 2008 to 2020. The search terms were diabetes, mobile apps, and self-management. Relevant data were extracted from the included studies and analyzed using a thematic synthesis approach. ResultsA total of 28 studies met the inclusion criteria. We identified a range of determinants related to patients’ and HCPs’ characteristics, experiences, and preferences. Young female patients were more likely to adopt DSM apps. Patients’ perceptions of the benefits of apps, ease of use, and recommendations by patients and other HCPs strongly affect their intention to use DSM apps. HCPs are less likely to recommend these apps if they do not perceive their benefits and may not recommend their use if they are unaware of their existence or credibility. Young and technology-savvy HCPs were more likely to recommend DSM apps. ConclusionsDespite the potential of DSM apps to improve patients’ self-care activities and diabetes outcomes, HCPs and patients remain hesitant to use them. However, the COVID-19 pandemic may hasten the integration of technology into diabetes care. The use of DSM apps may become a part of the new normal.

Abstract Background Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait. Methods We fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number ( R e $$ {\mathcal{R}}_e $$ ). We estimated the basic reproduction number ( R 0 $$ {\mathcal{R}}_0 $$ ) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated R e $$ {\mathcal{R}}_e $$ values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios. Results We estimate R e $$ {\mathcal{R}}_e $$ at 1·08 (95% CI: 1·00–1·26) for P1 and 2·36 (2·03–2·71) for P2. On March 22nd, R e $$ {\mathcal{R}}_e $$ for P1 and P2 are estimated at 1·19 (1·04–1·34) and 1·75 (1·26–2·11) respectively. After the partial curfew had taken effect, R e $$ {\mathcal{R}}_e $$ for P1 dropped modestly to 1·05 (0·82–1·26) but almost doubled for P2 to 2·89 (2·30–3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission between P1 and P2 greatly elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2. Conclusion Our results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.

BackgroundCognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. ObjectiveThis study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. MethodsA systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. ResultsFifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P

This viewpoint summarizes the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth.

BackgroundAnxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses. ObjectiveThis study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review. MethodsWe conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. ResultsOf the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03). ConclusionsThis review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

BackgroundDepression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings. ObjectiveThis study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies. MethodsA systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games). ResultsFrom an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003). ConclusionsSerious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969

BackgroundTechnologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. ObjectiveThis review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. MethodsWe conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. ResultsOf 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). ConclusionsTechnologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.

Background: As public health strategists and policymakers explore different approaches to lessen the devastating effects of novel coronavirus disease (COVID-19), blockchain technology has emerged as a resource that can be utilized in numerous ways. Many blockchain technologies have been proposed or implemented during the COVID-19 pandemic; however, to the best of our knowledge, no comprehensive reviews have been conducted to uncover and summarise the main feature of these technologies.Objective: This study aims to explore proposed or implemented blockchain technologies used to mitigate the COVID-19 challenges as reported in the literature.Methods: We conducted a scoping review in line with guidelines of PRISMA Extension for Scoping Reviews (PRISMA-ScR). To identify relevant studies, we searched 11 bibliographic databases (e.g., EMBASE and MEDLINE) and conducted backward and forward reference list checking of the included studies and relevant reviews. The study selection and data extraction were conducted by 2 reviewers independently. Data extracted from the included studies was narratively summarised and described.Results: 19 of 225 retrieved studies met eligibility criteria in this review. The included studies reported 10 used cases of blockchain to mitigate COVID-19 challenges; the most prominent use cases were contact tracing and immunity passports. While the blockchain technology was developed in 10 studies, its use was proposed in the remaining 9 studies. The public blockchain technology was the most commonly utilized type in the included studies. All together, 8 different consensus mechanisms were used in the included studies. Out of 10 studies that identified the used platform, 9 studies used Ethereum to run the blockchain. Solidity was the most prominent programming language used in developing blockchain technology in the included studies. The transaction cost was reported in only 4 of the included studies and varied between USD 10−10 and USD 5. The expected latency and expected scalability were not identified in the included studies.Conclusion: Blockchain technologies are expected to play an integral role in the fight against the COVID-19 pandemic. Many possible applications of blockchain were found in this review; however, most of them are not mature enough to reveal their expected impact in the fight against COVID-19.We encourage governments, health authorities, and policymakers to consider all blockchain applications suggested in the current review to combat COVID-19 challenges. There is a pressing need to empirically examine how effective blockchain technologies are in mitigating COVID-19 challenges. Further studies are required to assess the performance of blockchain technologies’ fight against COVID-19 in terms of transaction cost, scalability, and/or latency when using different consensus algorithms, platforms, and access types.

Background: Diabetes mellitus (DM) is highly prevalent in the Middle East and North Africa (MENA) region. Mobile health (m-health) can improve communications between diabetic patients and medical teams, and this, in turn, may enhance engagement and self-management. Droobi is a multi-language mobile application designed to support self-management of patients with DM. Objective: The study aimed to explore experiences of patients and educators about their communication before and after implementation of Droobi, a diabetes management app. Methods: We interviewed a convenience sample consisting of 9 patients and 5 nurse educators. Before interviews, Droobi was downloaded to participants’ mobile phone, and their profile on the application was created. To ensure optimum usage experience, all participants received education on how to use Droobi. Participants used Droobi for 6 to 12 weeks. All interviews were audio recorded, transcribed by professionals, and thematically analyzed. Results: Two main themes were generated from participants’ responses. The first theme relates to experiences of patients and educators about their communication before Droobi and consists of 3 sub-themes: (1) how patients communicated with medical team before Droobi (previous methods), (2) adoption of previous communication methods, and (3) shortcomings of previous communication methods. The second theme relates to experiences of patients and educators about their communication after Droobi and consists of 4 sub-themes: (1) adoption of Droobi, (2) advantages of Droobi, (3) shortcomings of Droobi, and (4) improvements suggested by educators and patients. Conclusions: Our findings suggest that Droobi provided a more efficient and convenient way for communication between health workers and patients, yet multiple shortcomings and several suggestions for improvements were noted. Future work should continue evaluating the Droobi app, they should include a number of different stakeholders when developing the upcoming Droobi version taking into account the limitations and suggestions put forth by the end-users.

The rising burden of non-communicable diseases is taxing health systems globally. Using data science and information systems is necessary to support public health practices. Geographic Information Systems (GIS) are key to inform and help guide public health policies related to place (i.e. location or where one lives) and how it affects health. Despite the increasing use of GIS for public health globally, its applications to health in the Gulf Cooperation Council (GCC) states remains largely unknown. This systematic scoping review aimed to uncover how GIS has been used in the GCC states to understand “place” and “health”. A comprehensive search of the literature was performed in PubMed, Scopus, Science Citation Index Expanded, ScienceDirect, Embase, IEEE Xplore, and ACM Digital Library during June 2020. All journal articles involving the use of GIS for human health applications in the GCC states published in English in peerreviewed scientific journals were considered. After removing duplicates and applying eligibility criteria, qualitative content analysis was performed for 24 of 630 studies. GIS uses in the GCC states were categorized as health access and planning (n=9), health risk analysis (n=8), disease surveillance (n=6) and community health profiling (n=1). The majority of the uncovered evidence in this study focused on the Kingdom of Saudi Arabia. The results of this study indicate a deficiency of published evidence regarding the use of GIS in support of public health in other GCC states. This stands to compromise planning and strategic decision making in health risk analysis, disease surveillance, community health profiling, health services provision and health interventions.

Abstract Background Current advances in information and communication technology have made accessing and obtaining health-related information easier than ever before. Today, many hospital websites use a patient-centric approach to promote engagement and encourage learning for better health-related decision making. However, little is known about the current state of hospital websites in the State of Kuwait. This study aims to evaluate hospital websites in Kuwait and offer recommendations to improve patient engagement and access to health information. Methods This study employs a cross-sectional analytical approach to evaluate hospital websites in Kuwait in 2017. The websites of hospitals that provide in-patient services were identified through a structured search. Only active websites that were available in either English or Arabic were considered. The evaluation of the websites involved a combination of automated and expert- based evaluation methods and was performed across four dimensions: Accessibility, Usability, Presence, and Content. Results Nine hospitals met the inclusion criteria. Most of the websites fell short in all four dimensions. None of the websites passed the accessibility guidelines. The usability of websites varied between hospitals. Overall, the majority of hospitals in Kuwait have rudimentary online presence and their websites require careful reassessment with respect to design, content, and user experience. The websites focus primarily on promoting services provided by the hospital rather than engaging and communicating with patients or providing evidence-based information. Conclusions Healthcare organization and website developers should follow best-practices to improve their websites taking into consideration the quality, readability, objectivity, coverage and currency of the information as well as the design of their websites. Hospitals should leverage social media to gain outreach and better engagement with consumers. The websites should be offered in additional languages commonly spoken by people living in Kuwait. Efforts should be made to ensure that health information on hospital websites are evidence-based and checked by healthcare professionals.

An international survey to explore current and future trends in Nursing Informatics (NI) was done in 2015. This article explores responses to questions about: what should be done to further develop NI as an independent discipline; existing policies and standards influencing NI; perceived support towards NI as a discipline; and advice from NI specialists to students and emerging professionals. Nurse and allied health professionals in academia and practice were reached with snowball sampling. Open-ended questions were analysed with thematic content analysis and the mean and standard deviation is reported for the perceived support towards NI (scale ranging from 1 (not at all supportive) to 10 (very supportive)). A total of 507 respondents from 46 countries responded to the survey. Respondents reported mediocre support towards NI from the environment (M 5.79, SD 2.60). Results showed that NI education needs development to better meet practice demands, that current NI resources seem insufficient, that NI expertise is not used to its full potential in health institutions and the community, and that NI needs to show its value through research and increase visibility to be recognised among stakeholders worldwide. In conclusion, there is a need to clarify NI as a discipline and a need for strong leadership to impact policy making. An increase in NI teaching at undergraduate level in nursing as well as an increase in postgraduate NI programmes worldwide would better support practice demands. National policies and international white papers in NI are needed to guide resource distribution to better support practice.

Intercoder reliability can increase trustworthiness, accuracy, rigor, collaboration, and power sharing in qualitative research. Though not every qualitative design can utilize intercoder reliability, this article highlights how positivist qualitative research, community-based participatory research, and participatory evaluation all strengthen when intercoder reliability is sought among coding teams. Basic calculations for intercoder reliability can be completed manually or with software, making it an accessible metric to inform counseling research and evaluation, benefitting counselor education and practice. Interpreting metrics like percent agreement or kappa statistic largely depends on data context and potential impact of the study, which warrants researchers and evaluators to assess and understand the consequences of their work. Using ICR with clinical data such as interviews and other qualitative sources can be utilized to teach trainees the method in counseling research and evaluation and help make visible the important contributions of qualitative research using collaborative teams in counselor education.

Objectives: From the perspectives of home care patients and caregivers, this study aimed to (a) identify the challenges for better fall-risk management during home care episodes and (b) explore the opportunities for them to leverage health information technology (IT) solutions to improve fall-risk management during home care episodes. Methods: Twelve in-depth semistructured interviews with the patients and caregivers were conducted within a descriptive single case study design in 1 home health agency (HHA) in the mid-Atlantic region of the United States. Results: Patients and caregivers faced challenges to manage fall risks such as unmanaged expectations, deteriorating cognitive abilities, and poor care coordination between the HHA and physician practices. Opportunities to leverage health IT solutions included patient portals, telehealth, and medication reminder apps on smartphones. Conclusion: Effectively leveraging health IT could further empower patients and caregivers to reduce fall risks by acquiring the necessary information and following clinical advice and recommendations. The HHAs could improve the quality of care by adopting IT solutions that show more promise of improving the experiences of patients and caregivers in fall-risk management.

Trans youth experience discrimination and marginalization in their homes, communities, and schools. Professional school counselors (PSCs) are positioned to support and advocate for trans youth as dictated by professional standards. However, an extensive review of literature revealed a lack of confidence and competence in counselors working with trans youth and their families. Further, there is a dearth of literature that addresses factors leading to increased school counselor competence with trans students. The current study uses a cross-sectional survey design to contribute to the extant literature and explore how PSCs in the United States work with students in the K--12 public school system. Results from multiple regression analyses indicate that PSCs who have had postgraduate training and report personal and professional experiences with trans students are more competent in working with trans students. Implications for PSCs and school counselor education programs are discussed.