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Abstract Background Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals. Methods The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences. Results The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression. Conclusions In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies. Trial registration The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182).

The current paper aimed to investigate the effectiveness of computer-based cognitive rehabilitation on cognitive flexibility and selective attention of high school students. A total of 30 high school students from Tehran were selected. The participants were randomly divided into two groups: experimental and control, using a convenience sampling method. The sample size for each group was determined to be 15, based on an effect size of 0.3, a power of 0.8, and an alpha of 0.05. The experimental group received 16 sessions of 45-minute computer-based cognitive rehabilitation intervention. The control group received no intervention. Research tools included the Wisconsin Card Sorting Test (WCST) and Stroop Color Word Test (SCWT). The data were analyzed using multivariate analysis of variance (MANOVA) with SPSS 26 software. The results showed that there was a significant difference between the experimental and control groups in some components of cognitive flexibility and selective attention. The findings demonstrated that computer-based cognitive rehabilitation intervention was effective on cognitive flexibility and selective attention of high school students. [ABSTRACT FROM AUTHOR]

Background: Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals. Methods: The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences. Results: The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression. Conclusions: In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies. Trial registration: The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182). [ABSTRACT FROM AUTHOR]

Prior studies have shown the efficacy of computer-based cognitive training programs in improving cognitive and academic functions in children diagnosed with a specific learning disorder (SLD). However, these studies often focused on center-based approaches without considering the involvement of parents or the inclusion of home-based tasks in evaluating their effectiveness, which needs to be addressed. This study aimed to investigate the efficacy of a mixed cognitive training program in children with SLD. The program consisted of computer-based games combined with home-based activities involving parental participation. In this pilot study, a single-subject research design with an A-B-A analysis was employed to assess the effects of a mixed cognitive intervention program. Six children (aged 10–13 years) with SLD participated in ten intervention sessions and underwent six pre- and post-evaluation sessions over a six-eight-week period. Parent interviews conducted before and after the training program provided insights into parents' perceptions of these cognitive activities and their access, knowledge, and utilization of these types of digital devices. The utilization of computer-based interventions, followed by home-based tasks, demonstrated effectiveness in improving cognitive and academic functions, fostering parental involvement, and enhancing the overall effectiveness of the program. After the intervention, all participants exhibited improvements in their cognitive and academic skills, the results indicated significant improvements in executive functions, including working memory, processing speed, attention, and academic functions, as assessed in the pre-and post-evaluation. While the parents' views regarding the effectiveness of the cognitive programs became more favorable. The utilization of computer-based interventions integrated with home-based tasks proved highly effective in enhancing cognitive and academic functions and promoting parental engagement and overall program efficacy. The participants displayed noticeable advancements in cognitive and academic skills, with parents' perceptions of the program's effectiveness improving. Furthermore, the study revealed significant enhancements in executive functions, such as working memory, processing speed, attention, and academic performance, as evidenced by pre-post evaluations. This comprehensive approach underscores the potential of a mixed intervention approach in both centers (clinics and families) to holistically enhance cognitive development and academic performance in children. [ABSTRACT FROM AUTHOR]

Aims: To synthesise the composition and effectiveness of computer‐based patient decision aid (PDAs) in interventions for patients with chronic diseases. Design: A systematic review with meta‐analysis. Methods: Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random‐effects model to conduct meta‐analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340). Data Sources: PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022. Results: The review included 22 studies, and most computer‐based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer‐based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self‐efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low. Conclusion: Although the quality of evidence was low, however, using computer‐based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above. Relevance to Clinical Practice: Computer‐based PDAs could assist health‐care providers and patients in the shared decision‐making process and improving the quality of decision‐making. Reporting Method: This study adhered to PRISMA guidelines. No Patient or Public Contribution: [ABSTRACT FROM AUTHOR]

CLOSER is a computer-based exercise program that aims to improve older adults' health, fitness and social lives. This pilot study aimed to examine the effect of CLOSER, the first computer-based exercise program developed for older adults on a national scale, on those with a history of falls. Forty-eight older adults (71.33 ± 7.47) with a history of falling at least once in the last year were included in the study. Older adults performed CLOSER exercises for (balance maintenance, neck rotation, rhythmic walking, knee flexion and trunk rotation) 2 sessions per week for eight weeks. All individuals were evaluated at baseline and the end of the eighth week. The primary outcome measures were the 30-s Chair-Stand Test (p = 0.002), the Berg Balance Scale (p = 0.002), the Falls Efficacy Scale International (p = 0.003), the Timed Up and Go Test (p = 0.008) and the motivation level (p = 0.007) statistically significant improvements were observed. The results show that a CLOSER-computer-based exercise program effectively increases balance and reduces the risk and fear of falling. In the future, CLOSER could significantly contribute to the healthcare system as an alternative aid for home-based exercise. [ABSTRACT FROM AUTHOR]

Objective: An important cognitive control process is the ability to inhibit, that mature at different rates during childhood to adolescence. The aim of our research was to construct and validate computer-based Stroop animal size test in children for measuring selective attention and response inhibition. Research Methodology: In this survey study, we prepared the test, after the approval of experts and software development, at first test-retest reliability with a two week was evaluated in a separate sample (N=50, 5-12 years old children), then data was collected from 92 children 5-12 years old (46 girls and 46 boys) included 22 children with attention deficit/hyperactivity disorder (ADHD) studied in the academic year 2022-2023 in Alborz province. Participants decided the real size of animals by pressing response keys on computer. ANOVA, Multivariate analysis, Pearson correlation coefficients and Cronbach α were used to assess reliability and validity (p<0.05). Findings: The findings showed test-retest reliability in significant range (p<0.01). The correlation was high for Stroopnum, (r=0.83), Inconsistent answers, (r=0.72), Wrong answers, (r=0.89) but lower for Consistent answers, (r=0.28) and Reaction time, (r=0.41). To assess the internal consistency, Cronbach Alpha 0.91 computed. ANOVA analysis for comparing children's function in different age groups was (p<0.000). Conclusion: Multivariate analysis was used in comparing children with ADHD to the control group, results showed significant difference between groups in Stroop components, (p<0.007). This computerized Stroop animal size test had satisfactory reliability and validity, that can measure cognitive functions such as selective attention and inhibition in children. [ABSTRACT FROM AUTHOR]

Social cognition (SC), the mental operations underlying social functioning, are impaired in schizophrenia. Their direct link to functional outcome and illness status have made them an important therapeutic target. However, no effective treatment for these deficits is currently applied as a standard of care. To address this need, we have developed SocialVille-an online, plasticity-based training program that targets SC deficits in schizophrenia. Here we report the outcomes of a double-blind, controlled, randomized, multi-site clinical trial of SocialVille. Outpatients with schizophrenia were randomized to complete 40 sessions of either SocialVille (N = 55 completers) or active control (computer games; N = 53 completers) from home. The a priori co-primary outcome measures were a social cognitive composite and a functional capacity outcome (UCSD Performance-based Skills Assessment [UPSA-2]). Secondary outcomes included a virtual functional capacity measure (VRFCAT), social functioning, quality of life, and motivation. Linear mixed models revealed a group × time interaction favoring the treatment group for the social cognitive composite (b = 2.81; P < .001) but not for the UPSA-2 measure. Analysis of secondary outcome measures showed significant group × time effects favoring the treatment group on SC and social functioning, on the virtual functional capacity measure and a motivation subscale, although these latter findings were nonsignificant with FDR correction. These results provide support for the efficacy of a remote, plasticity-based social cognitive training program in improving SC and social functioning in schizophrenia. Such treatments may serve as a cost-effective adjunct to existing psychosocial treatments. Trial Registration: NCT02246426.

Background and aim: Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders. Methods: A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered. Results: This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs. Conclusion: According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay. [ABSTRACT FROM AUTHOR]

The Queensland Basic Paediatric Training Network (QBPTN) is responsible for the selection of candidates into paediatric training in Queensland. The COVID-19 pandemic necessitated interviews to be conducted 'virtually' as virtual Multiple-Mini-Interviews (vMMI). The study aimed to describe the demographic characteristics of candidates applying for selection into paediatric training in Queensland, and to explore their perspectives and experiences with the vMMI selection tool. The demographic characteristics of candidates and their vMMI outcomes were collected and analysed with a mixed methods approach. The qualitative component was comprised of seven semi-structured interviews with consenting candidates. Seventy-one shortlisted candidates took part in vMMI and 41 were offered training positions. The demographic characteristics of candidates at various stages of selection were similar. The mean vMMI scores were not statistically different between candidates from the Modified Monash Model 1 (MMM1) location and others [mean (SD): 43.5 (5.1) versus 41.7 (6.7), respectively, p = 0.26]. However, there was a statistically significant difference (p value 0.03) between being offered and not offered a training position for candidates from MMM2 and above. The analysis of the semi-structured interviews suggested that candidate experiences of the vMMI were influenced by the quality of the management of the technology used. Flexibility, convenience, and reduced stress were the main factors that influenced candidates' acceptance of vMMI. Perceptions of the vMMI process focused on the need to build rapport and facilitate communication with the interviewers. vMMI is a viable alternative to face-to-face (FTF) MMI. The vMMI experience can be improved by facilitating enhanced interviewer training, by making provision for adequate candidate preparation and by having contingency plans in place for unexpected technical challenges. Given government priorities in Australia, the impact of candidates' geographical location on the vMMI outcome for candidates from MMM >1 location needs to be further explored. [ABSTRACT FROM AUTHOR]

There is increasing evidence that face-to-face treatments for verb and sentence production deficits in aphasia can be effective. However, very few studies have investigated supplementing such treatments with self-managed computer-based home practice. Given the increasing importance of computer-based aphasia treatment, it is imperative that the feasibility of this mode of delivering verb and sentence treatments is explored. This study explored the feasibility and preliminary effectiveness of a novel computer-based treatment for sentence production deficits in aphasia, delivered by a combination of face-to-face and self-managed treatment sessions. The effect of treatment on verb and sentence production, discourse and functional communication was assessed. The study used a pre-post design with six single cases: three males and three females aged 49 – 81 years. The Sentence Production Treatment (SPT) was developed based on the evidence from systematic reviews of verb-in-isolation and sentence treatments respectively. The SPT was low dose (8 hours) and clinician delivered, supplemented by a minimum set level (16 hours) of self-managed computer-based treatment. The feasibility of the SPT was investigated by: monitoring recruitment and retention of participants; logging any technical issues; assessing the fidelity of face-to-face treatment delivery using checklists; and monitoring compliance with self-delivered treatment. The SPT was found to be feasible and acceptable to the six participants. Treatment effects were noted on trained verb production and sentence production for five participants each. Generalisation to untrained verb and sentence targets and discourse was more limited, however four participants perceived functional communication improvements. The study represents the first preliminary evidence that a computer-based sentence level treatment for sentence production deficits in aphasia, which included a self-managed component, is feasible and can be effective. Given these overall positive findings of feasibility and benefit, further feasibility testing is warranted, exploring intervention refinement and candidacy. [ABSTRACT FROM AUTHOR]

Abstract Background The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. Methods Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. Results A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p

Abstract. A computer-based version of the Vividness of Movement Imagery Questionnaire (VMIQ-2) was tested and compared with the print version. Psychometric characteristics of the print version were replicated with the computer-based version using a between-subject design in Study 1 (n1 = 240; n2 = 254) and using a within-subject design in Study 2 (N = 285). Confirmatory factor analyses replicated the three-dimensional structure of the VMIQ-2. Model fits, test–retest reliability, interfactor correlations, and correlations with other questionnaires did not differ significantly between the computer-based and print versions. Convergent validity was shown by significant correlations with the Movement Imagery Questionnaire 3. The computer-based version of the VMIQ-2 is considered a valid instrument to measure vividness of action imagery.

The widely-used ATC simulator laboratory in air traffic control education lacks research on its development. This study aims to develop a computer-based aerodrome control tower simulator for ATC using the research and development method. The simulator offers a realistic training environment, covering simulation, technicalities, facilities, configuration, equipment, specifications, software, operations, and development. It is a crucial facility in ATC courses at Indonesian aviation universities. Findings demonstrate its effectiveness in enhancing student proficiency and reducing reliance on external suppliers. The resulting design concept, developed through research and development, can be utilized by local experts to promote advanced technology mastery and cost efficiency in ATC training systems. It provides opportunities for local experts and serves as a model for other countries, advancing ATC education. [ABSTRACT FROM AUTHOR]

Introduction Whiplash-associated disorder (WAD) often becomes a persistent problem and is one of the leading causes of disability in the world. It is a costly condition for individuals, for insurance companies, and for society. Guidelines for the management of WAD have not been updated since 2014, and the use of computer-based sensorimotor exercise programs in treatment for this patient group has not been well documented. The purpose of this randomized clinical trial is to explore the degree of association between self-reported and clinical outcome measures in WAD. Methods Individuals (n  = 180) with subacute WAD grades I and II will be randomized into 3 groups using block randomization. The 2 primary intervention groups (A and B) will receive physical therapy involving manual therapy and either a remote, novel, computer-based cervical kinesthetic exercise (CKE) program starting at visit 2 (Group A) or neck exercises provided by the corresponding physical therapist (Group B). These groups will be compared to a "treatment as usual" Group C. Movement control, proprioception, and cervical range of motion will be measured. Neck disability and pain intensity, general health, self-perceived handicap, and physical, emotional, and functional difficulties due to dizziness will be measured using questionnaires. The short-term effects will be measured 10 to 12 weeks after the baseline measurements, and the long-term effects will be measured 6 to 12 months after the baseline measurements. Impact The successful completion of this trial will help guide clinicians in the selection of outcome measures for patients with subacute WAD in the assessment of the short- and long-term effectiveness of treatment combining manual therapy with computer-based CKE compared with manual therapy and non–computer-based exercises. This trial will also demonstrate the potential of using a computer-based intervention to increase the exercise dose for this patient group and how this influences outcomes such as levels of pain and disability in the short and long term. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to evaluate the diagnostic accuracy of the intelligent flipper (IFLIP) system in identifying binocular vision anomalies. PATIENTS AND METHODS: This study comprised 70 participants aged 18 to 22. Participants underwent comprehensive eye assessments, including measurement of visual acuity, refraction, far and near cover test, stereopsis, and worth four dot test. The manual accommodation amplitude and facility, as well as the IFLIP system test, were also evaluated. The correlation between the indices of the IFLIP and manual accommodation tests was analyzed using multiple regression models, and the diagnostic ability of the IFLIP was characterized using Receiver Operating Curve (ROC) analysis. The significance level was 0.05. RESULTS: The mean age of the 70 participants was 20.03±0.78 years. The mean manual and IFLIP accommodation facilities were 12.00±3.70 cycle per minute (CPM) and 10.01±2.77 CPM, respectively. No correlation was found between the indices of the IFLIP system and manual accommodative amplitude. However, the regression model showed that the contraction/relaxation ratio of the IFLIP system was positively correlated to the manual accommodation facility, and the average contraction time was negatively correlated with the manual accommodation facility. The ROC analysis proposed a cutoff of 10.15 CPM monocularly for the IFLIP accommodation facility assessment. CONCLUSIONS: This study indicated that the parameters obtained by the IFLIP system and the manual accommodation facility were comparable, and the IFLIP system had good sensitivity and specificity in the assessment of the accommodation facility, thus may serve as a promising tool for screening and diagnosis of binocular visual function anomalies in clinical and community settings. [ABSTRACT FROM AUTHOR]

Background and aimAdvances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders.MethodsA scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients’ needs are covered.ResultsThis review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs.ConclusionAccording to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.

Background: The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. Methods: Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. Results: A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). Conclusion: This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills. Key messages: 1- This is one of the few assessment tools developed to measure both basic and EMR-related communication skills. 2- The tool had good scale and test-retest reliability. 3- The level of agreement among a diverse group of raters was good. [ABSTRACT FROM AUTHOR]

This study aimed to produce a computer-based test instrument for higher-order thinking skills (CBT-HOTS) on the chemical bonding materials and to determine the higher-order thinking skills of students in Class X MIA at MAN Binjai Academic Year 2021/2022. This research employed the ADDIE model of Research and Development (RD). The test instrument was created in the form of multiple-choice consisting of 30 questions measuring the cognitive domains of analyzing (C4), evaluating (C5), and creating (C6). Based on the findings, the developed instrument was declared feasible for use, considering that it had met the required content validity by expert assessments using the Aiken’s V index in the range of 0.97 to 1.00 and the reliability value of 0.93. The students' higher-order thinking skills on chemical bonding materials were included in the "high" category. It was shown from the percentages of answers to the HOTS questions in each involved domain; analyzing (C4) by 28%, evaluating (C5) by 44%, and creating (C6) by 28%. Additionally, the average score was 74.64, indicating that students' higher-order thinking skills were high.

Remote learning has reduced the mathematical performance of students. Mathematical reasoning is the critical skill that enables students to make use of all other mathematical skills. The aim of the present study was (1) to develop the mathematical reasoning skills of underachieving students and (2) to explore the application options, benefits and limitations of an online game-based intervention programme among third- and fourth-grade pupils (aged 9–11, N = 810). The content of the programme was designed to strengthen their basic maths skills in line with the curriculum. Beyond assigning the tasks, the digital intervention programme also performed the motivational, differentiation- and feedback-related tasks of the teacher. The reliability indices for pre-, post and follow-up test results proved to be high (Cronbach's alpha =.90,.91 and.92, respectively). The effect size of the programme proved to be significant in both grades (d =.22 and.38, respectively). The results confirm the potential of the intervention programme to close, or at least significantly reduce the Covid learning gap in basic maths skills, without the need for additional teacher work—which is an important aspect of successful implementation—in areas which are the most challenging for 9-to-11-year-old pupils in the domain of mathematics. [ABSTRACT FROM AUTHOR]

Although well-established therapies exist for post-traumatic stress disorder (PTSD), barriers to seek mental health care are high. Technology-based interventions may play a role in improving the reach of efforts to treat, especially when therapist availability is low. The goal of the current randomized controlled trial was to pilot the efficacy of a computer-based trauma intervention with elements of virtual reality (VR; 3MR system) and limited therapist involvement for the treatment of PTSD in a childhood sexual abuse (CSA) and war veteran sample and to compare this to “treatment as usual” (TAU). TAU consisted of evidence-based approaches such as imaginal exposure, EMDR, or narrative exposure therapy. A total of 44 patients with PTSD were included and randomly assigned to 12 sessions of 3MR intervention or TAU (completer n 3MR = 12, TAU = 18). Several measures (PCL-5, BDI-II, OQ-45-2, and the M.I.N.I. 5.0.0.) were administered to measure symptoms of PTSD and depression and scores of overall well-being at pre, post, and a three-month follow-up measurement. Analyses suggest that symptoms of PTSD and depression in the 3MR condition decreased, and overall well-being increased between pre and post measurements. Results did not indicate any clear differences between the treatment conditions over time which suggests that treatment gains of the 3MR intervention seem no less than those of TAU. Finally, both treatment conditions produced similar remission rates of PTSD and depression. Therefore, the 3MR intervention could possibly constitute an appropriate treatment alternative. The small sample size as well as evident drop-out rates in the 3MR condition (45%) do warrant further research. The procedures of this study were approved by the Medical Ethical Research Committee (MERC) of the Erasmus Medical Center in Rotterdam (MEC-NL46279.078.13) and pre-registered via ClinicalTrials.gov (Protocol Record CI1-12-S028-1).

Simple Summary: Brain tumour survivors are often burdened by late sequelae, especially neurocognitive deficits, ultimately affecting their quality of life. For many years, treatments for neurocognitive impairments have been limited to educational, pharmacological, home-based interventions, or clinic-based cognitive rehabilitation, but these treatment modalities showed several limits. More recently, cognitive rehabilitation through digital tools to increase cognitive performance through exercises and games is spreading in experimental clinical settings. However, since these are innovative interventions, there is a need to further investigate their effects on cognitive outcomes and quality of life for children with brain tumours. Therefore, in this systematic review, we analyse the current evidence and trends regarding computer-based cognitive rehabilitation in paediatric patients diagnosed with, or survivors of, brain tumours. To our knowledge, this is the first systematic review investigating these new approaches to cognitive rehabilitation in children with brain tumours. Background: Late neurocognitive sequelae are common among long-term brain tumour survivors, resulting in significantly worse quality of life. Cognitive rehabilitation through specific APP/software for PC/tablets represents an innovative intervention spreading in recent years. In this study, we aim to review the current evidence and trends regarding these innovative approaches. Methods: A systematic literature review was performed. Inclusion criteria were: (i) Studies recruiting patients diagnosed with any brain tumour before 21 years of age; (ii) studies assessing the role of digital interventions on cognitive outcomes. Case reports, case series, reviews, letters, conference proceedings, abstracts, and editorials were excluded. Results: Overall, nine studies were included; 152 patients (67.8% males) with brain tumours underwent a digital intervention. The mean age at diagnosis and the intervention enrolment ranged from 4.9 to 9.4 years and 11.1 to 13.3 years, respectively. The computer-based software interventions employed were: Cogmed, Captain's Log, Fast ForWord, and Nintendo Wii. Most of these studies assessed the effects of cognitive training on working memory, attention, and performance in daily living activities. Conclusions: The studies suggest that this type of intervention improves cognitive functions, such as working memory, attention, and processing speed. However, some studies revealed only transient positive effects with a significant number of dropouts during follow-up. Trials with greater sample sizes are warranted. Motivating families and children to complete cognitive interventions could significantly improve cognitive outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Technology provides occasions for language learners to engage in authentic communication with native speakers around the world. However, in order for such language learning to be successful, it must take into account learners' affective or emotional needs. Traditional approaches to language learning have neglected the affective domain. This study reports on the creation and verification of the learning framework. This framework relies on a case study in which pre-service Chinese language teachers use and apply technology to learn how to develop their future Mandarin as a foreign language speaking skills using affective learning strategies. Participants were 30 pre-service Chinese language teachers high-school teachers of spoken Mandarin in a ten-week teaching with technology course. Results showed that the learning framework for affective language learning included six processes, including 1) Remembering, 2) Understanding, 3) Applying, 4) Analyzing, 5) Creating, and 6) Evaluating. In addition, results indicated that the pre-service teachers used the affective strategies in terms of low anxiety and high motivation to design the website the most. The current research suggests the need for applying technology to learn how to develop future students' Mandarin as a foreign language speaking skill using affective learning strategies. [ABSTRACT FROM AUTHOR]

Aim: It is significant that students who prepare for the nursing profession must gain correct theoretical and practical knowledge. In this study, it was aimed to determine the effectiveness of different simulations, developed to teach nursing students the proper way to intramuscular medication administration. Methods: This quasi-experimental research was conducted between January 2017 and June 2017. The students' state-trait anxiety levels, exam scores and psychomotor skills, and their views on the simulation methods were assessed. Results: There were no statistically significant differences between the groups' pre-post test results (p=0.837; p>0.05). In the computer-based simulation group, students' scores for state anxiety levels were significantly lower (p=0.001; p0.01), however, their skill with intramuscular medication administration was significantly higher (p=0.001; p0.01). Conclusion: In the study, it was concluded that the computer-based method was more effective in teaching intramuscular injection in the cognitive and psychomotor areas whereas the hybrid simulation method was more effective in the affective area. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis based on randomized controlled trials (RCTs) from the last 10 years was conducted to identify the effect of computer-based training compared to routine methods on post-stroke cognitive rehabilitation and to provide recommendations for future research. A literature search was performed in the Cochrane Library, EMBASE, PubMed, EBSCO (CINAHL), and Web of Science that focused on studies comparing the effects of computerized cognitive training and routine methods in stroke survivors. After extraction of the study characteristics and methodological quality evaluation, a meta-analysis was conducted using the standard model based on the level of the overall cognitive domain. Ten out of 201 studies were included in the systematic review, with a total of 600 stroke survivors. The average age of the participants ranged from 42.1 to 66 years old, 305 participants used the computer-based training method, and males accounted for approximately 58.5%. All studies compared the baseline characteristics of participants at the onset of their studies, and no significant difference was shown. Six studies that reported the results for the overall cognitive domain were further analyzed by meta-analysis. The outcome of the meta-analysis showed that the effect size was 0.61 with a 95% confidence interval [-0.18, 0.35], and the P value (P = 0.54) indicated no significant difference between the control group and the computer-based cognitive training group. The results of the meta-analysis, based on a limited number of studies, did not show significant superiority of computer-based cognitive training compared to the traditional method in post-stroke patients. More high-quality studies focusing on different illness phases and various types of intervention software should be conducted to improve the meta-analysis and to explore the influence of computer-based cognitive training by subgroup analysis. [ABSTRACT FROM AUTHOR]

Background: Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a "GRADIOR" computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia. Method: This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60–90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2–3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann–Whitney was used. Results: The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02. Conclusions: good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent. [ABSTRACT FROM AUTHOR]

The Queensland Basic Paediatric Training Network (QBPTN) is the centralised pathway for entry into paediatric training in Queensland, Australia. In response to COVID-19 travel and social distancing restrictions imposed in 2020, QBPTN successfully adopted a Virtual Multiple Mini Interviews (vMMIs) model for the selection of candidates for entry into paediatric training. The authors describe the planning, implementation, challenges, and evaluation of candidates' and interviewers' experiences of vMMIs, including the differences between candidates from two geographical areas. The contents of six vMMI stations were similar to face-to-face MMI. Implementation required the identification of ZOOMTM as a preferred online platform, securing venues, communication, development of contingency plans and central coordination by the network. Candidates' experiences with vMMI were explored through thematic analysis of the qualitative data from focus groups and free text responses, and descriptive analysis of SurveyMonkey© questionnaire responses. Experiences between 'metropolitan' and 'regional and interstate' candidates were compared. 5-minute stations with 2-minute pre-reading were used. 78 candidates and 14 interviewers participated in the selection process. All candidates attended the focus group. 58.7% of candidates responded to post vMMI questionnaire. 93% of survey responders were happy to undertake vMMI in the future, with 23% feeling they would have performed better in face-to-face. Experiences between 'metropolitan' and 'other' groups were similar. Positive experiences of participants were related to the user-friendly IT platform, successful pre-interview communications, preparation, convenience, time, and cost savings. Stress related IT failures and difficulties establishing rapport with interviewers were reported as the main negative experiences. 'vMMI' is a feasible and acceptable method of selection into paediatric training. vMMI has many benefits and can be implemented relatively quickly by addressing key logistical requirements. The model under discussion could be adapted by other centres based on local needs. [ABSTRACT FROM AUTHOR]

The three-dimensional carpal alignment was measured in the neutral wrist position in 121 asymptomatic volunteers using computer-based cone-beam CT analysis. Normal values and the reliability of the automated analysis are reported. An analysis software based on segmentation of CT images and mathematical modelling was used to determine several axis variants based on different landmarks and to calculate the intercarpal angles automatically. Twenty wrists were imaged twice to determine intra-observer reliability. Mean values using the preferred axis variants were: scapholunate angle 57° (SD 9°), radiolunate angle 2° (SD 10°), lunocapitate angle –14° (SD 9°). Using alternate axis variants notably changed the angles produced. The intra-observer reliability of the analysis was excellent (mean intraclass correlation coefficient 0.97, SD 0.03). Computer-based CT analysis enables highly reproducible and automated assessment of carpal alignment. This study provides a reference database for measurement techniques and normal carpal angle values in three-dimensional imaging. [ABSTRACT FROM AUTHOR]

Introduction: There is growing literature on increasing feedback from Objective Structured Clinical Examinations (OSCEs) and one approach is a score report. The purpose of this study was to implement and evaluate a score report for a second and fourth-year medical school OSCE. Methods: We developed an electronic OSCE score report that displayed comments and performance by domain within and across stations (checklist items and rating scales were tagged to each domain). Our initial pilot released the score report after pass/fail decisions but subsequent iterations released the score report the same day as the exam. Our evaluation approach included both student surveys and focus groups. Results: Students felt the OSCE score report was accurate, identified strengths and weaknesses, and would likely cause them to take future action, with second-year students more likely to act on the report than fourth year students. The thematic analysis revealed barriers and enablers to utilizing feedback as well as the power of the score report to reduce anxiety. Conclusions: Our OSCE score report was simple to develop and implement the same day as an OSCE with an overall positive response from students with respect to accuracy and ability to use the information for future learning. [ABSTRACT FROM AUTHOR]

Background/Aim: Technology is gaining importance in medical education, along with distance learning and technology-enhanced learning systems. In certain conditions, such as the Covid-19 outbreak, adapting technology to our medical education is essential. Computer-based simulation is one of those technologies that can be used in medical education. We aimed to measure the contribution of computer-based simulation to students' knowledge of cardiac rhythms in the advanced cardiac life support (ACLS) curriculum, compared to the classic educational method. Methods: Interns (6th-grade medical students) were included in this observational study and divided into a study group and a control group. Both groups received a 2.5-hour-long ACLS rhythms lecture. Afterward, case studies were completed with a computer-based simulation program in the study group and with the classical didactic method in the control group. The participants took a multiple-choice test to measure the level of knowledge before (pre-test) and 4 weeks after (post-test) the training. "ACLS Simulator 2016" licensed program was used. Results: A total number of 80 medical students were included in the study. There were 35 (43.75%) males and 45 (56.25%) females, with a mean age of 23.7 (1.1) years. The mean number of correct answers in the pre-training test was 12.6 (3.2), and similar between the two groups (P=0.131), but significantly increased to 15.7 (3.3) (P<0.001) after the training. In the post-training test, the study and the control groups answered 16.0 (3.6) and 15.5 (3.1) questions correctly, respectively (P=0.477). Conclusion: Adapting a computer-based simulation program improves students' level of knowledge. Case scenario training with a computer-based simulation is as effective as the classical method. [ABSTRACT FROM AUTHOR]

The use of online learning and subsequent online testing has expanded rapidly in pharmacy programs across the United States. Numerous published studies have compared online learning with traditional methods in pharmacy. However, no such studies have been published in pharmacy. This study's objective is to compare first-professional year student preferences for computer-based vs. traditional paper-and-pencil testing for a required social and administrative pharmacy class. All students enrolled in the class were invited to complete one brief survey at the end of the semester to determine their testing preference. Of the 138 first-professional year students completing the survey, 79% (109 of 138) preferred computer-based testing, 9% had no preference, 6% (8 of 138) preferred paper-and-pencil testing, and the remainder (8 of 138) stated it depended on what was being tested. Ninety-one percent of students did not perceive the testing method to impact their grades. Students preferred computer-based testing over traditional paper-and-pencil as a convenient testing method (mean 4.73 vs. 3.4, P <.001), providing immediate feedback (mean 4.87 vs. 1.91, P <.001), and as a more effective testing method (mean 4.57 vs. 3.96, P <.001). First-professional year students preferred computer-based over traditional paper-and-pencil testing for a social and administrative science class, with the method of testing not perceived to impact grade. This finding is timely, given the recent required transitioning of all pharmacy classes and subsequent testing to an online format due to the coronavirus disease of 2019 pandemic. [ABSTRACT FROM AUTHOR]

Recently many medical schools have faced the challenge of redesigning their existing assessments to run in a virtual format. We ran a virtual Objective Structured Clinical Examination (OSCE) for a group of final year students assessing clinical communication skills, written communication, practical skills, examination skills and professionalism. OSCEs provide the opportunity to test skills that written papers cannot, so it was important to include such a clinical exam in the portfolio of assessments for graduating students. The virtual OSCE ran smoothly and was successful at discriminating between candidates. In this article, we share twelve practical tips from our experience and the small body of literature on how to successfully design and deliver a virtual OSCE. This format provides an opportunity to run similar assessments in the future if remote assessments or assessments of telemedicine skills are required. [ABSTRACT FROM AUTHOR]

Background: Information and communication technology (ICT) reading interventions can help children with reading difficulties, especially those in resource-constrained environments who otherwise might not have support. Objectives: (1) Provide an overview of ICT reading interventions used globally with primary school children. (2) Provide further information on the subset of studies conducted in majority world countries, describing the interventions used, their impact on reading and challenges faced. Method: A scoping review was used with a search strategy that yielded a total of 49 studies for inclusion in the main review (Objective 1), and a subset of five studies undertaken in the majority world (Objective 2). Results: Most published studies (93.88%, 46 studies) demonstrated positive outcomes of ICT reading interventions on learners’ reading. Well-researched programmes with demonstrated effectiveness included GraphoGame, ABRACADABRA, Reading RACES and Chassymo. Only five studies (10.2%) were conducted in the majority world, but all reported in this subset described positive literacy gains through ABRACADABRA and GraphoGame. Conclusion: There is a growing evidence base of ICT reading interventions that could be helpful in addressing the reading crisis in South Africa. Programmes such as ABRACADABRA and GraphoGame demonstrate effectiveness in a variety of contexts and may have a role to play in addressing the reading challenges faced by children in South Africa. Contribution: The review highlighted evidence supporting the use of ICT reading interventions. Evidence of such approaches in South Africa (and other majority world countries) remains limited and requires further evaluation of both existing and innovative, locally developed interventions.

The study aims to develop and pilot a telehealth social emotional program, MindChip™ delivered with a computer based interventions (CBI) (Mind Reading©) for autistic adults. MindChip™ combined four theoretical perspectives and community feedback underpinning the essential mechanisms for targeting the social emotional understanding of autistic adults. A randomised pragmatic pilot trial (N = 25) was conducted to explore the feasibility of MindChip™ (n = 11) and to understand the preliminary efficacy of combining it with CBI compared to CBI only (n = 14). The use of MindChip™ and CBI combined demonstrated partial feasibility, with preliminary efficacy findings revealing increased emotion recognition generalisation outcomes compared to CBI only. Further research is required to improve the engagement and personalisation of the intervention for autistic adults. [ABSTRACT FROM AUTHOR]

The advances in computer technology have brought the rise of computer-based instructional materials in many different fields including language learning. With regard to listening skill development, one obvious strength of the computer-based instructional materials is its capability of presenting audio component in various ways to improve students’ listening skill. For students who are preparing themselves to take a standardized test like Test of English as a Foreign Language (TOEFL), the materials can even be designed to provide a high degree of customization that can be geared specifically to meet students’ pace of learning. However, it can be a big challenge to design a computer-based listening material capable of ensuring that learning indeed takes place while the students are using and exploring its contents. This paper aims to propose the application of Gagne's nine events of instruction in a computer-based test preparation listening material design. More specifically, this paper tries to provide guidance in the process of developing the user interface and the content presentation within the material as to match each part of the nine events. It is expected that this strategy will successfully activate the required cognitive process of the students and help them achieve established learning objectives.

Objective: Both clinically observable and subclinical hemispatial neglect are related to functional disability. The aim of the present study was to examine whether increasing task complexity improves sensitivity in assessment and whether it enables the identification of subclinical neglect. Method: We developed and compared two computerized dual-tasks, a simpler and a more complex one, and presented them on a large, 173 × 277 cm screen. Participants in the study included 40 patients with unilateral stroke in either the left hemisphere (LH patient group, n = 20) or the right hemisphere (RH patient group, n = 20) and 20 healthy controls. In addition to the large-screen tasks, all participants underwent a comprehensive neuropsychological assessment. The Bells Test was used as a traditional paper-and-pencil cancellation test to assess neglect. Results: RH patients made significantly more left hemifield omission errors than controls in both large-screen tasks. LH patients' omissions did not differ significantly from those of the controls in either large-screen task. No significant group differences were observed in the Bells Test. All groups' reaction times were significantly slower in the more complex large-screen task compared to the simpler one. The more complex large-screen task also produced significantly slower reactions to stimuli in the left than in the right hemifield in all groups. Conclusions: The present results suggest that dual-tasks presented on a large screen sensitively reveal subclinical neglect in stroke. New, sensitive, and ecologically valid methods are needed to evaluate subclinical neglect. [ABSTRACT FROM AUTHOR]

The widespread use of mobile devices among students favors the use of mobile learning scenarios at universities. In this study, we explore whether a time- and location-independent variant of a formative progress test has an impact on the students' acceptance, its validity and reliability and if there is a difference in response processes between the two exam conditions. Students were randomly assigned to two groups of which one took the test free of local or temporal fixations, while the other group took the test at the local testing center under usual examination conditions. Beside the generated test data, such as test score, time-on-test, and semester status, students also evaluated the settings. While there was no significant effect on the test score between the two groups, students in the mobile group spent more time on the test and were more likely to use the help of books or online resources. The results of the evaluation show that the acceptability among students is increased by a mobile version of the formative progress test. The results suggest that the acceptance and motivation to participate in formative tests is enhanced by lifting local and temporal restrictions. The mobile version nonetheless does not have an impact on the students' performance. [ABSTRACT FROM AUTHOR]

A group of 22 medical educators from different European countries, gathered in a meeting in Utrecht in July 2019, discussed the topic of learning analytics (LA) in an open conversation and addressed its definition, its purposes and potential risks for learners and teachers. LA was seen as a significant advance with important potential to improve education, but the group felt that potential drawbacks of using LA may yet be under-exposed in the literature. After transcription and interpretation of the discussion's conclusions, a document was drafted and fed back to the group in two rounds to arrive at a series of 10 caveats educators should be aware of when developing and using LA, including too much standardized learning, with undue consequences of over-efficiency and pressure on learners and teachers, and a decrease of the variety of 'valid' learning resources. Learning analytics may misalign with eventual clinical performance and can run the risk of privacy breaches and inescapability of documented failures. These consequences may not happen, but the authors, on behalf of the full group of educators, felt it worth to signal these caveats from a consumers' perspective. [ABSTRACT FROM AUTHOR]

Computerized cognitive training programs (CCTP) are based on the assumption that cognitive abilities may be boosted by repetitively performing challenging tasks. The integration of game-like features in these programs, associated with the goal of amusing or rewarding participants, may contribute to generate cognitive benefits. Indeed, reinforcement contingencies have been reported to produce positive effects on performance and motivation, especially in children. This meta-analysis was aimed at providing a quantitative summary of the effectiveness of CCTP with game-like features in school-aged children with typical and atypical development. A total of 24 studies, with the cognitive and behavioral outcome data of 1547 participants, were selected for inclusion in the meta-analysis. Subgroup analyses were performed to identify the sources of the observed methodological heterogeneity. A robust variance estimation model, after removal of study outliers, yielded a small-to-moderate significant effect size. Final results pointed out smaller but more precise estimate effect sizes according to methodological aspects related to cognitive domain of outcomes, standardization of measures and type of control applied. Alongside supporting the use of CCTP for rehabilitating cognitive functions, the present results shed light on how different methodological choices are able to shape research findings in the field of children's cognitive rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract Introduction Communication breakdown, a consequence of hearing impairment (HI), is being fought by fitting amplification devices and providing auditory training since the inception of audiology. The advances in both audiology and rehabilitation programs have led to the advent of computer-based auditory training programs (CBATPs). Objective To review the existing literature documenting the evidence-based CBATPs for children with HIs. Since there was only one such article, we also chose to review the commercially available CBATPs for children with HI. The strengths and weaknesses of the existing literature were reviewed in order to improve further researches. Data Synthesis Google Scholar and PubMed databases were searched using various combinations of keywords. The participant, intervention, control, outcome and study design (PICOS) criteria were used for the inclusion of articles. Out of 124 article abstracts reviewed, 5 studies were shortlisted for detailed reading. One among them satisfied all the criteria, and was taken for review. The commercially available programs were chosen based on an extensive search in Google. The reviewed article was well-structured, with appropriate outcomes. The commercially available programs cover many aspects of the auditory training through a wide range of stimuli and activities. Conclusions There is a dire need for extensive research to be performed in the field of CBATPs to establish their efficacy, also to establish them as evidence-based practices.

Interaction element is one of the elements influencing the learning in e-learning environments. This study aimed to compare the effects of computer-based and web-enhanced learning environments on six elements of interaction (student-student, student-teacher, student-content, teacher-teacher, teacher-content and content-content) in the process of Occupational Health course.The study was quasi-experimental with pretest-posttest design with a control group. The population of the study included all students of Public Health at Asadabad Faculty of Medical Sciences in the academic year 2015-2016. Of these, 60 students were selected through a random sampling procedure and were randomly assigned to experimental and control groups (30 per group). The first group (control) was taught in a computer- based and the second one (experimental) was taught in a web-enhanced learning environment. The materials and instruments included instructional multimedia and the questionnaire of assessing six levels of interaction with 60 questions in likert scale. Analysis of covariance (ANCOVA) was used to analyze the gathered data. The results showed that there were significant differences between computer-based and web-enhanced learning environments on six elements of interaction (p

Statement of Problem: Fixed orthodontic appliances in the oral cavity make tooth cleaning procedures more complicated. Objectives: This study aimed to compare the efficacy of computerized oral hygiene instruction with verbal technique among fixed orthodontic patients referred to the evening clinic of Orthodontics of Shiraz Dental School. Materials and Methods: A single-blind study was performed in Orthodontic Department of Shiraz, Islamic Republic of Iran, from January to May 2015 following the demonstrated exclusion and inclusion criteria. The sample size was considered 60 patients with 30 subjects in each group. Bleeding on probing and plaque indices and dental knowledge were assessed in the subjects to determine pre-intervention status. A questionnaire was designed for dental knowledge evaluation. The patients were randomly assigned into the computerized and verbal groups. Three weeks after the oral hygiene instruction, indices of bleeding on probing and plaque index and the dental knowledge were evaluated to investigate post-intervention outcome. The two groups were compared by chi-square and student t tests. The pre- and post- intervention scores in each group were compared using paired t-test. Results: In the computerized group, the mean score for plaque index and bleeding on probing index was significantly decreased while dental health knowledge was significantly increased after oral hygiene instruction, in contrast to the verbal group. Conclusions: Within the limitations of the current study, computerized oral hygiene instruction is proposed to be more effective in providing optimal oral health status compared to the conventional method in fixed orthodontic patients.

Objective: Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands.Methods: First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy.Results: The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy.Conclusion: The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy.Practice Implications: Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid. [ABSTRACT FROM AUTHOR]