A rapid review of serious games: From healthcare education to dental education.

INTRODUCTION: Games involving technology have the potential to enhance hand-eye coordination and decision-making skills. As a result, game characteristics have been applied to education and training, where they are known as serious games. There is an increase in the volume of literature on serious games in healthcare education; however, evidence on their impact is still ambiguous. AIMS: The aims of this study were (i) to identify high-quality evidence (systematic reviews or meta-analyses) regarding impacts of serious games on healthcare education; and (ii) to explore evidence regarding impacts of serious games in dental education. METHODS: A rapid review of the literature was undertaken to synthesise available evidence and examine serious games in healthcare education (Stage 1) and dental education (Stage 2). RESULTS: Nine systematic reviews were included in Stage 1, four of which were of high, three of moderate and two of low quality. For Stage 2, two randomised control trials with moderate quality were included. The findings demonstrated that serious games are potentially effective learning tools in terms of knowledge and skills improvement, although outcomes of serious games over traditional learning approaches were not consistent. In addition, serious games appeared to be more engaging and satisfying for students, which could be considered as the most important positive impact. CONCLUSION: Serious games provide an option for healthcare and dental education but remain underutilised and researched. At best, they offer a similar experience to other methods in relation to educational outcome; however, they can provide a supplementary strategy to engage students and improve learner satisfaction.

Lessons learned on recruitment and retention in hard-to-reach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia.

BACKGROUND: Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS: Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS: The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS: Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION: ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.

KIBRA exhibits MST-independent functional regulation of the Hippo signaling pathway in mammals.

The Salvador/Warts/Hippo (Hippo) signaling pathway defines a novel signaling cascade regulating cell contact inhibition, organ size control, cell growth, proliferation, apoptosis and cancer development in mammals. The upstream regulation of this pathway has been less well defined than the core kinase cassette. KIBRA has been shown to function as an upstream member of the Hippo pathway by influencing the phosphorylation of LATS and YAP, but functional consequences of these biochemical changes have not been previously addressed. We show that in MCF10A cells, loss of KIBRA expression displays epithelial-to-mesenchymal transition (EMT) features, which are concomitant with decreased LATS and YAP phosphorylation, but not MST1/2. In addition, ectopic KIBRA expression antagonizes YAP via the serine 127 phosphorylation site and we show that KIBRA, Willin and Merlin differentially regulate genes controlled by YAP. Finally, reduced KIBRA expression in primary breast cancer specimens correlates with the recently described claudin-low subtype, an aggressive sub-group with EMT features and a poor prognosis.

Willin/FRMD6 expression activates the Hippo signaling pathway kinases in mammals and antagonizes oncogenic YAP.

The Salvador/Warts/Hippo (Hippo) signaling pathway defines a novel signaling cascade regulating cell contact inhibition, organ size control, cell growth, proliferation, apoptosis and cancer development in mammals. The Drosophila melanogaster protein Expanded acts in the Hippo signaling pathway to control organ size. Previously, willin/FRMD6 has been proposed as the human orthologue of Expanded. Willin lacks C-terminal sequences that are present in Expanded and, to date, little is known about the functional role of willin in mammalian cells. When willin is expressed in D. melanogaster epithelial tissues, it has the same subcellular localization as Expanded, but cannot rescue growth defects associated with expanded deficiency. However, we show that ectopic willin expression causes an increase in phosphorylation of the core Hippo signaling pathway components MST1/2, LATS1 and YAP, an effect that can be antagonized by ezrin. In MCF10A cells, loss of willin expression displays epithelial-to-mesenchymal transition features and willin overexpression antagonizes YAP activity via the N-terminal FERM domain of willin. Therefore, in mammalian cells willin influences Hippo signaling activity by activating the core Hippo pathway kinase cassette.

Effectiveness and acceptability of face-to-face, blended and e-learning: a randomised trial of orthodontic undergraduates.

AIM: This study compared e-learning (EL), face-to-face learning (F2FL) and blended learning (BL) with respect to their effectiveness and student attitudes towards them. It also evaluated the effect of the order in which the components (EL and F2FL) of blended learning are delivered. DESIGN: This was a prospective cluster randomised trial comparing four parallel groups. METHOD: Eight groups of fourth year dental undergraduate students were randomly allocated to one of four intervention groups: EL, F2FL, BL1 or BL2. These four groups were assessed for their baseline comparability of knowledge and skills. Each then received the same cephalometric tutorial but delivered by the allocated mode of learning. Effectiveness was immediately assessed with a MCQ which measured short-term recall of knowledge. Student attitudes were evaluated with a questionnaire followed by a focus group discussion. RESULTS: Ninety (57%) students completed the study. Pearson's chi-square test found no statistically significant difference between F2FL and BL; EL alone was less effective (P<0.05) for four MCQ questions but with no difference for the remaining six questions. Overall students were positive towards each learning modality, but a one-way analysis of variance found BL was the most and F2FL was the least accepted (P=0.002). EL was significantly (P=0.028) less preferred. The order of the components in BL had no significant effects. CONCLUSION: These results suggest that BL is more likely than either F2FL or EL alone, to be both effective and accepted when delivering cephalometric education to undergraduates.

Online learning in dentistry: an overview of the future direction for dental education.

This paper provides an overview of the diversity of tools available for online learning and identifies the drivers of online learning and directives for future research relating to online learning in dentistry. After an introduction and definitions of online learning, this paper considers the democracy of knowledge and tools and systems that have democratized knowledge. It identifies assessment systems and the challenges of online learning. This paper also identifies the drivers for online learning, including those for instructors, administrators and leaders, technology innovators, information and communications technology personnel, global dental associations and government. A consideration of the attitudes of the stakeholders and how they might work together follows, using the example of the unique achievement of the successful collaboration between the Universities of Adelaide, Australia and Sharjah, United Arab Emirates. The importance of the interaction of educational principles and research on online learning is discussed. The paper ends with final reflections and conclusions, advocating readers to move forward in adopting online learning as a solution to the increasing worldwide shortage of clinical academics to teach dental clinicians of the future.

Sizing, stoichiometry and optical absorbance variations of colloidal cadmium sulphide nanoparticles.

Simple preparative methods were used to synthesise cadmium sulphide particles in the size ranges larger than those associated with quantum confinement. UV/visible absorption spectra were measured. Rayleigh and Mie theories were used to analyse normalised absorption spectra to allow estimates of particle size and number to be obtained simultaneously. Each model was utilised in an appropriate size and wavelength range. Surprisingly, Mie calculations were found to over-estimate the absorbance of particles below 50 nm radius. Powder X-ray diffraction results showed the crystallites to be independent of particle size and suggested that the particles grew through aggregation of smaller bodies. The Mie results could therefore be interpreted in terms of changes in the particles' optical indicatrix with radius. Large poly-crystalline particles (>50 nm radius) should possess a near spherical indicatrix, fulfilling the assumptions of the Mie theory. The indicatrix of particles smaller than 50 nm should become increasingly anisotropic with decreasing size, leading to discrepancies between the Mie model and measured data. Although the results could also be explained through changes in the magnitude of the particle refractive index, compositional (Auger electron spectroscopy, energy dispersive X-ray analysis) and structural (powder X-ray diffraction) analyses of the particles complicate the hypothesis. Energy dispersive X-ray results showed that small cadmium sulphide particles possessed a large excess of sulphur suggesting a change in effective cadmium sulphide stoichiometry.

A vision of dental education in the third millennium.

This paper is the last in a series of 16 which have explored current uses of information communications technology (ICT) in all areas of dentistry in general, and in dental education in particular. In this paper the authors explore current developments, referring back to the previous 15 papers, and speculate on how ICT should increasingly contribute to dental education in the future. After describing a vision of dental education in the next 50 years, the paper considers how ICT can help to fulfil the vision. It then takes a brief look at three aspects of the use of ICT in the world in general and speculates how dentistry can learn from other areas of human endeavour. Barriers to the use of ICT in dental education are then discussed. The final section of the paper outlines new developments in haptics, immersive environments, the semantic web, the IVIDENT project, nanotechnology and ergonometrics. The paper concludes that ICT will offer great opportunities to dental education but questions whether or not human limitations will allow it to be used to maximum effect.

Nine years of DentEd--a global perspective on dental education.

This paper describes the three successive and successful DentEd projects, funded by the European Union, that established a productive thematic network which identified common content within the dental curriculum. It then developed an agreed professional profile, with a defined set of competences and a modular curriculum for all new dental graduates based on the European Credit Transfer System and trends in learning and assessment. The three phases took nine years to complete. Phase one investigated all aspects of dental undergraduate education and included over 30 visits to different dental schools by teams of dental educators. Phase two built on this work and included further visits to dental schools. Phase three refined the competency framework that had been developed in phase two and culminated in a global dental conference which finalised position papers on all aspects of dental education. The work and recommendations of the ICT in dental education group are considered in detail in the paper. The projects provided the stimulus for a number of European and international collaborations, including the web-based International Federation of Dental Education and Associations (IFDEA) Knowledge Centre and the International Virtual Dental School (IVIDENT), both of which aim to make increasingly sophisticated ICT-based educational material available worldwide and to promote international understanding.

Assuring quality.

All those involved in education have a strong motivation to ensure that all its aspects, including content and teaching practice, are of the highest standard. This paper describes how agencies such as the Quality Assurance Agency for Higher Education (QAA) and the General Dental Council (GDC) have established frameworks and specifications to monitor the quality of education provided in dental schools and other institutes that provide education and training for dentists and dental care professionals (DCPs). It then considers quality issues in programme and course development, techniques for assessing the quality of education, including content and presentation, and the role of students. It goes on to review the work that has been done in developing quality assessment for distance learning in dentistry. It concludes that, to date, much of the work on quality applies to education as a whole and that the assessment of the quality of e-learning in dentistry is in its infancy.

Making a mark--taking assessment to technology.

During any course of study, students are assessed usually through a range of methods which may include written examinations, coursework assignments, professional practice, oral tests and practical examinations. This article considers the various forms of assessment in dental education and how information and communication technology is being applied to them. As innovative teaching and learning methods such as computer simulations are introduced, the assessment of results, successes and failures is taking on new forms in many traditional courses. The web is also spreading its tentacles into assessment, with the benefits of offering almost instant feedback and support. However, technology brings its own problems, not least by making ever more ingenious methods of plagiarism easier. Educational establishments, therefore, must be aware of such problems and have policies in place to counteract them.

Continuing professional development and ICT: target practice.

Ever-increasing needs and demands by dentists and all other members of the dental team for education and training at all levels - undergraduate, postgraduate and continuing - are straining the resources of existing providers of such education. At the same time, there are ever-increasing opportunities to develop online delivery and the use of a range of information and communication technology (ICT) systems and services further, in all aspects of dental education. This paper reviews recent developments that have led to an increased demand for dental postgraduate programmes and continuing professional development (CPD) courses in the United Kingdom and then discusses how ICT has and will impact on teaching practice. Examples include the use of teaching and learning resources in a virtual learning environment (VLE) and the increasing use of blended learning. The paper then explores the need for both teachers and students to adapt to the new environment to ensure they can benefit to the maximum and that teaching and learning practices are changed accordingly.

Supporting the learner and teacher online.

Whether on or off campus, all students need support if they are to successfully complete their studies. Although 'good teachers' should be 'good teachers' in any medium, their support is especially important when technology is involved. Previous articles in the series have shown that the advent of ICT has added to the complexity of the type and provision of this help and advice, not least because it now involves technical as well as pedagogical and pastoral elements. However, rather than being a problem, ICT, particularly through its online facilities, can provide levels of support over and above those required by traditional face-to-face teaching. This has implications for tutors as well as students as it places greater pressure on their time and requires them to have a new skills-set, a situation that needs to be resolved if the full benefits of online support are to be realised.

An intricate web - designing and authoring a web-based course.

The Internet offers a great opportunity to deliver dental education in new ways. However, to achieve the maximum benefit from this medium, it is necessary to understand its strengths and weaknesses and, above all, not to lose sight of the key principle that in education it is the message and not the messenger (the content and not the medium) that should be given priority. After a brief introduction, this paper considers the principles of designing online programmes. It stresses the need for ensuring that students have easy access to the materials that have been designed and then describes 'learning objects' and virtual learning environments (VLEs). It concludes that with some notable exceptions, dental educators have hardly begun to grasp the benefits of web-based teaching and learning.

The many faces of interaction.

During the process of learning teachers and/or students interact with each other on a personal level. However, in e-learning the process is achieved through the intermediary of an information and communication technology (ICT) system or service. Descriptions of these ICT-human interface devices are given in this paper. Successful interaction depends not just on personal relationships, but also on understanding and the ability to use computers and communications equipment effectively. Interactivity, when using ICT, may as a result be different from that in a traditional classroom. The computer is the main man-machine interface and modulates people's ability to interact. Newer, mobile technology will extend the ability to interact in terms of time and place, as is illustrated by the use of portable digital assistants for dental teaching in clinics. The paper concludes that it is very important that both teachers and students should understand how to interact optimally with current and future ICT systems and devices.

Remember the days in the old school yard: from lectures to online learning.

Claims have been made that the traditional classroom/lecture-room mode of teaching is under threat with the future being purely online-based. There is no doubt that the impact of ICT systems and services have and will continue to transform teaching practice. From PowerPoint slides introduced to enliven lectures to virtual reality models accessed remotely, technology is bringing about new educational paradigms. The result is the emergence of new forms of distance learning with terms such as flexible learning, blended learning and full online instruction. All are making major contributions to the student experience, allowing access to more information and greater resources as well as opportunities for learning in a manner and timescale that is more attuned to their aims, abilities and lifestyles. In dental education the transition is providing undergraduates, postgraduates and CPD students with a greater variety of courses, access to more expertise and the opportunity for lifetime learning.

Better informed in clinical practice - a brief overview of dental informatics.

Uptake of dental informatics has been hampered by technical and user issues. Innovative systems have been developed, but usability issues have affected many. Advances in technology and artificial intelligence are now producing clinically useful systems, although issues still remain with adapting computer interfaces to the dental practice working environment. A dental electronic health record has become a priority in many countries, including the UK. However, experience shows that any dental electronic health record (EHR) system cannot be subordinate to, or a subset of, a medical record. Such a future dental EHR is likely to incorporate integrated care pathways. Future best dental practice will increasingly depend on computer-based support tools, although disagreement remains about the effectiveness of current support tools. Over the longer term, future dental informatics tools will incorporate dynamic, online evidence-based medicine (EBM) tools, and promise more adaptive, patient-focused and efficient dental care with educational advantages in training.