Game design elements of serious games in the education of medical and healthcare professions: a mixed-methods systematic review of underlying theories and teaching effectiveness.

Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game's effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements' underlying theories will be worked out, and third, the game design elements' effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games.

CGRWDL: alignment-free phylogeny reconstruction method for viruses based on chaos game representation weighted by dynamical language model.

Traditional alignment-based methods meet serious challenges in genome sequence comparison and phylogeny reconstruction due to their high computational complexity. Here, we propose a new alignment-free method to analyze the phylogenetic relationships (classification) among species. In our method, the dynamical language (DL) model and the chaos game representation (CGR) method are used to characterize the frequency information and the context information of k-mers in a sequence, respectively. Then for each DNA sequence or protein sequence in a dataset, our method converts the sequence into a feature vector that represents the sequence information based on CGR weighted by the DL model to infer phylogenetic relationships. We name our method CGRWDL. Its performance was tested on both DNA and protein sequences of 8 datasets of viruses to construct the phylogenetic trees. We compared the Robinson-Foulds (RF) distance between the phylogenetic tree constructed by CGRWDL and the reference tree by other advanced methods for each dataset. The results show that the phylogenetic trees constructed by CGRWDL can accurately classify the viruses, and the RF scores between the trees and the reference trees are smaller than that with other methods.

Nonlinear social evolution and the emergence of collective action.

Organisms from microbes to humans engage in a variety of social behaviors, which affect fitness in complex, often nonlinear ways. The question of how these behaviors evolve has consequences ranging from antibiotic resistance to human origins. However, evolution with nonlinear social interactions is challenging to model mathematically, especially in combination with spatial, group, and/or kin assortment. We derive a mathematical condition for natural selection with synergistic interactions among any number of individuals. This result applies to populations with arbitrary (but fixed) spatial or network structure, group subdivision, and/or mating patterns. In this condition, nonlinear fitness effects are ascribed to collectives, and weighted by a new measure of collective relatedness. For weak selection, this condition can be systematically evaluated by computing branch lengths of ancestral trees. We apply this condition to pairwise games between diploid relatives, and to dilemmas of collective help or harm among siblings and on spatial networks. Our work provides a rigorous basis for extending the notion of "actor", in the study of social evolution, from individuals to collectives.

Exploring the Reasons for Preferring Digital Games Over Physical Activity Games in Adolescents: A Qualitative Study.

PURPOSE: In the current world, adolescents are less likely to turn to physical activity games and often prefer to spend more time in the technological and digital world and have fun with digital games. This study aimed to explore reasons for preferring digital games to physical activity games in adolescents. METHODS: Twenty-one adolescents participated in this qualitative study. The participants' age ranged from 11 to 19 who participated in semistructured interviews. The recorded interviews underwent thematic analysis to identify overall themes. RESULTS: Five overall themes were identified from the interviews regarding reasons for preferring digital games over physical activity games. Identified themes included game characteristics, game space, game outcomes, peer pressure, and accessibility. DISCUSSION: The findings of this research contribute to design adolescent-centered interventions that sustain/increase adolescents' interest in physical activity games and protect them from excessive/harmful use of digital games.

External post-mortem examination in virtual reality-scalability of a monocentric application.

Conducting external post-mortem examinations is an essential skill required of physicians in various countries, regardless of their specialization. However, the quality of these examinations has been a subject of continuous debates, and notable errors were reviled. In response to these shortcomings, a virtual reality (VR) application was developed at Halle's medical department in Germany, focusing on the scene of discovery and the completion of death certificates. The initial trial of this VR application in 2020 involved 39 students and 15 early-career professionals. Based on the feedback, the application underwent improvements and was subsequently introduced to the medical department in Dresden, Germany, in 2022. Its primary objective was to showcase the VR training's adaptability and scalability across various educational structures and levels of medical expertise. Out of 73 students who participated, 63 completed the evaluation process. 93.1% (n = 58) of the evaluators reported increased confidence in conducting external post-mortem examinations, and 96.8% (n = 61) felt more assured in filling out death certificates, crediting this progress to the VR training. Additionally, 98.4% (n = 62) believed that repeating forensic medical aspects in their coursework was crucial, and 96.8% (n = 61) viewed the VR examination as a valuable addition to their academic program. Despite these positive responses, 91.6% (n = 55) of participants maintained that training with real corpses remains irreplaceable due to the insufficiency of haptic feedback in VR. Nevertheless, the potential for enhancing the VR content and expanding the training to additional locations or related disciplines warrants further exploration.

Comparing the effectiveness of game literacy education and game coding education in improving problematic internet gaming.

Objective: Problematic internet gaming by adolescents has been thought to be associated with low self-esteem, depression, anxiety, and attention problems. We hypothesized that both game literacy and coding education would effectively improve problematic internet use. However, game coding education would be more effective in enhancing self-esteem and social anxiety in adolescents than game literacy education. Methods: A total of 733 adolescent volunteers were included and randomly assigned to either the game coding education or game literacy education programs. Both programs consisted of eight sessions, each lasting 45 minutes, over four weeks. The coding education sessions included game planning and development lessons and allowed students to create the game's characters, stages, and tutorials directly using Scratch, a free coding program. Game literacy education sessions included lessons on enjoying gaming with a healthy rationale and etiquette. Data on demographics, gaming patterns, and psychological status, including positive/negative perceptions of online games, depression, social anxiety, and self-esteem, were collected. Results: Both game coding and game literacy education significantly improved YIAS scores compared to baseline, and there was no significant difference in the YIAS scores between the two groups after the interventions. In the hierarchical logistic regression analysis of all participants, higher YIAS scores, stronger negative perceptions of gaming, and lower attention problem scores at baseline predicted lower levels of internet gaming addiction after interventions. In the hierarchical logistic regression analysis among individuals with game coding education, higher YIAS scores, stronger negative perceptions of gaming, lower attention problem scores, and higher self-esteem scores at baseline predicted lower levels of internet gaming addiction after intervention. In addition, game coding education greatly improved negative perceptions of games, self-esteem, and social anxiety compared to game literacy education. Conclusion: Both game literacy and game coding education effectively mitigate internet game addiction. However, game coding education effectively mitigated problematic internet gaming by improving negative perceptions of games, self-esteem, and social anxiety in adolescents. We found that the application of knowledge by students in creating their own games was more effective than simply developing a conceptual understanding of the games.

We know that we don't know: Children's understanding of common ignorance in a coordination game.

Common ground is the knowledge, beliefs, and suppositions shared between partners in an interaction. Previous research has focused extensively on what partners know they know together, that is, "common knowledge." However, another important aspect of common ground is what partners know they do not know together, that is, "common ignorance." A new coordination game was designed to investigate children's use of common ignorance. Without communicating or seeing each other's decisions, 4- to 8-year-olds needed to make the same decision as their partner about whether to try to retrieve a reward. To retrieve it, at least one of them needed to know a secret code. The knowledge/ignorance of both partners was ostensively manipulated by showing one partner, both partners, or neither partner the secret code in four conditions: common knowledge (both knew the code), common ignorance (neither partner knew the code), common privileged self knowledge (only children knew the code), and common privileged other knowledge (only their partner knew the code). Children's decisions, latency, and uncertainty were coded. Results showed that the common ignorance states were generally more difficult than the common knowledge states. Unexpectedly, children at all ages had difficulty with coordinating when their partner knew the code but they themselves did not (common privileged other knowledge). This study shows that, along with common knowledge, common ignorance and common privileged self knowledge and other knowledge also play important roles in coordinating with others but may develop differently.

Competitive Video Game Exposure Increases Aggression Through Impulsivity in Chinese Adolescents: Evidence From a Multi-Method Study.

It is widely known controversies about the results of violent video game increase aggression. However, the role of competitive video games, has received less research attention, and the underlying mechanisms of their influence are unknown. This study aimed to expand the existing literature by systematically exploring the effects of competitive video game exposure on adolescent aggression and the mediating role of impulsivity. In so doing, three types of studies (collectively N = 2919, mean age varied from 13.75 to 15.44 years, with a balanced gender) combining cross-sectional, experimental, and longitudinal approaches, were conducted. The findings consistently show that competitive video game exposure increased adolescents' aggression and impulsivity. Also, impulsivity mediated the correlation and long-term effect of competitive video game exposure on aggression. However, the experimental study did not confirm the short-term mediating effect of impulsivity, which may be related to the type of aggression measured in the study. The results indicate that competitive video game exposure is an important antecedent factor for adolescent aggression, and impulsivity is the key underlying mechanism.

A Three-branch Jointed Feature and Topology Decoder guided by game-theoretic interactions for temporomandibular joint segmentation.

Segmentation of the temporomandibular joint (TMJ) disc and condyle from magnetic resonance imaging (MRI) is a crucial task in TMJ internal derangement research. The automatic segmentation of the disc structure presents challenges due to its intricate and variable shapes, low contrast, and unclear boundaries. Existing TMJ segmentation methods often overlook spatial and channel information in features and neglect overall topological considerations, with few studies exploring the interaction between segmentation and topology preservation. To address these challenges, we propose a Three-Branch Jointed Feature and Topology Decoder (TFTD) for the segmentation of TMJ disc and condyle in MRI. This structure effectively preserves the topological information of the disc structure and enhances features. We introduce a cross-dimensional spatial and channel attention mechanism (SCIA) to enhance features. This mechanism captures spatial, channel, and cross-dimensional information of the decoded features, leading to improved segmentation performance. Moreover, we explore the interaction between topology preservation and segmentation from the perspective of game theory. Based on this interaction, we design the Joint Loss Function (JLF) to fully leverage the features of segmentation, topology preservation, and joint interaction branches. Results on the TMJ MRI dataset demonstrate the superior performance of our TFTD compared to existing methods.

The relationship between game genre, monetization strategy and symptoms of gaming disorder in a clinical sample of adolescents.

Background: Gaming disorder (GD) has been introduced as a new diagnosis in the International Classification of Disease 11 (ICD-11). Currently, there's limited understanding of how various video games may differentially contribute to the risk of developing GD. The main aim of this study was to examine the relationship between individuals' game genre preferences, their preferred games' monetization strategies, and GD Symptoms. Methods: A total of 85 patients undergoing treatment for GD at a child and youth psychiatric clinic were included in the study. Their preferred games were classified into five novel genres based on gameplay similarities and objectives, and further categorized based on their monetization strategy. Results: Symptom burden of GD, measured with Game Addiction Scale for Adolescents (GASA), was highest for those playing Free-to-Play (F2P) games and lowest for Pay-to-Play (P2P) players. Players of Competitive Games endorsed higher GD symptom burden, whereas players of Story-driven games reported lower GD symptom burden. Symptoms of GD were associated with attention-deficit hyperactivity disorder (ADHD) diagnosis in males. Conclusions: This study reveals that game genre preference is influenced by sex, age, and certain psychiatric diagnoses. The categorizing of games into genres is increasingly complex and our research introduces a novel categorization in a developing research field. The result of this study suggests that the monetization model is important to consider while trying to understand the relationship between game characteristics and GD symptoms.

Understanding Senior Adults' Needs, Preferences, and Experiences of Commercial Exergames for Health: Usability Study.

BACKGROUND: Many senior adults are at risk of mental and physical disorders due to a lack of sufficient exercise. Therefore, adherent exercise should be urgently promoted to improve senior adults' muscle strength, preventing falls and conditions caused by physical and cognitive decline. However, off-the-shelf exercise games, so-called exergames, are mainly targeted at the younger generation or children, while senior adults are neglected, when this age group strongly needs exercise. Exergames could serve as a health intervention for promoting exercise. OBJECTIVE: This study aimed to investigate senior adults' experience, perceptions, and acceptance of game technology to promote exercise in order to suggest game design guidelines. METHODS: In this usability study, participants engaged in playing Nintendo Switch and Xbox Kinect games, after which semistructured interviews were conducted. Before the gameplay, the participants provided their background information, exercise habits, and use of technology products. Next, all participants completed a workshop including 3 activities (brief instructions on how to play the games: 20 minutes; playing the selected exergames: 80 minutes; semistructured interviews: 20 minutes) for 2 hours a day for 3 days each. The participants played the latest Nintendo Switch games (eg, Just Dance, Boxing, Ring Fit Adventure) and Xbox Kinect games (eg, Kinect Adventures!, Mini Games). Just Dance, Zumba, and Boxing were played in activity 1; Ring Fit Adventure and Mini Games in activity 2; and Kinect Adventures! in activity 3. Reflexive thematic analysis was applied to identify the relative themes generated from the interviews. RESULTS: In total, 22 participants (mean age 70.4, SD 6.1 years) were enrolled in the workshop in May 2021. The results of the generated themes included incomprehension of game instructions, psychological perception of game technology, and game art preferences. The subthemes generated from game art preferences included favorite game genres, characters, and scenes. CONCLUSIONS: There is a significant need for customized game tutorials considering senior adults' cognitive and physical aging. Furthermore, the adventure game genre is preferable to other games. Humanlike game characters are preferable, especially those with a fit and healthy body shape. Nature scenes are more enjoyable than indoor stages or rooms. Furthermore, the game intensity design and playing time should be carefully planned to meet the World Health Organization's criteria for physical activity in older adults. Intelligent recommendation systems might be helpful to support older adults with various health conditions. The guidelines suggested in this study might be beneficial for game design, exercise training, and game technology adoption of exergames for older adults to improve health.

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial.

BACKGROUND: Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. OBJECTIVE: The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS. METHODS: This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. RESULTS: In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. CONCLUSIONS: Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

Cue-driven microbial cooperation and communication: evolving quorum sensing with honest signaling.

BACKGROUND: Quorum sensing (QS) is the ability of microorganisms to assess local clonal density by measuring the extracellular concentration of signal molecules that they produce and excrete. QS is also the only known way of bacterial communication that supports the coordination of within-clone cooperative actions requiring a certain threshold density of cooperating cells. Cooperation aided by QS communication is sensitive to cheating in two different ways: laggards may benefit from not investing in cooperation but enjoying the benefit provided by their cooperating neighbors, whereas Liars explicitly promise cooperation but fail to do so, thereby convincing potential cooperating neighbors to help them, for almost free. Given this double vulnerability to cheats, it is not trivial why QS-supported cooperation is so widespread among prokaryotes. RESULTS: We investigated the evolutionary dynamics of QS in populations of cooperators for whom the QS signal is an inevitable side effect of producing the public good itself (cue-based QS). Using spatially explicit agent-based lattice simulations of QS-aided threshold cooperation (whereby cooperation is effective only above a critical cumulative level of contributions) and three different (analytical and numerical) approximations of the lattice model, we explored the dynamics of QS-aided threshold cooperation under a feasible range of parameter values. We demonstrate three major advantages of cue-driven cooperation. First, laggards cannot wipe out cooperation under a wide range of reasonable environmental conditions, in spite of an unconstrained possibility to mutate to cheating; in fact, cooperators may even exclude laggards at high cooperation thresholds. Second, lying almost never pays off, if the signal is an inevitable byproduct (i.e., the cue) of cooperation; even very cheap fake signals are selected against. And thirdly, QS is most useful if local cooperator densities are the least predictable, i.e., if their lattice-wise mean is close to the cooperation threshold with a substantial variance. CONCLUSIONS: Comparing the results of the four different modeling approaches indicates that cue-driven threshold cooperation may be a viable evolutionary strategy for microbes that cannot keep track of past behavior of their potential cooperating partners, in spatially viscous and in well-mixed environments alike. Our model can be seen as a version of the famous greenbeard effect, where greenbeards coexist with defectors in a evolutionarily stable polymorphism. Such polymorphism is maintained by the condition-dependent trade-offs of signal production which are characteristic of cue-based QS.

Video game addiction is associated with early stage of inhibitory control problems: An event-related potential study using cued Go/NoGo task.

Video game addiction (VGA) is associated with cognitive problems, particularly deficits in inhibitory control. The present study aimed to investigate behavioural responses and event-related potential associated with specific response inhibition using the cued Go/NoGo task to examine the effects of VGA on brain activity related to response inhibition. Twenty-five individuals addicted to video games (action video games) and 25 matched healthy controls participated in the study. The results showed that the VGA group had significantly more commission error in the NoGo trials and faster reaction time in the Go trials compared with the control group. The event-related potential analyses revealed significant reductions in amplitudes of N2 cue and N2 NoGo in the VGA group. While there was no significant difference between the N2 amplitudes of the Go and NoGo trials in the VGA group, the control group had a larger N2 amplitude in the NoGo trials. These results indicate that VGA subjects have difficulties in the early stages of response inhibition, as well as some level of impairment in proactive cognitive control.

Internet/Video Gaming: The Relevance of a New Phenomenon in the Youth.

The high level of technological growth in contemporary society, beside benefits, provokes different kinds of damages, especially among the worldwide youth population. World statistics have recognized that video and internet game addiction is a growing problem. In this context, it is supposed that 0.3 to 1.0 percent of the general population might be qualified as a potential sufferer of internet gaming disorder. However, youth between 18-34 years are the highest risk population. New research has shown the need of early identification of at-risk young people for internet addiction. Adverse experience in children of different forms of stress, negative life circumstances and especially negative, hostile parenting can lead to depression, social and cultural problems, together with significant boredom and loneliness levels. These are all confirmed to be related with addictive behaviour. Some neural correlates are discussed as the possible background of game addiction. Finally, therapeutic possibilities are presented.

Promoting teachers' wellbeing through a serious game intervention: a qualitative exploration of teachers' experiences.

Introduction: Teachers' wellbeing plays a critical role in their overall job satisfaction, motivation, and effectiveness in building supporting learning environments. In today's dynamic educational settings, where teachers often face numerous challenges and stressors, their wellbeing becomes increasingly vital. Consequently, there is an urgent need to innovate and develop targeted training interventions that can support specifically the wellbeing of educators. Methods: This study sought to provide an overview of the "Online Wellbeing Course - OWC," a serious game developed to enhance teachers' wellbeing, and to investigate the participants' feedback after being engaged in the OWC, utilizing a qualitative approach through focus group discussions. A total of 189 in-service teachers took part in the study. To qualitatively explore their experiences with the OWC, participants were involved in focus groups and asked to provide feedback about how and to what extent the course was beneficial for their wellbeing. Results: Teachers reported enhancements in areas such as emotional competence, self-care strategies, social awareness, relationship skills, decision-making, and school climate. Discussion: These outcomes suggested the potential of serious games as an innovative training approach for supporting teachers' wellbeing, offering valuable insights for researchers, policymakers, and educators.

Does hunted wild boar meat meet modern consumer nutritional expectations?

The present study aimed to evaluate the nutritional characteristics of hunted wild boar (WB) meat and compare them with those of meat from analogous domestic animals (pigs) reared in two different rearing systems: indoor-intensive (PI) and outdoor-extensive (PO). WB meat showed a lower amount of lipid content compared to pork and a higher antioxidant activity compared to PI and PO. The comparison of the fatty acid composition of WB and domestic pig reveals significant differences in saturated fatty acids (SFA) and polyunsaturated fatty acids (PUFA), with WB having the highest PUFA level and the lowest SFA level. The omega 6/omega 3 (n-6/n-3) PUFA ratio, PUFA/SFA, atherogenic and thrombogenic indices (AI and TI), as well as the hypocholesterolemic/ hypercholesterolemic index (h/H), were calculated. The n-6/n-3 PUFA ratio was higher in pork independently of the rearing system. The PUFA/SFA ratio of WB meat was above the minimum ratio of 0.40 recommended to contribute to a reduction in the risk of coronary diseases in pork from both rearing systems. AI and TI were lower in WB meat compared to commercially reared pigs, while h/H was higher in WB in comparison with pork meat. WB meat shows good nutritional quality; therefore, the use of game meat as a food source could be appropriate and could benefit contemporary consumers looking for "green" and high-nutritional products.

Differential game analysis of joint emission reduction decisions under mixed carbon policies and CEA.

To understand joint emission reduction (JER) of upstream and downstream firms under a low-carbon operational environment, this study incorporates green technology, remanufacturing, low-carbon promotion, consumer environmental awareness (CEA), and mixed carbon policies (carbon tax + cap-and-trade) into a dynamic framework to investigate JER decisions of the upstream manufacturer and the downstream retailer. Applying the differential game theory, we consider low-carbon goodwill as the state variable and explore members' optimal decisions in four cases, namely, idealized case, noncooperative case, unilateral cost-sharing contract (UCSC) case, and bilateral cost-sharing contract (BCSC) case. Our results show that the noncooperative case leads to a loss of efficiency in joint emission reduction. Although the BCSC is more advantageous than the UCSC in improving the efficiency of JER, a profit redistribution mechanism needs to be included, and the profit distribution ratio should be controlled within a certain interval. Only in this situation do both parties prefer the BCSC. Additionally, the impact of mixed carbon policies and CEA on JER decisions, low-carbon goodwill, profits, and coordination are fully discussed, and it is found that in the face of stricter mixed carbon policies, the downstream retailer plays a moderating role only in cooperative cases. Several practical implications are concluded for JER, contract design, CEA, and carbon policies. Governments and firms can benefit from our research by gaining a deeper understanding of JER.

Effects of game-based learning integrated with the self-regulated learning strategy on nursing students' entrustable professional activities: A quasi-experimental study.

BACKGROUND: In the field of nursing education, the expertise and knowledge required to perform Leopold's Maneuvers are critical, forming an integral part of Entrustable Professional Activities for nursing students. As a result, mastering Leopold's Maneuvers has become a core component of nursing education. Despite this, the prevailing didactic methods in many nursing courses tend to limit interactive and contextual learning experiences, which can hinder students' ability to engage deeply with the subject matter. This lack of engagement may subsequently affect both the effectiveness of students' learning and students' clinical judgment capacity, essential elements in the competencies of Entrustable Professional Activities. METHODS: A quasi-experimental design was employed in this study, involving a total of 55 nursing university students, with 28 participants in the experimental group and 27 in the control group. The research incorporated game-based learning integrated with the self-regulated learning strategy, and employed a pretest, posttest, and questionnaires to assess students' learning performance, self-efficacy, and learning motivation. The experimental group participated in game-based learning with the self-regulated learning strategy, whereas the control group experienced game-based learning without the integration of self-regulated learning. Learning performance was analyzed using an independent samples t-test, while Analysis of Covariance was employed to compare the self-efficacy and learning motivation of the two groups. RESULTS: The findings showed that the integration of game-based learning with the self-regulated learning strategy can significantly improve students' learning performance, self-efficacy, and learning motivation. CONCLUSION: As an integral part of Entrustable Professional Activities, Leopold's Maneuvers were integrated into an interactive game-based learning environment, coupled with the self-regulated learning strategy in nursing education. This approach aimed at cultivating core competencies among nursing students. This study has demonstrated its efficacy in engaging students effectively, serving as a dynamic resource for immersive learning in Leopold's Maneuvers, aligning well with the design considerations for promoting Entrustable Professional Activities in nursing education.

Restricting supply of tobacco products to pharmacies: a scoping review.

OBJECTIVE: We synthesised the published literature on proposals to restrict tobacco supply to pharmacies, covering (1) policy concept/rationale/attempts, (2) policy impact and implementation and (3) policy and research recommendations. DATA SOURCES: We searched eight databases (PubMed, CINAHL, Scopus, Web of Science, Embase, IPA, ProQuest and OATD) for publications with at least an English-language abstract. We searched reference lists of included publications manually. STUDY SELECTION: One author screened all publications, and a second author reviewed a 10% subset. We focused on approaches to restrict the supply of tobacco products to pharmacies, without any restrictions on study design, location, participants or publication date. DATA EXTRACTION: Data extraction adhered to the JBI Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS: We included 18 publications. Among the 13 studies conducted in specific geographical contexts, 8 were from Aotearoa/New Zealand. Most publications (n=8) focused on effectiveness domains, indicating potential reductions in retailer density, smoking prevalence, disease burden, cost and increased opportunities for cessation advice. Seven explored policy acceptability among experts, pharmacists and people who smoke. Publications noted that pharmacy-only supply aligns with other programmes involving pharmacists, such as needle exchange programmes, but conflicts with efforts to phase out tobacco sales from the US and Canadian pharmacies. CONCLUSIONS: Progress in tobacco retailing policy (eg, licensing, retailer incentives) and research (eg, assessment of policy equity and durability, application in other geographical contexts) are needed before a pharmacy-only tobacco supply model would be feasible.