***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Virtual environments offer a variety of benefits and may be a powerful medium with which to provide nursing education . The objective of this study was to compare the achievement of learning outcomes of undergraduate nursing students when a virtual patient trainer or a traditional lecture was used to teach pediatric respiratory content . Methods This was a r and omized , controlled , posttest design . A virtual pediatric hospital unit was populated with four virtual pediatric patients having different respiratory diseases that were design ed to meet the same learning objectives as a traditional lecture . The study began in Spring 2010 with 93 Senior I , baccalaureate nursing students . Students were r and omized to receive either a traditional lecture or an experience with a virtual patient trainer .  Students ’ knowledge acquisition was evaluated using multiple-choice questions , and knowledge application was measured as timeliness of care in two simulated clinical scenarios using high-fidelity mannequins and st and ardized patients . Results Ninety-three students participated in the study , of which 46 were in the experimental group that received content using the virtual patient trainer . After the intervention , students in the experimental group had significantly higher knowledge acquisition ( P = 0.004 ) and better knowledge application ( P = 0.001 ) for each of the two scenarios than students in the control group . Conclusions The purpose of this project was to compare a virtual patient trainer to a traditional lecture for the achievement of learning outcomes for pediatric respiratory content . Although the virtual patient trainer experience produced statistically better outcomes , the differences may not be clinical ly significant . The results suggest that a virtual patient trainer may be an effective substitute for the achievement of learning outcomes that are typically met using a traditional lecture format . Further research is needed to underst and how best to integrate a virtual patient trainer into undergraduate nursing education BACKGROUND An important facet of laparoscopic surgery is its psychomotor component . As this aspect of surgery gains attention , lessons from other psychomotor-intense fields such as athletics have led to an investigation of the benefits of " warming up " prior to entering the operating room . Practical implementation of established methods of warm-up is hampered by a reliance on special equipment and instrumentations that are not readily available . In light of emerging evidence of translatability between video-game play and operative performance , we sought to find if laparoscopic task performance improved after warming up on a mobile device balance game . MATERIAL S AND METHODS Laparoscopic novices were r and omized into either the intervention group ( n = 20 ) or the control group ( n = 20 ) . The intervention group played a mobile device balance game for 10 min while the control group did no warm-up whatsoever . Assessment was performed using two tasks on the ProMIS laparoscopic simulation system : " object positioning " ( where small beads are transferred between four cups ) and " tissue manipulation " ( where pieces of plastic are stretched over pegs ) . Metrics measured were time to task completion , path length , smoothness , h and dominance , and errors . RESULTS The intervention group made fewer errors : object positioning task 0.20 versus 0.70 , P = 0.01 , tissue manipulation task 0.15 versus 0.55 , P = 0.05 , total errors 0.35 versus 1.25 , P = 0.002 . The two groups performed similarly on the other metrics . CONCLUSIONS Warm-up using a mobile device balance game decreases errors on basic tasks performed on a laparoscopic surgery simulator , suggesting a practical way to warm-up prior to cases in the operating room OBJECTIVE The aim of this study was to assess , using a Web-based format , third-year medical students ' pediatric knowledge and perceptions of game playing with faculty facilitation compared with self- study computerized flash cards . METHODS This study used a repeated- measures experimental design with r and om assignment to a game group or self- study group . Pediatric knowledge was tested using multiple choice exams at baseline , week 6 of the clerkship following a 4-week intervention , and 6 weeks later . Perceptions about game playing and self- study  were evaluated using a question naire at week 6 . RESULTS The groups did not differ on content mastery , perceptions about content , or time involved in game playing or self- study . Perceptions about  game playing versus self- study as a pedagogical method appeared to favor game playing in underst and ing content ( P<.001 ) , perceived help with learning ( P<.05 ) , and enjoyment of learning ( P<.008 ) . An important difference was increased game group willingness to continue participating in the intervention . CONCLUSIONS Games can be an enjoyable and motivating method for learning pediatric content , enhanced by group interactions , competition , and fun . Computerized , Web-based tools can facilitate access to educational re sources and are feasible to apply as an adjunct to teaching clinical medicine Background Most patients with diabetes mellitus ( DM ) are followed by primary care physicians , who often lack knowledge or confidence to prescribe insulin properly . This contributes to clinical inertia and poor glycemic control . Effectiveness of traditional continuing medical education ( CME ) to solve that is limited , so new approaches are required . Electronic games are a good option , as they can be very effective and easily disseminated . Objective The objective of our study was to assess applicability , user acceptance , and educational effectiveness of InsuOnline , an electronic serious game for medical education on insulin therapy for DM , compared with a traditional CME activity . Methods Primary care physicians ( PCPs ) from South of Brazil were invited by phone or email to participate in an unblinded r and omized controlled trial and r and omly allocated to play the game InsuOnline , installed as an app in their own computers , at the time of their choice , with minimal or no external guidance , or to participate in a traditional CME session , composed by onsite lectures and cases discussion . Both interventions had the same content and duration ( ~4 h ) . Applicability was assessed by the number of subjects who completed the assigned intervention in each group . Insulin-prescribing competence ( factual knowledge , problem-solving skills , and attitudes ) was self-assessed through a question naire applied before , immediately after , and 3 months after the interventions . Acceptance of the intervention ( satisfaction and perceived importance for clinical practice ) was also assessed immediately after and 3 months after the interventions , respectively . Results Subjects ’ characteristics were similar between groups ( mean age 38 , 51.4 % [ 69/134 ] male ) . In the game group , 69 of 88 ( 78 % ) completed the intervention , compared with 65 of 73 ( 89 % ) in the control group , with no difference in applicability . Percentage of right answers in the competence subscale , which was 52 % at the baseline in both groups , significantly improved immediately after both interventions to 92 % in the game group and to 85 % in control ( P<.001 ) . After 3 months , it remained significantly higher than that at the baseline in both groups ( 80 % in game , and 76 % in control ; P<.001 ) . Absolute increase in competence score was better with the game ( 40 % ) than with traditional CME ( 34 % ; P=.01 ) . Insulin-related attitudes were improved both after the game ( significant improvement in 4 of 9 items ) and after control activity ( 3 of 9 ) . Both interventions were very well accepted , with most subjects rating them as “ fun or pleasant , ” “ useful , ” and “ practice -changing . ” Conclusions The game InsuOnline was applicable , very well accepted , and highly effective for medical education on insulin therapy . In view of its flexibility and easy dissemination , it is a valid option for large-scale CME , potentially helping to reduce clinical inertia and to improve quality of care for DM patients . Trial Registration Clinical trials.gov NCT001759953 ; https:// clinical trials.gov/ct2/show/NCT01759953 ( Archived by WebCite at http://www.webcitation.org/6oeHoTrBf Background Video-games have become an integral part of the new multimedia culture . Several studies assessed video-gaming enhancement of spatial attention and eye-h and coordination . Considering the technical difficulty of laparoscopic procedures , legal issues and time limitations , the validation of appropriate training even outside of the operating rooms is ongoing . We investigated the influence of a four-week structured Nintendo ® Wii ™ training on laparoscopic skills by analyzing performance metrics with a vali date d simulator ( Lap Mentor ™ , Simbionix ™ ) . Methodology /Principal Findings We performed a prospect i ve r and omized study on 42 post-graduate I – II year residents in General , Vascular and Endoscopic Surgery . All participants were tested on a vali date d laparoscopic simulator and then r and omized to group 1 ( Controls , no training with the Nintendo ® Wii ™ ) , and group 2 ( training with the Nintendo ® Wii ™ ) with 21 subjects in each group , according to a computer-generated list . After four weeks , all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session . All 42 subjects in both groups improved significantly from session 1 to session 2 . Compared to controls , the Wii group showed a significant improvement in performance ( p<0.05 ) for 13 of the 16 considered performance metrics . Conclusions / Significance The Nintendo ® Wii ™ might be helpful , inexpensive and entertaining part of the training of young laparoscopists , in addition to a st and ard surgical education based on simulators and the operating room Written and clinical tests compared the change in clinical knowledge and practical clinical skill of first-year dental students watching a clinical video recording of the three-step etch- and -rinse resin bonding system to those using an interactive dental video game teaching the same procedure . The research design was a r and omized controlled trial with eighty first-year dental students enrolled in the pre clinical operative dentistry course . Students ' change in knowledge was measured through written examination using a pre-test and a post-test , as well as clinical tests in the form of a benchtop shear bond strength test . There was no statistically significant difference between teaching methods in regards to change in either knowledge or clinical skills , with one minor exception relating to the wetness of dentin following etching . Students expressed their preference for an interactive self-paced method of teaching We investigated if engagement modes and perceived self-efficacy differed in surgical novices before and after r and omized training in two different video games during five weeks , and a  control group with no training . The control group expressed to a higher extent negative engagement modes during training in MIST-VR and GI Mentor II than the experimental groups . No statistically significant differences in self-efficacy were identified between groups . Both engagement modes and self-efficacy showed a positive correlation with previous and present video game experience . It is suggested that videogame training could have a framing effect on surgical simulator performance . EM and SE might be important intermediate variables between the strength of relationship between current videogame experience and simulator performance Cardiopulmonary resuscitation ( CPR ) is a first aid key survival technique used to stimulate breathing and keep blood flowing to the heart . Its effective administration can significantly increase the chances of survival for victims of cardiac arrest . LISSA is a serious game design ed to complement CPR teaching and also to refresh CPR skills in an enjoyable way . The game presents an emergency situation in a 3D virtual environment and the player has to save the victim applying the CPR actions . In this paper , we describe LISSA and its evaluation in a population composed of 109 nursing undergraduate students enrolled in the Nursing degree of our university . To evaluate LISSA we performed a r and omized controlled trial that compares the classical teaching methodology , composed of self-directed learning for theory plus laboratory sessions with a mannequin for practice , with the one that uses LISSA after self-directed learning for theory and before laboratory sessions with a mannequin . From our evaluation we observed that students using LISSA ( Group 2 and 3 ) gave significantly better learning acquisition scores than those following traditional classes ( Group 1 ) . To evaluate the differences between students of these groups we performed a paired sample s t-test between Group 1 and 2 ( μ1=35 , 67 , μ2=47 , 50 and p<0.05 ) and between students of Group 1 and 3 ( μ1=35 , 67 , μ3=50 , 58 and p<0.05 ) . From these tests we observed that there are significant differences in both cases . We also evaluated student performance of main steps of CPR protocol . Students that use LISSA performed better than the ones that did not use it Background —Many patients with high blood pressure ( BP ) do not have antihypertensive medications appropriately intensified at clinician visits . We investigated whether an online spaced-education ( SE ) game among primary care clinicians can decrease time to BP target among their hypertensive patients . Methods and Results —A 2-arm r and omized trial was conducted over 52 weeks among primary care clinicians at 8 hospitals . Educational content consisted of 32 vali date d multiple-choice questions with explanations on hypertension management . Providers were r and omized into 2 groups : SE clinicians  were enrolled in the game , whereas control clinicians received identical educational content in an online posting . SE game clinicians were e-mailed 1 question every 3 days . Adaptive game mechanics resent questions in 12 or 24 days if answered incorrectly or correctly , respectively . Clinicians retired questions by answering each correctly twice consecutively . Posting of relative performance among peers fostered competition . Primary outcome measure was time to BP target ( < 140/90 mm Hg ) . One hundred eleven clinicians enrolled . The SE game was completed by 87 % of clinicians ( 48/55 ) , whereas 84 % of control clinicians ( 47/56 ) read the online posting . In multivariable analysis of 17 866 hypertensive periods among 14 336 patients , the hazard ratio for time to BP target in the SE game cohort was 1.043 
    Output:
    
Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes .
There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other .
There was limited evidence for the effects of serious gaming/gamification on professional attitudes .
Serious gaming/gamification appears to be at least as effective as controls , and in many studies , more effective for improving knowledge , skills , and satisfaction .