Créativité numérique et innovation thérapeutique : recréer un lieu de soin sur Minecraft

ObjectivesToday, video games are recognized as an excellent tool for therapeutic mediation with young children with Autism Spectrum Disorder (ASD), playing the role of a malleable medium facilitating the evolution of group dynamics and creating a play area between the child and the adult, a space of creativity and shared pleasure allowing them to “be together,” to communicate, and to enter into a secure and holding-type intersubjective relationship. This is why we wanted to maintain this type of treatment during the general lockdown imposed in France in March 2020.MethodWe set up a virtual activity based on the use of the video game Minecraft, after having reconstituted our outpatient clinic for children and adolescents on a private server. Following the end of the lockdown, we were able to experiment with two workshops: one face-to-face; and the other in video therapy.ResultsWe were able to observe similarities and differences in the use of this medium by our young ASD patients, but also in the way in which this treatment allowed us to “put a little institution” back into the daily lives of youth during lockdown. Thus, we were able to see that the content of the Minecraft game, and more specifically the reconstructed clinic, functioned as a space of holding for the adolescents. The comparison between the digital institution and the real institution was present throughout the session in the adolescents’ exploratory actions. However, they were never “tricked” by this virtual reality, each one considering this digital clinic as a simple simulation of the institution where they go for treatment.DiscussionIt should be noted, however, that this type of mediation is not the easiest to set up for a team of professionals. Indeed, we were confronted with certain difficulties, notably the amount of time required to recreate the clinic in the game, problems with the private servers, the quality of the hardware, and the extraordinary public health situation.ConclusionThis therapeutic workshop with digital mediation allowed the very early establishment of a group dynamic and of a group psychic envelope. Therapy sessions conducted in Minecraft allowed us to work on group dynamics, on the real and digital representations of a place of care, on the children's identity references (therapeutic groups, home, etc.), and on their capacity to play in a group. The adolescents enrolled were able to individually search for their own identity markers, according to their place in the institution. Finally, the Minecraft project allowed for the emergence of many interactions and shared emotions between the members of the therapeutic group (children and adults).     

Readmission treatment price and product quality in the hospital sector

In this paper, we study the effect of readmission treatment payment in a dynamic framework characterised by competition among hospitals and sluggish beliefs of patients concerning the service quality. We find that the effect of readmission treatment payment depends on the interplay between the effect of quality in lowering readmissions and its effect on future demand. When the readmission occurrence strongly depends on the service quality, the higher the readmission treatment payment for hospitals, the lower the incentive to provide quality. Instead, when readmission depends barely on quality, the readmission payment acts as the treatment price for first admissions, and thus it reinforces the incentive to provide quality. We also show that the detrimental effect of readmission payments on quality are fed by a high degree of demand sluggishness, that is, by situation where current quality has modest effect on future demand changes. Our findings are robust to different equilibrium concepts of the differential game (i.e., open‐loop and state‐feedback). The results suggest that a discounted regulated price for readmission can be an effective (and cost‐free) policy tool to improve health care quality, especially when the market is characterised by sluggish beliefs about quality.     

An Educational Board Game to Assist PharmD Students in Learning Autonomic Nervous System Pharmacology

Objective. To examine whether playing a board game can assist PharmD students in learning autonomic nervous system (ANS) pharmacology.Design. Of 72 students enrolled in a required second-year pharmacology course, 22 students volunteered to play the board game, which was followed by an in-class examination consisting of 42 ANS questions (ANSQs) and 8 control questions (CTLQs). Participants were given a pretest and a posttest to assess immediate educational improvement. Participants’ scores for pretest, posttest, in-class examination, and ANSQs were compared. Also, scores for examination, ANSQs, and CTLQs were compared between board game participants (PART) and nonparticipating classmates (NPART).Assessment. Board game participants scored progressively higher between the pretest, posttest, examination, and ANSQs. Additionally, PART scores were higher than NPART scores for examination and ANSQs. Difference between PART and NPART CTLQ scores was not significant.Conclusion. A board game can assist PharmD students in learning ANS pharmacology.     

The effectiveness of finger puppet play in reducing fear of surgery in children undergoing elective surgery: A randomised controlled trial

BackgroundThe use of therapeutic interventions in the preoperative period reduces the fear in children by strengthening the relationship between the child, parent and the nurse.AimsThis study aimed to investigate the effect of finger puppet play with parental involvement on fear of surgery in children undergoing elective minor surgery.MethodsA prospective, randomised controlled study was conducted in a state hospital in Turkey with 70 children aged between 5-10 years. In addition to the routine care, children in the intervention group received an intervention that included finger puppet play with their parents while the control group received routine care. The data were collected via demographic form and Children’s Fear Scale.FindingsThe preoperative fear scores of the children did not show a statistical difference between the group (p > 0.05). The results showed that children in the finger puppet group reported significantly lower fear scores than those in the control group while entering the surgery room (p < 0.001), and in the postoperative period (p < 0.001). The proxy report of the parents and nurses were also lower for the children in the finger puppet group (p < 0.05).DiscussionThe results provide empirical data on the effectiveness of finger puppet play in children's preoperative care, entering the surgery room, and postoperative fear.ConclusionIn line with these results, it is recommended that finger puppet play is used by nurses and parents for reducing fear of surgery in children at paediatric clinics.     

创伤现场救护教育游戏的开发与应用

目的探讨创伤现场救护教育游戏的开发与应用效果。方法利用Unity3D虚拟平台开发教育游戏,并应用于本科护生创伤现场救护实验教学。将426名护生按随机数字表分为三组各142名,对照组采用"理论+实践操作"教学方式,实验A组采用"理论+3D创伤现场救护教育游戏"教学方式,实验B组采用"理论+3D创伤现场救护教育游戏+实践操作"教学方式。结果实验教学后,三组护生的理论与操作考核成绩比较,差异有统计学意义(均P0.01)。结论创伤现场救护教育游戏的开发与应用,有利于促进护生对创伤现场救护理论知识的掌握和运用,为其临床实践奠定基础。     

VIG-Express: Consenso de un sistema de valoración multidimensional/geriátrica rápida en Cataluña

ObjetivoConsensuar una herramienta de valoración multidimensional/geriátrica rápida (VMGR), como sistema compartido y universal de valoración multidimensional de personas con multimorbilidad, fragilidad, complejidad o situación avanzada, para todos los profesionales del sistema de salud y social de Cataluña.DiseñoConsenso de profesionales en tres fases, combinando sesiones presenciales con trabajo telemático.EmplazamientoCataluña.ParticipantesSe constituyó un grupo de 27 profesionales de carácter interdisciplinario representativo de los distintos ámbitos de atención.MétodoSe han combinado las metodologías de Design thinking para el consenso inicial de características de la herramienta de VMGR (fase 1), con la metodología Lean Start-Up para el diseño de la nueva herramienta de VMGR (fase 2), que finalmente se testeó en un grupo de pacientes (fase 3).ResultadosEn la fase 1 se consensuó que la herramienta de VMGR ideal debía permitir una valoración ad hoc de las personas, ser rápida y ágil (tiempo < 10 minutos), identificar las dimensiones alteradas mediante preguntas trigger y facilitar el diagnóstico de situación (idealmente cuantificado). En la fase 2 se elaboró el prototipo de una nueva herramienta de VMGR de 15 + dos preguntas (VIG-Express), finalmente testeada en 35 personas en la fase 3.ConclusionesEn los resultados preliminares, la herramienta VIG-Express parece facilitar una valoración multidimensional sencilla y rápida y la personalización de las intervenciones, así como una mirada única y un relato compartido entre los profesionales de los distintos ámbitos de atención. Serán necesarios más estudios para corroborar estos hallazgos.Palabras clave: Evaluación geriátrica, Consenso, Diagnóstico de la situación, Atención dirigida al paciente, Sistemas de atención de salud integrada     

《医道至尊》中医桌游在《中医各家学说》教学中的应用

探索《医道至尊》中医桌游在《中医各家学说》教学中的应用价值。以《中医各家学说》、《中药学》、《方剂学》等中医学科为理论核心,以当今流行的角色扮演类桌游为框架,设计制作原创桌游。同时招募志愿者参与游戏,并进行认同度实验和教学效果实验,以分析该桌游在《中医各家学说》教学中应用的可行性。结果显示《医道至尊》中医桌游能够很好地调动学生学习的积极性,激发学生的学习兴趣,培养主动学习、自主学习能力,提高学习效率。     

Parents' experiences of having their children take part in participatory action research creating a serious game about radiotherapy

IntroductionRadiotherapy (RT) is one of several treatment modalities used for children diagnosed with cancer. Several studies have designed interventions aimed to alleviate the stress that can occur in conjunction with RT. To include children in the design of interventions is rare and dependent on the parents giving consent to participation in research on their children's behalf. The aim was to illuminate, from the parents' perspective, the experience of their children being part in the co-creation of a serious game and their previous experiences of RT.MethodsTen parents of children taking part in a participatory action research study of the development of a serious game were invited to an interview and seven parents consented. An inductive, manifest content analysis was performed.ResultsThe analysis resulted in an overarching theme: Parents' pre-understanding from their child's cancer treatment created a sensitivity to their child's wishes and a willingness to contribute to science. Four categories are presented: Intrinsic factors influenced the intent to participate, Extrinsic factors that had an effect on participation, Parents role in the game development, and Radiotherapy impinged the child and the parent.ConclusionTo be able to pay it forward to healthcare and other families with a child diagnosed with cancer was a contributing factor for parents' willingness to consent to participation after their children had undergone RT, especially since their children wanted to do so. Parents indicated interest in the developmental process and in following their children being part of the creation of a serious game about RT.Implication for practiceTo understand why parents allow their children to participate in studies creates opportunities for the research community to structure studies that facilitate participation.     

Training to use a commercial brain-computer interface as access technology: a case study

Purpose: This case study describes how an individual with spastic quadriplegic cerebral palsy was trained over a period of four weeks to use a commercial electroencephalography (EEG)-based brain-computer interface (BCI). Method: The participant spent three sessions exploring the system, and seven sessions playing a game focused on EEG feedback training of left and right arm motor imagery and a customised, training game paradigm was employed. Results: The participant showed improvement in the production of two distinct EEG patterns. The participant’s performance was influenced by motivation, fatigue and concentration. Six weeks post-training the participant could still control the BCI and used this to type a sentence using an augmentative and alternative communication application on a wirelessly linked device. Conclusions: The results from this case study highlight the importance of creating a dynamic, relevant and engaging training environment for BCIs.

• Implications for Rehabilitation

• Customising a training paradigm to suit the users’ interests can influence adherence to assistive technology training.

• Mood, fatigue, physical illness and motivation influence the usability of a brain-computer interface.

• Commercial brain-computer interfaces, which require little set up time, may be used as access technology for individuals with severe disabilities

     

Intuition,deliberation, and the evolution of cooperation

Humans often cooperate with strangers, despite the costs involved. A long tradition of theoretical modeling has sought ultimate evolutionary explanations for this seemingly altruistic behavior. More recently, an entirely separate body of experimental work has begun to investigate cooperation’s proximate cognitive underpinnings using a dual-process framework: Is deliberative self-control necessary to reign in selfish impulses, or does self-interested deliberation restrain an intuitive desire to cooperate? Integrating these ultimate and proximate approaches, we introduce dual-process cognition into a formal game-theoretic model of the evolution of cooperation. Agents play prisoner’s dilemma games, some of which are one-shot and others of which involve reciprocity. They can either respond by using a generalized intuition, which is not sensitive to whether the game is one-shot or reciprocal, or pay a (stochastically varying) cost to deliberate and tailor their strategy to the type of game they are facing. We find that, depending on the level of reciprocity and assortment, selection favors one of two strategies: intuitive defectors who never deliberate, or dual-process agents who intuitively cooperate but sometimes use deliberation to defect in one-shot games. Critically, selection never favors agents who use deliberation to override selfish impulses: Deliberation only serves to undermine cooperation with strangers. Thus, by introducing a formal theoretical framework for exploring cooperation through a dual-process lens, we provide a clear answer regarding the role of deliberation in cooperation based on evolutionary modeling, help to organize a growing body of sometimes-conflicting empirical results, and shed light on the nature of human cognition and social decision making.Cooperation, where people pay costs to benefit others, is a defining feature of human social interaction. However, our willingness to cooperate is puzzling because of the individual costs that cooperation entails. Explaining how the “selfish” process of evolution could have given rise to seemingly altruistic cooperation has been a major focus of research across the natural and social sciences for decades. Using the tools of evolutionary game theory, great progress has been made in identifying mechanisms by which selection can favor cooperative strategies, providing ultimate explanations for the widespread cooperation observed in human societies (1).In recent years, the proximate cognitive mechanisms underpinning human cooperation have also begun to receive widespread attention. For example, a wide range of experimental evidence suggests that emotion and intuition play a key role in motivating cooperation (2–5). The dual-process perspective on decision making (6–8) offers a powerful framework for integrating these observations. In the dual-process framework, decisions are conceptualized as arising from competition between two types of cognitive processes: (i) automatic, intuitive processes that are relatively effortless but inflexible; and (ii) controlled, deliberative processes that are relatively effortful but flexible. In many situations, intuitive and deliberative processes can favor different decisions, leading to inner conflict: Rather than being of a single mind, people are torn between competing desires.Despite the widespread attention that dual-process theories have received in the psychological and economic sciences (including incorporation into formal decision making models; refs. 9–11); the existence of related discussion in the theoretical biology literature regarding error management (12–14), tradeoffs between fixed and flexible behaviors (15–18), and cultural evolution and norm internalization (2, 19, 20); and a long interdisciplinary tradition of arguments suggesting that strategies developed in repeated interactions spill over to influence behavior in one-shot anonymous settings (21–25), the dual-process framework has been almost entirely absent from formal models of the evolution of cooperation. Traditional evolutionary game theory models of cooperation focus on behavior, rather than the cognition that underlies behavior. Therefore, these models do not shed light on when selection may favor the use of intuition versus deliberation, or which specific intuitive and deliberative responses will be favored by selection.In this paper, we build a bridge between ultimate and proximate levels of analysis to address these questions, introducing an evolutionary game-theoretic model of cooperation that allows for dual-process agents. These agents interact in a varied social environment, where interactions differ in the extent to which current actions carry future consequences. To capture the tradeoff between flexibility and effort that is central to many dual-process theories, we allow our agents to either (i) use an intuitive response that is not sensitive to the type of interaction currently faced; or (ii) pay a cost to deliberate, tailoring their action to the details of the current interaction.We then use this framework to explore the consequences of reciprocity and assortment (26, 27), two of the most widely studied mechanisms for the evolution of cooperation. We ask when (and to what extent) agents evolve to pay the cost of deliberation; when evolution favors intuitive responses that are selfish versus cooperative; and whether deliberation serves to increase or decrease social welfare. In doing so, we provide a formal theoretical framework to guide the emerging body of empirical work exploring prosociality from a dual-process perspective, and provide insight into the cognitive underpinnings of human cooperation.