Identifying Potential Gamification Elements for A New Chatbot for Families with Neurodevelopmental Disorders: A User-Centred Design Approach (Preprint)

BACKGROUND Chatbots have been increasingly considered for applications in the health and social care fields. Currently, it remains unclear how a chatbot could engage users coping with complex health needs, such as parents of individuals with neurodevelopmental disorders (NDDs), who often need frequent and ongoing support. One approach to enhancing user engagement is the use of game elements in non-game contexts, known as gamification. To be effective, gamification needs to be tailored to users. OBJECTIVE We sought to identify which gamification elements would be the most useful in a chatbot that focuses on supporting families of children and youths with NDDs. METHODS We performed a narrative literature review of gamification elements and their current implementation. We then used a qualitative approach, which included a series of focus groups and interviews with caregivers of individuals with NDDs (N = 21) to identify potential gamification elements that could be well-suited for a chatbot focused on NDDs. Transcripts were analyzed for emerging themes. RESULTS From our 21 participants, we identified 3 main themes: 1) parents of individuals with NDDs were familiar and had positive experiences with gamification; 2) specific gamification element (goal setting) was considered an important feature for a chatbot for NDDs, whereas others (customization, rewards, and unlockable content) received more mixed opinions; and 3) although social networking was viewed positively, it is a complex feature to implement due to the pertaining issue of medical fact-checking. CONCLUSIONS We show for the first time that prospective users (parents of individuals with NDDs) support the use of gamification in a chatbot for NDDs. Our study illustrates the importance of adopting a user-centred design when deciding which gamification elements to include, as some commonly used elements were perceived negatively by this specific group of users.

Assessment of knowledge, perception and attitude towards antibiotic resistance among medical interns in Saudi Arabia

Background: Antibiotic resistance is a well-established medical fact that affects the clinical course of many infections. There are many risk factors that can contribute to antibiotic resistance clinically. Therefore, it is important to understand the attitude and practice of medical practitioners from their early life career.Methods: This is a cross-sectional descriptive online study that was done between February and March 2018 in Riyadh, Saudi Arabia. The included participants were medical interns only excluding all other medical students. The questionnaire is made up of four dimensions: Socio-demographic characteristics, antibiotics knowledge, attitude, and perception towards prescribing antibiotics. The questionnaire utilized from a previously validated questionnaire regarding antibiotic use, and the data was analyzed using SPSS, version 21. Results: A total of 292 medical interns completed the questionnaire. Majority of Interns reported that too many antibiotic prescriptions were important contributor to antibiotic resistance. Surprisingly, 55.6% felt that hand hygiene had low importance or was not important at all in compacting antibiotic resistance. Only half of respondents (51%) were sure that their hospitals had antibiotic guidelines, and only 21% of them had acknowledged reading the guidelines or been shown where the hospital’s antibiotic guidelines were kept. The majority of the interns (90.6%) believed that antibiotic resistance is a national problem in Saudi Arabia. Conclusions: There is a noticeable gap between the theoretical part of students’ curricula and clinical practice; students require more education regarding antibiotic prescription, especially about choosing the correct antibiotics, doses, and intervals.

False Myths versus Medical Facts: Ten Common Misconceptions Related to Dry Eye Disease

Since the first definition of dry eye, rapid progress has been made in this field over the past decades that has guided profound changes in the definition, classification, diagnosis and management of the disease. Although dry eye is one of the most frequently encountered ocular conditions, various “old” misconceptions persist, in particular among comprehensive ophthalmologists not specialized in ocular surface diseases. These misconceptions hamper the correct diagnosis and the proper management of dry eye in the routine clinical practice. In the present review, we described the 10 most common misconceptions related to dry eye and provided an evidence-based guide for reconsidering them using the format “false myth versus medical fact”. These misconceptions concern the dry eye definition and classification (#1, #2, #3), disease physiopathology (#4), diagnosis (#5), symptoms (#6, #7) and treatment (#8, #9, #10). Nowadays, dry eye is still an under-recognized and evolving disease that poses significant clinical challenges to ophthalmologists. The two major reasons behind these challenges include the heterogeneity of the conditions that fall under the umbrella term of dry eye and the common discrepancy between signs and symptoms.

Metachronic Small Bowel Metastasis of a Squamous Cell Carcinoma of The Cervix.

Clinical Image We report a case of a woman 33 years old with past medical fact of hypertension, in whom squamous cell carcinoma of the cervix was diagnosed within post coital bleeding. The tumor was classified stage Ib according to FIGO classification and were treated with brachytherapy followed by hysterectomy with oophorectomy and external iliac lymphadenectomy. The evolution was favorable and she remained asymptomatic for 3 years. She was than hospitalized for obstructive syndrome. Abdominal X ray showed hydro-aeric levels and abdominal computed tomography showed grelic tumor with distension of the small bowel.

Metachronic Small Bowel Metastasis of a Squamous Cell Carcinoma of The Cervix.

Clinical Image We report a case of a woman 33 years old with past medical fact of hypertension, in whom squamous cell carcinoma of the cervix was diagnosed within post coital bleeding. The tumor was classified stage Ib according to FIGO classification and were treated with brachytherapy followed by hysterectomy with oophorectomy and external iliac lymphadenectomy. The evolution was favorable and she remained asymptomatic for 3 years. She was than hospitalized for obstructive syndrome. Abdominal X ray showed hydro-aeric levels and abdominal computed tomography showed grelic tumor with distension of the small bowel.

The Matter of Beckett's Facts

An important part of Beckett's engagement with the matter-of-factness of modern everyday life is the literal concern in his writing with matters of fact. The collection and exchange of atomised facts has become part of the ordinary texture of social life, in modern societies in which facts are both abundantly available and provide everyday discourse with calming lubrication. It is clear from Beckett's notebooks that he had an Autolycean appetite for striking trifles of knowledge. The essay discusses examples of natural knowledge and medical fact in Beckett's writing, along with the names which erupt with juddering specificity into the generalised, frequentative world of repeated actions and nameless entities. The essay argues that, if facts provide meditative consolation, they can also enact something of the aggressive-defensive dissolution of connections identified in W.R. Bion's concept of ‘attacks on linking’. Where for Roland Barthes, arbitrary facts enact a reality effect, giving a legitimating and luxurious kind of surplus to the act of signification, facts in Beckett evoke the capacity of unintelligible ordinariness to interrupt the play of meaning-making. The essay concludes that matters of fact in Beckett are therefore at once mundane and exotic, signalling the insignificant universality of facticity.

It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient’s best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive.