New research claims a video game can improve doctors’ ability to recognise severe trauma in patients

New research has concluded a specifically-designed video game improves doctors’ ability to recognise when patients need to be transferred to a severe trauma centre.

The research, by the University of Pittsburgh School of Medicine and published today in the BMJ, revealed the game Night Shift was better at preparing doctors to recognise patients who needed higher levels of care than reading traditional educational materials.

This was the case even though doctors who were made to play the game, in which doctors play as a fictitious, young emergency physician treating severe trauma patients, enjoyed it less than those who were asked to read relevant materials.

“Physicians must make decisions quickly and with incomplete information. Each year, 30,000 preventable deaths occur after injury, in part because patients with severe injuries who initially present to non-trauma centres are not promptly transferred to a hospital that can provide appropriate care,” said the game’s creator Deepika Mohan, MD, MPH and assistant professor in Pitt’s departments of Critical Care Medicine and Surgery.

“An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still out-performing their peers in recognising severe trauma.”

Night Shift was designed by Mohan to tap into the part of the brain that uses pattern recognition and previous experience to make snap decisions by using subconscious mental shortcuts – a process called heuristics.

Doctors in non-trauma centres typically see only about one severe trauma per 1,000 patients. As a result, their heuristic abilities can become skewed toward obvious injuries such as gunshot wounds, and miss equally severe traumas such as internal injuries from falls.

On average, 70% of severely injured patients who present to non-trauma centres are under-triaged and not transferred to trauma centres as recommended by clinical practice.

“There are many reasons beyond the doctor’s heuristics as to why a severe trauma patient wouldn’t be transferred to a trauma centre, ranging from not having an ambulance available to a lack of proper diagnostic tools,” said Mohan.

“So, it is important to emphasize that recalibrating heuristics won’t completely solve the under-triage problem and that the problem isn’t entirely due to physicians’ diagnostic skills. But it’s heartening to know we’re on track to develop a game that shows promise at improving on current educational training.”

For the study, Mohan recruited 368 physicians from across the US who did not work at hospitals specialising in severe trauma. Half were assigned to play the game and half were asked to spend at least an hour reading the educational materials.

Participants then responded to questionnaires and completed a simulation that tested how often they “under-triaged,” or failed to send severe trauma patients to hospitals with the resources necessary to handle them.

Physicians who played the game under-triaged 53% of the time, compared with 64% for those who read the educational materials.

Six months later, Mohan reassessed the physicians and found that the effect of the game persisted, with those who played the game under-triaging 57% of the time, compared to 74% for those who had read the educational materials.

Multimedia courtesy of Schell Games.

London’s air pollution problem means that for the city’s older adults exercise counts for nothing

A study has concluded that even short-term exposure to air pollution in built up areas like London’s Oxford Street can negate the beneficial health effects of exercise in older adults.

The research by Imperial College London and Duke University, and published in The Lancet, adds to the growing body of evidence showing the negative impacts of urban air pollution on cardiovascular and respiratory health, and highlights the need for stricter air quality limits and greater access to green spaces.

“It’s possible that studies such as this could support new air quality limits, it shows that we can’t really tolerate the levels of air pollution that we currently find on our busy streets,” said senior author Fan Chung, Professor of Respiratory Medicine and Head of Experimental Studies Medicine at National Heart & Lung Institute at Imperial College London.

Image courtesy of Ron Porter

For the study, funded by the British Heart Foundation, researchers recruited 119 volunteers, aged over 60, who were either healthy, had stable Chronic Obstructive Pulmonary Disease (COPD) or had stable heart disease.

The volunteers were then split into two groups. One of the groups walked for two hours in a relatively serene part of Hyde Park, while the second group walked along a busy stretch of Oxford Street – which has regularly breached air quality limits set by the World Health Organization.

Physical measurements were taken before and after the walks to show the effects of the exercise on cardiovascular health, including measurements of lung volume exhaled, blood pressure and the degree to which the blood vessels could expand.

Environmental measurements were also collected, to track pollution levels and volunteers’ exposure.

Image courtesy of David Holt

Analysis revealed that all participants benefitted from a stroll in the park, with lung capacity improving within the first hour and a significant lasting increase for more than 24 hours in many cases.

By comparison, a walk along Oxford Street led to only a small increase in lung capacity in participants, far lower than recorded in the park.

Blood flow also increased after exercise, with decreases in blood pressure and an increase in heart rate. Arteries became less stiff in those walking in Hyde Park with a maximum change from baseline of more than 24% in healthy and COPD volunteers, and more than 19% in heart disease patients.

This effect was drastically reduced when walking along Oxford Street, however, with a maximum change in arterial stiffness of just 4.6% for healthy volunteers, 16% for those with COPD and 8.6% for heart disease.

“These findings are important as for many people, such as the elderly or those with chronic disease, very often the only exercise they can do is to walk,” said Chung.

“Our research suggests that we might advise older adults to walk in green spaces, away from built-up areas and pollution from traffic.”