GLP-1 Receptor Agonists, Gestational Weight Gain, and Pregnancy Outcomes

# GLP-1 Receptor Agonists, Gestational Weight Gain, and Pregnancy Outcomes *Published: 2026 May 19* Using Serious Games to Increase the Implementation of Trauma Triage Guidelines: A Randomized Clinical Trial. Mohan D(1)(2), Chang CH(2), Fischhoff B(3), Elmer J(2)(4)(5), Rak KJ(2), Barnes JL(2), Peitzman AB(1), Bendesky B(6)(7), Carr C(8), Chapman AC(9), Forsythe RM(1), Guyette FX(4), Hynes AM(10)(11), Oskvarek JJ(12)(13), Weingart SD(14), Weinstock MB(15)(16), White DB(2), Angus DC(2). Author information: (1)Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. (2)Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. (3)Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania. (4)Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. (5)Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. (6)Drexel College of Medicine, Philadelphia, Pennsylvania. (7)Trinity Health System, Mercy Fitzgerald Hospital, Darby, Pennsylvania. (8)Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma. (9)Division of Palliative Medicine and Critical Care, Departments of Medicine and Surgery, University of California, San Francisco. (10)Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee. (11)Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee. (12)US Acute Care Solutions, Canton, Ohio. (13)Department of Emergency Medicine, Summa Health System, Akron, Ohio. (14)Nassau University Medical Center, East Meadow, New York. (15)Department of Emergency Medicine, Adena Regional Medical Center, Chillicothe, Ohio. (16)Department of Emergency Medicine, Wexner Medical Center, Ohio State University, Columbus. Comment in doi: 10.1001/jama.2026.4133. doi: 10.1001/jamanetworkopen.2025.13375. ## IMPORTANCE Low-cost methods that improve physician adherence to clinical guidelines are lacking. Trauma triage exemplifies time-sensitive conditions where guideline adherence remains at 50% or less despite stakeholder efforts, particularly when treating older adults. ## OBJECTIVE To determine whether a theory-based serious game (a purpose-driven video game) improves emergency physician adherence to trauma triage guidelines for older adults. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial recruited 800 emergency physicians responsible for the triage of Medicare fee-for-service injured patients (≥65 years of age) at emergency departments within nontrauma centers in the US. Physician enrollment began November 27, 2023, and concluded February 7, 2024. Data collection began January 1, 2024 (or the date of enrollment), and ended February 6, 2025. The patients were treated during the 1 year after physician enrollment. ## INTERVENTIONS Game-based training on a tablet for an initial session of 2 hours and then a 20-minute session each quarter (4 doses; n = 400 physicians) vs usual education (n = 400 physicians). MAIN OUTCOMES AND MEASURES The primary outcome was undertriage (defined as the proportion of severely injured patients not transferred to trauma centers) during the year after randomization. The secondary outcomes were overtriage (defined as the proportion of transferred patients with minor injuries) and a composite clinical outcome of 30-day mortality or hospital readmission. Medicare fee-for-service claims were analyzed using mixed-effects regression models. ## RESULTS Of the 800 physicians, the length of experience was a median of 10 (IQR, 6-17) years in practice, 71% were male (563/789), and 750 (94%) had completed Advanced Trauma Life Support. The physicians worked at 1147 hospitals and treated 41 073 injured Medicare patients, of whom 1738 (4.2%) had severe injuries. Of the physicians in the game-based training (intervention) group, 99% (397/399) received 1 dose and 67% (268/399) received 4 doses. Physicians in the game-based training group had a lower proportion of severely injured older adults who were undertriaged (49%; 402/819) compared with the usual education (control) group (57%; 527/919) (model-adjusted difference, -7% [95% CI, -13% to -0.8%]; P = .02). The model-adjusted difference did not differ for the outcomes of overtriage (-3% [95% CI, -6% to 1%]; P = .14) and the composite outcome (-0.4% [95% CI, -5% to 4%]; P = .87). CONCLUSIONS AND RELEVANCE Among physicians responsible for the triage of patients in emergency departments of nontrauma centers, use of a theory-based serious game decreased the proportion of severely injured patients who were undertriaged. ## TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06063434. DOI: 10.1001/jama.2026.4079 PMCID: PMC13097024 DOI: 10.1001/jama.2026.2648