Image of Electroconvulsive Therapy in YouTube Videos.

OBJECTIVES: Image of electroconvulsive therapy (ECT) in TV shows and movies have been studied before. However, there is no study about image of ECT on YouTube as one of the most commonly used social media platforms for disseminating health information. Our study aims to study the image of ECT in YouTube videos. METHODS: Key word "Electroconvulsive therapy and ECT" were used to search on Youtube.com and only videos over 50,000 view counts and in English were selected. Above videos were reviewed by an ECT physician and were classified into neutral, negative, and positive groups based on the image of ECT. RESULTS: There were 41 YouTube videos selected based on the criteria as stated above, among which 14 were unrelated with ECT treatment, 8 were neutral, 9 were positive, and 10 were reflecting negative image about ECT. There was no significant difference among view counts of the positive, negative and neutral videos (χ = 2.746, P = 0.253). Furthermore, the most viewed 3 videos showed negative image of ECT. Additionally, only 6 videos showed the modified ECT and one showed both modified and nonmodified ECT. CONCLUSIONS: This is the first study conducted on image of ECT in YouTube videos. We found the stigma against ECT may persist in digital video platforms, such as YouTube.

Is Nonoperative Management Warranted in Ventral Hernia Patients With Comorbidities?: A Case-matched, Prospective, Patient-centered Study.

OBJECTIVE: The aim of this study was to determine patient-centered outcomes of nonoperative treatment of a ventral hernia. SUMMARY OF BACKGROUND DATA: Nonoperative management of ventral hernias (VHs) is often recommended for patients at increased risk of complications; however, the impact of this management strategy on outcome and quality of life (QoL) is unknown. We hypothesize that QoL and function are better among patients with VHs managed operatively. METHODS: Patients with a VH from a single-center hernia clinic were prospectively enrolled between June 2014 and June 2015. Nonoperative management was recommended if smoking, obesity, or poorly controlled diabetes was present. Primary outcomes were patient-centered outcomes, including QoL and function, which were measured using a validated, hernia-specific survey (modified Activities Assessment Scale) before surgeon' consultation and at 6 months. Other outcomes included surgical site infection (SSI) and recurrence. Risk-adjusted outcomes between nonoperative and operative groups were compared using: paired t test on a propensity score-matched subset and multivariable analysis on the overall cohort. RESULTS: A total of 152 patients (nonoperative = 97, operative = 55) were enrolled. In the propensity-matched cohort (n = 90), both groups had similar baseline QoL and function scores, but only repaired patients had improved scores on 6-month follow-up. In the overall cohort, nonoperative management was strongly associated with lower function scores (log odds ratio = -26.5; 95% confidence interval = -35.0 to -18.0). CONCLUSIONS: This is the first prospective study comparing management strategies in VH patients with comorbidities. Elective repair improves hernia-related QoL and function in low- to moderate-risk patients and should be considered in appropriately selected patients.

Underserved Patients Seeking Care for Ventral Hernias at a Safety Net Hospital: Impact on Quality of Life and Expectations of Treatment.

BACKGROUND: The purpose of this study was to identify issues important to patients in their decision-making, expectations, and satisfaction when seeking treatment for a ventral hernia. STUDY DESIGN: An exploratory qualitative study was conducted of adult patients with ventral hernias seeking care at a safety-net hospital. Two semi-structured interviews were conducted with each patient: before and 6 months after surgical consultation. Interviews were audiotaped, transcribed, and coded using latent content analysis until data saturation was achieved. RESULTS: Of patients completing an initial interview (n = 30), 27 (90%) completed follow-up interviews. Half of the patients were Spanish-speaking, one-third had a previous ventral hernia repair, and two-thirds underwent initial nonoperative management after surgical consultation. Patient-described factors guiding management decisions included impact on quality of life, primarily pain and limited function; overwhelming challenges to meeting surgical criteria, primarily obesity; and assuming responsibility to avoid recurrence. Patients were uninformed regarding potential poor outcomes and contributing factors, even among patients with a previous ventral hernia repair, with most attributing recurrence to inadequate self-management. CONCLUSIONS: Understanding patients' perspective is crucial to engaging them as stakeholders in their care, addressing their concerns, and improving clinical and patient-centered outcomes. Patient reports suggest how care can be improved through developing more effective strategies for addressing patients' concerns during nonoperative management, preoperative risk reduction strategies that are sensitive to their sociodemographic characteristics, treatment plans that harness patients' willingness for self-management, and patient education and decision-making tools.