Quality improvement initiative: implementing and redefining video review of real-time neonatal procedures using action research.

Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rate of acceptance by providers attending VR. For 9 months, VR sessions were evaluated with a study group, consisting of different stakeholders. A questionnaire was embedded at the end of each session to obtain feedback from providers on the session and on the safe learning environment. In consensus meetings, success factors and preconditions were identified and divided into different factors that influenced the rate of adoption of VR. The number of providers who recorded procedures and attended VR sessions was determined. A total of 18 VR sessions could be organised, with an equal distribution of medical and nursing staff. After the 9-month period, 101/125 (81%) of all providers working on the NICU attended at least 1 session and 80/125 (64%) of all providers recorded their performance of a procedure at least 1 time. In total, 179/297 (61%) providers completed the questionnaire. Almost all providers (99%) reported to have a positive opinion about the review sessions. Preconditions and success factors related to implementation were identified and addressed, including improving the pathway for obtaining consent, preparation of VR, defining the role of the chair during the session and building a safe learning environment. Different strategies were developed to ensure findings from sessions were used for quality improvement. VR was successfully implemented on our NICU and we redefined our guideline with various preconditions and success factors. The adjusted guideline can be helpful for implementation of VR in emergency care settings.

When do medical operators choose to use, or not use, video in emergency calls? A case study.

BackgroundAn evaluation report for a pilot project on the use of video in medical emergency calls between the caller and medical operator indicates that video is only used in 4% of phone calls to the emergency medical communication centre (EMCC). Furthermore, the report found that in half of these cases, the use of video did not alter the assessment made by the medical operator at the EMCC.We aimed to describe the reasons for when and why medical operators choose to use or not use video in emergency calls. METHOD: The study was conducted in a Norwegian EMCC, employing a thematic analysis of notes from medical operators responding to emergency calls regarding the use of video. RESULT: Informants reported 19 cases where video was used and 46 cases where it was not used. When video was used, three main themes appeared: 'unclear situation or patient condition', 'visible problem' and 'children'. When video was not used the following themes emerged: 'cannot be executed/technical problems', 'does not follow instructions', 'perceived as unnecessary'. Video was mostly used in cases where the medical operators were uncertain about the situation or the patients' conditions. CONCLUSION: The results indicate that medical operators were selective in choosing when to use video. In cases where operators employed video, it provided a better understanding of the situation, potentially enhancing the basis for decision-making.

Hand Gesture of Recognition Pattern Analysis by Image Treatment Techniques.

The goal of this project is to write a program in the C++ language that can recognize motions made by a subject in front of a camera. To do this, in the first place, a sequence of distance images has been obtained using a depth camera. Later, these images are processed through a series of blocks into which the program has been divided; each of them will yield a numerical or logical result, which will be used later by the following blocks. The blocks into which the program has been divided are three; the first detects the subject's hands, the second detects if there has been movement (and therefore a gesture has been made), and the last detects the type of gesture that has been made accomplished. On the other hand, it intends to present to the reader three unique techniques for acquiring 3D images: stereovision, structured light, and flight time, in addition to exposing some of the most used techniques in image processing, such as morphology and segmentation.

Partitioning variability in animal behavioral videos using semi-supervised variational autoencoders.

Recent neuroscience studies demonstrate that a deeper understanding of brain function requires a deeper understanding of behavior. Detailed behavioral measurements are now often collected using video cameras, resulting in an increased need for computer vision algorithms that extract useful information from video data. Here we introduce a new video analysis tool that combines the output of supervised pose estimation algorithms (e.g. DeepLabCut) with unsupervised dimensionality reduction methods to produce interpretable, low-dimensional representations of behavioral videos that extract more information than pose estimates alone. We demonstrate this tool by extracting interpretable behavioral features from videos of three different head-fixed mouse preparations, as well as a freely moving mouse in an open field arena, and show how these interpretable features can facilitate downstream behavioral and neural analyses. We also show how the behavioral features produced by our model improve the precision and interpretation of these downstream analyses compared to using the outputs of either fully supervised or fully unsupervised methods alone.

Youtube videos as an information source about urinary incontinence.

AIM: Youtube is one of the most popular video-sharing websites, and people use Youtube as a source of information. Patients with urinary incontinence may seek information about their condition on Youtube. This study aims to assess the videos on Youtube about urinary incontinence and evaluate the information regarding whether patients can understand and/or act accordingly. METHODS: We performed a Youtube search with the keywords of "incontinence," "urinary incontinence," and "overactive bladder" in the English language with the incognito mode on the browser. All links were extracted and recorded in an excel file. Duplicated links were removed, and metadata of the videos were collected. A custom python language script was used to perform this operation. We selected the most viewed 150 videos for the assessment. After removing the non-related videos, 112 of them were included in the study. Two researchers separately evaluated all the videos with the Patients Education Material Assessment Tool (PEMAT, audiovisual version). RESULTS: The total duration of all included (n:112) videos was 12.6 hours, and these videos had been watched 37,332,178 times until the query date. The vast majority of the videos were about information, management, and treatment options (Kegel exercises, surgery modalities) of incontinence, individual experiences of patients with incontinence, commercials about the diapers, and healthcare professionals who wanted to introduce themselves or their services. Mean understandability and actionability scores of the videos were 57.9% and, 44.7% respectively. Our analysis showed that only 12.5% of the videos on Youtube related to incontinence were understandable, as well as actionable, in terms of PEMAT scores. CONCLUSION: According to our study, 87.5% of the videos about incontinence on Youtube.com in the English language were not understandable and actionable for users. Development of high-quality content about incontinence is needed.

Driving specialist's ratings of on-road performance and naturalistic driving crashes and near-crashes.

BACKGROUND: This study aimed to evaluate the association between a Certified Driving Rehabilitation Specialist's (CDRS) ratings of on-road driving performance by older drivers and at-fault crash and near-crash involvement using naturalistic driving techniques where crashes and near-crashes are recorded in everyday driving through in-vehicle instrumentation. METHODS: This is a cohort study of 144 drivers aged 70 years and over who were recruited due to a recent ophthalmology clinic visit at the University of Alabama at Birmingham. Baseline measurements consisted of demographics, visual status, and other health variables. At-fault crashes and near-crashes over 6 months were identified through instrumentation placed in their personal vehicle that recorded vehicle kinematics and video. After 6 months, a CDRS completed an on-road assessment and provided a composite rating on specific driving behaviors and a global score. RESULTS: Rate ratios examining the association between older drivers with worse CDRS composite scores and rates of at-fault crashes, at-fault near-crashes, and combined at-fault crashes and near-crashes were significantly higher compared to drivers with better scores. Results were similar for the CDRS global score. CONCLUSIONS: Motor vehicle administrations use CDRS ratings to make decisions about licensure, and in clinical programs such as those based at rehabilitation clinics use them to make recommendations about fitness to drive and rehabilitation. This study suggests that these decisions and recommendations are valid from a safety standpoint.

Time to desaturation in preterm infants undergoing endotracheal intubation.

BACKGROUND: Neonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU. METHODS: Observational study at The Royal Women's Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks' postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%). RESULTS: Seventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26-29) weeks and birth weight 946 (773-1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14-32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24-44) s and to desaturation <60% was 56 (42-68) s. No episodes of bradycardia were seen. CONCLUSIONS: This is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation. TRIAL REGISTRATION NUMBER: ACTRN12614000709640.

YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study.

BACKGROUND: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. OBJECTIVE: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. METHODS: Using the keywords "coronavirus vaccination," we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. RESULTS: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. CONCLUSIONS: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts.

Fertility and Sterility top videos from 2017 to 2019.

OBJECTIVE: To objectively grade all video publications in Fertility and Sterility during the years 2017-2019 and compile a list of the top 10 surgical videos. DESIGN: Descriptive presentation of the 10 highest-scoring video publications from Fertility and Sterility in the years 2017-2019. SETTING: Not applicable. PATIENT(S)/ANIMAL(S): Not applicable. INTERVENTION(S): All 4 authors acted as independent reviewers of all video publications. A standardized scoring method was used to score all videos. MAIN OUTCOME MEASURE(S): Up to 5 points were awarded for each of the following categories: Scientific merit or clinical relevance of the topic; clarity of video; use of innovative surgical technique; and video editing or use of marking tools on the video to highlight important features or surgical landmarks. This allowed a maximum score of 20 for each video. The number of YouTube views and likes were used as a tiebreaker if ≥2 videos scored similarly. The interclass coefficient from a 2-way random effects model was calculated to assess for agreement between the 4 independent reviewers. RESULT(S): A total of 40 videos were published in Fertility and Sterility during the years 2017-2019. After averaging scores from all 4 reviewers, a top 10 list was created (Table). Only 2 videos (number 6 and 7 spots) had the same average score, and the number of YouTube views and likes were used as a tiebreaker. The overall interclass coefficient for the 4 reviewers was 0.68 (95% confidence interval, 0.52-0.76). CONCLUSION(S): An overall substantial agreement was noted between the 4 reviewers. Ten videos reigned supreme from a list of very competitive publications that had already undergone the peer review process. The subject matter of these videos ranged from complex surgical procedures, including uterus transplantation and use of a biologic graft for neovaginoplasty, to common procedures like hysteroscopic removal of intrauterine devices during pregnancy and approaches to the stenotic cervix.

A Needs Assessment of Video-based Education Resources Among General Surgery Residents.

BACKGROUND: Video-based education (VBE) is an effective tool for knowledge and skill acquisition for medical students, but its utility is less clear for resident physicians. We sought to determine how to incorporate VBE into a general surgery resident operative curriculum. METHODS: We conducted a single-institution, survey-based needs assessment of general surgery residents to determine desired content and format of an operative VBE module. RESULTS: The response rate was 84% (53/63), with 66% senior (postgraduate year ≥3) resident respondents. VBE was the most commonly cited resource that residents used to prepare for an operation (93%) compared with surgical textbooks (89%) and text-based website content (57%). Junior residents were more likely to utilize text-based website content than senior residents (P < 0.01). The three most important operative video components were accuracy, length, and cost. Senior residents significantly preferred videos that were peer-reviewed (P < 0.05) and featured attending surgeons whom they knew (P = 0.03). A majority of residents (59%) believed 5-10 min is the ideal length of an operative video. Across all postgraduate year levels, residents indicated that detailed instruction of each operative step was the most important content of a VBE module. Senior residents believed that the overall indications and details of each step of the operation were the most important contents of VBE for a junior resident. CONCLUSIONS: At this institution, general surgery residents preferentially use VBE resources for operative preparation. A centralized, standardized operative resource would likely improve resident studying efficiency, but would require personalized learning options to work for both junior and senior surgery residents.

Information about COVID-19 for deaf people: an analysis of Youtube videos in Brazilian sign language.

OBJECTIVE: to analyze YouTube videos with information about COVID-19 in Brazilian sign language. METHODS: a cross-sectional study conducted with 402 videos from the YouTube sharing platform. Chi-square, Fisher's exact, Mann-Whitney and Spearman's correlation tests were used. RESULTS: the videos mainly covered COVID-19 prevention (20.6%). There was a positive correlation between video length and number of views (p<0.001). The length of more than 20 minutes was associated with narration only in BSL (p=0.37) and in BSL with audio (p<0.001), while videos with less than 20 minutes were associated with simultaneous narration in BSL, audio and subtitles. Those with narration only in BSL had a similar number of views to those narrated with subtitles and/or audio (p=0.998). CONCLUSION: the videos were mostly short and included COVID-19 prevention. The longer the video, the greater the number of views. Regardless the presentation of narrations, the videos had a similar number of views.

Contents related to nursing professionals during the COVID-19 pandemic on the Youtube™ platform.

OBJECTIVE: to characterize the content of Youtube™ videos related to nursing professionals during the COVID-19 pandemic. METHOD: a qualitative study that examined 47 videos on Youtube™ posted between 11/03 and 11/04 2020, which were subjected to thematic analysis. RESULTS: four categories emerged: "the role of nurses in care production during the pandemic", which addresses the management of services and individual care; "Overview of the pandemic from the perspective of nurses in different countries", presenting experiences and encouraging physical distance; "Tributes and motivation to mobilize the category", in addition to targeted tributes, calls for nurses to claim their rights; "Criticisms and demands to improve working conditions", which highlights the insecurity of care provision settings. FINAL CONSIDERATIONS: nursing work conditions in different countries, recognition of the importance of professionals during the pandemic, and claims of the category to improve working conditions were the main content found on Youtube™.

The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia.

OBJECTIVES: To quantify the incidence and characteristics of purposeful headers and unintentional head impacts during male and female youth football (soccer) games in Australia. DESIGN: Cross-sectional observational study. METHODS: Ten match-videos (total n=110) per playing age (under 13-20 males; under 13-17 females) from the 2019 National Premier League season were coded for purposeful headers and unintentional head impacts. Total headers and head impacts as well as incidence rate (IR) per 1000 match-hours for different match characteristics were calculated. RESULTS: Purposeful headers accounted for 99% (n=4615, IR:1618) of total head impacts. The IR of purposeful headers per 1000 match-hours was highest for under-15 males (IR:2117) and under-17 females (IR:2090) followed by under-20 males (IR:1761). Midfielders completed the most headers in all female age groups (mean IR:713) and under 13-14 males (mean IR:891), with defenders completing the most headers in under 15-20 males (mean IR:760). Heading duels accounted for 16% of total headers with most headers performed during free play (68%), throw-ins (15%), free kicks (12%) and corner kicks (5%). Only 57 head impacts (IR:20) were coded as unintentional head impacts resulting from being struck by the ball or opponent body part with 4 (IR:1.4) requiring medical attention. CONCLUSIONS: Heading is a complex skill. Given the propensity of youth players of all ages to purposefully head the ball, consideration should be given to coaching heading technique based on specific game scenarios for their playing position and age group. The findings of this study can be used to inform heading guidelines.

Relation between educational reliability and viewer interest in YouTube® videos depicting endometrioma cystectomy surgical techniques.

OBJECTIVE: To assess the reliability of YouTube® endometrioma cystectomy videos based on technical video analysis and considering the surgical steps. MATERIAL AND METHOD: The present study yielded 756 videos after a search on YouTube® with the keywords "endometriosis cystectomy, endometrioma cystectomy, chocolate cyst cystectomy, and endometrioma surgery'' during the period from January 7, 2007 to January 7, 2019. The viewer interest parameters such as total number of subscribers, views, likes, dislikes, comments, source of the videos, and the date of upload were assessed. Besides, the surgical steps were also evaluated considering committee suggestions. RESULTS: There were 140 (78.7 %) videos in Group 1 (not useful and slightly useful) and 38 (21.3 %) videos in Group 2 (useful and very useful). The mean numbers of subscribers, views, and likes were 5737.843 ± 15741.302, 10614.257 ± 32702.339, and 17.7 ± 43.57, respectively, in Group 1, and 851.052 ± 1613.599, 8192.55 ± 15989.955, and 11.92 ± 27.52, respectively, in Group 2. The type of surgery was significantly different between the study groups. The videos of cases with robotic surgeries presented more useful descriptive information (p = 0.003). There was a significant difference between the study groups regarding the type of hemostasis. The presence of didactic steps was higher in Group 2 (47.4 %) compared to Group 1 (28.6 %) (p = 0.02) CONCLUSIONS: Overall, only around 21 % of YouTube videos presenting endometrioma surgery were defined as useful or very useful. The interest rates of the viewers may not compatible with the usefulness rate of the videos.

YouTube as a Source of Patient Information for Prenatal Repair of Myelomeningocele.

OBJECTIVE: With the increasing interest in fetal repair of myelomeningoceles (MMCs) over the last decade, it is reasonable to anticipate the need for high quality and accessible educational materials for patients. Patients often look to the internet for details regarding medical topics and specifically to YouTube for informative health-related videos. This study aims to analyze the content and shortcomings of currently available videos on YouTube regarding prenatal repair of MMCs. STUDY DESIGN: A YouTube search was performed on December 15, 2018, using the terms "fetoscopic surgery for neural tube defect" and "fetal surgery for neural tube defect." The first 50 videos from each search were sorted by relevance and evaluated for video source (i.e., professional, personal, or other), target audience (medical professionals or general public), general descriptive statistics (i.e., video length, number of views, number of comments), and for five areas of content determined by the authors to constitute basic patient information regarding a surgical procedure: (1) procedure details, (2) eligibility criteria, (3) alternatives to surgery, (4) surgical risks, and (5) success rate. Accuracy of videos was not assessed. RESULTS: Of the 16 videos that met inclusion criteria, only 1 discussed fetoscopic surgery. The majority (62.5%) of videos were produced by a professional source and 81.3% were targeted toward the general public rather than medical professionals. Of the 16 videos, 10 (62.5%) included details regarding the surgery, 3 (18.8%) discussed eligibility criteria, and 8 (50.0%) mentioned alternatives to surgery. Additionally, seven videos (43.8%) discussed risks of the procedure and six (37.5%) included surgical success rate. CONCLUSION: Only 2 of the 16 videos included all five areas of content that were evaluated, and both were in regard to open fetal repair. This study not only calls attention to the initial shortcomings of YouTube videos regarding fetal surgery for neural tube defects but also demonstrates the need for further investigation and more comprehensive analysis.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND: This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery. METHODS: The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically. RESULTS: A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively). CONCLUSIONS: Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care.

OBJECTIVE: To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care. DESIGN: Multicentre evaluation incorporating quantitative and qualitative items. SETTING: Level II and level III UK neonatal units. POPULATION: Families of neonatal inpatients and neonatal staff. INTERVENTION: Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019. MAIN OUTCOME MEASURES: Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression. RESULTS: In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent. CONCLUSIONS: Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.