YouTube as a source of education in perioperative anesthesia for patients and trainees: a systematic review.

BACKGROUND: Online video sharing platforms like YouTube (Google LLC, San Bruno, CA, USA) have become a substantial source of health information. We sought to conduct a systematic review of studies assessing the overall quality of perioperative anesthesia videos on YouTube. METHODS: We searched Embase, MEDLINE, and Ovid for articles published from database inception to 1 May 2023. We included primary studies evaluating YouTube videos as a source of information regarding perioperative anesthesia. We excluded studies not published in English and studies assessing acute or chronic pain. Studies were screened and data were extracted in duplicate by two reviewers. We appraised the quality of studies according to the social media framework published in the literature. We used descriptive statistics to report the results using mean, standard deviation, range, and n/total N (%). RESULTS: Among 8,908 citations, we identified 14 studies that examined 796 videos with 59.7 hr of content and 47.5 million views. Among the 14 studies that evaluated the video content quality, 17 different quality assessment tools were used, only three of which were externally validated (Global Quality Score, modified DISCERN score, and JAMA score). Per global assessment rating of video quality, 11/13 (85%) studies concluded the overall video quality as poor. CONCLUSIONS: Overall, the educational content quality of YouTube videos evaluated in the literature accessible as an educational resource regarding perioperative anesthesia was poor. While these videos are in demand, their impact on patient and trainee education remains unclear. A standardized methodology for evaluating online videos is merited to improve future reporting. A peer-reviewed approach to online open-access videos is needed to support patient and trainee education in anesthesia. STUDY REGISTRATION: Open Science Framework ( https://osf.io/ajse9 ); first posted, 1 May 2023.

RéSUMé: CONTEXTE: Les plateformes de partage de vidéos en ligne comme YouTube (Google LLC, San Bruno, CA, États-Unis) sont devenues une source importante d'informations sur la santé. Nous avons cherché à réaliser une revue systématique des études évaluant la qualité globale des vidéos d'anesthésie périopératoire sur YouTube. MéTHODE: Nous avons recherché des articles dans Embase, MEDLINE et Ovid publiés depuis la création de ces bases de données jusqu'au 1er mai 2023. Nous avons inclus des études primaires évaluant les vidéos YouTube comme source d'information sur l'anesthésie périopératoire. Nous avons exclu les études publiées dans une langue autre que l'anglais et les études évaluant la douleur aiguë ou chronique. Les études ont été examinées et les données ont été extraites en double par deux personnes. Nous avons évalué la qualité des études selon le cadre des médias sociaux publié dans la littérature. Nous avons utilisé des statistiques descriptives pour rapporter les résultats en utilisant la moyenne, l'écart type, la plage et n/total N (%). RéSULTATS: Parmi 8908 citations, nous avons identifié 14 études qui ont examiné 796 vidéos avec 59,7 heures de contenu et 47,5 millions de vues. Parmi les 14 études qui ont évalué la qualité du contenu vidéo, 17 outils d'évaluation de la qualité différents ont été utilisés, dont seulement trois ont été validés en externe (Score Global Quality, score DISCERN modifié et score JAMA). Selon l'évaluation globale de la qualité des vidéos, 11 études sur 13 (85 %) ont conclu que la qualité globale des vidéos était médiocre. CONCLUSION: Dans l'ensemble, la qualité du contenu éducatif des vidéos YouTube évaluées dans la littérature accessible en tant que ressource éducative concernant l'anesthésie périopératoire était médiocre. Bien que ces vidéos soient très demandées, leur impact sur la formation de la patientèle et des stagiaires reste incertain. Une méthodologie normalisée d'évaluation des vidéos en ligne est nécessaire pour améliorer les évaluations futures. Une approche évaluée par les pairs pour les vidéos en libre accès en ligne est nécessaire pour soutenir la formation de la patientèle et des stagiaires en anesthésie. ENREGISTREMENT DE L'éTUDE: Open Science Framework ( https://osf.io/ajse9 ); première publication le 1er mai 2023.

Evaluating YouTube as a Source of Education for Patients Undergoing Surgery: A Systematic Review.

OBJECTIVE: The objective of this systematic review is to characterize the peer-reviewed literature investigating YouTube as a source of patient education for patients undergoing surgery. SUMMARY BACKGROUND DATA: YouTube is the largest online video sharing platform and has become a substantial source of health information that patients are likely to access before surgery, yet there has been no systematic assessment of peer-reviewed studies. A comprehensive literature search was conducted using EMBASE, MEDLINE, and Ovid HealthStar from inception through to December of 2021. METHODS: All primary studies evaluating YouTube as a source of patient education relating to surgical procedures (general, cardiac, urology, otolaryngology, plastic, vascular) were included. Study screening and data extraction occurred in duplicate with two reviewers. Characteristics extracted included video length, view count, upload source, overall video educational quality, and quality of individual studies. RESULTS: Among 6,453 citations, 56 studies were identified that examined 6,797 videos with 547 hours of content and 1.39 billion views. There were 49 studies that evaluated the educational quality of the videos. A total of 43 quality assessment tools were used, with each study using a mean of 1.90 assessment tools. Per the global rating for assessments, 34/49 studies (69%) concluded that the overall quality of educational content was poor. CONCLUSIONS: While the impact of non-peer-reviewed YouTube videos on patient knowledge for surgery is unclear, the large amount of online content suggests that they are in demand. The overall educational content of these videos is poor, however, and there is substantial heterogeneity in the quality assessment tools used in their evaluation. A peer-reviewed and standardized approach to online education with video content is needed to better support patients.

YouTube as a Source of Patient and Trainee Education in Vascular Surgery: A Systematic Review.

Objective: Due to its video based approach, YouTube has become a widely accessed educational resource for patients and trainees. This systematic review characterised and evaluated the peer reviewed literature investigating YouTube as a source of patient or trainee education in vascular surgery. Data sources: A comprehensive literature search was conducted using EMBASE, MEDLINE, and Ovid HealthStar from inception until 19 January 2023. All primary studies and conference abstracts evaluating YouTube as a source of vascular surgery education were included. Review methods: Video educational quality was analysed across several factors, including pathology, video audience, and length. Results: Overall, 24 studies were identified examining 3 221 videos with 123.1 hours of content and 37.1 million views. Studies primarily examined YouTube videos on diabetic foot care (7/24, 29%), peripheral arterial disease (3/24, 13%), carotid artery stenosis (3/24, 13%), varicose veins (3/24, 13%), and abdominal aortic aneurysm (2/24, 8%). Video educational quality was analysed using standardised assessment tools, author generated scoring systems, or global author reported assessment of quality. Six studies assessed videos for trainee education, while 18 studies evaluated videos for patient education. Among the 20 studies which reported on the overall quality of educational content, 10/20 studies deemed it poor, and 10/20 studies considered it fair, with 53% of studies noting poor educational quality for videos intended for patients and 40% of studies noting poor educational quality in videos intended for trainees. Poor quality videos had more views than fair quality videos (mean 27 348, 95% CI 15 154-39 543 views vs. 11 372, 95% CI 3 115-19 629 views, p = .030). Conclusion: The overall educational quality of YouTube videos for vascular surgery patient and trainee education is suboptimal. There is significant heterogeneity in the quality assessment tools used in their evaluation. A standardised approach to online education with a consistent quality assessment tool is required to better support online patient and trainee education in vascular surgery.

Delivering Point-of-Care ultrasound teaching using a video conferencing technique.

Point-of-care ultrasound (POCUS) has usually been taught using a hands-on, in-person approach. We present a novel approach to delivering POCUS virtually using a dual image videoconferencing technique. We outline an easily implementable approach and summarize medical students' experience and feedback. This form of delivery has potential to improve instructional delivery in resource restricted settings or during pandemic restrictions where a hands-on approach may not be possible.

L'échographie au chevet fait généralement l'objet d'un enseignement pratique, en personne. Nous présentons une nouvelle approche, virtuelle, pour son enseignement, par visioconférence à double flux vidéo. L'approche que nous décrivons est facile à mettre en œuvre. Nous résumons l'expérience et les commentaires des étudiants en médecine sur cette modalité qui est susceptible d'améliorer l'enseignement dans des contextes où les ressources sont limitées ou en cas de pandémie, lorsque l'approche pratique n'est pas possible.

Use of wearable point-of-view live streaming technology for virtual physical exam skills training.

We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.

Nous avons mis à l'essai un outil d'enseignement virtuel, notamment pour les cours de techniques d'examen physique, qui consiste dans le fait de porter un téléphone intelligent fixé sur la poitrine pour diffuser en direct, par le biais d'un logiciel de vidéoconférence, pour réaliser un examen physique plutôt que subjectif. Comparativement aux étudiants en médecine qui pour le cours ont visionné une vidéo préenregistrée prise par caméra objective, suivie d'une discussion dirigée par un précepteur, un plus grand nombre d'étudiants ayant suivi le cours par le biais d'une technologie portable avec par le biais d'un dispositif technologique portable déclarent avoir amélioré leurs connaissances sur les techniques présentées, se sentir engagés et à l'aise pour interagir avec l'enseignant, et avoir été en mesure de bien voir les gestes d'examen montrés. Cette innovation accessible, abordable et facilement reproductible pourrait permettre d'améliorer l'enseignement virtuel des habiletés cliniques et d'offrir de nouvelles possibilités d'enseignement.

Waist circumference does not improve established cardiovascular disease risk prediction modeling.

Despite considerable evidence demonstrating that waist circumference (WC) is independently associated with cardiovascular disease (CVD) and/or all-cause mortality, whether the addition of WC improves risk prediction models is unclear. The objective was to evaluate the improvement in risk prediction with the addition of WC, alone or in combination with BMI, to the Framingham Risk Score (FRS) and a population specific model. 34,377 men and 9,477 women aged 20 to 79 years who completed a baseline examination at the Cooper Clinic (Dallas, TX) during 1977-2003 and enrolled in the Aerobics Center Longitudinal Study (ACLS). WC was measured at the level of the umbilicus and expressed as a continuous variable. Deaths among participants were identified using the National Center for Health Statistics National Death Index. A total of 728 fatal cardiovascular disease (CVD) events occurred over a mean follow-up period of 13.1 ± 7.5 years. WC was significantly higher in CVD decedents (P = .002). The FRS C-statistic for fatal CVD in men was 0.836 (0.816-0.855) and 0.883 (0.851-0.915) in women. The addition of WC did not improve the C-statistic in men (0.831 (0.809-0.853)) or women (0.883 (0.850-0.916)). Similar findings were observed for non-fatal CVD and all-cause mortality, and when WC was added to a population specific model. Upon adding WC, the net-reclassification index was 0.024 with an integrated discrimination improvement of -0.0004. The addition of WC, alone or in combination with BMI, did not substantively improve risk prediction for CVD or all-cause mortality compared to the Framingham Risk Score or a population specific model.

Does blood lactate predict the chronic adaptive response to training: A comparison of traditional and talk test prescription methods.

The purpose of this study was to test the hypotheses (i) that interindividual variability in acute blood lactate responses during exercise at 65% of peak work rate (WRpeak; relative WRpeak protocol (REL)) will predict variability in the chronic responses to exercise training and (ii) that exercising at an intensity that causes uncomfortable speech production (negative talk test (TT) stage (NEG)) elicits high acute blood lactate responses and large adaptations to training. Twenty-eight participants completed 4 weeks of exercise training consisting of REL (n = 14) or NEG (TT, n = 14). Fifteen additional participants were assigned to a no-exercise control group (n = 15). In REL, acute blood lactate responses during the first training session significantly predicted changes in peak oxygen consumption (r = 0.69) after training. TT resulted in consistently high acute blood lactate responses. REL and TT improved (p < 0.05) peak oxygen consumption, WRpeak, and work rate at the onset of blood lactate accumulation (WROBLA). Despite nonsignificance, small to medium between-group effect sizes for changes in peak oxygen consumption, WRpeak, and WROBLA and a higher work rate, heart rate, rating of perceived exertion, and blood lactate during training at NEG support the potential superiority of TT over REL. When exercise is prescribed using a traditional method (a fixed percentage of WRpeak; REL), acute metabolic stress may partly explain the variance in the adaptations to training. In addition, TT elicited significant increases in peak oxygen consumption, WRpeak, and WROBLA, and although our small sample size limits our ability to confidently compare training adaptations between groups, our preliminary results suggest that future investigations with larger sample sizes should assess the potential superiority of TT over REL.

Moving beyond threshold-based dichotomous classification to improve the accuracy in classifying non-responders.

We examined maximal oxygen consumption responses following exercise training to demonstrate the limitations associated with threshold-based dichotomous classification of responders and non-responders and proposed alternative methods for classification. Specifically, we: 1) calculated individual probabilities of response, and 2) classified individuals using response confidence intervals (CI) and reference points of zero and a smallest worthwhile change of 0.5 METs. Our findings support the use of individual probabilities and individual CIs to improve the accuracy in non-response classification.

Contribution of central and peripheral adaptations to changes in maximal oxygen uptake following 4 weeks of sprint interval training.

The current study examined the contribution of central and peripheral adaptations to changes in maximal oxygen uptake (V̇O2max) following sprint interval training (SIT). Twenty-three males completed 4 weekly SIT sessions (8 × 20-s cycling bouts at ∼170% of work rate at V̇O2max, 10-s recovery) for 4 weeks. Following completion of training, the relationship between changes in V̇O2max and changes in central (cardiac output) and peripheral (arterial-mixed venous oxygen difference (a-vO2diff), muscle capillary density, oxidative capacity, fibre-type distribution) adaptations was determined in all participants using correlation analysis. Participants were then divided into tertiles on the basis of the magnitude of their individual V̇O2max responses, and differences in central and peripheral adaptations were examined in the top (HI; ∼10 mL·kg-1·min-1 increase in V̇O2max, p < 0.05) and bottom (LO; no change in V̇O2max, p > 0.05) tertiles (n = 8 each). Training had no impact on maximal cardiac output, and no differences were observed between the LO group and the HI group (p > 0.05). The a-vO2diff increased in the HI group only (p < 0.05) and correlated significantly (r = 0.71, p < 0.01) with changes in V̇O2max across all participants. Muscle capillary density (p < 0.02) and ß-hydroxyacyl-CoA dehydrogenase maximal activity (p < 0.05) increased in both groups, with no between-group differences (p > 0.05). Citrate synthase maximal activity (p < 0.01) and type IIA fibre composition (p < 0.05) increased in the LO group only. Collectively, although the heterogeneity in the observed V̇O2max response following 4 weeks of SIT appears to be attributable to individual differences in systemic vascular and/or muscular adaptations, the markers examined in the current study were unable to explain the divergent V̇O2max responses in the LO and HI groups.

A representative volume element based micromechanical analysis of a Bi-layered Ganoid Fish scale.

The Mississippi Alligator gar (Atractosteus spatula) possesses a flexible exoskeleton armor consisting of overlapping ganoid scales used for predatory protection. Each scale is a two-phase biomineralized composite containing bio-modified hydroxyapatite (hard) minerals and collagen (soft) fibers. The protective layer consists of a stiff outer ganoine layer, a characteristic "sawtooth" pattern at the interface with the compliant bone inner layer. The garfish scale exhibits a decreasing elastic modulus from the external to the internal layers. Scanning electron microscopy (SEM) images of the cross-section revealed a two-layered structure. Elastic moduli, measured from nanoindentation experiments, were correlated to structural changes across each layer. The "material" symmetry of this materially and geometrically nonlinear biomineralized composite is unknown. Therefore, to be able to determine the stiffness tensor requires the use of finite element analysis (FEA). The gar fish scale was computationally modeled using the representative volume element (RVE) based approach. As a result, the unknown symmetry induced by the architecture and material layering require the use of complex FEA boundary conditions. The simulation was conducted in the pure uniaxial strain regimes of tension and shear, which necessitated the mathematical determination so appropriate surface loading conditions could be applied. This paper provides the results from a highly-resolved mesoscale RVE model based on iso-strain boundary conditions (ISBC) to determine the elastic stiffness tensor for the composite system. By assuming isotropic behavior in individual elements, the results for the RVE reveal the fish scale has an "orthotropic symmetry" with slight local strain variations occurring at the sawtooth interface.

Acute upregulation of PGC-1α mRNA correlates with training-induced increases in SDH activity in human skeletal muscle.

The purpose of the present study was to determine if acute responses in PGC-1α, VEGFA, SDHA, and GPD1-2 mRNA expression predict their associated chronic skeletal muscle molecular (SDH-GPD activity and substrate storage) and morphological (fibre-type composition and capillary density) adaptations following training. Skeletal muscle biopsies were collected from 14 recreationally active men (age: 22.0 ± 2.4 years) before (PRE) and 3 h after (3HR) the completion of an acute bout of sprint interval training (SIT) (eight 20-s intervals at ∼170% peak oxygen uptake work rate separated by 10 s of recovery). Participants then completed 6 weeks of SIT 4 times per week with additional biopsies after 2 (MID) and 6 (POST) weeks of training. Acute increases in PGC-1α mRNA strongly predicted increases in SDH activity (a marker of oxidative capacity) from PRE and MID to POST (PRE-POST: r = 0.81, r2 = 0.65, p < 0.01; MID-POST: r = 0.79, r2 = 0.62, p < 0.01) and glycogen content from MID to POST (r = 0.60, r2 = 0.36, p < 0.05). No other significant relationships were found between acute responses in PGC-1α, VEGFA, SDHA, and GPD1-2 mRNA expression and chronic adaptations to training. These results suggest that acute upregulation of PGC-1α mRNA relates to the magnitude of subsequent training-induced increases in oxidative capacity, but not other molecular and morphological chronic skeletal muscle adaptations. Additionally, acute mRNA responses in PGC-1α correlated with VEGFA, but not SDHA, suggesting a coordinated upregulation between PGC-1α and only some of its proposed targets in human skeletal muscle.