Is YouTube™ a good source of information for patients to understand laparoscopic fundoplication?

INTRODUCTION: Gastro-oesophageal reflux disease affects 10-20% of the population, and laparoscopic fundoplication is one management option. As the most frequently accessed video-sharing website, YouTube has become a popular source of information for patients. This study conducted a cross-sectional analysis of the quality and demographics of patient education videos available on YouTube for laparoscopic fundoplication. METHODS: Three searches were performed on YouTube using the phrases 'laparoscopic fundoplication', 'heartburn surgery' and 'reflux operation'. The Health on The Net (HON) code, DISCERN and Journal of the American Medical Association (JAMA) systems were used to score the first 75 results from each query. Information about each video was collected, including number of views, time since posting, number of comments and the author of the video. Relationships between these variables and video quality were investigated. RESULTS: The median number of views was 3,793. The most common author category was videos produced by surgeons. Overall the quality was poor, mean HON score was 2.5/8, mean DISCERN score was 29.3/80 and mean JAMA score was 1.5/4. Surgeon-authored videos scored higher when scored using the HON and JAMA systems. Videos of longer duration scored higher using all three scoring systems. No other factors were found to be associated with video quality. CONCLUSION: The quality of information in YouTube videos on laparoscopic fundoplication is unreliable. Doctors should be aware of this and caution their patients of YouTube's limitations. Further research is needed to develop validated scoring systems for evaluating the quality of patient education videos.

Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change.

BACKGROUND: Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS: Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS: From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION: The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.

Occult upper gastrointestinal mucosal abnormalities in critically ill patients.

BACKGROUND: The objectives of this study were to estimate the frequency of occult upper gastrointestinal abnormalities, presence of gastric acid as a contributing factor, and associations with clinical outcomes. METHODS: Data were extracted for study participants at a single centre who had an endoscopy performed purely for research purposes and in whom treating physicians were not suspecting gastrointestinal bleeding. Endoscopic data were independently adjudicated by two gastroenterologists who rated the likelihood that observed pathological abnormalities were related to gastric acid secretion using a 3-point ordinal scale (unlikely, possible or probable). RESULTS: Endoscopy reports were extracted for 74 patients [age 52 (37, 65) years] undergoing endoscopy on day 5 [3, 9] of ICU admission. Abnormalities were found in 25 (34%) subjects: gastritis/erosions in 10 (14%), nasogastric tube trauma in 8 (11%), oesophagitis in 4 (5%) and non-bleeding duodenal ulceration in 3 (4%). The contribution of acid secretion to observed pathology was rated 'probable' in six subjects (rater #1) and five subjects (rater #2). Prior to endoscopy, 39 (53%) patients were receiving acid-suppressive therapy. The use of acid-suppressive therapy was not associated with the presence of an endoscopic abnormality (present 15/25 (60%) vs. absent 24/49 (49%); P = 0.46). Haemoglobin concentrations, packed red cells transfused and mortality were not associated with mucosal abnormalities (P = 0.83, P > 0.9 and P > 0.9 respectively). CONCLUSIONS: Occult mucosal abnormalities were observed in one-third of subjects. The presence of mucosal abnormalities appeared to be independent of prior acid-suppressive therapy and was not associated with reduced haemoglobin concentrations, increased transfusion requirements, or mortality.

Friends and lovers: needle sharing in young people in Western Australia.

The Youth AIDS and Drugs (YAD) Study is a study of young people who inject drugs, and their risk of the transmission of HIV through needle sharing and/or unsafe sex. One hundred and five people, aged less than 21, 75% of whom were current or recent injectors, undertook in-depth interviews which were tape recorded, transcribed and analysed qualitatively. This paper focuses on the ways in which the young people in the group attempted to manage the risk of needle sharing. Needle sharing in the study group was not common behaviour. Almost all injectors employed one of four major Risk Management Strategies some of which included the possibility of sharing unbleached needles with a friend or a lover. These strategies were strongly related to beliefs that such friends and lovers were well enough known by the individual for there to be very little risk. The implications of these findings for health promotion with young people who inject drugs in Perth, a city of low IDU seroprevalence, are outlined.

Adolescent cigarette consumption: the influence of attitudes and peer drug use.

Predictors of tobacco consumption were investigated with path analytic techniques using household survey data from 1,093 teenagers aged 13-17. When current smokers are compared to past or never smokers, pro-tobacco attitudes are always the most important predictor variable followed by friends' use of marijuana and own use of marijuana, suggesting that pro-tobacco attitudes are responsible for maintaining tobacco consumption. We infer that peer illicit drug use has the greatest effect in taking up smoking because it is the most important predictor of past smoker status compared to never smoking and it does not appear as such an important predictor of current use compared to never smoker status. Pro-tobacco attitudes are a consequence of smoking rather than an influence upon taking up smoking.

Levels of drunkenness of customers leaving licensed premises in Perth, Western Australia: a comparison of high and low 'risk' premises.

A measure of the risk of licensed premises having customers involved in road traffic accidents and drink-driving offences was utilised in order to identify seven 'High Risk' and eight 'Low Risk' premises in metropolitan Perth, Western Australia. This measure, or 'Risk Ratio', was defined as the ratio of incidents of alcohol-related harm to an estimate of on-premises alcohol sales for a particular establishment. A study was conducted to test the hypothesis that a High Risk status would be associated with greater levels of customer intoxication. Interviews concerning drinking behaviour and breathalyser readings were collected from 74.2% of 414 customers exiting from the chosen premises between 8 p.m. and midnight on Friday and Saturday nights. High Risk premises had three times more customers whose readings were in excess of 0.15 mg/ml (p less than 0.01). The proportion of customers with BAL's above 0.15 correlated strongly with the premises' Risk Ratio (r = 0.63, p less than 0.01). There were also significantly more patrons from High than from Low Risk establishments who were rated as appearing moderately or severely intoxicated but refused to be interviewed or breath-tested. It is argued that these results support the need for strategies which aim to reduce very high levels of intoxication on licensed premises in order to reduce alcohol-related accidents, injuries and offences.