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.

Intraoperative use of balanced crystalloids versus 0.9% saline: a systematic review and meta-analysis of randomised controlled studies.

BACKGROUND: The evidence regarding optimal crystalloid use in the perioperative period remains unclear. As the primary aim of this study, we sought to summarise the data from RCTs examining whether use of balanced crystalloids compared with 0.9% saline (saline) leads to differences in patient-important outcomes. METHODS: We searched Ovid MEDLINE, Embase, the Cochrane library, and Clinicaltrials.gov, from inception until December 15, 2022, and included RCTs that intraoperatively randomised adult participants to receive either balanced fluids or saline. We pooled data using a random-effects model and present risk ratios (RRs) or mean differences (MDs), along with 95% confidence intervals (CIs). We assessed individual study risk of bias using the modified Cochrane tool, and certainty of evidence using GRADE. RESULTS: Of 5959 citations, we included 38 RCTs (n=3776 patients). Pooled analysis showed that intraoperative use of balanced fluids compared with saline had an uncertain effect on postoperative mortality analysed at the longest point of follow-up (RR 1.51, 95% CI: 0.42-5.36) and postoperative need for renal replacement therapy (RR 0.95, 95% CI: 0.56-1.59), both very low certainty. Furthermore, use of balanced crystalloids probably leads to a higher postoperative serum pH (MD 0.05, 95% CI: 0.04-0.06), moderate certainty. CONCLUSIONS: Use of balanced crystalloids, compared with saline, in the perioperative setting has an uncertain effect on mortality and need for renal replacement therapy but probably improves postoperative acid-base status. Further research is needed to determine whether balanced crystalloid use affects patient-important outcomes. CLINICAL TRIAL REGISTRATION: CRD42022367593.

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.

Regulation of ICAM-1 in human neutrophils.

Intercellular cell adhesion molecule 1 (ICAM-1) is a cell surface glycoprotein with a vital role in the immune response to pathogens. The expression pattern of ICAM-1 is wide-ranging, encompassing endothelial cells, epithelial cells and neutrophils. Recent work has characterized the role of ICAM-1 in murine neutrophils, but the function of human neutrophil ICAM-1 is incompletely understood. Herein, we investigated the expression and role of ICAMs in human neutrophils in vitro and in vivo. Our findings show clear expression of ICAM-1, -3 and -4 on peripheral blood-derived neutrophils and demonstrate that the pathogen-associated molecular pattern (PAMP) lipoteichoic acid (LTA) is an inducer of ICAM-1 expression in vitro. In vivo, neutrophils obtained from the pleural cavity of patients with a parapneumonic effusion display enhanced expression of ICAM-1 compared to peripheral blood- and oral cavity-derived neutrophils. Moreover, migration of peripheral blood-derived neutrophils across endothelial cells can upregulate neutrophil ICAM-1 expression. These findings indicate that PAMPs and/or cytokines, alongside transmigration, enhance neutrophil ICAM-1 expression at sites of inflammation. Mechanistically we observed that ICAM-1high neutrophils display elevated S. aureus phagocytic capacity. However, unlike murine neutrophils, ICAM-1 intracellular signaling in human neutrophils was not essential for phagocytosis of S. aureus and reactive oxygen species (ROS) generation. Taken together, these results have important implications for the regulation of neutrophil-mediated pathogen clearance.