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Posture, spontaneous movements, and behavioural state organisation in infants affected by brain malformations.

Posture, quantity of spontaneous movement patterns, quality of general movements (GMs), and behavioural state organisation were studied in nine infants affected by documented brain malformations. A single 1 h video recording of five infants and two or more serial video recordings of another four infants were performed after birth. The graphic representation of single movement patterns (actogram) and of behavioural states of one video recording was performed in eight out of nine infants. The quality of GMs was assessed according to Prechtl's method in all video recordings. All nine infants showed a less variable posture than normal newborn infants and an unusual resting posture was detected in seven infants. Poor behavioural state organisation without sleep cycles was common to the nine infants and excessive wakefulness was observed in six infants. As for the quantity of single movement patterns, six infants lacked one or two movement patterns normally present in healthy newborn infants. An abnormal quality of GMs was noted in all nine infants and distinct motor abnormalities were observed in single infants. A monotonous and sometimes stereotyped sequence of different body parts involved in the movement (i.e. poor repertoire GMs) was common to all infants. In the four infants of whom two or more video recordings were available, initial poor repertoire GMs were followed by a further deterioration in movement quality. No relationship was found between the quantity of defective brain tissue, lack of a specific part of the brain, type and severity of GM and posture abnormalities.

Brain↗

Outpatient video EEG recording in the diagnosis of non-epileptic seizures: a randomised controlled trial of simple suggestion techniques.

OBJECTIVE: To assess the yield of recorded habitual non-epileptic seizures during outpatient video EEG, using simple suggestion techniques based on hyperventilation and photic stimulation. DESIGN: Randomised controlled trial of "suggestion" v "no suggestion" during outpatient video EEG recording. SETTING: Regional epilepsy service (tertiary care; single centre). PARTICIPANTS: 30 patients (22 female, 8 male), aged over 16 years, with a probable clinical diagnosis of non-epileptic seizures; 15 were randomised to each group. MAIN OUTCOME MEASURES: Yield of habitual non-epileptic seizures recorded, and requirement for additional inpatient video EEG. RESULTS: 10/15 patients had habitual non-epileptic seizures with suggestion; 5/15 had non-epileptic seizures with no suggestion (p = 0.058; NS); 8/9 patients with a history of previous events in medical settings had non-epileptic seizures recorded during study. Logistic regression analysis with an interaction clause showed a significant effect of suggestion in patients with a history of previous events in medical settings (p = 0.003). An additional inpatient video-EEG was avoided in 14 of the 30 patients (47%). CONCLUSIONS: Habitual non-epileptic seizures can be recorded reliably during short outpatient video EEG in selected patients. Simple (non-invasive) suggestion techniques increase the yield at least in the subgroup with a history of previous events in medical settings. Inpatient video EEG can be avoided in some patients.

Adult↗

Personal computer-based small PACS for radiotherapy--analog image filing system for radiotherapy.

The purpose of this study is to evaluate the usefulness of a personal computer-based small PACS using analog video images. The analog video recorder, personal computer, and display monitor constitute our system. An analog video recorder is composed of a laser disk recorder for still images and a video cassette recorder for moving images. The acquired video images are managed by a personal computer and database software. The serial communication ports of the personal computer and a video recorder are connected with the reverse cable, and the video recorder is controlled by the personal computer using our program. This system enables filing of multi-modality images including moving images and is used for following up and treatment planning of the patients who received radiotherapy.

Aftercare↗

[Video technology and the personal computer in the therapy simulator].

PURPOSE: Technical progress in the development of radiation therapy simulators provided valuable addition of electronically stored images and monitor indicators for individual radiation parameters. One can store as well as print these data as a treatment plan. The possibility of supplementing older simulators with these technical options will be reported in the following paper. METHODS: The modification of our simulator installation was done simply. The new equipment needed to expand our simulator facility was almost exclusively derived from the fields of entertainment and home electronics (Visualizer/video camera, video tape recorder, video mixer, additional monitor; personal computer and printer). RESULTS: With these modifications we reached the technical standards of the latest simulator generation. In addition, we succeeded in implementing additional technical options: e.g. image inversion with contrast alignment to diagnostic displays, complete magnetic tape recording of the entire x-ray process with possible repetition, electronic overlapping of the simulator image and the diagnostic image (e.g. NMR; angiograms) to determine the treatment volume, automation in x-ray documentation. CONCLUSION: Increased precision and rational work steps employing readily available equipment will lead to further improvement in the quality of radiotherapy.

Computer Systems↗

Recording skills practice on videotape can enhance learning - a comparative study between nurse lecturers and nursing students.

Video recording techniques have been used in educational settings for a number of years. They have included viewing video taped lessons, using whole videos or clips of tapes as a trigger for discussion, viewing video recordings to observe role models for practice, and being video recorded in order to receive feedback on performance from peers and tutors. Although this last application has been in use since the 1960s, it has only been evaluated as a teaching method with health care professionals in the past 10 years and mostly in the areas of medical and counsellor education. In nurse education, however, use of video recording techniques has been advocated without any empirical evidence on its efficacy. This study has used nursing degree students and nurse educationalists to categorize statements from four cohorts of students who took part in a 12-day clinical supervision course during which their interpersonal skills were recorded on videotape. There were two categories: positive and negative/neutral. Analysis of the data showed that between 61% and 72% of the subjects gave an overall positive categorization to the statements in the questionnaire. Chi-square tests were significant for all groups in both categories. This suggests that both nursing students and nurse lecturers thought that course participants' statements expressed a positive belief that video tape recording is useful in enhancing students' ability to learn effective interpersonal skills in clinical supervision.

Adult↗

[Epilepsy and sleep as seen on video encephalographic recordings].

INTRODUCTION: The relation between epilepsy and sleep has been known for some time. Seizures are often not observed by the examiner and it is necessary to make prolonged recordings during sleep, both slow or no REM sleep and paradoxical or REM sleep. Objective. To show the way in which a video recording may be made of a patient s seizures, together with an electroencephalogram recorded on a suitable disk and both sets of data be synchronised and studied as often as necessary. PATIENTS AND METHODS: We describe some of the epileptic seizures, recorded by this technique, during sleep. At the same time we show other paroxystic non epileptic episodes occurring during sleep which may be needed to be ruled out of the differential diagnosis. CONCLUSIONS: We show that as a general rule the basic activity of paroxystic disorders seen on an electroencephalogram occurs during slow sleep phases and particularly during their early stages. These studies are especially relevant in children and in neonates a prolonged recording is essential

Child↗

Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the degree of agreement between different methods of assessing physical activities in daily life in patients with chronic obstructive pulmonary disease (COPD): video recordings (criterion standard), the DynaPort Activity Monitor (DAM), and patient self-report. DESIGN: Study A: outcomes from video recordings were compared with DAM outcomes and with patient estimation of time spent on each activity after a 1-hour protocol including walking, cycling, standing, sitting, and lying. Study B: DAM outcomes and patient self-report were compared during 1 day in real life. SETTING: Outpatient clinic in a university hospital. PARTICIPANTS: Study A: 10 patients with COPD (mean age, 62+/-6 y; forced expiratory volume in the first second [FEV1]=40%+/-16% of predicted). Study B: 13 patients with COPD (mean age, 61+/-8 y; FEV1=33%+/-10% of predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time spent on different activities and movement intensity during walking and cycling. RESULTS: Study A: time estimated by the patients in the sitting position was significantly lower than the time showed by the video recordings and the DAM (both P<.001). For the other variables, there were no statistically significant differences (all P>.05). However, Bland and Altman plots and intraclass correlation coefficients showed large disagreement between video recordings and patients' estimations, in contrast to the high degree of agreement between video recordings and DAM. Changes in walking speed correlated highly to changes in DAM movement intensity (r=.81, P<.01). Study B: patients significantly overestimated walking time (22+/-47 min, P=.04) and underestimated standing time (-45+/-71 min, P=.04). CONCLUSIONS: The DAM showed high accuracy in objectively assessing time spent on different activities and changes in walking speed in patients with COPD. Patients' estimations of time spent on physical activities in daily life disagreed with objective assessment.

Activities of Daily Living↗

Multimedia data capture and management for surgical events: Evaluation of a system.

The objective of this study was to design an electronic form of documentation of surgical procedures, which would include audio and video recording of the entire surgical procedure. Video clips have shown promise for teaching surgical procedures. To date, no systems have been described to fully record video and audio of all events during a surgical procedure. Much as such systems have aided the airline industry, surgical safety, documentation, and education could benefit from comprehensive, multimedia documentation systems. Four camcorders provided views of: (1) anesthetic monitors, (2) laparoscopic images, (3) room view, and (4) surgical field view. All video and audio were combined with real-time written documentation of events within a simple, inexpensive database for archiving, review, and evaluation. Electronic records provided answers to more than 90% of the structured review questions, leaving only 6% unanswered, versus 92% unanswerable based on the traditional paper records. This electronic documentation system provides a much more comprehensive and easily mined means of surgical documentation than traditional paper records.

Cholecystectomy, Laparoscopic↗

A systematic approach to the understanding and redesigning of cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) is a highly complex process. We developed a system to capture and study detailed information during cardiac surgery that serves as a framework for understanding variation that occurs during CPB. The system allows the surgical team to link unwanted variation (ie, hypotension) and unwanted events (ie, the production of microemboli) to the processes of care. A more thorough understanding of embolic activity and hemodynamic aberrations, precursors to both stroke and subtle neurologic injury, that occur during CPB, will allow the surgical team to identify high leverage, modifiable aspects of care and abate these precursors to patient injury. Multimodality simultaneous monitoring and recording of physiologic parameters, emboli in the CPB circuit and in the middle cerebral arteries, and cerebral NIRS during surgery was carried out in patients undergoing open heart surgery with CPB. A system was designed that captures physiologic data from the patient monitors and the heart-lung machine at 20-second intervals and time synchronizes all measures with a video recording of the surgical procedure. Emboli counts count in the CPB circuit and right and left middle cerebral arteries were continuously recorded. Video recordings depicting various surgical and perfusion techniques with associated embolic activity were provided to the surgical team. Wide variation in embolic counts, cerebral blood flow velocity, and physiologic parameters were observed. Periods of embolic activity and cerebral desaturation could be related to surgical and CPB processes of care. We have identified increased emboli counts in the CPB circuit and in the middle cerebral arteries related to the method of venous drainage, manipulation of the aorta, and anastomotic techniques. se of this model provides the surgical team detailed information about these precursors to neurologic injury. This system provides a systematic approach to the understanding and redesigning of CPB.

Cardiopulmonary Bypass↗

Clinical evaluation of mastication: validation of video versus electromyography.

BACKGROUNDS AND AIMS: The ability to evaluate masticatory function in people with neurological disabilities is important as this function is often compromised in these groups. However, current standard techniques are often impossible in such groups due to cognitive difficulties. This study is a validation of several variables read from standardised video recordings of mastication as indicators of masticatory function. METHODS: Fifteen healthy, fully dentate male subjects were recorded using EMG and by video simultaneously. An evaluation was undertaken of the video parameters (i) to compare their validity against the electromyographic parameters, (ii) to test intra-rater and inter-rater reliability and (iii) to test the ability to discriminate between four model foods differing in hardness. RESULTS: Masticatory time and the number of masticatory cycles counted on video were found to be valid and reliable indicators. In addition, the number of active chewing cycles performed with an open mouth and identification of the chewing side, were found to have reasonable validity and reliability. The former may allow discrimination between food types. CONCLUSION: As an alternative to the complex evaluation of masticatory function, observation of certain parameters from video recording could be an alternative for use in uncooperative patients.

Adult↗

Monitoring at the National Institute of Neurological and Communicative Disorders and Stroke.

Intensive monitoring (prolonged, telemetered EEG recording, video tape recording, and plasma drug level monitoring) has an integral role in the correct diagnosis and treatment of patients with intractable epilepsy or suspected epilepsy. The intensive monitoring unit at the Clinical Epilepsy Section, NINCDS, exemplifies a well-integrated system for clinical epilepsy research. The resulting library of video taped seizures is a valuable resource for teaching and the production of films on epilepsy.

Electroencephalography↗

Sleep-related laryngospasm: a video-polysomnographic recording.

We present a case of laryngospasm in a 12-year-old male who experienced sudden, nocturnal episodes of breathing difficulties and agitation. Apart from laryngospasm, the main differential diagnoses included frontal seizures, sleep-related choking syndrome, sleep asthma, sleep apnoea and REM sleep behaviour disorder. The video and the EEG recordings supported the diagnosis of laryngospasm. The pH-metry confirmed the existence of reflux. Its treatment successfully controlled the episodes. This case illustrates, with a typical video recording, this infrequent type of paroxysmal event with an important differential diagnosis.[Published with video sequences].

Child↗

Sonographic examination of the oral phase of swallowing: bolus image enhancement.

PURPOSE: The purpose of this study was to evaluate the ability of 4 liquid boluses to enhance pixel brightness and the ease with which the boluses could be identified during the sonographic evaluation of oral swallowing in healthy young adults. METHODS: Ten healthy adult volunteers (5 men and 5 women), ranging in age from 21 to 31 years, underwent sonographic evaluation of the oral phase of swallowing while sitting in their usual feeding position. We compared the ability of the 4 following liquids to improve sonographic visualization of swallowing with that of water: a carbonated cola beverage, 5.0 ml of Thick-It in 120 ml of water, 2.5 ml of Thick-It in 120 ml of water, and 7.5 ml of confectioners' sugar in 120 ml of water. Water was used as a control. In each case, 5 ml of the liquid was introduced into the subject's oral cavity using a syringe, and the subject was instructed to swallow. Digitized still images and recorded video sequences of sonographic examinations of the swallowing were analyzed. The brightness of the bolus image on selected digitized video frames was measured digitally using Image Analyst software. Pixel brightness within selected regions of interest for each of the test liquids was statistically compared with that for water. Seven clinicians rated the visualization of each test liquid and water on paired sonographic videotape sequences. These ratings and the level of agreement between them were statistically tested. RESULTS: Only the carbonated cola beverage demonstrated statistically greater pixel brightness than that of water on digitized video frames (p = 0.01), whereas both cola (with a moderate inter-rater agreement, kappa = 0.50) and 5.0 ml Thick-It mixed with 120 ml of water (with a fair inter-rater agreement, kappa = 0.24) were significantly better visualized on sonographic video sequences. CONCLUSIONS: The digital still-frame analysis confirmed the clinicians' ratings of bolus visualization on real-time sonography, but dynamic sonography is more important than still frames in assessing sonographic swallow media because the dynamic images more closely parallel what is seen in clinical practice. Future investigations of sonographic contrast agents for use in the examination of the oral phase of swallowing should use both static digital (still-frame) and dynamic (real-time) assessment methods, as well as expert reviewers.

Adult↗

Subtle involuntary movements are not reliable indicators of incipient Huntington's disease.

In the past, Huntington's disease was diagnosed when movement disturbances were present in concordance with a positive family history. Early motor signs, however, are often not found in a standard neurologic examination, and their expression is variable. Not until later stages of the disease could one be sure about the diagnosis. Since genetic diagnosis became available, the onset of symptoms and signs could be studied in the earliest phase. The aim of the study was to evaluate observer agreement of the assessment of early motor signs in Huntington's disease. A total of 17 gene carriers, 22 noncarriers, and eight partners were recorded on video performing several facial movements after instruction and engaging in a 5-minute conversation. Three experienced neurologists, unaware of the genetic status of the participants, judged and classified the video recordings independently. The cases with disagreement were judged a second time after the neurologists discussed these cases. The observer agreement after the first judgment is poor (kappas 0.09, 0.24, 0.45) and after the second judgment satisfactory (kappas 0.79, 0.90, 0.78). Consequences for clinical practice and research programs into early symptoms and signs are discussed.

Adult↗

Computer-based analysis of facial action in schizophrenic and depressed patients.

With a newly developed computer analysis the space coordinates of light-reflecting points, attached to a subjects' face, were recorded across time with high temporal and spatial resolution. Under different experimental conditions the facial actions of 20 schizophrenics, 20 depressives and 20 normal controls were analysed. Furthermore, raters watched the synchronously recorded video versions of the subject's face and rated them as to expressivity. The findings indicate that depressive and schizophrenic patients exhibited reduced facial activity in the upper part of their face in social interaction conditions. Schizophrenic patients showed reduced facial action responsivity across different conditions and emotions. All patients were judged to be less expressive than normal controls by raters, suggesting apparent disintegrated elements in facial activity, although when computer-analysed they exhibited the same amount of facial activity.

Adult↗

The effects of an ergonomic-educational course. Postural load, perceived physical exertion, and biomechanical errors in nursing.

OBJECTIVES: To evaluate the results of an ergonomic-educational course for nurses we assessed the number and percentage of harmful postures and of ergonomic and biomechanical errors made before and after the course. We also studied the perceived physical exertion. MEANS AND METHODS: In all, 12 nurses who had participated in the course (trainees) and 12 who had not (controls) were recorded on video while performing standardized nursing tasks. The wards from which the two groups of nurses came were comparable, as were the patient populations. The nurses were also comparable in some personal characteristics. The tasks they performed included washing, lifting, and repositioning a patient as well as certain tasks other than patient handling. Video recordings were made once before (1-2 weeks) and twice after the course (after 3 months and after 15 months). The harmful postures, the errors made, and the ratings of perceived exertion were measured by means of the Ovako Working-posture Analysis System (OWAS), a checklist, and Borg scores, respectively. RESULTS: When the first and last measurements of all the above tasks taken as a whole were analyzed the trainees showed a significant improvement in the number and percentage of harmful postures and errors, whereas the controls did not. The same could be concluded for lifting alone. After the course the new work routine did not appear to have caused any extra perceived physical exertion. CONCLUSION: It can be concluded that the course was successful, although it should be carefully investigated as to whether nurses remain capable of working safely in daily practice. The work pressure that nurses experience during their normal duties could prevent them from working safely during everyday work.

Adult↗

Microinjection into giant vesicles and light microscopy investigation of enzyme-mediated vesicle transformations.

BACKGROUND: 'Giant vesicles' have diameters of several micrometers and can be observed by light microscopy. Their size may allow manipulation of individual vesicles and direct observation of the progress of a chemical reaction in real time. We set out to test this possibility using enzymatic hydrolysis of vesicle components as a model system. RESULTS: We describe a novel micromanipulation technique that allows us to microinject femtoliter amounts of a reagent solution adjacent to or into giant vesicles with diameters ranging from 10 to 60 microm. The vesicle transformations can be monitored directly in real time by light microscopy and recorded by video analysis. Snake venom phospholipase A2 was added to vesicles composed of 1-palmitoyl-2-oleoyl-sn-glycerol-3-phosphocholine, and the enzymatic hydrolysis of components of the lipid bilayer was observed over time. A specific effect on the targeted giant vesicle was seen and video recorded, while the neighbouring vesicles remained unaffected. Addition of the enzyme to the outside of a vesicle caused it to burst, whereas injection of the enzyme inside a vesicle resulted in a slow and constant decrease in its size, until it eventually disappeared from the resolution power of the light microscope. CONCLUSIONS: These results show that it is possible to micromanipulate an individual vesicle, and to follow visually the progress of an enzymatic reaction occurring on the vesicle bilayer over time.

Microinjections↗

Evaluation of four blood pump geometries: fluorescent particle flow visualisation technique.

Artificial blood pumps play an increasingly important role in the treatment of end-stage cardiac failure. The fluid dynamics of blood flow through such devices crucially affects their clinical effectiveness. Specifically, if the flow of blood stagnates or slowly re-circulates thrombus formation can occur and the avoidance of such flow features is a primary consideration in the design of pumps. The present study concerns the development of a fluorescent particle visualisation technique and its application to investigate the flow environments in four prototype blood pump designs. The procedure involves recording video images of eight illuminated cross sections through the pumping chambers as the pumps operate in a mock circulatory loop using a test fluid seeded with fluorescent particles. The technique enabled a semi-quantitative characterisation of the entire flow field, throughout the pumping cycle, to be performed for each pump design. Flow features were then related to design properties of the individual pumps and recommendations made for design optimisation.

Anion Exchange Resins↗