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PubMedDate not supplied

Cognitive evaluation of decision making processes and assessment of information technology in medicine.

This paper describes cognitive methods for analyzing medical decision making and evaluating medical information systems. The overall approach focuses on understanding the processes involved in the decision making and reasoning of health care workers, both with and without the use of information technologies. The issue of developing appropriate evaluation tools, for use in the design and analysis of medical information systems is considered to be of great importance. However, conventional methods are limited in their ability to identify and characterize the effects of information technology on the cognitive processes involved in decision making and reasoning. In this paper a range of methods are described involving video recording for collecting data on the use of information systems. The techniques described allow for the collection of an integrated data set consisting of transcripts of health care workers as they 'think aloud' in interacting with a medical system, along with complete video records of user-computer interaction. In addition, the methods can be extended to allow for the collection of process data from video recording of systems in actual clinical and emergency situations. The use of a variety of approaches, borrowing from research in cognitive science, is discussed. The development and application of these evaluation methods within the Canadian Centres of Excellence network HEALNet is subsequently described. Finally, implications for the development and evaluation of medical information systems are considered.

Cognition↗

PubMedDate not supplied

Studies in infant behavioural audiometry. III. Six-month-old infants.

The behaviour of 95 clinically normal 6-month-old babies previously studied as neonates and as 6-week-old infants was video-recorded while they were presented with sound stimuli. The stimulus series varied in sound pressure level (SPL) (30 and 60 dB), band with (BW) and rise time (RT), and included two voice signals and a no-sound (control) trial. Video-records were made both for the whole body aspect and for a 3 1/2 X 'close-up' of the head. Later, the video-records were shown to 6 observers who were allowed to see the babies for 13 s at each trial. The first 5 s was a pre-stimulus observation period, and the second 8 s usually contained a sound stimulus. Between the trials, the observers were given 20 s in which to record pre-stimulus activity, confidence in response, and movement details. Data for movement details are not reported here. Different segments of the baby's body were observed on different occasions as detailed in our previous reports. The confidence ratings for response to tonal stimuli were analyzed using aspects of signal detection theory for differences amongst various body segments (n.s.), SPL (p less than 0.001), BW (p less than 0.05), and RT (p less than 0.01). A 60-dB broad-spectrum noise band (BSN) and the 2 voices were by far the most effective stimuli. They elicited detectablities which differed between segments. The response to different sound stimuli was affected by the baby's pre-stimulus activity state. The results are discussed in relation to our previous studies.

Acoustic Stimulation↗

PubMed2006

Video-based ergonomic analysis to evaluate thoracostomy tube placement techniques.

BACKGROUND: Thoracostomy for relief of pneumo- or hemothorax may be performed emergently at the bedside, in the emergency department or trauma area, often in nonideal circumstances. We hypothesized that ergonomic analysis of thoracostomy techniques can identify areas for potential improvement in patient and operator safety. METHODS: Interviews with Subject Matter Experts (SME) provided steps in the task of thoracostomy; 44 thoracostomies (emergent and elective) were video-recorded and reviewed by SMEs. Ergonomic analyses evaluated surgical performance techniques using video clips. RESULTS: Risks to the patient and operator included instrument-tray positioning and instrument content. Analyses of video records revealed that despite SME-survey consensus, operators inconsistently followed recommended techniques. CONCLUSIONS: Discrepancies between SME-recommended and observed practice are prevalent, with simple ergonomic problems impeding performance, and creating risks for patients and operators. Video-based ergonomic analysis is a rich source for identifying task performance problems and potential solutions.

Chest Tubes↗

PubMed1999

Digital still image recording during video endoscopy.

With the advances in telemedicine and virtual consultation services comes the need for state-of-the-art endoscopic imaging techniques and equipment. Concomitant with current day concerns of cost containment, the ability to utilize the aforementioned tools in a cost-effective fashion that lowers operating expenses, accurately depicts procedures, and expedites chart documentation is paramount. We report on a fast and efficient way to obtain and store images during endoscopic procedures, which can be stored on standard 3.5-inch floppy disks using an innovative digital image recorder. These images are stored as high-resolution (640x480x24) JPEG files, which can be placed in electronic medical records, imported into Internet Web pages, incorporated into slide presentations, and, most importantly, stored in easily accessed archives.

Computer Communication Networks↗

PubMed1978

A long term time-lapse video system to document the patients spontaneous clinical seizure synchronized with the EEG.

A long term audio/video clinical seizure monitoring system is described which is complementary to a previously described EEG seizure monitoring system. The video unit is mobile and based on time-lapsed video recording techniques to extend the unattended continuous video recording of the patient to many days if necessary. The simultaneous coverage of the EEG and behavior of the patient particularly during his seizure has been very useful in the workup of intractable epileptic patients being considered for neurosurgical treatment.

Electroencephalography↗

PubMed2003

Long-Evans and Sprague-Dawley rats have similar skilled reaching success and limb representations in motor cortex but different movements: some cautionary insights into the selection of rat strains for neurobiological motor research.

Many rat strains are used for neurobiological studies of nervous system function and behavior. The most widely used strain for studies of the neural basis of movement is the out bred, pigmented Long-Evans strain, while the most widely used strains for the study of movement impairments in neurological disease are out bred albino rats, including Sprague-Dawley rats. Although previous research has indicated that there are strain differences in skilled movements displayed by different rat strains, there has been no explicit comparison of the Long-Evans and Sprague-Dawley strains. This was the purpose of the present study. The rats were video recorded as they learned to reach for single food pellets and the video records were subjected to frame-by-frame analysis. Component movements of reaching were scored using a system derived from Eshkol-Wachman Movement Notation (EWMN). The quality of movements was described using Laban Movement Analysis (LMA). Forelimb representations in motor cortex were defined electrophysiologically. Acquisition scores and success in reaching did not differ between the two strains, nor did the topographical representation of the forelimb in motor cortex. Long-Evans and Sprague-Dawley rats did differ in the movements used for reaching and on the quality of their movements. The movements of Sprague-Dawley rats resembled the movements of Long-Evans rats with motor system injury. That rat strains can show both quantitative and qualitative differences in movement is useful for the understanding of the genetic, neural, and behavioral organization of the motor system. The results are also relevant to the question of appropriateness of particular rat strains for studies of neurological diseases and the effects of albinism on motor behavior, and suggest that some of the most widely used rat strains for neurological investigations may be less than appropriate.

Animals↗

PubMed2005

Non-participant observation: using video tapes to collect data in nursing research.

Observation is a highly valued and effective research method, as well as being an essential part of nursing practice. The authors explore the way in which non-participant observation as a research method might be enhanced by the use of video recording. The utility, ethical considerations and constraints of video recording as a data collection tool are discussed, with examples from a research study. The authors argue that the use of videos can enhance the credibility of non-participant observation studies through the minimisation of selectivity and bias and the opportunity to employ more rigorous strategies for ensuring reliability.

Attitude of Health Personnel↗

PubMed2005

Assessing the technical skills of surgical trainees.

BACKGROUND: The aims were to determine whether tests of technical skill on simple simulations can predict competence in the operating theatre and whether objective assessment in the operating theatre by direct observation and video recording is feasible and reliable. METHODS: Thirty-three general surgical trainees undertook five simple skill simulations (knotting, skin incision and suturing, tissue dissection, vessel ligation and small bowel anastomosis). The operative competence of each trainee was then assessed during two or three saphenofemoral disconnections (SFDs) by a single surgeon. Video recordings of the operations were also assessed by two surgeons. RESULTS: The inter-rater reliability between direct observation and blinded videotape assessment was high (alpha = 0.96 (95 per cent confidence interval 0.92 to 0.98)). Backward stepwise regression analysis revealed that the best predictors of operative competence were the number of SFDs performed previously plus the simulation scores for dissection and ligation, the key components of SFD (64 per cent of variance explained; P = 0.001). CONCLUSION: Deconstruction of operations into their component parts enables trainees to practise on simple simulations representing each component, and be assessed as competent, before undertaking the actual operation. Assessment of surgical competence by direct observation and video recording is feasible and reliable; such assessments could be used for both formative and summative assessment.

Anastomosis, Surgical↗

PubMed2006

Evaluation of a new self-contained, ambulatory, objective cough monitor.

OBJECTIVE AND BACKGROUND: Objective monitoring of cough may be preferred to subjective reporting of the symptom in clinical and research settings. Therefore, a self-contained, ambulatory cough monitoring system is needed that is non-invasive, usable for children and adults of all ages, inexpensive, and highly accurate with easy to use analysis software. METHODOLOGY: After development of a new device, 15 subjects with frequent coughing were recorded with the novel cough monitor and a simultaneous video recording in order to validate the monitor compared with a gold standard. Two investigators independently analyzed the recordings and counted the number of coughs during the study period from both the cough monitor and the video recording. RESULTS: When measuring agreement between the two investigators, the sample concordance correlation coefficient for audio counts was 0.998 (p < 0.001). In the comparison of video counts, the sample concordance correlation coefficient was 0.997 (p < 0.001). For the comparison of investigator 1's video counts to the corresponding audio counts, the sample concordance correlation coefficient was 0.968 (p = 0.026). For the comparison of investigator 2's video counts to the corresponding counts, the sample concordance correlation coefficient was 0.973 (p = 0.015). CONCLUSION: We have developed and piloted a new, valid, and reproducible method of objectively recording and analyzing cough. This device appears to be useful for subjects of any age and in clinical and research settings.

Journal Article↗

PubMedDate not supplied

Quantification of muscular activity in the shoulder region during monotonous repetitive work.

The purpose of this preliminary study was to evaluate the degree of myoelectric activity (EMG) in the shoulder muscles during repetitive monotonous work cycles in order to assess the load on the shoulder muscles. The tasks were video recorded and the movements performed were analyzed with a direct computer-based observational method (OS-WALD). The amplitude distribution probability function (ADPF) of the surface EMG from the deltoideus lateralis and trapezius pars descendens muscles was analyzed in 6 persons working on assembly lines. For each subject, "on-site" EMG and video recordings were performed over 10-minute periods at four different workstations on the same day. Force/EMG amplitude calibration curves had been previously calculated for the same subjects using a strain-gauge dynamometer. The results obtained during the working periods were the following: the mean static contraction level, as defined by Jonsson (13), was 1.3% MVC in the trapezius muscle and 0.5% MVC in the deltoid muscle; the medium contraction level was 5.2% MVC in the trapezius and 1.7% MVC in the deltoid; the peak contraction level was 17% MVC in the trapezius and 6.2% MVC in the deltoid. When compared to previously suggested upper limits of ADPF levels, all the contraction levels monitored were below the recommended limits. The assessment of musculoskeletal load in the shoulder region via EMG and video recordings led us to conclude that the work cycles examined were characterized by low-repetitive monotonous work and were well organized in order to avoid the occurrence of musculoskeletal injuries.

Adult↗

PubMed1993

Benign neonatal sleep myoclonus: clinical features and video-polygraphic recordings.

Benign neonatal sleep myoclonus is a syndrome characterized by the occurrence of repetitive myoclonic jerks of the extremities exclusively during non-rapid eye movement sleep in the early life of healthy newborns. No etiological factors are present. The onset is within the first 15 days of life with spontaneous disappearance within 3-4 months. These myoclonic events are commonly diagnosed as epileptic seizures. We observed 12 newborns with this clinical pattern; the follow-up ranges from 12 to 60 months. Long-term videopolygraphic electroencephalographic (EEG) monitoring demonstrated normal EEG activity, thus confirming that these unusual events were nonepileptic.

Brain Damage, Chronic↗

PubMed2000

Apoptosis - when the cells begin to dance.

We present a 24-hour time-lapse videosequence of in vitro behavior of Hep-2 cells treated with 10 m g/ml Etoposide, a topoisomerase II inhibitor. The cell behavior was recorded by a Mitsubishi video recorder, HS-S5600. In the presented sequence, we show the typical cell rounding accompanied by formation of numerous pseudopodia and rapid rhythmical contractions, so called membrane blebbing known as "dance of death".

Apoptosis↗

PubMed1997

Neuropsychological study during video-EEG recording of successive partial seizures of right temporo-central origin.

A 15-year-old, right-handed boy underwent video-EEG study as a first step in presurgical evaluation for a severe drug-resistant right temporo-central epilepsy. He was monitored while performing neuropsychological tests over a 67-minute period during which 23 brief seizures were recorded. Despite his right-handedness, both inter-ictal and ictal verbal performances were impaired. Analysis of the relationships between the characteristics of the EEG and the neuropsychological results revealed that a worsening in cognitive performances correlated with an increase in inter-ictal abnormalities, particularly when subclinical paroxysms were present; that the cognitive tasks executed peri-ictally were correctly performed in almost 50% of the cases; and that the error rate was higher when a task was presented during or immediately after a seizure rather than before its onset. A Wada test, performed on the basis of the cognitive results, demonstrated right hemisphere dominance for language. Our observations underline the importance of neuropsychological testing in presurgical procedures, and suggest that it should be performed peri-ictally whenever possible.

Adolescent↗

PubMed2003

Inexpensive ethography using digital video.

We describe an inexpensive method for digital video recording of behavioral experiments and present a simple, freely-redistributable software tool enabling ethographic analysis of these recordings via classification of video frames into user-defined categories. While high-end commercial solutions already exist for these purposes, we focus on minimizing equipment expenses and complexity for research projects or undergraduate laboratory courses employing compatible behavioral paradigms.

Computer Graphics↗

PubMedDate not supplied

Video-EEG recording: a four-year clinical audit.

In the setting of a regional neurological unit without an epilepsy surgery service as in our case, video-EEG telemetry is undertaken for three main reasons; to investigate whether frequent paroxysmal events represent seizures when there is clinical doubt, to attempt anatomical localization of partial seizures when standard EEG is unhelpful, and to attempt to confirm that seizures are non-epileptic when this is suspected. A clinical audit of all telemetry performed over a four-year period was carried out, in order to determine the clinical utility of this aspect of the service and to determine means of improving effectiveness in the unit. Analysis of the data showed a high rate of negative studies with no attacks recorded. Of the positive studies approximately 50% showed non-epileptic attacks. Strategies for improving the rate of positive investigations are discussed.

Electroencephalography↗

PubMed2001

Thyroplasty for adductor spasmodic dysphonia: further experiences.

OBJECTIVES: Two different surgical techniques for midline lateralization thyroplasty (type 2 thyroplasty) for adductor spasmodic dysphonia (SD) have been described, one using a composite graft and the other without. Indications and results for each method among different types of SD were compared, together with the theoretical background for the surgery. STUDY DESIGN: Retrospective. METHODS: The medical records of six patients with SD together with the fiberscopic video recording of laryngeal findings before, during, and after surgery were reviewed. The intraoperative video recordings of the surgical procedures were compared with the postoperative findings. RESULTS: The vocal features of SD, diverse preoperatively, disappeared postoperatively and a normal, or almost normal, voice was attained in 5 of 6 cases. The failure in one patient was attributed to combined focal dystonia of the neck muscles and difficulty in lateralization. Type 2 thyroplasty without a graft, which causes bowing of both vocal folds, is simple to perform and effective enough for most SD cases. No recurrence has been noted so far over postoperative periods ranging from 6 months to more than 3 years. CONCLUSION: The results suggest that thyroplasty is an effective therapeutic approach for SD.

Adult↗

PubMed2001

Irving S. Cooper and the early surgical management of movement disorders. Video history.

Irving S. Cooper was a pioneer in the field of functional neurosurgery. During his very productive and controversial career, he proposed the surgical treatment of Parkinson disease (PD) by ligating the anterior choroidal artery to control tremor and rigidity. Subsequently, he developed seminal techniques for chemopallidectomy and cryothalamectomy for PD. He also attempted to use electrical stimulation of the cerebellum or the thalamus to treat spasticity. Cooper continued his work on brain stimulation until his death in 1985. He made video recordings of nearly all of his patients during his tenure (1977-1985) at New York Medical College. Cooper's clinical video recordings were reviewed, and selected footage was compiled into a video history of Cooper's surgical management of various movement disorders. Included are pre-, post-, and some intraoperative recordings that Cooper made to document his treatment of patients with PD, tremor, Wilson disease, cerebral palsy, chorea, dystonia musculorum deformans, and some rarer entities.

History, 20th Century↗

PubMed1996

The endoscopic assessment of esophagitis: a progress report on observer agreement.

BACKGROUND & AIMS: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. METHODS: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42 endoscopists, including 13 endoscopists in training, assessed 23 endoscopic video recordings. In a third, ancillary study, using a simpler evaluation sheet, 219 gastroenterologists recorded their assessments of 20 still images. RESULTS: The agreement between endoscopists was similar for still images and video recordings. Agreement between experienced endoscopists was acceptable to good for recognition of minimal changes (erythema, friability, mucosal edema; kappa = 0.46 to kappa = 0.8), mucosal breaks (discretely, demarcated areas of slough or erythema; kappa = 0.84), and complications (ulceration, kappa = 0.92; stricturing, kappa = 0.80; columnar metaplasia, kappa = 0.81), although there was poor agreement when the circumferential extent and number of mucosal breaks were assessed. However, total circumferential extent of the mucosal break had a kappa value of 0.59. Agreement between inexperienced endoscopists was poor for recognition of minimal changes but was good for recognition of complications (kappa, 0.70-0.90). CONCLUSIONS: Endoscopists can identify mucosal breaks confined to a mucosal fold and lesions that extend throughout the esophageal circumference. Complications of reflux disease can be reproducibly recorded. Criteria for assessing the number of mucosal breaks and their radial extent must be defined more clearly, as must the features of minimal change esophagitis.

Esophagitis↗