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PubMed1997

Is review of videotape necessary after review of digitized cine-loop images in stress echocardiography? A prospective study in 306 patients.

The interpretation of stress echocardiography has been made easier by the comparison of digitized prestress and poststress frame-grabbed images (cine-loops), each representing a portion of a single cardiac cycle. Often, review of these digitized images is substituted for review of the complete videotape record of the examination. An alternative is to review both the digitized images as well as the videotape record of the rest and stress images. To date, there has been insufficient documentation of whether these options (cine-loop images alone versus cine-loop images plus videotape) provide comparable or additive information. Therefore, we prospectively evaluated information obtained from review of cine-loop images versus combined review of cine-loop images and videotape records in 306 consecutive patients undergoing treadmill (213 patients, 70%) or dobutamine (93 patients, 30%) stress echocardiography. An experienced echocardiologist first reviewed the cine-loop images and scored the wall motion in 16 segments at rest and with stress. Next, the complete videotape record was reviewed with repeated wall motion scoring. A questionnaire comparing cine-loop and videotape images was completed at the end of each review. Digitization of images was technically inadequate in 14 patients (4%). In 116 (40%) of the other 292 patients, the regional wall motion assessment, after relying solely on cine-loop images, was modified with subsequent videotape review. In 40 patients (14%), these modifications resulted in a change in the final impression regarding whether the study result was normal or abnormal. In a multivariate analysis, age, gender, and type of stress echocardiography had no significant influence on discordance of the cine-loop image and combined cine-loop and video information. Stepwise logistic regression analysis identified poorer image quality (p < 0.0001) and regional wall motion abnormalities (p < 0.0001) as predictors of discordance between cine-loop and combined review. We conclude that relying solely on digitized cine-loop images representing a single cardiac cycle is not optimal, especially if the quality of the digitized images is suboptimal and if regional wall motion abnormalities are present. Thus we recommend a combined review of both cine-loop images and videotape images in the interpretation of stress echocardiography.

Aged↗
PubMed2002

Improving residents' interviewing skills by group videotape review.

OBJECTIVE: Internal medicine residency training programs typically emphasize biomedical learning, but relatively few provide opportunities for residents to improve outpatient interviewing skills or to address challenging patient encounters. Even fewer programs provide resources to assess patient-resident relationship skills. To address these issues, we developed a curriculum that is designed to enhance patient-centered interviewing techniques in residents. DESCRIPTION: At the UCSF-VA PRIME residency program, interns on ambulatory block attend three didactic sessions that introduce basic medical interviewing techniques, including elicitation of patient concerns and mutual agenda setting, biopsychosocial interviewing, and conflict resolution in the patient-physician relationship. These sessions are taught using role-play exercises and interactive, case-based discussions. Second- and third-year residents on ambulatory block participate in an ongoing small-group seminar in which they present videotapes of their interviews with patients. To make these tapes, residents arrange to see patients in a clinic room where a videotape recorder is mounted on the wall. Patients who consent to be videotaped complete a form stating that the tapes are to be used solely for educational purposes. Twice a year, each of our 16 residents selects one encounter that highlights personal learning goals related to interviewing and presents those learning goals with associated videotape clips in a 90-minute seminar. Each seminar is devoted to two residents, who facilitate a discussion of the effectiveness of the interview and solicit feedback about potential methods for improvement. DISCUSSION: When the seminars were originally developed, we anticipated that this innovative combination of traditional individual videotape review with small-group learning would encourage self-directed learning. Indeed, over the last three years, residents have become more confident with their interviewing capabilities and less self-conscious about showing their own videotaped interviews. As a result, the seminars have unexpectedly evolved into a highly sophisticated series of learning modules, in which residents seek their most challenging patient encounters to videotape and show to the group. Residents have presented complicated scenarios involving critical patient-physician conflicts, somatizing patients, cross-cultural communication difficulties, overzealous family members, patients with substance abuse, and bad-news interviews. These dilemmas represent fundamental management challenges that are difficult to discuss in a more didactic format, and the immediate case-based nature of the interviews makes these often-emotional issues come alive. The group videotape reviews also give residents opportunities to reflect on their own interviewing encounters, to observe other interviewing styles and techniques, and to provide support to their fellow residents after particularly emotional interviews. An ancillary benefit of these exercises is that we have now developed a library of challenging interviews, which are easily accessible for further teaching seminars. Our residents consider this learning experience to be one of the most positive of their residency and valuable for their professional development. Residents report that this small-group seminar series has markedly improved their communication with patients, and they now clamor for the opportunity to present interviewing dilemmas. We believe that similar curricula can be readily instituted at other residency programs.

Humans↗
PubMed2007

Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients.

AIMS: The aim of this prospective randomized controlled study was to determine whether viewing videotape of themselves while experiencing delirium tremens (DT) reduces the relapse rate in alcohol-dependent patients. Our hypothesis about the efficacy of videotapes exposure to DT is consistent with a cognitive behavior model. DESIGN: Sixty patients with DT and a minimum of 3 years of severe alcohol dependence [Diagnostic and Statistical Manual version IV (DSM-IV criteria] were included in this study. Patients were videotaped during the acute phase of DT and randomized into two groups: group A patients received individual exposure to their videotape and an explanation of the symptoms by a psychiatrist; and control group B patients, who were without videotape experience. Both groups received the same treatment during the acute and the maintenance phases, without aversive therapy or psychotherapy. The two groups did not differ significantly in number of drinks per day prior to admission, age, marital status, social environment, education, professional and financial status or family psychiatric history. SETTING: An in-patient crisis unit for patients with alcohol dependence. MEASUREMENTS: All patients were observed for 6 months during monthly visits. Outcomes included relapse, drinking days per week and number of drinks per drinking day. All patients and their families signed informed consent. FINDINGS: The patients with videotape experience had a significantly lower relapse rate after the first month (0% versus 20%), 2 months (13.33% versus 46.67%) and 3 months (26.67% versus 53.33%). Patients with videotape experience had less severe relapses and consumed fewer units of alcohol than controls. CONCLUSIONS: Videotape exposure in delirium tremens is an original therapeutic method which seems to be effective in reducing relapse risk in patients with alcohol dependence.

Adult↗
PubMed1998

Videotape increases parent knowledge about poliovirus vaccines and choices of polio vaccination schedules.

OBJECTIVE: To study the effect of an educational videotape about poliovirus vaccines and choices of schedules for parents/guardians of children starting the polio vaccination series. DESIGN: Prospective, randomized trial comparing two educational interventions. SETTING: Five pediatric offices (two university-based, two health maintenance organization staff models, and one private practice) and a local health department immunization clinic in the greater Lansing, MI, area. PARTICIPANTS: A total of 287 parents/guardians of 2- to 3-month-olds presenting for well-child care and due for the first set of immunizations including poliovirus vaccine. INTERVENTIONS: Parents/guardians were randomized to read the vaccine information statement (VIS) alone or to read the VIS and view a 15-minute videotape about polio vaccination and choices of schedules produced by Michigan State University. The intervention groups were similar by race/ethnicity, education, and relationship to the child. OUTCOME MEASURES: Change in knowledge about the risk of poliomyelitis in the United States, transmission of poliomyelitis, characteristics of the two poliovirus vaccines, and choices of polio vaccination schedules; and parent opinion on effectiveness of the interventions, as measured by pre- and postintervention questionnaires. RESULTS: Both interventions resulted in increased test scores of knowledge. However, videotape viewers scored significantly higher on their posttest compared with parents/guardians assigned to VIS only. This significant increase was noted across all practice types, two of three major racial/ethnic groups, and educational levels. (The increase for Hispanic parents/guardians approached significance). Reading the VIS did not improve posttest scores for videotape viewers. Reading the VIS did improve posttest scores for those assigned to VIS only, but these scores still were not as high as for videotape viewers who did not read the VIS. CONCLUSIONS: This study demonstrated that a complicated discussion of risks/benefits of two vaccines and their schedules of administration could be communicated effectively via a videotaped presentation. In addition, the videotape was more effective than VIS alone in increasing short-term knowledge, regardless of practice type, race/ethnicity, or educational level. As immunization schedules increase in complexity and parents are asked to make more choices, videotaped information may be a better method to achieve the goal of truly informed consent.

Adult↗
PubMed1999

Videotapes in evaluating work-related upper extremity symptoms.

Thirteen patients with upper extremity symptoms that were claimed to have occurred in the course of employment were evaluated to determine the role of videotapes in their evaluation and management. Videotapes were of two types: work demonstration by patient or coworker (8 tapes) and surveillance tapes obtained by a private investigator (5 tapes). Four of eight work station videotapes demonstrated significant repetitive motion that could have contributed to their symptoms. Four of eight work station videotapes demonstrated that the tasks were neither forceful nor repetitive in nature. Return to work recommendations were made based on both clinical grounds and job site information provided on tape. After viewing five surveillance videotapes, two fraudulent claims were settled soon after medical opinions were rendered. Two patients were declared able to return to work; one returned to work and the other was dismissed. The videotape of patient No. 13 was not crucial for the decision and he was authorized to have surgery. The opinions formed concerning the causality of alleged claims of injury were often altered by viewing the content of the videotapes. Videotapes are a valuable tool and useful adjunct in the overall management of the workers with upper extremity symptoms.

Adult↗
PubMed1990

Videotape dietary assessment: validity, reliability, and comparison of results with 24-hour dietary recalls from elderly women in a retirement home.

The validity and reliability of a videotape method for quantifying food intake were tested, and results of the method were compared with results obtained from 24-hour dietary recalls. Participants were 37 elderly Catholic nuns (aged 81.8 +/- 4.1 years) who were ambulatory and living in a retirement home. The videotape method of dietary assessment consisted of videotaping food trays of each participant for three meals during 1 day and the subsequent identification of food types and amounts from the videotapes. Estimates of food amounts obtained were used in the calculation of energy and nutrient intake. Correlation coefficients between values for energy and 14 nutrients obtained by direct measurement of food and estimates from the videotape method were high (r = 0.86 to 1.0). Compared with measured food amounts, the videotape method underestimated food quantities by an average of 6%. The reliability test indicated that mean nutrient values obtained from the videotape method by two research assistants differed by an average of 3.7% and were highly correlated (r = 0.84 to 0.98). Comparison of the videotape method with 24-hour dietary recalls revealed differences between mean values that were greater than 10% for energy and 6 of the 14 nutrients and correlations that ranged from 0.09 to 0.82. These results suggest that use of 24-hour dietary recalls among the elderly may result in a high percentage of error.

Aged↗
PubMed2001

A teaching videotape for the assessment of essential tremor.

UNLABELLED: Teaching videotapes, developed to aid in the evaluation of several movement disorders, have not been used in essential tremor research. As part of the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET), we developed a reliable and valid tremor rating scale. Because this rating scale is currently being used by investigators at other centers, we developed a teaching videotape to aid in the consistent application of this scale. OBJECTIVE: To develop a teaching videotape for a revised version of the WHIGET Tremor Rating Scale and to assess the interrater agreement among raters who used this videotape to rate tremor. METHODS: The revised WHIGET Tremor Rating Scale was used to rate action tremor from 0 to 4 during six tests: arm extension, pouring, drinking, using a spoon, finger-to-nose, and drawing spirals. A 22-minute teaching videotape was developed that includes a 29-item educational section and a self-assessment section consisting of 20 examples of tremor ratings chosen by the two WHIGET study neurologists. Eight raters, including senior movement disorder specialists, movement disorder fellows, general neurologists, and a movement disorder nurse practitioner, independently viewed the videotape and rated tremor during the self-assessment section. Interobserver reliability was assessed with weighted kappa statistics (kappa(w)). RESULTS: Eight raters each rated 20 items (160 ratings total). Total kappa(w) was 0.97 (nearly perfect agreement). Interrater reliability was as follows: kappa(w) = 0.99 (movement disorder specialists), kappa(w) = 0.98 (movement disorder fellows), and kappa(w) = 0.97 (general neurologists); all kappa(w) were nearly perfect. CONCLUSIONS: This teaching videotape may be used to improve the uniform application of the revised WHIGET Tremor Rating Scale by raters with various levels of experience in movement disorders.

Essential Tremor↗
PubMed2002

Diagnosing Parkinson's disease using videotaped neurological examinations: validity and factors that contribute to incorrect diagnoses.

Field work is commonly required in movement disorders research. Sending neurologists into the field can be logistically challenging and costly. Alternatively, neurological examinations may be videotaped and reviewed later. There is little knowledge of the validity of the videotaped neurological examination in the diagnosis of Parkinson's disease (PD). We examined the validity of the videotaped Unified Parkinson's Disease Rating Scale (UPDRS) motor examination in the diagnosis of PD, and sought to determine which factors are associated with incorrect diagnoses. PD patients and controls were enrolled in a familial aggregation study between August of 1998 and June of 2000, and as part of that study each was examined by a physician who performed an in-person UPDRS motor examination. Each also underwent a second, videotaped UPDRS motor examination. Based on the review of this videotape, a neurologist, who was blinded to the previous clinical diagnosis, assigned a diagnosis of PD or normal. A total of 211 of 231 PD patients (sensitivity = 91.3%), and 170 of 172 controls (specificity = 98.8%) were correctly identified based on the videotape. True positives had a higher mean rest tremor score (1.7 vs. 0.3; P < 0.001), action tremor score (0.9 vs. 0.3; P < 0.001), bradykinesia score (11.2 vs. 7.4; P = 0.02), and disease of longer mean duration (8.9 vs. 5.8 years; P = 0.001) than false negatives. False negatives did not differ from true positives in terms of age, total dose of levodopa, Hoehn and Yahr score, or rigidity, gait and posture, or facial masking scores (each assessed during the in-person examination). The videotaped UPDRS motor examination is a useful means of diagnosing PD and provides an alternative approach for the diagnosis of PD in field studies. A limitation is that patients with milder PD of shorter duration may not be recognized as PD.

Adult↗
PubMed2005

The effects of a professionally produced videotape on education and anxiety/distress levels for patients with newly diagnosed melanoma: a randomized, prospective clinical trial.

OBJECTIVE: Little is known about the effects of videotape-based education on knowledge and anxiety levels among patients with melanoma. We sought to evaluate effects of a professionally produced videotape on the knowledge and distress levels among patients with newly diagnosed melanoma. Secondarily, we sought to compare these effects with those of a traditional clinic visit. METHODS: We conducted a randomized controlled trial involving 217 patients. An intervention group underwent questionnaire-based testing of melanoma knowledge and anxiety/distress levels before and after viewing an educational videotape. A control group underwent similar testing before and after a clinic visit. RESULTS: The videotape and clinical encounter significantly increased knowledge and decreased anxiety. Improvement in knowledge levels was significantly greater after viewing the videotape compared with the clinic visit, whereas anxiety levels decreased to a greater degree after the clinical encounter. Whether or not a synergistic relationship may exist between exposure to an educational videotape and a physician visit was not specifically evaluated in this study. CONCLUSION: Videotape-based education may be more effective than that provided by a clinic visit, whereas the clinical encounter appears to be more effective in alleviating patient anxiety/distress.

Anxiety↗
PubMed1979

The medium and the message: development of videotapes for teaching psychiatry.

The author examines the issues surrounding the development and use of videotapes to teach psychiatry. She describes the special capabilities of videotaped material as well as how videotapes are produced; the structure of videotapes that use feedback techniques; the different ways medical students, psychiatric students, and experienced clinicians respond to videotapes; the special problems involved with teaching nonpsychiatric medical students about psychiatry; and the use of videotaped materials for patients and the public. She concludes that the use of videotapes to teach psychiatry, especially to teach the public, is an important area for development by psychiatrists.

Curriculum↗
PubMed1992

The effectiveness of videotapes in communicating information to rural physiotherapists.

This study investigated the effectiveness of videotaped versus written discharge summaries in communicating patient information to rural physiotherapists. Twenty-seven rural Manitoba physiotherapists were randomly divided into two groups and tested after viewing videotapes and reading written summaries on four patients with neurological conditions. Group I saw the videotapes on the four patients first, then answered multiple choice questions regarding the patients' problems, goals and treatment for physiotherapy. Group II read the written reports first, then answered the same questions. The process was then repeated in reverse order. A statistically significant difference existed between Group I's videotape scores and Group II's written summary scores (t = 4.69, 25 d.f., p = 0.002, 1-tailed unpaired t test). There was no significant difference between Group I and Group II's videotapes score. A rating scale of the videotapes by the physiotherapists strongly supported videotaped communication. This study has relevance to those who need to communicate patient information to health care workers in distant locales.

Communication↗
PubMed2000

A picture is worth a thousand words: practical use of videotape in teaching.

Videotapes, through vividly displayed clinical images and teaching interactions, are valuable tools for both learners and teachers. Visual images in combination with verbal instruction have been shown to significantly increase recall and retention. Many clinicians and medical teachers are aware of videotape resources, but have not had a chance to develop their use in medical education. In this paper, we discuss creative applications of videotapes in three major categories: presenting information, triggering discussion, and as a tool for direct self-observation and feedback. Videotapes may be valuable for presenting information in settings of didactic instruction; for triggering discussion during teaching workshops; and for self-observation of patient-doctor interactions and learner-teacher encounters. The article presents learner-centered approaches to review a videotaped clinical encounter in order to enhance value and comfort for the learner and teacher. Sources of tapes include on-site videotaping, published educational tapes and commercial tapes shown in accordance with fair use guidelines, examples of which are referenced. Videotapes add another dimension to traditional sources of physician education.

Clinical Competence↗
PubMed2000

Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation.

BACKGROUND AND PURPOSE: Global assessment by direct observation has been validated for evaluating operative performance of surgery residents after formal skills training but is time-consuming. The purpose of this study was to compare global assessment performed from edited videotape with scores from direct observation. MATERIALS AND METHODS: Junior surgery residents (N = 22) were randomized to 2 weeks of formal videotrainer skills training or a control group. Laparoscopic cholecystectomy was performed at the beginning and end of the rotation, and global assessment scores were compared for the training and control groups. Laparoscopic videotapes were edited: initial (2 minutes), cystic duct/artery (6 minutes), and fossa dissection (2 minutes). Two independent raters performed both direct observation and videotape assessments, and scores were compared for each rater and for interrater reliability using a Spearman correlation. RESULTS: Correlation coefficients for videotape versus direct observation for five global assessment criteria were <0.33 for both raters (NS for all values). The correlation coefficient for interrater reliability for the overall score was 0.57 (P = 0.01) for direct observation v 0.28 (NS) for videotape. The trained group had significantly better overall performance than the control group according to the assessment by direct observation (P = 0.02) but not by videotape assessment (NS). CONCLUSIONS: Direct observation demonstrated improved overall performance of junior residents after formal skills training on a videotrainer. Global assessment from an edited 10-minute videotape did not correlate with direct observation and had poor interrater reliability. Efficient and valid methods of evaluating operative performance await development.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

The impact of a clinic-based educational videotape on knowledge and treatment behavior of men with gonorrhea.

The impact of a ten-minute, soap opera-style videotape on knowledge and treatment behavior of black men with gonorrhea was tested in randomized clinical trials. The videotape, shown to individual patients after diagnosis, produced a sizeable increase in the percentage of patients who returned for their test-of-cure examination: while only 43.3% of control group patients returned, 53.5% of those in the videotape group did so; chi 2(1) = 9.0; P less than 0.003. In a follow-up study, similar results were found: videotape group (59.0%), control group (39.1%); chi 2(1) = 6.2; P less than 0.015. The videotape also produced large, significant increases in patient knowledge, as measured by a test administered during patients' clinic visit (P less than 0.0001). No measureable effect of the videotape was detected on patients' willingness to refer sexual contacts for treatment. The findings suggest that clinic-based educational materials, particularly soap opera-style videotapes that engender audience identification, create emotional significance for the viewer, and model requisite communication skills, may have a significant role to play in control of sexually transmitted diseases.

Adolescent↗
PubMed2004

Interobserver and intraobserver reliability of therapist-assisted videotaped evaluations of upper-limb hemiplegia.

PURPOSE: Therapist-assisted videotaped sessions have been used to augment physical examinations in the evaluation of hand and arm function in patients with spastic hemiplegia. The purpose of this study was to assess the interobserver and intraobserver reliability of standardized videotaped examinations in the evaluation and functional classification of these patients. METHODS: Three examiners reviewed standardized videotaped examinations of 10 adolescents with spastic hemiplegia on 2 separate occasions. All 10 patients were under consideration for surgical intervention for their upper-extremity dysfunction. Videotapes were used to assess upper-extremity range of motion, finger and thumb deformity, and reach, pinch, and grip function. Upper-extremity function was graded according to the House and Mowery classification systems. Interobserver and intraobserver reliabilities were measured with the kappa coefficient. RESULTS: Range of motion, deformity, and upper-extremity functional strategy assessment showed slight to excellent interobserver reliability and good to almost perfect intraobserver reliability. Interobserver and intraobserver reliability of the consolidated House classification system was more reliable than the Mowery or standard House classification systems. CONCLUSIONS: Evaluations of standardized videotaped examinations in patients with hemiplegia were reliable between and among observers. Such therapist-assisted videotaped evaluations may provide useful data for clinical decision-making and multicenter outcomes studies in patients with upper-extremity involvement with spastic hemiplegia.

Adolescent↗
PubMed2003

Videotape review leads to rapid and sustained learning.

BACKGROUND: Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. METHODS: Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups. RESULTS: Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study. CONCLUSIONS: Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.

Clinical Competence↗
PubMed2000

Benefits of an informational videotape for emergency department patients.

To determine if an informational videotape affected patient's attitudes towards their emergency department visit, we conducted a prospective study using a convenience sample of patients waiting to be seen at a southern California emergency department. Patients waiting to be treated were randomized to view an informational videotape or to receive standard management (no videotape). The informational videotape lasted 6 minutes and served to orient the patients to the emergency department. It showed the sequence of steps from entry into the department to discharge, the nature of triage and causes for delays, the different services offered by the emergency department, and the roles of each of the department staff members. One week after discharge, patients were contacted at home by telephone and were asked to rate various aspects of their emergency department experience. A comparison of the telephone survey rankings between those who viewed the videotape (98 patients) and those who did not (100 patients) revealed statistically significant improvements in the former group on questions about level of anxiety and appropriateness of delays. An informational videotape for patients in waiting areas may be a useful tool to educate about emergency medical services, to reduce anxiety, and to improve satisfaction with the emergency department stay.

Adolescent↗
PubMed1997

Enhanced decision-making: the use of a videotape decision-aid for patients with prostate cancer.

We describe the development and evaluation of a videotape decision-aid to assist patients in considering treatment options for clinically localized prostate cancer. The content and form of the videotape were developed utilizing literature review, an expert opinion panel and patient focus groups. Thirty-two men, aged 50-85 years, who did not have prostate cancer underwent pre- and post-videotape testing. A quantitative analysis found the videotape to be moderately effective in improving short-term recall of treatment options and outcomes. Qualitative analysis demonstrate that after viewing the videotape, subjects were more likely to consider an active role in the treatment decision-making process. We conclude that a videotape decision-aid will benefit clinical practice by conveying knowledge to patients regarding treatment options and outcomes and encouraging them to participate with their physicians in medical decision-making.

Aged↗