Care Procedures Research Articles

Fracture toughness of aged oil paints

The fracture toughness in opening mode GIc for selected oil paints from Mecklenburg's Paint Reference Collection after approximately 30 years of natural ageing was determined using the procedure adopted from the ASTM D5528–13 standard in which double cantilever beam specimens are split in tensile tests. The careful reglueing procedure allowed multiple fracturing tests to be carried out that not only improved statistics of the measurements but also provided insight into the variation of the fracture toughness across the paint film observed for some paints. The latter was due to pigment sedimentation or chemical change of the oil binder as a result of the easier access of oxygen from the side open to the air. For the lead white paint, used over centuries both in paint films and oil grounds, the GIc values more than doubled from 18 to 39 J/m2 for three consecutive cracks formed at an increasing distance from one side of the paint film. The study demonstrated that fracture toughness corresponding to the first crack formation in aged oil paints ranged between 10 and 40 J/m2, relatively low values compared to the animal glue-based ground in paintings. In consequence, oil paints are more vulnerable to crack initiation and growth induced by tensile stress than the ground layer. The measurements filled the gap in the knowledge required for the analysis of fracturing or delamination processes in paintings.

Healthcare Information Systems (HIS): Implementation Challenges in Developing Countries

In developing nations, the establishment of sustainable healthcare information systems (HIS) is often hindered by insufficient government policies and outdated technology. Bangladesh is a notable example where many patients lack proper healthcare access due to fragmented and non-digitally recorded data. Research has shown that standardized hospital healthcare systems can streamline patient management, increasing the capacity to serve more patients simultaneously. These systems have the potential to improve healthcare in developing nations significantly. This article offers an overview of the key obstacles that impede HIS implementation in these countries. The study looked at relevant information systems literature using a systematic literature review (SLR). The systematic literature review (SLR) was governed by a review process, and relevant studies were gathered from three databases: IEEE Xplore, EBSCO Databases, and ScienceDirect. A total of 4014 papers were initially found. However, only 11 main studies were included for analysis after a careful selection procedure governed by inclusion and exclusion criteria. This study found 24 obstacles to adopting Healthcare Information Systems (HIS) in developing countries, divided into six groups. These obstacles include a lack of financial assistance, inadequate infrastructure, inadequate education and awareness, cultural and political obstacles, reluctance to change, and poor system quality.
 Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 314-326

A Scoping Review of the Mechanisms Underlying Developmental Anesthetic Neurotoxicity.

Although anesthesia makes painful or uncomfortable diagnostic and interventional health care procedures tolerable, it may also disrupt key cellular processes in neurons and glia, harm the developing brain, and thereby impair cognition and behavior in children. Many years of studies using in vitro, animal behavioral, retrospective database studies in humans, and several prospective clinical trials in humans have been invaluable in discerning the potential toxicity of anesthetics. The objective of this scoping review was to synthetize the evidence from preclinical studies for various mechanisms of toxicity across diverse experimental designs and relate their findings to those of recent clinical trials in real-world settings.

To close or not to close? Wound management in emergent colorectal surgery, an EAST multicenter prospective cohort study.

This study aimed to determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS), and mortality in emergent colorectal surgery. A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS, and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, intensive care unit admission, vasopressor use, procedure details, and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. In total, 557 patients were included (SC, n = 262; SLC, n = 124; SO, n = 171). Statistically significant differences in body mass index, race/ethnicity, American Society of Anesthesiologist scores, EBL, intensive care unit admission, vasopressor therapy, procedure details, and wound class were observed across groups. Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group. After risk adjustment, SO was associated with increased risk of mortality (OR, 3.003; p = 0.028) in comparison with the SC group. Skin loosely closed was associated with increased risk of superficial SSI (OR, 3.439; p = 0.014), after risk adjustment. When compared with the SC group, the SO group was associated with mortality but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. Therapeutic/Care Management; Level III.

Prolonged dialysis during ex vivo lung perfusion promotes inflammatory responses.

Ex-vivo lung perfusion (EVLP) has extended the number of transplantable lungs by reconditioning marginal organs. However, EVLP is performed at 37°C without homeostatic regulation leading to metabolic wastes' accumulation in the perfusate and, as a corrective measure, the costly perfusate is repeatedly replaced during the standard of care procedure. As an interesting alternative, a hemodialyzer could be placed on the EVLP circuit, which was previously shown to rebalance the perfusate composition and to maintain lung function and viability without appearing to impact the global gene expression in the lung. Here, we assessed the biological effects of a hemodialyzer during EVLP by performing biochemical and refined functional genomic analyses over a 12h procedure in a pig model. We found that dialysis stabilized electrolytic and metabolic parameters of the perfusate but enhanced the gene expression and protein accumulation of several inflammatory cytokines and promoted a genomic profile predicting higher endothelial activation already at 6h and higher immune cytokine signaling at 12h. Therefore, epuration of EVLP with a dialyzer, while correcting features of the perfusate composition and maintaining the respiratory function, promotes inflammatory responses in the tissue. This finding suggests that modifying the metabolite composition of the perfusate by dialysis during EVLP can have detrimental effects on the tissue response and that this strategy should not be transferred as such to the clinic.

SUD records and the machinery of care denial in the new era of relaxed privacy rights

As noted by this recent opinion piece published by The New York Times, “Denying Your Health Care Is Big Business in America,” the process of prior authorization has been around for decades, but has only recently been weaponized by insurers to maximize profits and reduce the provision of health care services. The piece documents people going blind, becoming paralyzed or dying when necessary health care procedures are denied. Around 80% of the time, patients simply give up. Medical care offices have hired huge staffs to battle prior authorization denials. One of the focuses of the piece is on efforts to make prior authorization for medical care by for‐profit companies illegal. It is stalled in Congress.

Implementing a Hospitalist Comanagement Service in Orthopaedic Surgery.

➤ Hospitalist comanagement of patients undergoing orthopaedic surgery is a growing trend across the United States, yet its implementation in an academic tertiary care hospital can be complex and even contentious.➤ Hospitalist comanagement services lead to better identification of at-risk patients, optimization of patient care to prevent adverse events, and streamlining of the admission process, thereby enhancing the overall service efficiency.➤ A successful hospitalist comanagement service includes the identification of service stakeholders and leaders; frequent consensus meetings; a well-defined standardized framework, with goals, program metrics, and unified commands; and an occasional satisfaction assessment to update and improve the program.➤ In this article, we establish a step-by-step protocol for the implementation of a comanagement structure between orthopaedic and hospitalist services at a tertiary care center, outlining specific protocols and workflows for patient care and transfer procedures among various departments, particularly in emergency and postoperative situations.

Knowledge and Risk Assessment of Hepatitis B Infection among Barbers and Beauty Salon Workers in Mwanza, Tanzania

Background and Objective Community-acquired hepatitis B virus (HBV) infection is increasing in developing countries. In Tanzania, there is an exponential increase in barbershops and beauty salons, which are potential sites of transmission of HBV. Occupational exposure rates and HBV vaccination rates among salon workers are unknown; their level of knowledge about infection prevention and control (IPC) is also unknown. This study aimed to evaluate the risk of infection and the knowledge of barbers and beauty salon workers about HBV transmission and prevention. Methods A cross-sectional study was conducted using a convenience sample of 200 barbers and beauty salon workers from 13 barber shops and 13 beauty salons in the urban district of Mwanza, Tanzania. Data were collected using a self-administered questionnaire, entered into EpiData version 3.1, and analyzed with Stata version 13. Categorical variables were expressed as frequencies, and association levels were compared using Fisher’s exact test. Results Fifty-four percent of the study participants were female, and the mean age was 25 (21.0–29.5) years. A total of 126 (63%) participants were aware of the existence of HBV infection, of which only 22% had general good knowledge of HBV transmission and prevention. Both HBV awareness (P < 0.001) and good knowledge of its transmission and prevention (P = 0.03) were positively associated with higher levels of education. Seventy-three (36.5%) participants reported a history of occupational injuries. Merely 27.8% of participants were familiar with the correct methods of decontamination beauty tools, and only 14.3% understood the correct procedures for post-exposure wound care. Vaccination coverage was low with only (2%) of barbers and beauty salon workers having received vaccines. Conclusion and Implications for Translations The frequent occupational injuries and inadequate vaccination among barbers and beauty salon workers amplify their risk of HBV infection. They also lack basic knowledge about HBV transmission and prevention, placing the clients they serve at high risk for infection. We recommend that training on HBV Infection Prevention and Control (IPC) should focus on this specific group, and the implementation of these measures should be closely monitored in barbershops and beauty salons. Moreover, this vulnerable group should be considered for a global vaccination program.

Safe usage of Mini 'C'-arm in operating room environment: Implications for clinical practice.

Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel. The main objective is to describe the various components related to patients, operator and equipment to ensure safe usage of Mini 'C'-arm machine. A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted using Embase, PubMed, Google Scholar and ResearchGate databases to identify suitable literature. The keywords used for the search included 'Fluoroscopy', 'Ionising Radiation' and 'surgical safety'. Safe usage of Mini 'C'-arm equipment involves components of operator training, operator safety, patient safety, radiation dose, operating room logistics, handling of images and auditing of Mini 'C'-arm use. Mini 'C'-arm provides an invaluable, portable imaging tool in a spectrum of general surgical and orthopaedic interventional procedures. However, safe usage of Mini 'C'-arm machine requires a multifaceted approach including operator responsibility and safety, patient protection, equipment maintenance, radiation dose awareness, documentation and sound reporting mechanisms.

A novel neonatal protocol for Safe Insertion of Umbilical Venous Catheters (SIUVeC): Minimizing complications in placement and management.

Insertion of umbilical venous catheters is a common procedure in neonatal intensive care. Though sometimes lifesaving, this maneuver is potentially associated with early and late complications, some of which may be severe and even life threatening (catheter malposition, hepatic lesions, venous thrombosis, pericardial effusion, etc.). The recent literature suggests several operative strategies that, if adopted systematically, may significantly reduce the incidence of both early and late catheter related complications. This paper describes a standardized protocol (Safe Insertion Umbilical Venous Catheter = SIUVeC) which incorporates such novel strategies, with the goal of minimizing the complications related to this procedure.

Managing End of Life Care for the Critically Ill: A Novel Program to Deliver Bedside Critical Care Without Transfer to the Intensive Care Unit.

Background: Navigating medical care at the end of life can be a challenging experience for patients. There are also significant resource burdens, including intensive care unit (ICU) admissions, accompanying terminal illness. For actively dying patients, developing a care plan based on patient goals and delivering care at the bedside can enhance patient well-being, avoid inappropriate transfers or interventions, and improve resource management. Methods: The Rapid Response Team (RRT) is an around the clock intensivist service that responds to all acutely decompensating patients in our hospital. Through the Appropriate Care Escalation (ACE) program, the RRT intensivist identifies amongst decompensating patients, terminally ill individuals for whom prognosis is extremely poor irrespective of available interventions. These patients receive discussions about goals of care, code status, and management options. They receive care on a dedicated stepdown unit without escalation to the ICU. If aligned with patient goals, care plans incorporate critical care interventions including ventilator and vasopressor therapy. Results: Over 5years, RRT identified 413 terminally ill patients under the ACE program to continue end of life care on the stepdown unit. Following discussions of goals, 60.8% of patients requested DNR/DNI, 30.9% were full code, and 8.5% requested DNR/OK-TO-INTUBATE status. At discharge, 82.1% of ACE patients expired compared to 23% of all RRT consultations. Patients received 233 critical care procedures at bedside including intubations, central access catheters and bronchoscopy. Conclusion: The ACE program helped identify, in real time, actively dying, terminally ill patients, establish patient goals, and expand critical care services outside the ICU.

Education and Socialization Of Pre Screening Developmental Questionnaire For Early Detection Of Child Development

A preliminary research at PMB Bidan Wike A in June 2023 revealed the developmental outcomes of toddlers using the Pre-Screening Development Questionnaire (KPSP). Out of 189 toddlers, 77.8% exhibited typical development, 21% had questionable development, and 1.2% displayed developmental deviations. Many mothers lacked knowledge about the care and examination procedures related to the pre-screening developmental questionnaire. This community service aims to provide mothers with knowledge about child growth and development while introducing the Pre-Screening Development Questionnaire instrument. This community service utilizes counseling and socialization methods for mothers with toddlers. Participants will undergo both pretest and posttest assessments. This initiative employs the Developmental Pre-Screening Questionnaire instrument and self-evaluation notes. In the initial stage, the counselor will engage in a question-and-answer session, followed by assessing the mother's comprehension using the feedback method. Subsequently, it proceeds with discussions or brainstorming sessions. The outcomes of the community service revealed that following counseling and the socialization of KPSP to mothers of toddlers, their knowledge increased by 93%. Early and regular screening is of utmost importance to prevent developmental deviations in toddlers, allowing for prompt treatment of any deviations that may arise. Growth screening enables the assessment of children's nutritional status, while developmental screening for children under five can be conducted using the KPSP (Developmental Pre-Screening Questionnaire) method. Keywords: growth screening, nutritional status, developmental screening, KPSP method.

Validating an Assessment Tool for Oral Health and Oral Care Procedures Performed by Healthcare Workers for Older Residents in Long-Term Care Institutions.

Poor oral health is a growing concern among older populations. It is often caused by a failure to maintain proper oral hygiene and inaccessible dental care. Poor oral health in older individuals in long-term care institutions (LTCIs) can be attributed to the fact that healthcare workers might be poorly trained in oral care assessment and practice. To address this issue, an assessment tool has been developed and validated to guide and evaluate healthcare workers' oral care practices, ensuring the delivery of adequate care and early detection of dental diseases in LTCIs. The tool includes an oral health assessment and an assessment of oral care procedures. It was developed following a robust literature review, two stages of expert reviews, content validity checks, and a pilot study. A total of twenty-three items were developed and validated, with seven items related to oral health assessment and sixteen related to oral care procedures. The items were assessed for content validity and relevance, with high values of 1 obtained for all Item-level Content Validity Index (I-CVI), Scale-level Content Validity Index (S-CVI), and S-CVI/Universal Agreement (UA) scores. This indicates a high level of agreement among the experts (n = 12) regarding the relevance and importance of the items. A pilot study involving 20 nursing students confirmed the tool's reliability, applicability, and feasibility, demonstrating its high appropriateness and applicability. The newly developed and validated assessment tool can effectively guide and evaluate healthcare workers' oral care practices, enhancing their competence and improving the oral health of older residents.

Does anesthesia duration or number of cases per patient predict safety events?

The need for dental rehabilitation under general anesthesia is increasing, with varying needs between patients. Mortality has been found to be a rare event in these patients; however other perioperative events can and do occur. Previous studies have established increased incidence of perioperative events with younger, sicker children, and longer anesthetics, however, no studies to date have evaluated if the incidence of perioperative events is more closely associated with one long anesthetic or multiple anesthetics per patient. To evaluate the association of perioperative events related to single anesthetic duration or number of anesthetics per patient for dental rehabilitation. After Children's Wisconsin Human Research Protection Program determined this quality activity did not meet the definition of human subjects research, we performed an epidemiologic observational evaluation by extracting all dental related cases (dental alone or with oral surgeon vs. dental with other specialties) with an associated general anesthesia encounter from Children's Wisconsin electronic data warehouse from June 1, 2015 to December 31, 2021. These cases occurred at a free-standing children's hospital or associated pediatric-only ambulatory surgery center. The risk of perioperative safety events was analyzed for previously identified risk groups such as American Society of Anesthesiologists Physical Status (ASA-PS), patient age, anesthesia case time with the addition of number of dental cases per patient. In this study, 8468 procedures were performed on 8082 patients. Of this cohort, 7765 patients underwent one procedure for dental care while 317 patients underwent a total of 703 dental-related procedures, ranging from two to five procedures per patient. Multivariable logistic regression identified increased risk of perioperative events in patients with ASA-PS 3 (n = 1459, rate 1.78%, p value .001, OR 5.7, CI 2.1-15.5) and ASA-PS 4 (n = 86, rate 5.8%, p < .001, OR 17.2, CI 4.4-67.3), anesthesia duration (p < .001, OR 1.46, CI 1.21-1.76), but no increased risk with number of anesthetics per patient (p value .54, OR 0.81, CI 0.4-1.61). Limiting dental care under general anesthesia to multiple short cases may decrease the risk of perioperative events when compared to completing all treatment in one long operative session.

Recommendations and guidelines of integrative medicine for COVID-19 care: The APEC project outcome

This article - Recommendations and Guidelines of Integrative Medicine (IM) for COVID-19 Care - was one of the outcomes from an Asia-Pacific Economic Cooperation (APEC) Project (Integrative Medicine (IM) and COVID -19 Care) during the time between May 2022 and March 2023. With the efforts from care providers, researchers, health policy makers and healthcare administrative leaders among APEC economies, the purpose of this file was to provide comprehensive IM systems for COVID-19 care as recommendations and suggestive guidelines including care methods, tools, procedures, symptom conditions and targets selections, and points need to be considered during care applications. All cited COVID-19 care practices have confirmed their efficacy and usefulness either used alone or combined with conventional medicine. This article provides current useful medical information on IM for COVID-19 care which could benefit APEC economies and world health communities on their healthcare system.

Autonomous scanning motion generation adapted to individual differences in abdominal shape for robotic fetal ultrasound

The shortage of obstetricians and gynecologists is increasing in developed countries; therefore, there is a need to improve prenatal care procedures. To automate fetal ultrasound (US) imaging, this paper presents a deep neural network (DNN) model that generates US scan motions for a robot. Additionally, the robot can adapt to the abdominal surface even if the abdominal shape is not precisely known. The latent space of the DNN model is designed to represent the abdominal-shape information. The DNN model can predict the proper trajectory by mapping the height and width of the abdomen to the latent space. Moreover, the robot can detect any deviations from the correct trajectory and return to the right position. For validation, we performed a US scan using the proposed model on tissue-mimicked phantoms that were not used for training. Subsequently, we evaluated the number of dots that were wiped off by the robot from the phantom surface. Overall, the number of dots removed accounted for 91.7% of the total dots. The results demonstrated the feasibility of using the DNN model for motion generation. Hence, the proposed system has the potential to automate fetal US scans according to the individual differences in the abdominal shape.

THE COMPREHENSIVE MIDWIFERY CARE WITH NY. R IN DEPENDENT MIDWIFERY PRACTICE NURIL’S SIDOARJO

Background: The maternal mortality rate in Indonesia in 2022 will be 189 / 100 thousand live births. This figure is still high when compared to the MMR target in 2024, namely 183 / 100 thousand live births. One of the midwives' efforts to reduce MMR is by providing comprehensive/ sustainable midwifery care (CoC). The purpose of this case study is to describe the results of implementing CoC midwifery care for Mrs. R aged 29 years at TPMB Nuril Sidoarjo for 3 days. Method: This midwifery care case study uses a descriptive method, where Mrs. R is given care starting from the third trimester of pregnancy, childbirth, newborns, postpartum to family planning. CoC midwifery care provided to Mrs. R is standard midwifery care. Result: The results of the case study show that from the midwifery care given to Mrs. R, it was found that the condition of the mother and baby was still within normal limits without any complications until the end of the implementation of comprehensive midwifery care. Conclusion : The midwifery care provided to the subject was in accordance with applicable standard midwifery care procedures. So that no complications occur in the subject when midwifery care is provided.

Insomnia Guidelines—The European Update 2023

The last ten years have seen the development and publication of numerous national and international guidelines devoted to the diagnosis and treatment of insomnia. These include guidelines by the American College of Physicians (ACP), the American Academy of Sleep Medicine (AASM), the British Sleep Society (BSS), the German Sleep Society (GSS), and the European Sleep Research Society (ESRS). Though coming from very diverse authors and backgrounds, these guidelines by and large agree concerning the therapeutic recommendations: cognitive behavioral treatment of insomnia (CBT-I), a multicomponent psychotherapeutic intervention, is unequivocally recommended as a first-line treatment. In this report, we will focus on the most recent guideline update from the ESRS, which was published in November 2023. After suggesting a careful diagnostic procedure, CBT-I, both applied face to face (F2F) or digitally (dCBT-I), is again recommended as a first-line treatment based on the available evidence. Hypnotic medications like benzodiazepines (BZ), benzodiazepine receptor agonists (BZRA), sedating antidepressants, and others are approved for short-term-treatment of up to four weeks. Orexin receptor antagonists (i.e., daridorexant) and prolonged release melatonin are considered as options for longer-term treatment when carefully considering the advantages and disadvantages. Both light therapy and exercise regimens were viewed as promising; however, they still lack convincing evidence for the time being. Given the fact that not every patient responds satisfactorily or even remits following CBT-I or other treatment options, the research agenda calls for the development and evaluation of new therapeutic avenues and combination therapies.

Health Care Contact Days Among Older Adults in Traditional Medicare : A Cross-Sectional Study.

Days spent obtaining health care outside the home can represent not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. Yet, these "health care contact days" have not been characterized. To assess composition of, variation and patterns in, and factors associated with contact days among older adults. Cross-sectional study. Nationally representative 2019 Medicare Current Beneficiary Survey data linked to claims. Community-dwelling adults aged 65 years and older in traditional Medicare. Ambulatory contact days (days with a primary care or specialty care office visit, test, imaging, procedure, or treatment) and total contact days (ambulatory days plus institutional days in a hospital, emergency department, skilled-nursing facility, or hospice facility); multivariable mixed-effects Poisson regression to identify patient factors associated with contact days. In weighted results, 6619 older adults (weighted: 29 694 084) had means of 17.3 ambulatory contact days (SD, 22.1) and 20.7 total contact days (SD, 27.5) in the year; 11.1% had 50 or more total contact days. Older adults spent most contact days on ambulatory care, including primary care visits (mean [SD], 3.5 [5.0]), specialty care visits (5.7 [9.6]), tests (5.3 [7.2]), imaging (2.6 [3.9]), procedures (2.5 [6.4]), and treatments (5.7 [13.3]). Half of the test and imaging days were not on the same days as office visits (48.6% and 50.1%, respectively). Factors associated with more ambulatory contact days included younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors (for example, "go to the doctor…as soon as (I)…feel bad"). Study population limited to those in traditional Medicare. On average, older adults spent 3 weeks in the year getting care outside the home. These contact days were mostly ambulatory and varied widely not only by number of chronic conditions but also by sociodemographic factors, geography, and care-seeking behaviors. These results show factors beyond clinical need that may drive overuse and underuse of contact days and opportunities to optimize this person-centered measure to reduce patient burdens, for example, via care coordination. National Institute on Aging.

Interrater Agreement between Bedside and Video Raters Using the CPOT-Neuro for Pain Assessment in Critically Ill Patients with a Brain Injury.

This study aimed to examine the interrater agreement of Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) scores as a newly developed tool for pain assessment in patients with critical illness and brain injury between raters using two methods of rating (bedside versus video) during standard care procedures (i.e., non-invasive blood pressure and turning). The bedside raters were research staff, and the two video raters had different backgrounds (health and non-health disciplines). Raters received standardized 45 min training by the principal investigator. Video recordings of 56 patient participants with a brain injury at different levels of consciousness were included. Interrater agreement was supported with an Intraclass Correlation Coefficient (ICC) > 0.65 for all pairs of raters and for each procedure. Interrater agreement was highest during turning in the conscious group, with ICCs ranging from 0.79 to 0.90. The use of video recordings was challenging for the observation of some behaviors (i.e., tearing, face flushing), which were influenced by factors such as lighting and the angle of the camera. Ventilator alarms were also challenging to distinguish from other sources for the video rater from a non-health discipline. Following standardized training, video technology was useful in achieving an acceptable interrater agreement of CPOT-Neuro scores between bedside and video raters for research purposes.