OBJECTIVE: Emergence delirium is frequently observed in pediatric patients. With advancements in video-based interventions, such as cartoons, video games, and virtual reality, these modalities may contribute to a reduced incidence of emergency delirium among children. However, robust evidence supporting their efficacy remains necessary.
METHODS: The authors conducted a systematic search across multiple databases, including Embase, MEDLINE, and Cochrane Library, to identify all randomized controlled trials comparing video-based interventions with control treatments in pediatric emergence delirium. Data were aggregated and analyzed using Review Manager 5.4 to evaluate the effectiveness of video-based interventions.
RESULTS: The analysis included eight randomized controlled trials comprising 872 children. The intervention group showed a trend toward lower Pediatric Anesthesia Emergence Delirium scores (p = 0.10) and fewer emergence delirium events (p = 0.52). Seven studies demonstrated that video-based interventions significantly reduced preoperative anxiety, as indicated by decreased scores on the modified Yale Pre-operative Anxiety Scale (p < 0.00001). Anesthesia duration did not significantly differ between the intervention and control groups (p = 0.16). Notably, subgroup analyses revealed a significant reduction in Pediatric Anesthesia Emergence Delirium scores among children under seven years of age (p = 0.001).
CONCLUSIONS: Video-based interventions were linked to lower Pediatric Anesthesia Emergence Delirium scores and a decreased incidence of emergence delirium events. However, these results did not reach statistical significance across the broader sample. Notably, in children under seven, these interventions significantly reduced the scores.
METHODS: III.

UNASSIGNED: Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness.
UNASSIGNED: To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics.
UNASSIGNED: Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis.
UNASSIGNED: A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar.
UNASSIGNED: Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings.
UNASSIGNED: None.
UNASSIGNED: PROSPERO (Ref no.: CRD42021245874).

OBJECTIVE: While graphics are commonly used by clinicians to communicate information to patients, the impact of using visual media on surgical patients is not understood. This review seeks to understand the current landscape of research analyzing impact of using visual aids to communicate with patients undergoing surgery, as well as gaps in the present literature.
METHODS: A comprehensive literature search was performed across 4 databases. Search terms included: visual aids, diagrams, graphics, surgery, patient education, informed consent, and decision making. Inclusion criteria were (i) full-text, peer-reviewed articles in English; (ii) evaluation of a nonelectronic visual aid(s); and (iii) surgical patient population.
RESULTS: There were 1402 articles identified; 21 met study criteria. Fifteen were randomized control trials and 6 were prospective cohort studies. Visual media assessed comprised of diagrams as informed consent adjuncts (n = 6), graphics for shared decision-making conversations (n = 3), other preoperative educational graphics (n = 8), and postoperative educational materials (n = 4). There was statistically significant improvement in patient comprehension, with an increase in objective knowledge recall (7.8%-29.6%) using illustrated educational materials (n = 10 of 15). Other studies noted increased satisfaction (n = 4 of 6), improvement in shared decision-making (n = 2 of 4), and reduction in patient anxiety (n = 3 of 6). For behavioral outcomes, visual aids improved postoperative medication compliance (n = 2) and lowered postoperative analgesia requirements (n = 2).
CONCLUSIONS: The use of visual aids to enhance the surgical patient experience is promising in improving knowledge retention, satisfaction, and reducing anxiety. Future studies ought to consider visual aid format, and readability, as well as patient language, race, and healthcare literacy.

BACKGROUND: Limited Health Literacy (HL) is an obstacle to accessing and receiving optimal health care and negatively impacts patients\' quality of life, thus making it an urgent issue in the health care system. Visual-based interventions are a promising strategy to improve HL through the use of visual aids and pictorial materials to explain health-related concepts. However, a comprehensive summary of the literature on the topic is still scarce.
METHODS: To fill this gap, we carried out a systematic review and meta-analysis with the aim to determine the effectiveness of visual-based interventions in improving comprehension of health related material in the clinical population. Independent studies evaluating the effectiveness of visual-based interventions on adults (> 18 years) and whose primary outcome was either health literacy (HL) or comprehension were eligible for the review. After a systematic literature search was carried out in five databases, 28 studies met the inclusion criteria and thus were included. Most of the studies were randomized controlled trials and they focused on HL and health knowledge as outcomes.
RESULTS: The review and meta-analysis showed that visual-based interventions were most effective in enhancing the comprehension of health-related material compared to traditional methods. According to meta-analytic results, videos are more effective than traditional methods (Z = 5.45, 95% CI [0.35, 0.75], p < 0.00001) and than the employment of written material (Z = 7.59, 95% CI [0.48, 0.82], p < 0.00001). Despite this, no significant difference was found between video and oral discussion (Z = 1.70, 95% CI [-0.46, 0.53], p = 0.09).
CONCLUSIONS: We conclude that visual-based interventions, particularly the ones using videos, are effective for improving HL and the comprehension of health-related material.

OBJECTIVE: Dental anxiety (DA) is characterized by the expression of tension, stress, apprehension, irritation, anger, and frustration experienced by patients during dental appointment. The objective of this study was to systematically review the literature to assess the effectiveness of the use of informative videos in reducing DA in patients undergoing 3 M surgeries.
METHODS: Searches were carried out on MEDLINE (via PubMed), the Cochrane Central Registry of Controlled Trials (CENTRAL), the Virtual Health Library (VHL), and the Web of Science. Articles published until November 20, 2021, were included. There were no restrictions on the data or language of publication.
RESULTS: A total of 9 randomized clinical trials were included in this review, and five studies were included in the meta-analysis, comprising 529 patients. There was no significant difference in DA between the groups in the baseline when it was evaluated by any of the tools, indicating sample balancing at the beginning of the study. After intervention (video vs. verbal and/or written orientation) in the preoperative period, DA was assessed again; however, there was no difference in DA between the groups when assessed by the MDAS or STAI-S tools. After 3 M removals, the DA was still not significantly different between the groups when measured by the different considered tools.
CONCLUSIONS: Informative videos addressing 3 M removal surgeries used in the preoperative period did not show an influence on the reduction of pre- and postoperative DA when compared to the verbal and/or written informative presentation.

To study the effect of modifying content and design elements within written informed-consent-forms (ICF) for patients undergoing elective surgical or invasive procedures.
We included (quasi-)randomized trials in which a modified written ICF (e.g. visual aids) was compared to a standard written ICF. We searched PubMed, Web-of-Science and PsycINFO until 08/2021. Risk of Bias was assessed. The complexity of intervention was assessed using the Intervention Complexity Assessment Tool for Systematic Reviews.
Eleven trials with 1091 participants were eligible. Effect sizes and levels of evidence varied from trivial to moderate andthere were contradictory findings for some outcomes. Providing patients with more informationin general or specific information on risks and complications mostly increased anxiety. The use of verbal risk presentation decreased anxiety and increased satisfaction.A lower readability level decreased anxiety and improved comprehension and knowledge.
Our results suggest that providing more information and addressing certain types of risks have differential effects. While more information improved knowledge, it also increased anxiety. We did not find any or only insufficient evidence for many other possible ICF modifications.
When developing ICFs the differential impact of different elements on patient important outcomes should be carefully considered.

Dentists have a wide variety of techniques available to them such as tell -show-do, relaxation, distraction, systematic desensitisation, modelling, audio analgesia, hypnosis, and behaviour rehearsal. There is no concrete research as systematic review and meta-analysis indicating which explains the most effective distraction technique.
OBJECTIVE: To summarize effectiveness of audio and audio-visual (AV) distraction aids for management of pain and anxiety in children undergoing dental treatment.
METHODS: Literature search: PubMed/MEDLINE, DOAJ, Science Direct from June - July 2020 with randomized control clinical trials conducted on children with audio and AV distraction aids as intervention and those which had anxiety and pain as outcomes were searched. Fifty articles were identified and relevance was determined. 14 studies were included for qualitative synthesis and 05 were eligible for meta-analysis. Cochrane handbook used to assess the risk of bias. The meta analysis conducted using review manager 5.3 software.
RESULTS: Meta-analysis, cumulative mean difference for audio and AV distraction techniques was calculated with main outcomes as pulse rate, O2 level, Vehman\'s picture and clinical test. These findings showed significant difference favoring the intervention (audio and AV) group when compared with control but indicating more effectiveness of AV distractions.
CONCLUSIONS: Different audio-visual aids assist in reducing pain and anxiety in children but using audio distraction aids when audio-visual aids are not available could be acceptable way for distracting and treating children.

Electronic resources have changed surgical education in the 21st century. Resources spanning from digital textbooks to multiple choice question banks, online society meetings, and social media can facilitate surgical education. The COVID pandemic drastically changed the paradigm for education. The ramifications of Zoom lectures and online surgical society meetings will last into the future. Educators and learners can be empowered by the many available electronic resources to enhance surgical training and education.

Dynamic visualizations such as videos or animations have been developed to exchange information that transforms over time across a broad range of professional/academic contexts. However, such visual tools may impose substantial demands on the learner\'s cognitive resources that are very limited in current knowledge. Cognitive load theory has been used to improve learning from dynamic visualizations by providing different instructional designs to manage learner cognitive load. This paper reviews a series of experimental studies assessing the effects of certain instructional designs on learning of tactical scenes of play through dynamic visualizations. An electronic database search was performed on the Web of Science and PubMed/Medline databases from inception to July 2020 using a combination of relevant keywords. Manual searches were also made. The search was limited to English language. A total of 515 records were screened by two researchers using the Population/Intervention/Comparison/Outcome(s) (PICO) criteria. The quality and validity of the included studies were assessed using \"QualSyst\". Learning indicators in students and/or players (male and female) at any age category and competitive level were considered. Eleven studies met the inclusion criteria for this review, which focused on the effects of four instructional designs (i.e., using static visualizations, employing sequential presentation, applying segmentation, and decreasing presentation speed) on learning various game systems through dynamic visualizations. These studies indicate that (i) the effectiveness of all instructional designs depend upon the level of learners\' expertise when learning soccer/Australian football scenes through animations/videos, (ii) the effectiveness of using static visualizations instead of animations/videos showing soccer/basketball scenes depend upon the type of the depicted knowledge (i.e., motor knowledge or descriptive knowledge) for novice learners, (iii) the effectiveness of employing static visualizations and decreasing presentation speed when learning soccer/basketball scenes from animations/videos depend upon the level of content complexity, for novice learners. The current review demonstrated important practical implications for both coaches and physical education teachers using either animations and/or videos to communicate game systems. Indeed, findings suggested that adapting instructional designs to the level of learners\' expertise, type of depicted knowledge, and level of content complexity is a crucial part of effective tactical learning from dynamic visualizations.

To conduct a scoping review on the literature on visual aids in health education for persons with low-literacy.
A scoping review methodology was employed. Pre-defined selection criteria identified 47 studies for inclusion. Data were extracted in relation to: (a) definitions of low-literacy and health literacy, (b) population studied, (c) research country, (d) consent procedures, (e) visual aids used, (f) development of visual aids, and (g) targeted outcomes.
Visual aids developed with persons with low-literacy demonstrated statistically significant improvements in health literacy outcomes, with benefits in medication adherence and comprehension also reported. Pictograms and videos were the most effective visual aids. Only one study adapted consent procedures for low-literacy participants.
Visual aids in health education materials may benefit persons with low-literacy levels, but large gaps in the research base are evident. Experimental research in low- and middle-income countries, with a particular focus on consent for participants with low-literacy is needed.
Visual aid design needs to include stakeholders. Consent procedures and decision-making need to be specifically adapted for participants with low-literacy.