Managing cognitive difficulties after traumatic brain injury: a review of online resources for families

Purpose: To identify and critically appraise the content, readability, reliability and usability of websites providing information for managing cognitive difficulties in everyday life for the families of adults with moderate to severe traumatic brain injury.

Method: Systematic searches on the Internet for relevant websites were conducted using five search engines, and through consultation of the lists of resources published on websites of traumatic brain injury organizations. Two team members assessed eligibility of the websites. To be included, they had to provide information related to management of cognitive difficulties following moderate to severe traumatic brain injury, to be in English or French and available free of charge. Two reviewers evaluated each website according to: (1) its readability using Flesch–Kincaid Grade Level; (2) the quality of its content using a checklist of eight recommendations for managing memory, attention and executive function problems; (3) its usability (e.g., clear design) and reliability (e.g., currency of information) using the Minervation Validation Instrument for Health Care Web Sites.

Results: Of the 38 websites included, 10 provide specific tips for families that cover several domains of cognitive function, including memory, attention and executive function. The most frequent recommendations focused on the use of environmental supports for memory problems (n?=?33 websites). The readability of information is below the recommended grade 7 for only nine of the websites. All sites show acceptable usability, but their quality is variable in terms of reliability of the information.

Conclusions: This review provides useful information for selecting online resources to educate families about the management of cognitive difficulties following moderate to severe traumatic brain injury, as a complement to information and training provided by the rehabilitation team.

• Implications for rehabilitation

• This review describes standardized criteria for the evaluation of the content, readability, reliability and usability of websites for family education post-TBI.

• Given the variability in the content, the readability and the reliability of websites providing information for families about the management of cognitive difficulties post-TBI, careful attention to the selection of appropriate resources is required.

• Findings from this review may facilitate clinicians’ identification of relevant websites to educate families about the management of cognitive difficulties post-TBI, as a complement to other information and training from the rehabilitation team.

     

Abdominal imaging and patient education resources: enhancing the radiologist–patient relationship through improved communication

Introduction

The relative ease of Internet access and its seemingly endless amount of information creates opportunities for Americans to research medical diseases, diagnoses, and treatment plans. Our objective is quantitative evaluation of the readability level of patient education websites, written for the lay public, pertaining to common radiologic diagnostic test, and radiologic diagnoses specific to abdominal imaging.

Methods

In October 2015, 10 search terms were entered in the Google search engine, and the top 10 links for each term were collected and independently examined for their readability level using 10 well-validated quantitative readability scales. Search terms included CT abdomen, MRI abdomen, MRI enterography, ultrasound abdomen, X-ray abdomen, cholecystitis, diverticulitis, hepatitis, inflammatory bowel disease, and pancreatitis. Websites not written exclusively for patients were excluded from the analysis.

Results

As a group, the 100 articles were assessed at an 11.7 grade level. Only 2% (2/100) were written at the National Institutes of Health (NIH), and American Medical Association (AMA) suggested 3rd to 7th grade level to meet the 8th grade average reading level in the United States. In fact, 49% were written at a level that required a high school education or higher (greater than 12th grade).

Conclusions

With websites like radiologyinfo.org, generating over a million visitors a month, it is that clear there is a public interest in learning about radiology. However, given the discordance between the level of readability of the majority of the Internet articles and the NIH and AMA guidelines noted in this study on abdominal imaging readability, it is likely that many readers do not fully benefit from these resources on abdominal imaging.

     

The readability of online Canadian radiotherapy patient educational materials

Introduction/backgroundIt is not clear if online radiotherapy patient educational materials that are published by the Canadian Cancer Society (CCS) and the various provincial health authorities meet the appropriate readability levels. The aim of this study is to determine the readability of online Canadian radiotherapy patient educational materials.MethodsThe publicly available educational materials were acquired from the provincial health authorities' and the CCS's websites. Only English language materials were included. Documents which mainly contained instructions or were part of interactive modules were excluded. The materials were transferred to Microsoft Word documents and labelled by source and category. Editing was then performed and the readability scores were acquired for each document.ResultsA total of 67 documents were included and 4 were excluded. The overall mean Flesch-Kincaid Grade Level from all sources was 7.5 (range, 3.6–13.2; 95% confidence interval [CI] 7.1–7.9), while the overall mean Flesch Reading Ease from all sources was 64.0 (range, 44.2–78.1; 95% confidence interval [CI] 62.0–66.1). The mean Flesch-Kincaid Grade Level scores from all sources were higher than the grade 6 recommended reading level for patient educational materials. This difference was found to be statistically significant (p ≤ 0.05) for Alberta, New Brunswick, Quebec, and Nova Scotia.Discussion/conclusionsOverall, the readability levels of online Canadian radiotherapy patient educational materials exceed the recommended grade 6 readability for patient educational resources. It is hoped that the findings of this study would inform and guide the future development and distribution of materials that meet the appropriate readability standards.     

Quality and readability of English-language internet information for aphasia

Purpose: Little is known about the quality and readability of treatment information in specific neurogenic disorders, such as aphasia. The purpose of this study was to assess quality and readability of English-language Internet information available for aphasia treatment.

Method: Forty-three aphasia treatment websites were aggregated using five different country-specific search engines. Websites were then analysed using quality and readability assessments. Statistical calculations were employed to examine website ratings, differences between website origin and quality and readability scores, and correlations between readability instruments.

Result: Websites exhibited low quality with few websites obtaining Health On the Net (HON) certification or clear, thorough information as measured by the DISCERN. Regardless of website origin, readability scores were also poor. Approximate educational levels required to comprehend information on aphasia treatment websites ranged from 13 to 16 years of education. Significant differences were found between website origin and readability measures with higher levels of education required to understand information on websites of non-profit organisations.

Conclusion: Current aphasia treatment websites were found to exhibit low levels of quality and readability, creating potential accessibility problems for people with aphasia and significant others. Websites including treatment information for aphasia must be improved in order to increase greater information accessibility.     

Evaluation of asthma websites for patient and parent education

The purpose of this study was to evaluate the quality of websites on asthma for patient and parent education. Seventy websites were evaluated based on the Health Information Technology Institute (HITI) criteria; eight core content criteria from the National Heart, Lung, and Blood Institute guidelines; and readability. The ten best websites for asthma education were identified for patient teaching and educating parents about asthma.     

Readability of printed educational materials used to inform potential and actual ostomates

• ? This paper is primarily concerned with the use of readability formulas to determine the reading ease of printed education materials (PEMs) given to ostomy patients. Whilst the particular clinical focus is stoma care nursing, the content is relevant to all nurses who use printed text to inform their patients. PEMs have significant advantages in conveying information compared with verbal presentations alone.
• ? Methods to calculate readability using the Flesch, FOG and SMOG readability formulas are described. Presentation factors that affect readability are briefly reviewed, including use of ‘white space’, font size and paper colour. The problem of functional illiteracy and the need for indirect assessment of patient literacy are discussed.
• ? PEMs in use are often found to be difficult to read. Stress is identified as a potential factor in further reducing a patient's ability to deal with information.
• ? Three commercially available PEMs are evaluated for ease of reading and their score on the FOG index indicates that only about 40% of the UK population would understand them.
• ? Nurses are advised to evaluate the readability of their PEMs and to assess indirectly the literacy of their patients, so that they can more sensitively match PEMs to patient ability and need.

     

Acute low back pain information online: an evaluation of quality, content accuracy and readability of related websites

The internet is increasingly being used as a source of health information by the general public. Numerous websites exist that provide advice and information on the diagnosis and management of acute low back pain (ALBP), however, the accuracy and utility of this information has yet to be established. The aim of this study was to establish the quality, content and readability of online information relating to the treatment and management of ALBP. The internet was systematically searched using Google search engines from six major English-speaking countries. In addition, relevant national and international low back pain-related professional organisations were also searched. A total of 22 relevant websites was identified. The accuracy of the content of the ALBP information was established using a 13 point guide developed from international guidelines. Website quality was evaluated using the HONcode, and the Flesch-Kincaid Grade level (FKGL) was used to establish readability. The majority of websites lacked accurate information, resulting in an overall mean content accuracy score of 6.3/17. Only 3 websites had a high content accuracy score (>14/17) along with an acceptable readability score (FKGL 6-8) with the majority of websites providing information which exceeded the recommended level for the average person to comprehend. The most accurately reported category was, "Education and reassurance" (98%) while information regarding "manipulation" (50%), "massage" (9%) and "exercise" (0%) were amongst the lowest scoring categories. These results demonstrate the need for more accurate and readable internet-based ALBP information specifically centred on evidence-based guidelines.     

超声辐射微泡剂抑制SMMC-7721移植瘤的实验研究及其作用机制探讨

目的研究低频超声辐射微泡剂对裸鼠移植肿瘤增长抑制情况和组织病理学变化,并探讨其与局部氧自由基代谢产物SOD浓度改变的关系。方法建立SMMC-7721系肝癌Balb/c裸鼠移植瘤模型,随机分为五组,对照组(A),微泡组(B),单纯超声组(C),超声微泡隔日组(D),超声微泡每日组(E)。连续一周观察肿瘤组织病理学损伤,肿瘤体积生长曲线和体积增长率。应用免疫组化的方法分析局部氧自由基代谢产物SOD的变化。分析增长率与SOD浓度之间的相关性。结果超声辐射D组、E组肿瘤体积明显小于对照组(P<0.05),超声辐射D组(73.20%±0.138%),E组(57.24%±0.1653%)肿瘤增长率明显低于对照的A组(121.24%±0.347%)、B组(123.13%±0.232%)和C组(108.74%±0.221%)(P<0.05),病理学检查见瘤内血栓形成和梗死,瘤组织细胞坏死。免疫组化法得出局部SOD阳性率D组(28.83%±2.483%)、E组(32.50%±3.017%)高于A组(11.50%±2.881%),(P<0.01)。并且SOD阳性率与肿瘤生长率间呈负相关(r=-0.663)。结论低频超声辐射微泡剂可以抑制肝癌移植瘤裸小鼠肿瘤的增长,并增加局部氧自由基代谢产物SOD浓度。肿瘤增长率与SOD浓度间有负相关关系。     

Patients should not rely on low back pain information from Brazilian official websites: A mixed-methods review

BackgroundWebsites from official organizations (e.g., Ministry of Health and Professional Councils) are assumed to be trustworthy sources of information.ObjectiveTo investigate the credibility, accuracy, and readability of low back pain (LBP) web-based content in Brazilian official websites.MethodsMixed-methods review. Google search was used for retrieving web-information about Brazilian trustworthy organizations. We assessed the URLs on three domains: credibility, accuracy, and readability of LBP contents. Qualitative analysis was performed using an open source platform in three stages: (1) organization into thematic units; (2) data exploration; and (3) interpretation of the data and summarization.ResultsWe included 84 URLs. Accuracy was assessed for 58 URLs and none fully adhered to the guidelines. Credibility analysis was performed for 67 URLs. Disclosure of authorship was not mentioned in 58 (87%) of the URLs, 63 (94%) did not mention the sources of their information, none presented a declaration of conflict of interest, and 16 (24%) did not provide the date of creation. Readability was assessed for 72 URLs and was classified as "easy" to read in 65%. Six main themes emerged in the qualitative analysis: (1) Explanations and causes for LBP, (2) diagnosis, (3) recommendations about medication, (4) recommendations for coping and self-management, (5) performing exercises, and (6) recommendations for children and adolescents.ConclusionsThe reading level is appropriate for patient-oriented information. However, Brazilian official websites demonstrated low credibility standards and while some of the content is partially supported by the current literature, there is also much inaccurate information about LBP.     

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

ObjectivesTo use 3 measures of intensity—time, observed repetitions, and wrist accelerometer activity counts—to describe the intensity of exercise carried out when completing a structured upper limb exercise program, and to explore whether a relationship exists between wrist accelerometer activity counts and observed repetitions.DesignObservational study design.SettingRehabilitation center research laboratory.ParticipantsCommunity-dwelling stroke survivors (N=13) with upper limb hemiparesis.InterventionNot applicable.Main Outcome MeasuresTime engaged in exercise, total repetitions, and accelerometer activity counts for the affected upper limb.ResultsMean session time ± SD was 48.5±7.8 minutes. Participants were observed to be engaged in exercises for 63.8%±7.5% of the total session time. The median number of observed repetitions per session was 340 (interquartile range [IQR], 199–407), of which 251 (IQR, 80–309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7%±15.9% of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (ρ=.627, P<.05).ConclusionsStroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise program and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted.     

Two surgeons and the ECG-a double blind study

ObjectiveTo assess the capability of operating abdominal and orthopaedic surgeons to analyze a set of standardized ECG.MethodsTwenty operating abdominal and orthopaedic surgeons at a university hospital were included. Each participant analyzed a set of five standardized ECG with an answering scheme for eight different items, giving a maximum score of 40. The answers were matched according to specialty and experience of the doctors of less than 5 years, between 5 and 10 years or more than 10 years. The reference standard was set by two independent consultants in cardiology.ResultsThe mean overall score was 25.25 (63.13%±4.78%) varying between 38 (95%) and 20(50%). Abdominal surgeons performed a mean score of 27.625 (69.06%±9.53%), and orthopaedic surgeons 23.67 points (59.17%±3.69%). The difference between the performance of abdominal and orthopaedic surgeons was not significant (P=0.09). 20/20 surgeons identified ST-elevation and no surgeon accepted the ECG showing acute ST-elevation myocardial infarction as normal.ConclusionsAbdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.     

Increased Risk of Carpal Tunnel Syndrome in People With Spinal Cord Injury: A Nationwide Longitudinal Follow-Up Study

ObjectiveTo investigate the long-term risk of carpal tunnel syndrome (CTS) in people with spinal cord injury (SCI).DesignRetrospective cohort study.SettingTaiwan's Longitudinal Health Insurance Database 2005, containing data about 1 million people randomly sampled from among those registered in the National Health Insurance Program as of 2005.ParticipantsThe SCI group consisted of 1681 subjects with SCI, and the comparison group comprised 6724 propensity score-matched subjects without SCI (N=8405). The variables included in propensity-score matching were age, sex, comorbid conditions, and socioeconomic status.InterventionsNot applicable.Main Outcome MeasuresThe occurrence of newly diagnosed CTS, defined by at least 1 hospital discharge or 2 outpatient visits with a diagnosis of CTS.ResultsThe incidence density of CTS in the SCI group was 7.55 per 1000 person-years (95% confidence interval [CI], 6.03-9.33), and in the comparison group, 4.61 per 1000 person-years (95% CI, 4.08-5.19). The hazard ratio (HR) of CTS for the SCI group was therefore 1.59 (95% CI, 1.24-2.03). Additionally, the HR of CTS for the cervical-SCI subgroup, 1.90 (95% CI, 1.21-2.97) was considerably higher than that of its noncervical counterpart, 1.47 (95% CI, 1.09-1.98).ConclusionsPeople with both cervical and noncervical SCI have an increased risk of developing CTS, as compared with those without SCI. Moreover, the CTS risk appears to be higher for individuals with cervical SCI than their noncervical SCI counterparts.     

超声心动图评价川崎病后冠状动脉内皮功能

目的应用超声心动图评价川崎病后冠状动脉内皮功能,明确川崎病急性期丙种球蛋白的应用是否对晚期冠状动脉内皮功能异常有作用.方法应用超声心动图仪测量39例有川崎病病史患者及17例健康对照者冷加压试验前后及舌下含服硝酸甘油后的冠状动脉左主干内径,计算其内径百分变化率.结果冷加压试验诱导的冠状动脉左主干内径百分变化率在川崎病组明显低于对照组,分别为1.0%±4.7%及 11.1%±3.8%,P<0.0001.舌下含服硝酸甘油所诱导的冠状动脉内径百分变化率两组间无显著性差异(P>0.05).川崎病急性病程中是否早期应用丙种球蛋白者冷加压前后冠状动脉左主干内径百分变化率无显著性差异(分别为1.0%±4.5%及0.4%±6.4%,P>0.05).结论冷加压试验诱导的冠状动脉左主干内径百分变化率在有川崎病病史者较健康儿童减低,提示川崎病后存在冠状动脉内皮功能的异常.川崎病急性期大剂量丙种球蛋白的早期治疗不能干预冠状动脉内皮功能.     

Quality Indicators (QI) of Acute Pain after Surgery in European Countries

ObjectivesIt is common practice to use pain quality indicators (QI) to accurately assess the medical care situation of patients. This literature review identifies the status quo of acute pain QI among adult inpatients.Data SourcesStudies published in English or German were identified using a systematic search on CINAHL, Cochrane Library, PubMed, Web of Science, and Google Scholar from 01/2007 to 02/2018. Additional pain management journals, conference proceedings, and websites of health organizations and pain societies were manually screened. Studies about postoperative pain in adults (≥18 years) during inpatient stay after all types of surgery in Europe were included in this review.Review/Analysis MethodsThe identified study results were categorized into structural, process, and outcome indicators based on Donabedian's framework of evaluating care quality.ResultsThe search identified 319 citations, of which 20 studies used structure, process, and outcome data including 180,988 patients and 1,970 health care professionals to gain insight into the quality of acute pain management. Overall, 80% used patient surveys to collect data. National data on pain management are reported in five European studies (France [2], the Netherlands, Spain, and Austria).ConclusionsEuropean studies comprehensively comparing acute pain management results are currently missing. Thus, this report highlights the need to develop consensus-based quality indicators in management of acute pain, which take into account both the methodologic quality and the relevance to clinical practice.     

Can Functional Capacity Tests Predict Future Work Capacity in Patients With Whiplash-Associated Disorders?

ObjectiveTo determine whether functional capacity evaluation (FCE) tests predict future work capacity (WC) of patients with whiplash-associated disorders (WADs) grades I and II who did not regain full WC 6 to 12 weeks after injury.DesignProspective cohort study.SettingRehabilitation center.ParticipantsWorkers (N=267) listed on workers' compensation with grade I or II WADs 6 to 12 weeks after injury.InterventionsPatients performed 8 work-related FCE tests.Main Outcome MeasuresWC (0–100%) measured at baseline and 1, 3, 6, and 12 months after testing. Correlation coefficients between FCE tests and WC were calculated. A linear mixed-model analysis was used to assess the association between FCE and future WC.ResultsMean ± SD WC increased over time from 20.8%±27.6% at baseline to 32.3%±38.4%, 51.3%±42.8%, 65.6%±42.2%, and 83.2%±35.0% at the 1-, 3-, 6-, and 12-month follow-ups, respectively. Correlation coefficients between FCE tests and WC ranged from r=.06 (lifting low at 12-mo follow-up) to r=.39 (walking speed at 3mo). Strength of the correlations decreased over time. FCE tests did not predict WC at follow-up. The predictors of WC were ln (time) (β=23.74), mother language (β=5.49), WC at baseline (β=1.01), and self-reported disability (β=−.20). Two interaction terms, ln (time) × WC (β=−.19) and ln (time) × self-reported disability (β=−.21), were significant predictors of WC.ConclusionsFCE tests performed within 6 to 12 weeks after WADs injury grades I and II are associated with WC at baseline but do not predict future WC, whereas time course, mother language, WC at baseline, and self-reported disability do predict future WC. Additionally, the interaction between time course WC at baseline and self-reported disability predicted future WC.     

Diagnosis of Carpal Tunnel Syndrome in Patients Without Diabetes With Hemodialysis Using Ultrasonography: Is It a Useful Adjunctive Tool?

Objective(1) To examine the ultrasonography (US) characteristics in patients with hemodialysis-related carpal tunnel syndrome (H-CTS) and (2) to evaluate the accuracy of a proposed US parameter-dynamic ratio of median nerve-to-hamate hook distance (RMHD) in diagnosis of H-CTS.DesignA case-control study.SettingA tertiary medical center and a secondary hospital from November 2017 to March 2021.ParticipantsConsecutive patients (N=207) without diabetes under hemodialysis were recruited and divided into a hemodialysis without carpel tunnel syndrome (CTS) (H-Control) group and an H-CTS group. Age-matched volunteers (N=89) without diabetes or upper extremity disorders were enrolled as the control group.InterventionUS examinations by 2 operators blinded to the patient's clinical information.Main Outcome MeasuresUS parameters including cross-sectional area of the median nerve at the carpal tunnel inlet (CSA-I) and outlet (CSA-O), the flattening ratio of the median nerve at the inlet (FR-I) and outlet (FR-O), and RMHD.ResultsHandedness and arteriovenous fistula showed no associations with CSA-I/O and FR-I/O. Compared with the control group (n=69), the CSA-I was significantly larger in the H-Control group (n=63) and H-CTS group (n=76) (P<.001, both). There were no significant differences in the FR-I/-O among the 3 groups. For the second aim, in the H-CTS group (n=38), there was a significantly lower RMHD compared with both the control (n=20) and H-Control groups (n=30) (0.1%±2.2% vs 3.5±2.3% and 3.8±1.7%, P<.001, both). An RMHD cutoff value of <2.7% yielded a specificity of 80.0%, a sensitivity of 94.7%, and an overall accuracy of 88.2% in the diagnosis of H-CTS.ConclusionsNeither CSA-I/-O or FR-I/-O have a role in the diagnosis of H-CTS. RMHD might be a useful US parameter in the diagnosis of CTS in patients without diabetes undergoing hemodialysis.