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Aim: To construct evidence-based sensitive quality indicators for patients' rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients' rehabilitation post-PD. Background: Since PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date. Methods: Based on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients' rapid rehabilitation after PD and evaluate the importance of such indicators. Results: There were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients' rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively. Conclusion: The constructed sensitive quality index system developed for patients' rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients' rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality. [ABSTRACT FROM AUTHOR]

Mortimer Adler and Charles Van Doren's classic How to Read a Book gives useful guidance. It explains how to evaluate whether a book is worth reading. It also gives you tips for getting the most out of the books that you read. Their advice on reading also suggests some tips for better writing. Pick an important topic and say something important about it. Do your research and organize your presentation. Keep your writing clear and simple. Make clear and reasoned arguments and anticipate the objections that your audience may raise. Above all, make sure that your title, front matter, back matter, and book cover tell the reader what your book is about and why it is worth reading. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of patients with a cochlear implant (CI) is usually an elective, complex and interdisciplinary process. As an important source of information, patients often access the internet prior to treatment. The quality of internet-based information regarding thematic coverage has not yet been analysed in detail. Therefore, the aim of this study was to analyse the information on CI care available on the internet regarding its thematic coverage and readability. Material methods: Eight search phrases related to CI care were defined as part of the study. A checklist for completeness of thematic coverage was then created for each search phrase. The current German CI clinical practice guideline and the white paper on CI care in Germany were used as a basis. As a further parameter, readability was assessed using Flesch Reading Ease Scores. The search phrases were used for an internet search with Google. The first ten results were then analysed with regard to thematic coverage, readability and the provider of the website. Results: A total of 80 websites were identified, which were set up by 54 different providers (16 providers were found in multiple entries) from eight different provider groups. The average completeness of thematic coverage was 41.6 ± 28.2%. Readability according to the Flesch Reading Ease Score was categorised as "hard to read" on average (34.7 ± 14.2 points, range: 0–72). There was a negative statistically significant correlation between the thematic coverage of content and readability (Spearman's rank correlation: r = − 0.413, p = 0.00014). Summary: The completeness of thematic coverage of information on CI care available on the internet was highly heterogeneous and had a significant negative correlation with the readability. This result should be taken into account by both the providers of internet information and by patients when using internet-based information on CI care and help to further improve the quality of web-based information. [ABSTRACT FROM AUTHOR]

Introduction: Health literacy is the ability of individuals to use basic health information and services to make well-informed decisions. Low health literacy among surgical patients has been associated with nonadherence to preoperative and/or discharge instructions as well as poor comprehension of surgery. It likely poses as a barrier to patients considering foregut surgery which requires an understanding of different treatment options and specific diet instructions. The objective of this study was to assess and compare the readability of online patient education materials (PEM) for foregut surgery. Methods: Using Google, the terms "anti-reflux surgery, "GERD surgery," and "foregut surgery" were searched and a total of 30 webpages from universities and national organizations were selected. The readability of the text was assessed with seven instruments: Flesch Reading Ease formula (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations. We performed a qualitative analysis gathering characteristics such as, type of information (preoperative or postoperative), organization, use of multimedia, inclusion of a version in another language. Results: The overall average readability of the top PEM for foregut surgery was 12th grade. There was only one resource at the recommended sixth grade reading level. Nearly half of PEM included some form of multimedia. Conclusions: The American Medical Association and National Institute of Health have recommended that PEMs to be written at the 5th–6th grade level. The majority of online PEM for foregut surgery is above the recommended reading level. This may be a barrier for patients seeking foregut surgery. Surgeons should be aware of the potential gaps in understanding of their patients to help them make informed decisions and improve overall health outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the readability and quality of online patient resources on knee osteoarthritis and lumbar spinal stenosis in Japan. Three search engines (Google, Yahoo, and Bing) were searched for the terms knee osteoarthritis and lumbar spinal stenosis. The first 30 websites of each search were screened. Duplicate websites and those unrelated to the searched diseases were excluded. The remaining 125 websites (62 on knee osteoarthritis, 63 on lumbar spinal stenosis) were analyzed. The text readability was assessed using two web-based programs (Obi-3 and Readability Research Lab) and lexical density. Website quality was evaluated using the DISCERN score, Clear Communication Index, and Journal of American Medical Association benchmark criteria. Readability scores were high, indicating that the texts were difficult to understand. Only 24 (19%) and six (5%) websites were classified as average difficulty readability according to Obi-3 and Readability Research Lab, respectively. The overall quality of information was low, with only four (3%) being rated as having sufficient quality based on the Clear Communication Index and Journal of American Medical Association benchmark criteria. None of the websites satisfied the DISCERN quality criteria. Patient information on Japanese websites regarding knee osteoarthritis and lumbar spinal stenosis were difficult to understand. Moreover, the quality of the websites was insufficient. Orthopaedic surgeons should contribute to the creation of high-quality easy-to-read websites to facilitate patient-physician communication. [ABSTRACT FROM AUTHOR]

BACKGROUND: Assessment of readability and reliability of online resources for orthopedic patients is an area of growing interest, but there is currently limited reporting on this topic for patellar instability (PI) and medial patellofemoral ligament reconstruction (MPFLR). METHODS: Utilizing the Searchresponse.io dataset, we analyzed inquiries related to PI and MPFLR. Readability and reliability were assessed using the Automated Reading Index, Flesch Reading Ease, and the JAMA benchmark criteria. RESULTS: Analysis of 363 frequently asked questions from 130 unique websites revealed a predominant interest in fact-based information. Readability assessments indicated that the average grade level of the resources was significantly higher than the 6th grade level and reliability varied between resources. CONCLUSION: Although the internet is an easily accessible resource, we demonstrate that PI and MPFLR resources are written at a significantly higher reading level than is recommended, and there is inconsistent reliability amongst resources with medical practice websites demonstrating the lowest reliability. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses readability, suitability, and accountability of online uveitis patient education materials (PEMs). Methods: Two uveitis specialists reviewed the top 10 websites on Google for keyword "uveitis," with a PubMed review control. Readability was assessed using an online calculator, suitability using the Suitability Assessment of Materials (SAM) tool, and accountability using JAMA benchmarks. Results: The mean SAM score was 21.05, indicating that websites were on average adequately suitable to educate patients. WebMD Uveitis website scored the highest at 25.5, while allaboutvision.org scored the lowest at 18.0. The average Flesch Reading Ease (FRE) score was 44.0 (95% CI: 34.2, 53.8). The average reading grade score was 11.0 (95% CI: 9.4, 12.6). WebMD Uveitis page scored highest on readability. The average accountability score among sites was 2.36 out of 4. Conclusions: Uveitis websites are only adequately suitable as PEMs, and all are above the recommended reading level. Uveitis specialists should advise patients on quality of online PEMs. [ABSTRACT FROM AUTHOR]

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10−8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the relationship between discourse comprehension and production in traumatic brain injury (TBI), especially for spoken language. This study examined to what extent narrative discourse comprehension accounts for narrative discourse production outcomes (story grammar, story completeness). A secondary aim was to provisionally test an assumption of a discourse model, the structure building framework (SBF), that discourse comprehension and production share cognitive processes by investigating the strength of the relationship between them. Method: Twenty-one individuals with TBI completed story comprehension and story retelling tasks. Discourse measures included the Discourse Comprehension Test, a picture story comprehension task, story grammar, and story completeness. Correlational and multiple regression analyses were performed using comprehension measures as predictors for production measures. Results: There were significant moderate-to-large correlations between all comprehension and production measures. Comprehension measures approached but did not reach significance for predicting story grammar performance but strongly predicted story completeness outcomes. Conclusions: The story comprehension measures likely tapped content aspects of discourse more so than organization. Results provided support for a link between content-focused discourse comprehension measures and discourse production outcomes, which may have clinical implications for approaches to discourse intervention. Findings were interpreted as providing preliminary support for the SBF's claim that discourse production deploys the same processes involved in discourse comprehension. [ABSTRACT FROM AUTHOR]

Psychologists have a duty of care to provide accurate evaluation results for the clients they serve. This expectation also includes communicating the results and related treatment recommendations in an understandable manner for the referred client, as well as those involved in their care. Despite these obligations, psychologists generally produce reports that are not as helpful as they could be. Consumers of psychological reports (e.g., parents, teachers, third parties, etc.) find reports to be difficult to understand and not very useful. The limited research on psychological report writing available shows considerable variability among clinicians and many issues contributing to poor readability and overall quality (e.g., generic recommendations, jargon, focus on test scores, time involved, etc.). Thus, psychologists could be doing more to uphold their professional and ethical responsibilities to write understandable, meaningful, and useful reports; however, there is little indication of improvement in any of these areas over the past few decades. As such, we aim to highlight psychologists' professional and ethical obligations to encourage growth. In this review, we discuss the current issues in psychological report writing, possible contributing factors, and the ethical principles involved in report writing. We also offer recommendations for psychologists and professional psychology training programs who wish to improve their practices in this core domain of professional practice. Public Significance Statement: This review article outlines current practice issues in psychological assessment reports and highlights psychologists' ethical obligations to encourage change. Additionally, research-based recommendations are provided for psychologists and professional psychology training programs to improve their report-writing practices. [ABSTRACT FROM AUTHOR]

This article explores the use of artificial intelligence (AI) in providing accurate and understandable responses to patient inquiries about Mohs micrographic surgery (MMS). The study found that an AI model called ChatGPT 4.0 improved the readability of responses and had mostly medically accurate answers. However, there were some responses that were considered potentially harmful or contrary to national guidelines. The authors recommend using AI to enhance patient education materials, but under the supervision of a board-certified dermatologist. The article also provides detailed information about Mohs surgery, including preoperative marking, intraoperative mapping, and postoperative margin assessment, highlighting the significance of accurate margin assessment for successful outcomes. Published by the American Society for Dermatologic Surgery, this article emphasizes the importance of precise margin assessment in achieving positive results. [Extracted from the article]

Background: Behavioural intention (BI) has been predicted using other variables by adopting the technology acceptance model (TAM). However, few studies have examined whether BI can predict learning performance. Objectives: The present study used an extended TAM to investigate whether students' BI is a predictor of their listening learning performance (LLP) through vocabulary learning performance (VLP) in the context of mobile vocabulary‐assisted listening learning by using two mobile learning tools. Methods: A total of 129 college students with a pre‐intermediate level of English were recruited as participants, and a 10‐week mobile vocabulary‐assisted, listening‐learning course was conducted in 2022. In each task of this course, the students had to learn target words from a listening passage on Quizlet and then engage in listening activities on Randall's ESL Cyber Listening Lab. Quantitative responses obtained through an online questionnaire were analysed through partial‐least‐squares structural equation modelling. Results: The analysis results indicated that BI significantly predicted LLP through VLP. Perceived ease of use (PEU) and perceived usefulness (PU) were significant antecedents of BI. However, PEU did not significantly predict PU because of the difficulty of navigating between the two technological tools used in this study. The extended model demonstrated its effectiveness in explaining listening learning performance, as evidenced by an explained variance (R2) of 69%. Conclusion: The extended model validates the influence of BI on learning performance and it can also draw teachers' focus toward the significance of enhancing students' BI to improve their listening learning performance. Pedagogical implications based on the results are provided in this paper. Lay Description: What is already known about this topic?: TAM was used to study learners' acceptance of mobile‐assisted language learning.TAM incorporates latent variables to explore mobile‐assisted language learning.Investigating factors influencing BI is a primary research focus in extended TAM literature.Mobile tools could improve listening learning and vocabulary retention. What this paper adds to that: Learning performance was considered as a dependent variable in an extended TAM.BI might predict students' learning performance in vocabulary and listening in an extended TAM.Teachers used two mobile tools to design mobile vocabulary‐assisted listening tasks.Pre‐learning the target words facilitate students' listening learning performance. Implications for practice and/or policy: We show the importance of BI on predicting listening learning performance.The impact of BI on other factors became another focus of TAM research.Results highlight pre‐learning target words' importance for better listening performance.Existing mobile tools improve listening performance, avoiding new system development. [ABSTRACT FROM AUTHOR]

Objective: Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI‐generated information sources. This study assessed the quality of ChatGPT responses to such queries. Methods: In this cross‐sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self‐care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p <.05. Results: On a scale of 1–5, with 5 representing the greatest appropriateness or overall score and a 4‐point scale with 4 representing the highest accuracy, the responses exhibited moderately high appropriateness (mean = 4.10, SD = 0.90), high accuracy (mean = 3.55, SD = 0.50), and moderately high overall scores (mean = 4.02, SD = 0.86). Scoring between response categories (self‐care recommendations, complication recommendations, lifestyle adjustments, and special device considerations) revealed no significant scoring differences. Suboptimal responses lacked nuance and contained incorrect information and recommendations. Readability indicated college and advanced levels for FRE (Mean = 39.5, SD = 7.17) and FKRGL (Mean = 13.1, SD = 1.47), higher than the sixth‐grade level recommended for patient‐targeted resources by the NIH. Conclusion: While ChatGPT‐generated tracheostomy care responses may exhibit acceptable appropriateness, incomplete or misleading information may have dire clinical consequences. Further, inappropriately high reading levels may limit patient comprehension and accessibility. At this point in its technological infancy, AI‐generated information should not be solely relied upon as a direct patient care resource. [ABSTRACT FROM AUTHOR]

This study examined the heterogeneity of literacy profiles for adolescents with and without a specific learning disability (SLD) in the U.S. state of Florida Student subgroups displaying common patterns of performance in word-level skills and reading comprehension were identified through latent profile analysis. Results indicate most of the total sample demonstrated below-average performance in one or both areas with word-level skill difficulties being more common than difficulties in reading comprehension alone. Changes in reading performance by profile over time (Grades 6–8) were examined through a latent transition analysis revealing consistent patterns in the SLD sample and variable patterns in the typically developing sample. Resulting profiles were utilized to predict performance on an end-of-year broad reading comprehension measure indicating very little change in performance over time. Findings suggest large numbers of adolescents with concurrent word-level and reading comprehension difficulties likely need sustained intervention in word-level skills to support their reading comprehension. [ABSTRACT FROM AUTHOR]

Background: To evaluate the accuracy, reliability, quality, and readability of responses generated by ChatGPT-3.5, ChatGPT-4, Gemini, and Copilot in relation to orthodontic clear aligners. Methods: Frequently asked questions by patients/laypersons about clear aligners on websites were identified using the Google search tool and these questions were posed to ChatGPT-3.5, ChatGPT-4, Gemini, and Copilot AI models. Responses were assessed using a five-point Likert scale for accuracy, the modified DISCERN scale for reliability, the Global Quality Scale (GQS) for quality, and the Flesch Reading Ease Score (FRES) for readability. Results: ChatGPT-4 responses had the highest mean Likert score (4.5 ± 0.61), followed by Copilot (4.35 ± 0.81), ChatGPT-3.5 (4.15 ± 0.75) and Gemini (4.1 ± 0.72). The difference between the Likert scores of the chatbot models was not statistically significant (p > 0.05). Copilot had a significantly higher modified DISCERN and GQS score compared to both Gemini, ChatGPT-4 and ChatGPT-3.5 (p < 0.05). Gemini's modified DISCERN and GQS score was statistically higher than ChatGPT-3.5 (p < 0.05). Gemini also had a significantly higher FRES compared to both ChatGPT-4, Copilot and ChatGPT-3.5 (p < 0.05). The mean FRES was 38.39 ± 11.56 for ChatGPT-3.5, 43.88 ± 10.13 for ChatGPT-4 and 41.72 ± 10.74 for Copilot, indicating that the responses were difficult to read according to the reading level. The mean FRES for Gemini is 54.12 ± 10.27, indicating that Gemini's responses are more readable than other chatbots. Conclusions: All chatbot models provided generally accurate, moderate reliable and moderate to good quality answers to questions about the clear aligners. Furthermore, the readability of the responses was difficult. ChatGPT, Gemini and Copilot have significant potential as patient information tools in orthodontics, however, to be fully effective they need to be supplemented with more evidence-based information and improved readability. [ABSTRACT FROM AUTHOR]

For common diseases such as lung cancer, patients often use the internet to obtain medical information. As a result of advances in artificial intelligence and large language models such as ChatGPT, patients and health professionals use these tools to obtain medical information. The aim of this study was to evaluate the readability of ChatGPT-generated responses with different readability scales in the context of lung cancer. The most common questions in the lung cancer section of Medscape® were reviewed, and questions on the definition, etiology, risk factors, diagnosis, treatment, and prognosis of lung cancer (both NSCLC and SCLC) were selected. A set of 80 questions were asked 10 times to ChatGPT via the OpenAI API. ChatGPT's responses were tested using various readability formulas. The mean Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning FOG Scale, SMOG Index, Automated Readability Index, Coleman-Liau Index, Linsear Write Formula, Dale-Chall Readability Score, and Spache Readability Formula scores are at a moderate level (mean and standard deviation: 40.52 ± 9.81, 12.56 ± 1.66, 13.63 ± 1.54, 14.61 ± 1.45, 15.04 ± 1.97, 14.24 ± 1.90, 11.96 ± 2.55, 10.03 ± 0.63 and 5.93 ± 0.50, respectively). The readability levels of the answers generated by ChatGPT are "collage" and above and are difficult to read. Perhaps in the near future, the ChatGPT can be programmed to produce responses that are appropriate for people of different educational and age groups. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Temporomandibular disorders (TMD) are a prevalent ailment with a global impact, affecting a substantial number of individuals. While some individuals are receiving treatment from orthodontists for TMD, a significant proportion of individuals obtain knowledge through websites.Our purpose had been to evaluate, from a patient‐oriented perspective, the readability of home pages of websites scored in the 10 most prominent devoted to TMD. We also determined what level of education would have been needed to get an overview of the information on the websites under scrutiny. This approach ensures that our findings are centred on the patient experience, providing insights into how accessible and understandable websites about TMD.We determined the top 10 patient‐focused English language websites by searching for ‘temporomandibular disorders’ in the ‘no country redirect’ plugin of the Google Chrome browser (www.google.com/ncr). The readability of the texts was assessed using the Gunning fog index (GFI), Coleman Liau index (CLI), Automated readability index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald grade level (FKGL), Flesh reasing ease (FRE) (https://readabilityformulas.com).The mean Flesch reading ease index score was determined to be 48.67, accompanied by a standard deviation of 15.04 and these websites require an average of 13.49 years of formal education (GFI), with a standard deviation of 2.62, for ease of understanding.Our research indicates that a significant proportion of websites related to TMD can be defined as a level of complexity that exceeds the ability to read comprehension of the general population. [ABSTRACT FROM AUTHOR]

Following a traumatic brain injury (TBI), people frequently have difficulty understanding nonliteral language, including irony and indirect requests. Despite the handicap that these disorders can represent in daily life, they are rarely treated clinically, and remediation studies are scarce. The present study thus aimed to evaluate the effectiveness of an explicit metapragmatic therapy targeting nonliteral language comprehension and taking into account cognitive processes likely to underlie this comprehension (i.e., contextual processing, theory of mind, and executive functions). This study was registered on the ClinicalTrials.gov system (ID: NCT04708561) before participant recruitment. Two adults with severe TBI took part in the study. An ABA design with multiple baselines was used to assess the evolution of treated and non-treated written literal and nonliteral story comprehension, as well as ecological tasks and tasks assessing the cognitive processes of interest (theory of mind and executive functions). An interview was also conducted at the end of treatment to assess participant satisfaction. Therapy resulted in significant improvement in treated items, with one-month maintenance of gains and generalisation to untreated items in both participants. The generalisation to a working memory task was also observed in one participant. Finally, participant satisfaction with the treatment was high. Our study demonstrated for the first time the potential of a therapy targeting irony and indirect request comprehension in TBI individuals. Clinically, it offers concrete therapeutic avenues and fills a critical gap in the TBI population's evidence for the remediation of nonliteral language comprehension. [ABSTRACT FROM AUTHOR]

This study examines the responses given by OpenAI's ChatGPT, an AI chatbot, to questions about acne. Two dermatologists evaluated the responses based on accuracy, completeness, and relevance. The study found that 40% of the responses met satisfactory standards for accuracy, completeness, and relevance. Treatment-related questions had fewer satisfactory responses compared to basic and acne-type questions. The study also assessed the understandability and actionability of the responses using the Patient Education Materials Assessment Tool (PEMAT) and their readability using the Flesch Reading Ease Score (FRES). Overall, the study provides insights into the usefulness and quality of information provided by ChatGPT for acne patients. However, it suggests that while AI models like ChatGPT can be helpful as a preliminary resource, they should not replace thorough consultations with a dermatologist. Further research is needed to evaluate the performance of AI models with less common skin conditions and other natural language models. [Extracted from the article]

Background Delirium has conventionally been considered a disorder of consciousness. Alertness and arousal are used as surrogates in clinical practice but are insufficient for the purposes of a more dimensional assessment of consciousness. We present a process of development and validation of candidate measures of phenomenal consciousness that could be applied to the diagnosis of delirium. Methods First, a narrative review of available instruments in the fields of phenomenal consciousness, including prereflective consciousness, the phenomenal-sensed experience and reflective thought, was undertaken. Eligibility of tools in the context of applicability to delirium was based upon objectivity in test interpretation and the requirement for tester administration. Second, where there was a gap in suitable cognitive tools, new items were derived using the silent generation technique. A process of face and construct validity using a diverse panel of experts was performed, and readability was evaluated. Results 814 articles were screened from the literature review. Fourteen candidate tools were reported from the three domains of phenomenal consciousness. One of these met the eligibility criteria for a delirium assessment. Fifty-seven new tests of phenomenal consciousness were identified. After a process of item reduction, a total of 26 individual tests were identified. After content validity, 22 of the 26 items were retained. The scale average content validity index was 0.89. The agreement between raters was between 80% and 97%. 100% of responses for face validity were rated as positive. Flesch Reading Ease Score was 91.6 (very easy to read). Conclusions Candidate measures of phenomenal consciousness are described, and early validity studies are promising. [ABSTRACT FROM AUTHOR]

Context.--A prior study in this journal, "Clinicians Are from Mars and Pathologists Are From Venus," demonstrated that clinicians can erroneously interpret pathology reports up to 30% of the time. After noticing reporting heterogeneity in the setting of inflammatory bowel disease (IBD), we speculated that a standardized synoptic report could improve gastroenterologist comprehension. Objective.--To investigate the effect of a synoptic table on gastroenterologist comprehension of IBD pathology reports. Design.--We recruited gastroenterology fellows and faculty to participate in this study. All participants were given 6 pathology reports and asked if the following were present: active inflammation, chronic inflammation, IBD, and dysplasia. Participants were also asked to rate their confidence. After a 6-week washout period, the same questionnaire was distributed with a synoptic report. We performed paired t-tests to compare the mean accuracy and confidence scores between the preintervention and postintervention responses. Results.--A total of 39 physicians participated: 9 fellows and 30 faculty. Mean accuracy scores were higher after the intervention (0.81 versus 0.86; P < .001). Mean confidence was also higher after intervention, but this was not statistically significant (3.91 versus 3.98; P = .24). Conclusions.--The improvement in accuracy scores after intervention confirms that clinician comprehension improved with the synoptic table. A synoptic report may provide a standardized way of communicating diagnostic information to clinicians in the setting of IBD and potentially other inflammatory conditions. [ABSTRACT FROM AUTHOR]

Background: End-of-life care (EOLC) is a critical aspect of healthcare, yet accessing reliable information remains challenging, particularly in culturally diverse contexts like India. Objective: This study investigates the potential of artificial intelligence (AI) in addressing the informational gap by analyzing patient information leaflets (PILs) generated by AI chatbots on EOLC. Methodology: Using a comparative research design, PILs generated by ChatGPT and Google Gemini were evaluated for readability, sentiment, accuracy, completeness, and suitability. Readability was assessed using established metrics, sentiment analysis determined emotional tone, accuracy, and completeness were rated by subject experts, and suitability was evaluated using the Patient Education Materials Assessment Tool (PEMAT). Results: Google Gemini PILs exhibited superior readability and actionability compared to ChatGPT PILs. Both conveyed positive sentiments and high levels of accuracy and completeness, with Google Gemini PILs showing slightly lower accuracy scores. Conclusion: The findings highlight the promising role of AI in enhancing patient education in EOLC, with implications for improving care outcomes and promoting informed decision-making in diverse cultural settings. Ongoing refinement and innovation in AI-driven patient education strategies are needed to ensure compassionate and culturally sensitive EOLC. [ABSTRACT FROM AUTHOR]

The importance of patient education has become increasingly apparent in recent years. A prominent patient education tool in neurosurgery is the Neurosurgical Conditions and Treatments page provided by the American Association of Neurological Surgeons (AANS). This study aimed to investigate the readability of this resource page as many new articles have been incorporated in the past decade. Flesch-Kincaid Grade Level and Flesch-Kincaid Reading Ease scores were calculated for each article. One-way analysis of variance and Scheffé, Tukey-Kramer, Bonferroni, Fisher least significant difference, and Dunnett test post hoc analyses were conducted to determine differences between each category with respect to their mean grade level and reading ease scores. Overall mean (SD) Flesch-Kincaid Reading Ease score was 40.2 (12.24), and overall mean (SD) Flesch-Kincaid Grade Level score was 7.48 (1.26). Significant differences were found between mean reading ease scores between each categorization by the AANS (P = 0.014). No significant differences were found between mean grade level score for each categorization (analysis of variance, P = 0.154). As compared to a single previous investigation conducted 10 years ago, the readability of articles has changed modestly, and the reading grade level remains well above the recommendations by the American Medical Association and National Institutes of Health. The 6 new articles introduced in the past decade have demonstrated similar readability, presenting a persistent challenge in the realm of patient education in neurosurgery. [ABSTRACT FROM AUTHOR]

Are you baffled by when to use which and when to use that? When is it okay to drop that? When should you say who (vs whom), and when should you say whoever (vs whomever)? This article explains the grammar and usage of relative clauses and noun clauses. Like other clauses, a relative clause has its own subject and predicate. However, the relative clause serves as an adjective, modifying a noun in some other clause. The relative clause is linked to its referent by a relative pronoun (eg, that, who/whom, which, or whose). Similarly, an adverb clause can be introduced by a relative adverb (eg, when, where, why). The words that serve as relative pronouns and relative adverbs can also serve as complementizers. A complementizer is a word that creates a noun clause that serves as a subject or object in some other clause. Knowing these principles can help you untangle long, complicated sentences. Thus, you can make your text more readable. A sentence diagramming app can help you visualize and understand the syntactical relationships. [ABSTRACT FROM AUTHOR]

This study aimed to assess the potential of using an artificial intelligence (AI) large language model to improve the readability of burns first aid information. An AI language model (ChatGPT-3) was used to rewrite content from the top 50 English-language webpages containing burns first aid information to be understandable by an individual with the literacy level of an 11-year-old, as recommended by the American Medical Association and Health Education England. The assessment of readability was conducted using five validated tools. In their original form, only 4% of the patient education materials (PEMs) met the target readability level across all tools. The median grade was 6.9 (SD=1.1). One-sample one-tailed t -test revealed that this was not significantly below the target (p =.31). After AI-modification, 18% of PEMs reached the target level using all tools, with a median grade of 6 (SD=0.9), which was significantly below the target level (p <.001). Once rewritten using AI, paired t-test demonstrated that all readability scores improved significantly (p <.001). Utilising an AI language model proved an effective and viable method for enhancing readability of burns first aid information. • Online burns first aid information is often written above the recommended level. • An AI language model can improve readability of burns first aid information. • This is likely to require an iterative process of prompts. [ABSTRACT FROM AUTHOR]

This study examined the response of two students in the Southwestern United States with autism spectrum disorder and IQ in the intellectual disability range to a comprehensive, text-based reading intervention. The intervention, Friends on the Block, includes multiple strands of literacy providing explicit instruction in phonics, phonemic awareness, high-frequency irregular or temporarily irregular words, decoding, vocabulary, oral language, and comprehension. Multiple supports for students with intensive needs are embedded within the intervention, such as specially designed multi-criteria books, extensive scaffolding, and intensive cumulative review. Teachers customize the program to address the varying needs of students. We used single-case multiple baselines across levels of instruction design to assess growth on a measure of reading (words read correctly). Results indicated a positive, functional relation between reading intervention and word reading. Both students also demonstrated modest growth on measures of phonemic awareness, letter–sound knowledge, and word identification from pre- to post-intervention. [ABSTRACT FROM AUTHOR]

The effects of psychotherapy for men perpetrating violence toward their female partners have been found to be modest or equivocal; therefore, further research is necessary to determine how therapists can intervene to help clients stop acting violently. To obtain a better understanding of successful therapist strategies in a particular case, we conducted an interpretive phenomenological analysis of interactional patterns and change processes during therapy sessions in four carefully selected cases - two cases in which the use of violence ended after the completion of therapy (violence ended) were compared with two cases in which the client completed therapy but continued to act violently (violence continued). The client's use of violence was addressed repeatedly in all four cases, but the scripting of such events varied between the two case types. I) Violence ended: Joint explorations of the script of "the annoying other" led to therapist strategies that fostered new experiences of the states of mind of the client and partner. This seemed to help clients develop more caring and safer ways of relating to their partner. II) Violence continued: Engagement in the script of "hopeless me" was associated with therapist strategies that relied more on explanations of the client's vulnerability to acting violently. This seemed to hinder deeper comprehension of the clients' use of violence and the needs and intentions of their partners. Contrary to expectations, engagement in the script of "the annoying other" facilitated exploration of emotional states in both the client and his significant other. We present some empirically derived principles for moment-to-moment therapist strategies that facilitated in-session change with men acting violently toward their partner. [ABSTRACT FROM AUTHOR]

Study Design: Observational study. Objective: To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery. Summary of Background Data: Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient. Materials and Methods: We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES> 79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability. Results: Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10--96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1--25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1). Conclusions: Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion. [ABSTRACT FROM AUTHOR]

Purpose: Chat generative pretrained transformer (ChatGPT) has the potential to significantly impact how patients acquire medical information online. Here, we characterize the readability and appropriateness of ChatGPT responses to a range of patient questions compared to results from traditional web searches. Methods: Patient questions related to the published Clinical Practice Guidelines by the American Academy of Otolaryngology-Head and Neck Surgery were sourced from existing online posts. Questions were categorized using a modified Rothwell classification system into (1) fact, (2) policy, and (3) diagnosis and recommendations. These were queried using ChatGPT and traditional web search. All results were evaluated on readability (Flesch Reading Ease and Flesch-Kinkaid Grade Level) and understandability (Patient Education Materials Assessment Tool). Accuracy was assessed by two blinded clinical evaluators using a three-point ordinal scale. Results: 54 questions were organized into fact (37.0%), policy (37.0%), and diagnosis (25.8%). The average readability for ChatGPT responses was lower than traditional web search (FRE: 42.3 ± 13.1 vs. 55.6 ± 10.5, p < 0.001), while the PEMAT understandability was equivalent (93.8% vs. 93.5%, p = 0.17). ChatGPT scored higher than web search for questions the 'Diagnosis' category (p < 0.01); there was no difference in questions categorized as 'Fact' (p = 0.15) or 'Policy' (p = 0.22). Additional prompting improved ChatGPT response readability (FRE 55.6 ± 13.6, p < 0.01). Conclusions: ChatGPT outperforms web search in answering patient questions related to symptom-based diagnoses and is equivalent in providing medical facts and established policy. Appropriate prompting can further improve readability while maintaining accuracy. Further patient education is needed to relay the benefits and limitations of this technology as a source of medial information. [ABSTRACT FROM AUTHOR]

Background: This study assesses the quality and readability of Arabic online information about orthodontic pain. With the increasing reliance on the internet for health information, especially among Arabic speakers, it's critical to ensure the accuracy and comprehensiveness of available content. Our methodology involved a systematic search using the Arabic term for (Orthodontic Pain) in Google, Bing, and Yahoo. This search yielded 193,856 results, from which 74 websites were selected based on predefined criteria, excluding duplicates, scientific papers, and non-Arabic content. Materials and methods: For quality assessment, we used the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net (HON) code. Readability was evaluated using the Simplified Measure of Gobbledygook (SMOG), Flesch Reading Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL) scores. Results: Results indicated that none of the websites received the HONcode seal. The DISCERN assessment showed median total scores of 14.96 (± 5.65), with low overall quality ratings. In JAMA benchmarks, currency was the most achieved aspect, observed in 45 websites (60.81%), but none met all four criteria simultaneously. Readability scores suggested that the content was generally understandable, with a median FKGL score of 6.98 and a median SMOG score of 3.98, indicating middle school-level readability. Conclusion: This study reveals a significant gap in the quality of Arabic online resources on orthodontic pain, highlighting the need for improved standards and reliability. Most websites failed to meet established quality criteria, underscoring the necessity for more accurate and trustworthy health information for Arabic-speaking patients. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we evaluated readability and understandability of nine French-language Patient-Reported Outcome Measures (PROMs) that are currently used in a contemporary longitudinal cohort of breast cancer survivors as part of an effort to improve equity in cancer care and research. Methods: Readability of PROMs was assessed using the Flesh Reading Ease Score (FRES), the Gunning's Fog Index (FOG), and the FRY graphics. Readability was considered ideal if mean score ≤ 6th-grade level and acceptable if between 6th and 8th grade. Understandability was evaluated using the Patient Education Materials Assessment Tool and defined as ideal if PEMAT ≥ 80%. The Evaluative Linguistic Framework for Questionnaires (ELF-Q) provided additional qualitative elements to assess understandability. Plain-language best practice was met if both readability and understandability were ideal. Results: None of the 9 PROMs evaluated had ideal readability scores and only 1 had an acceptable score. Understandability ranged from 55% to 91%, and only 3 PROMs had ideal scores. ELF-Q identified points for improvement in several understandability dimensions of the PROMs. None of the instruments met the definition of plain-language best practice. Conclusion: None of the studied PROMs met the standards of readability and understandability. Future development and translation of PROMs should follow comprehensive linguistic and cultural frameworks to ensure plain-language standards and enhance equitable patient-centered care and research. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyze the quality, reliability, comprehensibility, and the mentioned medical concepts of traumatic brain injury (TBI) related videos on YouTube. "Traumatic brain injury (TBI)" and Google Trends related queries were used, and 328 videos were included. Categorization, quality assessment via a 5-point Global Quality Scale, reliability evaluation using a modified DISCERN scale, comprehensibility assessment using Flesch–Kincaid Reading Ease and Flesch–Kincaid Grade Level, and consensus-based classification for usefulness were performed. Target audience categorization was content-based. Text mining techniques were used to identify biomedical terms in video transcripts. Most of the videos were intended for nonhealthcare professionals and deemed useful. The videos had intermediate quality and a moderate level of reliability. The comprehensibility of the videos exceeded the recommended levels. Videos predominantly covered TBI symptoms, the severity of the condition, its impact on individuals, and possibly strategies related to diagnosis and treatment. Results suggest the requirement for higher quality and reliability in YouTube content about TBI. Emphasis should be placed on clear and accurate language to promote comprehensibility. Continued research, guidelines, education, and platform oversight can enhance the spread of reliable health information on social media, benefiting creators, and consumers in this field. [ABSTRACT FROM AUTHOR]

This study sought to 1) identify linguistic features important for Chinese text complexity with a theory-based and systematic approach, and 2) address how feature sets and algorithms affect the performance of Chinese text complexity models. Texts from Chinese language arts textbooks from Grades 1 to 6 (N = 1,478) in Mainland China were analyzed. The predictor variables were 265 linguistic features of texts: 154 lexical features and 111 sentence and discourse features. The outcome variable was the complexity level of texts; a one-semester-scale was applied, thus 12 levels in total (two semesters per grade). Features of the categories of character and word frequency, character and word semantic features, lexical diversity, part-of-speech syntactic categories, and referential cohesion were found the most important. With the important features identified, we found that text complexity models with features at all levels outperformed those with features at only one level. Models using the two machine learning algorithms (Random Forest Regression and Support Vector Regression) outperformed those using Linear Regression. This work clarifies important linguistic features for Chinese text complexity, and points to the necessity of considering features across levels and using machine learning algorithms in future text complexity research. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare advances are hindered by underrepresentation in prospective research; sociodemographic, data, and measurement infidelity in retrospective research; and a paucity of guidelines surrounding equitable research practices. Objective: The Joint Research Practices Working Group was created in 2021 to develop and disseminate guidelines for the conduct of inclusive and equitable research. Methods: Volunteer faculty and staff from two research centers at the University of Pennsylvania initiated a multi-pronged approach to guideline development, including literature searches, center-level feedback, and mutual learning with local experts. Results: We developed guidelines for (1) participant payment and incentives; (2) language interpretation and translation; (3) plain language in research communications; (4) readability of study materials; and (5) inclusive language for scientific communications. Key recommendations include (1) offer cash payments and multiple payment options to participants when required actions are completed; (2) identify top languages of your target population, map points of contact, and determine available interpretation and translation resources; (3) assess reading levels of materials and simplify language, targeting 6th- to 8th-grade reading levels; (4) improve readability through text formatting and style, symbols, and visuals; and (5) use specific, humanizing terms as adjectives rather than nouns. Conclusions: Diversity, inclusion, and access are critical values for research conduct that promotes justice and equity. These values can be operationalized through organizational commitment that combines bottom-up and top-down approaches and through partnerships across organizations that promote mutual learning and synergy. While our guidelines represent best practices at one time, we recognize that practices evolve and need to be evaluated continuously for accuracy and relevance. Our intention is to bring awareness to these critical topics and form a foundation for important conversations surrounding equitable and inclusive research practices. [ABSTRACT FROM AUTHOR]

Background: The readability of online bariatric surgery patient education materials (PEMs) often surpasses the recommended 6th grade level. Large language models (LLMs), like ChatGPT and Bard, have the potential to revolutionize PEM delivery. We aimed to evaluate the readability of PEMs produced by U.S. medical institutions compared to LLMs, as well as the ability of LLMs to simplify their responses. Methods: Responses to frequently asked questions (FAQs) related to bariatric surgery were gathered from top-ranked health institutions. FAQ responses were also generated from GPT-3.5, GPT-4, and Bard. LLMs were then prompted to improve the readability of their initial responses. The readability of institutional responses, initial LLM responses, and simplified LLM responses were graded using validated readability formulas. Accuracy and comprehensiveness of initial and simplified LLM responses were also compared. Results: Responses to 66 FAQs were included. All institutional and initial LLM responses had poor readability, with average reading levels ranging from 9th grade to college graduate. Simplified responses from LLMs had significantly improved readability, with reading levels ranging from 6th grade to college freshman. When comparing simplified LLM responses, GPT-4 responses demonstrated the highest readability, with reading levels ranging from 6th to 9th grade. Accuracy was similar between initial and simplified responses from all LLMs. Comprehensiveness was similar between initial and simplified responses from GPT-3.5 and GPT-4. However, 34.8% of Bard's simplified responses were graded as less comprehensive compared to initial. Conclusion: Our study highlights the efficacy of LLMs in enhancing the readability of bariatric surgery PEMs. GPT-4 outperformed other models, generating simplified PEMs from 6th to 9th grade reading levels. Unlike GPT-3.5 and GPT-4, Bard's simplified responses were graded as less comprehensive. We advocate for future studies examining the potential role of LLMs as dynamic and personalized sources of PEMs for diverse patient populations of all literacy levels. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effectiveness of an Artificial Intelligence‐Large Language Model (AI‐LLM) at improving the readability of knee radiology reports. Methods: Reports of 100 knee X‐rays, 100 knee computed tomography (CT) scans and 100 knee magnetic resonance imaging (MRI) scans were retrieved. The following prompt command was inserted into the AI‐LLM: 'Explain this radiology report to a patient in layman's terms in the second person:[Report Text]'. The Flesch–Kincaid reading level (FKRL) score, Flesch reading ease (FRE) score and report length were calculated for the original radiology report and the AI‐LLM generated report. Any 'hallucination' or inaccurate text produced by the AI‐LLM‐generated report was documented. Results: Statistically significant improvements in mean FKRL scores in the AI‐LLM generated X‐ray report (12.7 ± 1.0–7.2 ± 0.6), CT report (13.4 ± 1.0–7.5 ± 0.5) and MRI report (13.5 ± 0.9–7.5 ± 0.6) were observed. Statistically significant improvements in mean FRE scores in the AI‐LLM generated X‐ray report (39.5 ± 7.5–76.8 ± 5.1), CT report (27.3 ± 5.9–73.1 ± 5.6) and MRI report (26.8 ± 6.4–73.4 ± 5.0) were observed. Superior FKRL scores and FRE scores were observed in the AI‐LLM‐generated X‐ray report compared to the AI‐LLM‐generated CT report and MRI report, p < 0.001. The hallucination rates in the AI‐LLM generated X‐ray report, CT report and MRI report were 2%, 5% and 5%, respectively. Conclusions: This study highlights the promising use of AI‐LLMs as an innovative, patient‐centred strategy to improve the readability of knee radiology reports. The clinical relevance of this study is that an AI‐LLM‐generated knee radiology report may enhance patients' understanding of their imaging reports, potentially reducing the responder burden placed on the ordering physicians. However, due to the 'hallucinations' produced by the AI‐LLM‐generated report, the ordering physician must always engage in a collaborative discussion with the patient regarding both reports and the corresponding images. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Objective Internet-based patient education materials (PEMs) are often above the recommended sixth grade reading level recommended by the U.S. Department of Health and Human Services. In 2016 the U.S. Food and Drug Administration (FDA) released a warning statement against use of general anesthetic drugs in children and pregnant women due to concerns about neurotoxicity. The aim of this study is to evaluate readability, content, and quality of Internet-based PEMs on anesthesia in the pediatric population and neurotoxicity. Study Design The websites of U.S. medical centers with pediatric anesthesiology fellowship programs were searched for PEMs pertaining to pediatric anesthesia and neurotoxicity. Readability was assessed. PEM content was evaluated using matrices specific to pediatric anesthesia and neurotoxicity. PEM quality was assessed with the Patient Education Material Assessment Tool for Print. A one-sample t -test was used to compare the readability of the PEMs to the recommended sixth grade reading level. Results We identified 27 PEMs pertaining to pediatric anesthesia and eight to neurotoxicity. Mean readability of all PEMs was greater than a sixth grade reading (p <0.001). While only 13% of PEMs on anesthesia for pediatric patient mentioned the FDA warning, 100% of the neurotoxicity materials did. PEMs had good understandability (83%) and poor actionability (60%). Conclusion The readability, content, and quality of PEMs are poor and should be improved to help parents and guardians make informed decisions about their children's health care. Key Points The FDA issued a warning statement against the use of general anesthetic drugs in children and pregnant women. Readability, content, and quality of Internet-based patient education materials on the topic of neurotoxicity are poor. Improving the readability, content, and quality of PEMs could aid parents in making important health care decisions. [ABSTRACT FROM AUTHOR]

Purpose: This study examined narrative discourse in youth offenders, focusing on quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. Method: The participants were 15 incarcerated adolescents, ages 13–18 years (Mage = 16 years). Each was evaluated at their detention center via Zoom, using a standardized language test and language samples that elicited narrative speaking with fables. After retelling a fable, the participant answered questions that examined story comprehension and critical thinking. Results: Most participants performed below average on the standardized language test and had difficulty on one or more of the language sampling measures. Areas of concern included quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. Had language sampling not been employed, those weaknesses might have been overlooked. Conclusions: When evaluating youth offenders, it is important to elicit language samples that can provide detailed information about an adolescent’s ability to communicate for genuine purposes. In this regard, the tasks employed in the current study could be helpful to speech-language pathologists in working with youth offenders, enabling them to pinpoint deficits and offer targeted intervention. [ABSTRACT FROM AUTHOR]

Background: Gynaecological cancer symptoms are often vague and non‐specific. Quality health information is central to timely cancer diagnosis and treatment. The aim of this study was to identify and evaluate the quality of online text‐based patient information resources regarding gynaecological cancer symptoms. Methods: A targeted website search and Google search were conducted to identify health information resources published by the Australian government and non‐government health organisations. Resources were classified by topic (gynaecological health, gynaecological cancers, cancer, general health); assessed for reading level (Simple Measure of Gobbledygook, SMOG) and difficulty (Flesch Reading Ease, FRE); understandability and actionability (Patient Education Materials Assessment Tool, PEMAT, 0–100), whereby higher scores indicate better understandability/actionability. Seven criteria were used to assess cultural inclusivity specific for Aboriginal and Torres Strait Islander people; resources which met 3–5 items were deemed to be moderately inclusive and 6+ items as inclusive. Results: A total of 109 resources were identified and 76% provided information on symptoms in the context of gynaecological cancers. The average readability was equivalent to a grade 10 reading level on the SMOG and classified as 'difficult to read' on the FRE. The mean PEMAT scores were 95% (range 58–100) for understandability and 13% (range 0–80) for actionability. Five resources were evaluated as being moderately culturally inclusive. No resource met all the benchmarks. Conclusions: This study highlights the inadequate quality of online resources available on pre‐diagnosis gynaecological cancer symptom information. Resources should be revised in line with the recommended standards for readability, understandability and actionability and to meet the needs of a culturally diverse population. [ABSTRACT FROM AUTHOR]

Background: Stroke profoundly affects quality of life (QOL), including loss of employment, reduced social activity, shrinking social networks and low mood. Dysgraphia (impaired writing) is a common symptom of aphasia yet is rarely targeted in rehabilitation. Recent technological advances might challenge this, since much communication is now conducted digitally through writing. The rehabilitation of writing may therefore help to address the wider consequences of stroke and aphasia. Aims: Can assistive technology (AT) training for people with dysgraphia: (1) improve written output, and are gains achieved only with AT? (2) improve reading comprehension scores, and are gains achieved only with AT? and (3) affect social participation, mood or QOL Methods and Procedures: Design A mixed‐methods, repeated measures, small group study design was adopted (qualitative outcomes will be reported elsewhere). Participants: Recruited from community settings, for example, Stroke Association communication support groups. Inclusion criteria: over 18 years old, aphasia due to stroke, acquired dysgraphia, writing more impaired than speech, fluent English prior to stroke, access to computer and Internet. Exclusion criteria: currently receiving speech and language therapy, significant cognitive impairment, neuromuscular/motor‐speech impairments/structural abnormalities, developmental dyslexia, uncorrected visual/auditory impairments. Procedures: Screening and diagnostic assessments at time T1 (first baseline). Outcome measures at T1; repeated at T2 (second baseline), T3 (end of intervention), T4 (3‐month follow up). Social participation assessment and cognitive monitoring at T2, T3, T4. Intervention: Seven–ten hours individual therapy weekly and additional email support. Participants were trained to operate Dragon NaturallySpeaking (speech to text package) and ClaroRead (read writing aloud). Outcome measures were administered on pen and paper (control) and on computer, with AT enabled only at T3, T4. Outcomes and Results: Computer narrative writing was significantly improved by AT training (Friedman's χ2 (3) = 8.27, p = 0.041), indicating a compensatory effect of AT. Though reading comprehension significantly improved in the computer condition (Friedman's χ2 (3) = 21.07, p = 0.001), gains could not be attributed to the AT. Gains were achieved only when measures were administered on the keyboard, with AT enabled. Thus, a compensatory rather than remediatory effect was suggested. Social network size significantly increased; there were no significant changes in mood/QOL. Individual success rates varied. Conclusion and Implications: The customisable AT training was acceptable to participants and resulted in significantly improved narrative writing. Compensatory AT interventions are a useful adjunct to remediatory writing interventions and may particularly support functional writing. WHAT THIS PAPER ADDS: What is already known on this subject: Writing is rarely spared in aphasia and may present as the most impaired communication modality. Yet, people with aphasia report that writing is seldom included in their rehabilitation. Many communication activities are now conducted digitally through writing, therefore rehabilitation of this is more important than ever before. This study sought to address whether an assistive technology (AT) software package can improve writing and whether any changes were compensatory or remediatory. What this study adds to existing knowledge: This group study found that AT training led to gains in written discourse and social network in people with aphasia and dysgraphia. Gains were not replicated in handwritten tasks, suggesting this was a compensatory therapeutic approach. What are the clinical implications of this work?: AT programs such as this may present speech and language therapists with a practical, pragmatic adjunct to writing or typing therapy, particularly for clients with chronic, intractable impairments for whom remediatory therapy may have a low chance of success. [ABSTRACT FROM AUTHOR]

Background: Despite the potential advantages of Internet-based diabetes self-management education, its adoption was not widespread among Singapore's public primary care clinics (polyclinics). An interactive online tool was thus developed to help educate patients with Type 2 diabetes mellitus (T2DM), and was now ready for user testing before implementation. Aim: To explore the perceived utility and usability of the educational tool in patients with suboptimally-controlled T2DM in a Singapore primary care setting. Methods: In-depth interviews were used to gather qualitative data from multi-ethnic Asian adults who had suboptimally-controlled T2DM. A total of 17 IDIs were conducted between April 2022 to March 2023, audio-recorded, transcribed, and analyzed to identify emergent themes via thematic analysis. Results: Regarding utility, users found the educational tool useful because it provided them with information that was comprehensive, accessible, reliable, and manageable. Regarding usability, the majority of users reported that the educational tool was easy to use, and suggested ways to improve navigational cues, visual clarity, readability and user engagement. Conclusion: Participants generally found the educational tool useful and easy to use. A revised educational tool will be developed based on their feedback and implemented in clinical practice. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate and compare the quality and readability of responses generated by five different artificial intelligence (AI) chatbots—ChatGPT, Bard, Bing, Ernie, and Copilot—to the top searched queries of erectile dysfunction (ED). Google Trends was used to identify ED-related relevant phrases. Each AI chatbot received a specific sequence of 25 frequently searched terms as input. Responses were evaluated using DISCERN, Ensuring Quality Information for Patients (EQIP), and Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics. The top three most frequently searched phrases were "erectile dysfunction cause", "how to erectile dysfunction," and "erectile dysfunction treatment." Zimbabwe, Zambia, and Ghana exhibited the highest level of interest in ED. None of the AI chatbots achieved the necessary degree of readability. However, Bard exhibited significantly higher FKRE and FKGL ratings (p = 0.001), and Copilot achieved better EQIP and DISCERN ratings than the other chatbots (p = 0.001). Bard exhibited the simplest linguistic framework and posed the least challenge in terms of readability and comprehension, and Copilot's text quality on ED was superior to the other chatbots. As new chatbots are introduced, their understandability and text quality increase, providing better guidance to patients. [ABSTRACT FROM AUTHOR]

Background: A Patient Information Leaflet (PIL) is a widely accepted counselling aid to educate patients. The current study aimed to prepare and validate an easy-to-understand PIL explicitly tailored for patients with Heart Failure with reduced Ejection Fraction (HFrEF). Its psychometric properties were evaluated to confirm its reliability and readability. Materials and Methods: Information was curated from credible sources and validated by experts using the Lawshe method. Readability and design were assessed with metrics like the Flesch Reading Ease (FRE) Score, Flesch-Kincaid Grade Level (FKGL), and the Baker-Able Leaflet Design (BALD) index. A user testing questionnaire was also developed and validated for reliability through test-retest methods. This same questionnaire evaluated the PIL's readability before and after exposure to the PIL, ensuring it effectively communicated crucial information to the target population. Results: The English PIL scored 76.9 on FRE and four on FKGL, showing good readability. BALD scores were 29 (English) and 25 (Kannada and Malayalam), denoting excellent design quality across languages. A psychometric evaluation of 60 HFrEF patients (English [n=15], Malayalam [n=15], Kannada [n=30]) using a reliable UTQ (ICC=0.94) significantly improved the score from 36.81±10.6 to 88.29±10.11 (p<0.001), highlighting the ease of understanding. Moreover, 92% of patients provided favourable opinions about the PIL, describing it as well-designed and well-written. Conclusion: This study underscores the significance of a well-developed and validated PIL as a potent educational resource, aiding health professionals in designing and assessing PIL using robust scientific methodologies. [ABSTRACT FROM AUTHOR]

The 3D digital reproduction of panel paintings is an efficient practice through which to document their state of conservation thanks to the ability to study artwork both at the microscopic level, visualising the craquelure and the detachments of pictorial layers, and at the macroscopic level, analysing support structures and their deformations. In recent years, research has focused on new methodologies to handle multiple 3D scans acquired over time and to achieve data fusion to obtain multi-resolution products. In this paper, we present the results of the acquisition of the central panel of an earthquake-damaged triptych using two different 3D techniques (close-range photogrammetry and structured light) before and after its restoration to carry out a multi-temporal analysis of the conservation status and document the effects of the restoration. Furthermore, we performed laser scanning micro-profilometry on a small area of the painting to study the artist's technique and identify previous restorations. Finally, we merged the two 3D datasets (obtained by structured-light projection and micro-profilometry) to produce a multi-resolution 3D model with the aim of increasing the accuracy and readability of the final product. [ABSTRACT FROM AUTHOR]

This study aimed to (1) develop evidence-based resources and (2) test face, content validity, and usability of a newly developed mobile application (app) to equip and empower caregivers with resources and skills to promote better oral health for autistic children. A series of resources on oral health, including information on oral diseases and home care and social stories on dental visits were developed. Concurrently, an app was developed by dentists, occupational therapist and software developers. The resources underwent content validation by an international panel of paediatric dentists (Expert Working Group). Face validation of the resources and usability testing of the app by parents were then carried out. Validation and feedback were obtained by the Delphi method, with consensus set at 70% agreement. A total of 12 resources and 2 social stories were developed. Consensus was achieved among the Expert Working Group regarding the content and illustrations of the resources and social stories. Both the Expert Working Group and parents agreed that the resources were easy to read and understand. Parents also found the app easy to use, aesthetically pleasing and help them to better care for their child's oral health. Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents. [ABSTRACT FROM AUTHOR]

To compare the readability and accuracy of large language model generated patient information materials (PIMs) to those supplied by the American Urological Association (AUA), Canadian Urological Association (CUA), and European Association of Urology (EAU) for kidney stones. PIMs from AUA, CUA, and EAU related to nephrolithiasis were obtained and categorized. The most frequent patient questions related to kidney stones were identified from an internet query and input into GPT-3.5 and GPT-4. PIMs and ChatGPT outputs were assessed for accuracy and readability using previously published indexes. We also assessed changes in ChatGPT outputs when a reading level was specified (grade 6). Readability scores were better for PIMs from the CUA (grade level 10-12), AUA (8-10), or EAU (9-11) compared to the chatbot. GPT-3.5 had the worst readability scores at grade 13-14 and GPT-4 was likewise less readable than urologic organization PIMs with scores of 11-13. While organizational PIMs were deemed to be accurate, the chatbot had high accuracy with minor details omitted. GPT-4 was more accurate in general stone information, dietary and medical management of kidney stones topics in comparison to GPT-3.5, while both models had the same accuracy in the surgical management of nephrolithiasis topics. Current PIMs from major urologic organizations for kidney stones remain more readable than publicly available GPT outputs, but they are still higher than the reading ability of the general population. Of the available PIMs for kidney stones, those from the AUA are the most readable. Although Chatbot outputs for common kidney stone patient queries have a high degree of accuracy with minor omitted details, it is important for clinicians to understand their strengths and limitations. [ABSTRACT FROM AUTHOR]

The transition from sounding out unfamiliar words to effortlessly reading connected text does not occur all at once or at the same rate for students. The purpose of this study was to explore the accuracy of three decision rules (data point, median, and trend line) applied to progress monitoring outcomes of alphabetic principle (nonsense word fluency [NWF]) and oral reading rate (curriculum-based measurement of reading [CBM-R]). Outcomes from a sample of U.S. students receiving Tier-2 supports in oral reading and decoding were analyzed to generate model parameters. Scores were simulated for NWF and CBM-R, and decision rules were applied to schedules where one observation was collected per week. The trend-line rule was viable with NWF after 7 weeks and 9 to 10 weeks with CBM-R. Differences in base rates of non-proficiency between measures call into question the utility of NWF to capture student improvement in alphabetic principle as they encounter increasingly complex word types. [ABSTRACT FROM AUTHOR]

To evaluate the readability of surgical clinical trial consent forms and compare readability across surgical specialties. We conducted a cross-sectional analysis of surgical clinical trial consent forms available on ClinicalTrials.gov to quantitatively evaluate readability, word count, and length variations among different specialties. The analysis was performed between November 2022 and January 2023. A total of 386 surgical clinical trial consent forms across 14 surgical specialties were included. The main outcomes were language complexity (measured using Flesch–Kincaid Grade Level), number of words (measured as word count), time to read (measured at reading speeds of 240 per min), and readability (measured by Flesch Reading Ease Score, Gunning Frog Index, Simple Measures of Gobbledygook Index, FORCAST, and Automated Readability Index). The surgical consent forms were a mean (standard deviation) of 2626 (1668) words long, with a mean of 12:53 min to read at 240 words per min. None of the surgical specialties had an average readability level of sixth grade or lower across all six indices, and only 16 out of 386 (4%) clinical trials met the recommended reading level. Furthermore, there was no significant difference in reading grade level between surgical specialties based on the Flesch–Kincaid Grade Level and Flesch Reading Ease indices. Our findings suggest that current surgical clinical trial consent documents are too long and complex, exceeding the recommended sixth-grade reading level. Ensuring readable clinical trial consent forms is not only ethically responsible but also crucial for protecting patients' rights and well-being by facilitating informed decision-making. • Largest meta-analysis study of more than 79,000 surgical patients. • Mortality is increased almost 10-fold in surgical patients with COVID-19. • COVID-induced mortality risk is double in low-income and middle-income countries. • Type of surgery is not associated with mortality risk. [ABSTRACT FROM AUTHOR]

Objective: To assess the readability and the comprehensiveness of patient‐reported outcome measures (PROMs) utilized in primary headache disorders literature. Background: As the health‐care landscape has evolved toward a patient‐centric model, numerous PROMs have been developed to capture treatment outcomes in patients with headache disorders. For these PROMs to advance our understanding of headache disorders and their treatment impact, they must be easy to understand (i.e., reading grade level 6 or less) and comprehensively capture what matters to patients with headache. The aim of this study was to (a) assess the readability of PROMs utilized in headache disorders literature, and (b) assess the comprehensiveness of PROMs by mapping their content to a health‐related quality of life framework. Methods: In this scoping review, recently published systematic reviews were used to identify PROMs used in primary headache disorders literature. Readability analysis was performed at the level of individual items and full PROM using established readability metrics. The content of the PROMs was mapped against a health‐related quality‐of‐life framework by two independent reviewers. Results: In total, 22 PROMs (15 headache disorders related, 7 generic) were included. The median reading grade level varied between 7.1 (interquartile range [IQR] 6.3–7.8) and 12.7 (IQR 11.8–13.2). None of the PROMs were below the recommended reading grade level for patient‐facing material (grade 6). Three PROMs, the Migraine‐Treatment Assessment Questionnaire, the Eurolight, and the European Quality of Life 5 Dimensions 3 Level Version, were between reading grade levels 7 and 8; the remaining 19 PROMs were above reading grade level 8. In total, the PROMs included 425 items. Most items (n = 134, 32%) assessed physical function (e.g., work, activities of daily living). The remaining items assessed physical symptoms (n = 127, 30%; e.g., pain, nausea), treatment effects on symptoms (n = 65, 15%; e.g., accompanying symptoms relief, headache relief), treatment impact (n = 56, 13%; e.g., function, side effects), psychological well‐being (n = 41, 10%; e.g., anger, frustration), social well‐being (n = 29, 7%; e.g., missing out on social activities, relationships), psychological impact (n = 14, 3%; e.g., feeling [not] in control, feeling like a burden), and sexual well‐being (n = 3, 1%; e.g., sexual activity, sexual interest). Some of the items pertained to treatment (n = 27, 6%), of which most were about treatment type and use (n = 12, 3%; e.g., medication, botulinum toxin), treatment access (n = 10, 2%; e.g., health‐care utilization, cost of medication), and treatment experience (n = 9, 2%; e.g., treatment satisfaction, confidence in treatment). Conclusion: The PROMs used in studies of headache disorders may be challenging for some patients to understand, leading to inaccurate or missing data. Furthermore, no available PROM comprehensively measures the health‐related quality‐of‐life impact of headache disorders or their treatment, resulting in a limited understanding of patient‐reported outcomes. The development of an easy‐to‐understand, comprehensive, and validated headache disorders–specific PROM is warranted. Plain Language Summary: Patient‐reported outcome measures (PROMs) are used so we can better understand headache disorders (HDs) and how well treatments work; to be most effective, they should be specific to HDs and easy for patients to understand. This study looked at the reading grade level of 22 PROMs used in HD studies and what quality of life topics they covered; the reading grade level ranged from 7.1 to 12.7, higher than the recommended grade level of 6. Most items in the PROMs focused on physical function, symptoms, and treatment effects, but none did a good job of learning about HDs' impacts on quality of life, revealing a need for the development of an improved, easy‐to‐understand HD‐specific PROM. [ABSTRACT FROM AUTHOR]

Background/Aim: Childhood dental trauma poses a prevalent concern, and the limited knowledge of lay caregivers toward the needed immediate actions can adversely affect a child's well‐being. This study aimed to create and validate an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases, and assess its effects toward enhancing reader knowledge. Methodology: The four‐stage study involved: (1) Literature review and script development; (2) Version 1 of the comic book creation (including illustrations, layout, and design) and Flesch Readability Index (FI) calculation; (3) Version 1 validation by expert judges, assessed by the Content Validity Index (CVI); (4) Version 1 refinement based on the judges' feedback, recalculation of FI, and a pilot test (CVI) involving lay individuals who validated the final material (Version 2). The validation process involved 67 participants, including 13 specialist judges and 54 elementary school teachers. Results: The CVI for Version 1 was calculated at 0.89 (89%), indicating a favorable level of agreement on the evaluated criteria. The FI was determined as 91.1%, indicating a high level of readability. The FI for Version 2 was 92.1% (indicating a very easy level of comprehension). The CVI calculated for the target audience after the pilot test was 0.99 (99%), denoting a substantial agreement among the participants. In assessing the level of knowledge, a significant increase was observed in the rate of correct answers after the comic book was read by lay individuals (p < 0.05), inasmuch as the percentage rose from 50.5% before to 81.2% after reading it. Conclusion: The educational comic book proved valid in terms of readability, appearance, and content. Furthermore, it had a positive impact on gaining the knowledge needed to take the appropriate actions, thus making it a valuable tool for guiding the lay population in cases of dental trauma. [ABSTRACT FROM AUTHOR]